ESSAYS IN MEDICAL SOCIOLOGY
ESSAYS
IN
MEDICAL SOCIOLOGY
BY
ELIZABETH BLACKWELL, M.D.
_VOLUME I._
LONDON
ERNEST BELL, YORK STREET
COVENT GARDEN
1902
PREFACE.
At the request of friends I have willingly consented to the
republication of my writings of past years in a uniform edition.
Truth never grows old, though re-adaptation to different phases of life
may be necessary. I shall rejoice if anything I have written in the
past may prove helpful to the younger generation of workers, with whom
I am in hearty sympathy.
ELIZABETH BLACKWELL, M.D.
HASTINGS,
_May, 1902_.
CONTENTS OF VOL. I.
ESSAY PAGE
I. THE HUMAN ELEMENT IN SEX 1
II. MEDICAL RESPONSIBILITY IN RELATION TO THE CONTAGIOUS
DISEASES ACTS 83
III. RESCUE WORK IN RELATION TO PROSTITUTION AND DISEASE 113
IV. PURCHASE OF WOMEN: THE GREAT ECONOMIC BLUNDER 133
V. THE MORAL EDUCATION OF THE YOUNG IN RELATION TO SEX 175
THE HUMAN ELEMENT IN SEX
CONTENTS
PAGE
INTRODUCTION 3
CHAPTER I
THE DISTINCTIVE CHARACTER OF HUMAN SEX 9
CHAPTER II
EQUIVALENT FUNCTIONS IN THE MALE AND FEMALE 18
CHAPTER III
ON THE ABUSES OF SEX--I. MASTURBATION 34
CHAPTER IV
ON THE ABUSES OF SEX--II. FORNICATION 44
CHAPTER V
THE DEVELOPMENT OF THE IDEA OF CHASTITY 60
CHAPTER VI
MEDICAL GUIDANCE IN LEGISLATION 70
APPENDIX I 75
APPENDIX II 79
INTRODUCTION
This work is written from the standpoint of the Christian physiologist.
The essence of all religions is the recognition of an Authority
higher, more comprehensive, more permanent than the human being. The
characteristic of Christian teaching is the faith that this Supreme
Authority is beneficent as well as powerful. The Christian believes
that the Creative Force is a moral force, of more comprehensive
morality than the human being that it creates. Under the symbol of a
wise and loving parent--the most just, efficient, and attractive image
that we know of--we are encouraged to regard this unseen Authority as
being in direct relation with every atom of creation, and as desirous
of drawing each atom into progressively higher forms of existence.
The Christian physiologist, therefore, knowing that there is a wise and
beneficent purpose in the human structure, seeks to find out the laws
and methods of action by means of which human function may accomplish
its highest use.
The task can only be carried out gradually. Ultimate function is not
revealed by structure, nor ultimate use by function.
The empty arteries did not suggest the circulation of the blood
to ancient physiologists, nor did the curious arrangements of the
intestinal canal explain the complicated function of digestion.
Ignorance of facts, preconceived notions, or fanciful theories as
to ‘vital spirits,’ ‘cold and hot humours,’ etc., long delayed the
attainment of correct knowledge of physiological facts.
Neither does physical knowledge of individual function reveal the
developed use of which it is capable. The new life that may be given
through touch to the blind, or the destruction of a nation through its
vices, is not revealed by the minutest examination of the mechanism of
touch, or the physical structure of the nervous system. Function and
use are only proved by observation, reflection, and rational experiment
patiently carried on age after age, with generalization based upon
accurate and accumulated facts.
Structure, function, and extended use, although closely connected,
are, nevertheless, separate branches of inquiry. Applied physiology
comprehends them all. Function is the arrangement by means of which the
independent life of the sentient being is carried on and maintained.
Developed function or use includes the growth and improvement of the
individual in relation to his fellows, and to existence outside his own
personality.
No physiological truth is more firmly established than the fact that
we can modify the action of our physical organs towards the special
objects related to them, by the way in which we use our organs. By
long-continued and careful study of the apparatus and processes of
digestion, the physiologist has discovered the general plan by means
of which food is converted into the substance of the body, and the
part which each portion of the complicated digestive system takes
in the maintenance of daily life. He does not stop, however, with
this discovery of the general plan by which food is converted into
flesh. He studies the way in which our habits of eating and drinking
may destroy or improve the power of digestion, and recognises the
effects which various kinds of food and drink may exercise upon the
character of the individual and the race. The physiologist, therefore,
proceeds to investigate, as a direct branch of necessary human
physiological inquiry, the influence which the consumption of flesh
or fruit, of alcohol or water, of warm or cold articles, of quantity
or quality, etc., exerts upon the unique organization of the human
being, in producing health or disease in mankind; or upon the power of
self-control or endurance, with the promotion of ferocious or genial
tendencies in Man. Both human strength and human character can be
affected by enlarged knowledge and control of the uses which belong to
the digestive system.
