the cups, and grow into new cup-shaped animals that float up out of the top of the parent cup. Then they saw the hydra, a little more complex, something like a sac with tentacles around the top. This multiplies in two ways. In one,

buds grow and fall off as new hydras. In the other they saw a bunch of cells called egg cells, another called sperm cells, which ripened, fell in the water, and the sperm cells of one hydra united with the egg cells of another, developing new hydras. In many other simple land and water animals they saw egg cells, sperm cells, hermaphroditism and external fertilization, all with slight modifications. They made similar studies in many kinds of worms, and more complex animals. The many devices for hatching eggs and protecting the young were especially interesting, through insects, mollusca, fish, frogs, reptiles, birds and mammals. The whole was as fascinating as any fairy tale, and more wonderful. They begged for the privilege of working overtime and after school; and you will remember they were studying the other vital functions along with this. All were equally interesting.

66

Finally, the instructor gave them a talk on the sacredness and the meaning of the home, and the importance for both boys and girls of right living for the sake of the home, reminding them of the heredity they had seen in their specimens. Living germs something like single-celled animals, as causes of several diseases, some carried by mosquitos and other animal life, were discussed. Social diseases were enumerated with the others, the social evil being merely mentioned as one of their sources, and their harm to many millions, including little children; all in the same scientific spirit as the study of injurious parasites under the microscope. All was received in that frank-eyed, truth-seeking spirit. Their interest had been wholesomely answered. Both they and their parents were satisfied. Their understanding grew after nature's own fashion, a few new simple truths day by day. Both mind and character reacted healthfully.

"In several primary and grammar grades I found plant life studied with the same method. Few, except biologists, know how closely plant reproduction parallels animal reproduction; and how simple but fundamental principles of heredity, parenthood, physical integrity, care of the young and home responsibilities can be fixed in the impressionable mind and heart in these ages, anticipating vulgar misinformation, the cause of so many mistakes.

"Teachers, of course, must be as well prepared to teach the conditions of life as all are to teach the rudiments of mathematics. These schools demonstrate that there is time for this. We have but to substitute scientific, correct, well co-ordinated instruction by prepared teachers for the vague and often useless work now required from the already overtasked general teacher.

"Some of the results the teacher saw are signficant. Perhaps the most encouraging was the clearing up of the faces of the uncleanminded children. The embarrassment, the drooping eyes, the furtive smile gave place to a frank, open face and earnest manner, and the teachers felt sure they had undergone a mental and moral change for the better.'

The writer goes on to tell of further changes these studies produced, their lead

ing attraction to out-door life, giving the children larger interests and sympathies, improving their dispositions and increasing their educational powers. She then adds:

"The keenest impressions brought out by these two months of school study is the plasticity of the childish intelligence. What some schools were positive could not be accomplished others were doing with apparent ease. Another vivid impression I have brought away is this: We are wronging children in school unforgivably-and society is suffering as a consequence -by prolonging their infancy too far into youth. We are giving them trivialities, non-essentials, during years when their wondering minds are reaching out for vital truths by questions, through eyes and groping thoughts and instincts, according to nature's mandates. In these years larger realities and beauties can be presented in such simplicity as to make a lasting impression for good upon the sensitive, childish imagination; knowledge that progressively unfolds the true values and meaning of living, of social co-operation to preserve the good; knowledge of the forces that make for health and happiness, that in these early susceptible years can become deeply ingrained in character, a resistance to evil misleadings offered in tempting disguise on so many sides."

Now let us review what may be done in the way of the instruction we have been considering. As I said, the world is just awaking to the absolute need of such instruction. As yet little has been done, and it will require much experience, as well as careful scrutiny thereof, to attain to the best results. But to some extent we may already speak definitely of means and methods.

