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As in the United States, approximately 10 per cent. of the population of the British Isles was syphilitic before the war began. Medical authorities estimate that unless the present rate of spread of the disease is diminished, 30 per cent. will be infected before the war is over! Syphilis and gonorrhea have spread so rapidly in Canada, through soldiers returning from the front, that public discussion of the subject is now permitted for the first time and repressive measures are being introduced, as they are in England, where the former attitude of indifference has given place to genuine alarm.

No accurate recent data are available from Russia, Italy, or Germany, but in all of these countries there has been a material increase in venereal infections among the civil population and a considerable percentage of incapacitation of the fighting forces through these causes.

AMERICA FIRST TO TRY REGULATION

America, alone of the belligerent nations, began its participation in the war with regulatory, sanitary, and disciplinary measures in effect which have already proved their value in reducing the percentage of infection in the Army and Navy, and at the same time began to build a machine designed to prevent the spread of these diseases among the civilian population. What official England, France, Canada, and Germany have only recently awakened to the necessity of doing, after more than three years of war, America has been doing aggressively from the start.

Prophylactic and curative measures have, of course, been in use everywhere, but the American programme is the ambitious one of elimination on the one hand of sources of infection and the inculcation on the other hand of a new standard of sex morality among the men of the Services. Ours is the only army in the world, so far, that makes infection with a venereal disease a punishable offense. Moreover, both in the Army and the Navy, the fact that sexual continence is entirely compatible with good health is drilled into the men, along with the teaching that it is their duty to conserve every ounce of physical energy for the service of their country. There are, of course, in both Services, veterans filled with the old tradition of the fighting man as a hard-drinking, lustgratifying individual when off duty. To these

officers and men of the old school this type of soldier seems much more virile than the youth who goes to the soda-fountain and the Y. M. C. A. rather than to the saloon and the brothel. Heretofore all conscious consideration of the matter in any army has been from the viewpoint of the soldier's entire right to follow his instincts to the limit, and control has taken no more drastic form than official supervision of prostitution. Germany at the beginning of the war practically mobilized the prostitutes of the Empire at the concentration camps and at the front, with some ineffectual attempts to segregate infected individuals. The world knows the story of rape officially condoned, if not officially sanctioned, that followed the invasion of France and Belgium. Prostitutes plied their trade with the French army "everywhere but in the first-line army trenches," as one American observer puts it. Similar conditions are reported to prevail in the Italian army. No restrictions have been imposed by the Russians. The English Government, up to a very few months ago, left to civilian effort all attempts at any sort of control. Officially the British military authorities have only just awakened to the fact that, as Kipling phrases it, "Single men in barracks don't grow into plaster saints." Now that England has awakened to the situation, a complete and thorough solution may be expected.

Nobody is trying to make American soldiers and sailors grow into plaster saints, but the departments concerned, with the coöperation of a great body of civilian volunteers are striving, with unexpected success, to instil continence and moral cleanliness while at the same time removing temptation. This is coupled with the physical rehabilitation of those who brought venereal infection with them into the Services. The number of these latter is surprising, even to physicians. There have been no accurate statistics of venereal diseases in civil life, because these diseases are in most states not reportable, like other infections. Statistics being available from the Army and Navy, the impression has gained ground that the Services are hotbeds of vice and disease. It is, to be sure, startling to contemplate statistics that show an annual rate of 88 cases of venereal disease per 1,000 soldiers in the Regular Army, compared with a rate of 13.4 for all other diseases, but

Soldiers of the National Army, for a period

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146 139 136 115 95 69 104 80

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of a few million young civilians. For a long time, except for the medical treatment of cases after they had developed, the only preventive measure was the issuing to every man of the Navy, whenever he had shore leave, of a packet containing medicaments for preventive treatment, on the assumption that he would certainly have occasion to use it. Similar preventive packets were purchasable by soldiers at their post exchanges and by sailors. ashore at the Navy Yards. Three years ago this system was abolished in the Navy, partly on the moral ground that it was an encouragement to incontinence, partly because of the expense involved, and partly because it proved inefficacious. In its place were inaugurated moral and sanitary advice to the sailors, provision for early treatment of every man who had been exposed to infection, and the cleaning up of infected districts in the vicinity of naval stations. Statistics compiled by Medical Inspector Charles E. Riggs of the Navy show a progressive falling off in the proportion of venereal disease in the Navy and of exposure to infection in the thirty months succeeding the establishment of the new order.

