VICE AND HEALTH VICE AND HEALTH PROBLEMS SOLUTIONS BY JOHN CLARENCE FUNK, M.A., LL.B. DIBBCTOB, BUBEAU OF PBOTECTIVB SOCIAL MEASURES, PENNSYLVANIA STATE HEALTH DEPARTMENT; SCIENTIFIC ASSISTANT, U. S. PUBLIC HEALTH SEBVICE; FOBMEBLY U. 8. NAVY LAW ENFORCEMENT BEPBESENTATIVE; VICE-AGENT, U. S. DEPABTMENT OP JUSTICE; SUPERVISING INSPECTOR, U. 8. OFFICE OF NAVAL. INTELLIGENCE J. B. LIPPINCOTT COMPANY PHILADELPHIA AND LONDON fK COPYRIGHT, 1921, sfr j. B. LIPPINCOTT COMPANY PRINTED BY J. B. LIPPINCOTT COMPANY AT THE WASHINGTON SQUARE PRESS PHILADELPHIA, U. 8. A. TO THE LEAGUE OF WOMEN VOTERS WHOSE INTEREST AND INSPIRATION WILL DO MUCH FOR GOOD MORALS, GOOD HEALTH AND GOOD LIVING THIS LITTLE BOOK IS DEDICATED BY THE AUTHOR 50584V PREFACE With a very definite development of interest among groups and indi- viduals having a locality's welfare sincerely at heart, it was felt that a practical guide to certain phases of one of the most important municipal problems would be of some assistance. Personal experience, covering a number of years, has emphasized the fact that many people who become concerned in the suppression of vice and in its corollary, the reduction in the incidence of venereal disease, are quite ignorant of many of the neces- sary details essential to a successful attack. Then, too, officials are some- times sincerely wedded to certain ideas of control and tolerance which have been cleverly inspired from in- sincere motives. 7 8 PREFACE If, therefore, the facts herein set forth will aid in a rational approach to the vice and venereal questions, this small volume will have served its pur- pose and justified its existence. 300 N. Second Street, Harrisburg, Pa. Sept. 1, 1921. J.C.F. CONTENTS CHAPTER AO PREFACE 7 I. PROSTITUTION AND ITS CAUSES 11 II. PROSTITUTION* AND ITS MANIFESTATIONS... 20 III. THE BUSINESS SIDE OF PROSTITUTION 33 IV. RESULTS OF PROSTITUTION 44 V. THE GOVERNMENT'S FIGHT 62 VI. MEDICAL MEASURES 83 VII. LAW ENFORCEMENT 98 VIII. MEDICO-LEGAL MEASURES 120 IX. EDUCATION 137 X. WELFARE AND REHABILITATION 148 XI. GOOD GOVERNMENT 161 8 PREFACE If, therefore, the facts herein set forth will aid in a rational approach to the vice and venereal questions, this small volume will have served its pur- pose and justified its existence. 300 N. Second Street, Harrisburg, Pa. Sept. 1, 1921. J.C.F. CONTENTS CHAPTER AOB PREFACE 7 I. PROSTITUTION AND ITS CAUSES 11 II. PROSTITUTION* AND ITS MANIFESTATIONS... 20 III. THE BUSINESS SIDE OF PROSTITUTION 33 IV. RESULTS OF PROSTITUTION 44 V. THE GOVERNMENT'S FIGHT 62 VI. MEDICAL MEASURES 83 VII. LAW ENFORCEMENT 98 VIII. MEDICO-LEGAL MEASURES 120 IX. EDUCATION 137 X. WELFARE AND REHABILITATION 148 XI. GOOD GOVERNMENT 161 VICE AND HEALTH CHAPTER I PROSTITUTION AND ITS CAUSES Prostitution is based upon a funda- mental impulse, and is but the com- mercialized or misguided manifesta- tion of a normal physiological func- tion. The crime involved, so far as the public is concerned, is not so much in the act itself but in its promiscuity and consequences. Thousands of men, by no means limited to the unmarried group, seek distractions which the common woman can readily supply; and vi- cious persons, quick to see the advan- tage of the situation, individually and collectively long ago sought to stock the market naturally existing and at 11 p: HEALTH' IS the same time to stimulate a greater one. The net result was, that in the United States a comparatively few years ago, nearly every community of any size either possessed an open " red-light " district, of which in some instances actual boasts were made, or had its quieter section to which one could be easily directed. The denizens of these vice neighbor- hoods were recruited in a number of ways. Some were forced into the life through faked or actual marriages to dissolute men whose only purpose was to victimize and profit thereby ; others by sheer inclination; still others by unfortunate steps leading to seduc- tion, illegitimate children and dis- grace; another group because of poverty; and yet others through a false idea of the ease and excitement of a gay life and fine feathers ; and a very large class who owing to a low PROSTITUTION A;ND- i'I.$Atf SJ&S 13 mentality were for any reason, or for no reason at all, inducted into activi- ties by professional procurers. It must be realized that behind every woman of vice there are others sharing in her proceeds. Prostitu- tion is very definitely a business proposition. The corruption funds of the manipulators have time and again proved all too alluring to the police and other officials, and thus legal immunity was, and is, pur- chased. It is almost axiomatic that a municipality is only as good as are its politicians and police force, and they are strict or lax depending upon the amount of general interest displayed ; and indifference has been the rule. DesirejLor .gain and jmblic unconcern may therefore be considered as two of the basic causes of prostitution. A good income being securable from vice, its fostering and develop- 14 ment was but a natural sequence. In large cities " rings " involving men and women actually engaged in the traffic were developed ; and under the paid protection of the police were usually allowed to flourish unmolest- ed. A number of these groups, as will be seen, have been successfully broken. Many smaller units, while possibly not so highly organized, still have their leaders who control the major portion of the segregated business. The relentlessness with which pro- fessionals seek recruits is almost un- believable. With an average of three to five years' activity for the prosti- tute, a definite necessity to fill the gaps in the ranks has developed a high efficiency. Small wonder, then, that hundreds of girls annually " dis- appear ", that fresh young faces are constantly being fed to patrons of PROSTITUTION AND ITfc> CAUSES 15 public places, and new women are continually arriving at houses of prostitution or are otherwise engaged in various vice enterprises. At the outset, therefore, it must be thor- oughly appreciated that commercial- ized immorality is not sporadic but is backed by power, influence, and the complexities of a modern business organization. After eliminating feeble-minded- ness, the. dance hall, liquor adjunct removed, is one of the most potent vice f actorsythe niain ob- jection to this institution is the com- pany to be found there. Many young men who act with comparative decen- cy among their own set, resort to the public dance to prey upon the pretty young girls frequenting them. Be- sides, men and women, especially in the larger cities, seek such places for outright recruiting purposes. Permit 16 a young woman to habitually patro- nize these resorts, no matter how decently conducted they may claim to be, her chastity and possibly her fut- ure life are in danger. Thejjii^nncMU--a6 an element of vice, looms large. Joy-rides are pro- lific of harm, even with the urging appeal of liquor now minimized. Mothers permit their daughters to accompany young men upon excur- sions leading to the dark and solitary rendezvous, who would not counte- nance their remaining alone in a dimly-lighted room with the same escort; and many girls without par- ental knowledge make a casual ac- quaintanceship with men in cars who " cruise " the streets for willing vic- tims. In numerous instances the first downward step has thus been taken. Again, many a young woman after a hard day's work in a store or factory, PROSTITUTION AND ITS CAUSES 17 has innocently sought amusement, and in so doing has permitted herself to be taken to places of questionable character such as shady restaurants, cabarets, and road-houses, there to be gradually, if not abruptly educated to the false idea that to work for ten or fifteen dollars a week was foolish when three or four times as much could be " made easily ". One of the fundamental causes of moral dereliction rests with the^ome andjtS-Siirroundings. Crgseded tene- ment existence and JDOQIL JioiisingL conditions generally, sap the stamina ofmanyTtEus developing a predispo- sition to weaken before the onslaughts of evil. Even in the higher social strata, lack of training in self control, in understanding of the sex impulse, and of preventive knowledge, coupled with an over confidence of parents in the moral stability of their children, 18 VICE AND HEALTH have led to dire consequences. More- over, the general independence of the modern youth and maid, who as a care-free and pleasure-seeking class has openly revolted at the " old fashioned ideas " of life and living, comes in for its toll. And finally, youth is not so protected as formerly. Immature girls are filling offices and factories. The old time safeguards of sex have therefore considerably broken down; and thus unrestricted and unconstrained daily mingling of men and women creates possibilities leading to illicit ventures for those disposed in that direction. Notably in New York and Chicago investigations undertaken some years ago resulted in bringing before inter- ested people astonishing facts in con- nection with prostitution as a traffic ; and the large vice districts of those cities were consequently eliminated. PROSTITUTION AND ITS CAUSES 19 Occasionally a reform wave would strike a smaller place, resulting in a general exodus of vice habitues, who immediately returned to their former haunts when the official order had spent its force. At the outbreak of hostilities with Germany the United States took a definite and systematic stand against prostitution which extended over the entire land; but despite concerted action by the federal and state gov- ernments from that time up to the present, many cities still have more or less well defined vice localities. The reasons for this will be explained in a subsequent chapter. CHAPTER II PROSTITUTION AND ITS MANIFESTATIONS Commercialized vice is plastic; it adapts itself when it must to condi- tions. The most usual form, how- ever, is to be found in a group of women living in a certain neighbor- hood where the business is either openly flaunted by the aid of a red- light and window solicitation, or is more discreetly operated, depending upon the official attitude. Such places are usually located in the side streets and alleys, and frequently near rail- roads. In seaports a number of them are close to the water front. These localities are known as " districts ' : or " the line ". A district marks the last step in the demoralization of women, many of 20 PROSTITUTION AND ITS MANIFESTATIONS 21 whom need institutional care rather than the psuedo-correctives of the police court with its usual fine and infrequent jail sentence. It is in such places that liquor may be yet obtained at bankrupting prices ; it is here one will find congre- gated at certain hours the men who " farm " the women and solicit for them; it is here that debauchery reaches its lowest level ; and it is here that blasting disease is transmitted to the outside world. But with all of that, it is prostitution's popular and favorite form. It appears to be a very general opinion that such neighborhoods, with their known houses, measurably reduce the existence of other vice manifestations. Nothing is further from the truth. It is quite out of the question to limit the majority of the >rostitutes to one locality. This fact 22 VICE AND HEALTH was well illustrated in certain second class cities wherein recent investiga- tions proved segregated districts to be in full swing. The " high visi- bility " of these places had dimmed official and civic eyes to the fact later disclosed, namely, that over forty=fi.Y.e r>r-eefit. (a conservative estimate )jof the_cpmmon women in thes^communi- ties lived outside .-jo^thej>ale> It- should be evident therefore that " segregation does not segregate"; on the contrary the presence of grouped houses of assignation merely stimulates the commercial feature, develops an added peril to virtue and health, and dulls vision to the other forms of vice. It is also said that the prostitute is necessary to protect the chastity of other women. Such a statement, even if sound, could have no ethical justi- fication; but the case really works PROSTITUTION AND ITS^MANIFESTATIONS 23 the other way more. lintiousness, more license. +**"~ m --^ In a large northwest city* a reign of violence and assault took place upon the closing of its several vice localities ; women were terrorized, and law and order were at low tide. When the police corralled the offenders, it was discovered that they were paid hirelings of the underworld whose only purpose was to win the public over to the idea of the necessity of vice as a matter of social protection. The notorious failure of this plot was a terrific boomerang. No district has been tolerated in that city for years, and other forms of prostitution have been greatly minimized. Women are as safe there as in any other Ameri- can community. Moreover, violence as an argument against the elimina- tion of commercial vice has never * Seattle, Wash. 24 VICE AND HEALTH been attempted elsewhere. Mothers, daughters and wives need have no fear for themselves if a district is closed; a very vital concern should exist, however, if a district and prosti- tution generally, are allowed to flourish. With the segregation theory goes its partner, medical regulation. Again, there is no such thing. The vaunted medical inspection (upon which certificates of health are given and then displayed by the prostitute as an earnest of her good physical con- dition) is usually Even if the examination is honest, means are at hand to camouflage certain condi- tions. And further, assuming that there is no open evidence of disease, in a few hours a prostitute may be- come infectious. PROSTITUTION AND ITS MANIFESTATIONS 25 In 1917, in a Pacific Coast city* >^ ninety-seven per cent, of the common women we]^loun3^to]be infected. In an eastern city t, in 1915, ninety-six per cent, of the prostitutes had a venereal Disease. Medical certificates were^ freely used by these women^ In a small locality, in 1919, there were three houses with twenty prostitutes, each of whom had a physician's cer- tificate, and eighteen of them had syphilis or gonorrhea, or both. That the clandestine and " char- ity " girl may also be infected, as she frequently is, does not lessen the out- standing fact that segregated districts and disease go hand in hand. Then, too, while the clandestine and charity girl expose comparatively few, the known prostitute exposes hundreds. In a raid upon a house containing * San Francisco, Cal. t Baltimore, Md. 26 VICE AND HEALTH three women, all of whom were syphi- litic, cards punched by the madam indicating a payment in advance for the prostitute desired, were seized and used in court as evidence ; th.ese contained forty-nine, thirty-seven, and twenty-eight punch marks respec- tively for the day's activities.* " What always has been, always will be " is an assertion frequently heard in support of a district's con- tinuance ; but immutability has proved to be but a phantom in the face of a virile attack. Variations of the above reasons are repeatedly advanced, and like the main arguments, apparently possess a certain logical basis which thus makes them dangerous. The propa- ganda of the underworld in this re- spect has been most effective; conse- * See " The Case Against the Red Light ", a pamphlet published by the American Social Hy- giene Association and State Boards of Health. PROSTITUTION AND ITS MANIFESTATIONS 27 quently there are thousands of men and women in the United States, well meaning people, who being casually attracted to the question, are con- vinced that the segregated district and its known house of prostitution is vice's safest form. Public opinion is in this manner fortified in an attitude of tolerance which truth alone can finally dissipate. General Pershing, whose experi- ence with the medical regulation of vice in Mexico and with the various phases of control applied to the American Expeditionary Forces, qualifies him to speak, has thus summed up the case against segrega- tion: "Many of us who have experi- mented with licensed prostitution or kindred measures, hoping thereby to minimize the physical evils, have been forced to the conclusion that they are generally ineffective. Abra- 8 VICE AND HEALTH ham Flexner has argued the case so convincingly that on the scientific side, it seems to me, there is no escape from the conclusion that what he terms 4 abolition 9 as distinguished from i regulation' is the only effective mode of combating this age-old evil." Hotels are being generally used for the purposes of clandestine prosti- tution, and in a great many instances with perfect safety. The conditions found in large hostelries are particu- larly adaptable to professional im- morality. The hotel lobby or corridor becomes an attractive setting for the marketing of wares, which is usually aided by bell-boys or procurers ; and once met, the contracting parties have little difficulty in securing accomoda- tions, if not at the assignation point then at some near-by house, the de- tails of baggage being previously arranged. PROSTITUTION AND ITS MANIFESTATIONS 29 The small and disorderly hotel, of which there are several in every city of any size and many in the larger ones, operates either boldly or clan- destinely, as conditions warrant. Such resorts, irrespective of any dis- trict, contain many of the disadvan- tages of the segregated form and are less likely to be disturbed by munici- pal interference. A prostitute will remain at one of these places for a week or so, then move on to another, thus operating in a cycle which may involve several cities. Her " guests", who have been procured by her own efforts upon the streets, or have been steered to her by the hotel boys, are entertained in her room. The low-grade apartment house is quite akin to the disorderly hotel, with the difference that detection is somewhat less easy in the former than in the latter. 