The ideal instructor would be the parent. The mother, after a few years of preparation through the lesson of plants and birds, might tell the story of mother and babies at about eight years of age, when the child is especially curious, and is likely to get misinformation from its companions. As the child gets older, at the appropriate time the mother could teach the girls, the father the boys, the further lessons that should be given them. This would be the ideal mode of instruction, providing the parents were wise and discreet, well equipped with the necessary knowledge, fully understanding their children, in sympathy with them, and prepared to devote sufficient time to the purpose. To-day that ideal condition is rarely found, but the newer education should include preparing parents for such duties.

Next we come to school teachers. The instruction of which we are speaking should become a necessary part of their training, for they can receive none of more intrinsic value. At the same time not all of them should be expected to impart that knowledge in the school. This should be reserved for

those whose temperament and understanding of children, as well as the course of instruction they are giving, best fit them for the purpose. For, as I have already indicated, the effort must be to make the necessary facts appear merely as a natural part of life and knowledge, not to attract gaping attention, nor excite morbid curiosity. It may become a difficult matter to properly group children for purposes of instruction. For younger children and for a large part of biological and like teaching of reproduction, class teaching is natrally the appropriate thing. But when it comes to what may arouse lascivious thoughts it will often be best to give individual instruction, or give it to groups of children whose mental equipment, disposition and temperament fit them to receive it together.

The age at which instruction should be given is also an extremely important matter. Naturally, the answer to this question should accord with conditions presented. I have already indicated something in this matter. I can only add that the purpose should be to anticipate harm, that the child usually gets his information at an early age on the street, that he often acquires bad habits early, and not rarely disease, and that one-half the children leave school before they are twelve or thirteen years old, so that what school instruction they are to get they must receive before that time.

What should be taught by means of printed matter? The printed pamphlet is a common and valuable mode of giving instruction to adults upon this, as well as upon other subjects. There is usually a great reluctance to speak to children on sexual matters, and it is a source of relief to resort to the printed page. But, as a rule, it is not wise to put such reading in the hands of school children. One reason is that the printed page quickly passes from hand to hand, and is very likely to come to those not prepared or fitted for it, and where it can only harm. Another reason is that reading over the matter, secretly, as it were, may tend to arouse lascivious thoughts, rather than to accomplish the purpose for which it was written.

I have so far been speaking about instruction in schools, the primary, grammar and high-schools. But in another place, where fundamentally less important, as things stand to-day, this instruction should be imperatively demanded. I refer to our colleges. Only recently has there been any notable efforts made to give students instruction in sexual physiology and hygiene, and probably the number who receive this instruction sufficiently is an extremely small per cent. of

those attending American colleges. Every student should be compelled to receive this instruction in his freshman year, at the time it would best protect himself from harm. This should be done not only for his own sake, but in order that in future years he may become a living centre for the education of the people on the same lines.

I need scarcely add, in order that these lessons should do most good, and least harm -harm chiefly through inspiring morbid fears in the neuropath's heart-they should be given somewhat with the same rules and limitations as apply to instruction in the school. The teaching of venereal disease should find its place in the course on hygiene, and be given no more prominence than the other infections. At the same time its relation to the social evil, course and dangers should be clearly outlined. The study of reproduction in the vegetable and animal world should be a part of this course of instruction, and its chief aim the understanding of heredity, and ennobling the ideas of love and life and parenthood. For this is still a formative period for ideals, and there is no time when they have a more controlling influence on character and conduct.

Physicians should be important agencies in carrying out this course of instruction. I do not refer now to that important function, his personal advice and influence with those who entrust to him their health and lives, but to the part he may take as a school instructor. As an instructor of the guardians of childhood, a lecturer at mothers' meetings, a speaker to classes in grammar or high school, and especially to college boys, he should be a great aid to the accredited teacher. But just as not every parent nor every teacher is fitted for this character of work, neither is every physician. He should be fitted by temperament and interest. He should have full sympathy for the work, and know well the heart of the child. Just as it is true that we will obtain the best results in the inspection of schools when the physician who does the work has been specially trained for it, so for this purpose, too, to obtain the best results the physician should have special training, a chief part of which would be in the psychology of childhood and adolescence, and full knowledge of the work done in the schools in this direction.

