avoided. Thus the problem of syphilis to the community resolves itself into the problem of controlling early syphilis. This is the period of maximum transmissibility. The disease can be combated only by recognizing it and treating it intensively at once. This places the burden squarely where it should be, upon medical schools, hospitals and clinics. These institutions must rise to the occasion by selecting competent teachers, physicians and equipment. The department of syphilis must be centralized. Social service bureaus must be adequately conducted, the cases must be reported to the municipality whether by institutions or private practitioners, and finally, alien syphilitics must be excluded at our borders.

108 West 87th Street, New York City.

The Problem of Venereal Disease in its Relation to

Penal Institutions.

EDITH R. SPAULDING, M.D.

(Director of the Psychopathic Hospital of the Laboratory of Social Hygiene, Bedford Hills, N. Y.)

While controversies are being carried on as to whether the honor system or self-government is more efficacious in remodeling the criminalistic man and helping him to readjust himself to social conditions, and whether a course in domestic science or an industrial training is better adapted to fit a woman to be selfdependent, the problem of venereal disease which needs no prolonged argument is being neglected. As clear cut and as important as the problem is in the community in general, it becomes much more definite when related to the population of our prisons and jails. If society does not assume the responsibility for these individuals, and treat them adequately, it must face the fact that later on, they will not only be a source of danger in the community, by causing the spread of the disease among innocent persons, but that a certain percentage will become so incapacitated by the disease, either mentally or physically, that they will be public charges.

Of the two venereal diseases which are most prevalent― gonorrhoea and syphilis-the latter is perhaps more far-reaching in its social aspects because it affects the succeeding as well as the present generation, and therefore, seems to demand the first consideration. The following figures will show the prevalence of syphilis in some of our reformatories and penal institutions where laboratory tests have been adopted as a routine procedure in the physical examination.

Among 500 cases1 studied at the Reformatory for Women at Framingham, Mass., 44 per cent had positive Wassermann reactions, while 10 per cent were doubtful. In 440 cases2 studied at the New York State Reformatory for Women, at Bed

ford Hills, 48 per cent gave positive results, while in Auburn Prison, New York, the percentage among the women was 33 and among the men 16.

Dr. Davis* reports that in the Department of Correction in New York, all women admitted are given the Wassermann test. I am also indebted to her for the information that during the last year 55.83 per cent of the women committed under the indefinite sentence were syphilitic.

Dr. Glueck* states that among 940 cases admitted to Sing Sing Prison between August 1, 1916, and May 1, 1917, 18.9 per cent gave a one, two, three or four plus Wassermann reaction while but 10.3 per cent gave a four plus Wassermann reaction.

The high correlation in the percentages of syphilis in the institutions for women quoted above is due doubtless to the large number of prostitutes included in their populations. A special study, however, made of 243* prostitutes at Framingham showed 65 per cent giving a positive Wassermann reaction and nearly 10 per cent more giving a doubtful Wassermann reaction. It is interesting to compare this with an examination reported by the Baltimore Vice Commission" which shows 63.7 per cent of 289 prostitutes to have syphilis.

From the earliest times prostitution has existed in spite of all conceivable means of repressing it, but it is only in recent years with the increased knowledge of laboratory tests for the detection of venereal diseases, and the increased knowledge of the diseases themselves, that true realization has come of the mental and physical devastation which has resulted from it. According to Aschaffenburg" "prostitution was originally instituted by priests for the honor of the divinity, and the benefit of the temple, and later put into practical form by statesmen like Solon . . . Louis XI of France tried to abolish it altogether and founded places of refuge for fallen women. On his return from Palestine, he ordered it to be completely exterminated. The concealed prostitution that immediately began to flourish everywhere, however, compelled him before a year had elapsed to repeal the order *Personal Communication.

and assign certain streets to the use of prostitutes." And so it has continued till the present day, when in this year of 1917, a city in our own country, after repeated attempts by the citizens to effect such a procedure had failed, was finally ordered by the Federal government to close its segregated district because of troops quartered in the vicinity. As a result 4,000 women who had been plying what up to that time had been considered in the city a legitimate trade, were without employment, and were liable to arrest if they returned to their previous occupation. Whatever the solution of the moral problem may be which has remained unsolved through so many centuries, of one thing we are certain, and that is, that the spread of physical disease should be as far as possible controlled, not, however, by the physical examination of prostitutes, which in all instances has proved ineffectual, if not a farce, but by recognizing venereal disease as contagious and infectious, and treating it accordingly.†

The increased knowledge of syphilis which has come to us since Schaudinn and Hoffmann discovered the Spirochaeta pallida in 1905, and Wassermann, Neisser and Bruch established the serum diagnosis of syphilis in 1906 and Plaut the Wassermann reaction of the cerebro-spinal fluid in 1908, is remarkable, but would be disheartening, interesting as it is, had it not been offset by Ehrlich's discovery of salvarsan in 1909. Even before the introduction of the Wassermann test there were appalling statistics published of the prevalence of syphilis in the various countries. These ranged between estimates of from 3 to 5 per cent in the general population of Prussia and Sweden, to 45 per cent and even 77 per cent in groups of selected persons such as clerks and merchants between the ages of 18 and 28 years in certain of the German cities.8

The effect which syphilis has on the birth rate and the large numbers of women and children who are infected innocently, will show to some extent the possibilities of further harm which

+ Buckley (7) some years ago emphasized the need of controlling the spread of venereal disease in prostitution by examining the man rather than by the old and unsatisfactory method of examining the woman.

untreated syphilitic delinquents may have in the community. Fournier describes forty-four pregnancies among women recently infected with syphilis. From these there resulted forty-three deaths and one living child. Four hundred and ninety-one pregnancies in syphilitic families, in which one or both parents were syphilitic, resulted in 382 deaths or 77 per cent. Taking into account the most favored cases in which the father only was syphilitic or had had previously prolonged treatment, there were 68 per cent of deaths. Gregg10 reports in the families of seventy syphilitic patients 133 deaths, fifty-two miscarriages and eight stillbirths. Fournier also emphasizes the large number of women who are infected innocently. About 5 per cent of 887 cases seen over a period of twenty-seven years had syphilis of non-venereal origin, while 19 per cent were married women who had received the infection from their husbands. In our own country we have ample evidence of the number of innocent victims of the disease. During a period of twenty-seven months, 600 children under twelve years of age passed through the venereal ward of the Cook County Hospital in Chicago.11 Of these 16 per cent had syphilis, and 84 per cent gonorrhoea. Sixty per cent of the children had been innocently infected. Twenty per cent showed congenital conditions and 25 per cent had been assaulted by diseased persons.

Baseley12 shows by studies made at the Boston Psychopathic Hospital that there is increasing authority for considering the infectious psychoses and psychoneuroses to be the last offshoots of luetic heredity. He has also shown in a study of children under fifteen, constituting social problems, that those children showing evidences of congenital syphilis show a larger proportion of feeble-mindedness and retardation, were more delinquent and had greater defects of vision, hearing and speech than the nonsyphilitic group.

Perhaps the greatest danger of syphilis as a cause of social inefficiency lies in the fact that it may do so much damage to the central nervous system. Williams 13 states that 10 per cent of the patients who enter the Massachusetts State Hospitals for the Insane are suffering from syphilitic mental disease. In New York State there are 12.7 per cent, while in Ohio there are 12