the Bureau of Venereal Diseases, has made the following statement:

"We must have more careful reports on all cases of venereal diseases, sources of infection must be more closely watched and quarantined and all cases of venereal diseases must be kept under close surveilance if we desire to lower the rate in the state, though our rate is rather hypothetical at present because of failure to report these cases. All citizens and communities should take the greatest interest in this work and co-operate with us in establishing clinics and getting hospital beds, for it is only through hospitalization of prostitutes that we can hope to get results. This is also true of many other cases in the first stage of syphilis.

to

"Moreover, we are firmly convinced that the State of Ohio must adopt a plan much like that of Virginia, Michigan, Kansas, Connecticut and several other places if we wish to protect the small communities. We refer to the establishment of a large central hospital farm where the prostitutes and those venereally dangerous others may be placed for a greater or less length of time, put under careful treatment both physically and mentally, and if necessary, even quarantined. This is a very urgent need in the State of Ohio. At present we are hesitating to close up a line consisting of some seventy houses because we do not know where to place the women after they are arrested. We know from findings in other places that about ninety per cent of the women will have gonorrhea, that from fifty to sixty per cent of them will have syphilis in contagious stages and that there will be prac

tically none without some venereal disease. Yet it is useless simply to arrest them until we can place them and treat them at once. We might add that there are several such black spots in our State at present. On a central hospital farm the patients would not only be treated but would have an opportunity for clean outdoor work and an opportunity to become clean mentally and morally."

NEW PUBLICATIONS
OUT.

Write to the State Department for copies of these publications, recently issued:

Educational Circular 114 -"A Few Facts About Gonorrhea."

E. C. 115-"A Few Facts About Syphilis."

E. C. 116-"A Few Facts About Chancroids."

E. C. 117-"Influenza: How to Avoid It; How to Care for Those Who Have It" (poster).

E. C. 119 "Influenza, How to Avoid It; How to Care for Those Who Have It" (pocket-size folder).

E. C. 119- “Influenza, Pneumonia and Tuberculosis Are Spread by Careless Spitters" (anti-spitting cartoon designed for posting in factories).

Administrative

Bulletin

130 "Laboratory Service of the Ohio State Department of Health."

We are at war. Every man, woman, and child in the country is alert, caring for his health, saving food, money and time, getting ready for battle. Whatever hinders action or weakens strength is cut out. Society is coming to a war basis. Physical health and rugged character are of prime importance. Bad teeth, bad feet, poor blood, measles and other contagious diseases are our enemies. So are weak wills, low ideals, and moral cowardice. We are moving against these with power. The discipline of camp and the self-denials of home are making us a stronger and better people.

The tragedy of the situation is thisnot that we have foes across the water, but in our midst; foes in our own household whom we do not and will not see and bring out into the open. More subtle and dangerous to our success in this war than German propaganda, pacifist or anarchist, are two diseases which are insidiously working into the vitals of our young men and women, and which by a traditional conspiracy of silence the people refuse to recognize.

You have no reason to believe me in medical matters. But you cannot escape the statements of medical experts of world-wide reputation. Listen while I quote from them.

Dr. Rosenau of the Harvard Medical School, writes, "As a danger to public health, as a peril to the family and as a menace to vitality, health and physical progress of the race, the venereal diseases are justly regarded as the greatest of modern plagues."

Dr. Osler says that syphilis is one of the four greatest killing diseases.

Dr. Morrow says, "No disease has such a murderous influence upon the offspring as syphilis; no disease has such a destructive influence upon the health and procreative function of women as gonorrhea. Inherited syphilis

is a powerful factor in the degeneration of the race."

Dr. Biggs states that in 1912 of the population of New York City at least eight hundred thousand people, one-fifth of the population, have or have had some venereal disease, and that in a large percent the disease is still active.

At a medical meeting in Vienna in November, 1916, figures were given to show that of the seven million in the Austrian army, seven to eight hundred thousand were suffering from venereal diseases.

Statements issued under the auspices of the United States Army report of syphilis: "There is as much syphilis as consumption in the average community, but syphilis is more infectious; it is a blood disease and may be transmitted to children before birth, making them physically and mentally defective; it is the cause of nearly half the abortions and miscarriages. It is the cause (experts say the chief cause) of locomotor ataxia, softening of the brain, paralysis, and a great percentage of insanity; it is the cause of a large proportion of diseases of the heart, blood-vessels and other vital organs."

"Gonorrhea is the most prevalent of all diseases except measles; one of the most dangerous and difficult to cure. It blinds thousands of men and women in this country every year and is the cause of eighty percent of blindness in new born babies; is the cause of most surgical operations on women and of much of the sterility of women.'

