In the second place, it is generally admitted that the treatment is not sufficiently prolonged to cure the maladies discovered; that as a rule, in case of syphilis, the prostitute is dismissed from the hospital while quite capable of transmitting the disease. The external appearance of the disease is made to vanish; the disease remains. As a French writer has put it, the prostitutes are whitewashed, not cured. This is pretty largely the case with gonorrhoea also. For the first two or three years, the syphilitic may at any time transmit disease; gonorrhoea, if not completely cured, may be transmitted for an indefinite period. To cure the latter malady completely, several months of treatment may be required; it is still a disputed point whether or not there is not a large proportion of women infected with it who can never be cured at all.' The question arises whether this can be remedied. From a practical point of view, it is hard to see how it can. It is out of the question to detain all the prostitutes with latent syphilis in the hospital 5609 prostitutes thus "disappeared" definitely in the eleven years. Of course many reasons besides desire to escape the hospital must have operated; but no one can doubt that many disappeared in order to prostitute themselves clandestinely either in Paris or in other cities, carrying disease with them. 'Kromayer makes this contention. Jadassohn, on the other hand, claims that in most cases it may be cured if time enough be given. But he frankly states that it is merely an opinion, and admits that it is not as yet proven. Conférence Internationale, Brussels, 1899; Rapports Préliminaires, 2me Question, 41. until the two- or three-year period of contagion is over. Tarnowsky, Jadassohn, Finger, and a host of other medical men suggest the erection of asylums where they may be confined, and where the women afflicted with exceptionally stubborn cases of gonorrhoea may be kept. According to Finger, about 25% of all licensed prostitutes are in the highly contagious stage of latent syphilis. From this we may form an estimate as to the practicability of the asylum scheme. In our hypothetical system of regulation in New York, we should constantly have from 1000 to 1500 persons serving two- and three-year terms in a species of health reformatory. We should also have a considerable number under indeterminate sentence for gonorrhoea,-a sentence which would in some cases expire only when old age should render the woman innocuous. The question of the costs at once looms up. But, quite apart from that, the plan is absurd, for no prostitute would submit to an examination that might lead to such consequences, if she could by any possible means escape it. Voluntary inscription would be unthinkable, and the difficulties of official inscription would be immeasurably increased. There is a minor factor that may be taken into account before we leave the question of the safety of regulated prostitution. The question has often been raised, generally by laymen, it is true,whether contagion is not frequently mediate. When it is remembered how frequently a low-class prostitute performs the same office, it would seem reasonable that some of her patrons may receive the virus of disease indirectly from others. This has been adduced to explain the alleged fact that cases of disease traceable to inmates of licensed houses are likely to be more frequent, proportionately, than those originating with the isolated but registered prostitutes, in spite of the fact that the former may show a smaller percentage of disease. It may be seen, then, that many subtractions from the ideal of sanitary control must be made before we reach the actual efficiency of existing and practicable regulation. If, as seems reasonable, a system of regulation encourages indulgence to a certain extent, it will be necessary to make a further subtraction. If, however, the small sanitary good that is due to reglementation were a permanent acquisition of society, much might be said for the system. If venereal disease might in this manner be diminished, little by little, through the generations, it might be seriously considered whether the grave present costs ought not to be assumed. As a fact, so long as diseased patrons of prostitution are permitted to transmit their maladies without restraint, practically no permanent improvement is to be expected. A brief relaxation of sanitary control would restore exactly the conditions prevail ing before its institution, provided the moral habits. of the community remained unchanged. In undertaking one-sided regulation, society takes upon itself a burden which it can never lay down without losing every advantage gained by its assumption. This fact has led to the demand that all visitors of prostitutes should be subjected to sanitary inspection. The scheme is obviously impracticable, since such inspection could take place only in the brothel. If physical examination were required of visitors of licensed brothels, the licensed brothel would disappear for want of patronage, and isolated and clandestine prostitution would take its place. CHAPTER IX THE ACTUAL EFFECTIVENESS OF SANITARY CONTROL SINCE the system of sanitary control of prostitution has been tried in many parts of Europe, and since it has in some cities been consistently applied for over a century, one would naturally expect to find statistical proof of its effectiveness in preventing venereal disease. In attempting to establish the usefulness of sanitary control, comparisons of morbidity have been made between cities subject to regulation and cities in which regulation does not exist; secondly, comparisons of morbidity before and after the introduction or abolition of regulation have been made; and thirdly, a study has been made of the comparative frequency of disease in cities and countries where severity of control has varied.' The third method is, of course, the most doubtful of all. The degree of severity of control is a mere matter of opinion; the frequency of venereal Blaschko, Conférence Internationale, Brussels, 1899; Rapports Préliminaires, Ire Question, 76. |