CHAPTER IV

MEDICAL PHASES

_By Andrew C. Smith_

Some idea of the prevalence of venereal diseases in the United States may be obtained from the following statistics of the census for 1910. The registration area covered a population of 48,877,893 persons. The figures are here extended to cover a population of 90,000,000 people: Deaths ascribed to venereal disease, 5275; spinal cord diseases, 2598; paresis, 4845. Other diseases partly due to syphilis: softening of the brain, a term indiscriminately used to cover a number of diseases including brain syphilis and paresis, 2111; paralysis, usually meaning apoplexy, but always including many cases of brain syphilis, 14,479; premature birth, by some believed to be the result of syphilis in one half of all cases, 34,174; congenital debility, deaths due in many cases to feebleness of the child resulting from syphilis, 25,285; blindness, one fourth the total number of blind in this country estimated at 15,000 to 20,000. Many estimate that over half of the entire male population have had gonorrhea. The principal reason for this alarming distribution among all classes of these infections and their steady increase is ignorance and misunderstanding of physiological facts, particularly the viciously false teaching of the street corner that sexual activity is a physiological necessity.

These diseases would be arrested were there a widespread knowledge of their disastrous effects. Although young men hear the mischievous lie that "gonorrhea is no worse than a bad cold," thousands of them are punished with sterility as a result of the disease. Nearly all the neglected cases result in so-called ascending infections, reaching the bladder and kidneys and causing many deaths, and many men carry the infection in dormant form, to infect innocent wives in later years.

Appalling as are the consequences of gonorrheal infection in men, they are not so fatal or so far-reaching as syphilis. The causative parasite of this disease spares not a single tissue in the body and may disturb any or all of its functions, not even mentality escaping. As a cause of death it is extremely frequent. Our statistics ordinarily ascribe to syphilis but a small percentage of the deaths actually due to it; for instance, many of our cases of spinal disease, paralysis, arterial and other organic diseases are tabled under other names, although directly due to syphilis.

In women gonococcic infections are even more destructive than in men, as it is extremely common for the infection to extend to the tubes and to the peritoneal cavity, thus necessitating dangerous and mutilating operations, generally followed by sterility and often by death. Syphilis, though less frequent in women than in men, is nearly if not quite as fatal as in men, and otherwise similar in its baneful effects. I The child suffers the most tragic results of venereal infection, for it is always wholly innocent, yet infected to a greater or less extent, if the parents be syphilitic, and frequently if the birth-canal be gonorrheally infected. Although silver nitrate is a remedy for gonorrheal infection, if applied to the eyes immediately after birth, nevertheless the babe frequently suffers with infected eyes, and not infrequently with blindness.

If the child's sad infection is syphilis, instead of gonorrhea, there are still other miseries in store for it. If it is not so fortunate to be stillborn, it may have infection that ranges from almost imperceptible degrees to the most loathsome extent that it is possible for animal tissue to harbor. Its brain may be so invaded by the syphilitic parasites that it can never attain any degree of mentality; its spinal column maybe so involved that paralytic conditions will surely result; and if these nerve centers escape special involvement, other organs may be affected, such as the stomach, bowels, and liver; if these escape, the bones may be so deficient in vitality as to be incapable of sustaining the frame as development proceeds; the skin only may be involved, or the mucous membranes so affected as to make of the child a perpetual snuffler and inefficient breather. In most cases of lesser as well as greater mental defect, the tests show syphilitic infection. Endless are the complications that may be visited upon the innocent progeny of syphilitic antecedents.

The gonorrheal infections occur in the mucous membranes lining the cavities, especially those of the urethra and female genital tract. It is in these tissues that the germ of gonorrhea finds lodgment, and once there its development is hard to interrupt. Although the growth of the gonorrheal germ produces acute symptoms, such as discharge and pain, these pass off under treatment in a few weeks. Unfortunately the disease is far from cured, for the microbe has found its natural habitat in the inter-cellular structure of the genital mucus, from which it cannot readily be dislodged, and from which it may invade other tissues. It may remain in a state of latency for an indefinite time; then transferred to a new field, it may resume its original activities. While in this stage of latency it is difficult to destroy. At this time it is more likely to be further disseminated, as the patient, ignorant of the condition, is more likely to convey the disease, which so often occurs in married life after a long forgotten infection.

The gonococcus (the microbe of gonorrhea) is a pus--producing bacterium, occurring in pairs, resembling in form two coffee grains, generally with a distinct interval of separation. Although its natural habitat is the mucous membrane lining the genito-urinary tracts it may invade the muscular and serous and other tissues. If often affects the Fallopian tubes and ovaries and the serous lining of the pelvic and abdominal cavities. The deeper sub-mucous tissues of the uterus and the male genito-urinary tracts are also frequently involved, it being sometimes impossible to eradicate it from these deeper retreats. From these deeper tissues it is more commonly taken up by the circulation and deposited in distant parts, frequently in the joints. When it becomes thus systematically disseminated, the so-called secondary or metastatic lesions are almost as numerous, though not as virulent, as syphilitic infection. Recent pathological researchers have found that occasionally the gonococcus becomes the causative factor in inflammations of the muscles, tendons, and glands, and in inflammatory conditions of the lungs, kidneys, heart, and even the brain, spinal cord, and the serous membranes enveloping these great cranial and spinal viscera.

