the American army and navy, before the present war, were the worst in the world, the Japanese navy next, the English army and navy next. [168] _Expansion of Races._ New York, 1909. [169] _Medical News_, December 21, 1909. [170] _New York Med. Jour._, November 12, 1910. Sullivan and Spaulding[171] reported on the prevalence and effects of gonorrhea in 522 women and girls in a Massachusetts reformatory for women. Of these women 75.7 per cent. had gonorrhea by positive diagnosis. The average length of time the infection had existed when diagnosed was four years and five months, but one woman had had the disease for twenty-six years, and seven had had it for over twenty years. In 82.7 per cent. there had been no cessation of the clinical symptoms from the time of infection to the time of diagnosis. Of the total number 68 per cent. had pelvic inflammation on one side, and 27 per cent. had it on both sides. There were 41 per cent. of the cases which had had surgical operations or which required such treatment. [171] _Jour. Amer. Med. Assoc._, January 8, 1916. Of 63 women committed for alcoholism 52.4 per cent. had gonorrhea, 42.8 per cent. had syphilis, and 9.6 per cent. had doubtful syphilis; but of 400 women who had been at some time prostitutes 98.2 per cent. had gonorrhea, 65.5 per cent. had syphilis, and 9.5 per cent. had doubtful syphilis. Of 119 mental defectives among these women, 90.8 per cent. had gonorrhea, 61.3 per cent. had syphilis, and 6.7 per cent. had doubtful syphilis. Dr. Thomas Haines[172] reported on 365 cases of boys and girls under eighteen years of age committed to an Ohio reformatory, and of these 20.8 per cent. had syphilis, and it was mostly acquired syphilis, not congenital--over one-fourth of the boys were so affected. McNeil[173] examined 1200 adult negroes in Galveston, Texas, for syphilis and found the disease in 30 per cent. of the 1200. [172] _Jour. Amer. Med. Assoc._, January 8, 1916. [173] _Jour. Amer. Med. Assoc._, September 30, 1916. Howard Kelly[174] estimated that venereal diseases cost the United States three billion dollars annually, and Norris thinks this estimate too low. The ravages of the disease are so frightful, physically and morally, that any one who spreads it by infection, especially of an innocent woman, is guilty of the gravest moral injustice. Morrow[175] thinks that 250,000 married women in the United States are suffering from gonorrhea. As most of these unfortunate women are infected by immoral husbands, and as the invalidism and suffering they undergo are indescribable and cure is often impossible, the physician who permits a gonorrheic to marry without a protest is responsible for the evil as an accomplice; and, as has been said, once a gonorrheic, probably always a gonorrheic. [174] _Jour. Amer. Med. Assoc._, October 6, 1912. [175] _Social Diseases and Marriage_, 1904.