Precis of Author's Views.

It will be in the recollection of persons interested in the subject of this paper that both branches of the Legislature have recently appointed Committees to investigate the results of the Contagious Diseases Act.

Favourable Report of the House of Commons.

—P. iii.

In consequence of these strong recommendations, it is probable that another session will not pass without the Legislature enacting some measure for the extension of the Contagious Diseases Act to the civil population. In the face of this possibility, it seems of the highest importance that the question, how far such an extension is desirable or possible, should receive very careful and accurate consideration at the hands of the profession and the public, and I am anxious to assist the progress of the discussion to the utmost of my power.

The passing of the Contagious Diseases Act is a step in the right direction; it is an effort, and, as the parliamentary reports, to which I hare alluded, show, a successful effort to mitigate a great physical mischief. In considering the attitude which a civilized community should assume towards prostitution, the nature of the evil must not be lost sight of.

Would that we Could Eradicate Prostitution.

I wish that I could believe with some of our opponents, that we could do away with prostitution altogether. If I thought it possible or probable, I would mast willingly assist in eradicating the evil, but I believe, that by aiming at the possible and the practical, we shall do more good than by seeking to attain a state which, however desirable, is beyond our reach. Prostitution we cannot prevent, but we can mitigate the misery entailed by it, and can do much if we will to prevent women becoming prostitutes. The evil cannot be done away, but it may be lessened, and that to a very great extent. We cannot do all we wish: is that a reason for doing nothing? Let us do what we can. A mischief that must always exist will have more or less intensity according as we regulate it or leave it to itself. The women will become more or less depraved according as good and healing influences arc brought to bear upon or withheld from them.

Prostitution an Inseparable Condition of Society.

It is useless to shut our eyes to facts. Prostitution is no passing evil, but one that has existed from the first page 5 ages of the world's history down to the present time, and differs but little, and in minor particulars, in this the nineteenth century, from what it was in the earliest times. The records of the human race, from the Book of Genesis downwards, through the whole range of ancient and medieval literature to the writings of our own day, bear witness to the perpetual presence among men of the daughters of shame. Kings, philosophers, and priests, the learned and the noble, no less than the ignorant and simple, have drunk without stint in every age and every clime of Circe's cup; nor is it reasonable to suppose that in the years to come the world will prove more virtuous than it has shown itself in ages past. From time to time men's purer instincts, revolting from the sin, have striven to repress it; but such efforts have too often ended in failure, and entailed disasters more terrible than those from which relief was sought.

As one among many other instances of the futility of repressive measures, I may cite the example of the city of Berlin. This capital has on three separate occasions, since the Reformation, been purged of prostitutes, but has as often immediately fallen a prey to desertion of infants, adultery, abortions, and clandestine prostitution. Hence the present public recognition of that which the Government could neither suppress nor ignore with public advantage, has been forced upon the authorities. It is evident that it would be unreasonable to expect any other result. Equally irrational is it to imagine that this irrepressible evil can exist without entailing upon society serious mischief, which, though incapable of extinction, yet admits of mitigation. To ignore an ever-present evil appears a mistake as fatal as the attempt to repress it.

Were Prostitution Unattended by Contagious Diseases we should not Advocate Government Interference.

I must here admit that if prostitution carried moral mischiefs only in its train, it would be to a great extent, if not entirely, outside the proper sphere of legislation. Failure must always be the fate of any attempt to make people virtuous by Act of Parliament. The evils produced by prostitution are two-fold, moral and physical. page 6 The remedies adopted must be in like manner twofold—the moral mischief must be left to the influences of religion and civilization, and to the care of those who from their special position are peculiarly fitted for grappling with moral evil. The physical mischiefs on the other hand must be met by physical measures; the same thing which is true of the results is true of the causes of prostitution. These also are two-fold, moral and physical—the moral causes must be met in the same way as the moral results—the physical causes in the same way as the physical results, that is to say, the means adapted to dealing with moral evil must he applied to the one; the means of grappling with physical evil to the other. It will be at once apparent that the question how to deal with prostitution is a very wide one.

Other Mischiefs Connected with Prostitution.

That the mischiefs which result and will result from it are various, and therefore that the machinery for dealing with it must be as various as the evils sought to be remedied. I may allude to Infanticide Illegitimacy, and Inadequate Lodging Accommodation for the Poor It as evils already connected with prostitution, which ought to be the objects of legislation.

