prophylaxis, of course, means prevention, and it has been a large part of the purpose of the present study to deal with syphilis from the standpoint of prevention and cure. the material of this chapter is, therefore, only a special aspect of the larger problem.

repression of prostitution.—by the moral prophylaxis of syphilis is meant the cultivation of such moral ideals as will contribute to the control of a disease which is so closely associated with sexual irregularities. since public and secret prostitution serve as the principal agencies for the dissemination of the disease, it follows that anything tending to decrease the amount of disease in prostitutes, on the one hand, or to diminish the amount of promiscuous sexual activity, on the other, will retard the spread of syphilis. systems based on the first ideas, aiming rather to control the disease in public women by inspection of their health and activities than by suppressing prostitution, have failed because the methods of control ordinarily practised are worthless for the detection of infectiousness. so-called regulation has, therefore, given way very largely in progressive communities to the second ideal of repressing or[pg 157] abolishing the outward evidences of vice as far as possible. in behalf of sanitary control of prostitution, leaving out of the question its moral aspect, it must be admitted that neisser, probably the greatest authority on the sexual diseases, believed that, as far as syphilis is concerned, the use of salvarsan as a means of preventing infection from prostitutes has never had a satisfactory trial. in behalf of abolition it would seem that systematic stamping-out of the outward evidences of vice, the making of immorality less attractive and conspicuous, is, in theory at least, a valuable means of diminishing the extent and availability of an important source of infection.

educational influences.—to do something positive against an evil is certainly a more promising mode of attack than to use only the negative force of repression of temptation. education of public opinion offers us just such a positive mode of attack. men and women and boys and girls should first be taught sexual self-control even before being made aware of the risk they run in throwing aside the conventional moral code. teach honor first and prudence next. the slogan of education in sexual self-restraint is the easiest to utter and the most difficult to put into practice of all the schemes for the control of sexual diseases. a large part of the difficulty of making education effective arises from one or two situations which are worth thinking over.

economic forces opposing sexual self-control.—in the first place, while continence, or abstinence from sexual relations, is a valuable ideal in its place,[pg 158] it cannot be indefinitely extended with benefit either to the individual or to the race. the instinct to reproduce is as fundamental as the instinct of self-preservation and the desire for food. a social order which disregards it or defies it will meet defeat. to an alarming extent the tendency of the present economic system is to create unsocial impulses by making the normal gratification of sexual instinct in marriage and the assumption of the responsibility of a family more and more difficult. the cost of living is steadily rising without a corresponding certainty on the part of a large proportion of young men that they can meet it for themselves, to say nothing of meeting it for wife and children. the uncertainties of a 'job' are often serious enough to discourage the rashest of men from depending on a variable earning power to help him do his share for the advancement of the race. it will be an impossible task to convince even naturally clean-minded, healthy young men and women that they should live a life of hopeless virtue because it is part of the divine order that they should be so held down by hard times and small earnings as to make marrying and having children an unattainable luxury. continence and clean living as preparations for decent and reasonably early marriage and the raising of a healthy family are the highest of ideals, and ought to be preached from every housetop. continence as a life-long punishment for the impossible demands of an oppressive social and economic order gets as little attention as it deserves. first, let us make a clean sexual life lead with greater certainty to some of the rewards that make life[pg 159] worth living and we shall then have a more substantial basis for making continence before marriage other than empty words. if every father, for example, could say to his sons and daughters that if they showed themselves clean men and women he would back them in an early marriage, there would be an appreciable decrease in the amount of young manhood which is now squandered on indecency. if every employer, or the state itself, would give a clean marriage a preferred position in the social and economic scale, and, by helping to meet the cost of it, recognize in a substantial way the value to the race of a family of vigorous children, an important factor in youthful sexual laxity would be robbed of its power. no one will assert that such remedial proposals are of themselves cure-alls for present evils, but they must have at least an emphatic place in the future of moral prophylaxis.

the teaching of sexual self-control.—first then, make the social order such that sexual self-control yields a reward and not a punishment. second, teach sexual control itself, since it is one of the fundamental means of attack on the problem of syphilis. how can such control be taught? information about the physical dangers of illicit sexual indulgence is of course of value, and should be spread broadcast. but taken by itself, the fear of disease, especially if it enters the individual's life after the age when he has already experienced the force of his sexual instincts, is a feeble influence. the person who has nothing but the knowledge that he is taking great risks between him and the gratification of his[pg 160] sexual desires will take the risks and take them once too often. one cannot begin to teach the boy or girl of high school age that sexual offenses mean physical disaster, and expect to control syphilis. the time to control the future of the sexual diseases is in the toddler at the knee, the child whose daily lesson in self-control will culminate when he says the final 'no' to his passions as a man. the child who does not learn to respect his body in the act of brushing his teeth and taking his bath and exercise, and whose thought and speech and temper are unbridled by any self-restraint, will give little heed when told not to abuse his manhood by exposing himself to filth. the prevention of syphilis by sexual self-control goes down to the foundations of character, and has practical value only in those whose self-control is the expression of a lifelong habit of self-discipline bred in the bone from childhood, not merely painted on the surface at puberty. those who want their sons and daughters never to know by personal experience the meaning of syphilis must first build a foundation in character for them which will make self-control in them instinctive, almost automatic. knowledge of sexual matters has power only in proportion to the strength of the character that wields it, and on well-rounded character education, rather than mere knowledge of the facts, the soundest results will be based.

