i>^ ;va]AiNa-3v\v ' -'//'•■ i.^ >MIIBRARY^/ y >* ;ijnv}jo'»' s^ ris; ^WEUNIVERS/A :'li3N\iOV^" '^/SaiAi.Na-j'.W ^OfCAl 6: iilWJJO' OSANC[l/-j> q^S — g ,>^^.llBRARYr?/ . m/^. %a3AINn3UV ■^vinsANi .13AIN(1-3WV % ^smwm^ '^/sa]AiN ' LlBKAin (>/ ii^ OJIIVJ-JO'^ 'JUJi^VMJi" 'oajAi!>i!jn>- 'au:1livjiv! .'JI|VJj\) FCAIIFO/?^ c-> £9 '^/5a3AINn-3WV^ •3^ ~^ 5^ . - OSANCElfj> ^1 ^^UIBRARYQ^ -v^lLIBRARYQ/: ^. %JI1V3J0>-^ %i AWEUNIVERS/a .vlOSANCElfj> -n V-J O u_ OUR NATION'S HEALTH ENDANGERED BY POISONOUS INFECTION THROUGH THE SOCIAL MALADY THE PROTECTIVE WORK OF THE MUNICIPAL CLINIC OF SAN FRANCISCO AND ITS FIGHT FOR EXISTENCE BY DR. JULIUS ROSENSTIRN, Chief of Staff and Attending Surgeon Mount Zion Hospital; Chairman Advisory Committee Municipal Clinic. SAN FRANCISCO 1913 Printed by Thk Town Talk Press San Francisco. Cal. 9574N \-,q 12.5 a5R7 PREFACE This publication is issued for a tzi'ofold purpose. It is a public denouncemeut of an uin^'arrantable ivrong done in this city by the suppression of an institution that has been niost active for the benefit and preservation of the public health. This institution, the Municipal Clinic of San Francisco, a pioneer in its aims and system, has made a truly successful effort tozcard a solution of the ever present problem of the social malady, prostitution, and tozcard minimizing its resulting injuries. The zvave of a frantic and reckless so-called moral' purity Reform movement, zvhich has temporarily destroyed the good zi'ork of the Municipal Clinic, is inundating the entire country and foreshadozvs stricggles sijiiilar to the one fought here. Efforts elsezt'here of the character of the Municipal Clinic, to check the terrible spread of venereal disease, zvill meet zvith the same mode of opposition by the same kind of people zcho are responsible for the harm done here. The same pious prudery zvill voice its horror, the same tactics, the same political pressure zvill be used to suppress or retard the good zcork. I am divulging the plan of attack of the opponents of sanitary reforms of the social malady, and offer some of the zveapons which in time zvill surely bring victory to the banner of Social Hygiene. I sincerely hope these pages zcill aid in defeating tJie reaction- ary measures of those zvho zvorship at the shrine of shattered antiquated idols, and zvho are offering as a sacrifice, the Natio)i's health. Julius Rosenstirn. San Francisco, September, ipi^. Copyright, 1913 By DR. JULIUS ROSENSTIRN OUR NATION'S HEALTH ENDANGERED BY POISONOUS INFECTION THROUGH THE SOCIAL MALADY THE PROTECTIVE V/ORK OF THE MUNICIPAL CLINIC OF SAN FRANCISCO AND ITS FIGHT FOR EXISTENCE BY DR. JULIUS ROSENSTIRN, Chief of Staff and Attending Surgeon Mount Zion Hospital; Chairman Advisory Committee Municipal Clinic. These pages are written for men and women. Read them with a mind free from prejudice, and with a spirit not shrink- ing from a full, clear and unminced discussion of the most important sanitary problem of the hour, the SOCIAL MALADY— PROSTITUTION. Among the American people there has always been a most stubborn opposition to the free discussion of this burning question. The taboo that educators have put on the theme of sex relation, on a thorough instruction in the origin of human life and its procreation, has resulted in the profoundest ignor- ance among the laity of these most vital matters. Not only the young, who are carefully kept in complete darkness, but the great masses of people, grown-ups and old, have at best but a vague and hazy conception of conditions, the knowledge of which is far more essential to their happiness than familiarity with the geography of Asia or even the history of the L^nited States. Instead of arming the young with the clean and sharp weapon of knowledge, they are permitted to enter the battle of life with its temptations and pitfalls, ignorant of all its most vital constructive and destructive conditions, or they are at best merely provided with scraps of misinformation snatched from the gutter. And the good, oh so good, people, indulge in speeches de- ploring the depraved morality, the downfall of the present generation. Tears are shed mourning over lost souls and ruined bodies; but all this emotional display is obscured by mysteriously veiled language, that the new young who come after the lost ones, who form the fresh clean ranks replacing tlitisc ilociiiKitoil hy imi< uaiut', ma\ imt Icani, may not know ; may not have the only protcctit*!! that counts — knovvlcdi^c. Ilca\cn l\trbi(l that anyone slionld discuss such matters pul)Iicly and freely ; it mij^ht afTect the pure, — open their eyes perchance — it mij^ht injure tlie hHnd to i^ive them sig^ht ! Do these same .i;i)od people really believe they can sale- jjuard the fiercely dominant sex-call of awakening youth with mild and vas;ue precepts? Cage tiie monarch of the jungle hehiml moscpiito bars and rejoice in the safety it guarantees? lUit these good people declare that the public does not want to hear about the social malady, about prostitution and its dreadful consequences in the spread of loathsome diseases. That is not true. The public, the great mass of the people, are always eager to gain knowledge of conditions for the preservation of their health and happiness. But they are ig- norant, i^itiably ignorant. Tell them of the dangers, of the terrible ravages due to \ enereal diseases, tell them that 80 per cent of all deaths from inflammatory diseases peculiar to women, the necessity for 7S per cent of all gynecological operations and for more than 60 per cent of all that kind of medical work is due to these infections. Let them know that up to a few years ago, before the Crede prophylactic eye-treatment was generalized in Germany, and even now where it has not been adopted. 80 per cent of disastrous inflammation of the eyes (ophthalmia) and 20 to 25 per cent of all blindness has been caused by gonorrhoeal infection, chiefly due to the passing of the new-born babe through the diseased maternal genitals. Tell them that about 80 per cent of syphilis-infected children die in their mothers' wombs, and the 20 per cent living carry w^ith them the lifelong marks and defects of mind and body as their heirloom, transmissible again to their offspring. Add to that the recital of the efTects of acquired syphilis, its de- structive work on the vital organs, its causation of paralysis, locomotor ataxia, insanity combined with the unceasing appre- hension of Damocles' sword during the victim's lifetime. Our institutions for the feeble minded, our insane asylums, both filled to overflowing, draw their largest percentage of inmates from the victims of acquired or inherited syphilis. All these unfortunates, sheltered in public places of refuge, constitute only a fraction of the stricken ones; the far greater number are kept cautiously guarded from the public eye under private care. . Let the public know that gonorrhoea, considered by them a slight, if not a negligible disease, is the cause of untold suf- fering to wives infected by their incompletely cured, inno- cently ignorant, young husbands, finally resulting in their 8 becoming unhappy matrons of childless homes. Tell the pub- lic that the individuals infected with these venereal diseases far outnumber the sufferers from all the other infectious dis- eases combined: that a moderate estimate from the pen of Dr. Adolphus Knopff (Professor of Medicine in the New York Post Graduate Medical School and Hospital, and Director of the New York Health Department Clinics), for that great city alone reaches 200.000 syphilitic, and 800,000 gonorrhoeal, or a total of 1,000,000 venereally infected individuals. A later statement made only a few weeks ago by the eminent British army surgeon, Major H. A. French, before the International Medical Congress in London last July ( 1913) gave the number of sufferers from syphilis in Paris as 17 out of every 100 men. New York exceeds this, having over 20 per hundred or one out of ever}^ five. And let them hear that part of the last annual report of Secretary of War Stimson, wherein he says : "The high percentage of venereal disease continues to be the reproach of the American army, and the daily average number of those sick from that cause during the past calendar year was larger than the daily number of those sick from all other of the more im- portant diseases combined." The figures as given by the Surgeon-General for diff'erent armies emphasize this statement. The percentages of venereal diseases are: in the British army, 7.6; in Austria-Hungary, 5.4; in Prussia, 1.9; in the United States, 19.7. "I believe," continues Secretary Stimson, "that the ultimate causes which make the record of our army in this respect shameful beyond that of the army of any other civilized nation, are inherent in our own shortcomings as a nation in dealing with this matter. So long as in our civil communities, and particularly our larger cities, we continue to close our eyes to the magnitude and extent of the evil and refrain from attacking it with all of the weapons which modern scientific knowledge places in our hands, it cannot but be expected that the younger men in our army, leading the abnormal life of the soldier, will show the effect of the evil to a marked degree." After all this has been said to our general public, does anyone believe the people will still be adverse to a free and open discussion? Or is it not more likely that from all quar- ters a great cry will arise demanding light for all the dark corners — a cry for protection — for relief from this devouring monster Minotaur? Investigations of red light conditions of a most serious and far-reaching nature have recently been carried on more or less simultaneously in numerous large cities of the Ignited States. \''ice commissions voice their rightful indignation at the existence of a white slave traflfic flourishing under the very eyes of official authority, with those eyes closing at convenient intervals. These commissioners have not stopped at mere plaintive coiniiKiits. The}- appidaclicd this task uiiprci)areil t\)r what it would reveal, i.mioram ••! tlu' \ ast extent of the tioUl thev had to cover; ignorant ui tlic many and widespread rainitications their work disclosed. They were good men, all of them. They were deeply and profoundly shocked. And from the vitilence of their reaction from this shock there emerged a code of laws, a series of e^licts. to legislate sex-virtue to mankind; to dic- tate ahstemious purity, to su])press prostitution and persecute its votaries. All this cant about the iminirit}- ul the sexual act sounds like blasphemy. As the ultimate expression of the loftiest sentiment that moves the heart of humanity, the ecstasy of its emotions lends inspiration for the most beautiful works of art by sculptors and painters, poets and musicians. If anything is really impure in itself can a few words uttered by an official oi state or church render it pure and holy? Is there any sense in the laws of some of our states making the sexual act of unmarried individuals a punishable crime, while sanctifying it with a license issued by either state or church? On physiological grounds the necessity of the sexual act for the preservation of the individual's health has been dis- puted. The greatest nerve specialists of the day, Professor Freud of Vienna, and the followers of the modern school of phsychiaters and neurologists, claim on pathological grounds, and give satisfactory proofs, that many grave disorders of the nervous system are caused by the suppression of sex desire. But does the belief or unbelief in the dire necessity of sexual intercourse really decide anything? Or is not the only important essential fact best stated in the words of Havelock Ellis*, the greatest authority on matters relating to sexual relationship? "Love and hunger are the foundations of life, and the impulse of sex is just as fundamental as the impulse of nutrition. It wmII not remain absent because we refuse to call for its presence ; it will not depart because we find its presence inconvenient. At the most it will only change its shape, and mock at us from beneath masks so degraded, and some- times so exalted, that we are not longer able to recognize it." etc.. etc. It is needless to add that application of the oft proposed remedy of early marriage is as impossible for the great majority of laboring men as following an advice to loaf at the Riviera for the impecunious tuberculous patient. Fortunate * Havelock Ellis, The Task of Social Hygiene, 1912, p. 255-6. 