John H. Stokes

“ Think of syphilis as the wages of sin, as well-earned disgrace, as filth, as the badge of immorality, as a necessary defense against the loathesomeness of promiscuity, as a fearful warning against prostitution, and our advantage slips from us. The disease continues to spread wholesale disaster and degeneration while we wrangle over issues that were old when history began and are progressing with desperate slowness to a solution probably many centuries distant. Think of syphilis as a medical and a sanitary problem, and its last line of defense crumbles before our attack. ”

“ The struggle of man against his unseen and silent enemies, the lower or bacterial forms of life, once one becomes alive to it, has an irresistible fascination. More dramatic than any novel, more sombre and terrifying than a battle fought in the dark, would be the intimate picture of the battle of our bodies against the hosts of disease. If we could see with the eye of the microscope and feel and hear with the delicacy of chemical and physical interactions between atoms, the heat and intensity and the savage relentlessness of that battle would blot out all perception of anything but itself. ”

“ In these days of sanitary measures and successful public health activity, it is becoming more and more difficult for us to realize the terrors of the Black Plagues, the devastation, greater and more frightful than war, which centuries ago swept over Europe and Asia time and again, scarcely leaving enough of the living to bury the dead. Cholera, smallpox, bubonic plague, with terrifying suddenness fell upon a world of ignorance, and each in turn humbled humanity to the dust before its invisible enemies. ”

“ Today's truth may be tomorrow's error in any field of human activity, and medicine is no exception to this law of change. It is impossible to speak gospel about many things connected with syphilis, or to offer more than current opinion, based on the keenest investigation of the facts which modern methods make possible. None the less, the great landmarks in our progress stand out with fair prospect of permanent place. The germ, the recognition of the disease by blood test and dark field microscope, the treatment and prevention seem built on a firm foundation. ”

“ There are few things about our situation with regard to syphilis that deserve more urgent attention than questions connected with the cure of the disease, and few things in which it is harder to get the necessary coöperation. On the one hand, syphilis is one of the most curable of diseases, and on the other, it is one of the most incurable. At the one extreme we have the situation in our own hands, at our own terms—at the other, we have a record of disappointing failure. As matters stand now, we do not cure syphilis. ”

“ Even within our own recollection, the germ of influenza, gaining a foothold inside our defenses, took the world by storm, and beginning probably at Hongkong, within the years 1889-90, swept the entire habitable earth, affecting hundreds of thousands of human beings, and leaving a long train of debilitating and even crippling complications.
Here and there through the various silent battles between human beings and bacteria there stand out heroic figures, men whose powers of mind and gifts of insight and observation have made them the generals in our fight against the armies of disease. ”

“ For every man or woman to whom the word syphilis can be made to mean, not a secret, private, shameful disease, but a great open problem in public health, a recruit has been called to the colors. There are no signs more hopeful of the highest destiny for humanity than those of today which mark the transition of disease from a personal to a social problem. Such a transition foreshadows the passing of syphilis. ”

“ We have crippled the power of tuberculosis through knowledge,—wide-spread, universal knowledge,—rather than through any miraculous discoveries other than that of the cause and the possibility of cure. We shall in time obliterate cancer by the same means. Make a disease a household word, and its power is gone. We are still far from that day with syphilis. The third great plague is just dawning upon us—a disease which in four centuries has already cost a whole inferno of human misery and a heaven of human happiness. ”

“ When we awake, we shall in our turn destroy the destroyer—and the more swiftly because of the power now in the hands of medicine to blot out the disease. To the day of that awakening books like this are dedicated. The facts here presented are the common property of the medical profession, and it is impossible to claim originality for their substance. Almost every sentence is written under the shadow of some advance in knowledge which cost a life-time of some man's labor and self-sacrifice. ”

“ Not only does syphilis fail to punish justly, but there is also something savage, akin almost to the mental attitude that makes "frightfulness" possible in war, in the belief that it is necessary to make headway against a sexual enemy by torturing, ruining, and dismembering men, women, and children, putting out the eyes of the boy who made a slip through bad companionship and mutilating the girl who loved "not wisely but too well." Only innocence pays the spiritual price of syphilis. ”

“ Against syphilis, the astonishing progress of our knowledge in the past ten years has armed us for triumph. When the fight against tuberculosis was brought to public attention, we were not half so well equipped to down the disease as we are today to down syphilis. For syphilis we now have reliable and practical methods of prevention, which have already proved their worth. The most powerful and efficient of drugs is available for the cure of the disease in its earlier stages, and early recognition is made possible by methods whose reliability is among the remarkable achievements of medicine. ”

