the use of a suitable soluble suppository alone may be sufficient to
protect against impregnation, but the protection by this means does
undoubtedly fail at times, and therefore, by itself, the soluble
suppository is unreliable. Still it eliminates the majority of the chances
of impregnation. The use of the rubber pessary is also sometimes
unsuccessful because it does not fit properly, or because it is porous, or
because in removing it some of the seminal fluid from the under-surface
may be accidentally spilt in the vagina, and in this way the spermatazoa
may later find their way upwards to an ovum. Therefore, the soluble
suppository and the rubber pessary should be used in combination. A woman
should first push up, as far as possible, a suitable suppository, and then
insert the rubber pessary (slightly soaped--with soap-suds), so as to
occlude the whole of the upper part of her genital passage and thus cover
the mouth of the womb and effectively prevent entrance of the spermatazoa.
The rubber pessary _must_ in the first instance be fitted by a doctor,
because if it does not fit properly it will be ineffective. The seminal
fluid may pass by its loose rim and impregnation may result. If the rubber
pessary has been properly fitted, and _it is not porous_, the protection
should be complete; but if, by any accident, spermatazoa should get beyond
the rubber pessary, they will be destroyed and tangled in the melted
suppository--provided, of course, that a suitable suppository has been
used. It is all a question of getting the right articles to begin with and
using them intelligently. But there is this chance--a bare chance--of
accidental impregnation, and we want to eliminate all chances, if
possible. Assuming the rubber pessary fits properly, as it will if
skilfully selected and applied in the first instance by a competent
medical practitioner, then the seminal fluid must remain in the lower part
of the vaginal passage. An hour or two after intercourse, or next morning,
this seminal fluid can all be washed away by the use of syringe and bidet.
It is far better to sit over the bidet and syringe in that position than
to squat down over a basin--an uncomfortable and unsuitable position for
douching, because the walls of the vagina in that position may be pressed
hard together. The fluid should be retained in the vagina for a minute or
two, by pressing the flange of syringe closely against the orifice of the
vagina. _After syringing, but not before_, the rubber pessary should be
removed (to be washed with soap and water, dried carefully, and put away
till required again), and immediately after removing the rubber pessary it
is a good plan to facilitate the ejection of the surplus fat of the
suppository by urinating and re-syringing. It is quite easy for a woman to
insert and remove these rubber pessaries for herself as occasion requires,
provided that whilst inserting and removing the pessary she has placed her
body in a suitable posture--say, lying on the back with knees drawn up,
sitting on bidet, or standing with one foot on a chair, or whatever other
position she finds suitable. A doctor's help is needed only when first
selecting the right size of pessary. The pessaries are made in ten
different sizes, each size being numbered, and the right size can always
be obtained on order. No harm may come from wearing the pessary for a day
or two, but it is highly desirable as a matter of cleanliness and
otherwise to remove the pessary in the morning when performing the sexual
toilet. The pessary should, of course, never be worn during the menstrual
period. A good rubber pessary should last from three to four months, and
it should be tested occasionally by filling it with water to see that
there is no hole in it. If it has been fitted shortly after a miscarriage
or confinement, refitting is desirable at the end of a few months. But in
normal circumstances refitting is not necessary.
[Illustration: DIAGRAM 5.--Scale: One-sixth actual size.]
[Illustration: DIAGRAM 6.
Two FORMS OF SUPPOSITORIES. ACTUAL SIZE.
These melt rapidly after introduction and provide a pool of antiseptic
fluid around mouth of womb.]
[Illustration: DIAGRAM 7.
COVERED SPIRAL SPRING RUBBER PESSARY. SEEN IN PROFILE.
It is understood that this is circular. The thickened rim retains this
circular shape by means of enclosed spiral spring when the pessary is in
position. To insert conveniently, the thumb and forefinger are placed on
opposite sides of rim, and the spring pressed into a long oval shape.]
5. _Antiseptic Douching._--If antiseptics of any kind are used, such as
lysol, they should always be used in _very very weak solutions_, and
should be varied from time to time. There is no necessity ordinarily to
use anything but plain warm water, with perhaps a little table-salt in it,
for internal cleansing, and soap and water for external cleansing; then
dry parts carefully. But some women prefer a weak antiseptic vaginal wash,
as they do a weak antiseptic mouth wash. If a woman is unfortunate enough
to be married to a man liable to infect her, then she should follow the
same practice as detailed here (every effort, of course, being made for
her husband to be cured as soon as possible), and she should use a
_special suppository_, as prescribed by her doctor or otherwise
authoritatively recommended, and should douche and urinate _immediately
after each sexual connection_. She should also, before douching with weak
disinfecting lotion, wash thoroughly--internally and externally--with
suitable soap and water. This will certainly help to prevent infection in
the vagina and elsewhere. The rubber pessary and the suppository will give
her a very real measure of protection against the worst of all forms of
infection, viz., uterine and ovarian. She can also protect herself against
infection in the female urethra--that is, the passage from the bladder--by
urinating _immediately after each connection_, as advised. A good deal of
nonsense is still talked by some medical practitioners about the alleged
harmfulness of douching. The same kind of distracting and misleading
statements were made a few years ago regarding antiseptic mouth-washes,
which were similarly condemned. Fortunately, we are passing out of these
dark ages! Soon it will be regarded as quite as natural and necessary and
desirable to cleanse the genital passages as to rinse out the mouth or
wipe the nostrils.