The individuality and characteristics of the syphilis microbe were not positively determined until in 1905, Schaudinn, of Germany, convinced the medical world that it was a spiral, corkscrew-like organism, from a quarter to one millimeter in thickness, and from four to twelve millimeters in length. It is not so discriminating as the gonococcus in its points of inoculation, nor is it as vulnerable to attack; and it is vastly more destructive to the tissues invaded. It spares no tissue in the human frame, and resists destruction by any known drugs of vegetable origin. When in a latent state its presence was often impossible to determine until, two years after its discovery, a test was worked out by Wasserman, also of Germany, by which diagnosis of the infection may be made,--even in latent form,--as in a hereditary case where no clinical manifestations have yet asserted themselves. There is another valuable blood test worked out by Noguchi. With these two tests we are now able to diagnose the disease, almost absolutely, and follow up the treatment till cure is complete, except in some of the incurable brain and spinal cord cases.

In 1909, Ehrlich determined, after a series of laboratory experiments on animals inoculated with the syphilis germ (spirochæta pallida), that a complex compound, with arsenic as its base, had the desired effect of destroying the parasite, in a dose not poisonous to the animal. This compound, first designated as "606," representing its number among his many laboratory experiments, he later named "salvarsan." With the assistance of his clinical friends, he soon demonstrated the action of his compound on man, and gave it freely to the world. Although it is now almost universally used, it has not proved to be the absolute cure that it was hoped it would be, as some of the spirochætæ seem to be hidden away where they are protected from the circulating poison,--to bring forth new progeny,--thus producing so-called recurrence.

The possibility of the infection of innocent persons is always uppermost in the mind of the medical man, and should equally concern the layman. Contaminated articles and utensils, such as towels and common drinking-cups, have caused many infections. This danger is greater from syphilis than from gonorrhea, for the reason that the spirochæta pallida is more virulent than the gonococcus. In our own fields, camps, and mines, it is common for men to drink from one jug or dipper. Infection almost surely follows if one of the crowd has a syphilitic sore on the lip. So intense is the activity of the spirochæta pallida in the primary stage that it may be borne to innocent parties by unwashed clothes and utensils of any kind, that have been in recent contact with a primary syphilitic sore. A dentist's or a doctor's instruments, for instance, are extremely dangerous as infection carriers, if they are not thoroughly sterilized by boiling. The danger of infection in syphilis and gonorrhea depends largely upon the virulence of the individual infection. As some living tubercle bacilli may be harbored and thrown off with impunity, while others will destroy the strongest man, regardless of all treatment, so some spirochætæ or gonococci may be safely disposed of, while others are most deadly.

Of all the sad instances of germ infection, the saddest are those from venereal germs, for they are disseminated mostly in vice, and inoculated into the innocent through ignorance. A common cause of infection of the innocent is the false popular belief that venereal germs are transmitted only in sexual congress. The truth is that any part of the body is in danger of inoculation from syphilis if the germ be virulent. So may any membranous point be infected by the gonococcus, whether conveyed by hand or instrument or fabric. This explains the number of gonococcic infections occurring in girl children. They come in membranous contact (at the outlet of vagina or rectum, or in the eye) with a contaminated article of clothing, or with the contaminated hands of an infected person. Ignorance is the cause of nearly all venereal infections. Why, then, should venereal infection not be eradicated? With adequate education, if there is not eradication, there will at least be compensation, for the sacrifice will be mainly of those who will not accept education--the unfit.

The possibility of recovery from syphilis is greater at present than it has been in the past, but we cannot yet say that the disease is absolutely curable in a given case. While most cases treated early with salvarsan, and followed by judicious use of mercury, are curable, there are nevertheless those which do not thus respond, and which in spite of all treatment go from bad to worse, till the patient's miseries are ended in insanity, paralysis, and death.

While the venereal diseases are the greatest physical evils to be attributed to sex ignorance, there are others chargeable to the same cause. There are, for instance, important physiological phenomena pertaining to sex development, ignorance of which is often baneful to the developing adolescent of either sex. When the boy's voice begins to change, and hair begins to appear on his face and body, and more thrilling sensations occasionally command his attention, he should be told, modestly but distinctly, that a pure and manly function is developing within him, the sole object of which is reproduction, and he must not consider it in a vulgar way, nor discuss it with others than his parents or physician or minister. Tell him that these physical changes of oncoming manhood are due to the establishment of the secretion of the procreative fluid,--the semen,--and will be safely cared for by nature. Fortify him against the mental pollution of the quack advertisement, and the satanically false teaching of ignorant associates that sexual intercourse is physiologically necessary, by impressing him with the fact that nature cares for the disposal of the seminal secretion. When clearly made aware of these simple sex principles, and convinced that it is unmanly and depraved to consider them vulgarly, the rapidly developing manly boy will not become a masturbator or a frequenter of bawdy-houses and a victim of the gonococcic or spirochætic infections; nor will he become a moral assassin, a seducer of girls.

The sister, no less than the brother, needs pure, plain, non-prudish sex education. If her mother is not qualified to impart it, she, like the boy, should seek the aid of her minister, or physician, or a qualified school teacher; better a few suggestions from an experienced, modest source than many suggestions from inexperienced and often lewd companions. As the brother was told of the physical phenomena accompanying his sex development, so the sister should be apprised of the physiological necessity of her periodical functions, and of nature's kindly care and development of her delicate and wonderful sex mechanism, the sole purpose of which is maternity. It will fortify her maidenliness to tell her that much of the world is deceitful and degrading in sex matters, and that if she would be a perfect woman, mentally and physically, she must vigilantly guard her virtue, maintaining absolute purity, not only with persons of the opposite sex, but with persons of her own sex, and the person of her own self. Incalculable good can be done toward the uplift of wayward humanity by sex education.