generally unsatisfactory and may often even become dangerous, and I
decidedly advise every woman who suspects that she has contracted
gonorrhea to apply at once to a competent physician. But it happens
not infrequently that a woman is so situated that she cannot consult a
physician. And in the meantime there is danger of the gonorrhea
spreading further and further. In such cases it is advisable for the
woman to use an injection until such time when she can consult a
physician. The injection I am going to advise may in itself produce a
cure; and, if it does not produce a complete cure, it at any rate
improves the condition, prevents the extension of the disease, makes
subsequent treatment easier, and besides is perfectly harmless. The
best injection for self use in gonorrhea is tincture of iodine; the
proportion is two teaspoonfuls to a quart or two quarts of water. If
the case is very bad, such an injection may be taken twice a day. If
the case is not very bad, once a day is sufficient. After using the
tincture of iodine for five days to a week, it is good to change off
to lactic acid. Buy a pint or so of lactic acid in a drug store, and
use one tablespoonful to a quart of water. It is preferable to have
the water hot, about 100 deg., but where this is inconvenient it may
be used lukewarm. The lactic acid injection is used for three days,
then the iodine injection is resumed, then again the lactic acid, and
so on. I know of many cases that were cured by this treatment alone.
And I might mention that these injections are generally also very
efficient in leucorrhea, as stated in the chapter on Leucorrhea.
CHAPTER TWENTY-FOUR
VULVOVAGINITIS IN LITTLE GIRLS
Former Causes of Vulvovaginitis in Little Girls--Discharge Chief
Symptom--Evil Results of Vulvovaginitis--Psychic Results of
Treatment--Effects in Hastening Sexual Maturity--Vulvovaginitis a
Cause of Permanent Sterility--Measures to Prevent the
Disease--Toilet Seats and Vulvovaginitis.
The mucous membrane, or the lining of the vulva and vagina, in little
girls is very tender, and therefore very readily subject to infection.
An infection of the vulva and vagina due to the gonococcus or to some
other germ is very common in little girls. At least it used to be,
particularly among children of the poor, in institutions and
hospitals. The very dangerous infective character of vulvovaginitis
was not known, and the infection was therefore easily transferred by
towels, linen, toilet seats, bedpans, syringe nozzles, thermometers,
the nurses' hands, and in various other ways. Now great care is being
taken and in most hospitals no children are admitted in the general
wards unless it is determined that they are free from vulvovaginitis.
Generally speaking, vulvovaginitis in children is a mild infection. A
child may have it for several weeks or months without being aware of
it, without saying anything about it, the diagnosis often being made
by the mother, who begins to notice the creamy discharge on the girl's
linen or underwear. And this is the principal symptom in little girls
thus afflicted--the discharge. This discharge may be very profuse,
covering the vulva, vagina, and cervix.
In severe cases, there is also an infection of the urethra, and the
child may complain of burning at urination, itching and pain around
the vulva and anus, and slight pain in the abdomen. There may be a
moderate rise in temperature, up to 101 deg. F., and in some instances
the attack is sufficiently acute to give rise to a chill and fever. A
mild inflammation of the joints may set in within the first weeks of
the infection, although as a usual thing it comes later on.
=Evil Sequelæ of Vulvovaginitis.= While, as stated, vulvovaginitis is
a comparatively mild infection as far as its symptoms are concerned,
it nevertheless has a very bad effect on the child who is unfortunate
enough to become a victim of the disease. First of all, it is an
extremely long drawn, persistent disease. It usually takes months, and
these months may run into years, before a complete cure, is effected.
Second, relapses are quite common. Third, the treatment is a
disagreeable one for the child, and is occasionally painful. Fourth,
it has a disastrous effect on the child's _morale_; most parents,
though they may love the child most affectionately, look somewhat
askance at it; and continuous vaginal treatment somehow or other has a
humiliating effect on the child, which begins to consider itself as an
outcast, as something apart from other children. Fifth, the child's
education is very frequently seriously and permanently interfered
with, because it must often be taken out of school, whether public or
private, and private tutoring is of course feasible only for the few.