It is important to remember that the "_personal equation_" counts for
something in choosing a disinfectant, some substances suiting one person
and some suiting others. "One man's meat is another man's poison." It is
also very desirable to "_ring the changes_" by using, say, lysol one day,
something else the next, and so on. Using three or four simple
disinfectants alternately on different days of the week tends to make the
disinfectants less irritating and more efficacious, as well as adding a
fresh interest to the toilet performance. On this and other points
_personal instruction_ is far the best--provided you can find a good
instructor. Every man and every woman should seek an opportunity of
learning, from competent authority, precisely what to do in the matter of
prevention, and what it all means. Reading books is all very well, but
personal tuition as well is a great advantage.
SUMMARY.
Finally, the following briefly summarises the recommendations for women:--
1. _Before Intercourse, Wash and be Clean._--Insert soluble suppository,
and then place rubber pessary in position, concave side downwards. This
will slip up more easily if slightly soaped. No harm can possibly come
either to husband or wife from these appliances, and neither party will be
conscious of the presence of the occlusive rubber pessary (some other
kinds of rubber pessary have not these advantages). The pessary can be
inserted some hours before intercourse, and need not be removed till some
hours afterwards. _The rubber pessary should not be worn continuously._ If
you have mislaid the rubber pessary, a small sponge, a piece of clean
cotton-wool, or even a piece of soft tissue paper can be used. Native
women in different countries use seaweed, moss, sponge, etc., and Japanese
women use rice-paper. But these articles are not so clean or effective as
the occlusive rubber pessary. If sponge or cotton-wool is used, it should
be saturated in contraceptive lotion or smeared with contraceptive
ointment before insertion. But always remember--the rubber pessary is
cleanest and safest.
2. _After Intercourse._--Douche next morning (or earlier), remove rubber
pessary, wash and dry it and put it away slightly powdered. Where there is
any chance of venereal infection, the woman should urinate _immediately_
after _each_ connection, wash with soap and water, and then _at once
douche with weak and warm disinfecting lotion_. If medically directed, she
should also use a little calomel ointment for anointing parts that have
been touched in any way.
3. _Daily._--Cultivate in yourself and in the members of your household
habits of sexual cleanliness. _Wash and be clean._ Apply this to all the
openings of the body, but in particular to the vagina, urethra and anus,
which should all be cleansed night and morning. This practice is not
simply cleansing and refreshing, but it is preventive of many forms of
disease, such as piles, etc., etc., and
4. Always remember that the spread of this kind of knowledge has been made
possible by the long and patient efforts of hundreds of doctors, many of
them unknown and forgotten, and that women will best be able to apply this
knowledge efficiently by working in loyal co-operation with medical
practitioners who have made a special study of these matters.[H]
[Footnote H: The chief pioneers in teaching Birth-Control in England were
Mrs. Annie Besant, Mr. Charles Bradlaugh, and Dr. Drysdale, Senior.]
DIGEST OF BEST PREVENTIVE PRECAUTIONS.
_Before Connection._
1. Douche with warm water or weak antiseptic
lotion (warm).
2. Insert suitable suppository.
3. Place rubber pessary in position
_After Connection._
4. Douche.
5. Remove rubber pessary. (Urinate to facilitate
ejection of surplus fat.)
6. Douche and dry parts.
The use of rubber pessary does _not_ do away with desirability of
douching, but it does enable the woman to douche at her own convenience
with safety.
ANTISEPTIC LOTIONS.
Dr. K.R.D. Shaw, of 144, Harley Street, London, W.1, who has had a very
wide experience of "prevention" in different parts of the world during the
last twenty-five years, has named the following as suitable disinfecting
lotions:--
Half a teaspoonful of Lysol in 5 pints of warm water;
_or_ One teaspoonful of Sanitas " "
_or_ One quarter teaspoonful of Bacterol "
_or_ 2 grains of Sulphate of Copper " "
N.B.--Where there is grave danger of venereal infection, it is an
excellent additional precaution to douche first with soap and water, and
douche again with antiseptic lotion. The sooner this is done the better.