80 VICE AND HEALTH Booming houses ofttimes, when revealed, are places of accomodation where regular " lodgers " are dis- creetly made available. These estab- lishments differ from the usual house of prostitution in that they have no parlor attachment. Besides, the mad- am is likely to have certain women on her list, living privately, who are readily summoned by telephone. The latter class is sometimes com- posed of women who are legitimately employed during the day but for vari- ous reasons are willing to quietly prostitute themselves. Houses hav- ing no residents but to which women are summoned, are known as " call ' resorts. One of the most general manifes- tations of clandestine prostitution is observed in street solicitation. This may take the direct form of the spok- en word or the more tactful flirtation. PROSTITUTION AND ITS MANIFESTATIONS 31 If the woman does not happen to be a regular inmate she will invariably lead her victim to a place designed for the purpose of catering to transient and illicit accommodations. The automobile, especially the "f or- hire " car, is a definite element in vice activity. The chauffeur frequently has several women who are subject to his call; and the automobile being driven to a secluded spot, is used as the locus operandi, when necessary. And lastly, there is the quiet girl who to all appearances lives decently yet who commercializes herself. While the various phases men- tioned above comprehensively cover the commercial manifestations it must be remembered that hundreds of young women become charitably pro- miscuous ; they are decidedly hard to control, and present as great a prob- lem as the commercial counterpart. 34 VICE AND HEALTH Thus it appears that the difficulties in eradicating prostitution are more general than might at first be sus- pected, and are by no means re- stricted to a segregated locality. It follows that numerous points of attack are indicated; these must be planned with care and be persistently, conscientiously and generally pur- sued. Spasmodic local efforts make good press material but do not hit at the heart of the matter. Constant suppression of vice in all of its forms in every locality is essential to any reasonable advance against the prob- lem. Modern methods, among other things, involve just that. CHAPTER III THE BUSINESS SIDE OP PROSTITUTION Prostitution pays and pays hand- somely. Finance is its life, gain its very heart. Eliminate the dollar and the elaborate machinery sustaining the traffic disappears. In districts the girl does not rely upon her own energies for trade. She is regularly established, and has her interested parties on the outside who are masters in the art of information. Men are engaged for the most part, and operate occasionally directly; that is, without any visible means of support, but more often under the blind of some kind of employment. The automobile has created an excel- lent shield for this activity. As in the old horse-cab days, the driver of the modern public convey- 3 33 34 VICE AND HEALTH ance is well informed on vice locali- ties; and for his regular fare plus a bonus will take the inquirer to them. After landing his patron he subse- quently receives an additional com- pensation from the landlady whose establishment he favors. While all taxi-cab drivers are not connected with the prostitutes, and companies of good standing penalize by im- mediate dismissal any employee oper- ating illegally, this method of obtain- ing admission to the underworld may nevertheless be relied upon for satis- factory results. Policemen also frequently direct inquiring strangers. In short, a dis- trict is one of the easiest neighbor- hoods in a city to locate, if one exists. A distinction, however, must be drawn between the occasional inform- ant and the out-and-out " cadet ". The latter is a despicable person who THE BUSINESS SIDE OF ^PROSTITUTION 35 is directly controlling one or more women, in whose proceeds he largely shares, if, indeed, he does not get all of them. This is a matter of personal slavery and is most difficult to ex- plain. The power exerted over the unfortunate girl is absolute, and cruelty appears to be an essential to its success. Her type of mind trans- lates a beating into displayed affec- tion, though the logic involved is quite incomprehensible. Once inside of the resort the will- ing victim pays a dollar or more for a drink of poor whisky, usually treat- ing the inmates in the parlor who are at leisure, they however sipping cold tea at the same exorbitant price. If the man has plenty of money and can be induced to become suf- ficiently intoxicated he may later find himself penniless by reason of his indiscretion. 36 VICE AND HEALTH It has long since been demonstrated that with the high rents and various extortions connected with the busi- ness, resorts are compelled to rely upon other than the up-stairs fees. Liquor, therefore, has always been considered a necessary adjunct. The " underground railroad " still deliv- ers this commodity freely to such places. However, with the existence of prohibitive prices some madams (as the proprietresses are styled) have successfully adapted themselves to national prohibition by selling soft drinks at a fancy figure, and thus manage to conduct a profitable con- cern. Incidentally, it may be added that higher charges prevail for privi- leges than formerly obtained. It is unnecessary to discuss the details of the internal economy of an establishment, except to remark that by a clever charge system for fashion- THE BUSINESS SIDE OF PROSTITUTION 37 able apparel, peddled by agents cater- ing to the trade, and by the usual fees for board and lodging, the bulk of the earnings of the inmates finds its way into the hands of the madam, who, in turn, surrenders a large portion of it to the landlord. The men directly backing the resorts come in for their share; and the " friends " of the girls receive, either in the form of gifts or money, the small amount net to them. In the larger cities the tribute sys- tem is sometimes operated upon an elaborate scale; the " higher-ups r down to the precinct policeman fre- quently sharing in the profits. Re- peated exposure has to some degree minimized this practice but the oc- casional scandal and convictions in the courts for this type of extortion, suggest that it yet flourishes. As has been observed, the necessity 88 VICE AND HEALTH of keeping the ranks in the district filled with a marketable product re- sulted in an elaborate scheme of pro- curation. It is difficult to believe that men and women could become so utterly demoralized as to prey upon virtue for gain. This fact is, never- theless, true. Procurers still seek recruits from farms and villages; newspaper advertisements offering " congenial work and good hours " are successfully employed; factories are combed for susceptible material; and tenement districts scoured for possibilities. Even foreign countries are drawn upon; the international procurer negotiating the passage of the attractive Danish, Polish or Italian girl to this country through the golden lure. Despite national and international regulations, trans-At- lantic liners are met and unsophisti- cated immigrant girls are occasion- THE BUSINESS SIDE OF PROSTITUTION 39 ally carried off on one pretence or another into a life of shame. And for all this nefarious business large sums are paid. While " white slavery " formerly played a part in commercial vice, and chastity was thus sometimes defeated by means of a padlock; the indirect method, because of its safety, has always been the more popular way employed to break a woman's morale. It is quite true that in many cities " districts " are ostensibly closed and in others are running in an admitted- ly crippled fashion, but the demand for inmates still makes procuration financially attractive, and a nation- wide activity. However, it is not over-enthusiasm which suggests that prostitution as a centralized institu- tion is actually on the wane. The signs of the times are unmistakably pointing in that direction. 40 VICE AND HEALTH It is not an indictment against either the American girl or American soldier, rather it is merely the state- ment of a psychological fact applic- able to the civilized race everywhere, but it remains that a certain lure of the uniform and the excitement inci- dent to the World War resulted in thousands of moral casualties on this side of the Atlantic. Many young women, with no im- moral tendencies, were led into sex experiences which were conceivably not within the realm of their con- scious possibilities prior to the recent conflict; especially was this true of those who at the time were outside of the control of parents, either by reason of their indifference or on account of living elsewhere. Also, the girl who would naturally fall into such a life became an easy victim and thus developed into a " charity " THE BUSINESS SIDE OF PROSTITUTION 41 proposition. The war ended, the military rainbow faded, but the expe- rience was left and the practice con- tinued. Fine clothes and a " good time " were always to be had. Excite- ment had become a necessary feature of life and the downward step was easy as well as rapid^Especiattf were these things true in communi- ties near large groups of soldiers or sailors. Hotels had been used before with perfect safety and hotels could be used again ; this time for money. As a consequence there is today a large class of women posing as legitimate guests, frequenting the better and low grade houses for commercial pur- poses. That a loose ring exists and that by a careful working out of itin- eraries girls are floated from one locality to another, there can be no question; though many of them are operating independently. 42 VICE AND HEALTH Respected and otherwise respect- able citizens have buildings or rooms which are rented out promiscuously for a term. Corporations and small companies evade the question by hid- ing behind their charters and conse- quently lease to women, or men and women, without more than a perfunc- tory inquiry as to their means of live- lihood and general reputation. The fact that this business pays is impressed not only upon the men and the women in the traffic but upon municipal officials as well. Today many cities in this country are virtually licensing vice. The old time attitude toward the scarlet woman and those who follow in her train still obtains; the police court desires to make a financial showing under the belief that large sums extracted from offenders in fines is synonymous with justice and efficient police perform- THE BUSINESS SIDE OF PROSTITUTION 43 ance. Money, however, is a small item in the life of a prostitute and, like disease, is as apt to be in her possession as not. If financially embarrassed, her " friend " mysteri- ously appears and pays the fine, which results in the offender's im- mediate return to the streets for further operations. The city has thus added an extra fifteen or twenty- five dollars to its account and the prostitute has purchased the right to ply her trade for another few months, when she will be caught and fined again.* It is therefore observed that from the procurer's first concern down to the inevitable interest of justice, money is the motive and the prize. * The above criticism is based on averages ; large cities such as Chicago, New York, Phila- delphia and Pittsburgh possess municipal, and! morals courts whose function involves- 'the handling- of sex-delinquents along most modern and approved methods. CHAPTER IV RESULTS OF PROSTITUTION It is evident from the preceding pages that prostitution as a demoral- izing agency is one of the big prob- lems with which nations have to con- tend. This has been realized to a cer- tain extent for a long time. Professional reformers, clergymen and others have attempted methods of suppression. Moral suasion, public opinion and legislative enactment have been applied to the end that vice should be eliminated as vice ; but the lasting advantages of these various forms of attack have been slight. The World War created a very dif- ferent angle of approach, based at the time upon sheer military necessity. This offensive, while recognizing the 44 RESULTS OF PROSTITUTION 45 value of morals as such and the potency of effective punishment, sub- merged these matters to the basic fact of national preservation. Never before in the country's his- tory were conditions such as to make possible a discovery of the terrifically vital results of prostitution. With an emphasis startling in its force, the medical men of the draft boards and of the armed services in camp and Navy Yard were confronted with venereal disease. Conscription, be- ing comprehensive as to classes, brought the average youth from all strata of our national life before the rigidly inspecting eye of the official physician; and the prevalence of syphilis and gonorrhea thus found to be coming direct from the civilian communities, compelled national interest. 46 .VICE AND HEALTH In seeking causes for the physical condition of our emergency army, a prompt and thorough investigation by the government was conducted, which indicated beyond question that the main source of infection was pros- titution, either professional or ama- teur. A procedure to control this situation, to be later explained, was adopted by the authorities at Wash- ington. However, the main point is, that the medical world was at last alive to a situation hitherto suspected but never before fully realized, namely, that while moral delinquency annually ruined a large number of women and girls, this form of vice was a colossal disease problem and as such was insidiously devitalizing the race. The following statements taken from the Standard Statistics on Gon- RESULTS OF PROSTITUTION 47 orrhea and Syphilis * should be im- pressive : 33 per cent, of all prostitutes are feeble-minded. 90 per cent, of all syphilitic infec- tions in men are derived from the prostitute, either profes- sional or amateur. 50 per cent, of all syphilitic women are infected innocently. 70 per cent, of women who came to *) the New York hospital for venereal disease treatment were respectable married women in- fected by their husbands. 85 per cent, of married women who \ have syphilis have contracted it from their husbands. 15 per cent, of all first admissions to the New York State hospital for the insane are traceable to syphilis. * Pamphlet published by The American Social Hygiene Association, / 48 VICE AND HEALTH 100 per cent, of all cases of paresis (general paralysis) are directly traceable to syphilis. per cent, of all cases of locomo- tor ataxia are directly traceable to syphilis. 98 per cent, of prostitutes (white) have at least one venereal disease. 19.6 per cent, of all routine hos- pital cases (white) are syphi- litic. 2 out of every 13 deaths in the United States today are directly or indirectly caused by syphilis. $628,750,000 is the yearly cost of supporting prostitution, itemized as follows : $165,250,000 Annual sum paid to prostitutes.* $51,000,000 Care of insane due to venereal disease. * Figure based on estimate of 50,000 prosti- tutes receiving three customers a day at $3.00 each. RESULTS OF PROSTITUTION 40 $97,000,000 Annual economic loss on insane. $3,000,000 Cost of blindness due to venereal disease. $3,000,000 Detention of prosti- tutes. $300,000,000 Economic loss caused by venereal infection in the general population. $10,000,000 Treatment of new cases among men. In addition to the above amount, large expenditures for courts, police, jails, hospitals, clinics, and for many operations on women must be con- sidered. Doctor Edward Martin says: " In the line of present knowl- edge, syphilis is probably more gross- ly destructive of human health, effi- ciency, and happiness than is tu- berculosis. 