Sixth, and this is a point not sufficiently appreciated by the
profession and the laity, but it is an important point, nevertheless:
vulvovaginitis in children has unfortunately a disastrous effect in
_hastening the sexual maturity of the child_. Whether this is due to
the congestion of the organs produced by the inflammation, or to the
speculum examinations, paintings, douches, applications, tampons,
suppositories, etc., the fact remains that girls who suffer from
vulvovaginitis in childhood become sexually mature considerably
earlier than normal girls of the same class, stratum and climate, and
their demand for sexual satisfaction is much more insistent. Seventh,
a mild vulvovaginitis may be the cause of permanent _sterility_.
It will therefore be seen that vulvovaginitis is a calamity, and
everything possible should be done to guard female children from
contracting it. _All_ children should _always_ sleep alone. Under no
circumstances should a child sleep with anybody else, be it a sister,
a mother, a friend, a governess, or a servant girl. People should be
very careful in sending their children to spend a night or two with
some friends. The friends may be all right, but still a friend of the
friends or a relative of the friends may not be. I have known several
cases where the origin of the vulvovaginitis could be traced to little
girls spending a week at the house of some friends where a boarder or
relative was infected with gonorrhea. That children should be kept
away from associating or playing with adults or other children who are
known to have gonorrheal infection goes without saying. The child's
genitals should be frequently inspected by the mother, and scrupulous
cleanliness by frequent bathing, sponging with warm solutions and
powdering, should be maintained. The toilet seats in school should
receive special attention. The wooden seat is a menace because it
often harbors gonorrheal pus from either the female or male genitals,
while the only proper seat is one of the so-called U-shaped style,
that is, one in which the front is entirely open, like the letter U.
CHAPTER TWENTY-FIVE
SYPHILIS
Syphilis Due to Germ--Syphilis a Constitutional Disease--Primary
Lesion--Incubation Period--Roseola--Primary Stage--Secondary
Stage--Mucous Patches--Tertiary Stage--Gumma--Hereditary Nature
of Syphilis--Milder Course in Women Than in Men--Obscure Symptoms
in Syphilis--Necessity for Examination by Physician--Locomotor
Ataxia--Softening of the Brain--Chancroids.
Syphilis is a disease caused by a germ called spirocheta; the full
name is spirocheta pallida--a pale, spiral-shaped germ. Though the
disease has been ravaging Europe and America for centuries, the germ
of it has been discovered only a few years ago, namely, in 1905, and,
like the gonococcus, also by a German scientist, Fritz Schaudinn.
Syphilis is a constitutional disease. In ten days to three weeks after
a person has contracted syphilis, he (or she) develops a sore (at the
spot where the germs got in). This sore is called _chancre_ or
_primary lesion_. But when this sore makes its appearance the
spirochetæ and the poison which they elaborate are already circulating
in the blood, all over the system. The disease is already systemic, or
constitutional, and the chancre is the local expression of a
constitutional disease. Cutting out the chancre will not cure the
disease, because, as stated, the germs are already in the system. The
time between the contraction of the disease (the infectious
intercourse) and the appearance of the chancre is called the
_Incubation Period_. The time between the appearance of the chancre
and the appearance of the rash on the body (the rash looks like a
measles rash and is called roseola, which means a rose-colored rash)
is called the _Primary Stage_. It lasts about six weeks. With the
appearance of the rash commences the _Secondary Stage_. This stage is
characterized by all sorts of _eruptions_, mild and severe, by white
little patches (called mucous patches) in the throat, mouth, tonsils,
vagina, by falling out of the hair, etc. The length of this secondary
stage depends a good deal upon the sort of treatment the patient gets.
Improperly treated, or not treated at all, it may last two or three
years or more. Properly treated, it may be cut short at once, in a few
days, so that the patient may never again in his or her life get an
eruption. The third or _Tertiary Stage_ is characterized by
_ulcerations_ in various parts of the body and by _swellings_ or
tumors. The name of a syphilitic swelling or tumor is gumma (plural,
gummata). The tertiary stage is the most terrible stage and it used to
be the terror of syphilitic patients. But at the present time, under
our modern methods of treatment, patients, if properly treated, _never
have a tertiary stage_. We have seen many patients who considered
syphilis a trifling disease, because all they knew of their disease
was the chancre and the first eruption, i.e., the roseola, and perhaps
a slight falling out of the hair. They then put themselves under
energetic treatment, the _activity_ of the disease was checked, and
they never had another symptom afterwards, though a Wassermann test
showed that the disease was not entirely eradicated. It was merely
held in check--which is the second best thing.
