the causative relations of bacteria and other forms of microscopic life to certain diseases, supplied the foundation upon which preventive medicine has been built up. When Neisser discovered the organism which causes the most prevalent of the so-called "social diseases" he forecast the probability that some day preventive medicine would count among its greatest battles those fought against venereal diseases. When the causative agent of syphilis, after escaping under cover of something like 106 indictments of harmless organisms, as the exciting cause of syphilis, and baffling scientific researchers for twenty years, yielded to the patient work of Schaudinn, the whole world felt a quickened interest in working out the remaining scientific facts upon which a successful campaign against these diseases could be based. The rapid advances during the past few years in methods of diagnosis and treatment of venereal diseases and in knowledge of their channels of spread made it inevitable that the lines of battle against this group of diseases would be drawn and volunteers called for. Before sketching the history of The American Social Hygiene Association and of other organizations which are enlisted in this arm of the Preventive Medicine Army, it will be profitable to ask and answer some questions on the epidemiology of these diseases, and what the chief factors in their transmission are. Are they insect-borne like malaria? No. Therefore, they cannot be attacked through warfare upon any insect as has been done with such remarkable success in yellow fever. Are they water or food-borne like typhoid fever? No. Therefore, they cannot be attacked through enforcement of sanitation laws as has been so successfully done in cholera. Are they soil-borne, like hookworm disease? No. Therefore, they cannot be attacked by the educational and public-health methods which have proved effective in fighting that disease. Are they contact-borne like tuberculosis? Yes, they are contact-borne, but not like tuberculosis. They are so closely limited to immediate contact, and so largely spread through the contact involved in sex relations that they may properly be called sexcontact diseases. The fact that venereal diseases are essentially sex-borne constitutes the scientific basis for organizing a special association, distinct even from the national tuberculosis association. This latter organization, although fighting a contact disease, is striving for nourishing food, sunlight and fresh air, sanitary homes, proper balance between work and rest,-above all for the effective destruction of sputum and the prevention of prolonged intimate association of the tuberculous sick with the well. None of these measures will in any direct way reduce the prevalence of venereal infection, although, of course, they are all of vital importance as factors in promoting better moral standards. In planning a national campaign against these diseases only those measures need be discussed which combat the sex-contact of the sick with the well or their direct contact through practices illustrated, for example, by the custom of kissing or "smoking the pipe of peace." It is just these forms of contact which from biological necessity and from ancestral custom are most vitally interwoven with all that is beautiful and sacred in love, marriage, and the birth of children. Hence it follows that the promotion of that standard of conduct for men and women, which we call "the single standard of morals" is of major importance among the cardinal measures upon which a successful campaign must be built up. For the same reasons, it is important to promote the minimizing of marriage between the venereally sick and the well; the safeguarding of children against these diseases, both before and after birth; the instruction of the sick in methods of preventing the transfer of their diseases to others; and the education of the well to a realization that there are such diseases, and that their family physicians and their ministers can advise them or place them in communication with others who can safely advise them should it become necessary to know more. Only the novice in preventive-medicine campaigning can complacently look over this statement and enlist for the battle with the delusion that rapid progress can be made or that the way has been blazed by other organizations attacking preventable diseases. There is, of course, much in the details of administration of many organizations which may be directly applied, but the involved relations of moral standards, economic and social status and disease are peculiar to this one of all the preventive-medicine problems. Granted that these diseases are communicable and preventable, the question may be fairly asked, are they sufficiently prevalent and dangerous to life and health to warrant the expenditure of time and money upon a serious effort to control their spread? Although little accurate data is as yet available, it has been proved by every kind of investigation attempted, whether medical, moral or economic, that this is one of the greatest of the preventivemedicine problems and worthy the expenditure of limitless effort and expense in the right direction. The question may also be asked, "Are not the medical sciences making such rapid strides in mastering the principles of immunity, and specifically in the early diagnosis and treatment of venereal diseases, as to hold out hope that the spread and disastrous consequences of these diseases will be largely brought under control before much progress can be made upon any national campaign: if this were to occur, would not the money and effort spent on the campaign be wasted?" There are