problem still facing us and presenting a more formidable front than ever before. To have relied upon moral suasion alone, and to have expected any great result in four years, during which time all the incentives to sexual indulgence were strongly reinforced, would have been unreasonable. The loss of home life and the lack of rest, recreation, and entertainment were partly compensated by the invaluable Y.M.C.A. Huts, Church Army Huts, and Soldiers' Clubs. A patchy effort was made to teach the men that sexual incontinence was unnecessary, and that self-restraint was desirable, attainable, and by no means the sign of the milksop. Such enlightenment was, and still is, ardently desired by the men. It is their right to know that, by acquiring venereal disease, they run the great risk of passing on the infection to their present or future wives and children. This part of the work, however, was but casually done; it was, indeed, left to voluntary effort. It was never believed that antivenereal lectures were just as important as physical exercise parades, and should be equally compulsory. To a certain extent prophylaxis has been introduced, but it was carried out in a half-hearted manner. The proper foundation of knowledge and training has not yet been laid upon which to erect a proper prophylactic scheme. At present the whole structure is jerry-built. The authorities guaranteed treatment to the venereal patient; it was impossible to do less. It was to the interest of the country that the infected man should as soon as possible again take up his place in the firing line. The measures taken by the military authorities embraced the following: (1) punishment for concealing the disease; (2) stopping a certain amount of pay from men admitted to hospital with venereal disease; (3) stopping leave and promotion for venereal patients; (4) putting brothels out of bounds. In some armies such houses were licensed and the inmates medically inspected. It will be seen that the first three measures are punitive. The value of punishment for the concealment of venereal disease is infinitesimal. The incentives to the concealment of venereal disease are ignorance and the fear of punishment for having acquired the disease. The power to dispel ignorance lies in the hands of the authorities. Were there no punishment, there would be no more concealment than there is at present. The men, when they are infected, naturally want to be cured; and, since treatment is free in the army, they, in the vast majority of cases, report sick at once without any thought of concealment or the punishment it entails. In any case, whenever a man with venereal disease does report, he is penalised by stoppages of pay, leave, and promotion. The fear of punishment in a few cases has the effect that a man in whom gonorrhoea develops takes the risk of trying to cure himself and thus avoiding all the above-mentioned penalties. The result usually is that he does himself some serious harm, either by his own hands or by those of some quack, or he becomes the possessor of a chronic gleet and is thus a continual source of danger to others. Experience has proved the utter futility of such punitive measures. At the present time there is no justification for the infliction of punishment upon a man who has venereal disease. If the army authorities had decided that a man must not indulge in illicit sexual intercourse, then punishment would be justifiable for any breach of that regulation, irrespective of whether he acquired venereal disease or not. But the army authorities have not so decided. At present the man is punished for having the disease, even if he acquired it from his own wife when on leavewhich is not an unheard-of occurrence. If a village near a camp is put out of bounds on account of an epidemic of scarlet fever among its inhabitants, no one could justify the punishment of every man in camp who got the fever. There would, however, be justification for punishing any man found in the village, whether he developed the disease or not. He would be punished for having broken orders by entering a forbidden area. Regarding venereal disease, the attitude of the authorities is: Thou shalt not have syphilis or gonorrhoea.' This is as absurd as saying: 'Thou shalt not have measles or scarlet fever.' It would be rational to say: 'Thou shalt not put thyself in the way of acquiring venereal infection,' and to punish all who did so; just as it would be rational and proper to say: 'Thou shalt not enter the village X. on account of an epidemic of scarlet fever,' and to punish any man who disobeyed this order. But this is not even attempted, unless the Vol. 233.-No. 463. Y putting of brothels out of bounds has this end in view. Experience has demonstrated that the putting of brothels out of bounds is futile, for it in no way limits the incidence of the disease. There is little indeed to be said for the brothel, but in most brothels there is some attempt at cleanliness and prophylaxis. With the clandestine and amateur prostitute there is none. Besides diverting trade towards the irregular prostitute, the closing of these houses of ill-fame is simply offering a salve to the consciences of the powers that be, showing that something has been done. It is very doubtful if any good whatever is accomplished. There is neither sense nor value in instituting any repressive measures halfheartedly. The only thing to do in that way is to deport the whole female population from the area occupied by the troops. That would undoubtedly get rid of the occasional prostitute and the accommodating young woman, who are the most frequent sources of infection. The