very frequent. Probably at least twenty-five per cent, (some say fifty
or seventy-five per cent.) of all women suffer with it in a greater or
lesser degree. In some cases it is only an annoyance, necessitating
the frequent changing of napkins, but in others it causes a great deal
of weakness, backache, erosions, itching and burning. It is very
resistant to treatment, particularly in girls. The reason it is so
resistant to treatment is because the discharge, while coming from
the vagina, _does not usually originate_ in the vagina; it originates
in the neck of the womb, and the hundreds and hundreds of injections
that women take for their leucorrhea only reach the vagina; they
cannot penetrate into the womb. And it is only by treating the cavity
of the cervix, which can only be done by a physician, through a
speculum, that the root of the trouble can be reached. And, if any
erosion or ulcer is noticed, it can be directly touched up with the
necessary application. And it is for this reason that in girls
leucorrhea is so much more difficult to treat. For fear of having the
hymen ruptured the girl objects to a thorough examination and to local
treatment, and the leucorrhea is permitted to proceed until perhaps a
chronic inflammation of the womb and the Fallopian tubes is
established. There is no doubt that many cases of sterility or
childlessness in women are due to long-neglected leucorrhea in
girlhood.
=What Is the Cause of Leucorrhea?= We can answer simply: the cause of
leucorrhea is catarrh in any part of the female genital tract. But
this is no real answer. What are the causes of the catarrh? The causes
of catarrh are many: the most common cause is a cold. Wetting the feet
and getting chilled, particularly during the menses, may set up a
catarrh in the cervix. Long standing on one's feet, lifting and
carrying heavy bundles, dancing in overheated rooms and then going out
scantily clad in the chill night air, prolonged ungratified sexual
excitement, lack of cleanliness in the external genitals--all these
are factors in setting up a catarrh of the cervix with a resultant
leucorrhea. A general rundown condition, worry, overwork, too hard
study, lack of fresh air, and a general scrofulous condition also
favor the development of catarrh of the womb and leucorrhea. It will
therefore be seen that the treatment of leucorrhea to be successful
must be general and local.
=General Treatment.= The general treatment consists in general
hygienic measures and in common sense. The patient should not be on
her feet more than she can help, and she should not walk until
exhausted or fatigued. It is better to take several short walks than
one long one. The corset she wears, if she wears any at all, should be
of the modern kind: not one that presses the womb and the other
abdominal organs down, but one that supports the abdominal walls, and
rather raises the abdominal organs up. The lacing or buttoning must be
from below up, and not from above down. That it should not in any way
interfere with the freedom of respiration goes without saying.
Constipation if any, to be treated, must be treated intelligently, by
mild measures (see Constipation, in the chapter on pregnancy), and
care must be taken that the bowels move at regular hours. Where the
leucorrhea is due to or is aggravated by anemia and general weakness,
a good iron preparation, such as one Blaud's five-grain pill three
times a day, or a tonic of iron, quinine and strychnine, will do good.
A daily cold bath or cold sponge, followed by a brisk dry rubbing with
a rough towel, is also useful.
=Local Treatment.= Local measures consist of painting or swabbing the
vagina and cervix with various solutions, of tampons, suppositories
and douches. Local application to the vagina and uterus can be done
satisfactorily by the physician or nurse only. The insertion of a
suppository or douching can be easily done by the patient herself.
While it is always best and safest to consult a physician, and, while
self-medication is generally inadvisable, there are occasions when a
physician is not available; in some small places a woman may, _for
various reasons_, have a strong objection to gynecological examination
and treatment; and some women may be too poor to pay the doctor. In
such circumstances self-treatment is justified and there can be no
objection to it if the remedies are harmless and are sure to do some
good; that is, to improve the condition where they do not effect a
complete cure.