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NATIONAL ARMY

Dec.

THE PREVALENCE OF VENEREAL DISEASES IN THE NATIONAL ARMY Demonstrating the responsibility of civil communities. During September and October when drafted men were mobilized, a large number of cases of venereal disease, contracted in civil life and reported for the first time by the army, caused a conspicuous rise in the annual rate. (These figures show the annual rate for venereal disease per 1,000 men for the years 1915 and 1916 based on annual reports, and the computed annual rate per 1,000 for the year 1917 based on weekly reports)

of nine weeks after the first drafted men got to camp, brought with them venereal infections at a rate of 212 cases per 1,000 annually! In one week the newly-drafted men showed a rate as high as 418 per 1,000! These were young men who had been passed by the examining boards and adjudged fit for military service. In other words, after the worst cases had been weeded out, venereal disease was shown to be nearly three times as prevalent among selected civilians as in the Regular Army. Under the influence of medical treatment, moral propaganda and the beginnings of control of infection sources, the rate began to drop rapidly. For the week ending December 7, 1917, it was down to 80, or below the threeyear Regular Army average, and has since steadily declined. In the National Guard camps the rate has dropped below 50. Medical officers are beginning to hope they can keep the rate for the whole Army down to 6 per cent. or less.

The methods adopted are those which have been in use in both Army and Navy for some years, amplified and added to to meet the exigency of the sudden influx into the Services

It was largely on the basis of this experience, to which was added a practical demonstration on the Mexican border in 1916, that the measures now in force in the Army were adopted. The border experience proved conclusively that the rigid suppression of public prostitution in the vicinity of camps had a decided effect in lowering the venereal rate. The troops that developed the smallest proportion of venereal diseases, the New York National Guard, were surrounded by a barred zone into which no known prostitute was permitted to enter. When mobilization began for Mexican border service a delegation of leaders of the social hygiene movement conferred with the Secretary of War and advised the appointment of a special representative

to study the problem of prostitution in relation to the Army. Mr. Raymond D. Fosdick was appointed. As a result of his reports, corroborated by commanding Generals, medical officers and others, there developed the plan for the present Commission on Training Camp Activities, as well as the provision in the National Army law which authorizes the President to direct the establishment of zones around each camp and cantonment in which prostitution shall be suppressed.

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Venereal

Diseases

Other

Communicable Diseases

(see list below)

REGULAR ARMY

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THE PREVALENCE OF VENEREAL DISEASES Compared with other communicable diseases in the United States Army-Pre pared from reports made to the Surgeon General. (Figures given show computed annual rate per 1,000 based on reports to the Surgeon General for the twelve-week period, September 21 to December 7, 1917)

Venereal Diseases.

Other Communicable Diseases, i. e.: Pneumonia, dysentery, typhoid, paratyphoid, malaria, meningitis, and scarlet fever (not including measles)

A comprehensive plan for national control of the situation is now in full effect, under the direction of Surgeon-General Gorgas and Colonel F. F. Russell, Medical Corps, in charge of the Division of Infectious Diseases. Dr. William F. Snow, Professor of Hygiene and Public Health at Stanford University, who has exercised a wide influence in developing the attack on venereal diseases through his position as editor of "Social Hygiene" and his practical work as a State health officer, was commissioned a Major in the Medical Reserve Corps and placed in direct control of the venereal disease work. A special section has been organized in the Division of Infectious Diseases, under the direction of Colonel Russell. The personnel of this section includes, besides Major Snow, Major Edward L. Keyes, Professor of Urology in Cornell University, who represents this branch of the service with the American Expeditionary Force in France, Major W. A. Sawyer, State Health Officer of California, Major Eugene F. McCampbell, Dean of the Medical Department of Ohio State University and formerly State Health Officer; Captain Alan Nicoll Thomson, Director of the Genito-Urinary Clinic of Brooklyn Hospital; Major Bascom Johnson, Attorney of the American Social Hygiene Association; Captain T. N. Pfeiffer and thirty-two lieutenants with a number of