I, who am only a layman, could make you shudder at the tragedies from the disease: men who have thought themselves cured years back compelled for life to care for and look upon their imbecile or hideously deformed child, which silently cures them for the ignorance or sins of their youth. We could conjure up an host of children, men and women imbeciles, deformed, insane,

who for no fault of their own have had this curse laid upon them by the sins of others and by the neglect of society to take action.

What interests us today is, however, the question of the War. How can we let these diseases wage their warfare against the strength of soldiers, sailors and citizens, and not count ourselves slackers or traitors? How can we as patriots allow the whole people to be in danger of infection, weakening the whole body politic in physical strength, in morals and character? What waste of time to save food and money, to cheer our sons off while these diseases lie in wait fo rthem! Overwhelmed as our people are with new problems and multiplying campaigns, this problem must be met if we are to win the war: it is a military problem.

This is the time to meet it, for our compulsory service system gives the first real opportunity for exact statistics. This is the time, for even though the Army and Navy may be clean, the whole people, the munition workers, the ship builders, the mill people, every one is in the service: their whole vitality is needed. This is the time, for when peace comes the competition of nations for trade, commerce, and leadership will be on, and success will come only to nations whose people are strong in physique, clear in brain and sound in character.

Clear that the day for action has come, we now take up the study of the subject and the program.

First, a word of history, for it is interesting. Until 1493 Europe had never been touched by syphilis; in 1494 and 1495, parts of Europe, Spain, Italy, and France were scourged with syphilis. This is strong evidence that the disease was brought back from the West Indies by the crews of Columbus and of succeeding ships. The disease, finding virgin soil in Europe, was rampant for a while; and then in the voyages of commerce and adventure was carried throughout the world. The Cross, the sword, and this curse went together.

How are these diseases passed on through the people? Chiefly through sexual intercourse; one person infected ever so slightly infects the other, and no one can tell how lightly or severely.

Syphilis also passes from one to another by contact with those infected, an abrasion of the lips, for instance. Think of this medical report: at a game of boys and girls with kissing as a for

feit, six girls went home infected with syphilis from the lips of one boy. Hence the danger of common drinking and eating utensils. More infectious even is gonorrhea, for that quickly affects the eyes; a common towel, touching the eye with an unclean finger is enough.

Through inheritance. The infection of either parent is enough to carry the curse of syphilis down to the innocent child, even to the second and third generations.

Other methods of propagation by the score you may find in the books and physicians' experiences, but sexual intercourse is the one great outstanding method of transmission.

Some one says that the publication of these things may create a panic: everyone will imagine that he has the disease; many will be made unhappy by the discovery that they do have it. Have we not troubles enough now?

If a panic must be raised, let it come: better panic than defeat or death. In the long run, however, panics are due to suppression of facts, to secrecy. Thus the imagination is aroused and people dread the unknown. Publicity is the best preventive of panics.

War has always brought a fresh outcropping of venereal diseases; hence they have been thought of as especially army and navy diseases. There is reason for this, too. Masses of men trained to fight and kill have the brute forces brought to the front; away from home and good women, they are free from the conventionalities and oversight of society and home. Under the monotony of training and the heavy stress of battle, the nervous reactions are almost overwhelming. In masses of men there are a certain number of lowminded and low-living brutes, and they make themselves felt in camp.

The tradition too that a certain number of low women always have followed the camp, and always will, is strong; and the assumption on the part of officers that a certain percentage of men have got to have women has some foundation in experience.

Thousands on thousands of patriotic fathers and mothers have therefore watched their boys go into camp, and have followed them in imagination with anxious, very anxious forebodings. Even wives let their husbands go, trusting them, but with forebodings of the possible.

My purpose in this lecture is to state the facts to these fathers and mothers,

For brevity I shall use the word "disease" for the group of venereal dis-. eases; and the word "army" for all the military and naval forces of the country.

The Army comes from the people, and in physique and character is the embodiment of the people. The Army after war returns to the people. There is therefore such close interplay of Army and society that they cannot be studied separately. Hence my study will at each point take up the Army and then society.

How prevalent is the disease in the Army? First a few facts of a few years ago by way of comparison.

In the various leading armies there were per thousand soldiers afflicted with the disease:

No wonder these figures brought alarm. Since then, and especially since the opening of the European War, the Medical Departments of the Army and the Navy have attacked the problem with determination, skill and high purpose, so that today the Secretaries of the Army and Navy, the Surgeons General, the staff and officers are bringing to the problem the forces of science, medical skill, discipline, and social service.

