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A” represents the large group of persons in any community
who are free from venereal diseases, but are susceptible to infection
if exposed. “B” represents the smaller group of persons in that
community who are infected. The public health problem to be solved
is the prevention of transfer of the “germ” of syphilis, or the “germ"
of gonorrhea, or the "germ” of chancroid (each these three dis-
eases being a distinct infection entirely different from the other
two) from the “B's" to the “A's."

health than the chief method of transmission because such small
numbers of “A's” are thus infected.

Bearing these facts in mind it is obvious that these diseases
should be attacked by measures promoted simultaneously for (1)
the education and the protection of the "A's" from..exposure and (2)
the treatment of the "B's" and their instruction in avoidance of
exposing "A's."

This chart has been prepared to stimulate careful discussion of
this problem along the broad lines which must be followed in plan-
ning measures for its solution. The suggested blocks 1 to 10 are
merely illustrative. It must be kept in mind that success depends
upon utilizing public-health, medical, and sanitary measures
first line of attack, and of rescue for those already infected, while
main forces are mobilizing and putting their plans into operation
during the next twenty years for the training and protection of the
generation now in its infancy.

as a


The chief source of transmission is by sexual contact indicated by the direct line between “B” and “A.” Other ways of transmission are indicated by the curved lines. While these are different for each of the three diseases, and for each disease are of differing degrees of importance at the several stages of their development, they are nevertheless collectively of far less importance to public



MANUAL, 1921


Social hygiene seeks to preserve and strengthen the family as the basic social unit. In the United States the present activities being stressed in this field are directed specifically toward bringing about the best adaptation of the sex factor in human life to the growth, happiness, and character of the individual and the good of society. Indirectly it seeks to encourage all means which tend to build up healthy, happy, and socially wholesome life. These activities are both constructive and remedial.

Its constructive activities are mainly educational. They are designed to foster such character-education and training from childhood up as shall develop correct attitudes, ideals, standards, and behavior in respect to sex in its broadest sense.

Its remedial activities are aimed at securing the most wholesome social environment by the elimination of all factors which tend to weaken or destroy the home and oppose the best development of the individual. An outstanding factor is sex delinquency which results in prostitution and the dissemination of venereal diseases.

These allied public foes, aided by a policy of ignorance and mock modesty, menace the health and happiness of multitudes in this country. Innocent women and children are often their victims, and many of the nation's blind, crippled, and insane owe their disabilities to prostitution and its corollaries, syphilis and gonorrhea. Divorce, desertion, and illegitimacy are other conditions often resulting from them.

In former days public opinion decreed prostitution a “necessary evil,”—that it was necessary for some women to be sacrificed in order that others might be protected.

Now the public realizes that it is wholly evil and absolutely unnecessary. This change in opinion marks a genuine advance in social hygiene. Most cities have awakened to the fact that redlight districts mean crime and disease. Some of them appointed





impartial commissions to investigate the matter and thus the light of scientific inquiry was turned on this age-old “profession,”-a profession which it was thought should never be disturbed because it never had been.

The unanimous conclusions of these investigations may be summarized in the words of the Chicago Vice Commission : "Constant and persistent repression of prostitution, the immediate method: absolute annihilation, the ultimate ideal.”

Many members of these vice commissions were driven by the facts brought out in these investigations to change their former convictions that the only way to treat prostitution was to tolerate and regulate it under police control, in the “European fashion.” The utter failure of this “European fashion" in Europe has been demonstrated by Mr. Flexner in his book Prostitution in Europe. Its transplantation to this country is now generally recognized as a blunder of the first magnitude.

All progressive cities in the United States have substituted therefore the policy of repression above outlined. Repression, which started as an experiment ten years ago, may now be fairly described as a successful demonstration. Many cities report a 75% reduction in the commercialized aspects of prostitution through repressive action by the police and courts. This experience was repeated and confirmed during the war in the camp communities which coöperated with the government in the adoption of a repressive policy. Red-light districts and open houses of prostitution were closed by the score. A striking reduction of prostitution and of the disease rate among the troops was the immediate result.

1 During the period 1910-20 such investigations were conducted in the following cities in the United States: Atlanta, Ga., 1912 Grand Rapids, Mich., Philadelphia, Pa., 1913 Baltimore, Md., 1916 1912

Pittsburgh, Pa., 1917 Baton Rouge, La., 1914 Hartford, Conn., 1913 Portland, Me., 1914 Bay City, Mich., 1914 Kansas City, Mo., 1911 Portland, Ore., 1912 Bridgeport, Conn., 1916 Lafayette, Ind., 1913 St. Louis, Mo., 1914 Buffalo, N. Y., 1913 Lancaster, Pa., 1913 San Francisco, Cal., 1911 Chicago, Ill., 1911 Lexington, Ky., 1915 Shreveport, La., 1915 Cleveland, Ohio, 1916 Little Rock, Ark., 1913 Springfield, Ill., 1915 Columbus, Ohio, 1919 Minneapolis, Minn., 1911 Syracuse, N. Y., 1913 Denver, Colo, 1913 New York, N. Y., 1910 Utica, N. Y., 1918 Elmira, N. Y., 1913 Newark, N. J., 1914


Repression as a policy of dealing with prostitution cannot however stand alone. Permanent progress rests fundamentally

. upon an improvement in community standards of sex conduct.

This improvement depends primarily upon information and education information which shows the relation of prostitution and venereal diseases to the wreckage of the family and the deterioration of the race; and education which formulates and stimulates the adoption of sex habits and customs in the interest of individual and public welfare.

Repression must also be supplemented by medical, rehabilitative, and recreational measures: medical measures to salvage those who leap every barrier of restraint and become diseased; rehabilitative measures to provide a new outlook, a different environment and honest work; recreational measures to provide for the wholesome use of leisure time as a substitute for vice.

The nation's war experiences emphasized these and other facts of a similar nature, and it has been truthfully said that the socialhygiene movement advanced further during the three war years than it had during the preceding half century.

While preparing for and carrying on the war, officials found answers to many mooted questions and dealt death blows to many old time fallacies. The detention, medical examination, and treatment of many prostitutes, done as a war measure, proved beyond doubt that prostitution cannot be made safe. The actual abolition of red-light districts and of single houses of prostitution outside of the district proved that commercialized prostitution can be destroyed. Draft examinations demonstrated that venereal diseases are the greatest menace to our national health and efficiency and that adequate facilities for their early diagnosis and treatment are necessary if they are to be successfully controlled. Other facts brought into the open were that ignorance of these diseases and their consequences underlies much of the wreckage they cause, and that protective measures are essential elements in


effective community program. Money must be spent to carry on these measures which have proved. their worth, but this money will be well spent.

The war also served to secure for social hygiene, governmental recognition and administrative machinery of the highest order.


2 From 60% to 95% of these prostitutes were found infected with syphilis, gonorrhea, or both, despite the fact that many of them had medical certificates to the contrary.

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