For the present, I will deal only with contagious disease that results from prostitution, and here I may repeat that contagious disease is inseparable from it, and will merely premise that any efforts to grapple with this result ought to be accompanied by measures dealing with the other cognate evils to which I have referred.

Summary of the Effects of Contagious Disease.

Doubts have recently been expressed as to the magnitude of the evil occasioned by venereal disease, it being imagined by some that not only is the disease comparatively infrequent but productive of mere ephemeral mischief; it has moreover been hinted by the medical officer of the Privy Council, and asserted m the protest issued by the Ladies' Association that the object of those who advocate the extension of the Contagious Diseases Acts to the civil population is simply to enable men to indulge their sexual passions with impunity.

In consequence of these grave misconceptions it seems necessary to say a few words as to the extent, the rigour, and the insidious character of the venereal disease, also as to the mortality occasioned by it.

I.—As to the Extent.—In my treatise on syphilis I have shown that in our leading public hospitals in London, one-half or fifty per cent of the surgical outpatients came there in consequence of being affected with venereal diseases, page 52.^* I have proved that at the time my statistics were taken at St. Bartholomew's Hospital, about one in every five surgical out-patients was a woman or child, Loc. Cit. p.54. Before the Contagious Diseases Act was put in force in the British Army, 325per l000 soldiers were annually affected with venereal disease,^† Loc. Cit. p.8. At page (S3, evidence is given that 35 per cent, per annum of sailors were rendered unfit for service by this scourge of our seaport towns.^‡ I have also shown that

^* Captain Harris has kindly placed the following data at my disposal, which are even more alarming than those referred to by Dr. Stewart with reference to Greenwich, see p. 28. They are most valuable as showing the amount of disease discovered in the newly protected districts immediately on their being brought within the provisions of the act, and as furnishing us with authentic evidence of the enormous amount of disease that must be existing in all the unprotected districts, i.e. throughout by far the greater part of the United Kingdom.

"The first 250 women brought up for examination in the Plymouth district were found to be diseased without a single exception."

"Return of the number of women examined in the Winchester District since the acts came into operation there (Thursday, Jan. 6 to Feb. 1, 1870), shewing the number found diseased, number free, and also the nature of the diseases, whether syphilis or gonorrhœa. Number examined, 76. Number found diseased, 50. Number found free 20. Nature of disease: syphilis, 28; gonorrhœa, 28."

^† It is instructive to compare these returns with those showing the freedom from venereal disease among soldiers in foreign armies. "In Paris 40 per 1000 men only were affected with venereal disease in the garrison of Paris in the years 1858 to 1880."—Acton on Prostitution, p. 125. "At Brussels when I visited that city, only 1 men were laid up out of a garrison of 3500 soldiers."—Loc. Cit., p. 131. "In the Prussian army the proportion of venereal was 62 per 1000."—Loc. Cit., p. 143.

^‡ During the discussion which followed the reading of this paper, Dr. Kidd, Staff-Surgeon of the Army Medical Service, said the last report of the Army Medical Department was for 18G7, and was published in September. The returns for the United Kingdom show that from 1860 to 1866, even before the application of the Contagious Diseases Act, there had been a progressive decrease in the cases of venereal diseases. In 1860 the proportion of admissions per 1000 of the strength was 369, in 1866 it was 258. In 1860 the proportion constantly sick from venereal disease was 23-69 per 1000, in 1866 16.19 per thousand. In 1867 an increase had occurred. The proportion of admissions was 291 and of constantly sick 17-13. Dr. Kidd quoted statistics from Dr. Parke's work on hygiene as to the relative number of soldiers attacked with primary venereal sores in 1868, at "protected" and at "unprotected" stations "In the protected stations, the number attacked in 1868 is not only below the mean in the previous four years in every station, but is, in every case, lower than the minimum of any former year, whereas, in two out of the four non-protected stations, the number of attacks in 1868 is above the mean of the previous four years; in one station is only-just below, and in only one station is lower in 1868 than in any of the preceding years. The mean number of attacks in the five protected stations in 1864 was 108-98, and in 1868 was 67-63. In the four unprotected stations the corresponding numbers were 115-13 and 101-08." "On the whole, considering how imperfectly, and for how short a time, the Act has been applied, I think there is every reason to hope that the lessening of syphilis at all the protected stations in 1868 (though it is inconsiderable in the ease of Aldershot) is really owing; to the influence of the Act." Dr. Kidd thought the recruiting returns would furnish some means of comparing the civil population with the army in respect to the prevalence of venereal diseases. The returns from 1860 to 1866 showed that the proportion of recruits rejected for venereal diseases was about 16 per 1000 annually, or very nearly the same as the proportion of soldiers constantly sick from the same causes during the last few years. While, however, there has been a marked diminution in the number of soldiers constantly sick, there has been no corresponding diminution in the proportion of rejected recruits for venereal diseases."