[Illustration: SPIROCHETA PALLIDA, OR TREPONEMA PALLIDUM, THE
GERM OF SYPHILIS AS SEEN UNDER THE MICROSCOPE.]
As stated before, syphilis is the most hereditary of all diseases.
Fortunately, if the disease is still very active in the parents,
particularly in the mother, the child is generally aborted. Some
syphilitic mothers will have half a dozen or more miscarriages in
succession. When the disease has become "attenuated," either by
treatment or by itself--many diseases lose their virulence in
time--the child may be carried to term. It then may be born dead, or
it may be born strongly syphilitic, and die in a few days or weeks, or
it may be born without any signs of syphilis and be apparently healthy
and then develop the disease at the age of ten, twelve, fourteen, or
later, or it may be born healthy and remain healthy. But no woman who
had syphilis, or whose husband had syphilis, should _dare_ to conceive
or to give birth to a child unless she has been given permission by a
competent physician. I mean just what I say. It is not a personal
matter. A woman has a right to marry a syphilitic husband if she wants
to and run the risk of contracting syphilis. Her body is her own, and
if she does it with her eyes open it is her affair. But a woman has no
right to bring into the world syphilitic or syphilitically tainted
children. Here society has a right to interfere.
Syphilis runs a milder course in women than it does in men. But this
milder course is not an unmixed blessing; it may be considered a
misfortune, because, the same as gonorrhea in women, syphilis is often
present for months and years until it has made such inroads that it
is but little amenable to treatment. In many women the disease runs
such a mild course, as far as definite symptoms are concerned, that
they are sure they never had anything the matter with them, and they
are perfectly sincere in their denial of ever having had any
infection. Often it is only when they complain of obscure symptoms,
for which we can find no explanation, and then take a Wassermann test,
that we discover what the real trouble is. And then the internal
organs are sometimes found so deeply affected that it is hard to do
anything. So it is seen that the mildness of the course of the
disease, while a good thing in itself, is bad in that respect that it
prevents timely treatment. It is therefore important that whenever a
woman is in any way suspicious that she may have the disease that she
have herself examined; and if she has reasons to suspect that her
husband or partner has the disease, she should persuade him to have
himself examined.
Locomotor ataxia, one of the most terrible sequelæ of syphilis, is
much more rare in women than it is in men. So is general paresis, also
called general paralysis of the insane, or softening of the brain.
=Chancroids=
There is one other minor disease belonging to the venereal diseases;
that is chancroids. Chancroids are little ulcers on the genitals; they
are purely local and do not affect the system. They are due largely to
uncleanliness, and are found only among the poorer classes of
prostitutes and therefore among the poorer classes of men. One sees
them now and then in public dispensaries, but in private practice they
are now quite rare. They used to be quite common, which shows that the
general level of cleanliness has been raised considerably among all
classes of people. At any rate, chancroids are of little significance,
as compared with syphilis and gonorrhea, and when speaking of the
venereal peril, these are the two diseases we have in mind.
CHAPTER TWENTY-SIX
THE CURABILITY OF VENEREAL DISEASE
Gonorrhea May Be Practically Cured in Every Case in Man--Extensive
Gonorrheal Infection in Woman Difficult to Cure--Positive Cure in
Syphilis Impossible to Guarantee.
Just as the usual statements in regard to the extent of venereal
disease have been found untrue or greatly exaggerated, so do the
statements regarding the curability or rather incurability of venereal
disease need careful revision. The picture usually painted of the
hopelessness of gonorrhea and syphilis is too sombre, too black, and,
contrary to the assertions made by laymen and laywomen and physicians
who do not specialize in the treatment of venereal disease, I wish to
make the statement that every case of gonorrhea in man, without any
exception, if properly treated, can be perfectly cured, _as far as
practical purposes are concerned_. I add the last phrase because the
cure may not be perfect in the scientific sense of the word; that is,
the man may not be brought back into the condition in which he was
before he got the disease. But, for all practical purposes, as far as
he himself is concerned, as far as his wife is concerned, and as far
as the future children are concerned, every case may be cured, without
any doubt. And I say this, basing myself upon a varied professional
experience extending over nearly a quarter of a century.