sergeants, assigned to educational work in the cantonments. In addition there is an advisory committee composed of five specialists of National reputation: Drs. William Allen Pusey, Francis R. Hagner, Grover W. Wende, S. Pollitzer, and Henry H. Morton.

PREVENTIVE MEASURES

The campaign against venereal disease as it directly touches the individual soldier is thorough and effective. Of prime importance, of course, is the medical side, which consists, besides treatment of actual cases in regimental or base hospitals, of the establishment of stations for the prompt application of preventive measures for soldiers who have exposed themselves to infection. These stations for early treatment are located near railroad terminals in towns to which soldiers in considerable numbers go on leave, and at the regimental hospitals. In New York, for example, there is an early treatment station close to the terminal of the Long Island Railroad, over which all traffic to Camp Upton passes. The regulations fixing the responsibility of the individual soldier are

venereal disease in an infectious form will be allowed to go to France but that such cases will be kept in America for the hard and unromantic work of the home garrisons and forts, or sent over later after treatment, which means the soldier will probably not get back to his own company and so will lose opportunity for advancement.

very strict. No soldier having venereal too, that no one who is suffering from a disease in an infectious form is permitted leave from camp. Every soldier who, when on leave, has run the risk of infection, must present himself at one of the early treatment stations within eight hours after exposure. It is not left to the soldier's judgment to determine whether or not he has been infected. The rule is that if he has had intercourse with any woman not his wife he must report himself as having been exposed to infection. Enough instances have been discovered, in the vicinity of various cantonments, of girls whose known activities could have infected entire companies in a few days, to indicate the menace that one woman of easy virtue might be.

At the early treatment station treatment that has proved almost uniformly effective when used within six to eight hours is administered. The soldier who thereafter, and before another exposure, develops a venereal disease suffers no further penalty than the loss of all pay while confined to the hospital or otherwise non-effective as a fighting unit. The rule depriving soldiers of pay for time lost to the Army through diseases resulting from their own indiscretions dates back to 1912, and has proved a valuable deterrent. If, however, a soldier who has not reported at the early treatment station develops a venereal disease after having been off on leave, he is summoned before a summary court-martial which may sentence him to hard labor or otherwise discipline him for infraction of regulations. The men understand that the Army in no wise condones or favors the toleration of their exposure to infection and that courts-martial for conduct detrimental to the Army may be ordered. independently of any question of infection.

THE IMPORTANCE OF AMUSEMENTS

Educational work among the soldiers consists in placing in each soldier's hands a pamphlet, which he is required to study, telling him the facts about the nature and consequences of venereal diseases; of lectures, by medical and lay speakers; stereopticon and motion picture exhibitions that give the uninitiated youngster an eyeopening view of the ravages of venereal diseases, and various placards and fixed exhibits to keep the warning fresh in the young soldier's mind. To manage this part of the work the Surgeon General's Office and the Committee on Training Camp Activities coöperate in maintaining a Department of Social Hygiene Instruction. Equally important is the provision of sports, games, entertainment of divers sorts, through the Y. M. C. A., the Knights of Columbus, and other organizations. Previous experience indicates the great majority of infections would never have occurred but for the lack of entertainment to keep the soldier's mind and body fully occupied.