page 8 in the merchant service, 1 out of every 3 patients who applied to the Dreadnought Hospital suffered from venereal disease, page 67.

II.—As to The Rigour.—There is no doubt that the disease, though quite as frequent, is less virulent now than it was a few years ago. The decrease in its virulence is attributable, of course, to the improved method of treatment, to the altered and more regular habit of living, and better hygienic conditions of the population, and shows how much may be done in the way of mitigating the syphilitic poison, where the opportunity of exercising his skill is afforded to the medical man. This decrease of the activity of the disease seems to me a strong reason for giving to the profession increased facilities for dealing with it. It must not be imagined page 9 that because the poison is now followed by by less serious consequences than formerly, that the mischief produced by syphilis is not of very great magnitude; it is true that, if taken in time, and if the patient have a strong constitution, permanently injurious results are generally avoided; but wherever these conditions are not fulfilled—and, in many cases, even, where they are—broken constitutions and a poisoned state of the blood, which make the procreation of healthy offspring a physical impossibility, are the results.

III.—The Insidious Nature of the Disease.—I will now say a few words on the insidious nature of syphilis. It is generally assumed that the sufferer from syphilis is necessarily an immoral person. This is a great mistake; the disease doubtless comes in every case primarily from an immoral source-In the present day it never arises spontaneously, it does not follow, however, that the individual sufferer is the guilty party. For instance, the drunken husband, waylaid in his cups by the harlot, contracts the disease syphilis. Would that the complaint stopped here! We have the innocent mother becoming infected, and the babe that she conceives inherits the taint, which it may communicate to a stranger suckling it—who, again, may contaminate her own child, and the chain of contagion may thus be indefinitely lengthened out. Again, in the case of a trade, such as glass-blowing, a diseased man^* may communicate his complaint to any of his fellow workmen who may use the same mouthpiece with himself, and they, of course, in their turn infect their wives. Cases, moreover, like the following are far from uncommon. A single man consorts with prostitutes, and, as a consequence, becomes

^* For many years the medical school in which I was educated in Paris was reluctant to admit that contamination could be spread in these ways. Private practice during the last thirty years, and the facilities for accurate observation among the middle and upper classes of society, now enable me to assert that syphilis may be thus communicated. In making this statement, let me not be understood as admitting that all the published cases of asserted contagion by spoons, drinking-cups, or other vehicles, are true. The medical man has many appeals made on his credulity, and experience can alone sift the true from the false evidence.

page 10 infected, is treated for the complaint, supposes himself cured—vain delusion!—marries a virtuous girl, when, sad to relate, the disease breaks out in the wife, the offspring becomes tainted, and the contagion may be further indefinitely spread, as I have already stated.

IV.—Mortality Arising from Syphilis.—The weekly average of deaths from syphilis in London, within the last ten years, (1860-9 inclusive) varies from 4.9 to 9.0.

The Registrar-General has kindly supplied me with the following most important tables, showing the mortality arising from syphilis, and my readers will not fail to remark the appalling but incontrovertible fact that the greatest mortality exists among infants under 1 year of age. What a sad commentary do they furnish on Scripture, "visiting the iniquity of the fathers upon the children."

I think I have now disposed of the notion suggested by the medical officer of the Privy Council "that very exaggerated opinions are current as to the diffusion and malignity of contagious diseases (p. 13), and have shown conclusively that syphilis is an evil too great to be left to work its fatal course unchecked, and may now proceed to indicate the means by which it can be most efficiently contended with.

How Contagious Disease can be Controlled.