What is true of the effects of food is equally true of the effect of
every other physical condition of human life. It is, therefore, a
special work of the rational physiologist to discover the higher uses
of our varied human faculties. We only see at present the beginning
of this great work of applied physiology in enabling us to comprehend
the full effects of food, air, exercise, climate, etc., upon human
character. We possess only vague knowledge of the great facts of the
hereditary transmission of diseased or healthy tendencies; and we give,
as yet, no due consideration to the important results which follow from
such transmission. We only faintly realize the transforming power of
habit or mind in healthy growth and in morbid degeneration.
These investigations form a distinct branch of applied physiology;
and such investigation and application of physiology is the especial
duty of the rational or Christian physiologist who sees clearly that
creative force is a beneficent power; and this perception cheers and
guides him in the perplexed paths which lead towards human growth and
perfection.
Medicine and morality being related to function and use are, therefore,
inseparable in a Progressive State. The union between the physical,
moral, and intellectual elements of our nature cannot be dissolved
during lifetime. To speak of the ‘Physician of Nature’ and ‘Physician
of Grace,’ as two entirely distinct classes is an untenable position or
a misleading sophism. Sound education, State medicine, healthy society,
must all be based upon the inseparable union of the various elements
of the human constitution. This is the only rational system in a
Progressive State; any other practice leads to empirical medicine and
hypocritical morality.
The unity of human nature gives immense importance to the influences
which surround the beginning of life and the education of the young.
The greatest present obstacle to progress is the ignorance of parents,
and above all of mothers, of many facts of physiology, and particularly
of the facts of sexual physiology. For want of this knowledge our
nurseries and schools are not wisely guarded, young people lack
guidance, and marriages are too often the mischievous union of two
unsuitable partners.
By the present lamentable ignorance of sound physiology, men and women
lack the elements necessary for forming correct judgment on the most
important relations of life. Parents are thus unequal to their first
duty, viz., the guiding of domestic and social life, as helpmeets to
one another.
In all the excellent treatises on physiology, domestic economy and
education, prepared for the special instruction and help of parents and
teachers, all knowledge is generally omitted which refers to the sexual
functions; yet to the parent or educator this is an essential branch
of knowledge. A woman attempts to carry on her work blindfold, who
tries to educate her children, guide her household, or take her proper
part in society without this knowledge. She understands nothing that
is going on around her; she sees nothing but the surface of things;
her influence is either stupid, mischievous, or negative, if she is
not truthfully instructed in relation to the central force of human
emotion and action.
Mothers, requiring this knowledge for their special duties which
commence with infant life, can with propriety, purity, and reverence
study the action and uses of our sexual powers. Their intense interest
in the family and self-sacrificing devotion to its welfare, their
insight into its needs, and their sensitive consciousness of the
approach of danger to their offspring, make them the providentially
appointed guardians of the young. The profound depth of the passion of
maternity in women extends not only to the relations of marriage, but
to all the weak or suffering wherever found. It gives a sacredness to
the woman’s appreciation of sex, which has not yet been utilized for
the improvement of the social life of the nation.
The ignorance of parents in relation to essential facts is deplorable.
I believe it to be the source of our gravest social evils. In the
present work, therefore, which I offer to my profession as an aid in
the instruction of parents and guardians of the young, I shall speak
with the frankness of profound respect in relation to our God-created
faculties. As a Christian physiologist, I shall endeavour to show the
true and noble use involved in the highest of our human functions.
CHAPTER I
_The Distinctive Character of Human Sex_
A fundamental error as to the nature of human sex too generally exists
amongst us, from failure to recognise that in the human race the mind
tends to rule the body, and that sex in the human being is even more
a mental passion than a physical instinct. This superficial view dims
our perception of the causes which produce the facts around us; it also
prevents our recognising the essential difference which exists between
human and brute sex, and it blinds us to the imperative necessity of
giving human education to this part of our nature.