4 * It is entirely controllable ; is prob- 50 VICE AND HEALTH ably curable, if taken in its early stages; therefore, there is no health problem more urgent in its need and more completely within the power of a profession and a community work- ing together, than the control of syphilis. " Dr. C. C. Pierce, Assistant Surgeon General U. S. Public Health Service, has remarked: " When the people of the United States realize the prevalence of gonor- rhea and syphilis among all classes of society ; when they appreciate the ex- tent of the social damage caused by these diseases ; when they understand that thousands of innocent women and children are being martyred by them and that this suffering is alto- gether unnecessary, the venereal dis- eases are doomed. Then at last the present program of the State boards of health for the eradication of gonor- RESULTS OF PROSTITUTION 51 rhea and syphilis will be effective, and just as typhoid fever, yellow fever and other devastating plagues have been brought under control, so it will be possible to control these diseases. But until the people of the United States are fully awake to the situa- tion, progress will be slow. It is for them alone to say how soon this scourge shall end." Doctor Ellen C. Potter states : " The venereal diseases undoubt- edly constitute the most serious men- ace to the mother and child. * ' Any group of men and women who are concerned with the welfare of children must, of necessity, concern themselves with venereal disease, and a constructive program of education, recreation, medical care and law en- forcement is essential if these dis- eases are to be prevented and con- trolled." 58 VICE AND HEALTH Dr. S. Leon Grans makes this state- ment: ' ' The venereal diseases have caused an inestimable amount of suffering to the innocent wife and child. In most instances it has been the result of ignorance and unintentional action of the individual originally infected." Major Edgar S. Everhart, M.C., in charge of Venereal Disease Con- trol, Pennsylvania National Guard, has said : " Venereal diseases with their attendant evils are responsible for a greater number of deaths than are the spectacular diseases, influenza and yellow fever. Gonorrhea by prevent- ing conception, and syphilis by caus- ing the death of the unfortunate indi- vidual are in truth the scourges of the present day." Dr. J. W. Williams found 11.2 per cent, positive Wasserman reactions RESULTS OF PROSTITUTION 53 (indicating syphilis) among four hundred pregnant women. Dr. C. P. Jean claims 5-6 per cent, of infants of the poorer class in this country have syphilis ; older children from 2-3 per cent. Dr. John H. Stokes, of the Mayo clinic, is authority for the follow- ing statements : "51-60 per cent, of the male popu- lation of the United States has or have had gonorrhea. " The genital transmission of syphilis covers from 80-90 per cent, of all cases. About 50 per cent, of the infections of married women have seemed to me to be contracted in marriage. " About 5 per cent, of the children who are idiotic are so because of syphilis. " Williams estimated, it will be recalled, that one hundred men in- 54 VICE AND HEALTH sane from syphilis, represented a net loss based on a life expectancy, of $212,248.00 in earning capacity, and a cost to the state of Massachusetts of $39,312.00. According to the cen- sus of 1910 there were 180,000 insane persons in the United States. Esti- mating 12 per cent, of the insanity to be due to syphilis and the experience of Massachusetts to be applicable to the country as a whole, the economic loss in earning capacity and cost of care on the score of a single item in the total bill of only one of the genital infections, would approximate $467,- 000,000.* If insanity, a relatively uncommon complication of syphilis, can alone cost more than a half bil- lion dollars, the cost of idleness and death from other and equally grave complications, such as heart and kid- *It is to be noted that this estimate includes the loss of life expectancy. RESULTS OF PROSTITUTION 56 ney disease, blindness, deafness, paralysis due to nervous change, when added together, will total fig- ures that take rank beside the stu- pendous costs of war. These are esti- mates of the cost of consequences. The wastage of money spent on ineffective treatment, on the maintenance of hos- pitals and dispensaries, on medical fees, and through reduction of effi- ciency without absolute crippling and death, is beyond the reach of compre- hension. " one-half the blindness dating from birth, due to gonorrhea of the eye, conveys no impression whatever of the tragedy. One has to see one of these little children rocking back and forth in a railed-in chair, waving its hand between face and window because the flickering of the finger shadows across the twilight is all it will ever know of more than half of 56 VICE AND HEALTH life; one has to see this thing and watch the baby groping about on the floor and gurgling as it feels of your shoe strings, really to know in the soul of him what gonorrhea means. " Getting at the matter indirectly, figures drawn from recent army expe- rience indicate that gonorrhea is 3 or 4 times as prevalent as syphilis. " The percentage of gonorrhea in women varies largely with their social status. Among the most refined types of unmarried women and girls it is probably negligibly small. Of the pregnant women in the public hos- pitals of a number of Continental cities, 20 to 25 per cent, were said to have had gonorrhea. Prostitutes, professional or occasional, nearly all have it. The estimated prevalence of the disease in these types ranges from 70 to 95 per cent., as determined by various vice investigations, and by studies of delinquent women, such as RESULTS OF PROSTITUTION 57 that of Haines, who found percent- ages ranging from 75.7 to 98.2 in 500 cases. " enough women are wrecked by gonorrhea in one way or another to maintain an entire specialty in medicine gynecology, which would become relatively a side issue in sur- gery if the effects of gonorrheal pel- vic inflammation and of abortion or miscarriage could be eliminated. Few have been found to dispute the opinion of Noeggerath, who first recognized gonorrhea in women as a definite and distinct condition when he stated that 80 to 90 per cent, of pel- vic inflammatory disease and 50 per cent, of absolute and one-child steril- ity in women is due to gonorrhea. ' ' Though accidental infection must of course be considered in computa- tions of this character, the fact as already stated, that 80 to 90 per cent. 58 VICE AND HEALTH of syphilis is by way of direct geni- tal transmission gonorrhea higher fortifies the logic in attributing the bulk of these diseases and their per- sistence directly or indirectly to prostitution. Despite the fact that prostitutes are the dregs and outcasts of society, and as such are scorned by the gener- ality of women, men unhappily are not disposed to assume the same an- tagonistic attitude toward them. In this matter, therefore, the mistress of the mansion and the sister of the vice district are more closely related than the former ever imagines. It is very well and most proper to argue single standard, continence and the like, but young men (speaking in averages) have so far not been particularly sus- ceptible to these suggestions, and con- sequently invade vice districts or seek prostitution in Jts other forms. RESULTS OF PROSTITUTION 59 While it is not to be concluded that all men are immoral, the fact to be emphasized is, that so long as the prostitute is a readily accessible ele- ment in society, the nation's youth is quite likely in large numbers to wend its way to her and thus wound them- selves and others. Parenthetically, a vast amount of suffering and even death can be elimi- nated if parents of daughters will insist that prospective husbands pre- sent authentic evidence of good physi- cal condition ; this should include not only an examination for gonorrhea but a laboratory test for syphilis as well. In a vice raid which caught in its net a number of young boys from a small town, it was freely admitted that excitement and adventure were the compelling forces of the lure the sexual act a post incident merely. It 60 VICE AND HEALTH was a group idea for a good time con- ceived and executed spontaneously. Sex impulses on the other hand are by their nature individual. As a matter of fact, a large proportion of the males who patronize vice resorts are not driven there by any overwhelm- ing sex desire. The excitants of the old time " line ", such as music, liquor and negligee, prove the neces- sity of stimulation to produce indis- criminate sex activity. It is fair to assume, therefore, that with the allur- ing possibility removed, the physi- ological enthusiasm in a large num- ber of cases would be suppressed. The argument applies equally to the quieter accessible forms of vice. Something must be done to counter- act these influences. The attack has already begun. The enemy is even now forced to fight, but specialists cannot do it all ; generals we certainly RESULTS OF PROSTITUTION 61 must have, but the common soldier must do the actual hand-to-hand work. To better understand the present of- fensive and the necessity of individual community interest, a brief history of the government's attack upon vener- eal diseases follows. CHAPTER V THE GOVERNMENT'S FIGHT When the White Slave Act became law in 1910, a vigorous attempt was made to enforce it; this was insti- gated by the Department of Justice and supervised by its Bureau of In- vestigation. Under the direct leadership of S. W. Finch, local officers were appoint- ed in all of the important centers of population throughout the country. The duty of such agents resolved itself into a general intimidation of the underworld by keeping a direct supervision over the movements of the known prostitutes. It must be recalled that as late as 1914 many of the cities in the United States had well-defined vice districts, the deni- es THE GOVERNMENT'S FIGHT 63 zens of which were known to the respective police departments. As the United States had no au- thority to dictate local policies, the situation, so far as vice neighbor- hoods were concerned, was frankly recognized as part of the process to eliminate inter-state traffic in women ; this being the purpose of the Mann Act. A list of known madams and inmates was compiled from police data which was supplemented by direct governmental investigation ; and by forceful suggestion with the sanction of the city authorities, the heads of the houses were required to notify the government officer of the arrival or departure of inmates, on cards prepared for the purpose. In this manner, a constant state of fear was inculcated among the women and their male partners, as unexpected visits were made by the special agents 04 VICE AND.HEALTH to resorts to check up reports ; and at these times the consequences of vio- lating the state law were emphasized. While this procedure was in force, a large amount of repression was effected, and a measure of education brought home to likely offenders. Valuable facts were also obtained during this activity, so that when it later became necessary through mili- tary emergency for the federal gov- ernment to again approach the sub- ject, a strong weapon in the form of information was at hand for immedi- ate application. From the above it is noted that, prior to the war, organized vice so far as Washington was concerned, was attacked mainly from a legal and inter-state standpoint While American troops were on the Mexican border, the Secretary of War ordered investigators to Texas THE GOVERNMENT'S FIGHT 65 for first-hand vice facts, which re- sulted in conclusively demonstrating that restricted districts near large groups of soldiers were a decided health menace to the military popu- lation, and that the fine phrase of " medical control " was but a myth. From this the Government deduced that, having proved futile so far as the Service was concerned, this fact held with equal force when applied to civilian communities. Therefore, when the European war involved the United States, the Secre- tary of War was in possession of incontrovertible and impressive facts. With wise forethought, in a letter dated May 26th, 1917, he wrote the Governors of states and the Council of National Defense as follows : "We cannot allow these young men, most of whom will have been drafted to service, to be surrounded 5 M VICE AND HEALTH by a vicious and demoralizing envi- ronment, nor can we leave anything undone which will protect them from unhealthy influences and crude forms of temptation. Not only have we an inescapable responsibility in this mat- ter to the families and communi- ties from which these young men are selected, but, from the standpoint of our duty and our determination to create an efficient army, we are bound as a military necessity, to do every- thing in our power to promote the health and conserve the vitality of the men in the training camps." The Navy Department also took a firm stand in the matter, all of which caused a solid front to develop, in- volving the Army and Navy, the United States Public Health Service, the State Boards of Health, the Coun- cil of National Defense and the Com- mission on Training Camp Activities, THE GOVERNMENT'S FIGHT 67 in an effort to rid the camps of their surrounding vice-infected areas. It was, however, very soon dis- covered that the communities beyond camp influence were necessary ele- ments of concern. Segregated and scattered prostitution had to be sup- pressed wherever possible, irrespec- tive of the geographic factor. The burden, in large measure, fell upon the law-enforcement representatives of the Commission on Training Camp Activities, the personnel of which included officers of the Army and Navy, as well as civilians, whose expe- rience fitted them for their work; these men operated in close co-opera- tion with the medical and police offi- cers of both branches of the military service and also with the United States Public Health Service rep- resentatives inside and outside of the camps. 68 VICE AND HEALTH State, county and municipal au- thorities were thus awakened to the vital importance of the subject and to the necessity of generating a maxi- mum of efficiency in vice suppression through the duly and legally consti- tuted agencies. Even with the war emergency this was no easy task. The apathy of police in such matters is proverbial, and in many instances energetic education, coupled with diplomatic threats, was necessary to obtain results. Moreover, numerous city organizations and their repre- sentatives had looked upon the class against which the offensive was di- rected as an asset, and selfishly real- ized that their sanction to a vigorous uprooting of the evil would probably cause the loss of their own politi- cal prestige. In this connection, it is recalled that a quarantine covering a period THE GOVERNMENT'S FIGHT 69 of six weeks was placed upon one of the large cities of the country which effectively restrained the soldiers of the nearby cantonment (at that time numbering over fifty thousand) from entering it; and incidentally, during the same period quite as effectually educated the predominating political influences that the United States gov- ernment was serious and meant busi- ness. An unusual interest in social hygiene and law enforcement sud- denly developed which is, to that city's credit, still heartily sustained. In some cities, before elections, a public expression of candidates on the vice question was compelled (the Government not visibly appearing in the compulsion however) and thus an issue of opposing factions made. When this situation arose, the " clean " candidates were usually, if not invariably, elected. 