10 these laborers are, if they earn enough throughout the year to support themselves decently. Here, free love or, where circumstances prevent this, pros- titution offers the substitute wife, and it is prostitution only that stamps the sexual intercourse with impurity. The com- mercialization of an act, that should be the last and highest consummation of mutual affection, is to all our better instincts revolting and abhorrent. If the suppression of sex desire and abstinence from its gratification cannot be generally enforced by legal or other methods, how about the present effort to persecute and sup- press prostitution by the enactment and enforcing of laws? These investigators of the social malady question could not have been ignorant of its history. They must have known that Europe for many centuries had enacted and enforced similar and much more cruel laws, imprisoning, banishing, maiming, flogging, nay, even killing prostitutes and their allies, up to the time and during the reign of Maria Theresia of Austria. And in spite of all the laws similar to, and severer than ours that have been written, enacted and enforced, in spite of most cruel punishments inflicted, the social malady has remained with us since time immemorial and is as widespread today, secretly and openly, as at any time in the world's history. The social malady remains the most ancient cancer of society ; it does not stop at the moral and physical corruption of its own votaries, but carries germs of loathsome diseases along diverse channels and secret pathways, permeating the social structure in all directions. From the house of shame these germs are carried to the trusting helpmate of the home and to its innocent blessing in the cradle, turning it into a curse. Can we legislate people to become deaf to the passionate call of sex? Do the laws stuff cotton into the ears of men and women, as Ulysses put Avax into the ears of his crew when his ship passed the isle of the sweet singing sirens? We, in the United States of America, have preserved through centuries of progress along other lines, antiquated criminal laws in a moral code of puritan manufacture. They have long been abandoned or ignored by the other civilized nations, but enjoy perennial bloom in this countr3^ These laws have not helped to improve our morals and they cer- tainly fail to enlist a higher respect abroad. Havelock Ellis* says with reference to tliis: "F^aws and * Op. cit., p. 281. 11 rejjulations of the incilic\al kind, idi" tlii' moral (irdcrin;^ of the -niallost ilctails i>f life, arc still enacted in America, but they irc rciianlcd with i^rowiiij;- contempt by the community and even by the administrators of the laws. It is realized that >uch minute inijuisition into the citizen's ])rivate life can only be ctTectively carried out where the citizen himself recognizes the divine ri.ijht t)f the inquisitor. Hut the theocratic conception of life tio lonj^er corresponds to American ideas or American customs; this minute moral le.y,islation rests on a basis which in the course of centuries has become rotten. Thus it has come about that nowhere in the world is there so j^reat an anxiety to place the moral ret^ulation of social afTairs in the hands of the police; nowhere are the police more incapable of carryinc^ out such regulation." And furthert : "A sudden impulse seizes on a community and spreads to other communities to attempt to suppress some form of immorality by law. Such attempts, as we know, have always ended in failure or worse than failure, for laws against morality are either not carried out, or, if they are carried out, it is at once realized that new^ evils are created worse than the original evils, and the laws speedily fall into abeyance or are repealed. That has been repeatedly seen and is well illustrated by the history of prostitution, a sexual manifestation which for two thousand years all sorts of persons in authority have sought to suppress ofT-hand by law or by administrative fiat." To illustrate the working of some of these laws, let me mention a law against adultery passed in New York State in 1907 and rendering any person convicted of adultery liable to be punished by six months' imprisonment, a heavy fine, or both. The National Christian League for the Promotion of Puritv was responsible for the enactment of this law, which was intended to prevent adultery. The law became a dead letter less than three months after its enactment, and in the two years following only three persons, under this act. were sent to prison for a few days and only four fined a small sum. The Committee of Fourteen in New York City stated: "It is of practically no efifect," adding, "The preventive values of this statute cannot be determined, but judging from the prose- cutions, it has proved an ineffective w^eapon against immorality and has practically no efifect upon commercialized vice."* I'pon an infjuiry into the state of red light conditions in cities with a poj)ulation of 25.000 and over, tliroughout the p. 284. The Social Evil in Xew Vork City. i>. 100. 12 country, the ^^lunicipal Clinic received answers from ninety cities, showing the inefficiency of restrictive laws. Answers were requested to questions regarding" the preva- lence of the social malady, the attitude of the authorities toward its toleration or suppression, and the ensuing result as to its presence or absence in their community, with its effect upon the distribution of specific diseases, and the state of local opinion. This collection of answers to our queries is a sadly con- firming commentary on our views regarding the effect of a relentless persecution. I shall only quote here Iowa, as the pioneer state for strictest suppression. The legislature" of Iowa passed the severest ^restrictive laws (October, 1908). and from a com- parison of the three answers from three different Iowa towns to our questions, one easily perceives which one of the three officials states the true condition of affairs, and the attempt of the others to paint with rose-colored tints. \A c t- *• 3 a •? o — " '- 6 « ,_ t"^ ^ u -s y s S.E c •a u R u c P 2 t. u o y C = ri " S te O E : o';: o S^o 2-" •^Xl g-S E" n O n c •" u u c- n m S 2 = o i2 < J cap "J So o2 o2 •J.'S O O o I. » o O u S ^'- Sc3 go au, HO S * S o n mC I -2S5^c S!-- 11 bee's c t3 o g * b c »'""^" . 1-1 > re E ax S « oi o c o " S cjf)(^>^E2 «puZ QOKO >hHP c« -U a Oh HgQc/2 H r,* K ► -, "■• OSTI FI Y O RIOl CITY CJc=^< ^aS^^ f^gn^ T3 hPmW <0W05z;h « X " 'f '" v o ^ c c o « o . ■no ^ c •- ^"^"^ aE2 lu .5 HW mW Q w H J C/5q mI-I ^< :50 ^S o ■^ o. >> 5 S wg o m 5, E-i D a < J 0^0 ah " O m •5^ S «'*' bo's 4J bo <" m "^ M ^ ■- " ag "^ x £ Ss U 0:= c3 « j; "^ ta X.^ V. "-^ £ tr S I " S vl 0X1 T3 Q iv. n 5 o o — ';:; o u e-s 6:i bo 4^ U) bo m'' 1) O ^J2 i-J n H cr, << , , Hr nur own sister t«'\\n, I.ns Aul^cIcs. has tried stern rcpros- si\e measures ami the sail results are (tul\- too well known. \\ itli the enforcement of pcrsecutinj; laws, and upon the closure <*\ their tolerated iiouses of prostitution, the inmates scattereil all over the various city districts. Residential and business parts became alike infested with the presence of prostitutes. Street walkers multiplied and reports of scandals of the worst character, in the city and its siuToiuKling' suburbs, filled the air and the colunms of the public press. Worse than all. an era of spyinjj^ and blackmailinj.; has followed which clouils the serenity of the suutheru sk\-. Portland. Oreg'on. is another of the cities which have be- come aware that means. difTerent from suppression, and far closer to the root of the social malady, must be employed to inhibit prostitution. The actin_e^ mayor of that city authorized the representatives of the Clinic, in their memorable confer- ence before our Mayor Rolph. to inform him that the abolition of re.^^lementation and segregation and the enforcement of prohibitory punitive measures had scattered the votaries of the red light districts all over the city, and had proved a lamentable failure. These examples could be multiplied indefinitely. Recently, in New York, before the investigating Board of the Curran Committee, Mr. S. London, a former District Attorney of Texas, stated, as a sworn witness, that he had been employed for seven years as a government expert with a corps of sometimes fifteen assistants to examine the white slave traffic conditions throughout the country from Alaska to Florida and Maine, and gave as his opinion that San Fran- cisco ranked morally as one of the very best cities in the United States, on account of its reglementation. a measure which he considered the best means of minimizing the evils of prosti- tution. Identical information from municipal bodies has come to us from all parts of the country. These are not the views of vice commissions, professors, academic and moral theorists, but convictions acquired after long years of daily contact with this phase of life. There are very good reasons why these repressive measures fail in their purpose. Medicine has long ago recognized that the real delivery from diseases in general, and from filth and germ diseases especially, lies not in the cure of attacked individuals, but in the prevention of the attack. Formerly a fresh supply of newly infected cases always replaced those who had recovered 16 through the administration of drugs. Thus the course of the epidemic continued. For centuries we have used the properties of cinchona, or quinine, as the sovereign remedy for malarial fevers. But only since the discovery of the transmission of these disease germs through the mosquito, and the successful warfare against this death-dealing insect have we achieved any real results in checking the spread of that disease. We did not create or enforce laws for the people of Havana, of Louisiana, or the Canal Zone, rendering them guilty of a misdemeanor or a felony if stricken with malarial and yellow fevers. But we went to work and cleaned up the cities, the cesspools, the marshes, spread oil over the breeding places of the infectious insects — in short, gave them a general house- cleaning, and we obtained results that astonished the world. The discovery of the relation of the rat to the plague and its consequent extermination is another example of the victory of modern preventive science. The social malady will offer the same resistance to any sur- face scratchings for extermination. Ignorance, mental de- ficiency, sordid surroundings, love of finery, seduction and fraud, economic struggles, sex desire, all combine to furnish fresh recruits for the ev^r renewing contingent of the red light district. Is a law against the ready-made prostitute a remedy for these evils? Will laws against the houses that harbor ready-made prostitutes eliminate the causes that created them? Can laws stifle the most passionate desire that human flesh has been endowed with? Can laws restrain young men and women, the mariner returning from the voyage, the miner, the w^oodsman, the cowboy, all those who invade social centers after periods of isolation ; can laws force them to wear the garb of purity and grow the wings of angels? Let us remedy the lack of education for the ignorant and the failing, the lack of close guardianship and protection for defective children, for the houseless, homeless waifs, the off- spring of the shiftless and inebriate, for all those drifters to- ward the abyss. Poor social conditions among the great masses of women workers, domestic and industrial ; and last but not least, the absence of sex education for the young; these are the causes for the continuous recruiting of the ranks of pros- titution. It will not suffice to close the brothels, to tear down the shelter of the prostitute, to hunt and imprison the street walker. For the RED PLAGUE as well, we have to exter- minate the mosquitos, kill the rats, fight the causative ills; 17 and tlic ills \\ c ha\o to coikhkt arc st>c'ial untUness, is^iiorance and poverty. Not io the violence of revolution, with destruction left in its path, but to the work of evolution do we look forward; evolution, mother of all real progress in this world of ours. But the proj^ress of this work will be slow. Generations will pass, will come and pass as^ain, before it will be achieved. During: all that time a constant current of poison from the social malady will ceaselessly,, unrelentingly, enter the body of the nation, and will penetrate to its very marrow. STOP IT! FOR YOUR OWX SAKE, FOR YOUR CHILDREN'S SAKE. FOR YOl'R COUNTRY'S SAKE. STOP IT! An imperative demand for active sanitary interference with this general pollution of all classes and ages is urged by modern hygiene upon its medical disciples, leaving the task of the moral and sociological struggle to specially skilled edu- cators and social workers. The first institution to carry out strictly sanitary, scien- tific and humanitarian methods was established in this city March. 