Recent changes in French policy on venereal diseases and prostitution.

In recent years the social scientist has shown as much interest in the so-called social evils, such as venereal disease, as has the medical scientist seeking a cure. Developments in the rapid and effective treatment of syphilis and gonorrhoea have been paralleled, though without the same success, by legislation to deal with the social problems they present. Attempts to combat the diseases at source have led to consideration of the control of prostitution and methods of epidemiological investigation of infectious contacts. Unfortunately, there has been little agreement between those who approach the problem of venereal disease as moral reformers and those whose aim is simply to diminish the possibility of infection and to ensure the efficient, speedy treatment of all those who have contracted the disease. In addition, objective evaluation of the various policies proposed is made difficult by the lack of reliable statistics on the incidence of the disease. But in spite of this, an account of French experience in the field is of interest because of the variety of control legislation attempted. The first important official action to deal with the problem of venereal disease in France came in 1924 with the passing of a law which assured the patient free and confidential treatment. Special clinics were set up (both individually, sponsored by various reform bodies, and attached to hospitals), but they operated mainly in the larger towns and cities. The majority of cases were (as they still are) treated by private practitioners who thenceforth received a subsidy for each patient plus a free supply of whatever drugs or medicines were prescribed. This law merely provided for a special health service. The patient was in no way coerced or required to seek treatment or to continue with it until he or she had ceased to be infectious; nor was the physician forced to disclose any information regarding the patient, the extent of the disease, or the treatment followed. No facilities existed for diagnosis or detection of the disease among the population at large, nor for following up the contacts of the patients to discover the source of infection and other possible cases. In general, venereal diseases were considered like any other illness to be treated by the family physician. However, some recognition was given to the social nature of the disease by attempts to control prostitution. Recognizing that prostitutes were the principal source of infection, the government followed a policy of legalized and licensed prostitution with strict medical supervision of the women concerned. In 1938 there were two kinds of " official'" prostitutes in France, those employed in the maisons tole'rejes and those practising en carte. The maisons tolkdrees were licensed brothels, owned privately or by the municipality, and the prostitutes were medically examined each week. These establishments were generally operated as " respectable " businesses; the girls were strictly chaperoned outside business hours and were adequately paid. In 1938 there were some 196 of these houses in Paris, employing 1,500 girls, 819 in the provinces, and 61 in Algeria; the total number of girls employed being 4,900 (Lahille, 1939). The prostitutes en carte were much more numerous. In 1938 in the Paris area alone there were 6,000 such women. They solicited men openly, either as their sole means of income or on a part-time basis, and worked independently or on a percentage arrangement for the owner of a bar, dance-hall, or apartment block. They invariably had a special " beat" or headquarters for seeking customers and took their clients to a furnished room or flat. There was an element of stability in their activities which lent itself to fairly constant supervision. In order to retain their carte (which did not " legalize" their work-because prostitution is not illegal in Francebut ensured both them and their clients a measure of medical protection), the women were obliged to report weekly at the local Prefecture of Police or Gendarmerie for a blood test and medical examination. Periodically their rooms were inspected by the