It appears to me, that the only effectual way of dealing with the disorder, is to detect early, to seclude effectually, and place under medical treatment, as many affected persons as possible. It is as vain to hope to reach all, as it is to deny that there are many upon whom the healing hand can he laid. Only those utterly ignorant of what has been achieved, will be so bold as to deny the excellent effects produced by the Contagious Diseases Act in the protected districts. The reasonable conclusion seems to be that what is good for the few will be good for the many, and that the provisions of this Act should be extended to the whole population.

Who Shall Come Under the Control of the Act.

I may at once state that there are many women whose lives are immoral, whom it will be impossible—perhaps even undesirable—to bring within the provisions of the Act, on account of the secrecy and reserve with which they pursue their calling.

Many of these women are doubtless diseased, but the very secrecy which places them beyond the reach of legislation, at the same time limits their sphere of mischief, and the men infected by them, are for the most part able to obtain prompt and efficient medical advice, so that the mischief caused by such women as, these, is comparatively slight. The lower we descend in the social scale, the more mischievous does syphilis become,^* for it is among the poorer classes that neglect of the disease, inability to obtain proper medical treatment, and feeble constitutions, are at present most frequently met with.

The Common Prostitute is the Person We Wish to Control.

I am, I think, not saying too much when I affirm, that if we could only lay our hands upon the notoriously vicious women, upon all, in short, who can be fairly included in the term "common prostitute" we should get rid of the greater, and most dangerous part of the mischief. Now, thin is the very tiling that is done by the Contagious Diseases Act.

The principle of this Act is, that every woman known to the police as a common prostitute, who fails, on notice, to submit herself to a voluntary examination, is liable to be summoned before a magistrate, and subjected by his order, if he shall think fit, to medical examination and supervision, and on the certificate of the medical officer, that she is diseased, subjected to treatment in hospital until cured. It is perhaps unfortunate that no attempt was made by the framers of this Act to define accurately the persons to whom they intended to apply this term "common prostitute." As might be expected, much capital has been made by opponents of the measure, out of this omission, though I believe that no practical evil has hitherto resulted from it. To guard against all possibility of misconception in future, it may, perhaps, be wise for the legislature to supply this omission in any act dealing with the population at large.

Definition of a Common Prostitute.

I am, however, far from considering the insertion of any such clause a necessity, as it is a most remote possibility that any woman should be charged with being a common prostitute, unless her conduct was notoriously and openly bad, and it is obvious that any distinct statement of the acts that shall render a woman liable to be included in the class supplies, by the definition, the means of evasion. It is worthy of remark, that the number of women, returned by the police, as common prostitutes, reaches to little more than (5000, though the metropolis is believed to contain an infinitely greater number of vicious women. This shows the strong reluctance that exists on the part of the police, to include in such page 13 a category any but the most abandoned. It also shows that there are certain women, whose number is far from inconsiderable, whose profligate mode of life is open and undisguised, and admits of no reasonable doubt. These at least may be dealt with by this act, and we may, I think, lay it down as a general rule, that it is reasonable to treat as a common prostitute every woman who can be shown to be an habitual street walker, or frequenter of casinos and similar places of resort, or in the habit of hiring herself out to different men, and every woman known to resort to houses of accommodation, and whom no respectable man will acknowledge as cither wife or mistress.

How the Act Affects the Common Prostitute.

To show how considerately, and with what little hardship to the women subject to the existing Act, its regulations can be carried out, I may quote the evidence of Inspector Smith, the efficient officer of the Aldershot district, given before the committee of the House of Lords in 1869.

His examination, so far as material to this point, was as follows:—

976. Will you tell the Committee what your duties are with regard to the Contagious Diseases Act?—I will. The duties consist in watching for women who are supposed to be prostitutes, women who are not residing in brothels, and women who are practising clandestine prostitution; and warning them to attend for medical examination, and conveying them to and from the hospital, or to their homes; in fact, every duty connected with the carrying out of the Act.

977. You have spoken of clandestine prostitution, and do you believe that there is much clandestine prostitution within the camp at Aldershot?—I do.

978. Have you any power over clandestine prostitutes?—We have no power; but I satisfy myself always either by myself or from some good information that I obtain, and I always make it a point to see those people. I see them and tell them what I have seen or heard, and in most cases they do not deny it, and I warn them to attend for medical examination. That is my practice.