1911, and has been in existence ever since, under the name of the iMUNICIPAL CLINIC OF SAN FRANCISCO. A short time after the conflagration of April, 1906, the Civic League of Improvement Club&, an association repre- senting all the various improvement societies throughout the city, inspired by a rejuvenated ambition, was founded to help in rebuilding, for the old. a beautiful and modern sanitary city. The Committee on Health, Pure Food and Tenement Legislation, the chairman of which I am honored to have been since the birth of the League, soon recognized the importance of its task. Directly after the fire, with the general scattering all over the city of the unhoused prostitutes, occurred a period of unusual frequency of venereal infections. We felt it to be one of our first duties to stem as far as possible the inflowing tide of contaminating disease from the red light votaries. In order to be sufficiently prepared for future recommenda- tions, the Health Committee, together with the Committee on Public Morals, through its chairman. Dr. Frink. entered into an extensive correspondence with many of the large European cities where regulation is practiced, and obtained thorough information on the various systems in vogue there, which was collected in a voluminous report. After an unusually long period of preliminary discussion, extending over 3^ears, the Board of Health at last called a meeting with my Committee 18 of the Civic League, a small committee of representative citizens, including clergymen of various denominations and members of the State Board of Health, for the purpose of formulating ways and means for the reglementation of the red light district. Prolonged deliberations finally culminated in the unanimous passing of resolutions, which, recognizing the urgent necessity of measures for a sanitary regulation of immoral houses, called upon the Board of Health to pass or- dinances for such a purpose. In a later joint session, a set of ordinances was passed by the Board of Health establishing the Municipal Clinic under the management of an independent Advisory Commission, to consist of representatives of various classes of citizens and the President of the Board of Health. Through changes in the personnel of this board, its president dropped out, and the present Advisory Board is composed of a lawyer, Mr. W. H. Metson; two business men, Mr. W. H. Ford and Mr. H. L. Morrison ; a broad-minded clergyman. Father Wyman ; the Superintendent of Public Schools, Mr. Alfred Roncovieri ; and two physicians. Dr. Martin Regensberger and Dr. Julius Rosenstirn. (Chairman). The Advisory Committee is non-political, its members at present are permanent trustees, not subject to appointment either by public officials or by election, and fill vacancies or add to their number by determination of the Commission itself. While it must be recognized that such an institution should be conducted best by the proper city authorities, this separation from all public officialism in the early part of its existence had its great advantages and was one of the fundamental condi- tions for its success. It freed the Commission from all political influence, and positions in the service could be given and held for merit only. If there existed any graft, the Clinic stopped it effectively. Financial independence was secured by charg- ing the nominal fee of fifty cents for an examination. There is a certain moral efifect connected with the exacting of this fee, a sense of self-dependence is developed in these women and they feel that the benefits derived from the Clinic are not charity gifts, but paid for and their proper right. From this income the Clinic not only defrayed all its expenses but a surplus was accumulating intended to help in time toward estab- lishing an intermediate rescue home for girls who want to abandon that life. In cases of financial disability the fee is remitted. The Municipal Clinic was opened in March, 1911, and its more than two years of active existence had given promise of 19 cry slate of health, a certificate to that effect ensures freedom from petty harassment, consequently there shouUl be no reason for the purchase of tolerance or favors, nor the necessity oi protection by a special friend. The Clinic lias until lately liecn enjoying the active co- operation of the police dejiartment ; and two policemen, care- fully selected for their s])ecial fitness, were detailed for its per- manent service. They made daily and nightly rounds of the red light district, prevented the infected bookless women from plying their trade, and remanded the delinquents for clinical control. For every new client, a booklet* is prepared at the first ex- amination, which contains a small photograph supplied by the girl, and the records of subsequent examinations. Votaries of the red light district without this certificate were charged with vagrancy and brought before the police judges who suspended the sentence under order of compliance with the sanitary regula- tions of the Clinic. All houses of the red light district that harbored inmates without this certificate, or with prolonged delinquencies, w'ere permanently closed after the first warning had not been heeded, and a repetition of the offense detected. The examinations of the Municipal Clinic are thorough, being carried on with all the requisites of modern science. The staff of the Clinic consists of a superintendent, two male physicians for the examinations, and one female physician for the treatment of the clients, a bacteriologist, a nurse, a matron, a cashier and stenographer, a clerk and a porter. The annexed plan will help to illustrate the modus operandi. It shows the entrance, the first waiting room, the microscopical and bac- terio-serological laboratory, the examination booths, the second waiting room, where the women await the result of the micro- scopical examination and the exit. • See Page 22. 20 Z .0*^ \ z Q: UJ a Z O o cr vo z < cr Z o o a e5 z I o z o o lu CO Y V. I LU U. -I U_ O O / \ X LU \ r »- O O CD SHlOOa Ol AVMmVH < X 4 OCP r ^ >- o O CD < I'laoli iicwiy roi^istorod j;irl must iindor^o a s])ccial l)k)od lest to ilctormiiie whctlior she is atilicted with a specific blood disease. If ihc test proves distinctly positive, even though no other synipti>ius are present, two intravenous injections of Khrlich's latest remedy, the new Salvarsan, are given at in- tervals of one week. If after a varying period of ohservaticMi and regular after-treatment no s\niptonis aiijiear, a booklet is given to her and she must then ctmform to the connnon regulations of clinical inspection. ^■■H Rr,.;. . As- -, 1 li,r _ 1 Grn«»! Byild Va.U.M«luo.SMr,? 1 s. r. M iclpal Clinic Report of Eiamlnalioifl ■ — *-■•-— _ jJH Upon an examination showing the client to be suffering from an infectious disease her booklet is taken away from her and she must go into retirement and undergo medical treat- ment until pronounced cured by the doctors of the Clinic. It is the client's privilege to employ her own physician if she chooses, or be treated by the specialist of the Clinic. In the latter case no fee is charged, the previous payment for exam- ination insuring gratuitous treatment for specific illness, in- cluding free hospital accommodations, if such are necessary, or financial straits render self-support difificult during a longer vacation. The patients are distributed among the wards of the City and County Hospital, but the Clinic pays the hospital charges, thereby also relieving its clients from the objectionable demon- stration before student classes. It has been most gratifying 22 to note that the number of patients seeking aid from the Clinic has been steadily growing during the last year, so that only a very small percentage of our clients sought outside medical attention when ill. Whatever has been their choice, a return of the booklet depends upon the result of three or more exam- inations during the course of a week by the chief clinician ; upon their satisfactory outcome rests the permission for end- ing the retirement. Precautionary measures against any sort of graft are amply provided for in the Clinic itself. These cards : "THE FEE PAID FOR EXAMINATION IS THE ONLY FEE THAT WILL BE AC- CEPTED BY THIS INSTITUTION. ANY CASES COMING FOR TREATMENT RE- CEIVE ATTENTION ABSOLUTELY FREE OF CHARGE. NO GRATUITY OF ANY KIND CAN BE ACCEPTED BY ANY NURSE, PHY- SICIAN, OR ATTENDANT, UNDER ANY CONSIDERATION WHATSOEVER. ANY VIOLATION OF THIS RULE WILL BE PUNISHED BY THE DISCHARGE OF THE EMPLOYEE ACCEPTING THE GRATUITY AND THE PENALIZING OF THE PERSON GIVING THE GRATUITY BY WITHHOLD- ING THEIR CERTIFICATE." are placarded in every booth and at various other places in the Clinic rooms. The threat of being deprived of the booklet prevents any attempt on the part of the clients to gain favor- itism. The clients are called and known to the physicians by their current number of the day only, and are continually shifted around ; moreover, the physicians of the Clinic are, on penalty of instant dismissal, forbidden to attend any one of them in their private practice. Each client receives a folder* slip with a small diagram-sketch of the anatomy of the female organs for her booklet giving brief instructions about the various maladies to which she is in constant peril of being exposed. They are urged to ask the examining physician for instructions how to protect themselves against infection. As a further precaution for the strict conformance to the Clinic's rules and for the public's protection, cards have been placed in all the private rooms of these houses urging the visitors to ask for the booklet of the inmate and inspect the date of last examination, warning them, at the same time, that no complete protection against infection can be assured under existing conditions. • See Pajjes 24-25. 23 - C c « J= = ^ 01 X E S - o ■>-' ^ ESS ^ o 5 o -« _o -^ ^ E ^ ■•r. > H E ^ Ha) o •S fJ S « C 3 5 •^ -4-» m C 3 <1> ^ (O ,i2 ^ <*-( O _£- - o ~ 2- £ ^ ^ pi ».i >~t 0? ;ii " cs £ >^ 2 a . .r rt 2 tc — be o 9 >- rt ';: '5 (^ c £ •^ ►^ -c M «4-l * 15 ^ to C^ m ■w O -4-> •^ rt j3 S =M .a "e ;:; tyt rt tao 1^ tH Zi xn M Jz; Q ■ ■ O w § Eh pq g C3 M g S tc f^ w < oo cc Z a c (9 >- e/> •- U c c C w ■"* f3 05 oi ^>'^';3'OJ .3-^ ^ r= Oc -t^ C . E — -">•'^ac«'rlr- c« -a 5 a «+-! be i ra « ^ ^ b£ i; t: c c; p- a sa '5 s ^ bt TJ ."t^ ^ a a ^ a ^ rt +^ ^ £^ 'a l-« >-, =4-1 .» -^ /-s M « be be (m a ;-! be Cj .^ — rt _a p , -i-» Vj rt ti "^ 2 £ a « o v -M ;^ a 'S •^ ce S a y. o a a 2 'a - PI TJ C :« s c a 02 "-^ *A -^ JT- w C3 PL4 ;>. o >* ■r. a CQ o te t: o ^ t- m o bO a eS 0) rt :s o bjD bo •- a E-. -.^ 24 Look at and study this lengtuwise halfcut (Longitudinal section), through female pelvis with its organs, and try to understand it. ASK THE DOCTOR AT THE CLINIC HOW TO MAKE PROPER EXAMINATION OF YOUR VISITORS, AND ABOUT ANYTHING ELSE YOU DO NOT UNDERSTAND; HE WILL GLADLY EXPLAIN. DO NOT FORGET THAT THE MUNICIPAL CLINIC IS YOUR FRIEND AND FOR YOUR OWN PROTECTION. 