the simple device of talking plain, matter-of-fact english about a thing has a value that we are growing to appreciate more and more every day. it is only too easy for an undercurrent of ill to make headway under cover of a false name, a false silence, or misleading speech. the fact that syphilis is a disease spread to a considerable extent by sexual relations too often forces us into an attitude of veiled insinuation about it, a mistaken delicacy which easily becomes prudish and insincere. it is a direct move in favor of vulgar thinking to misname anything which involves the intimacies of life, or to do other than look it squarely in the eye, when necessity demands, without shuffling or equivocation. on this principle it is worth while to meet the problem of a disease like syphilis with an open countenance and straightforward honesty of expression. it puts firm ground under our feet to talk about it in the impersonal way in which we talk about colds and pneumonia and bunions and rheumatism, as unfortunate, but not necessarily indecent, facts in human experience. nothing in the past has done so much for the campaign against consumption as the unloosing of tongues. there is only one way to understand syphilis, and that is to give it impartial, discriminating discussion as an issue which concerns the[pg 16] general health. to color it up and hang it in a gallery of horrors, or to befog it with verbal turnings and twistings, are equally serious mistakes. the simple facts of syphilis can appeal to intelligent men and women as worthy of their most serious attention, without either stunning or disgusting them. it is in the unpretentious spirit of talking about a spade as a spade, and not as "an agricultural implement for the trituration of the soil," that we should take stock of the situation and of the resources we can muster to meet it.
the confusion of the problem of syphilis with other issues.—two points in our approach to the problem of syphilis are important at the outset. the first of these is to separate our thought about syphilis from that of the other two diseases, gonorrhea, or "clap," and chancroids, or "soft sores," which are conventionally linked with it under the label of "venereal diseases."[2] the second is to separate[pg 17] the question of syphilis at least temporarily from our thought about morals, from the problem of prostitution, from the question as to whether continence is possible or desirable, whether a man should be true to one woman, whether women should be the victims of a double standard, and all the other complicated issues which we must in time confront. such a picking to pieces of the tangle is simply the method of scientific thought, and in this case, at least, has the advantage of making it possible to begin to do something, rather than saw the air with vain discussion.
[2] the three so-called venereal diseases are syphilis, gonorrhea, and chancroid or soft ulcer. gonorrhea is the commonest of the three, and is an exceedingly prevalent disease. in man its first symptom is a discharge of pus from the canal through which the urine passes. its later stages may involve the bladder, the testicles, and other important glands. it may also produce crippling forms of rheumatism, and affect the heart. gonorrhea may recur, become latent, and persist for years, doing slow, insidious damage. it is transmitted largely by sexual intercourse. gonorrhea in women is frequently a serious and even fatal disease. it usually renders women incapable of having children, and its treatment necessitates often the most serious operations. gonorrhea of the eyes, affecting especially newborn children, is one of the principal causes of blindness. gonorrhea may be transmitted to little girls innocently from infected toilet seats, and is all but incurable. gonorrhea, wherever it occurs, is an obstinate, treacherous, and resistant disease, one of the most serious of modern medical problems, and fully deserves a place as the fourth great plague.
chancroid is an infectious ulcer of the genitals, local in character, not affecting the body as a whole, but sometimes destroying considerable portions of the parts involved.
let us think of syphilis, then, as a serious but by no means hopeless constitutional disease. dismiss chancroid as a relatively insignificant local affair, seldom a serious problem under a physician's care. separate syphilis from gonorrhea for the reason that gonorrhea is a problem in itself. against its train of misfortune to innocence and guilt alike, we are as yet not nearly so well equipped to secure results. against syphilis, the astonishing progress of our knowledge in the past ten years has armed us for triumph. when the fight against tuberculosis was brought to public attention, we were not half so well equipped to down the disease as we are today to down syphilis. for syphilis we now have reliable and practical methods of prevention, which have already proved their worth. the most powerful and efficient of drugs is available for the cure of the disease in its earlier stages, and early recognition is made possible by methods whose reliability is among the remarkable achievements of medicine. it is the[pg 18] sound opinion of conservative men that if the knowledge now in the hands of the medical profession could be put to wide-spread use, syphilis would dwindle in two generations from the unenviable position of the third great plague to the insignificance of malaria and yellow fever on the isthmus of panama. the influences that stand between humanity and this achievement are the lack of general public enlightenment on the disease itself, and public confusion of the problem with other sex issues for which no such clean-cut, satisfactory solution has been found. think of syphilis as the wages of sin, as well-earned disgrace, as filth, as the badge of immorality, as a necessary defense against the loathesomeness of promiscuity, as a fearful warning against prostitution, and our advantage slips from us. the disease continues to spread wholesale disaster and degeneration while we wrangle over issues that were old when history began and are progressing with desperate slowness to a solution probably many centuries distant. think of syphilis as a medical and a sanitary problem, and its last line of defense crumbles before our attack. it can and should be blotted out.
syphilis, a problem of public health rather than of morals.—nothing that can be said about syphilis need make us forget the importance of moral issues. the fact which so persistently distorts our point of view, that it is so largely associated with our sexual life, is probably a mere incident, biologically speaking, due in no small part to the almost absurdly simple circumstance that the germ of the disease cannot grow in the presence of air, and must therefore[pg 19] find refuge, in most cases, in the cavities and inlets from the surface of the body. history affords little support to the lingering belief that if syphilis is done away with, licentiousness will overrun the world. long before syphilis appeared in europe there was sexual immorality. in the five centuries in which it has had free play over the civilized world, the most optimistic cannot successfully maintain that it has materially bettered conditions or acted as a check on loose morals, though its relation to sexual intercourse has been known. as a morals policeman, syphilis can be obliterated without material loss to the cause of sexual self-restraint, and with nothing but gain to the human race.
it is easier to accept this point of view, that the stamping out of syphilis will not affect our ability to grapple with moral problems, and that there is nothing to be gained by refusing to do what can so easily be done, when we appreciate the immense amount of innocent suffering for which the disease is responsible. it must appeal to many as a bigoted and narrow virtue, little better than vice itself, which can derive any consolation in the thought that the sins of the fathers are being visited upon the children, as it watches a half-blind, groping child feel its way along a wall with one hand while it shields its face from the sunlight with the other. there are better ways of paying the wages of sin than this. best of all, we can attack a sin at its source instead of at its fulfilment. how much better to have kept the mother free from syphilis by giving the father the benefit of our knowledge. the child who reaped his[pg 20] sowing gained nothing morally, and lost its physical heritage. its mother lost her health and perhaps her self-respect. neither one contributes anything through syphilis to the uplifting of the race. they are so much dead loss. to teach us to avoid such losses is the legitimate field of preventive medicine.
on this simplified and practical basis, then, the remainder of this discussion will proceed. syphilis is a preventable disease, usually curable when handled in time, and its successful management will depend in large part upon the co?peration, not only of those who are victims of it, but of those who are not. it is much more controllable than tuberculosis, against which we are waging a war of increasing effectiveness, and its stamping out will rid humanity of an even greater curse. to know about syphilis is in no sense incompatible with clean living or thinking, and insofar as its removal from the world will rid us of a revolting scourge, it may even actually favor the solution of the moral problems which it now obscures.