70 VICE AND HEALTH Ordinances attacking the taxicab menace, infringement of national pro- hibition, and dance hall mismanage- ment, together with sundry health measures were under the stress of emergency and the spirit of patri- otism, successfully passed through the city councils and often conscienti- ously enforced. Allied to the fight against the pros- titute who, with the abolishment of the districts, attemped to ply her trade clandestinely, was a direct attack upon low grade apartment houses and hotels. In some instances it became regrettably necessary to assume a belligerent attitude toward even the first class hostelries. Occasionally a demonstration of conditions became essential and this was accomplished by quiet investiga- tions with the results placed before officials and others directly inter- THE GOVERNMENT'S FIGHT 71 ested. The military police efficiently assisted in making raids and obtain- ing data upon which demonstrations were predicated. Qualified women lecturers reached the various groups of young women in many cities close to camps, and thus made available authentic infor- mation upon the consequences of sex delinquency. Their activity un- doubtedly possessed a marked pre- ventive power. While the extra-cantonment re- pressive activities were in force, much was being done within the camps themselves. The work in this in- stance rested upon the shoulders of the medical men, including United States Public Health Service per- sonnel attached to the various com- mands. Inasmuch as a sick soldier was a decided military liability, defi- nite steps were taken to eradicate dis- ease among the men. The venereal 72 VICE AND HEALTH patients were isolated or semi-quar- antined, and through rational treat- ment restored to health; but the of- fensive did not stop with that. The medical departments of the Army and Navy established prophy- laxis stations in the camps and in the cities frequented by service men. Possibly this open recognition of a fundamental fact of nature did more to keep the Army and Navy clean than any other measure. Under this system every man in the service who subjected himself to exposure, was ordered to present himself at a sta- tion for treatment within four hours ; failing in this and subsequently found to be infected, he was punished. To some men this necessity, unattractive to say the least, was in itself sufficient to deter natural inclinations; and if otherwise, made the chances for unfortunate complications compara- THE GOVERNMENT'S FIGHT 78 tively remote provided treatment was promptly taken. Furthermore, the Public Health Service and the Red Cross established clinics and made hospital beds avail- able for the purpose of treating com- munity venereal disease. The wisdom of this procedure becomes evident upon the authoritative statement that " Over five-sixths of the venereal dis- ease treated in America up to the time of the armistice, was acquired before the boys put on the uni- form."* In this regard it is also interesting to note that "The inci- dence of venereal disease actually contracted in the United States after entering into the army was about forty-five per thousand per year (less than half the rate obtaining for the five years preceding the war."t * Major Sawyer in "Today's World Problem in Disease Prevention " Stokes. t Col. Ashburn in Social Hygiene, January, 1921. 74 VICE AND HEALTH Through the United States Public Health Service, the Training Camp Commission, and kindred lay organi- zations, such as The American Social Hygiene Association, placards and pamphlets of a sex-educational char- acter were made available to the men. Compulsory lectures on hygiene, reaching the entire personnel, were periodically delivered by the medical officers at the camp, and these were frequently illustrated by moving pic- tures and slides. Physical examin- ations were regular and searching. In addition, a constructive program of wholesome recreation was substituted by the government for the former allurements of vice. This took the form of athletics and amusements both within the camp and without, and the establishment of social cen- ters such as Soldiers and Sailors Clubs, T. M. C. A. and K of C. huts, Jewish Welfare Boards, and Ameri- THE GOVERNMENT'S FIGHT 75 can Library Association buildings ; so that, in reality, the enlisted men came under a more rigid paternalistic in- fluence while in the service than that to which, in most cases, they were accustomed in private life. The sum total of these various activities was that Pershing's Army, and the million awaiting absorption in it at the time of the armistice, was the cleanest group of men in the entire world. With the conclusion of the war, however, the Government's interest in the problem of prostitution and kindred subjects did not cease; nor could it have logically assumed such an attitude. Hostilities happily coming to an end before the Govern- ment's fight against the venereal dis- ease situation could be developed to its maximum, many conditions still obtained which made immediate, con- 7 VICE AND HEALTH scientious and continued effort im- perative. A failure to recognize this fact would have been but an admis- sion of national indifference. With the signing of the armistice certain reactions were, and even yet, are noted. And vice, along with other matters, such as industrial un- certainty and crime in general, has been affected. The idea still appears to be prevalent "that war being over there is no reason to keep the lid on." Upon this theory various municipali- ties relaxed their law enforcement programs and clinical facilities de- veloped during the war, and govern- mentally subsidized clinics, in part, if not entirely, went out of existence through the lack of local support. The professional woman and her intermediaries became bold, and in numerous instances districts were re- opened. THE GOVERNMENT'S FIGHT 77 With a view to continuing repres- sive measures and assisting in pre- ventive and educational activities, the Interdepartmental Social Hygiene Board was created by Congress, July, 1918. This bureau inherited the duties, among others, formerly exer- cised by the Law Enforcement and Social Welfare Departments of the Commission on Training Camp Ac- tivities; and fortunately retained a large part of the latter 's personnel trained and efficient professional men and women. Where state health bureaus signified their desires, and where in addition, the state itself had evidenced a proper attitude toward social hygiene, representatives of the board were assigned to them; such agents' activities being directly under the control of the state health offi- cer. In the states where interest had not been sufficiently aroused, 78 VICE AND HEALTH representatives worked out of and under the direction of headquarters in Washington. Incidentally, it may be stated, that a Congressional appropriation known as the Chamberlain-Kahn fund, liber- ated money from the federal treas- ury for state social hygiene purposes on a pro rata basis as to population ; only in those cases, however, where the state itself appropriated or ob- tained a part or whole of a similar amount. The fund in addition pro- vided for hygiene instruction in insti- tutions of learning; for scientific medical research in colleges and uni- versities; and " for the assistance of states in the care of civilian persons for the protection of the military and naval forces of the United States against venereal diseases ". Peace duties of the Board's per- sonnel, included the direction of all THE GOVERNMENT'S FIGHT 79 activity looking to greater efficiency in law enforcement, a campaign of education personally applied for per- suasive and constructive purposes, and the drafting and engineering of state, county, and municipal legisla- tion, which from time to time was found necessary. The women agents of the Board made social studies of the problems involved in cases of seventeen thousand delinquent girls, thus providing valuable statistical material for demonstration through- out the nation. Working in the closest kind of association with the IT. S. Public Health Service and state departments of health it was possible for this Board to assist in aiding the medical program directly by arousing public opinion to the necessity of clinics, quarantine hospitals, education for all classes of people, and to help ob- 80 VICE AND HEALTH tain funds for such purposes ; the end in view being to make the state, or smaller units (counties, cities, bor- oughs) practically autonomous so far as finances for a continued fight against venereal diseases are con- cerned. Congress recently 1 reap- propriated $225,000 for the continu- ance of the Board's field work. A separate division under the direction of Assistant Surgeon General C. C. Pierce, was created 2 in the U. S. Public Health Service for the official administration of its venereal dis- ease policies. The following figures taken from "Two Years Fighting Venereal Disease 3 will indicate to some extent the excellent co-opera- tive work accomplished by the Public Health Service and the state boards of health: 1 June, 1921. *By authority of the Chamberlain-Kahn Act. Pamphlet issued by the U. S. Public Health Service. THE GOVERNMENT'S FIGHT 81 427 clinics have been established. 185,200 clinic patients have been given 2,103,900 treatments. Nearly 60 per cent, of the druggists of the country have voluntarily agreed to stop the sale of quack remedies for self treatment of venereal diseases. 19,800 newspapers and magazines have agreed to take out or keep out advertisements of quack doctors and medical institutions treating " pri- vate diseases of men ". 150,000 placards for the purpose of attracting persons to clinics and for education, have been posted. 60,700 physicians have pledged co-operation. 740,000 young men and boys have seen the " Keeping Pit " exhibit. Thousands of high schools, Y. M. C. A.'s, and industries have co-oper- ated in showing exhibits. 82 VICE AND HEALTH Exhibits and lantern slides have been shown to 13,000 audiences. Motion pictures have been shown to 3,600 audiences. 5000 industrial establishments have undertaken venereal disease work. More than 20,500 lectures have been given. 31 conferences of educators have been held. An appropriation by Congress of $200,000.00 was made to continue this work.* Until the various states (which, after all, means the people in them) are sufficiently interested to carry this national problem them- selves, governmental aid, at least in advice and personnel assistance, if not in money, will doubtless be continued. * February, 1921, CHAPTER VI MEDICAL MEASURES There are two vital medical fac- tors to be considered in attacking venereal disease. The first, because of its emergency, is the treatment of existent cases ; the second, by far the more fundamental one, is the removal of the sources of infection. Only the former will be discussed in the pres- ent chapter. Free clinics should be an integral feature of community sanitation. The institution, as such, may take various forms. Clinics, financed en- tirely by the state government and operated by its medical and nursing personnel, have been found to be extremely effective; these, however, should function only sufficiently long 83 84 VICE AND HEALTH to demonstrate their need, when they should be taken over locally. Clinics are most logically estab- lished in hospitals; such a location removes undue advertisement of the patient's motive for the visit, reduces overhead to a minimum, and makes a pay clinic possible through a legiti- mate diversion of those who can afford a small fee. The income de- rived from this source should neutral- ize the outlay for the free operation and should, indeed, show a profit. Many hospitals depend in part upon the city, county or state for financial support. At least one in every municipality, and more than one in the larger places, should there- fore be persuaded to organize clinics. If necessary, appropriations should be made contingent upon such action. Further, no general hospital receiv- ing public funds should be permitted MEDICAL MEASURES M to exclude venereal patients for there is no valid excuse for this attitude unless it be the one of over-crowded conditions; even so, unfair discrimi- nation against treating gonorrhea and syphilis is unjustifiable. It may be stated, however, that the building programs, projected and consum- mated, of many institutions are pro- viding ample space for the care and treatment of venereal diseases. A trained woman social worker should be attached to each clinic as part of the regular personnel. Her work should include the financial classification of the patients (to pre- vent the public's pauperization), the determination of the " public-health- menace " feature of the case, and the application of rehabilitative measures upon the delinquent fe- male or a proper delegation to a recognized agency. 86 VICE AND HEALTH In rural and sparsely settled com- munities clinical facilities may very properly be substituted by the choice of a capable and responsible physi- cian to represent the state, drugs and treatment apparatus to be supplied free ; and when necessary, state-subsi- dized post-graduate work, looking to a proper professional qualification, should be afforded the appointee. Country people unable to pay can, in this way, also have the advantage of efficient service. This plan, or modi- fications of it, has been successfully employed in several states. A fair proportion of the patients will, in the first instance, seek per- sonal medical advice ; the ethical spe- cialists being the more likely men to be approached; and a minimum fee agreed upon by them (which should be the maximum of the pay clinic) will work reciprocally to the advan- MEDICAL MEASURES 87 tage of the treatment units private practitioner, the pay and free clinics. All public institutions in the state should require of inmates examina- tion for, and the treatment of, exist- ing venereal disease; penal institu- tions especially should emphasize this work as much infection can thus be detected and treated. One of the greatest obstructions to effective curative measures has been the advertising quack whose sole ob- ject is to bankrupt his victim, usually accomplished by long and inadequate treatment. Millions of dollars an- nually are in this manner contributed by gullible victims. There is no excuse for the existence of quackery, and laws to prevent it if not already enacted should be passed and rigidly enforced. In lieu of sufficient legis- lation, or its evasion by carefully worded notices, newspapers carrying 88 VICE AND HEALTH such advertising should be persuaded to refuse it; if unsuccessful, pres- sure inspired by a local hygiene com- mittee or others interested is quite justified. Some years ago this method was successfully employed upon one editor, manifesting itself in the form of an inspired threat by two large department stores to discon- tinue the use of his paper as an adver- tising medium if quack matter were carried. The business office immedi- ately saw the light and the false promises of " restored manhood >: and "ten days' sure cures" became newspaper history.* Self -treatment through the medium of " cures " sold over a drug store counter should also be legislated out of existence ; most of them are value- less, and if not, require technic in ad- ministration quite beyond the ability or experience of the laity. The false * Portland, Ore. MEDICAL MEASURES 89 idea of " secret cure " has already taken a tremendous toll ; it has been authoritatively stated that " a large proportion of the venereal infections of wives and children are to be traced back to the use of some nostrum pur- chased at a drug store".* The physician, whether in his pri- vate office or on the staff of the pay or free clinic, must be concerned not only with the treatment of the indi- vidual patient but should make every effort to locate the probable source of infection. Equally important is the systematic follow-up of the neg- lectful patient. The social worker, connected with the clinic, working in co-operation with a properly educated health officer and deputies, and cer- tain members of the police force, should be able to adequately handle this phase of the problem. * Medical Measures, a pamphlet published by The American Social Hygiene Association. 90 VICE AND HEALTH Pre-natal and post-natal clinics, from the standpoint of prevention, are of inestimable service. These become child welfare centers, which not only have a vast effect in conserv- ing the life and health of children, mothers and families generally, but produce a definite reduction of syphi- lis and blindness in children; they also carry with them a powerful edu- cational appeal. The necessity for this service is more readily appreciated when it is realized that " syphilis affects the race by destroying outright seventy- five per cent, of the children of syphi- litic parents before they are born, or during the first year of life, and by crippling or weakening a consider- able portion of those who survive ".