25 ASK FOR THE MUNICIPAL CLINIC BOOKS AND SEE THAT THE LAST EXAMINATION HAS TAKEN PLACE WITHIN FIVE DAYS PRECEDING TODAY. *The public slionld realize, however, that not- withstandincT the i;reat improvement of conditions throus;h these res^^ular examinations, no guarantee of absolute safety can be assured. MUNICIPAL CLINIC 682 Commercial Street. This warning- has been especially insisted upon to remove from the visitors' minds the impression that the Clinic con- siders it possible that any activity in this direction could be so complete as to insure a perfect immunity from contamina- tion. And yet this very precaution has been construed by the opponents of the Clinic to be an attractive encouragement to frequent these resorts as it allayed the fear of infection. The fear of disease is an infinitesimally small factor in pre- venting men from visiting prostitutes. Every physician who ever handled patients with these aflflictions knows that even before complete recovery they are urging their medical ad- viser's consent to their resumption of sexual intercourse. If those who have had the experience and suffering from an attack of sexual diseases do not refrain from rushing into the hotbed of danger of repeated infection, how many without this still vivid memory of recent anguish will be restrained by the mere phantom of fear? Even if there should be a few isolated cases induced by reliance upon the Clinic's examina- tions to visit the red light district, are they not far outweighed by the numberless preventions insured by the added pre- cautionary control from this card? Another objection has been raised against the claim of efficacy in the Clinic's preventive sanitary work. Our oppon- ents insist that no benefit can spring from control, as no matter in how clean a state a woman leaves the Clinic after her examination, she may become infected within a few hours and be again a source of contamination for her visitors. We do not deny that such cases may and do occur, but under this system of regulation she will have to undergo another examination after four days and if diseased she will then be stopped. With no 26 control she would go on indefinitely. We have never claimed to be able to prevent each and every infection. We do the best possible — no more and no less. So many opponents of regulation seem to worry about an apparent discrimination against women, caused by the exclus- ive examination of females. They should know that the exam- ination of the male visitors is made in a practically thorough manner by the women themselves. The physical configura- tion of the male organs makes this an easy task, and, fur- thermore, the doctors of the Clinic give to those few who are inexperienced the necessary information. A daily consulta- tion hour for the free examination and treatment of men for venereal diseases had moreover been determined upon by the Advisory Committee. At our institution these women are accorded the treatment of private patients. We experience no difficulty or resistance in the carrying out of our system ; we issue no commitment to a lock hospital ; the hospital in which our patients are taken care of is unlocked, free, with only one escape registered dur- ing the two years of our work. Thus we try to reconcile the necessity of enforcing sanitary control of this distressing malady with the modern spirit of forbearance. Although during the two years of our \vork the morbidity among our clients has been decreased from 147 to an average of about 50 per thousand and although of those continually under our supervision (old registration) only 4.5 per cent are infected, while among the fresh entries (new registration), 38.6 per cent, or more than eight times as many are afiflicted, still we realize that our work is far from accomplishing per- fect results. Here are the exact figures for this year : COMPARATIVE LABORATORY REPORT OF INFECTED CASES OLD REGISTRATIONS Month Number Number Reporting Found Diseased 1911, Mar. (1st month of clinic's operations) 1913, Jan. 685 30 Feb. 665 31 Mar. 678 34 Apr. 650 31 May 664 31 POLICE SUPPORT OF THE CLINIC WAS W^ITHDRAWN MAY 20. 1913 Nothing in our work should hinder the immediate intro- duction and energetic pursuit of other medical as well as edu- cational measures to lessen the ills and to guard against the temptations of prostitution. It would greatly aid the sanitary work if an immediate report by physicians of every client 27 NEW REGISTRATIONS r Cent Number Registered Number Found Pe r Cent Diseased 14.69 14.69 4.3 70 16 22.8 4.8 31 12 38,7 5.0 29 4 13.8 4.77 26 6 23.08 4.66 29 3 . 10.35 sutTorin_ii' from \oiiorcal diseases would be sent lo the local hcallh authorities and suhse(|ueiU official watchfulness exercised o\er these jxitients. It is very doubtful, however, if laws to compel full reports and control would be obeyed in the face of the social disi;race which, at present, these venereal diseases, when disclosed, entail upon their unfortunate victims. The California State r.oard oi liealth has issued a regulation for all physicians within this state to report such cases of venereal infections, by a private current number only, to the secretary of the board. Although secrecy is fully guarded by this measure, as the board never learns the names (,)f the patients reported to them by number, nor identifies them in any other way. still the re- turns during the three years' life of this regulation have been quasi nil. It will take many years to reconcile the American public to such a step which uncovers the most intimate private actions. While it must be granted that a general law requiring full report and strict control of all venereal diseases, if eventually carried out, is bound to aid in the preservation of the nation's health, it will not replace the Clinic's work which is based upon immediate action against the scourge of today. The plan to have sex hygiene taught in the higher grades of the public schools is most commendatory, according to our judgment. This work has for some time been carried on in various European countries and an extensive illustration of its methods, with all the paraphernalia requisite for a thorough although delicate and painstaking instruction, w^as ex- hibited in that wonderful Dresden Hygiene Exposition of 1911, and on a smaller scale in the Congress of Hygiene and Demo- graphy at \\'ashington, D. C. in 1912. This instruction has, in a measure, been introduced in the schools of Chicago and, according to a most reliable and lucid report of Prof. C. E. Rugh, has met with complete success. Its general introduction throughout the country, however, will have to fight a very powerful opposition which will retard its adoption for an indefinitely long period. One of the inestimable advantages of the Clinic's work is that it need not rely upon vague promises of a possible future help, but it benefits the people of today and tomorrow. Its good results, however, were not solely confined to the field of sanitation. To our successful work was also due the practical dis- appearance of the procession of street walkers, so that solicit- ing on public thoroughfares rarely occurred in this city. In 28 the reduction of the morbidity to about one-third among our entire floating contingent of approximately 2,500 women and of nearly 1,000 individuals during each month, we prevented at a conservative estimate, the possibility of infection in far over 100,000 cases annually in this city alone. This is a task well worth every possible effort, and if our application for separate examination of the public dance hall girls had be- come an order, these girls having been freed from control, although they are nearly exclusively recruited from houses of prostitution and constantly interchange with the inmates, we should have increased considerably the number of prevented infections. The constant friendly commvmication between staff, em- ployees and clients has been conducive toward establishing a confidential relationship, and, without any direct missionary effort or intention, it has been possible to rehabilitate a large number of these unfortunates. ABOUT 140 WOMEN HAVE BEEN PROVIDED WITH AN OPPORTUNITY OF QUITTING THIS LIFE BY SECURING THEM RESPECTABLE POSITIONS. OVER 50 NEOPHYTES, UPON MAKING APPLICA- TION FOR REGISTRATION, WERE PERSUADED TO REFRAIN FROM ENTERING THE LIFE. A NUMBER OF MINORS WERE TURNED OVER TO THE JUVENILE COURT. A RELATIVELY LARGE NUMBER OF WHITE SLAVERS WERE TRIED AND CONVICTED IN THE LOCAL AND FEDERAL COURTS MAINLY THROUGH OUR AGENCY AND EFFORTS. The labors of all the local social and religious societies for moral uplift in this special field have been incomparably far outdone by the results of this part of the Clinic's work. Although not loudly programmed as lying within the scope of our chiefly sanitary efforts, this growth of kindly relations between the sympathetic physicians as well as nurses, and their clients, offers by far the best opportunities to ask for and take the ever-ready, helping hand of the Clinic's staff. The Clinic has received many inquiries from all over the United States, especially since the preliminary publication in the New York Medical Record, March 13, 1913. of my paper on the Municipal Clinic of San Francisco read before the Inter- national Congress of Hygiene and Demography in Washington, D. C, September, 1912. The Boards of Health of many places, including that of the great City of New York, honored us by re- 29 qiicsliiij; the ik'tails o\ our system, a comploto set of our cards and fonns. tor stutly aud imitative adoptiou. I-'ven to the I'liited States Ciovermnent otVicials in l^orto Rico, this system appealed and they recpiested complete and detailed information. 'I'he interest in our successful experiment has extemled farther from mere i)rofessional and official circles into the ranks of civic clubs and societies. Let me (|uote, as one of many instances, letters from the Woman's Municipal League c^f Xew York C'itv. as follows: WOM.WS MrXUIl'AI. Li;.\GrF. OF •46 EAST 29TII STRKET Miss Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Mrs. Directors Sadie American Walter S. Brewster Camden C. Dike Harvey E. Eiske Wm. M. Jackson Edward E. I.oomis George .\. Lung Gilbert Montague Redford J. Mount George D. Pratt Henry Seligman Brandreth Symonds John C. Tappin Gordon Wendell THE CITY OF NEW YORK. Tel. Madison Square 4190 President Mrs. Edward R. Hewitt Vice-President Mrs. Barclay Hazard Second Vice-President Mrs. Thomas B. French Third Vice-President Mrs. H. Clinton Backus Corresponding Secretary Mrs. Annette .Summer Ross Recording Secretary Mrs. John Hiiddleston Treasurer Mrs. Frederick C. Hodgdon Dr. Julius Rosenstirn. Municipal Clinic, San Francisco, California. Dear Sir; — It is some time since vvc have had any exchange of correspond- ence, but our interest in your work continues unabated. As you are aware, we are trying in New York to bring ourselves to some systematic way of dealing: with the great question of pros- titution. So far, there are nearly as many theories advanced as tliere are social science students to advance them, but we still think (those of us who are not run away with their own ideas), that it is possible to learn by the experience of other people and other communities. W'ith this end in view, I am writing to ask if you would be will- ing to receive as a volunteer worker in your Clinic, Miss Marjorie Clark of this city. Miss Clark is a trained nurse and had charge for three years of the free dental clinic established by Judge Peter T. Barlow. We wish to emphasize the fact that should you be willing to give Miss Clark the benefit of this opportunity to observe the workings of your Clinic, that the investigation would be conducted in a most sympathetic spirit. This is not to say that we commit ourselves to either segregation or to a Clinic such as yours, but it does mean that we consider, granted these conditions, that San Fran- cisco and your Municipal Clinic are meeting the question logically and scientifically, and that no better laboratory could be found to study this terrible question. Miss Clark will enclose a letter from herself, and your reply may be addressed either to her or to us here. 30 In closing, may I request you to send me any other material that you may have on hand that may be useful for us here. With renewed assurances of our best wishes for the success of your experiment, I remain. Yours very truly, MRS. BARCLAY HAZARD. ALIDA B. HAZARD, Vice-President. 