visit them ad libitum? Wisconsin has a new law which requires a certificate of freedom from venereal disease as a condition of marriage. This law in its effect is rather punitive than preventative. It is possibly worth while to have some such legal recognition of the social canker in its relation to marriage, if for no other reason than its publicity value. However, there is to be said that all legal restraints to marriage, if not circumvented, as they usually are, tend to increase licentiousness and hence to become self-nugatory.

The only sensible way to cope with this growing menace to society is to look on the so-called venereal diseases in exactly the same dispassionate, scientific spirit as we look on any and all other communicable diseases. We must disassociate the problem of preventing them entirely from the question of sex morality. The latter is a spiritual question, the former a purely material matter.

To what conclusion do we arrive?

First, that venereal diseases should be made reportable. To secure the enforcement of such a law now would be difficult for the reason that infected voters and many physicians hold that the privilege of individual secrecy is more sacred than the rights of the public. In a well ordered state the individual should have no privilege at variance with public welfare. While this feature of a successful plan is desirable it is not essential and I doubt if it is at present practicable. Second, let the extent and the consequences of venereal disease be made as familiarly known to the public as they are known to physicians. This could best be done by medical organizations, which should cause to be published and republished in the public press authoritative statements concerning these diseases, their cause, their communicability and their grave effects. Third, and by far the most important feature of our plan is to supply adequate personal instruction as to the means and measures that will prevent infection where the possibility of

infection may exist. This proposal is the pons assinorum in the geometry of venereal problems. Instantly popular and professional objection arises. This plan indeed proposes to cross the Rubicon that lands us in a purely materialistic relation to the problem of venereal disease. Well, so be it. It is certain that so long as we are dominated by the moral aspect of this vital question, just so long will this curse of the ages hang on the neck of society, a veritable old man of the sea.

Can we cure yellow fever or smallpox? No. But we do prevent them until no longer do they scourge mankind.

Suppose that the problem of preventing these diseases had been entangled with a moral question, so as to practically thwart successful preventative measures? Where would the world be today?

To contend that to teach the means of personal protection is to promote immorality is beside the mark. Each human being is alone answerable for his own morals. Besides, the moral quality of an act is not altered by the accident of escaping or acquiring disease.

If we ever make any progress whatever in the way of lowering the rising tide of these diseases, then we will have to lay aside prejudice and apply the scientific principles of prevention that have been so eminently successful in ending all the other great plagues that have afflicted mankind.

We, as physicians, know this to be the bald, repugnant truth, but the truth nevertheless. Through moral cowardice and the shocking ignorance of the public we have thus far done practically nothing to effectively stay the march of two perfectly well understood and preventable diseases, which, taken together, cause more physical suffering, more mental anguish and more race degeneration in these United States of ours than any other dozen causes, alcohol excepted. I would not be understood as intending to make the way of the transgressor easier; but I would be understood as offering the only real effective protection to the

transgressor's family present or prospective. Every other method of controlling these diseases has been tried and found wanting. Instructions as to personal protection has heretofore been rejected as inconsistent with sound morality and as beneath the offices of self-respecting physicians. The ground of both these objections is untenable. Must we see our daughters and grandchildren syphilized in order that a prospective son-in-law be punished for his transgressions!

The notion that it is beneath professional dignity to prescribe means of personal protection against venereal disease, that to do so is to enter into a compact with the desire to promote vice, is as unscientific as it is inconsistent. If we propose to refuse to prescribe means of prevention, let us consistently refuse to interfere with divine vengeance and withhold all curative measures.

Which is the more humane, to allow a man to fall into a hidden ditch and then help to fish him out, bruised and battered and maimed for life, or to warn him of the hidden danger in his pathway and to tell him how to avoid it? To sum up the matter in a word: Our moral obligation to protect society by any means whatsoever from disease transcends all petty considerations of professional dignity, or the negative power to permit vice to punish its votaries.

If any person will study the results of all the crusades against venereal disease from the remote past to the near present, he will discover that all attempts save one have served to increase rather than diminish their prevalence. The one exception is the method introduced into the United States navy several years ago. Since then the diminution of venereal diseases in the navy has been remarkable. The method is highly interesting as being the only measure that has ever had the slightest obvious effect in lessening these diseases. The plan consists solely in personal protection.

Mankind is forever bemoaning his fall from Eden, his descent from divinity. Far more profitable would it be for

him to realize his ascent from animalism. For only by a true appreciation of our place in nature can we evaluate all the factors that enter into the complex subject of sex relationship.

Carlyle defined man as an animal surrounded by clothes, and civilization as veneered savagery. These half truths lie close to the root of the social evil. Moralists have conceived an ideal of sex relationship which, however beautiful and perfect in theory, is at war with an instinctive tendency that reaches back into the dim period of our anthropoid origin.

Because humanity in the matter of sex relationship falls short of a lofty ideal, must humanity be scourged with these hellish diseases? I say from the bottom of my heart, No! The day that marks our conquest of venereal disease will mark a new birth for idealism. How and why would here carry us too far afield. Suffice it to say that venereal disease is doing more today to make marriage ofttimes a miserable failure than any other single factor that may operate in that direction.

I would not end this paper and omit to pay a tribute to the force inherent in human nature that makes for righteousness. The very burden it has imposed on the scientific management of venereal diseases is, in itself, a testimony of its existence and power. But this force is here misdirected and is always misdirected when it interferes with public health measures.

Let us all recognize, what no sane man can question, that the highest interests of the race are best served by continual sacrifice at the altar of chastity; and that the moral salvation of mankind, as regards this matter, lies in keeping within the law. But, let me emphasize, there is no inconsistency between preaching idealism with reference to sex relationship and teaching personal prophylaxis with reference to venereal disease.

Selected Articles

BACTERIAL BY-PRODUCTS AND THEIR THERAPEUTIC USES.*

BY RALPH WALDO HOLBROOK, M.D., KANSAS CITY, MO. Superintendent South Side Hospital; Lecturer on Diseases of the Chest, South Side Hospital.

In selecting a subject that would interest the members. of this society, I naturally considered the one uppermost in the minds of the internist and one of the most prominent in medical literature today. With the enthusiasm, the opposition, the good and indifferent results, the lack of standardized and tried products, the claims of some producers and their gross lack of experience, plus the growing demand, and also because I believe this to be the ultimate treatment for all infections, enough cannot be written from actual personal experience.

In justice to some producers, let me say that their products are sent to various parts of the country, accompanied by all the theoretical information possible to be gained from their laboratories, together with a statement of the experiences of men in actual practice. If a majority of adverse reports come in, the product is discarded. This oftentimes means thousands of dollars expended and no returns.

This paper is given to you after four years of experimental and private application of the bacterial by-products. By the term "bacterial by-products" I mean vaccines, serums, and filtrates. Bacterial vaccines are suspensions, in a preservative or physiological salt solution, of killed pathogenic bacteria. This product is sterilized and standardized to contain a given number of bacteria to each cubic centimeter. The therapeutic action is dependent upon a stimulating action on the body cells, thereby producing

*Read before the Bates County Medical Society, September 24,

1914.