Herewith I have presented what I wished to say about the prevention of venereal disease. I have not mentioned many measures which have been spoken of or have been attempted for this purpose, such as various modes of police regulation, the proper and

sufficient treatment of venereal disease in the individual case, suitable housing so as to permit due privacy to life, increase of the starvation wages of young girls, modes of life that will permit of earlier marriage, and the like, some of which have proven to be failures, others appear to be of great promise, but most of which seem almost impossible of realization.

I have aimed to concentrate your attention on the educational measures we have been considering, for it appears altogether feasible that they be introduced and carried out. And if this can be accomplished to the fullest extent and in the best manner, it seems but reasonable to expect such a lessening of disease and death, of suffering and misery and family discord, such an improvement in the nervous tone and. vigor of mankind and womankind, as well as added possibilities in the building of character and realization of the fullness of life, that it had well-nigh revolutionized the world.

DISCUSSION.

DR. A. RAVOGLI: I congratulate Dr. Zenner for his beautiful paper, and for the subject, which is one of greatest interest. The prevalence of venereal diseases is surprising, is shocking. Gynecologists can tell of the terrible consequences of gonorrhea on the uterus and appendages. Ophthalmologists can tell how many children have lost their eyesight from gonorrheal infection. Neurolgists can tell of the sad cases of locomotor ataxia, of general paralysis, of chronic affection of the nervous system, on account of syphilis. One of the greatest subjects is how to diminish the horrible diseases which threaten our race. Dr. Zenner has shown us how we can do this by education. But I am afraid that this education does not reach the most of society. Education is not so general as to reach the masses of the people. The physician can do a great deal by showing and telling of the horrors and sufferings from venereal disease. But we see a great many who have undergone operations for venereal diseases, have been laid up for several weeks, yet when cured they go back and after awhile get infected again. They have no horror of it; their sufferings have not been a sufficient lesson. For this reason I am more in favor of public prophylaxis in venereal disease. I am in favor of preventing infection.

When a man is applying for a license to be married he should be compelled to go before a physician for examination and have that physician give an extract of the examination; and he should be free from infectious disease before he can be granted a license. Some men are married who surely believe that they do not need any treatment at all, and yet they are still infected and their poor wives have to suffer the most terrific tortures. I advocate that in the probate court a man has to be examined first and then get a license for marriage.

Dr. Heidingsfeld has shown some samples of the aggravated cases which we see at the City Hospital since the surveillance of prostitution has been abolished; it is something horrible.

Under the regulation of prostitution the diseases are usually not so bad, because the cases are sent to the hospital as soon as the disease is discovered, and the cases are not so neglected. Prostitution is the hot-bed of infection, aud when prostitution is left undisturbed the prostitutes conceal their ailments, the cases that be come so bad and severe we do not know where to begin to treat. Now the prostitutes in O Ward are few, but we have cases like those which Dr. Heidingsfeld has shown you, besides scabies. pediculi pubis. and many other dirty diseases.

Public prophylaxis of prostitutes, public as well as clandestine, is one of the most important points in order to prevent the spreading of venereal disease. Education will do a great deal, but public prophylaxis will do better.

eases.

Another thing: Blascko gives interesting statistics of venereal diseases among different classes of people in Berlin. He has shown that soldiers are affected 8 or 9 per cent. with venereal dis The class of employees gives not more than 18 per cent. Merchants give about 20, and prostitutes about 33 per cent. The class of students, however, those who ought to know the peril of venereal diseases, gives nearly 60 per benefit of instruction. In these last years there cent. This is not much in accordance with the has been a great diminution, due especially to the anti-venereal and moral societies. But venereal diseases among students are still prev alent.

