much information, since the immediate or determining cause is usually some factor other than the venereal disease. The group of men who are infected by occasional prostitutes are somewhat more liable to spread venereal disease to innocent women, children and men than those who are infected by professional prostitutes.

Clandestine Prostitutes. Clandestine prostitutes spread infection. They get peritonitis and salpingitis. They are prone to have babies born with infected eyes and therefore they increase blindness. They are frequently sterile. Amongst this and the preceding class are most of the illegitimate children. The death rate amongst illegitimate children is barbarously high. The morbidity rate amongst clandestine and occasional prostitutes is higher than amongst moral women of the same age-periods and in the same strata of society.

Amongst the medical phases of these forms of prostitution is their tendency toward professional prostitution.

Male Prostitutes. (Principally perverts.) They spread infection. They have a high mortality and morbidity rate. They increase the number of drug habitues.

Occasional and Clandestine Male Prostitutes. They spreal infection. An infected man will not infect as many people as an infected woman, but an infected woman usually infects non-virtuous people; a large part of those infected by men are virtuous-wives and young children. An infected man usually takes infection into a clean home -an infected woman seldom does.

Amongst male occasional and clandestine prostitutes there is an increase in the morbidity and mortality rate. The diseases caused are in some measure immediate. Such as brain disease, insanity, paralysis, kidney and heart disease. They are usually remote. They spread infection of eyes and add to blindness. They beget children that are defective and deformed. Men given to great sexual excesses die from conditions due to those excesses. But the disability and inefficiency caused by such excesses is greater than its effect on the death rate.

A consideration of the medical aspects of vice is not complete without reference to the congenital and acquired physical conditions which tend towards prostitution, the woman or man being driven

to it almost irresistibly as the result of congenital or acquired physical conditions.

Of more importance in a consideration of the medical aspects of this subject is the inefficiency which follows the increased morbidity and immorality. The short period of self-maintenance is followed by the long years of dependency in hospitals and poor houses, the spread of contagious diseases, the inherited defects and the blindness, the syphilis and gonorrhoea amongst innocent children.

The medical aspects of control are:

1. Registration of venereal disease. 2. Segregation of the infectious.

3. Supervision of candidates for marriage.

4. Registration of births.

5. Compulsory treatment of the eyes of newly born babes.

6. Hospitalization of infected prostitutes.

7. Hospitalization of those innocently infected.

8. A study of eugenics.

VENEREAL DISEASES.

How to Diminish Venereal Diseases. The time is ripe for a united attempt to diminish venereal diseases. To accomplish this both sexes should be taught the social and personal dangers of the black plague, far more to be dreaded than the white plague-venereal disease. They should be taught with emphasis that these diseases, like all other contagious diseases, may be innocently acquired and transmitted. Woman peculiarly needs such instruction, not only that she may protect herself, but that she may protect her child against danger from those to whose care it may be intrusted. Both sexes should be so instructed that they may teach sexual hygiene in all its relations. Innocence is too often dangerous ignorance. The period of instruction should be at the onset of adolescence since careful studies by Fournier in France and Erb in Germany have shown that it is about this period that first infection is most likely. The work of national, state and municipal organizations with the fundamental aim of instruction in sexual hygiene and sanitation should be encouraged and broadened. The public should be educated when practicable by exhibits as to the results of venereal disease, its causes and germs, its methods of spreading and

control. In this instruction the viewpoint should be that of prophylaxis and not the impracticable one of creating terror. Public lectures should be given at night at social centers, at school, and churches, so that the parents of school children can obtain information needed to enable them to give proper instruction at home. Similar instruction should be given the employes of large business houses, manufacturing plants, etc., so that this class which is thrown on its own resources at an early age may profit by this training.1

Infection of the Innocent. No marriage should be legal unless both parties furnish certificates of health and freedom from venereal diseases given by legally qualified physicians. In these certificates, the physician giving them should assume all civil and criminal responsibility for them. The person officiating at a marriage ceremony should be obliged by law to require such certificate.