One of the simplest things is an alum tampon. You take a piece of
absorbent cotton, about the size of a fist, spread it out, put about a
tablespoonful of powdered alum on it, fold it up, tie a string around
the center, insert it in the vagina as far as it will go, and leave it
in for twenty-four hours. Then pull it gently by the string and
syringe yourself with a quart or two quarts of warm water. Such a
tampon may be inserted every other day or every third day, and I have
known many cases where this simple treatment alone produced a cure. In
some cases, however, douches work better and the two best things for
douching are: tincture of iodine and lactic acid. Buy, say, four
ounces of tincture of iodine, and use two teaspoonfuls in two quarts
of hot water in a douche bag. This injection should be used twice a
day, morning and night. Of the lactic acid you buy, say, a pint, and
use two tablespoonfuls to two quarts of water. The lactic acid has the
advantage over the tincture of iodine that it is colorless, while the
iodine is dark and stains whatever it comes in contact with. Sometimes
I order the use of the tincture of iodine and the lactic acid
alternately: for one douche the tincture of iodine, for the next the
lactic acid, and so on. When the condition improves, it is sufficient
to use one teaspoonful of the tincture of iodine and one tablespoonful
of the lactic acid to two quarts of water. These injections are quite
efficient and have the advantage of being perfectly harmless. One
point about the injections: they should be taken not in the standing
or squatting position (in which position the fluid comes right out),
but while lying down, over a douche pan. The douche bag should be only
about a foot above the bed, so that the irrigating fluid may come out
slowly; the patient, after each injection taken in the daytime, should
remain at least half an hour in bed (in the night time she stays all
night in bed). This gives the injection a better chance to come in
contact with all the parts of the vagina, and a portion of it comes in
contact with the cervix, where it exerts a healing effect. Avoid the
use of patent medicines.
CHAPTER TWENTY-ONE
THE VENEREAL DISEASES
Derivation of Word "Venereal"--Three Venereal Diseases--Innocent
Contraction of Syphilis Through Various Objects--The Hygienic
Elimination of Common Sources of Venereal Infection--Measures for
Prevention After Sexual Relations.
The word "venereal" means pertaining to sexual intercourse: venereal
excess--excess in sexual intercourse; venereal disease--a disease
acquired from sexual intercourse with an infected person. The word is
derived from Venus (genitive--veneris), the Roman goddess of spring,
flowers and Love.
There are three venereal diseases: gonorrhea, syphilis and chancroid.
Of these, gonorrhea is the most widespread, syphilis the most serious.
Chancroid is of comparatively little importance.
While by far the greatest amount of venereal diseases--probably ninety
per cent, of the total--is contracted from illicit[7] intercourse, it
is well to bear in mind that some of it is contracted innocently,
either from a kiss, or from using a sponge or a towel which has been
used by an infected person, etc. While the gonorrheal germ is
generally transmitted directly, the syphilitic poison may be
transmitted through various objects. Syphilis contracted not during
intercourse, but in an innocent manner, from a kiss, a towel, a
toothbrush, a razor, etc., is called syphilis of the innocent, or
syphilis insontium. In former years doctors would not very rarely
contract syphilis from examining syphilitic women with their bare
fingers. Now since gloves have come into use for examining purposes,
the number of infections has considerably diminished. And no doubt
that as the people become more familiar with the danger of venereal
infection from non-venereal sources, the number of innocent infections
will greatly diminish. The dangerous roller towel and the no less
dangerous common drinking cup are being gradually eliminated as
factors of _non-venereal_ infection; and we may confidently expect
that in a decade or two the amount of venereal disease from _venereal_
infection will be greatly lessened in all civilized countries. The
general increase in cleanliness in all strata of society and the
universal use of antiseptics after suspicious sexual relations will
constitute the chief factors in this diminution of venereal disease.
FOOTNOTES:
[7] Illicit--illegal, non-permissible, outside of marriage.