DR. B. MERRILL RICKETTS: This is an interesting subject, and its review by Dr. Zenner a pleasing pastime. All life, whether animal or vegetable, is polygamous, and any variation from the rule is due to enforcement or education.

Venereal diseases are absent in polygamous communities, whether savage or civilized, unless communicated to them by missionares. This has been especially so with the Esquimaux and other uncivilized peoples. Education to fear these diseases is the only hope.

One of the most effectual steps along educational lines was by the Rajah of India about 1825, when, after being complained to by the wives that their husbands were going with women of easy virtue, he appointed a committee of physicians to investigate the cause of such a custom, not, however, until after he had conferred with both the husbands and women of easy virtue. The result of the report by the investigating physicians was the publication of a large book, costing $25.00, which, without price. was distributed throughout India. This publication was for the purpose of teaching both husbands and wives their proper sexual relations. It was profusely illustrated, and the purpose was twofold, namely, to prevent immorality, and thereby venereal diseases. The book is now published by the Calcutta Society for the Prevention of Crime.

Several attempts have been made in this country to teach the layman something of the art of intercourse and its freedom from disease. One notable lecturer resided in one of our neighboring cities. For twenty years it was the custom of this classic in these arts to give an annual lecture upon these subjects. Physicians, medical and theological students, and the laity in general, especially the men, were frequenters of these dissertations. Much good—and it might be said much harm-resulted. At any rate, the course was discontinued because of adverse criticism.

Ida C. Craddock, of Chicago, had her effort concluded abruptly by adverse public sentiment. Melechamp, of Minneapolis, who recently published a work on "Sexuality," is now confiined in the penitentiary, having been convicted by the U. S. authorities for using the mails for immoral purposes. His publisher shared the

same fate for the same offense.

These are a few who have made efforts to educate a grateful public in matters pertaining to venery and its consequences. If physicians are to be guardians of the people, let the people guard them in their education.

There is no sentiment in science; it is a coldblooded proposition. It does not recognize modesty or false teachings. A spade is a spade, and no other teaching will answer the purpose in making known the ways and means of immorality and its dangers and consequences.

DR. M. L. HEIDINGSFELD: I wish to repeat what I have said on a previous occasion when I had the pleasure for the first time of listening to this interesting and excellent paper of Dr. Zenner's. We cannot be blind to the fact that venereal disease is very prevalent and widespread at the present time; that it has always been widely spread and prevalent in character; that its distribution and prevalence is commensurate with prostitution; that the latter always has and always will continue to exist, in spite, on the one hand, of the most repressive, and, on the other, of the most ideally uplifting influ

ences.

Of the three measures which have been instituted for the repression and diminution of the prevalence of venereal disease-first, the abolition of prostitution; second, the control of prostitution; and third, education-the last measure seems to be the one which gives promise for the greatest good and the best results. The abolition of prostitution, from the light of past experience, appears to be absolutely infeasible. The stern measures of Maria Theresa and of the city of Bonn were followed with the most disastrous results; and when even death was the penalty imposed for the transgression, rapine, seduction, infanticide, were most active and venereal disease most widely prevalent in its severest form. Until the past decade the best results in this special direction were obtained by measures which exercised a wholesome control over prostitution, and these measures to-day, when properly applied and successfully carried out, have been attended with much good. Only in instances where the measures have been too stern and repressive in character and too rigidly enforced, or have been faulty in their application, has control effected any harm and no small amount of good. Without doubt the future spread of venereal disease will be most effectually held in check, as Dr. Zenner has pointed out in his paper, by means of education.