* In response to an inquiry made at a large institution for blind childrent "Today's World Problem in Disease Pre- vention" Stokes. tOverbrook, Pa. MEDICAL MEASURES 01 the following telegram was received: " Of 239 pupils enrolled, fiscal year ended May 31, 1920, 79 were blind from ophthalmia neonatorum. Our ophthalmologist estimates that sixty per cent, of these are gonorrheal infections " Such facts speak for themselves. A report from Thavies Inn, a treat- ment center of London for venereally infected pregnant women, states: " . . . .Every child born during the past year and treated at the center was free from any syphilitic mani- festations If systematic inten- sive measures could be applied to every mother who has syphilis, while she is carrying a child, we should wit- ness an immediate and surprising decrease in the transmission of infec- tion to off-spring. " So effective is this treatment of the mother before the birth of her 92 VICE AND HEALTH child that it is the duty of every phy- sician called upon to deal with preg- nant women to be familiar with the essentials of syphilology and to secure for those under his care proper expert investigation and treatment if find- ings show the presence of disease." There can be no question as to the value of reporting venereal diseases ; especially is this procedure necessary upon a neglect of treatment or remov- al from the jurisdiction. Physicians and the public must be educated to this idea, either by the logic of such a regulation or by the painful experi- ence of penalties imposed for the fail- ure to carry out its purport. Whether the report should be by name or num- ber still remains to be determined. It is quite necessary, however, that the quacks be first out of the way; otherwise for very apparent reasons, a large portion of the business (to the MEDICAL MEASURES 93 patient's and the public's detriment) will fall into their hands. Funda- mentally, the success of such a meas- ure depends upon an enlightened pub- lic and professional opinion, and this feature should be most vigorously pressed. The profession must be made to realize that a disease caused by moral dereliction has no higher standing than maladies innocently acquired, and that an equal obliga- tion exists to protect the public from infection. The question 01 personal prophy- laxis, as found in the sale of early treatment packages or administra- tions at a public clinic, appropriately comes under a discussion of medical measures. This form of prevention, if applied early and properly, is like- ly to kill the germs which develop syphilis and gonorrhea. Those fav- oring this preventive measure state 04 VICE AND HEALTH their argument somewhat in this fashion : Beady accessibility to such treatment is not likely to in- crease immorality by inspir- ing a feeling of security. The real incentive to sex activity is the primal biologic law for the propagation of the spe- cies. Skirts to the knees, jazz dancing, bare-legged musical revues, and the abso- lute freedom of the sexes in daily life may perhaps be considered as some of the more immediate excitant in- fluences, if indeed any are required; but to give credit to prophylaxis for popu- larizing extra-marital inter- course is much easier claimed than proved. The real con- cern, therefore, does not ap- MEDICAL MEASURES 95 pear to rest so much upon morals as upon the possible medical results to be obtain- ed from such a procedure. For more than a year one of the largest states * after laboratory tests made by it, has marked an approval of certain " immediate-treatment ' : packages. The value of this plan lies not merely in such an approval and the consequent distribution of the article to the various drug stores but in its use by the ultimate con- sumer. But despite legitimate adver- tisement upon the platform, by mov- ing picture slides and commercial posters, the rush for this commodity by the youth of the state, which was prophesied by over-sensitive alarm- ists, has not materialized. The British Government has offi- cially placed itself on record as follows : * Pennsylvania. VICE AND HEALTH " The question which con- fronts the British Govern- ment is that there is no un- animity of opinion on the medical side as to the prac- ticability of self -disinfection for the civilian population, whereas on the moral and social side most weighty ob- jections are advanced against it. This question is one in which the moral and social considerations as well as the medical, are important. In the circumstances the Brit- ish Government has decided that it cannot give official support to self-disinfection as a policy. The Ministry of Health is of the opinion, however, that the arguments which have influenced the British Government in de- MEDICAL MEASURES 97 tiding against this measure, do not apply to the provision of ablution centers. Final conclusions as to the value of such centers cannot be drawn, but experience thus far, warrants the continu- ance of the experiment."* * Statement of policy filed under date of May 31st, 1921. Note The U. S. Public Health Ser- vice, the U. S. Interdepartmental Social Hygiene Board, and the American Social Hygiene Asso- ciation have not officially expressed themselves upon this point; however, the question still to be a moot one in the United States. 7 CHAPTER VII LAW ENFORCEMENT Every locality possesses its duly constituted officials, as well as agen- cies, for the enforcement of law. Cities especially have complex and ample machinery for this purpose; boroughs are less fortunate. The police departments of first, second and third class municipalities are usually sufficient in personnel to maintain law, order and decency; though more frequently than other- wise where vice is concerned, inspi- ration is somewhat lacking. Heads of departments are sometimes con- trolled figureheads, whose capabili- ties are measured not by their pro- fessional ability and experience, but rather by the number of votes that 08 LAW ENFORCEMENT 99 they can command. The force itself is fertile ground for a spoils system, despite so-called civil service. How- ever, it is gratifying to note that a number of cities realize the wisdom of an efficient police department. It has been estimated that in one of the largest American cities * ten thousand follow crime as a profes- sion, practising it with all of the skill and system of modern business. It was also calculated that this crime trust's annual profits exceeded twelve million dollars. This is alarming, if true. It certainly indicates that vice and crime in very large communities are not the outcome of individual and scattered effort, but are centralized activities with master minds in con- trol. Smaller localities reflect the same conditions. Therefore, if mu- nicipal security is desired, a system- * Chicago, HI. 100 VICE AND HEALTH atic and efficient fight must be made, and due compensation allowed for it. Recently, an eastern city,* over-run with vicious elements, obtained the services of a then captain; of state police. Politics and tradition were thrown aside and the new head of the department was given carte blanche. A strict disciplinarian, this profes- sional officer has obtained most satis- factory results. While the effort was by no means limited to the successful suppression of prostitution, neverthe- less under his direction and tutelage the proverbial sympathy of the po- liceman toward the prostitute was promptly dissipated. ^In passing, it may be mentioned that the average guardian of the law has been made to feel by those com- mercially interested, that the removal of vice is an encroachment upon the * Wilkes Barre, Pa. LAW ENFORCEMENT J01 personal liberties of the male popu- lation, and that facilities for the pro- miscuous exercise of the sex instinct are very practically embodied in places of assignation. Protection money, more common than generally supposed, paid to certain policemen, strategically stationed, has also served to maintain false attitudes of leniency. Experience has proved, however, that a half hour's lecture given to the force by a health expert supplemented by an unmistakable attitude by the chief himself, not only officially but personally impresses the patrolmen with the advisability of obeying orders. After all, policemen are reasonable human beings, and when made acquainted with the plain facts of venereal disease in its rela- tion to prostitution, are apt to de- velop a satisfactory viewpoint. However, a police department, even 102 VICE AND HEALTH if effectively functioning, is but the first phase in the legal process. Though the detection of crime and the arresting of criminals is properly delegated to that arm of the law, the disposition of the case rests with the judicial branch. Difficulties are here confronted. Under existing legisla- tion, evidence of a most direct char- acter is usually required to hold pros- titutes and other sex offenders for a trial by jury, and indeed, even within those jurisdictions where the laws are of sufficient strength, magistrates are too prone to accept a charge of dis- orderly conduct and thus summarily dispose of the case by the imposition of a fine, rather than to bind over for court. Then, too, if the case does reach the jury, verdicts in favor of the defendants and against the weight of the evidence are likely to ensue. The" fine " system ia utterly inade- LAW ENFORCEMENT 103 quate as a deterrent. If prostitutes realized that, whether a health menace or not, they could be put to work for sixty or ninety days, or detained in an institution for an indefinite period under penal regulations; and if the men involved in this insidious busi- ness were equally aware that their activities would, if detected, send them to the penitentiary for a term of years, less enthusiastic activity would be the direct result. It is readily understood that jail sentences may in some instances work a hardship, especially toward young women new to the business; but sympathy should not outride the vital importance of results or the principle of the greatest good to the greatest number. Young girls will hesitate to lead a prostitute's life when they realize that being caught involves more than reaching into their purse 104 VICE AND HEALTH and producing a small fine and costs ; the procurer will become more chary when he discovers that an attempt to make a fee out of some girl's shame means the closing of prison doors upon him. A crooked or narrow-visioned magistrate can thus quite easily upset the conscientious effort of a police department. It is here that enlight- ened officials become essential. Theo- retically, the mayor is the inspiration back of the police policy in the average community, and he reflects the atti- tude of the group of politicians responsible for his election. A police department dominated by a red-light mayor means wide open vice until the public, urged by reformers, rebels. Even then a removal or two from the force, a notice to the underworld to keep under cover, or a conference called by the chief executive to which LAW ENFORCEMENT 105 prominent citizens are asked for the purpose of hearing selected speakers deliver addresses on the community's purity, are the general results and usually represent the sum total of consequences. Thus it is observed that local politi- cal and official antagonism to the enforcement of law represents a prob- lem most difficult of solution. Where the question is one merely of unen- lightenment, the obstacles are not so hard to overcome. But in either event, the successful handling of the problems comprehends the modern definition of law enforcement activity. Such service calls for a highly specialized and qualified representa- tive, whose activities must essentially be inspiring in character. Officials, and not the law enforce- ment representatives, enforce the law; therefore if the desired ends are 106 VICE AND HEALTH to be obtained a careful study of the administration personnel of any given city should be made. Such a survey, properly conducted, will determine which officials are wrong and those whose sympathies may be counted upon for help. State health departments, therefore, should have upon their payrolls an individual thoroughly competent to perform these duties, operating under the direction of, or in connection with, the division for venereal control. After a preliminary survey of the views of the officials is completed, authoritative facts of the conditions must also be in the representative's hands before he can suggest a change either directly to the administration or through accredited sources. The vice inspector thus becomes essential. The term " police detective ", ex- cept in large cities, is a misnomer. LAW ENFORCEMENT 107 City plain-clothes men are merely dis- guised officers and the vice elements know them better than they do the average blue-coat; to employ their services, even if obtainable, would be for many reasons plainly absurd. The same is true of local detective agen- cies; not so, however, with the state police. With nothing but their effi- ciency records at stake, two or three trained agents from such a force will in a week's time gather legal evidence against the vice system of a city, in- cluding prostitution, gambling and associated crimes. Lacking such a possible source from which to draw, the national agencies may be called upon for assistance in securing infor- mation, or the state health depart- ments may have operatives for this purpose attached directly to their organizations. The practical advantage of such 108 VICE AND HEALTH service is readily understood by the following illustration: A city of two hundred thousand population showed a high venereal rate. The clinician at the state dispensary found unmis- takable evidences of red-light opera- tions. State police were called in and in five days obtained the facts. The mayor, with a leaning toward segre- gation, inspired by a very commercial city health physician, was approached by the state's law enforcement repre- sentative, who was informed that vice had been eradicated a year be- fore. Sworn affidavits of a recent date were then offered in refutation. The Commissioner of Public Safety was likewise advised; he, in turn, de- manded the presence of the police chief, who sent for his captain, and finally the patrolmen on the beat involved were brought in and officially reprimanded. While the side-play LAW ENFORCEMENT 109 was unimpressive and the attempts to shift responsibility almost ludicrous, the net result nevertheless was the suppressing of the district and an in- creased attention given to clandestine vice. Usually, however, the issue is not so clean cut nor the results quite so speedily obtained. It, therefore, becomes necessary to educate local organizations as to the need of im- provement, to form committees, and even resort to publicity measures in an effort to develop sufficient oppo- sition to existing vice conditions. It should be readily understood that the law enforcement representative is likely to secure better results by remaining discreetly in the back- ground in this offensive. If he func- tions to standard he will so instill in the local groups and individuals the principles for which he stands, that after making his evidence and argu- 110 VICE AND HEALTH ments available to these persons he can assume second place ; in fact, drop comparatively out of sight. His power should be felt rather than per- sonally demonstrated. Though local units, of course, must be given attention, the state, in terms of the general population, must also be his concern. Inadequate penal and health laws must be supplemented by advanced legislation, and state offi- cials must be persuaded to assist in its enactment. General policies for the establishment of clinics, detention hospitals, educational and rehabilita- tive measures should be within his jurisdiction, and their adoption suc- cessfully negotiated. Unquestionably from a health standpoint, clandestine vice presents the most difficult problem for law enforcement solution. Disseminated and clandestine prostitution, as LAW ENFORCEMENT 111 already noted, take the following general forms : Hotel and apartment house activity, rooming-houses, auto- mobile services, dance halls, skating rinks, and other places of public con- gregation. To appreciate the diffi- culties likely to be encountered it becomes necessary to consider these questions in detail. As previously mentioned, the com- plex life found in the larger hostelries proves a substantial obstruction to a successful attack. Moreover, the standardization of dress on the part of women and the general use of cos- metics have made it almost impossible to distinguish the lady of refinement from her sister of easy virtue; per- sonalities therefore cannot be safely indulged in by the clerks unless sus- picion is well grounded. And im- moral persons can with little difficulty, assuming they present an appearance 112 VICE AND HEALTH of respectability, obtain accommoda- tion. If the prostitute discovers a too inquisitive attitude on the part of the desk man (which in rare instances occurs), she calls to her assistance the obliging taxicab driver who, posing as her husband, registers for himself and for her as man and wife at another hotel, takes his fee, and leaves the woman free to work the place. The more general