As to gonorrhea in women, that depends to a great extent upon the
virulence of the disease and the promptness with which treatment is
instituted. If the gonorrhea is limited only to the cervix, the vulva
and the urethra, then prompt treatment will usually bring about a cure
in a comparatively short time. But if the gonorrheal inflammation has
extended to the body of the uterus, or still worse, to the tubes, then
the treatment may become a very tedious one, and some cases may not be
curable without an operation.
With syphilis the matter is different. Since the introduction by
Ehrlich of the various arsenic preparations, we have much better
success in the treatment of syphilis, and we can positively render
every case non-infectious to the partner. But, as to guaranteeing a
positive cure, that is, guaranteeing that the patient will never have
an outbreak or relapse of his disease in the future, and that the
children will be perfectly free from any taint, this we can do no more
now than we could before the modern treatment of syphilis was
introduced. The decision, therefore, as to whether we may or may not
permit a once syphilitic patient to marry will depend a great deal
upon whether or no the husband or the wife or both desire to have
children. If this is the case, we must often withhold our permission;
but if the man and woman agree to get married and to get along without
children, we will grant permission to the marriage in the vast
majority of cases. The subject of venereal disease and marriage will
be further discussed in separate chapters.
Venereal disease, I have to repeat, is terrible enough in itself,
without any exaggeration, without picturing it in too black colors.
And it is necessary that people should not have too black an idea of
it. It is necessary that they know that there are thousands and tens
of thousands of patients who suffered with gonorrhea or syphilis and
who were perfectly cured, who married, and whose wives remained
perfectly well, and who gave birth to perfectly healthy untainted
children.
CHAPTER TWENTY-SEVEN
VENEREAL PROPHYLAXIS
Necessity for Douching Before and After Suspicious Intercourse--
Formulæ for Douches--Precautions Against Non-venereal Sources of
Infection--Syphilis Transmitted by Dentist's Instruments--
Manicurists and Syphilis--Promiscuous Kissing a Source of
Syphilitic Infection.
In his book, _Sex Knowledge for Men_, the author treated the subject
of prevention of venereal disease very thoroughly. Men need this
knowledge. As men _will_ indulge in illicit relations, we must teach
them to guard themselves against venereal infection. We must do it not
only for their own sake, but for the sake of their wives and children.
For, infection in the man may mean infection in his wife and children.
But as women readers of this book are not likely to indulge in
promiscuous relations with strangers, a detailed discussion of the
subject would be out of place.
I will merely say, that where the woman has a suspicion that her
husband is in an infectious state, she should abstain from relations
with him until she is sure that he is safe. But where for some reason
a suspicions intercourse is indulged in, the woman should use an
antiseptic douche _before_ and _after_ intercourse. Where it is
inconvenient to use a douche both before and after, a douche after
will have to suffice, but it is much safer and surer to use the douche
both before and after. When you use a douche there is always some of
the solution left in the vagina and that destroys wholly or in part
the infective germs. The following makes an effective douche: Dissolve
a tablet of bichloride (they come on the market of the weight of about
7½ grains) in two quarts of water--hot, lukewarm or cold. Use before
intercourse a small amount--about a pint or half a pint, and use the
balance after intercourse. Instead of the bichloride you may use a
tablespoonful of carbolic acid, or two tablets of chinosol, or a
tablespoonful of lysol, or two tablespoonfuls of boric acid.
Instead of the douche an antiseptic jelly in a collapsible tin tube
with a long nozzle may be used.
But besides the venereal sources of infection the woman must guard
against the non-venereal sources. Do not ever, if you can avoid it,
use a public toilet. If you are forced to use it, protect yourself by
putting some paper over the seat.
Do not use a public drinking cup. If you have to use one, keep your
lips away from the rim. One can learn to drink without touching the
rim of the glass or cup with the lips.
Do not under any circumstances use a public towel. The roller towel is
a menace to health and should be forbidden in every part of the
country.