As the study of the human body is carried on from its simpler to
its more complex parts, it is perceived that the physiology of the
more complex functions takes in a wider range of relations. The wise
guidance of these more complex powers by parent or physician in
health, and disease, demands a careful consideration of this extended
range of relations. Thus the proper nourishment and exercise of the
brain require more extended knowledge than the hygienic treatment
of the skin, and diseases of the brain cause more serious danger to
the individual. So all the faculties which belong to the life of
relation--viz., the faculties which, like the senses, link us to our
fellows--involve a broader range of study than those which appertain
solely to those functions of the body which concern only the individual.
The portion of our organization most difficult of study, but also
requiring the widest range of knowledge for its healthy guidance, is
the faculty of sex. This faculty has a very complex aspect from its
three-fold relation to the race, to men, and to women.
Sex is not essential to individual existence, but it is indispensable
to the continuance of the race; and the progressive or retrograde
character of the race largely depends upon the wisdom with which this
faculty is guided in youth, and the character of the parental relations
which are established.
A serious difficulty in understanding how to educate and regulate the
relations of sex arises from the fact that it is the relation of two
equal but distinct halves of the human race, and exists in the dual
form--male and female. Unless the distinctive characteristics and
requirements of each of these equal halves are fully understood, the
relation between them cannot be satisfactory. The physiological meaning
of the differences in organization between the sexes is at present very
imperfectly understood.
The most striking distinction, however, in the manifestation of the
sexual faculties exists between man and the brute creation, and is
found in the mental or moral aspects which it assumes in man. The
general structural resemblance between man and the lower animals
affords no guidance to the education of this human faculty, for the
differences between man and the lower animals are radically greater
than the resemblance between them.
The most evident form of this mental difference shows itself as a
sentiment of self-consciousness which is not observed in the brute.
If an animal is not frightened by human beings it never hesitates in
carrying on sexual congress in their presence, and neither before nor
after the special act does it exhibit the smallest approach to shame
in relation to it. In man, however, from the earliest dawn of the
approaching faculty, self-consciousness is intense. This is not only
observed in well brought-up boys and girls, who shrink from indecency
of word or action, but it is never entirely extinguished in the most
corrupt man or woman; and even the poor little waifs of our streets,
blighted from earliest infancy, exhibit marked consciousness in their
infantile depravity. All the vast difference between the gregariousness
of the lower animals and the highest human civilization indicates the
mental difference which moulds the human form of the sexual relations.
Permanent parental care of offspring, mutual respect between the sexes,
reverence for these faculties as typifying the mighty Creative Power
of the universe, are stages of social progress based upon this mental
difference in human and brute sex.
It is the mental or moral aspect of our sexual powers which, as
society grows, shapes so much of the literature of every civilized
country. In the popular ballads of a people, songs of love are even
more abundant than patriotic songs; and as education spreads amongst
the masses, romances and novels form the bulk of popular reading.
The subject of love is always of the most absorbing interest to the
younger and more active portion of a people; sexual passion, in its
ennobling or debasing form, exercises irresistible attraction.
Our amusements and our customs are largely moulded by the same powerful
attraction, viz., the mental and moral quality of the relations which
are formed between the sexes. As civilization advances, and dense
masses of human beings are crowded together in heterogeneous selfish
strife, the destructive extremes of luxury and pauperism appear. From
this state of society, where misery will do anything for money, and the
satiety of luxury seeks fresh stimulus, speculation in this strongest
part of our nature--sex--arises. Its creative use disappears, and it
becomes a subject of merchandise. Every variety of effort is made to
stimulate and debase the mental quality or sentiment of sex, and the
strength of human passion furnishes an exhaustless field for corrupt
speculation.
It is therefore not the simple physical aspect of the reproductive
powers which is remarkable in humanity. The physical instinct is shared
with the rest of the animal creation. It is the unique and powerful
mental and moral element, the principle that moulds and governs human
sex, which produces such striking results in the life of our race.
The mental or emotional element in these powers, both in relation
to the action and reaction of mind and body, and the hereditary
transmission of tendencies, will, therefore, largely engage the
attention of the physiologist who truly studies our human nature. The
distinctive moral character of human sex renders the exclusive study
of physical phenomena in man as useless and unscientific a method of
investigation as would be the study of music on dumb instruments. The
distinctively mental character of human sex must therefore always be
recognised as a guide in any physiological inquiry into the structure
and functions of the physical organs especially appropriated to the use
of sex.
The clue to a true knowledge of sexual functions in man and woman is
found in this striking peculiarity of the human race, viz., that these
functions are largely dominated by mental action, and that sex in the
human being does not mean simply the action of the physical organs, but
also the conjoined mental principle directing those organs.