If all or most of these hygienic measures are widely made known to women,
it can rightly be claimed that women have been released from the twin
terrors of unwanted pregnancy and venereal infection, which are at the
present time ruining their marital health and happiness in so many cases.
Even if _some_ only of these measures are adopted, the nation as a whole
cannot fail to benefit mentally, morally and physically. The success of
the measures, of course, depends to some extent on their being taken _in
time_, but in this, as in many other directions, the old proverb holds
good: _Better late than never._
II.--PRACTICAL METHODS OF PREVENTION.--(_Contd._)
B. FOR MEN:
Marriage cannot be made safe, of course, so long as men are permitted to
contract venereal diseases, and spread them. Early marriage will greatly
lessen the chances of this; tolerated houses under _effective_ medical
supervision (such as we had in Paris during the War)[I] would enormously
lessen the chances of infection, even where marriage was delayed or
interrupted; prophylactic depots where disinfection was properly applied,
_and efficiently taught on request_, would be invaluable; but it is at
present from self-disinfection, properly understood and efficiently
applied, that the community can hope for the greatest and most immediate
gain in sexual cleanliness.[J] The following were the directions I gave
the Anzacs during the war, distributing these with prophylactics for men
and for women (the directions for women being printed in French and
English); this action was endorsed by all the leading British, American
and French military and medical authorities, from the Commanders-in-Chief
downwards, and the effort undoubtedly saved many thousands of men from
damage and ruin:--
"AVOID INFECTION.
"If you become infected with V.D., the fault is really your own.
Either do not risk infection at all, or, risking infection, take
proper precautions. These are quite simple. If you take the
following precautions _without delay_ you are very very unlikely to
contract disease:--
1. Use vaseline or some other grease (such as calomel ointment)
_beforehand_, to prevent direct contact with the source of
infection.*
(* Note: Any personal discomfort or unpleasantness grease causes is
counteracted by the woman's having douched beforehand, as should
always be done for the sake of cleanliness. A mere film of grease
is sufficient to fill up pores of the skin, cover over abrasions,
and prevent penetration of microbes, and it greatly facilitates
subsequent cleansing.)
2. Urinate _immediately_ after _each_ connection to wash away all
infective material, and to prevent the invasion of the urethra by
the microbes of V.D.
3. Wash thoroughly with soap and water, because ordinary soap is
destructive to germs--of syphilis and of gonorrhoea--and bathe
parts with weak solution of pot. permang.
You had far better carry a blue-light outfit with you as a "town
dressing," in the same way as you would carry a "field dressing."
If you cannot get an outfit, carry a tiny bottle of pot. permang.
lotion and a scrap of cotton wool. If you swob yourself _carefully_
with this, you will not become diseased. Remember always _it is
delay that is dangerous_. If there has been delay, use a syringe
sufficiently large for the contents to flood the urethra and
slightly distend it, so that every nook and cranny is cleansed.
Whatever you do, make certain of _going home clean_. Be sure of
your health and doubly sure before you embark. While you are in the
army and on this side of the world you can be cured easily and
privately. If you go home infected, there will be embarrassment and
expense to yourself and _great danger_ to the women and children
you love.
_Get cured NOW._" (Paris, April, 1919).[K]
[Footnote I: The following is taken from a paper read by Captain H.L.
Walker, Canadian Medical Service, O.C. Report Centre (British), Paris, at
Conference on V.D., organised by the American Red Cross in April, 1918:--
"Speaking in regard to licensed houses, Captain Walker said that he
_had not found one case of venereal disease_ contracted in a
licensed house in the City of Paris, and he could only suppose that
the people who were responsible for putting the licensed houses in
Paris out of bounds knew nothing at all about the real facts of the
case.... In the licensed houses in the City of Paris, during the
year 1917, _only five cases of venereal disease_ were contracted;
and in 1918, up to April 20th (the day he was speaking), _there had
not been one case of venereal disease contracted in a licensed
house in the City of Paris_. But out of 200 women arrested on the
streets of Paris during the month of April, _over twenty-five per
cent. were found to be infected with venereal disease_. In the
months of November and December, 1917, the French authorities had
made a round-up on one boulevard of seventy-one women, of whom
_fifty-five were infected with venereal disease_; a few days later
the French authorities repeated the same procedure on another
boulevard; something like _one hundred women_ were arrested, _and
ninety-one per cent. were infected with venereal disease_."--p.
134, _Public Health_ (England), September, 1918.
I supervised a tolerated house in Paris for over twelve months
(1918-1919), and had no cases of disease either among the women or the
men. The women attended from 2 p.m. to midnight and resided in their own
homes.--E.A.R.]
