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if exposed. "A" represents the large group of persons in any community who are free from venereal diseases, but are susceptible to infection "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 of these three distwo) from the "B's" to the "A's." eases being a distinct infection entirely different from the other

by the direct line between "B" and "A."
The chief source of transmission is by sexual contact indicated
mission are indicated by the curved lines.
Other ways of trans-
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

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

Bearing these facts in mind it is obvious that these diseases exposing "A's." 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

are

as a

merely illustrative. ning measures for its solution. This chart has been prepared to stimulate careful discussion of this problem along the broad lines which must be followed in planThe suggested blocks 1 to 10 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 generation now in its infancy. during the next twenty years for the training and protection of the

[4]

SOCIAL HYGIENE LEGISLATION

MANUAL, 1921

WHAT IS SOCIAL HYGIENE?

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

WHAT IS SOCIAL HYGIENE?

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.1

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
Baltimore, Md., 1916
Baton Rouge, La., 1914
Bay City, Mich., 1914
Bridgeport, Conn., 1916
Buffalo, N. Y., 1913
Chicago, Ill., 1911
Cleveland, Ohio, 1916
Columbus, Ohio, 1919
Denver, Colo, 1913
Elmira, N. Y., 1913

Grand Rapids, Mich.,
1912

Hartford, Conn., 1913
Kansas City, Mo., 1911
Lafayette, Ind., 1913
Lancaster, Pa., 1913
Lexington, Ky., 1915
Little Rock, Ark., 1913
Minneapolis, Minn., 1911
New York, N. Y., 1910
Newark, N. J., 1914

Philadelphia, Pa., 1913
Pittsburgh, Pa., 1917
Portland, Me., 1914
Portland, Ore., 1912
St. Louis, Mo., 1914
San Francisco, Cal., 1911
Shreveport, La., 1915
Springfield, Ill., 1915
Syracuse, N. Y., 1913
Utica, N. Y., 1918

WHAT IS SOCIAL HYGIENE?

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.

2

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 any 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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