609 West 127th St., New York, N. Y. May 7th, 1913. Dr. Julius Rosenstirn, Municipal Clinic, San Francisco, Cal. Dear Dr. Rosenstirn: Enclosed please find Mrs. B. Hazard's letter. It fully explains my ambition to study your Clinic which I think is the first logical step towards the solution of this great problem. I have studied your cards and administration and believe it to be the best system in vogue. I shall be deeply grateful to you for whatever assistance you may be able to give me. Should you see the way clear to grant my request, I would like to report at your Clinic in September. Respectfullv yours, (Signed) MARJORIE CLARK. In the face of this general appreciation from so many and so widely different communities and institutions throughout the country, what has been the support and encouragement given to this pioneer pathseeker by its own home legislative and governing bodies and townsmen? From the legal departments we received the following letters: DISTRICT ATTORNEY. HALL OF JUSTICE San Francisco, February 26th, 1913. Honorable James Rolph, Jr., Mayor of City and County of San Francisco, San Francisco, California. Dear Sir: — I have been informed tliat there is an agitation started for the purpose of abolishing the Municipal Clinic. I am strongly of the opinion that it would be a great mistake to abolish that institution. The Clinic has given this ofifice valuable assistance. During the past year we have tried about twenty-five white slave cases. In the majority of these cases the evidence has been furnished through the assistance of the officers connected with the Clinic. In fact, the prose- cution of these cases could not have been successful if it were not for the help of that office. I may also add that members of the U. S. Immigration Office have been given like assistance. An army physician informed me that venereal diseases among soldiers had declined greatly since the opening of the Clinic. Tlie closing of the Clinic cannot nor will not tend to check prostitulioii, 31 .111(1 (111 tlu> dtlicr liaiul it it is ch^st'd it will destroy the good work already accomplished in clieckin>i: disease. Tlie fact that the white slaver and the t|uack doctor are strongly opposed to its existence is a strong argument why it should con- tinue to exist. I am contulent that the Clinic is not only scicntilically. hut is honestly C(Mulucted. The two past (jraiul Juries, after a thorough investigation, not only commended the manner in which it was con- iluctcd, but also recommended its continuance. I believe members of the medical profession arc better able to judge of the necessity for its existence than any other class of people, and I feel confident that most all members of the medical profession will admit that such an institution is necessary in a city of this size. Very truly yours, (Signed) C. M. FICKERT, District Attorney. Department of Justice OFFICE OF UNITED STATES ATTORNEY Terms of Court. For the Northern District of California. U. S. Circuit of Appeals — At San Francisco, first Mondays in October, February and May. U. S. District Court — At San Francisco, first Monday in March ; second Monday in July : first Monday in Xovember. At Sacramento, first Monday in April. At Eureka, Third Monday in July. San Francisco, February 18, 1913. Dr. Julius Rosenstirn, 126 Stockton Street, San Francisco. My Dear Doctor: — I am in receipt of your request that I write you briefly the ex- perience which the United States Attorney's oflfice has had with the Municipal Clinic of San Francisco. Practically the only opportunity which I have had for the ob- servation of the work of the Clinic has arisen in the trial of the white slave cases. Possibly you may be aware of the extreme diffi- culty which the prosecution has always experienced in securing the testimonj'^ of the keepers of questionable resorts. This difficulty has confronted us in the presentation of cases, but has been practically removed through the prompt and efficient assistance given to us by the officials of the Municipal Clinic. In every case where we have been confronted with the difficulty of securing testimony of this character when we knew that in truth it could be produced, all we have had to do is to request the Municipal Clinic to order the women in question to call at this office and state the truth and then go on the stand and testify fully and freely. This, the women have done in every case where we have called upon the Clinic for assistance. The result has been conviction after conviction, where, without the assistance of the Clinic, I think we would have been helpless. I have not hesitated to express my opinion repeatedly that the experience of this office with the Clinic has left a most favorable im- pression on our part. In prosecutions it is the result, and not the sentiment that counts, and any organization which enables the gov- ernment to secure convictions of guilty persons, is entitled to have that fact stated to its credit. Respectfully, (Signed) J. McNAB, United States Attorney. 32 The report of the last Grand Jury speaking of the Municipal Clinic, states: "The so-called social evil, which has been a source of much serious reflection and consideration, is now being handled by the Municipal Clinic, a sub-body composed of professional and business' men, and is- doing splendid work, and the attention of all large cities in this and foreign countries has been called to it. This work should be assisted in every possible way and made lawful by an act of the Board of Supervisors. A Vice-Commission might be the best way to control this class, and with the backing of the Police Courts and Police Department the splendid results so far attained would be added to and this particular work be a precedent to the whole world. "We recommend that women who are employed in dance halls in this city should be under the control of the Municipal Clinic, in order that they may report thereto for examination. This recom- mendation is made in view of the fact that women of the under- world, when diseased and unable to meet the rigid examination of the Clinic, usually resort to dance halls in the Tenderloin district above referred to and to the dance halls on Pacific street and thereabouts. This method should either be regulated by an ordinance to be passed by the Board of Supervisors or a rule of the Police Department. The present Grand Jury has not yet submitted its report, but its foreman Mr. Dumbrell, in a letter addressed to his Honor, the Mayor, says : "Particularly do I desire to commend the maintenance of what is known as the Municipal Clinic and the so-called "Segregation Dis- trict.' Nothing could more conduce to civic morality, nothing could better militate against the spread of the 'world old evil' than this separation of the evil and the immoral from the clean and good." At about this time the universal immediate purity move- ment, wildly rampant in the Middle West, this movie show of the vanguard of self-righteous civilization, struck our city. Here, as everywhere, excellent men, leaders and members of church organizations, men with the best intentions but strangely ignoring the ways of the world, refusing any conces- i sion to natural human instincts and passions, were the in- j stigators of this movement. It was primarily aroused through 1 the most justified horror and indignation from the Vice Com- mission's exposure of the terrible White Slave traffic, and led to a relentless warfare against this miserable pest, the White vSlaver. But, not satisfied with that, the movement culminated in a fiery crusade against the victims of the social malady and the more or less tempting places of amusement — dance halls, restaurants and cafes with dancing licenses. The leaders of this movement disregarded the outcome of hundreds and hundreds of years of the most cruel ill-treatment and punishment of prostitutes. They disregarded the fact that the Church had for the same purpose of su])pression put 33 into ;iotii»n its i;rcat ijowor of luatorial and spiritual persecu- tion ami anatlicuias. lUil prostitution has siu-vived, is ilauntinij^ its soilcil banner in Sjiite of all persecution and anathemas, and even the thurch has spent its jiower in vain. A new era has dawned — a modern science called Social Hygiene has turned its searchlight upon the domain of public life in its sanitary as well as social phases. It has taken a firm hold of the jiroblems of prostitution with its injuries to sanitary and social well being, lu^t iov the purpose of persecu- tion but for devising possible he\p. While some of the ministers here realized that this work rightly belonged to scientific experts, others were less will- ing^ to take this view. A cry was started against the Municipal Clinic. A meeting was called, predominantly un- der the .sway of the unwilling gentlemen. One of these ex- cellent divines, a man of rare intelligence and strength, be- came violently condemnatory in his denunciation of the morals of this city. Later on, in the course of his address he grew^ strongly abusive of the Municipal Clinic, an institution he had never been curious enough to visit or inspect. The zeal for his reformatory views carried him so far as to threaten the men in charge of the World's Fair, with exposing local con- ditions as he saw them on his proposed Eastern lecture tour, which expose would prevent religious associations from hold- ing' their conventions here in the Exposition year, 1915. and would rob San TVancisco of the well known lavish expend- itures of this class of good citizens. These accusations and threats roused energetic protests from several other representative clergymen. One of them, a gen- tleman of the highest standing, felt it his duty to denounce him as a traitor, and he with others refused to join in the attack on the Clinic. Nevertheless, a set of resolutions was passed by the assemblage, appointing a committee to go be- fore the flavor and demand, among other things, the abolition of the Clinic. The stenographic report of these deliberations furnishes most remarkable evidence. There were men whose lifework revolved around the task of inculcating the human mind with the great geocentric error of raising this insignificant little planet of ours to the center of importance among the millions and millions of other astral bodies filling the universe. These same men, by a curious transportation of letters, changed the geocentric into the egocentric error, placing themselves in the center as models for the rest of humanity to emulate what they preach, if not always practice. 34 As a result of this agitation Supervisor ]\Iur(lock attacked the CHnic at a meeting; of the Board of Supervisors on February 13, 1013, and introduced a resolution to forbid the use of the word "Municipal" in connection with the name of the Municipal Clinic, also to censure its existence and purpose, and to withdraw official recognizance or aid. This resolution was shown to his Honor, the Mayor, pre- vious to the meeting of the Board. The Mayor assured me privately that he had asked Supervisor Murdock, as a personal favor, not to present it, and that Mr. Murdock promised to comply with the request. Later, during the progress of the meeting, this gentleman asked the Mayor to release him from his promise and allow him to introduce it. The respect for the age of the Supervisor, and the evident honesty of his purpose, although its error was recognized, carried the first part of the resolution — the disapproval of the name ; the rest of it was stricken out unanimously, with the exception of the originator's vote. The resolution as it passed, read as follows : Joint Resolution, No. 604 "Whereas, the use of the word 'Municipal' in connection with the Clinic conducted by individuals at 682 Commercial street is mis- leading, implying that the agency is conducted or controlled by the City Government, therefore be it "Resolved; that the use by any organization or individuals of the name 'Municipal Clinic' is hereby forbidden." This was done to relieve the shock the title gave to Mr. Murdock, regardless of the fact that this name was not chosen by us, but given to our institution by the previous Board of Health, which called the Clinic into existence. Another fact remained undiscussed, that not fifty yards from the new Hall of Justice a saloon is being conducted under the name of "The Municipal Bar," with nobody holding the honorable Board responsible for the quality of its liquors. The Advisory Board was most willing to comply with the Supervisorial order but wished for the new name to be un- objectionable to all parties, as change of stationery and print- ing entailed a not inconsiderable expense. I first called upon the Police Commissioners and was directed by them to seek the Mayor's sponsorship for the new baptism. Some little time elapsed before an api)ointment could be made and then I was told by his Honor, the Mayor, to seek the advice of Mr. Roche, the newly ap])()jnte(l ])resi- dent of the police commission, with the promise that anythinpj which pleased him would also suit the Mayor. After several 35 unsuccessful attcmins. Mr. KdcIic was caupjht on the telephone and preferreil. as 1 understood him, not to make any detinite l>roposition at that time, hut recommended that we wait until the entire contrmersy had heen settled. The aijitation did not stop there. A meeting was called for I-'ehruary 20. VH3, for the committee of the hostile anti- clinicians, composed of Rev. Dr. Leavitt, and Messrs. Wein- stock and ITerrin,q:ton. They were to meet the Police Com- missioners and the Advisory Committee before the Mayor and the I'oard of Supervisors. The opposition to the Clinic was voiced by the three named e^entlcmen of the anti-clinicians. The Clinic was represented by ^Messrs. Metson and Ford and the writer from the Advisory Committee. I am glad to say the Police Commissioners. Messrs. Roche. Kuhl and Cook, also spoke very strongly and favorably for the Clinic. At the close of the very prolonged session the Mayor stated in a short speech that he had attentively listened to the arguments, would carefully examine all the submitted proofs and documents, and later announce his decision accordingly. His decision came out in a personal interview published in "Town Talk." March 8. 