CHAPTER TWENTY-TWO
THE EXTENT OF VENEREAL DISEASE
Former Ban on Discussion of Venereal Disease and Its Evil
Results--Present Reprehensible Exaggerations of Extent of
Venereal Disease--Erroneous and Ridiculous Statements of
"Reformers"--Senseless Fear of Marriage in Girls Due to Lurid
Exaggerations--Study by Woman Psychologist Reveals Harmful
Results of Exaggerated Statements--Truth in Regard to Percentage
of Men Afflicted with Venereal Disease.
=Former Silence.= Only a very few years ago respectable women, by
which I mean all women outside of the women called "fallen," did not
know of the existence of venereal disease. It was considered a
prohibited, disgraceful subject, not to be mentioned or even hinted at
in conversation, in books or magazines, in lectures, or on the stage.
When I say that they did not know of the _existence_ of such a thing
as venereal disease, that the very words gonorrhea and syphilis were
unknown to them, I use these expressions not as figures of speech, but
in their literal meaning. All avenues of acquiring such knowledge
being closed to them--lay people don't usually now and they surely
didn't then purchase and read strictly medical works--where could they
obtain the information? The result was that when a woman was so
unfortunate as to contract a venereal disease from her husband, she
did not understand its character and did not suspect its source. Which
was a rather good thing--for the husband. Family peace was more
secure.
=Present Exaggerations.= Now a change has taken place in this respect,
and, as is often the case with recent changes, the pendulum has swung
to the other extreme. The silence of former days has given place to
shouting from the housetops. The last phrase is also used almost in
its literal sense. Many men and women, deeply stirred by the venereal
peril, and sincerely anxious to guard boys and girls from venereal
infection, have been indulging in very reprehensible exaggerations.
Particularly lurid have been the exaggerations as to the prevalence of
the disease in the male sex, with its consequent disastrous effects on
married women. A statement made by a Dr. Noeggerath (a German
physician who practiced at the time in New York), nearly half a
century ago, to the effect that 80 per cent, of all men have gonorrhea
and that 90 per cent. of these remain uncured and infect or are apt to
infect their wives, has been shown to be a ridiculously absurd
exaggeration. If it had been true, the race would now be at the point
of dying out. Nevertheless, this statement is copied from book to
book, as if it were gospel truth, as if it were a scientifically and
statistically established fact instead of a wild, sensational guess.
An esteemed New York physician, Dr. Prince A. Morrow, did excellent
pioneer work in calling attention to the dangers of venereal disease.
But, as is the case with so many "reformers," he permitted his zeal to
run away with him occasionally, and he made statements which caused
and are still causing the judicious to grieve. The statement, for
instance, that there is more venereal disease among innocent, virtuous
wives than among prostitutes is one to cause the real honest
investigator to weep (over the human tendency to exaggeration), or to
burst out in uproarious laughter. The ridiculousness of this statement
becomes especially evident when we recollect that the same gentleman
made the statement that every prostitute, without exception, was
diseased at one time or another. If venereal disease exists among
prostitutes to the extent of 100 per cent., then how can it exist to a
greater extent among innocent, virtuous wives? And to still further
emphasize the absurdity of the above statement, I will tell you that
the extent of venereal disease among married women is believed by
careful non-sensational venereologists not to exceed five per cent.!
Yes, the silence of former years has given place to the lurid
exaggeration of the present day. While on the whole the former was
worse than the latter, the latter is bad enough, because it makes many
girls unhappy, sowing in them the seeds of suspicion and cynicism,
tends to make them antagonistic to the entire male sex, and inoculates
them with a senseless fear of marriage. A study made by Miriam C.
Gould, of the department of psychology and philosophy in the
University of Pittsburg (_Social Hygiene_, April, 1916), corroborates
our remarks in a striking manner.
She has had confidential chats with 50 young girls, with whom she has
had some acquaintance; of these 50, 25 were college students and 25
were not. She asked them a number of questions, the purpose of which
was to find out what psychologic effect, if any, their knowledge of
prostitution and of venereal disease has had on them. She states in
her conclusions that "the histories reveal a large percentage of
harmful results, such as conditions bordering upon neurasthenia,
melancholia, pessimism and _sex antagonism_ (italics mine), directly
traceable to this knowledge. Eleven of the girls interviewed developed
a pronounced repulsion for men, although prior to their 'knowledge'
they had enjoyed men's company. They now avoid association with them,
and six have declared that they have totally lost faith in the moral
cleanness of men. Eight have already refused to marry, or intend to do
so, because of their belief that the risk of infection was too great.