Sex, therefore, in the human race alone, resting upon that broad,
well-marked mental foundation, is capable of great development towards
good or towards evil. As simply material satisfaction soon reaches
the limit which bounds matter, so mental or spiritual enjoyment is
capable of indefinite growth. It is this mental sentiment peculiar to
human sex which is capable of a twofold development. It may grow into
a noble sympathy, self-sacrifice, reverence, and joy, which enlarge
and intensify the nature through the gradual expansion of the inborn
moral elements of sex. It is also this same intensity of the mental
form and power of sex, possessed by mankind alone, which allows of the
perversion and extreme degradation of sex which is observable only in
the human race. It is the degradation of this mental power when running
riot in unchecked license that converts men and women into selfish and
cruel devils--monsters, quite without parallel in the brute creation.
These facts are strikingly illustrated by the anatomical and
physiological constitution of the human being. The structure and
functions of the generative system in our race are contrived in such a
way as to support two great leading principles of existence.
These fundamental principles are--First, the independence, freedom,
and perfection of the individual. Second, the preservation of the
race. These two objects are secured to a certain extent in all
highly organized creatures; but in the human race provision is made
for individual freedom in a much more marked and perfect manner, in
accordance with the superior rank of man in creation.
The brute, both male and female, is at certain times blindly dominated
by the physical impulse of sex. This impulse in the lower animal is
a simple imperative instinct, unhesitatingly yielded to, with no
preparation or after-thought, with no calculation, shame, triumph, or
regret. But it is very different with the human race, as it grows from
lower to higher states of society. Thoughts and feelings, social ties
and conscience, religious training and the objects of life, all act
upon the distinctive mental character of sex; and it is seen that the
welfare of a third factor, viz., the child, is inseparably connected
with these relations.
Its character is thus changed to a very complex faculty. The young man
or woman blindly yielding to this power of sexual attraction, against
the remonstrance of a high sense of duty, is torn by remorse, and is
consciously self-degraded.
The influence of the moral element is also strikingly shown by an evil
peculiar to the human race, viz., suicide or insanity as the result of
unhappy love.
The growing power of the mental element over sex in all the higher
races of mankind is demonstrated by the ennobling friendships between
men and women which increasingly brighten life in our own Anglo-Saxon
civilization. The free and friendly intercourse of self-respecting
youth of both sexes satisfies the complex wants of early man and
womanhood; there is physical as well as mental refreshment in such
honourable and natural human intercourse.
In the young man or woman, just entered into the full possession of all
the human faculties, where the special attraction of two tends towards
marriage, this moral or mental predominance is still remarkable. The
attraction towards the other sex is rich in mental delights. The
passing sight of the object beloved, a word, a look, a smile, will
make sunshine in the gloomiest day. The consciousness of spiritual
attraction will sustain and guard through long waiting for more
complete union.
The physical pleasure which attends the caresses of love is a rich
endowment of humanity, granted by a beneficent Creative Power. There
is nothing necessarily evil in physical pleasure. Though inferior
in rank to mental pleasure, it is a legitimate part of our nature,
involving always some degree of mental action. The satisfaction which
our senses, sight, hearing, touch, etc., derive from all lovely objects
adapted to the special sense, indicates that beneficence latent in the
‘cosmic process’ which enters into the physical manifestation of our
present earthly life. The sexual act itself, rightly understood in its
compound character, so far from being a necessarily evil thing, is
really a Divinely created and altogether righteous fulfilment of the
conditions of present life. This act, like all human acts, is subjected
to the inexorable rule of moral law. Righteous use brings renewed
and increasing satisfaction to the two made one in harmonious union.
Unrighteous use produces satiety, coldness, repulsion, and misery to
the two remaining apart, through the abuse of a Divine gift.
At a public table in the Tyrol I once heard an Austrian officer, a most
repulsive spectacle, dying of his vices, boast of his ruined life, and
declare that he would take the consequences and live it over again had
he the power to do so. This is the insanity of lust. But it illustrates
the inseparable union of soul and body in human sex.
It is the mental element dominating the physical impulse in man, for
evil, which produces that monstrous creation, cold, selfish, and cruel,
which is seen only in the man or woman abusing the creative powers of
sex.
It will thus be seen that in the varieties of degradation of our
sexual powers, as well as in their use and ennoblement, it is the
predominance of the mental or spiritual element in our nature which
is the characteristic fact of human sex. The inventions and abuses of
lust, as well as the use and guidance of love, alike prove the striking
and important distinction which exists between the sexual organization
of man and that of the lower animals.