three points to be made in reply. In the first place, inspiring as have been the recent discoveries of medical science in these directions, there is no way to predetermine just when the trail may become lost and require years before some scientist again picks it up. Secondly, the argument of Sir Ronald Ross is pertinent. In commenting upon the application of knowledge on malaria prevention, he said, "It requires ten years for any scientific truth to reach the environment of the people." Lastly, it must be born in mind that if there were no venereal diseases, there are ample arguments for the promotion of a single standard of morals and for the right understanding and application of the sex principle to the social and economic relations of men and women. The public has come by degrees to recognize the term social hygiene as covering all matters related to the medical and moral issues involved in discussions of the venereal diseases or sex relations of men and women. In the rest of this paper, I shall accordingly use the phrase "the social hygiene movement.” Serious and well-directed efforts to apply the principles of preventive medicine on a broad scale date back barely twenty years. Efforts to support and accelerate this work through the building up of strong national, state and local volunteer associations are practically all traceable to their origin within the twentieth century. Efforts to develop a national social hygiene movement are just beginning. There are some twenty-six state and local societies for social hygiene in the United States. The majority of these, meeting in St. Louis to discuss their problems in 1910. formed a National Federation for Sex Hygiene, for the purpose of meeting annually and of maintaining a central clearing-house for information and new ideas being successfully tried out by the component societies. This Federation had the leadership of Dr. Prince A. Morrow, and associates of the highest standing both from the ranks of medicine and from education, religion, and other professions. It received the substantial backing of men and women who saw the need and had the courage of their convictions. But public opinion was so totally unformed and the proper lines of national work so uncharted that progress has been slow. Except for the active extension work of the Society of Sanitary and Moral Prophylaxis, the national field remains unorganized. The latter society, occupied as it has been with its own enormous and complex local problem, has found time to publish "Social Diseases" and pamphlets which have had a nation-wide formative influence. Through its correspondence and lecture-bureau service, in coöperation with the other social hygiene societies, it has kept the general interest alive while the national association was growing. All realize that the time has now come when the latter association must make good, thus relieving the local and state societies from the drain of national work upon their time and resources, or failing, must give way to some other body which can succeed. Paralleling this growth of the Federation, there has developed a different organization known as the American Vigilance Association. It has likewise passed through various stages and under several names, the National Purity Alliance being the best known of its antecedent titles. The primary purpose of this association has been to suppress commercialized vice, as that term is commonly understood. Unlike the Federation for Sex Hygiene, this association has pursued an active national policy of organized work, but has only incidentally undertaken to develop local society influences. The publication of "Vigilance” has had the same formative influence throughout the country that has characterized "Social Diseases." The directors of this organization came to realize that they had increasingly to deal with the preventive-medicine and educational problems of venereal disease and sex hygiene. Their greatest aid in the battle against commercialized vice is the observance of a "single standard of morals," or, as Dr. Richard Cabot has phrased it, "the consecration of the affections." For reasons already given, this is also the first of the measures to be promoted in an effective campaign of the Federation for Sex Hygiene. In August, 1913, the preliminary steps were taken to consolidate these organizations, and in January, 1914, the final legal papers were filed which cleared the way for the new "American Social Hygiene Association." The purposes of the association are set forth in the constitution as follows: "To acquire and diffuse knowledge of the established principles and practices and of any new methods, which promote, or give assurance of promoting, social health; to advocate the highest standards of private and public morality; to suppress commercialized vice; to organize the defense of the community by every available means, educational, sanitary, or legislative, against the diseases of vice; to conduct on request inquiries into the present condition of prostitution and the venereal diseases in American towns and cities; and to secure mutual acquaintance and sympathy and coöperation among the local societies for these or similar purposes." Thus comes into existence, with its national office in New York, a volunteer organization which it is to be hoped may effectually promote the enforcement of administrative measures, and of general practices, the principles of which were probably first set forth in the following proclamation posted on the bulletin boards of New York City two hundred and sixteen years ago: "BY HIS EXCELLENCY, RICHARD EARL OF A PROCLAMATION WHEREAS, it is of absolute Necessity for the Good |