“ If war and our mobilization for defense leave us with every hospital and dispensary and public health resource and all the expert judgment we have available within our borders enlisted finally in a great campaign against gonorrhea and syphilis, it will have accomplished a miracle, though it will have done no more than war has done for Europe. If it leaves us even with our more progressive states committed to an expanding program of universal efficient and accessible diagnosis and treatment, it will have conferred a blessing. ”

“ So one hears, as if in a speaking-tube from a long distance, the words that Schaudinn and Hoffmann, on April 19, 1905, discovered the germ that causes syphilis, not realizing that the fact contained in those few brief words can alter the undercurrent of human history, and may, within the lives of our children and our children's children, remake the destiny of man on the earth. ”

“ The Broader Outlook.—If, then, it avails nothing in the uplifting of our morals to treat syphilis as a disgrace, if the disease is ineffective as a deterrent, and barbarously undiscriminating, inhuman, and unjust as a punishment, let us in all fairness lay aside the attitude of mind which has so hindered and defeated our efforts to deal with it as an arch enemy to human health, happiness, and effectiveness. ”

“ The Necessity for Legal Control.—All these repulsive details have a place in driving home a conception of the cost to society of the immoral and irresponsible syphilitic. Syphilis is an infectious disease, dangerous to the individual and to society. If it is rational to quarantine a mouth and throat full of diphtheria germs, it is rational to quarantine a mouth and throat full of syphilitic germs at least until the germs are killed off for the time being. There can be no more excuse for placing society at the mercy of the one than of the other. ”

“ It is practically an axiom that no woman who is lax in her relations with men is safe from the danger of the disease, or can long remain free from it. The type of man who is a Light o' Love does not go far before he meets the partner who has been infected by some one else. Becoming infected himself, he passes on his infection to his next partner. Syphilis is not so often transmitted in prostitution, open or secret, as gonorrhea, but it is sufficiently so to make the odds overwhelmingly against even the knowing ones who hope to indulge and yet escape. ”

“ The man who has been cured of syphilis has passed through a discipline which calls for the best in him, and repays him in terms of better manhood as well as better health.
The physician's coöperation in the development of the necessary sense of responsibility and the requisite character basis for a successful treatment is invaluable. To the large majority of the victims of the disease it is a severe shock to find out what ails them. Many of them, without saying much about it, give up all hope for a worth-while life from the moment they learn of their condition. ”

“ If we fail to find the germs, it is no proof that syphilis is absent, and we reëxamine and take blood tests at intervals for some months to come, to be sure that the infection has not escaped our vigilance, as it sometimes does if we relax our precautions. In recognizing syphilis, the wise layman is the one who knows he does not know. The clever one who is familiar with everything "they say" about the disease, and has read about the matter in medical books into the bargain, is the best sort of target for trouble. Such men are about as well armed as the man who attacks a lion with a toothpick. ”

“ A conscientious patient is one who is not content with any ideal short of that of radical cure. It takes unselfishness and self-control to go without those things which make the patient in the infectious stage dangerous to others. For a time life seems pretty well stripped of its pleasures for the man who may not smoke, must always think beforehand whether any contact which he makes with persons or things about him may subject others to risk of infection, and perhaps must meet the misunderstanding and condemnation of others whom he has to take into his confidence for the same purpose. ”

“ Yet it is both amazing and discouraging to find how many irresponsibles there are in the ordinary and even in the better walks of life. To the wilful type of irresponsible person the transmission [Pg 151] of a syphilitic infection is nothing, and cannot weigh a straw against the gratification of his desire or the pursuit of his own interest. The disease cannot teach such people anything, and if it cannot, how can the physician? Such people pursue their personal and sexual pleasure, marry, spread disaster around them, and outlive it all, perhaps brazenly to acknowledge the fact. ”

“ Just as there are sounds we cannot hear, and light we cannot see, so there is a world of small things, living in us and around us, which sways our destiny and carries astray the best laid schemes of our wills and personalities. The gradual development of an awareness, a realization of the power of this world of minute things, has been the index of progress in the bodily well-being of the human race through the centuries marking the rebirth of medicine after the sleep of the Dark Ages. ”