No one can doubt but that the vast majority of children from twelve to sixteen years of age, almost without exception, possess an intimate knowledge of sexual relationship. It is likewise true that the vast majority of children from fourteen to eighteen years of age, or even older, almost without exception possess this knowledge without any preconception of the attendant dangers from veneral infection. If this is the case, then the campaign for education must be much bron ler and more specific in character than that indicated in Dr. Zenner's paper, and the slow process of induction from prolonged biological

studies is both impractical and superfluous. The already over-crowded curriculum of our common schools does not permit such an unnecessary digression-totally unnecessary, if the desired information has already been acquired in the most prurient manner from low-minded companions and trashy literature. The imparting of this knowledge by means of biological studies is not a new departure; the German Society for the Prevention of the Spread of Venereal Diseases promulgated it some two or three years ago.

In considering education of this character, four questions of paramount importance should be carefully considered: (1) Is this instruction necessary? (2) Where should it be given? (3) When should it be given? (4) How and by whom should it be imparted? The affirmative of the first question can scarcely be denied by any who have given the matter careful consideration. The home would be the most ideal place which could be selected, but, unfortunately, most parents possess neither the knowledge, tact nor heart for the undertaking. The schools, therefore, must replace the home in this task, at least until parents become better instructed for the purpose, the same as they perform the purpose of general education. The time should be deferred as long as practicable, namely, to that period when the youth are removed from its molding influence, when the greater numbers withdraw to pursue their independent vocations, namely, the last years of the intermediate and high school training. The instruction, to my mind at least, should be made as impressive and realistic as possible, not with verbal and textbook descriptions. words that are soon forgotten, but by means of photographic portrayals of clinical evidence, with details sufficiently harrowing not to be easily effaced from memory. The instruction should be of such a character as to inspire a wholesome fear, than which there is no greater conservator of virtue. In addition to this, some control should be exercised over prostitution, which in itself should be condoned rather than penalized. Whatever repressive measures are exercised over prostitution, they should be directed not so much in its restraint as against the untoward effects and pernicious results from knowingly and willfully disseminating venereal disease.

There is no question but that the prostitutes of Cincinnati at the present day are indulging themselves in an extravagant licentiousness in this direction, judging at least from the abject, filthy and highly infectious condition in which they present themselves at our public institutions, which must have continued for weeks and months prior to their admission, far in excess and entirely out of proportion to that when a moderate control was exercised. Prostitution must be regarded as a polluted fountain-head of an endless and never-ceasuig stream of contamination, with a sufficiently widely disseminated and far-reaching distribution to become a universal menace, possessing powers of dissemination and infection directly commensurate with its degree of pollution. Any negligence in the exercise ef a careful control works greater pollution, more widespread misery and suffering, with a much greater penalty imposed upon the health and well-being of present day and future generations than that levied by any other far less easily controlled affection.

Another great menace in this special direction

is the untoward harm which results from the practices of quacks, who not only give inadequate attention, but ruthlessly sacrifice the health of many innocent consorts with their make-believe cures. This is particularly the case with that enormous share of their practice which pertains to prescribing by mail, and laws should be enenacted making it a felony for any physician, quack, individual or corporation to prescribe for or pass judgment on the cure of any one afflicted with gonorrhea by mail without the privilege of a personal examination.

I heartily concur with Dr. Ravogli, that if the marriage certificate were issued ouly when vouchsafed by a physical examination, a step nearer the ideal would be taken, but Neisser's statement that 27 per cent. of venereal cases of his enormous polyclinic in Bresslau occurred in married men, shows the futility of success from a measure of this character. This step will be more easily accomplished when education will teach the brides of the future, or those interested for them, to demand a physician's health certificate before the nuptial tie is consummated.

Dr. Ricketts has mentioned that the work of education along the lines indicated in the paper is beset with many difficulties, as attested by the experience of Dr. Palmer, of Louisville, and a number of other individuals. I wish to add that if the character of their work is of the same type as that of Dr. Palmer, their paths were justly strewn with thorns, and the prison was none too good for them. Although the work is far from enticing in its character, no sincere, high-minded individual, earnest in his endeavors to achieve great positive good and benefit to his fellow-creatures, need be deterred from any phase of so important a question by the untoward experience of those who were doubtless unqualified for their undertaking.