1913. where he answered to the question: "How about the Municipal Clinic?" Mayor Rolph — "I think it's one of the best institutions \vc have. It does a great work of charity, as well as of cleanliness. After hearing the arguments pro and con I am more in favor of it than ever." This suspended state of affairs continued until May 20, 1913, when to my great surprise, the Clinic was suddenly in- formed that police protection had been withdrawn. I voiced my astonishment and asked the Police Commissioners for the reasons. They assured me privately, and also openly ex- pressed in the daily papers, their appreciation of the Clinic's work, their desire that it should be continued uncurtailcd, and their great regret that political influence forced them to de- cline the continuance of police protection. What could this political influence be? Whence did it emanate? The Police Commissioners are appointed by the Mayor, responsible to him only. He had expressed himself strongly and unmistakably in favor of the Clinic. Could this emasculated resolution of the Supervisors have influenced the Mayor and Commissioners so far as to change their at- titude toward the Clinic in spite of their personal convictions? • I interviewed the eighteen members of the P)Oard of Supervisors, who with one or two exceptions, all assured me of their friendliness toward the ^lunicipal Clinic. In order 36 to wipe out any false impression possibly created by that memorable Murdock resolution of February 3, 1913, the fol- lowing new resolution was presented by Supervisor Paul Ban- croft, and carried : Joint Resolution. Xo. 790 Whereas, the Board of Supervisors, on February 3, 1913, adopted Joint Resolution, No. 604, as follows: "Whereas, the use of the word 'Municipal' in connection with the Clinic conducted by individuals at 682 Commercial street is mislead- ing, implying that the agency is conducted by or controlled by the City Government; therefore be it "Resolved, that the use by any organization or individuals of the name 'Municipal Clinic' is hereby forbidden"; and "Whereas, in consequence of the adoption by the Board of Super- visors of the above resolution, the impression has erroneously gone forth that said Board of Supervisors disapproves of the institution commonly known as the 'Municipal Clinic" and "Whereas, on the contrary, said Board of Supervisors does ap- prove of the manner in which said institution has been conducted and considers that the work performed by Dr. Julius Rosenstirn and the Advisory Board has resulted in a benefit to the health of the com- munity; therefore be it "Resolved, that the Board of Supervisors hereby endorses the manner in which the so-called 'Municipal Clinic' has been conducted in the past; and be it "Further resolved, that in order to better safeguard the health of this community the Board of Supervisors hereby expresses itself as favoring the continuation of the assistance that has been rendered until recently to said institution by the Police Department. It was adopted June 9th, 1913, with the following- vote : Ayes, 15 — Supervisors Bancroft, Andrew J. Gallagher, Giannini, Hayden, Hilmer, Hocks, Jennings, Koshland, McCarthy, McLeran, Murphy, Nolan, Payot, Vogelsang — 15. Noes, 3 — Supervisors Caglieri, Mauzy, Murdock — 3. I thought it was easy sailing now; but upon my urging, and that of other members of the Advisory Committee, the Police Commissioners again refused restitution of the police detail, admitting at last that it was his Honor, the Mayor, James Rolph Jr.. who was the real wielder of the Big Stick. I then sought and obtained an interview with the Mayor. With me were Supervisors Bancroft, Payot, Andrew Gal- lagher, and Hilmer. The last named two gentlemen had visited the Clinic during morning treatment hours, and had incidentally seen an apparently perfectly healthy looking woman, who showed on her soft palate a perforated syphilitic ulcer of about the size of a quarter of a dollar. This woman, during the weeks of treatment at the Clinic, since the cessa- tion of police supervision, had been continuing her sad trade ■61 9574?^ in the low ili\o she occupied, and consiitutiiii; a source of in- fection lor e\ery one of her fifteen or twenty daily \isitors. With this horrify inj;- example of the many simihir incidents fresh in their memories, the Sni)ervisors forcibly presented their impressions to the Mayor. lUit neither the outspoken desire of the lioard's request for the restoration of police surveillance, nor the clear reasoning;" of the interviewinj;' Super- visors could induce the Mayor to alter his strange change of view. When 1 told his Jlonor that 1 would see the Police Commissioners in the evening, he went so far as to be willing to wager that everyone of its members would agree with him. That evening Mr. Ford and I went to the meeting of the Pc^iice Commissioners to call their attention to the injustice of their action. While they were each expressing their high appreciation of the valuable work performed by the Clinic, and their regret at being obliged to revoke the grant of police surveillance, his Honor, the Mayor, appeared upon the scene. The discussion changed to the reasons profifered by his Honor, the INIavor, and his Commissioners, for the refusal of the re- quest. They were : (1) The discrimination against women, only requiring their examination, and not of men visitors. It constitutes an interference with the personal liberty of the individual to re- quire this examination. (This was not pressed seriously, be- ing only an echo of the reasoning of the women protestants.) (2) The law of the State prohibiting the existence of Houses of Prostitution, (not prostitution itself), police sur- veillance formed an act of recognition of their existence. (3) The new Red Light Abatement laws just passed by our legislature, and shaped after the notorious Iowa laws. (4) The private, instead of municipal control of the Clinic. Their objections were met, and we believe are convincingly disproved, by these statements of facts : Discrimination Against Women. Interference with Personal Liberty I. The examination of male visitors is regularly made by the women themselves. Owing to the external position of the male sexual organs this is an easily performed task, the knowledge and understanding of which is learned almost at once. The doctors of the Clinic have been instructed to ask clients if they understand these measures for their self-pro- 38 tion, and advise them. The little printed folders of. the Clinic books inform their owners of this precautionary measure. As to the discrimination against women see Case 51, N. Y. St. Rep., p. 339 and 127, N. Y. Suppl.— N. Y. Supreme Court 484, and same case 129 N. Y. Suppl., p. 646, N. Y. Supreme Court, Appellate Division. It was decided that it does not violate the constitutional rights of a prostitute to be remanded or arrested for the pur- pose of examination for being infected with venereal disease, nor if found infected, to committal to a hospital or work- house, nor is the act discriminating against women as it relates to all public prostitutes and there are no public male pros- titutes. All this being a sanitary measure for the protection and security of the public health. This decision was reversed by the Court of Appeals of New York on a mere technical default of the law which in no way afifects its constitutionality and will be easily corrected. People ex rel. Barone vs. Fox. 202, N. Y. 616 — 96 North Eastern Reporter, page 1126. People ex rel. Barone vs. Fox. Warden of the Workhouse (Court of Appeals of New York, June 16, 1911). Appeal by permission from an order of the Appellate Division of the Supreme Court in the First Judicial Department (144 App. Div. 611, 129 N. Y. Suppl. 646) entered May 16, 1911, which reversed an order of Special Term (69 Misc. Rep. 400-127. N. Y. Suppl. 484) sus- taining a writ of habeas corpus and discharging the relator from custody, dismissed the proceeding and remanded the relator to cus- tody. The proceeding was brought to determine the constitutionality of section 79 of chapter 659 of the laws of 1910 providing for a medical examination of prostitutes and their commitment to a public hospital if found to be afflicted v.-ith any venereal disease. Bertha Renibaugh, for appellant. Charles S. Whitman, District Attorney (Robert S. Johnstone of counsel* for respondent). Per curiam Order reversed and relator discharged on dissenting opinion of Clarke J. Below. Cullen, C. J., and Haight, Werner, Willard, Bartlctt, Chase, and Collin, J. J., concur. Gray, J., dissents on opinion of Ingraham, P. J., below. Clarke's dissenting opinion states (adopted by Court of .Appeals)^ (conclusion): . If the magistrate to be satisfied from the confession r,f tlie person (plead guilty) brought before him or by competent testimony he must convict him. It is the absence of the reciuircment of competent testimony in the case at bar that affects the statute. In the fundamental defect, namely, that the term of imprisonment depends upon a fact found out of court _by a non-judicial officer, this legislation is similar to that condemned in: Matter of Kenny, 23 Misc., Rep. 9-49 N. Y. Suppl. lO,'^ F affirmed on the opinion below 30 App. Div. 624, 53 X. Y. Suppl. 1111. Soo also 39 People ex^ rcl. Abranis vs. I'^ox FF App. Divis. 245-79 N. Y. Suppl. 56: where the hiw under eonsideration in said cases after anienthiient to meet tlie defects pointed i)ut was sustained, h'or the proposition that tile fact that tlie oliject and purposes of an act are not penal, but protective, does not take said act without the constitnional i)rovisi(Mi as to due process of law, see People ex rel. Ordway vs. St. Saviour's Sanitarium 34 App. Div. 363. 56 N. V. Suppl. 