practice, however, is to be accompanied by her cadet who "plants" her and acts as procurer and cashier. Strict supervision upon each floor by competent house detec- tives is capable of reducing the possi- bilities in this regard; though up to the present time a majority of the managements have had little concern as to the conduct of their guests so long as quiet and order prevail. Here again the question of education be- comes a vital factor. LAW ENFORCEMENT 113 Experience has demonstrated that the average hotel manager or owner is amenable to constructive criticism ; conferences called at the request of the local Association including its representatives, and addressed by law enforcement and health officials, very often have a most salutary effect. Once more, authoritative facts based upon evidence, will afford the most impressive method of presentation. While the better type of apartment house is less likely to be invaded by the prostitute than are the others, many women of questionable charac- ter have been accepted by rent agents and have landed safely in these estab- lishments. The eyes and ears of neigh- bors, however, are quick to detect irregularities, and unless operating very quietly the immoral woman is soon made aware that she has selected an uncomfortable site for her activi- 8 114 VICE AND HEALTH ties. On the other hand, lower grade places, with little or no ownership supervision, coupled with the general indifference of the other inmates, ful- fill a demand comparatively safe for operation. A strict watch kept upon such houses by capable city police, or other secret service men, and the obtaining of direct evidence, will remove the worst features; this fail- ing, the abatement law now in force in a number of states, which provides for the closing of such resorts under a restraining order from the court, may be invoked. The misnamed " rooming-house " is difficult to undermine. As a "blind" several men may be lodging there, as well as women ; the business is ostensi- bly conducted by the inmates upon a personal basis rather than under the direction of the proprietress herself. LAW ENFORCEMENT 115 To combat the situation direct evi- dence is necessary. The element of salesmanship is a more important problem to the prosti- tute than ever before ; in this respect she is now deprived of the advantages of beer gardens, cheap dance halls with liquor facilities, and of ttimes of open street solicitation. Theatres, fairs, and large public gatherings are still left to her but are not permanent opportunities, and at best are precari- ous. This predicament creates an increased demand for the man solici- tor, known in the vernacular as the " pimp ". To meet this necessity, bell-boys, taxicab drivers and even night clerks readily fall into line. Internal sanitation of a large or small hostelry therefore, to be worth while, must involve the utmost scrutiny of the conduct of its personnel. Taxicab chauffeurs present a very 116 VICE AND HEALTH difficult problem; and this may be properly considered with the third phase of the question, namely, that of the automobile itself. Though statistics are not available, the assertion is ventured that at this time there is not a less responsible class of men in the country than the auto-for-hire chauffeur. Lazy and frequently vicious, many of these fel- lows are in direct touch with the underworld and have contacts with the tangible and intangible forms of vice. An effective method of control is in the passage and enforcement of regulative ordinances. Such a law should provide for the answering of questionnaires as to age, residence, prior occupation and references; and a license should only be issued when the police department is thor- oughly satisfied as to the appli- cant's reliability. LAW ENFORCEMENT 117 While the lower type dance halls largely went out of existence with the passage of the Volstead Act, there are yet many places where dances are conducted with assignation oppor- tunities. Of this type the " closed " dance hall is the most offensive. A " closed " resort is one wherein the feminine contingent is limited to per- sonnel hired by the management. An institution of this character virtually predominates as an assignation cen- ter. Investigations based upon per- sonal experience led unquestionably to the conclusion that women who are found in these places are there pri- marily for the purpose of prosti- tution. In a resort of this kind raided sometime ago * the disease rate was discovered to be over 97 per cent. ; and the women operating in this place, ranging from sixteen to thirty years of age, had been assembled from vari- * Outside Tacoma, Wash. 118 VICE AND HEALTH ous sections of another state where laws against prostitution made it uncomfortable for further activi- ties there. Though resorts of this nature are more likely to be found in the west- ern section of America than in the East, its close competitor is the ordi- nary public dance hall with no real police or moral check upon it. Defi- nite supervision in charge of female probation officers, and the enforcing of the age law, are valuable to a limited extent. Both skating rinks and cabarets, especially the latter, possess assigna- tion possibilities to a very great de- gree. However intangible this situ- ation appears to be, it is neverthe- less one, which with earnest effort, can be minimized; such an effort should include a tactful policy of police intimidation. LAW ENFORCEMENT 119 With proper ordinances passed and enforced to eliminate street solici- tation, the employment of investigat- ing personnel, the proper patrolling and lighting of parks, and due punish- ment meted out to the convicted offender, this clandestine aspect of the problem can be considerably reduced. There must not be any confusion as to the limitations of the purpose in- volved in law enforcement activity. In the present meaning of the term, its application does not seek to control or regulate personal morals. Such matters properly come within the domain of others. Often in practical experience the two objects have been confused with most damaging results. A strict law enforcement, however, along lines indicated above, has already demonstrated itself to be one of the most powerful methods of com- bating venereal disease. CHAPTER VIII MEDICO-LEGAL MEASURES There appears to be a very definite feeling among those having first-hand information, that law enforcement activities alone, which deal with the courts in the first instance, do not lead to the desired results as effectually as does medical procedure. This idea is well founded. During the world hos- tilities the major attack was waged against the segregated vice districts upon the theory that these places represented the large tangible and removable sources of venereal infec- tion. But as time went on and care- ful investigations were made, it was appreciated that as a matter of health policy the closing of vice districts was 120 MEDICO-LEGAL MEASURES 121 but the beginning of the program for venereal disease control. Some workers today labor under the misconception that a vice district includes the larger share of market- able prostitution. Consequently, it is not surprising that in many communi- ties well intentioned and interested people are enthusiastic over the idea that a district closed, no matter how, means vice and disease removed. This view, however, takes little account of disseminated and clandestine activity. The ramifications of sex iniquity have already been explained in a former chapter, but the fact must not be overlooked that individual prosti- tution as found in hotels, assignation houses, automobile activities and the more recent road-house developments, carry with them as large a disease bur- den as the district itself. While vice neighborhoods must be 12 VICE AND HEALTH eliminated, there is more to the ques- tion than the mere closing of these places. A large percentage of the women of such districts being in- fected, it is evident that without medi- cal control of some kind over them, disease is merely spread. Inspired by a reform group or by political expediency a mayor may order his chief of police to abolish the district. What follows? The average head of a police department already has the names and addresses of the known prosti- tutes upon his desk, and he quietly issues orders to the underworld to go out of business. Bags are packed and the inmates leave town or seek other fields of operation within the same community, taking their disease with them. Madams of resorts who own their places assume an air of respect- ability and live more or less pre- MEDICO-LEGAL MEASURES 123 cariously until official vigilance is again dormant. It should at once be appreciated that a score of red-light districts thus closed, while undoubtedly affecting the element of ready marketability and diminishing to a certain extent exposure to infection, does not in any real way lower the disease incidence. It is true that new legislation has been passed in a number of states defining prostitution and calling for prison sentences. But the handicaps in obtaining legal evidence and the general attitude of leniency by jurors, will make the advantages of this procedure from the standpoint of health a problematical one, unless medical measures are contemporane- ously applied. A jury box containing female representation may in a meas- ure overcome the latter objection. Nevertheless the fact remains that a 124 VICE AND HEALTH tremendous amount of education must be applied to enforce drastic laws on prostitution. A report recently re- ceived from a large city having most progressive anti-vice legislation, elo- quently indicates that laws and law enforcement are not always synonymous. After all, the nation's vital interest in vice, at least at the present time, centers around the venereal diseases and their consequences. Most prop- erly, therefore, if the matter can be handled from this point of view it is more logical, and as has been demon- strated, is likely to be more effective. The establishment of treatment fa- cilities in the form of clinics, even with a thorough follow-up, leads no- where with a certain class of patients. Young men have been observed loiter- ing in the neighborhood of public clinics for the sole purpose of meet- MEDICO-LEGAL MEASURES 125 ing women when they leave, appar- ently under the misguided notion that these patients have been rendered temporarily innocuous. It becomes evident that different types seek medical advice. First, men and women who are sincerely interested in their own recovery and whose conduct, including continence during the infectious period, does not make them detrimental to the public health ; and second, those who by their habits, occupation or lack of it, are health menaces. Police cases referred to the clinic, prostitutes and procurers are among the latter class. The laws, both punitive and medi- cal, are not unfair in their discrimi- nation against the woman. However, a man who has contracted venereal disease, unless of the criminal class or sexually debased, is likely to remain continent during the inf ectiousness of 126 VICE AND HEALTH his malady. Women, to him, from a sex standpoint, are quite unattractive, and his mood is one of extreme con- cern for his physical welfare rather than toward licentiousness or promis- cuous sex contact. It can, therefore, be fairly assumed that the " respect- able " man, married or single, who by reason of a moral lapse becomes dis- eased, will not deliberately and with malice aforethought pass on his infec- tion to others. It is quite the reverse however, with the degraded man who has no regard for his own physical welfare or that of anybody else. Unfortunately, there are many such. The largest number of the " health- menace " type are to be found among the prostitutes whose bread and butter depend upon general sex activi- ties. This is the big problem. The absurdity of merely treating persons of this kind is clear. It would MEDICO-LEGAL MEASURES 127 be just as sensible for a physician or hospital to prescribe for an ambula- tory case of diphtheria and then per- mit the patient to mingle freely in the community until the next visit, as to allow a public-health-menace venereal case to transmit the disease as soon as he or she leaves the treatment room. This type must be controlled and iso- lated during the infectious period. Without an effective quarantine a vast amount of preventable damage is done. In the very nature of things, the woman who prostitutes herself is more than likely to come under clini- cal observation from one or another source ; and quarantine should at once apply if she is infectious. In raids conducted by police or medical au- thorities, reasonable discrimination, after proper investigation, can be made against the inmate in favor of 128 VICE AND HEALTH the casual male visitor. If, however, the man either within the house of prostitution or elsewhere, is a police character or is spreading disease, he too should be quarantined. It is recalled that a vice district in a certain city was successfully in- vaded, and those found there were brought to the police station, where the legal and medical quarantine fea- tures simultaneously functioned. The representative of the State Department of Health put a blanket quarantine upon all the women, pend- ing diagnosis; but after physical examination for gonorrhea he per- mitted all but three of the men to leave (bail having been obtained for the criminal charge) upon a promise that they would appear at the clinic for blood tests. This procedure was only adopted after conferring with the police and confirming statements MEDICO-LEGAL MEASURES 129 as to names and addresses. All of the men reported at the clinic and the majority were found to be free from disease. The greater number of the women, however, were found to be infected, and quarantine was in their case continued. The point is, that the male fre- quenters in this instance were not vi- cious but indiscreet; the women on the other hand were thoroughly de- praved, and, but for restraint, would have immediately left the jurisdiction. It may be mentioned, incidentally, that the medical officer referred to above, was two days later informed that the manager of a chain store com- pany was being promiscuous while suffering from gonorrhea; and the s report being confirmed the man was apprehended and kept under absolute quarantine, despite the efforts of his business associates to secure his re- 9 180 VICE AND HEALTH lease. From a practical standpoint, therefore, there should be absolutely no difference of attitude or of treat- ment when dealing with the man or woman if there is any reason to sup- pose that his or her liberty will result in a further spread of contagion. There are two methods of imposing quarantine: First, to placard the home of the patient; second, to iso- late and control in a detention hos- pital. The majority of quarantinable venereals are naturally incorrigible and at best lead nomadic existences, therefore immediately upon the pla- carding of the house the card is torn down and the person under quaran- tine leaves town to pollute other fields. Without the establishment of guards at the front and back doors main- tained for a twenty-four hour pe- riod, this type of restraint is unavail- ing. Detention quarters adequately MEDICO-LEGAL MEASURES 131 equipped for the care, treatment and isolation of persons who are public health menaces is the only reason- able alternative. The ideal institution is a separate hospital operated by municipal and county funds, constructed for the pur- pose and providing wards for both men and women. However, in lieu of this arrangement, hospitals receiving state appropriations should be per- suaded to set aside wards for such patients, if possible. Where over- crowded conditions will not permit such a disposition, the renting or pur- chasing and operating of a building supported by municipal or county finances, is a very proper solution; lacking such possibilities, county jails and almshouses should be utilized as a temporary expedient. Prisons, par- ticularly, due to prohibition, now have vacant sections frequently equipped 132 VICE AND HEALTH with modern conveniences, quite adaptable for such a make-shift policy. The installation of clinical apparatus is a minor detail. The practical objections to this last mentioned plan involve first, the con- sent of the officials, which is often hard to obtain; and second, the idea of incarcerating people whose menace is limited to infection with a com- municable disease. However, when it is realized that most of these patients are not unfamiliar with the penal fea- tures of a jail, based upon previous personal experience at one time or another, the second objection becomes one of sentiment rather than of solid reason. It may be stated that a grati- fying attitude of co-operation by officials, in these various phases of control is being observed. The establishment of a centralized institution or a group of institutions MEDICO-LEGAL MEASURES 133 within the state and under its direc- tion, operated upon a financial plan similar to hospitals for the insane, is already receiving consideration by several states.