DR LOUIS STRICKER: The discussion of this subject brings to mind the manner in which physiology was introduced into the public schools throughout the entire United States Now every one at all conversant with the subject knows that this was a covert and insidious method of introducing the subject of alcoholism to the rising generations as long as forty years ago. In all these years children have been taught the effect of alcohol on the individual cells of the body. And what is easier, after once having instilled into the developing mind the knowledge of the action of alcohol and its deleterious effect, to make a convert to the cause of temperance and prohibition! I was astonished a short time ago to see a map of the United States showing more than half of the country "dry" and other parts with local option, and but a small percentage entirely free. This could never be the result of a sudden wave of so-called righteousness, but must be looked upon as due to the education of several generations, whose minds have been prepared to not only give heed, but assent to these views Now the same holds true of the subject before us this evening. I agree with Dr. Zeuner's views as to education, and in the beautiful way in which it has been set forth by him. Those who are "grown up" and whose minds are filled with vulgarity and misconceptions are beyond redemption Public lectures and recitals of horrible stories only increase the lewd and vulgar recitals. But the teaching of the child at school of the development and transmission of life as exemplified in the lower plants and animals

prepares the mind to grasp, almost by intuition. the true facts of sexual life and relations. Those so educated will see the true facts robbed of all vulgarity, and the knowledge can then be instilled without any shock to their moral sensibilities.

I do not believe that may have ever refrained from sexual intercourse because of fear of gonorrhea or syphilis, but I do believe that many have taken the first step out of inquisitiveness. It is difficult at best to teach medical students concerning gonorrhea and syphilis; why, then, should we hope to reach the common masses by, so to speak, scaring them? A rational understanding of sexual life and the sexes, and that which leads to introducing new life into this world, is all education can hope to bring about, and when this has been done in and of itself it will do much to raise the self-respect of person in the masses, and will thus do much to prevent sex al diseases, especially in the young.

DR. MOSES SALZER: I do not wish to discuss the question as to how an improvement in present conditions is to be brought about. I merely wish to state that if any good is to come of education, it must be begun very early in the life of the child, for 50 per cent. of all girls above puberty who have been sent to the House of Refuge during my service have been afflicted with either gonorrhea or syphilis, and very often both. These cases are not all from the lower walks of life, either, but quite a few come from very good homes. Among the boys, however, venereal diseases are not nearly so prevalent.

DR. J. AMBROSE JOHNSTON: Education along the lines laid down by the essayist is to be commended. He did not refer to the part alcohol plays in the propagation of venereal dis eases. Alcohol is one of the chief causes, if not the greatest. of immorality; it is classed by our materia piedicas as an aphrodisiac; besides this action. it blunts the mind, which then does not restrain one from doing wrong and makes one oblivious to the danger of disease. Because alcohol makes the negro immoral, a ravisher of white women, and worthless as a laborer, the people of the Southern States are generally prohibiting the sale of alcohol. There is no doubt in my mind but that the greatest factor in the spreading of venereal disease is alcohol. The medical profession should be educated up to this fact.

DR. ZENNER, in closing the discussion, said: Dr. Johnston's statement as to the part alcohol plays in this problem is undoubtedly true. The Prosecuting Attorney of the Police Court recently stated to the speaker that of some 15,000 cases that appear in that court in a year, about 95 per cent. are due to alcohol, so great is its influence on crime and vice. Alcohol is doubtless responsible for no small part of sexual excesses, prostitution, venereal disease and the like, but, nevertheless, if this element were entirely eliminated, we would still have the problem of venereal disease before us.

Very likely Dr. Stricker's statement of the relation of the teaching of the harmful effects of alcohol in the schools, and the spread of prohibition laws throughout the land, is correct, and if so, they show what power instruction in school may exercise.

Dr. Salzer's experience emphasizes very strongly the need of early instruction in sexual matters, and this doubtless accords with every physician's experience. This afternoon a little