431. I'dr these reasons, and without considerinj^ further objections to the legislation, properly disposed of at the Special Term, I think the order appealed froiH was riglit and sliould be affirmed. Dowling, J., concurs. l-'urtherniore, to overcome even the la.st .scruples, the Advisory Coniiiiittee offered to set apart an hour daily for the examination and treatment of men afflicted with venereal diseases. Recognition of Prostitution by Police II. It seems like an insult to the intelligence of the people to ask them to believe that the police had been ignorant and intolerant of prostitution until those two police officers were detailed to the Clinic, and that by the removal of those two officers there was again restored to the ])olice its happy state of ignorance as to the existence of prostitutes, of venereal dis- eases and all the horrors attendant upon prostitution. The sole connection the Clinic had with these proceedings was that it received the official typewritten information from the police authorities that such and such a woman had been granted permission to occupy the house No. , in street, or that such a woman had been permitted to enter house . These blanks are the only source of information of such actions the Clinic possesses, and they remain on our files for reference. No house of prostitution could ever have been opened without the permission of the police authorities. No girl could ever have become an inmate of such a house without their knowledge and consent; no brothel could ever continue to exercise its lure without the watchful approval of the police. The Red Light Abatement Law^s III. ^Ve all know that special laws concerning morals, upon which the views of people are decidedly at variance, can only be followed and carried out to a certain extent. Such following the spirit rather than the letter of the law is apparently the better way, and has been since long before the birth of the Clinic. The new^ Red Light Abatement Laws belong to this class of laws. Even if they should ever be accepted by the people of this state, a consummation devoutly to be not wished, they 40 cannot be snccessfully enforced. The conditions in the towns of Iowa furnish the latest example, and the results of ex- haustive historical research as expressed by Havelock Ellis and quoted in the foregoing pages illustrate the experience of civilized nations the world over with similar attempts of prohibitory laws in the history of prostitution. There was no reason to withdraw police surveillance long before the time arrived for the legal enactment of the new law in California. A referendum petition, which has since been filed, was then circulating. It will put the vote for or against these laws before the people in November. 1914. until which date their enactment is suspended. \\'hy let contamina- tion with disease go on unhindered until that time? The Private Instead of Municipal Control of the Clinic IV. The Advisory Board made repeated offers and ap- peals to the municipal authorities to take over the fully equipped quarters and laboratories of the Clinic, including the cash surplus for the rescue home. These have been per- manent standing offers, but have constantly been declined. Our proposition was referred to the Hospital Committee of the Board of Health with power to act. Two of the three (all medical) members voted against the adoption of the Clinic. One of them voted for reasons of shocked morality, the other, a specialist for women's diseases, said the medical profession would be injured financially, and would object to free treat- ment and relatively free examinations of these women. I feel certain that this gentleman did not voice the true sentiment of the medical fraternity. Is it right to refuse protection to a voluntary fire com]:)any and thus hinder it from doing effective work, if no other fire company exists and the local government refuses to estal)lish one? This regulation for examinations should be construed simply as a police measure for the protection of the public health. (See New York decision.) The Clinic's only activity has been the execution of tiie well-founded sanitary requirements, justly and most neces- sarily added to the other general police regulations for the supervision of prostitution. Supervision and obligation to conform to these regulations were exercised by the police, who merely took their iiifoniiatioii. not their iiistruetion. from our records. To satisfy the hypersensitive, special jjolice officers' stars might be awarded to the superintendent and doctors of the 41 (.'linic. and even the mcinbcrs of the Advisory Board would iitil object to a similar decoration. After all, there is a great deal of truth in this remark of the presiilent of the lioard of Health, a lawyer of high standing and reputation : "The present independent and private char- acter of the Municipal Clinic should be preserved so that persistent and sometimes irresistible political demands for appointments might be ignored." The same may be said regarding the su])pression of red light graft through the Municipal Clinic. Reviewing some of the past, and considering the possibilities that may arise from ever-changing future, municipal administrations, we be- lieve the freedom from this most sordid kind of graft, a free- dom which the regulating system of the Municipal Clinic in- sured, cannot be too highly estimated. Alas, our arguments, although found incontrovertible, were unsuccessful in moving the Police Commissioners, reinforced by his Honor the Mayor, to alter their decree. I regret to state that two ministers of the gospel deemed it their duty to voice in the public press their great satisfaction with this crippling of the sanitary service of the Clinic. If the remarks of these two gentlemen had been simply confined to expressions of their gratification over the injury the Clinic had suffered. I would not have thought it necessary to com- ment upon them. But their articles contained serious accusa- tions against the character of the Clinic's work, and, charging the members of the Advisorv Board with being criminals through their connection with this institution, called upon them to confess their sins and repent. It was impossible to pass this public arraignment un- noticed. I felt compelled to correct the false impressions that had been introduced into the people's minds through the public utterances of these distinguished gentlemen and most reluctantly I asked the newspapers which had brought the original accusations to insert the following explanatory an- swers : CFrom San Francisco Examiner, Sunday, June 1, 1913) CLINIC GUARDS CITY'S HEALTH, SAYS PHYSICIAN Rosenstirn Replies to Aked, and Asserts Vice Was Not Sanctioned. Upholds San Francisco's Morality. One of the Nation's Cleanest Municipalities, Declares Medico. Others Copying Methods. To the Editor of "The San Francisco Examiner": The trium- phant cock-a-doodle-doo of the Rev. Dr. Aked, which found its exult- ant expression in your Sunday issue did not reach my ears until this 42 morning, owing to my absence from the city yesterday. In his phihppic against the institution he thunders a column of accusations which demand immediate rectification for an all too credulous public. Every statement he has made regarding the actions of the Clinic has been, to say the least, erroneous and misleading. The Municipal Clinic is purely a sanitary institution. When it took up its work it dealt with existing conditions. No sanction of commercialized vice, no license for its practice was ever issued by its authority. Police in Control If an honest search for the truth would be Dr. Aked's aim, he could have easily ascertained that the police authorities have always, before and since the opening of the Clinic, had the exclusive and absolutely independent regulation of these matters in their own hands, as it naturally should be. The Clinic merely prevented those women who were tolerated to ply their pitiable trade from combining with it the spread of disease. It was merely adding this sanitary condition to the other existing rules exacted by the authorities. The protection granted by these examinations simply provided visible means of defense against harass- ment by petty grafting from self-appointed authoritative persecutors. During the two years' life of the Clinic, the highly efficient and scientific control has reduced the rate of disease among these un- fortunates 66 per cent. The Clinic Not Closed For the first time in the history of similar sanitary controls, a humane, honest and sympathetic treatment has been followed, and the absolute confidence of these unfortunates gained, so that incidental rescue work and white slaver prosecution could be handled as it never has been done before. This confidence is shown bj^ the continued voluntary submission to the examinations of the Clinic now that the police protection has been withdrawn; and, for the pacification of the Rev. Dr. Aked. let it be known that on Saturday last we had 129 individual examinations, so the Clinic has not been closed, nor will it be closed until the enforcement of the red li.ght abatement bill in this city. If it is a blot on the fair escutcheon of San Francisco, as Dr. Aked contends, that the Clinic has successfully controlled the sanitary status of these women and has helped the sick freely, then Dr. .\kcd has shown the qualities of a high-grade polisher in wresting from the administration of this city the withdrawal of police protection of the Clinic. The withdrawal was granted, as stated by the Police Com- missioners openly in the public press, unwillingly and against their better judgment. Conditions in England What has he to offer instead? The reports of vice commissions that segregation has not decreased the social evil, and the anticipated changes from the red light abatement law of absolute suppression? Vice commissions and their reports have been known before. As Dr Aked undoubtedly knows, the British Royal Commission, upon the administration, etc., of the Contagious Disease Act .of 1871, and the Parliamentary Committee of 1882 for the same purpose, were such vice commissions, and although their majority reported in favor of existing regulations, the minority report for their abolition was 43 .uloptotl by Parliiinu'iit to satisfy just siuli petitions and ciTorts of purists and hystorical woniou as have intUK-nccd tliis administration. Wliat lias Ik on the result? Liverpool, tlie luime place of our eminent divine, shows about the worst conditions of any luiropean liarbor; l.inidon, justly the pride of the jjreat British Kmpire, displays on its thoroughfares an ever moving chain-ganj^ of solicitinjj street Avalkers. this greatest pest of the social evil; all the lar.ner and nieiihlic sense of decency liy tlieir offenses avjainst morals. DR. JULIUS ROSEXSTIRN, Chairman Advisory Committee, Municipal Clinic. This part of the controversy fortunately ceased with the inililication of these necessary rectifications, which contained perhaps more acrimony than was concomitant with the dignity of the cause but seemed pardonable in the light of severe and grountlless accusations. Without the police surveillance, without the police of- ficers to prevent the bookless and diseased prostitutes from Inlying their sorry trade, the usefulness of the Clinic is practically destroyed and the flow of contamination from venereal dis- eases takes up again its constant, unhindered course into the flower of the city's manhood and womanhood. If the reader, at the close of these pages, will review with me briefly some of the salient points, we shall arrive at this : As a result of the Clinic's efforts we not only reduced the number of venereally infected women among our clients to one-third, thereby saving an incalculably large number of in- dividuals from infection with loathsome diseases, but also made it possible for many of these unfortunates to re-enter a life of decency, and prevented a great many neophytes from adopting the career of shame. We w^ere instrumental in send- ing quite a number of minors to educational institutes ; and last, but not least, succeeded in convicting and conveying to the peni- tentiaries a number of white slavers — these most contemptible and despicable of all criminals. The methods of protective sanitation pursued at the Mu- nicipal Clinic differ widely from those employed in the prin- cipal European countries. AVe have received complete copies of their regulations for the moral and. sanitary control of the social malady. They show conclusively that older criminating measures have not been abandoned but are still rigorously en- forced. In a long communication received but a few davs ago through the Department of State from the American Consul- General at Dresden. Germany, the ordinances and rules for the regulation of prostitution in that citv have been transmitted to us. They examine prostitutes there once a week in a similar manner to ours. The report of the Consul-General states verbatim : "The present system has been in existence foi" ten years and has proven a success, so that the condition of the health of the prostitutes can be stated to be excellent." If. however, one would take the trouble to read their 46 regulations one would be astonished at some of the medieval restrictions that are enforced upon the life of these women. The more humiliating and oppressive these rules be- come in the effect of their enforcement upon the red light dwellers, the less willing these women are to submit to regis- tration and periodical examination, but seek refuge in the ranks of clandestine prostitution, the most active by far in the spread of venereal disease. In spite of their onerous medieval regulations, the