The jurisdiction of the Commission on Training Camp Activities extends to the fivemile zone around each camp and cantonment. Both the military police and women patrols are employed in the zones, to keep undesirable women out. Outside of the five-mile zones and covering a territory so wide as to be almost co-extensive with our national boundaries, an ambitious but increasingly effective campaign is under way for the closing of "red-light" districts, the suppression of streetwalking, the supervision of young girls afflicted with the prevailing epidemic of "uniformitis," the control of venereally-infected women and the education of the great mass of the public that has never given any thought to the subject. This work is being participated in by many agencies. A very important part of the work of sanitation in the vicinity of camps and cantonments, which the United Word has been passed out to the soldiers, States Public Health Service is charged with,

A very large percentage of cases in which infection occurs after having joined the colors is, of course, curable. In syphilis, the standard treatment with salvarsan-"606"is used, the Army now having an ample supply of this remedy, made in the United States. It is comparatively easy, too, so to reduce the active symptoms of gonorrhea as to send the soldier back to duty very quickly, although modern medical science, when asked the question: "Is gonorrhea ever permanently cured?" can only answer: "Yes, probably but you never can tell."

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consists of the closing of brothels and disorderly resorts, the suppression of prostitution, and the provision of dispensaries for the treatment of venereally-infected civilians of both

sexes.

The American Red Cross is helping through its appropriation of $173,500 to help finance this extra cantonment sanitation. The educational work is being done largely under the leadership of the Sub-Committee for Civilian Coöperation in Combating Venereal Diseases of the Council of National Defence, and the American Social Hygiene Association. This committee includes in its membership military and civilian physicians, business men and leaders of social welfare movements. activities are largely carried on by the volunteer services of a group of three young business men, Mr. William Zinsser, Mr. Gurdon Parker and Mr. Mark Wiseman, and field secretaries of the Association under the Direction of Mr. H. H. Moore.

Its

The programme of this committee involves primarily public education and stimulation to coöperation, both for the protection of the soldier and for the suppression of prostitution and the better treatment of venereal diseases generally.

The results obtained in the matter of closing segregated districts have been especially gratifying. On August 10, 1917, Secretary Baker, sent the following letter to the mayor of every city and the sheriff of every county in the vicinity of every camp:

"The War Department will not tolerate the existence of any restricted district within an effective radius of the camp. Experience has proved that such districts in the vicinity of army camps, no matter how conducted, are inevitably attended by unhappy consequences. The only practical policy which presents itself in relation to this problem is the policy of absolute repression, and I am confident that in taking this course the War Department has placed itself in line with the best thought and practice which modern police experience has developed. This policy involves, of course, constant vigilance on the part of the police, not only in eliminating regular houses of prostitution but in checking the more or less clandestine class that walks the streets and is apt to frequent lodging houses and hotels."

It has been necessary in only one or two instances, after the Secretary's attention had been called to the reluctance of local officials to "clean up," to add to the foregoing warning.

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There still remain such problems as what to do with those already infected, of both sexes. Several cities have set apart wards in the public hospitals in which both men and women found to be suffering from venereal diseases are treated until no longer a public menace. Some cities are interning infected women for the duration of the war. There is the problem of clandestine prostitution-far more difficult in its solution, though less dangerous to the morals and health of the soldier than the open vice district, with its glamor of music, lights, and the crowd, because less accessible and alluring. To further aid in handling this phase of the situation the Commission on Training Camp Activities has organized a Committee on Protective Work for Girls, under the chairmanship of Miss Maude E. Miner of New York, which has worked out a programme which, if carried out, should greatly reduce the sort of promiscuousness that has, in the vicinity of some of the cantonments, reached appalling proportions.

As our soldiers get to France, they find measures in effect which, while not completely paralleling those adopted in this country, are nevertheless already proving effective among the American contingent now "over there." The venereal disease rate in our army in France has already been reduced from 94 per thousand per annum to 75, or below the Regular Army rate of its last three and cleanest years. No detailed reports of the work in France have been made public, but the coöperation of the French authorities has been enlisted and while the question of control is more difficult than in America, the officials charged with this work are optimistic in their belief that it will prove possible to reduce and keep the rate below 6 per cent. for the duration of the war, while at the same time the progress of venereal diseases back here in the States will have been definitely checked.

The one essential, it is pointed out by everyone having a part in the huge task of protecting America from the venereal plague that is already threatening to engulf Europe, is public cooperation based on the fullest public discussion and education on a heretoforeforbidden subject.

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