979. In what class of life arc those clandestine prostitutes?—Various classes. As a rule, they are of the lower order; I could not say that any person who is practising as a clandestine page 14 prostitute is moving in what I might call a respectable sphere of life. They arc as a rule labourers' daughters, and people of that class.

980. Shop girls?—I think not.

981. Servants?—Servants occasionally.

982. Under the present Act, what power would you have over a servant who you had reason to believe was practising clandestine prostitution?—First of all, I should warn her to attend for examination under the 17th section of the Act. If she did not attend for examination, and I had good reason to suppose that she was diseased, and was conducting herself as a common prostitute, I should then lay information before a magistrate in the usual way, and get her summoned before him; and if she did not appear by herself, or by some person on her part, then I should ask the magistrate to be good enough to make an order for her examination, which of course would depend upon the magistrate. If the evidence was sufficient to justify him in making the order, he would do so; and if he did, I should then serve a copy on her; and in the event of her not attending, I should then apply to a magistrate for a warrant to apprehend her; she would then be apprehended and brought before the magistrates in the usual way, and charged with the offence.

983. What nature of evidence could you offer with regard to a woman in service in a house?—For instance, if I went to the military hospital, and a man was in his bed and he told me that So-and-so had given him the disease, I should then make some inquiries; I should very likely ask the hospital serjeant or some person about, if the man's statement was to be relied upon, and if he was likely to tell me the truth or not; I should be very cautious not to interfere in any way with any person in service or living in any respectable place, or anything of that sort, without good foundation. If I found that the man's statement was to be relied upon, I should keep observation upon this party for some time, and if I found out that the woman went out to public-houses, and was seen in company with various men, and that kind of thing, then I should take upon myself to warn her; but if I saw nothing of the kind whatever beyond the man's mere assertion that such was the case, I should not take any notice of it.

Even if the police employed in carrying out this Act are occasionally guilty of tyrannical or vexatious interference with the liberty of the subject, little mischief can result so long as the medical officer retains the discretionary power, at present exercised by him, of refusing to examine any woman who can suggest to his mind a page 15 reasonable doubt as to the justice of her apprehension, until such time as the doubt shall be removed. It must also be remembered that no woman can be brought to the surgeon for examination, except by her own submission, until a magistrate has been satisfied that such a proceeding is justifiable.

Reasons for Compulsory Confinement.

Were the plan feasible, I should agree with the proposal, that in preference to this compulsory legislation, large hospitals should be opened for the treatment of diseased women on their own voluntary application, but experience teaches us that they will not come. At the present moment, notwithstanding the inadequate accommodation in proportion to the disease existing among prostitutes, provided by the London hospitals, numbers of the beds at these institutions remain unoccupied, owing to the disinclination of those women to enter the wards of their own accord, therefore the adoption of compulsory measures seems unavoidable.

It is now many years ago since I called public attention to the error committed by philanthropists and medical men in treating prostitutes as out-patients. I regret to say that what I wrote and published, regarding our civil hospital arrangements, twelve years ago, applies equally at the present day. I, however, now go farther, and venture to question whether it is desirable for our civil hospitals to treat prostitutes as out-patients at all.

Every man who frequents the street, after nightfall, must meet many a woman, apparently sound and healthy, who, patched up by voluntary charity in the morning, knows no other way—nay, whose only possible resource—to get her necessary food, or bed at night, is to sally forth into the streets. The ministers of charity may have cased her pain in the morning, dressed her sores and given her drugs, but in a month she will be no nearer soundness than had she been taken care of by the State within the walls of the hospital for one week; and within that month what a scourge upon society will the surgeons not have kept afoot by their exertions? Here is the power of charity again working to waste.

We have seen, that, to confer any permanent benefit page 16 on society, and on sanitary grounds, when a woman is diseased, an early detection of her complaint is necessary, and that when discovered she should at once he placed in confinement, so as to prevent her disseminating the plague. Moreover, she should not be allowed to leave the hospital till perfectly well and unable to contaminate any one she may have relations with. Our existing civil hospitals fulfil few of these conditions. The diseased prostitute is not sought after; she applies only when the mischief she can cause is done, and many men have been diseased, and she finds herself unable any longer to carry on her trade. If there be room in the wards to take the patient in, she occupies a bed say for many months, and even then society has no guarantee that she will remain till cured and do no more mischief. On the contrary, as soon as she pleases, the girl of her own free will (and many do so) can quit the hospital long before the surgeon gives his sanction; hence society and sanitary laws are baffled, and instead of the hospital benefiting the girl and the plague of syphilis becoming checked, the propagation of the disease is aided by both the in-and out-patient hospital system of treating our sick prostitutes.