With what disappointment, therefore, you will listen to these figures of our Army showing the computed annual rate of admission for venereal disease per 1000 men, based on reports to the Surgeon General for the twelve-week period, September 21 to December 7, 1917.3

Of the 1,000 men in our Army there were afflicted with disease:

May I point out to you incidentally that while 121.9 was the figure for this disease, the total figure for pneumonia, dysentery, typhoid, paratyphoid, malaria, meningitis, and scarlet fever was only 25.7.

Why is it that with the great activity and skill of the Medical Department these figures should be so large, so alarming? Note the time during which these figures were taken,-the twelve weeks when the Army was absorbing great masses of citizens.

Inasmuch as the newly discovered cases, whether old or new infections, were being reported as the "new cases" during this twelve-week period in the National Army of drafted men, these figures should not be compared_with either the National Guard or the Regular Army. However, the National Army, more than either of the others, is a cross-section of the physique and character of the men of this country. Of this typical cross-section based on an annual rate for this twelve-week period, 162 were diseased out of every thousand men.

Let me now give you some suggestive figures of the Army during two weeks.

The first week, ending September 20, 1917, there were admitted to sick report for venereal disease of every 1,000 men in the Army distributed as in the three main divisions:

service.

See foot-note 5, p. 513.

community, have a far greater percentage of the disease than the others.

2. Under military discipline and methods of repression and prevention the number of the diseased decreases.

3. Under the conditons of camps in this country the boys and men are far safer from disease than in their own home towns and cities.

4. The high purpose and determination of the medical service and of our military leaders give strong assurance that in meeting the very difficult conditions in France, a country desolate, in parts demoralized, weary of war, bereft of strong men, full of chivalric and self-sacrificing women ready to show their gratitude to America, the young men of our Army will as a whole be held to loyalty, purity and health. And so far as I can get figures and impressions from personal letters, I believe that even there the American boy is safer from disease than in his home city. The time has now come for society to turn upon itself with alarm. For fathers and mothers, for all citizens to look to the base of supply of venereal diseases, our own streets and homes. "Physician, heal thyself."

I will not harrow your feelings any more with the awful tragedies at our doors. I am only a layman. Read the reports of experts, Osler, Rosenau, Biggs, Morrow, Vedder, Exner, and a score of others. Study the records of your poor houses, insane asylums and jails, your orphanages and hospitals: talk with your physician, though professional honor prevents him from telling you all. And note that the disease permeates every class in society, especially the poorest and the richest.

If we at home are to start and carry on a warfare against this disease, we may turn to the Army for our principles and methods so far as we can use them. The first and deepest reason for the success thus far attained is the high purpose and the determination of the men who have the fight in hand. They know better than we do the tremendous conservatism which army life brings with it. What has been, bust be, says the conservative soldier. "Men must have women, you can't help it." "You cannot put out of business the oldest profession in history, prostitution." "Disease of course, it has always been. You may do something to check it, but you can't be too sanguine."

But the modern soldier knows that to make an effective army the day of

swash-bucklers, of drink, and loose women has gone by. The facts, military and medical, are against them: and each year sees that class dying off.

The Army regulations of today are in all questions of morals pitched upon a very high note: the soldier's character as well as his physique is a serious matter to his officers. The whole atmosphere of the camp is that a man who falls under the disease has been untrue, disloyal to his comrades-and that brings many to a better mind and life.

What are the definite means of prevention of the disease in the Army?

1. See the man that has the disease and keep a keen eye on him. To do this every man entering the service undergoes a thorough examination and afterwards a biweekly inspection. When necessary, the Wassermann blood test is given and in the course of the year, so far as practicable, every man will receive this test. Then if he is admitted to service and is also infected, he is, so long as he is a danger to others, isolated in the venereal disease hospital, and when release from hospital is safe, he is followed up until his cure is as certain as is possible: and even then his record stands for the future. If this man and all men could be held in camp all the time, they could be kept from infection. But on leave they must go outside of the discipline of the camp and into society. There is the danger of infection.

2. Hence the prophylactic treatment. This perhaps does more to cut down the numbers of infected men than any one cause. It is as radical as it is effective. Every man returning from leave who has been in danger of infection must report immediately to his medical officer and receive prophylactic treatment.

If this is given within a certain time after the possible infection, it is a sure preventive. Hence any man who has the disease is liable to be court-martialed on the ground that he did not report. Thus reporting is really very general.

Combined with this, are the shame attached to the exposure to infection, the disgrace of the venereal ward, the rebuke and advice of his officers, and the loss of pay. In the hospital he receives the most skillful treatment, the use of salvarsan and other modern methods: for the Nation is paying the costs, and he must get back into the ranks at the earliest safe date.