only way in which to deal with prostitution of any kind is to institute penalties so severe and to apply them with such ruthlessness to both sexes that illicit sexual intercourse will not be worth while. The licensing of brothels and the medical examination of the inmates possess not the slightest value. This has been fully proved wherever it has been tried. In spite of medical examination, it is quite impossible to guarantee that any public woman is free from infection. Regulation gives a false sense of security, and makes the authorities directly responsible for any infection that may result. It implies that the licensing body can give an assurance to all clients that venereal disease will not ensue from connexion with any of these women. This assurance is impossible. There is, moreover, a tendency for the average man to seek a more private object for his temporary amour and to neglect the sexual banquet provided by the State. For these reasons alone, the licensed and regulated brothel stands condemned as being not only useless and expensive but also dangerous. If the preventive measures already taken had been carried out thoroughly and completely, then the results would be extremely disheartening; but, when it is realised that the work has not been done efficiently, then, from such results as appear, one is justified in being optimistic as to the effect that will be produced under proper organisation and by scientifically directed efforts. It is clear that the means hitherto taken to combat the venereal menace have resulted in utter and complete failure. What then remains to be done? No amount of pious hopes will cure this national canker; no trifling with the enemy and sitting down to trench warfare is of any avail. What is needed and what alone will bring success is an energetic offensive. The combative spirit must be cultivated, and a well-thought-out, well-balanced and scientific attack launched. In the army all existing penalties should be abolished. It should be an order, with which all officers and men are familiar, that any person subject to military law who has sexual intercourse outside the married state must report to his medical officer or to a military hospital and apply for prophylactic treatment within twelve hours after exposure to infection. Each medical officer dispensing such treatment would keep a confidential 'prophylaxis register,' in which he would enter the man's name, number, unit, and date, also the nature of the treatment administered. The man would then receive a card bearing his serial number in the register. On this card would be eight ruled spaces for the medical officer's initials and the date. Instructions would be printed on the card directing the man to report to the medical officer for seven consecutive days, inclusive of the first day on which he applied for treatment, and then once again twenty-eight days after first reporting. The medical officer would, after each visit of the patient, place his initials and the date in the special space provided. In this way the incubation periods of syphilis, gonorrhoea, and soft chancre would be covered and the first sign of disease detected. Experience has shown that prophylactic treatment properly carried out within twelve hours of exposure will prevent the appearance of any venereal disease. Any man, then, in the army who developed such a disorder would be charged with disobedience of an order, namely, after exposure to infection failing to report himself for preventive treatment.' If he stated that he did apply for treatment, the production of his card bearing the medical officer's signature would constitute a complete defence. The presence of disease would show one of two things: (1) that the medical officer had been careless in the administration of prophylaxis; or (2) that the man had exposed himself again to infection during the observation period. The stage and appearance of the disease would make the differential diagnosis easy, and action would be taken accordingly. If the soldier was unable to produce his card, and if on inquiry it was found that his name did not appear on the prophylaxis register, he would be held to be guilty and would be heavily sentenced after his discharge from hospital. This, with a scheme of compulsory notification, could be made to apply to civil life. A scheme of prophylaxis was adopted by me in Persia and in Baku. There was nothing official about it, but an anti-venereal campaign was started among the troops in the area, and this was enthusiastically carried out by battalion medical officers. The following results representing the observations of three months were obtained: Number applying for prophylaxis Number of above who developed symptoms Number of these who had prophylactic treatment 894 nil 78 2 The history of these last two men was that they had not adopted any preventive measure till three days afterwards, and then they administered it themselves. The above figures are of considerable value and deserve close attention. The adoption of prophylactic measures before the act is not to be commended; it gives a false sense of safety. There is a tendency to apply it in a slipshod manner; and very often the conditions, from excitement, want of opportunity, or drunkenness are such that it is impossible. We may now set forth six remedial measures, suggested by war-time experience and applicable to civil life: (1) A real effort must be made to counteract all that tends towards sexual temptation. The two greatest enemies are prostitution and drunkenness; these must be stamped out with ruthless vigour. It is only making bricks without straw |