“ At any day or hour the disease which he scorned or ignored may crush him, or what is worse, may crush what is nearest and dearest to him in the world. It does it with a certainty which not even the physician who sees syphilis all the time as his life-work can get callous to. It is gambling with the cards stacked against one to let a syphilitic infection go untreated, or treated short of cure. It is criminal to force on others the risks to which an untreated syphilitic subjects those in intimate contact with him. ”

“ The disease has in its turn become more subtle and deceiving, its course is seldom marked by the bold and glaring destructiveness, the melting away of resistance, so familiar in its early history. The masses of sores, the literal falling to pieces of skeletons, are replaced by the inconspicuous but no less real deaths from heart and brain and other internal diseases, the losses to sight and hearing, the crippling and death of children, and all the insidious, quiet deterioration and degeneration of our fiber which syphilis brings about. ”

“ If every employer, or the state itself, would give a clean marriage a preferred position in the social and economic scale, and, by helping to meet the cost of it, recognize in a substantial way the value to the race of a family of vigorous children, an important factor in youthful sexual laxity would be robbed of its power. No one will assert that such remedial proposals are of themselves cure-alls for present evils, but they must have at least an emphatic place in the future of moral prophylaxis. ”

“ Destructive Effects of Late Syphilis.—Late syphilis is, therefore, destructive, and the harm that it does cannot, except within narrow limits, be repaired. It is responsible for the kind of damaged goods which gives the disease its reality for the every-day person. It is a matter of desperate importance where the damage is done. Late syphilis in the skin and bones, while horrible enough to look at, and disfiguring for life, is not the most serious syphilis, because we can put up with considerable loss of tissue and scarring in these quarters and still keep on living. ”

“ There is nothing about the test that need make anybody hesitate in taking it, and it is safe to say that, when properly done, the information that it gives is more than worth the trouble, especially to those who have at any time been exposed, even remotely, to the risk of infection. But the test must be well done, by a large hospital or through a competent physician or specialist, and the results interpreted to the patient by the physician and not by the laboratory that does the test, or in the light of the patient's own half-knowledge of the matter. ”

“ Even while we concede the value of generations of experience with syphilis in determining the probable risk of infection, it is a duty to investigate thoroughly by the modern methods, such as the Wassermann blood test, the condition of all members of a family in which syphilis has appeared. This means, for example, that even though the husband with syphilis may have married years after the usual period of infectiousness has passed, his wife, though outwardly healthy, should have a Wassermann test, and his children would be none the worse for an examination, even though they seem normal. ”

“ A syphilitic infection which has not been cured not only makes a man a poor risk to an insurance company, but a poor risk to the family which has to look to him for support and for his share and influence in the bringing up of the children. A sufficient number of men and women in the thirties and forties are crippled, made dependent, or lost to the world entirely, to make the responsibilities of the family when assumed by persons with untreated or poorly treated syphilis a matter of some concern, whether or not they are still able to transmit the disease to others. ”

“ To some extent, the abortive cure of the disease, with its 100 per cent certainty, will therefore remain a luxury until the public is aroused to the necessity of providing it under safe conditions and without restrictions for all who need it. At all stages of the disease after the earliest it is an aid, and a powerful one, but it cannot do the work alone, as mercury usually can. But though mercury is efficient, it is slow, and the greater rapidity of action of salvarsan and its power to control infectious lesions give it a unique place. ”

“ Only the ignorant undertake to treat themselves for syphilis, though how many of these there are can be inferred from the amount of patent medicine and quack treatment there is in these fields. Properly given, mercury has no harmful effects, and there is no ground whatever for the notion some people have, that mercury will do them more harm than a syphilitic infection. Improperly used, either as too much or too little, it is capable of doing great harm, not only directly, but indirectly, by making it impossible later for the patient to take enough to cure the disease. ”

“ Education of public opinion offers us just such a positive mode of attack. Men and women and boys and girls should first be taught sexual self-control even before being made aware of the risk they run in throwing aside the conventional moral code. Teach honor first and prudence next. The slogan of education in sexual self-restraint is the easiest to utter and the most difficult to put into practice of all the schemes for the control of sexual diseases. A large part of the difficulty of making education effective arises from one or two situations which are worth thinking over. ”

“ So we are compelled in practice to limit our conception of radical cure to the condition in which we have not only gotten rid of every single symptom of active syphilis in the patient, but have carried the treatment to the point where, so far as we can detect in life, he never develops any further evidence of the disease. He lives out his normal span of years in the normal way, and without having his efficiency as a human being affected by it. ”