Infection of an innocent wife by a husband under the common law principle of the Kentucky decision in Hoove v. Hoove is a criminal offense in itself and unlike adultery cannot be condoned by the wife. Under the Canon law since infection interferes with procreation which the Canon law regards as essential to marriage. Such infection can under the spirit of the Canon law create annulment of marriage, like any other factor of sterility. Under these principles the marital limitations of evidence would be nullified. The penalty for such infection should be one which would punish the criminal and not the family or the innocent wife as does most of the legislation against cruelty, abandonment and like offenses involved in marital relations. As quarantine and isolation require increased hospital provision, especially since, as shown by experience, police regulation is a failure so far as venereal disease is concerned being replaced in the Scandinavian speaking countries by sanitary supervision quarantine and isolation, hospital provision and dispensary facilities for the care of venereal disease should be increased along the lines shown to be practicable by the English lock hospitals.

Health Department and Venereal Diseases. Under the police powers now granted by the State, except where specifically limited by statute, the Department of Health could quarantine persons when notified.

1See Chapter V, "Child Protection and Education," page 253.

of venereal diseases in them by physicians. To secure proper enforcement of this right, it should be specifically guaranteed by statute. This should embody the common law view that venereal infection of the innocent is an assault with intent to do bodily harm, laid down by the English courts in Regina v. Taylor, by the Oregon courts in Geis Mardo v. The People, by the Kentucky courts in Hoove v. Hoove, and by courts in other states where the principles of the common law obtain. That the Health Department must have the power under this principle now practically denied it, is shown by the existence of folklore beliefs peculiarly affecting the venereal diseases, that one can get rid of a disease by infecting an innocent person. Under this belief rapes have been committed which have sometimes, but very rarely, led to penitentiary sentences. Another great danger against which the Health Department requires power to guard, is that pointed out by Isadore Dyer before the International Congress on Venereal Disease at Brussels in 1899. A harlot infected with syphilis refused to be treated until she had infected five hundred men in revenge for her own infection. When seen by Dyer she had infected two hundred men who in all probability later infected at least the same number of persons. In Louisiana, where this occurred, the Code Napoleon voices the Roman law with its supremacy of the State, yet statutory limitation prevented interference with this woman's revenge on society.

That the Health Department should have the right to inspect prostitutes by a legal extension of the right granted it to inspect other persons exposed to contagious disease. This will require an amendment of the statute which interferes with the logical right of the Health Department in this particular. To secure proper inspection the fact should be recognized that experience in despotic and theocratic governments has shown that suppression of prostitution has often driven it into the mass of the community making it take the peculiarly dangerous clandestine type. The existence of venereal diseases among people is much underestimated. There are credible statistics to show that one-half of the population of civilized countries have had or have gonorrhoea, and that from one-fifth to one-tenth have had syphilis. Not infrequently gonorrhoea produces many dangers, constitutional results and exerts a very decided influence in the production of many

female disorders. It underlies many cases of what are called rheumatism and joint disorders. It is an exceedingly common cause of blindness in the new born. According to German statistics, 30,000 cases of blindness in that country are due to gonorrhoea. According to recent statistics much of the sterility in the male is due to gonorrhoea. About 40 per cent. of the cases in women result from gonorrhoea as a determining cause. Gonorrhoea is very easily spread from the fact that nostrum advertisements and popular beliefs practically teach it is simply a catarrh. This has led to the belief that female discharges due to gonorrhoea are often what is called "whites," and therefore not likely to occasion disease in other persons. The germ of gonorrhoea may infect any mucous membrane with which it may in any manner come in contact. This has been the source of gonorrhoea epidemic in little children, so that in infant hospitals gonorrhoea has required special observation and care to prevent its spread. The local instillation of silver in the eye of the new born, while yielding good results, has not been quite the success which it was claimed. The employment of ignorant midwives had been a factor in this case. To some extent this indicates the registration and license of all hospitals where women are confined, whether designated maternity hospitals or not. The registration of venereal diseases could be best effected through making the names of the afflicted a strict matter of confidence with both the physician reporting and the Health Department. The statute which obtains in some States forbidding the revelation of information given by a patient to a physician that is necessary to enable him to treat the patient unless the confidence is waived by the patient, should be amended in this State so as to extend to venereal diseases and to the officials of the Health Department.

Hospitals and Venereal Diseases. The Cook County Hospital has 40 beds for male cases and 40 beds for female cases. This at present is the only institution to which these patients can be sent for treatment. At this hospital is a small isolation building with a capacity of 40 beds for the care of the children suffering from gonorrhoeal vaginitis. This is always filled. The Alexian Brothers' Hospital is the only one in the city receiving pay patients which receives venereal cases without objection. There should be at least one bed set apart