If it were not for the existence of these diseases, they say they
would be glad to marry. All of these say their decision has rendered
them more or less unhappy."
In the laudable desire to keep our young women pure and to protect
them from infection, in the endeavor to make them demand one moral
standard for both sexes, our exaggerating reformers are condemning
them to lifelong celibacy, which in the case of women often means
lifelong neurasthenia and hypochondria.
=The Truth of the Matter.= Here is the Truth about venereal
disease--the truth as I know it, without concealment on the one hand
and without exaggeration on the other. Exact figures are, of course,
unobtainable anywhere; but results obtained from unbiased
investigations of _different_ classes of society, from hospital
reports, from questionnaires among students, etc., tell us that
probably about twenty per cent. of the adult male population are the
victims of gonorrhea at one time or another; that probably eight or
ten per cent. are not entirely cured when they enter matrimony; and
four or five per cent. (some would say two per cent.) of wives become
infected with gonorrhea. This, I say, is terrible enough, and makes
the greatest care and caution imperative; for, if you should be one of
the victims of the two or five per cent., it would be little
consolation to you that the other ninety-eight or ninety-five per
cent. of wives have escaped.
Of course the percentage of venereal disease among young men, and
afterwards among their wives, will vary greatly with the stratum of
society. Among the "lower" strata you may find fifty per cent. of
infection, with a very large percentage of those uncured. Not because
they are of a lower morality than the higher classes, but because the
cheap class of prostitutes that they are obliged to patronize are
frequently diseased and because they cannot afford expert treatment,
or any treatment at all. Among these classes you will naturally find a
much larger percentage of diseased wives. But then to counteract this
we must bear in mind that there are large classes of men in whom
gonorrhea exists only to the extent of five or ten per cent., and we
have large classes of wives among whom the victims of gonorrhea will
come up only to a fraction of one per cent.
The above figures, you see, differ materially from the statements
found in so many sex books that "80 per cent. of all married men in
New York have gonorrhea," and that "at least three out of every five
[60 per cent.!] married women in New York have gonorrhea." Whenever
you read or hear such a statement treat it with a smile--or with
contempt, as all false statements should be treated.
As to syphilis, the extent of the prevalence may be given as between
two and five per cent. Which percentage differs considerable from the
75, 50 or 25 per cent. given us by some sex lecturers, but which is
terrible enough as it is, without any exaggerations.
CHAPTER TWENTY-THREE
GONORRHEA
Source of Gonorrhea--Mucous Membrane of Genital Organs and of Eye
Principal Seats of Disease--Symptoms in Men and in Women--Vagina
Seldom Attacked in Adults--Nobody Inherits Gonorrhea--Ophthalmia
Neonatorum--Differences of Course of Disease in Men and Women--
Gonorrhea Less Painful in Women--Symptoms not Suspected by Woman--
Necessity for the Woman Consulting a Physician--Self-treatment
When Woman Cannot Consult Physician--Formulæ for Injections.
The subject of gonorrhea and syphilis is treated pretty fully, from a
layman's point of view, in the author's _Sex Knowledge for Men_. I do
not intend to devote much space to a discussion of the details of
these two diseases here, because the subject is not of such direct
interest to women. Respectable girls and women do not indulge in
illicit relations the same as respectable men and boys do, and their
danger of contracting a venereal disease is insignificant as compared
with men's liability. I will, therefore, touch upon only a few points,
particularly insofar as the diseases differ in their course from the
course pursued in men. Those, however, who are interested may read the
chapters on the subject in the author's _Sex Knowledge for Men_, and
if they want still fuller details, they may study the author's
_Treatment of Gonorrhea and Its Complications in Men and Women_.