* Obviously, as a preliminary condi- tion to the above outlined ideas, legis- lation, if not already existing, should be enacted. The benefits of quarantine are quite apparent. The possibility of the patient's infecting others is elimi- nated ; and with the prostitute this is an exceedingly large factor. Figur- ing on five exposures a day and two infections, the control for thirty days of one hundred patients saves six hundred from disease. Again, the possibility of reinfection during the treatment period is also removed. The state of Pennsylvania has a 400-bed hospital for the treatment, care and isolation of volitional and public-health-nenace patients; (the latter admitted under quarantine^ Act of May, 1921.) 184 VICE AND HEALTH Moreover, with proper social service, rehabilitative measures can be insti- tuted, and with some chance of suc- cess where the young offender is con- cerned. Then, too, medical observa- tion can be undertaken, and the psy- chiatrist can with care seek for feeble mindedness, and after cure of the venereal disease can have the mental defectives permanently removed from society. And finally, quarantine has a deterrent influence upon further harmful activity after the offender is released. Being thus detained and liberty taken away, the patients are made to appreciate to their sorrow that here is an instance where the shyster lawyer, bail and even habeas corpus proceedings are absolutely impotent. Pennsylvania perhaps has gone further in applying quarantine than any other state in the Union. By law, MEDICO-LEGAL MEASURES 135 patients may be quarantined while diagnosis is being confirmed, upon a reasonable suspicion that a com- municable disease exists.* A prima facie or convicted prostitute, there- fore, is reasonably suspected of hav- ing venereal disease, based upon in- controvertible medical statistics that from ninety-four to ninety-six per cent, of her kind have gonorrhea, or syphilis, or both. This is a powerful weapon and its effectiveness has been most clearly demonstrated. Pennsylvania State Police have been commissioned health officers and as such obtain evidence; later the prostitutes are apprehended and quarantined in a house of detention. This is accomplished in the business- like and efficient manner for which this organization is known the world over. State police in other jurisdic- * Act of April 16, 1921. 186 VICE AND HEALTH tions should be utilized in the same way. Lacking these, trusted mem- bers of the local police forces, with health officer authority, could thus function. In this way poor law en- forcement and jury leniency can be overcome when necessary. On the other hand, the evidence upon which the quarantine is predicated is usually of court quality; and the agitation locally aroused by the medical meas- ure will demand activity in the crimi- nal courts, at which time the state po- lice can testify in court to excel- lent advantage. But whatever the particular method may be, until the public-health-men- ace type of patient is not only treated but detained under quarantine, mere medication is a travesty and the vicious circle of disease remains solidly intact. CHAPTER IX EDUCATION Education is considered by many as the only practical antagonist to vice and disease. Undoubtedly personal education in sex hygiene will be of great value, but the perversity of human nature is so strong and the sex instinct so powerful, that an academic fortification, unless surrounded by assisting barriers, will not be as avail- ing as might at first be supposed. However, education in a broader mu- nicipal sense (to be explained in a suc- ceeding chapter) applied contempo- raneously with personal propaganda, will come closer to obtaining desired results than any other form of attack. It is not too much to hope that the present day parent can be effectually 197 138 VICE AND HEALTH and generally reached by education, though difficulties are in the way. Home life as an institution is not the compact organization it formerly was; too frequently it represents a comfortable refuge where the neces- sary creature comforts are obtain- able, and stops there. There is a reason for this. The modern attitude toward diversion is one of the out- standing features of our social life. Today, young and old demand a crowd and a ticket to measure up to their idea of fun ; self -satisfying pleasures are passe. Firesides, in consequence, are forsaken for automobiles, caba- rets, dances and theaters ; and normal family life loses its grip. Parents, therefore, must be taught to reaffirm their natural prerogatives and cease to permit young daughters and sons to become imbued with the false standards of life so frequently ab- EDUCATION 139 sorbed at the motion picture house, dance hall and the all too common joy- ride. Belying less upon the virtue of their offspring and more upon ration- ally applied discipline, the morals and health of children can be success- fully guarded. It is apparent that the above state- ment is considerably easier to make than is its application ; and will need in addition to the parents' ambition, assistance from the children them- selves. It is right here that opti- mism is justified. Self control taught in childhood can be relied upon to so fortify the average youth that he will not fall an easy prey to sex temptations. The adolescent, too, is most impres- sionable amenable and retentive to new ideas and thoughts. Teachers, if qualified, can be of immeasurable assistance in instilling moral values 140 VICE AND HEALTH in their students, though the assump- tion is unfortunately general that young people should not be brought into academic contact with vice lest it corrupt virgin thought. In this re- spect we lose sight of our own " wis- dom " acquired in devious ways dur- ing the early years. It is safe to say that nearly every young girl or boy possesses a fund of misinformation upon matters of which they are sup- posedly ignorant. Venereal diseases among school children of grammar and high school grades are painful evidence of this fact. It is not surprising that young men are ignorant of the consequences of promiscuous sex activity when but a few years ago the medical profession, except for a comparatively few spe- cialists, was unacquainted with their far reaching ravages. Personal con- tact with prostitutes was, and still is, EDUCATION 141 urged by some as one of the necessi- ties to experienced young manhood. And among many, the theory of im- munity with the clandestine or charity girl still obtains with great force. These false conceptions must be eliminated. While, generally speaking, it is harder to control virile youths than maidenhood by demonstrating the dis- ease pitfalls incident to vice ; properly inspired fear will lead to preventive measures, preventive treatment and even continence. Normal schools could accomplish much by including instruction in social hygiene. Per- haps the most powerful weapon against illicit sex experience is to be found in a constructive sex edu- cation which gives to the boy and girl a real incentive for clean living as exemplified in a happy marriage and healthy children. 142 VICE AND HEALTH Teachers are the links between parents and children, and as such can supply deficiences in sex-education not received at home. Institutions of higher learning should have compul- sory courses in physical, mental and emotional hygiene, preferably given in the first term of the first year. Many first sex experiences take place during this trying period, when with the restraint of the home or the pre- paratory school removed, temptation is strong and delinquency becomes a line of least resistance. Women's institutions, moreover, must not be overlooked in this regard. Too often young women while informed upon many subjects are deplorably ignor- ant with respect to their own bi- ologic and physiologic nature; and this lack of information has fre- quently created conditions leading to unfortunate results. EDUCATION 143 In any educational program, group contacts should be made ; for example, such as are found in large industrial plants, factories, stores, Boy Scouts, Girl Scouts, the Y. M. C. A., the Y. W. C. A. and various civic organizations ; in short, the entire community should be systematically covered. How is this to be accomplished? Extreme caution must be applied to the technic of approach. Tact should be the controlling factor in the pre- sentation. While no definite general rules can be laid down, anything which smacks of fanaticism should be studiously avoided, both as to per- sonnel and subject matter. To be effective the subject must be handled sanely by sane people. Over or mis- placed emphasis may kill the chances for desired results. Reformers should not be employed for publicity pur- poses; on the other hand, business 144 VICE AND HEALTH men and women and physicians of both sexes command and obtain re- spect. Lectures should be standard- ized for the various groups, and as far as possible be distributed to the speak- ers from a central office, such as that of a state health department. With the youth especially, personal rather than sex hygiene, should represent the burden of the message, but elo- quence and emphasis should be di- rected as an incident to the latter. With more mature audiences subtlety may be dispensed with and a direct presentation made. With the various avenues of pub- licity accessible, it becomes a question of logical utilization rather than of choice. Any and all of the propa- ganda channels may be employed. The motion picture as a medium is unsurpassed, reaching, as it does, millions of people. Most state boards EDUCATION 145 of health possess for distribution movie films and stereoptican slides designed to impress the observer with facts which should deter and reduce promiscuous vice. Private agencies, such as The American Social Hygiene Association of New York City, also make similar material available. Commercial picture houses, churches, schools, industrial plants, all should be urged to display such exhibits. It imust, however, not be overdone too much familiarity in the form of repe- tition will breed indifference and even contempt. Short articles in the public press are most advantageous, but the ut- most care should be taken as to the presentation of the subject. State supervision through the educational division, or officer, of its health department, is most desirable. Own- ers and editors of newspapers, fre- 10 146 VICE AND HEALTH \ quently uninformed of the necessity of publishing such features, refuse them; courteous pressure in these cases is indicated and essential. The distribution of approved pamphlets prepared for the main social groups will familiarize many with the disease risks of promis- cuity and thus help to engender a proper feeling against the various vice manifestations. The methods of presentation above outlined call for local initiative. While a state department of health may be reasonably relied upon to fur- nish a measure of the impetus, it can- not furnish all of it. If education is to be really effective the inspiration involved must be produced from the inside, which plainly depends upon community interest. A state cam- paign imposed upon a locality, by its very nature, is a temporary matter; and in this phase of the attack as well EDUCATION 147 as in all of the others, perseverance and persistence alone can bring last- ing results. With misinformation acquired over a long term of years as the result of ignorance, patience must be exercised in the attitude of many men and women upon the general questions concerned. When it is discovered that there are leading business men and city officials, who, despite overwhelm- ing scientific and medical evidence to the contrary, still believe in segre- gated vice and in attempts at medical regulation, one cannot be too hard upon the individual official and the av- erage man who treats this matter with indifference. Conversion will come, but it can- not be attained in a day or even in a year. Patience and consistent per- severance, however, will eventually reap their reward. CHAPTER X WELFARE AND REHABILITATION The development of social work has been exceedingly rapid in recent years. Juvenile, morals and domestic relations tribunals, as well as organi- zations specifically interested in these phases of community and individual welfare, have called for a special group of trained persons, who, as the need arose, were found. Universities and colleges have introduced courses of wide range into their curricula designed to qualify men and women in this type of activity. Applied philanthropy and social service may therefore be considered as a pro- fession in itself. No community is properly equipped to handle the general problem of vice in its relation to health, unless it has 148 WELFARE AND REHABILITATION 140 trained sociological personnel con- nected in some manner with the law enforcing staff. Where special courts do not exist workers should be at- tached to the police department or the district attorney's office. As intimated in a previous chapter, small communities are limited in en- forcement personnel. Too often the dignity of the law is upheld in a desul- tory fashion by an, eighty-dollar-a- month chief of police and two or more equally underpaid assistants. This deficiency, so far as vice is con- cerned, can in some measure be over- come by an efficient welfare worker. Every community, be it large or small, possesses its relatively fixed number of delinquent women and girls; and in addition presents a clearly defined pre-delinquent prob- lem. The specialized case worker as a detector of sex dereliction in neighbor- 150 VICE AND HEALTH hoods of limited population becomes therefore a highly necessary adjunct ; she can render invaluable assistance in locating the known characters com- mercially inclined, and even in the face of police indifference can direct to clinics those found to be in need of treatment. Also, when required, she can initiate and complete an institu- tional disposition of the case. The value of such work should at once be clear. Venereal diseases in many small places can be traced to a comparatively few delinquents who usually are of the clandestine or semi- clandestine variety. This results in their walking the streets, engaging in solicitation, and becoming rather well fixed in the eyes of the community. However, with a cleverness born of necessity, this type frequently so con- ducts herself that the arm of the law cannot, or does not, reach out for her ; WELFARE AND REHABILITATION 151 it is then that the case worker's inter- est may be tactfully applied. She is not compelled to wait until the of- fender has been arrested ; and the lack of court evidence need not embarrass her. Inferences drawn from appear- ances and actions are all of the evi- dence she requires. Her official stand- ing makes the approach easy ; and her training qualifies her for a tactful handling of the situation, A dozen girls removed from the community and an additional number rendered non-infectious, will markedly reduce the incidence of venereal disease in small places. An efficient representa- tive should be able to accomplish this within a short time. In cities the individual interest of the social worker only becomes active after a diversion of a case by the courts or by a welfare group. With the reference of the case personal his- 152 VICE AND HEALTH tories are obtained, mental and physi- cal tests made, and the conditions pre- requisite to proper disposition ascer- tained. A personal study of the hard- ened prostitute leads to the conclusion that as a class rehabilitative measures have little, if any, effect. Feeble- mindedness, neurasthenia, criminal tendencies and drug addiction indi- cate that the chances are decidedly against any real headway in reform. Institutional restraint is the only reasonable solution. A different outlook, however, ob- tains with the young delinquent of normal or slightly sub-normal men- tality. Often proper advice tactfully applied, coupled with a judicious fol- low-up, will make possible a change for better in her mode of life and in the end restore her to a firm social footing. It is in cases of this kind that the worker can produce the most impressive results. WELFARE AND REHABILITATION 153 The pre-delinquent phase is by its nature quiet, but most important work. Young people living in over- crowded rooms and amidst insanitary conditions, or under the domination of criminal or cruel parents, or sur- rounded by other demoralizing influ- ences, are removed to better planes of life, thus saving them to them- selves and to the state. It may be remarked that more energy is being directed toward this question than formerly the proverbial ounce of prevention being properly considered as worth more than the pound of cure. But whether it is the pre-delinquent rescued, the young woman reformed, or the hardened character restrained, the value of social service to a community, viewed from the angle of the individual case, more than justi- fies itself. 