It may be in the recollection of my readers, that some years ago it was given in evidence that prostitutes who were lying in hospitals suffering from venereal diseases, at Portsmouth, (on being sent for by the brothel-keepers) on the occasion of a ship being paid off, one and all left their beds to participate in the drinking and rioting that was a necessary consequence, to the no small detriment of Her Majesty's jolly tars, who of course became affected with the most serious forms of disease. This, I may add, took place before the existing Contagious Dis eases Act came into force, and compulsory residence in hospital (as now enforced) was carried out.

If the British public could only once conceive the idea that the treatment, cure, and temporary segregation of the syphilitic, was as much a matter of public interest as that of the lunatic, whose seclusion all counties, towns, and parishes provide for with such remarkable alacrity, not so much out of love or respect for the patient as page 17 because it is a dangerous thing to leave him at large, I think I should not long be without followers in wishing for equally public recognition of both complaints.

In another twelve months those who follow me may, I hope, have to chronicle that no prostitute in civil life will be treated week after week as an out-patient; but that she, like her sister in garrison towns and ten miles round, will, on the discovery of her diseased condition, be confined in hospital and restrained from infecting alike soldiers and civilians.

Beneficial Effects on the Women Themselves.

We have now had sufficient experience of the Act to test the effect the Contagious Diseases Act has had on the women themselves, and I see around me gentlemen^* this evening who will, I am sure, corroborate the following statement:—

The women are at least taught to respect themselves, and they are already less dirty and less disreputable. If care be taken in the selection of the health inspectors, every prostitute who comes within the scope of the Act, will every week find herself brought face to face with a man who disapproves and stands aloof from her life of sin, she will have the necessity of cleanliness impressed upon her, she will have the filthiness of her life imperceptibly brought to her notice. I have suggested that page 18 at the inspector's office papers should be kept, to be had on application, showing how those who desire to turn from a life of prostitution can have the means placed before them of doing so, and a notice should be fixed up in the office that such papers are there, and may be had on application. This would at least prevent the women who came for inspection, from supposing that their calling was either allowed, or tolerated, or considered necessary. But the weekly inspections will lead to something more, they will lead to the detention of numbers of these women; the life in the hospital will give to all the very opportunities that now penitentiaries give to some, and give them in a far more judicious and salutary manner. It may be that many weeks of inspection will be undergone, and more than one visit made to the hospital, before the desired change is produced. But I have said that the method that I propose is gradual, and that the change to be real must be gradual.

Average Number of Beds Required, and the Probable Expense.

I may be told, perhaps, that the number of beds required, and the expense of their maintenance would be so great, that my plan would become impracticable. I have met this objection in my recent work on "Prostitution." There I state that if we wish to provide accommodation in proportion to the number of beds devoted to females in Paris and Berlin, we should require 800 beds, if in proportion to the five great capitals or Europe, we should require 1,400. The expense of maintaining them is estimated at £24 10s. per bed: thus we could maintain the 800 beds for £20,000, or the 1,400 beds for £34,000. Let my readers recollect that if economists should grumble at such an expenditure, statistics show us that we spend upwards of this sum annually in curing the men among the 40,000 quartered in the eight garrison towns, independently of the subsequent injury to the health of and invaliding in the army.

If we try to form some estimate of what venereal disease is at present costing the community or what the page 19 individual would save by the introduction of the Contagious Diseases Act among the civil population, so as to protect our adult male population from the effects of syphilis, we may arrive at a serious, but, I believe, approximate estimate.

Dr. Farr is my authority for stating that, in the year 1868, there were 474,500 men in the metropolis between the ages of twenty and forty. If, therefore, it costs £56,000 to cure the venereal patients among 46,000 soldiers, it must at present be costing £577,670, or upwards of half-a-million, to cure the venereal cases among the 474,500 men liable to be affected in the metropolis, supposing that the venereal disease is as common among the adult civil population, as it is among Our soldiers.