civic authorities in Dresden have succeeded far better than other cities in overcoming this resistance of the red light contingent against medical examination. This is undoubtedly due to the manner of enforcing or ignoring the obnoxious rules in the well known, good-natured, easy-going fashion of the Saxons. Professor Adolphus Knopff, of the New York Post Gradu- ate Medical College, and Director of Clinics in the Xevv York Department of Health, in the above cjuoted Oration on Medi- cine, delivered before the Illinois State Medical Society, says regarding this system of sanitary regulation : "This brings us to the most difficult of all the problems created by the social ill. Shall a community, such, for example, as New York, which has according to a conservative estimate, 200.000 syphilitic subjects and perhaps four times as many gonorrhoics, and 40,000 to 50.000 ])rostitutes. of which a very large number is venereally infected, attempt the regulation of prostitution? According to so great an authority as Fournier of Paris, regulation and sanitary supervision are of little avail. On the other hand, according to Bierhoff, an A.merican author- ity on the subject, they have been most successful in reducing venereal morbidity and mortality in Dresden. Neither regula- tion nor sanitary supervision, nor their absence, nor their aban- donment are new conceptions of the problem. lUit the results obtained and tabulated in the Hygiene Exposition of Dresden (1911) must give one food for thought, and, because of our present state of civilization, and the fearful i)revalence of venereal disease, and its terrible consequences to the health of our nation, they make me look a little more favorably upon the Dresden method." And to further quote Professor Knopff": "The Municipal Clinic of San Francisco is trying, as an experiment, a method similar to the one in vogue in Dresden and claims good results, particularly because it combines medical and sociological work. For further details of this difficult subject, I refer mv readers to Dr. Roscnstirn's com- munication to the I^fteenth Congress on Hygiene and Dcuio- 47 i^raphv , ami to three most a(lmiral)k' articles hy Dr. l-'reilerick IWerhotY of Xcw York. "There is not the siii^htesl tlouht in my miiul that lhroUL;h riiiiil exaininatioii ami the treatment of tliscovered cases, many centers of infection will cease to exist and the morbidity and, mortality from syphilis and gonorrhtiea will be very materially decreased. "I would wish to add that all this should be done in a most huniane manner with no intention tn ]nmish. liut to cm-e and to redeem." I'"or fully two years before these words of Professor Knopff's were written, the Municipal Clinic of San bVancisco, as the first anywhere, had inau_!.;urated and ])racticed the principles of a humane and kimll\- tolerant sanitary regulation of the social malady. We not only succeeded in bringing about great smiifary im- proi'CDieiits but also achieved some remarkably good sociological results, because we freed the sanitary control of these women from all the past and present criminality attached to other svstems, and met them in a humane and sympathetic spirit at the Clinic. While we do not approve of methods of criminal regulation heretofore exercised in various countries, with house examina- tions of dubious value as to their impartiality and scientific reliability, even these have shown great results for the sanita- tion of the different European armies. They offer an ideal material for statistical comparison, soldiers being all men of about the same age, of similar physical and mental caliber, and living under similar conditions as to food and occupation. Germany, with her strict regulation, shows, during a period of twenty years, only 38 per thousand annual admissions to hos- pitals for infections with venereal diseases ; Prussia alone only 18; while Great Britain, with no regulation, showed about 225 to 250 per thousand. The above results in the armies of European countries, where sanitary control of the social malady prevails, were at- tained even before the present thorough microscopical and bacteriological methods of examination had been introduced. Our own American army has until recently shown similar unsanitary conditions to the British, as presented in Secretary Stimson's report. The English act for sanitary regulation was reyoked through an agitation of just such people as oppose sanitary measures here. In the face of the findings of two specially appointed and fitted commissions, both reporting in favor of its continuance on account of excellent results during 48 Its. short-lived existence. Parliament abolished these sanitary measures, foolishly yielding- to hysterical outcries. Ever since sorrow has been theirs, and the terrible results in their Indian army have led, for this continij^ent at least, to the resurrection of sanitary regulation in garrison posts. The great International Medical Congress, which met in London less than a month ago (July, 1913), discussed the ter- rible danger threatening the health of the nations from the poison of venereal diseases. Strong resolutions were passed endorsing the principles of the Clinic's work. In his memorable address before the bodv of the Congress, the great army surgeon, Major H. C. French. R. A. M. C, stated, as an instance of the beneficial effect of state control, that these measures adopted in 1900. had, in the last thirteen years, reduced by over two-thirds the proportion of soldiers admitted to hospitals suffering from venereal diseases. He earnestly hoped that definite resolutions might be drawn up by the Congress and a serious attempt made to ensure legis- lative control of the disease, apart from the state regulation of vice. His conclusions are pre-eminently authoritative, being the outcome of many years of most exact and painstaking military observation of an entirely unobjectionable material; a large body of soldiers of unchanging physical characteristics, spread over an enormous area and subject to unvarying conditions of life. In its freedom from any vitiating influence this experi- ment on the largest scale furnishes in a satisfactory manner all the points of a quasi mathematical proof that can 'reason- ably be demanded. Based upon this long and enormous experience and the brilliant results obtained by the sanitary control employed, Major French recommended the following measures, sum- marizing them under three headings : "First. Control at the source which is concerned with pros- titution before disease is contracted or spread. This embraces : (a) medical notification of disease; (b) suppression of souteneurs and public solicitation in the streets; (c) protection of orphans and destitute children; (d) police measures. "Secondly. Prevention by medical measures, i. e.. prophy- laxis by treatment after disease has been contracted. This includes: fa) provision of hospital beds and segregation; (b) professorships at large hospitals; (c) instruction of students and the public; (d) treatment. "Thirdly. Moral and- religious considerations. These are 49 placcil last hut hy lui means least, ami arc more applicable to NDUth ami adolescence before disease is contracted." In conclusion. Major i'^rencb ((noted from Lecky's "History oi luiro])ean Morals," in wbicli'tbat writer deplores the fact that an epiilemic which is one of the most dreadful now exist- ing' amongst mankind, which communicates itself from the iiuilty to the innocent, should be sutl'ered to rage unchecked because the legislature refuses to take official cognizance of its existence or proper sanitary measures for its repression. The Congress, by a large majority, adopted the official resolutions, wherein it was recommended among other items, that the governments of all countries there represented, be called upon to institute a system of confidential notification of the disease to a sanitary authority wherever such notification does not already obtain, and to make systematic provision for the diagnosis and treatment of all cases not otherwise pro- vided for. A general expression, however, from the members of this Congress as to the necessity of combined energetic action against the spread of venereal diseases did not appear suf- ficiently mandatory to the heads of the British medical pro- fession. They realized that their own country required a more stirring appeal, and voiced their judgment as to the great and immediate need of the British people for a thorough investiga- tion of the poisoning of the nation with a continuous inflow of venereal diseases and for the adoption of measures to stem this noxious current, in the following letter to the English press:. (Extract from the Morning Post, July 22, 1913) THE PUBLIC HEALTH Doctors' Demand for a Royal Commission To the Editor of the IMorning Post, Sir: The increase in medical knowledge during the last sixt}' years has been extremely rapid and the control of health problems by the state and municipalities has become one of the most striking features of modern civilization. The state has compelled local authorities to build asylums for the insane; it has encouraged them to make provision for the segregation of cases of infectious fevers; it has insisted on the notification of many in- fectious diseases; it has undertaken the inspection of children on a colossal scale; it has introduced an elaborate machinery to_ ensure the purity of foods, and it is steadily at work laboriously building up a vast system of public health legislation. Today we are all looking forward to what may be the effects of the campaign against tubercu- losis, and the community has cause to congratulate itself on the organized national effort that it is about to make to eliminate the disease. In all this organized effort there is one noteworthy omission. There has always been a conspiracy of silence as regards venereal 50 diseases. The time, however, has come when it is a national duty to face the facts and to bring them prominently to the notice of the public. When the subject was discussed last year at the Royal Society of Medicine it was stated without contradiction that in London alone there are forty thousand new cases of the gravest form of the disease every year, and in the United Kingdom as a whole a hundred and thirty thousand such cases. The worst form of venereal disease is highly contagious and dire in its efifects. It claims its victims not only from those who have themselves to blame for contracting it; it is one of those diseases that may be transferable from parent to'child, so that the offspring of a sufferer is born with the virus actually in its tissues, to cause, it may be, hideous deformity, or blindness, or deafness, or idiocy, ending often in premature though not untimely death. Inno- cent members of the public, wives, children, doctors, dentists, students and nurses, are among those who, during the routine of their daily life, are often accidentally called upon to pay a tragic penalty for the wilful blindness that ignores its existence. There is a great volume of evidence that locomotor ataxia and general paralysis are its belated manifestations. We are living today in a new era as regards diagnosis and treat- ment. The microbes responsible for these diseases have been dis- covered in recent years; means of diagnosis far in advance of previous experience have been elaborated and treatment has been enormously improved. The time is, therefore, appropriate for an organized effort on a comprehensive scale to reduce the incidence of these diseases. The experience of the Royal Army Medical Corps during the last few years has shown the enormous reduction in all forms of the dis- ease that can be brought about as a result of systematic effort. Organized effort among the civilian population is impracticable until the public conscience has been aroused, and can only be at- tempted after a full and authoritative investigation. We appeal, there- fore, to the public through your columns to demand the appointment of a Royal Commission — its members to include a substantial majority of medical men — to investigate the facts and to recommend what steps, prophylactic and thernpeutic, should be taken to cope with these diseases. Yours, etc., THOMAS BARLOW, President of the Royal College of riiysici.ins of London. RICKMAN J. GODLEE, President of the Royal College F Y< ^^ADVXflll-^^^