154 VICE AND HEALTH While, primarily, the social work- er's first concern should be the suc- cessful handling of individual cases, it is by no means her limitation. In fact, unless connected with a court or an organization in a large city, where the amount of work naturally calls for exclusive specialization, the possi- bilities will not be reached, if she stops there. With the ever-increasing and natural interest of women's groups in national, state and local welfare, much constructive work can be ac- complished through them. Armed with convincing facts developed with- in her field, the worker should be able to generate a decided interest for the general program. Therefore, a well- guided influence in this direction will assist in molding personal and official opinion to the necessity of clinics, detentional facilities, community edu- WELFARE AND REHABILITATION 155 cation, recreation, and rational law enforcement. Indeed the agent is only restricted by her own qualifi- cations. Accordingly, it becomes ex- tremely important to obtain for such service an individual not only thoroughly acquainted with the ab- stract academic features, but one who is qualified as to personality. Sex hygiene demands a solid back- ground of common sense to keep the subject, from the worker's angle, on an even keel. Over-trained spe- cialists should therefore be studi- ously avoided. For a state approach, rehabilitative measures are fittingly applied by the social service personnel connected with the clinics, already touched upon in a former chapter. In addition,, employment bureaus of both the state and municipality can be utilized in restorative activities. A successful 156 VICE AND HEALTH plan has been operated in Pennsyl- vania, which involves the diversion of the hopeful cases freed from quaran- tine to the State Employment Agency which, in turn, locates the person in self-respecting work, either in a state institution (by way of demonstra- tion) or other suitable place, the scar- let letter being removed in the pro- cess. It is, however, emphasized in this connection that only the women amenable to rehabilitative attempts during the quarantine period should be considered. There is another class (all too com- mon) which becomes a very impor- tant problem ; and its solution has as yet not received the attention that it deserves. Reference is made to those young girls and women who possess a constitutional moral obliquity, and whose actions are based upon an in- herent weakness of character rather WELFARE AND REHABILITATION 157 than upon downright criminality or viciousness. Experiments made upon women of this kind indicate that rehabilitation methods are of little, if any avail; they are neither responsive to the con- structive help of the social service worker nor to the punishment meted out by the legal authorities. Imprison- ment is apparently a periodic experi- ence in their lives, and while, of course, smarting under the confine- ment, they are not in the least deterred by it. These are the repeaters the familiar faces coming before the magistrate ; and no end of counsel and no amount of punishment appear to do them any good. Under present conditions, medical treatment is about all that can be given them. Once rendered non- infectious, they are turned loose upon the community and a reinfection 168 VICE AND again makes it possible for them to do great damage. While industrial schools will very greatly help a number of such per- sons, the majority are not susceptible to any training. Being neither insane nor imbecile it is impossible to com- mit them to psychopathic institutions. Personal care and custody for a long period seems to be the only solution; and farm colonies with their outdoor work and manual labor seem to pos- sess the elements of humanitarism and rational therapy so necessary under such circumstances. As a distinct remedial measure, the industrial home is of great service. Particularly is this so with the youth- ful misdemeanant. An indeterminate sentence calling for confinement at such a place, where training, work and moral uplift are all emphasized, will have infinitely more permanent WELFARE AND REHABILITATION 169 effect upon her than being lodged with the demoralizing company of the average jail. As a matter of fact, iron bars alone have never ac- complished reform. These questions likewise call for the leadership to be found in the quali- fied social worker. Suggestions, while in themselves necessary, are of little moment unless carried out; and the sustained interest looking to such a conclusion, is properly and should be effectively borne by those in the com- munity who are paid to do just that sort of thing. The angles of general social wel- fare work are many and diverse. Fac- tories, industrial plants and com- munity service organizations, all de- signed to increase the social morale, indicate to some extent the large pro- portions of this comparatively recent activity. It is being realized more ICO VICE AND HEALTH and more that factories filled with, fresh air and sunshine together with general sanitary conditions, plus mental and social therapy, are sound business principles. The outlook from a community welfare standpoint is exceedingly favorable. Moreover, organized recreation is playing its part. The American Play- ground Association and the Boys and Girls Scouts are engendering princi- ples of morality and body building which should have a lasting effect upon American youth. As a moral regulator, and hence as a prophylactic against disease, properly guided play and recreation are unsurpassed. A social worker is in a position to suc- cessfully advocate the gospel of fresh air and rational outdoor diversion for all classes; and her program is not complete unless she does so. CHAPTER XI GOOD GOVERNMENT The various methods of attack already mentioned, while essential to any headway with the venereal prob- lem, very decidedly need an alliance with good government for any basic readjustment. The present system of local ad- ministration, as applied in the ma- jority of cities, is dominated by politi- cal groups, which, concerned with their own selfish interests, are prone to be quite indifferent to rock-bottom reconstructive measures. Conse- quently candidates are chosen for office not because of any displayed or supposed aptitude but upon a basis of expediency. A certain western com- munity, for example, recently elected 11 MI 162 VICE AND HEALTH as its chief executive a man of limited education and lacking in personal business initiative ; and his associates who were chosen at the same time were more or less of the same caliber. It is not strange that men of this type are controlled and the finer sensibili- ties of office thus throttled. Police departments as a result do not possess the necessary inspiration, and fail to develop morale ; and organized forces j of evil already established become | more or less permanently powerful, jj Rotary, Kiwanis Clubs, Chambers of Commerce, and civic organizations undoubtedly have great community value, but as the above suggests, pres- ent day municipalities are not ruled by resolutions from such bodies pro- fessional politicians have the last word always. The fault is not with the politician or the form of government, but with GOOD GOVERNMENT 163 the average citizen who prefers to delegate his inherent political inter- ests to someone who has more time than he has to " bother with them ". The inevitable thus occurs. The man looking for the job and the cash it will bring him connects with the politician if he himself is not already one and spends time, money and energy to accomplish his desires ; while the bank president and success- ful business man are content to gather their coats about them, keep out of the mud and vote for those of their party who are being cleverly manipu- lated to office. In this connection! an eastern city recently lost a police magistrate who was slain in a disorderly house whose patron he was. The righteous indig- nation of the men and women who represent the commercial life of that community was consequently aroused. 164 VICE AND HEALTH They at last realized that while the very life blood of their locality, through its manufacturing interests, commerce and tangible wealth, was controlled by them, another group who existed upon crime and its pro- ceeds, were dictating the conditions under which they and their chil- den should live. And, further, that these conditions developed a danger- ous atmosphere.] Today the representative men of that locality are politically in control, and inspired and assisted by their women-folk, are officially directing affairs. With the erstwhile politician discredited, and people in office whose primary interest is service, crime and disease among other disorders are be- ing relentlessly fought. While the above illustration was an aggravated case and the reaction ex- ceedingly strenuous, the general out- GOOD GOVERNMENT 165 look nevertheless is bright. By perse- verance and elemental justice, women now have their word at the polls, and in consequence they are intensely interested in politics. Attempts to develop blind partisanship within the feminine ranks have failed. This con- tingent is not especially interested in local Eepublican or Democratic can- didates, as such, but it is anxious to see men in control who represent ideals, clean conditions and real ser- vice. Is the candidate personally decent? Does he stand for a right- eous administration? Will he sin- cerely and conscientiously protect the community against vice ? These ques- tions will have to be answered satis- factorily before the women bestow confidence with their ballots. In addition to voting for candi- dates, women of organizations, such as the League of Women Voters, The 166 VICE AND HEALTH Federated Clubs, and others, will suc- cessfully persuade their husbands, hitherto scorning politics, to become personally interested. This will re- sult in enlisting them in the fight against corrupt politics, even to the extent of their becoming candidates themselves. Moreover, women will soon be directly controlling the house- keeping phases of government by popular election to offices of this nat- ure ; and it cannot come too soon. Due credit must be given to the men on their own account. Recent years have demonstrated a weakening of the old-time laxity in municipal matters. A very definite minority have, under one guise or another, sup- ported an aspirant for reasons other than his political connection. Indeed, the non-partisan feature of com- mission government has given great strength to this attitude even though, GOOD GOVERNMENT 167 by reason of machine tactics, its full- est expression is as yet unrealized. It is but logical to suppose that thoughtful and progressive men and women will in the near future under- stand that community welfare is a much larger problem than punish- ment and prison; and that from the standpoint of venereal diseases, the immoral can no longer be left to churches and courts to reform, the vi- cious to the penitentiaries to punish, and the feeble-minded to roam at large. It will also be appreciated, that housing problems are by no means limited to cries against the tenement house profiteer, and that the general uplift of a city cannot solely rely upon the occasional expression of some rich man's philanthropy. Prophylaxis in its most compre- hensive sense will then be considered a vital necessity. Community houses, 168 VICE AND HEALTH recreation centers, rational amuse- ments and municipal welfare will receive the attention they deserve. Stress will be placed upon the pre- vention of crime, more time and energy will be expended upon the con- ditions that foster disease, and hous- ing conditions will be approached from other than the ledger point of view. All of this is reasonable, and the more so because it will pay. Eliminating sentiment, the Golden Rule is the soundest kind of a busi- ness principle ; crime, disease and its associate, corrupt politics, cost enor- mously in dollars and cents alone. This cold-blooded business argument is being realized more and more ; and the sentimental one (if compassion and pity for suffering and disease can be so styled) is becoming most vigor- ously the concern of women. To conclude: If citizens will look GOOD GOVERNMENT 169 upon their town as a corporation in which, they have a special personal interest, and elect worthy representa- tives on the planks of righteousness, efficiency and economy, the elimina- tion of vice and its attendant evils will speedily ensue. INDEX Almsihouses, use of, as place of quarantine, 131 Apartmemt Houses, regulation of, 113 Army, physical condition of, 45 Automobiles, adjuncts to vice, 16, 31, 33 Cabarets, assignment possibilities in, 118 " Call " resorts, definition of, 30 Camps, eradication of disease in, 71 Case work, in clinics, 151 Central quarantine hospital, advantages of, 132 Chamberlain-Kahn fund, purpose of, 78 Chauffeurs), connection with vice, 116 Clandestine vice, definition of, 110 Clinics, establishment of, 73 "Closed" dance halls, definition of, 117 Commission on training camps, 67 County jails, use of as place of detention, 131 Dance halls, control of, 118 Dance halls, evils of, 15 Delinquency, how handled, 152 Detention hospitals, necessity of, 131 Education, advantages of, 137 Everhart, Dr., remarks of, 52 Fines, inefficiency of, 102 171 172 INDEX Free clinics, how financed, 83 Gans, Dr. S. L., statement of, 52 Government's fight, statistics on, 81 Group education, how accomplished, 143 Hardened prostitutes, disposition of, 152 Health menaces, defined, 126 Hospitals, clinics in, 84 Hotels, attack in, 112 Hotels, government's attack upon, 70 Hotels, use, of, for immorality, 28, 41 Houses of prostitution, internal economy of, 37 Industrial homes, advantages of, 158 Interdepartmental Board, creation of, 77 Jails, use of, as place of detention, 131 Law enforcement, limitations of, 119 Law enforcement representative, duties of, 105 Liquor, use of, in houses of prostitution, 36 Martin, Dr. E., statement of, 49 Mayor, power of, 104 Medical regulation, failure of, 24 Mexican border, activities on, 64 Motion pictures, publicity use of, 144 Normal schools, education in, 141 Pamphlets, educational use; of, 146 Panderers, definition of, 115 INDEX 173 Pennsylvania, quarantine in, 134 Pennsylvania State Police, duties of, as health officers, 135 Pershing, General, remarks of, 27 Pierce, Assistant Surgeon General, remarks of, 30 Play, a moral regulator, 160 Policemen, attitude toward prostitution, 101 Potter, Dr. E. C., statement of, 51 Pre-delinquency, how handled, 153 Pre-natal clinics, necessity of, 90 Prison sentence, advantages of, 103 Prison, sentence, handicaps of, 123 Prisons, objections to use of, as places of quaran- tine*, 132 Prisons, use of, as place of quarantine, 131 Procurers, methods of, 38 Prophylaxis, arguments for and against, 93 Prostitution, causes of, 12 Prostitution, definition of, 11 Prostitution, statistics on, 48 Publicity, advantages of, 145 Quacks, disposition of, 87 Quarantine, advantages of, 134 Quarantine!, methods of applying, 130 Quarantine, military, 69 Raids, discrimination in favor of casual, 127 Reform, attempts at, 19 Rehabilitation, in clinics, 155 Reporting venereal cases, necessity of, 92 174 INDEX Rooming houses, how regulated, 114 Rooming houses, immoral, 30 Rural sanitation, how accomplished, 86 Seattle, violence, attempted in, 23 Segregation districts, attacks against, 120 Segregation, failure of, 22 Social service, advantages of, 133> Social work, development of, 148 Social work, need of, 149 Social workers, clinical activities, 89 Social workers, necessity of, 85 State Police, use of, as investigators, 107 Street solicitation, definition of, 31 Taxicabs, control of, 116 Taxicabs, ordinances regulating, 70 The American Playground Association, activities of, 160 Vicei, forms of, 20 Vice Inspector, duties and necessity of, 106 White Slave Act, explanation of, 62 Women, political activities of, 165 - . 72 31173810)476^1.32 General Library University of California Berkeley Yb 07009