[Illustration: GONORRHEAL GERMS.]
=Gonorrhea= is an inflammation caused by a germ called the gonococcus,
discovered by Dr. A. Neisser, of Breslau, Germany, in 1879. Any mucous
membrane may be the seat of gonorrhea, but it attacks by preference
the mucous membrane of the genital organs, and of one other organ--the
eye. Its principal symptoms are: inflammation, pain, burning and
discharge. In men, it attacks the urethra; in women it attacks the
cervix--the neck of the womb--the urethra, and the vulva. The vagina
is seldom attacked in adult women, because the mucous membrane of the
adult vagina is rather tough and does not offer a good soil for the
development of the gonococcus germ. The discharge that a woman has
when she has gonorrhea comes principally or exclusively from the neck
of the womb. In little girls, however, in whom the lining of the
vagina is tender, gonorrhea of the vagina and the vulva is common.
(See chapter Vulvovaginitis in Little Girls.) Gonorrhea is a local
disease. While in some cases, after the disease has lasted for some
time, a certain poison is generated by the germs which circulates in
the blood, and while the germs may occasionally wander into distant
organs, still in 98 per cent. of all cases gonorrhea is a local
disease, and if taken in time is cured without leaving any traces on
the general organism.
=Gonorrhea Not Hereditary.= Then, gonorrhea is not a hereditary
disease. Nobody ever _inherits_ gonorrhea. A child may be born with a
gonorrheal inflammation of the eyes (ophthalmia neonatorum), but this
inflammation is not inherited; it can only be acquired if the mother
is suffering with gonorrhea while the child is being born: some of the
pus in the mother's birth canal gets into the child's eyes while it
passes through the uterus and vagina. This is not heredity; this is
simple infection, and can be avoided by keeping the mother's birth
canal clean by antiseptic douches before childbirth. In short, I
repeat gonorrhea is essentially a local and not a constitutional
disease, and is not hereditary. In which two respects it differs from
syphilis, which is the most constitutional and most hereditary of all
diseases.
=Course of Gonorrhea in Men and Women.= Gonorrhea runs an entirely
different course in women than it does in men. When a man has
gonorrhea he knows it immediately; first, because the discharge tells
him that there is something the matter with him, for a man is not used
to having any discharge from the urethra unless there is something the
matter with him. Second, the urine becomes at once burning and
painful. In women the urethra is a separate canal from the vagina, and
the urethra is very frequently not affected in gonorrhea. The
infection generally starts in the cervix, and the disease may last for
considerable time before the woman becomes aware of it. In general,
gonorrhea is a less painful disease in woman, and this is a bad thing,
because she thus neglects treatment and loses valuable time,
permitting the disease to develop. Even when the urethra is affected
in women, it does not give as severe symptoms as inflammation of the
urethra in men. If the woman does have pains she often pays no
attention to them, because woman is used to pains; as we have seen
before, fifty per cent. of all women suffer more or less with
dysmenorrhea. Many of them have a leucorrheal discharge of greater or
lesser degree, and therefore if there is an increase in the pains, or
an increase in the discharge, little attention is paid to the matter.
In fact, a woman may have a chronic gonorrhea for months or years
without being aware that there is anything the matter with her. It is
important to teach women to seek medical aid as soon as they notice
any increase in the amount of the discharge, or change in color,
particularly if it becomes greenish, or if the odor becomes offensive,
or if there is chafing, burning, or irritation around the genitals,
and particularly if there is an increase in the frequency or urgency
of urination, or if there is a burning, scalding, or cutting sensation
during the act of urination. Also whenever the sexual act becomes
painful. If women consulted a physician as soon as they noticed any of
the symptoms referred to above, they would save months and years of
suffering and expense, because the disease would often be taken in
hand while still limited to the cervix, and not, as is now often the
case, after the inflammation has extended into the uterus and
Fallopian tubes.