If you have to sleep in a hotel or in a strange bed, make sure that
the linen is clean and fresh. Never sleep on bed linen which has been
used by a stranger.
Never use a public brush or comb.
Be sure that your dentist is a careful, up-to-date man, and sterilizes
his instruments carefully. Many a case of syphilis has been
transmitted by a dentist's instrument. A syphilitic who goes to a
dentist to be treated generally conceals his disease, and if the
dentist is not in the habit of sterilizing his instruments after each
patient, disaster may result.
Be sure that your manicurist is not syphilitic, or at least that her
hands are healthy, clean and free from any eruption.
And, last but not least, do not indulge in promiscuous kissing. This
is a particularly important injunction for young girls. This is a real
peril and there are thousands of cases of syphilis that are known to
have been contracted directly from kissing. People suffering with
syphilis often have little white sores (mucous patches) on their lips,
tongue and inside of cheeks. These sores are very infectious, and by
kissing the disease is readily transmitted. Kissing games have been
responsible in more than one case for the spread of syphilis to many
persons. I have now under treatment a girl of nineteen who contracted
syphilis on her summer vacation from having kissed a man once. Avoid
promiscuous kissing! It is a bad practice for more than one reason.
CHAPTER TWENTY-EIGHT
ALCOHOL, SEX AND VENEREAL DISEASE
Alcoholic Indulgence and Venereal Disease--A Champagne Dinner and
Syphilis--Percentage of Cases of Venereal Infection Due to
Alcohol--Artificial Stimulation of Sex Instinct in Man and in
Woman--Reckless Sexual Indulgence Due to Alcohol--Alcohol as an
Aid to Seduction.
That Bacchus, the god of wine, is the strongest ally of Venus, the
goddess of love, using love in its physical sense, as the French use
the word _amour_, has been well known to the ancient Greeks and
Romans, as it is well known to-day to every saloon-keeper and every
keeper of a disreputable house. And all measures to combat venereal
disease and to prevent girls from making a false step will be only
partially successful if we do not at the same time carry on a strong
educational campaign against alcoholic indulgence. Of what use to
young men is the knowledge of the venereal peril and familiarity with
the use of venereal prophylactics, when under the influence of alcohol
the mind is befuddled, they forget everything and do things that they
never would do in the sober state? Of what use are warnings to a
girl, when under the influence of a heavy dinner and a bottle of
champagne, to which she is unaccustomed, her passion is aroused to a
degree she has never experienced before, her will is paralyzed and she
yields, though deep down in her consciousness something tells her she
shouldn't? Yields, becomes pregnant, and is in the deepest agony for
several months, and has a wound which will probably never heal for the
rest of her life? Of what use have all the lectures, books and
maternal injunctions been to her?
Or this case. Here is a young lawyer, twenty-eight years of age,
engaged to a fine girl, and with everything to look forward to. He
always was very moderate and circumspect in his sexual indulgence,
and, though careful in choosing his partners, he never failed to use a
venereal prophylactic after intercourse. There was too much at stake
for him, and he did not care to take any chances, even if the chances
were one in a thousand. For a period of one year during which he had
been engaged he abstained from sexual intercourse altogether, though
it cost him a great deal of effort to do so. He was to be married very
shortly. But ill-luck made him accept an invitation to a bachelor
dinner, where champagne and smutty stories were flowing freely, too
freely. He left about midnight, and as the night was beautiful he
decided to walk home. He met a siren, who invited him to accompany
her. Under other circumstances he would have sent her on her way, or
at least he would have stepped into a drugstore for a prophylactic.
But, excited by the wine, the smutty stories and the year's
abstinence, he went along like a sheep, as a matter of course, without
trying to reason or interposing any objections. He remembers
distinctly his feelings and the state of his mind. He was not drunk,
only exhilarated, but nevertheless the whole thing seemed to him so
normal, so natural, so expected, so matter-of-course, that he couldn't
think of acting otherwise than accept her invitation. And he stayed
two or three hours; and he used no prophylactic. And as a
result--three weeks later he had a typical primary syphilitic lesion.
How he felt and what it all meant to him the reader can imagine. This
is far from being an isolated, an exceptional case.