e. roux e. roux

élie metchnikoff [1845-1916] élie metchnikoff [1845-1916]

(from mcintosh and fildes, "syphilis from the modern standpoint," new york, longmans green & co., 1911.)

the moral prophylaxis of syphilis is then briefly summed up in the repression of as many of the recognized agencies for the spread of the disease as possible; the making of continence a preparation for a normal sex life rather than an end in itself; the[pg 161] control and remedying of those influences which are making normal marriage harder of attainment; and the development of an instinctive self-control and self-discipline in every field of life from childhood up as the character basis necessary to make knowledge about sexual life and sexual disease effective.

personal preventive methods.—continence.[15]—there remains to be considered what is often called the personal prophylaxis of syphilis, meaning thereby the methods by which the individual himself can diminish or escape the risk of infection. the first and most effective method of avoiding syphilis is abstinence from sexual relations and intimacies except in normal marriage with a healthy person. although it has been alluded to under the moral prophylaxis of syphilis, it deserves to be re?mphasized. no consideration as to the justice or desirability of continence and self-restraint can add anything to the simple fact that it is the way to avoid disease, and can be unhesitatingly recommended as the standard for personal prophylaxis. in the experience of physicians it is an axiom that disillusionment sooner or later overtakes those who think they are exempt from this rule. persons who discard continence in favor of what they believe to be some absolutely safe indulgence are so almost invariably deceived that the exceptions are not worth considering. although infection with syphilis is no necessary[pg 162] evidence of unclean living, clean living will always remain the best method of avoiding syphilis.

[15] the american social hygiene association, 105 w. 40th street, new york city, can supply pamphlets and lists of authoritative publications bearing on this and related subjects.

the metchnikoff prophylaxis.—the second method of personal prophylaxis of syphilis was developed as a result of the discovery of metchnikoff and roux in 1906, that a specially prepared ointment containing a mercurial salt, if rubbed into the place on which the germs were deposited within a few hours (not exceeding eighteen hours, and the sooner the better) after exposure to the risk of syphilis, would prevent the disease by killing the germs before they could gain a foothold. this method of protection against syphilis has been subjected to rigid tests, with fairly satisfactory results. it has been adopted by the army and navy of practically every country in the world, and, as carried out under the direction of physicians and with military control of the patient, has apparently reduced the amount of syphilitic infection acquired in the armies and navies using it to a remarkable degree. the method, of course, cannot assume to be infallible, but if intelligently applied, it is one of the important weapons for the extinction of syphilis in our hands at the present day. it fails to meet expectations precisely in those circumstances and among those persons in whom intelligent employment of it cannot be expected. this of course covers a considerable number of those who acquire syphilis. what disposal an awakened opinion will make of this knowledge remains to be seen. at the present time it may well be doubted whether the indiscriminate placing of it in the hands of anybody and everybody would not work as much harm as good through ignorant and unintelligent[pg 163] use. this opinion is shared by european as well as american authorities. administered under the direction of a physician, the metchnikoff prophylaxis of syphilis would undoubtedly be at its best in the prevention of the disease. for these reasons, as well as to prevent the spread of the knowledge to those who would be damaged by it, those interested are referred to their physicians for a description of the method. any one having the benefit of it should be able to convince his medical advisor that there is good reason why this kind of professional knowledge should be brought to bear on his case. the ordinary methods of preventing infection by washes and similar applications used by the "knowing ones" are most of them worthless or greatly inferior to the metchnikoff prophylaxis. they are, moreover, a positive source of danger because of the false sense of security which they create. if every person who has run the risk of contracting syphilis should visit his physician at once to receive prophylactic treatment, the effect on syphilis at large would probably be as good as in the army and navy. there would still be opportunity on such occasions to bring moral forces and influence to bear on those who would respond to them. there can be no object in withholding such knowledge from those who are confirmed in their irregular sexual habits. at the same time there could be few better influences thrown across the path of one just starting on a wrong track than that exerted by a physician of skill and character, to whom the individual had appealed to avert the possible disastrous result of an indiscretion.