[Footnote J: Among the first medical men in Great Britain to recognise the
importance and effectiveness of self-disinfection was Mr. Frank Kidd,
M.A., M.Ch. (Camb.), F.R.C.S. (Eng.), etc., of the London Hospital. A full
statement of his evidence before the Royal Commission on Venereal Diseases
is given in Mr. Kidd's book, "Common Diseases of the Male Urethra"
(published by Longmans, Green and Co., 39, Paternoster Row, London, etc.,
in 1917). The diagram of male organs of generation I have used on page 36
was taken in outline from Mr. Kidd's frontispiece, and during the war I
found all the illustrations he gave most helpful with the soldiers,
although the book itself was written for the purpose of enabling doctors
in outlying districts to treat patients on modern lines with success. Mr.
Kidd designed prophylactic tubes, which have been sold in England on his
order for more than fifteen years. He tells me they have been used all
over the world by his patients, and that as far as he can ascertain "_they
have never failed, when used properly and intelligently_."--E.A.R.]
[Footnote K: Since this was written, a large number of experiments have
been made with the single treatment tube, containing an ointment
destructive of all forms of venereal disease microbes, whether used before
or after connection. The Pennsylvania Department of Health is within
measurable distance of finding a solution of this problem--the production
of a cheap, portable, easily applied and thoroughly efficient
self-disinfecting ointment.--E.A.R.]
It was clearly proved that so long as men took these simple precautions
(which I always explained _personally_) they were very unlikely to
contract disease; most cases of disease came from multiple connections
with the women of the cafes, etc. It was difficult to impress on ordinary
men's minds the fact that _each and every connection was a danger_; that
the danger of infection began immediately there was any contact, and that
it continued until disinfection, and was renewed as well with each fresh
connection during the night. If the danger had continued for several hours
in this way, the men were told to go to the medical depot or report to a
doctor as soon as possible. When they did so they were saved from disease
in the vast majority of cases, even up to twenty-four hours afterwards or
a little longer.[L]
[Footnote L: In 1915-1916 Colonel Sir James Barrett, then A.D.M.S. of the
Australian Force in Egypt, had successfully applied prophylaxis, but
unfortunately he was invalided for a time to England in November, 1916,
and with the evacuation of the Dardanelles there was a severe outbreak of
v.d. in Egypt. Prophylaxis was then steadily applied during 1917 by
Colonel Sir James Barrett and others, and at the end of 1917 v.d. had been
reduced to small proportions. In December, 1917, Colonel P.G. Elgood, Base
Commandant of Port Said, wrote:--
"Fortunately, however, at this stage, I came into contact with Colonel Sir
James Barrett, K.B.E., R.A.M.C, and Miss E. Rout, New Zealand Volunteer
Sisterhood. The first suggested that the solution of the problem would not
be found in police measures or in medical examination, but in prophylaxis;
while the second, in correspondence relating to her own experiences gained
in England, encouraged me to advocate this remedy."
The successful results of the Port Said efforts are quoted in full by
Colonel Sir James Barrett in his book, "A Vision of the Possible" (Lewis),
and Colonel Barrett had early in 1917 sent me to London the following
tremendously valuable letter of advice and warning:--
"I suppose my instinct is rather more in the moral direction than
many people, but I recognise, as you will see from these articles
(published by _Lancet_), that it is by direct prophylaxis, and
direct prophylaxis alone that we are likely to get rid of this
abomination. I should never in any campaign exclude all the
additional aids--proper soldiers' clubs, such as I have established
in Egypt, the influence of decent women, and the one hundred and
one factors that go to make a decent and reputable life; but you
have, in the long run, to recognise the fact that a percentage of
men are certain to seek women who are prepared to cater for them.
If the steps indicated are taken, the proof is absolute that the
disease can be practically extirpated and without great difficulty.
The failure of prophylaxis depends on two factors--firstly, it
requires someone charged with responsibility, earnestness and high
character to explain to men precisely what they are doing and what
it means; and secondly, prophylaxis is of very little use to
drunken men. My experience has been that when these precautions are
properly used venereal disease may disappear."
That proved to be exactly my own experience in the army. Failures in the
army were due to the absence of proper personal instruction of the men and
the laxity of control, and these conditions can always be assumed to exist
in any army having a high v.d. infection rate.--E.A.R.]
Nevertheless, the people who would put sacerdotalism before science, and
the still meaner minds who would substitute legality for morality, raised
storms of objection to my work, in the midst of which came a few strong,
clear calls of understanding and encouragement.
One Scotch padre wrote me in 1918:--
"It is a magnificent adventure for a woman to go practically alone
on the very edge of things, and I salute you, and congratulate you,
and wish you _God-speed_."
An old family doctor, then with a colonial ambulance, wrote:--
"Many women ... will owe their health and happiness to you, and not
a few will be indebted to you for their lives."
The editor of the Sydney _Bulletin_ (Australia) was continually publishing
helpful articles and paragraphs--after my letters and articles were
censored;[M] and from Dr. W.H. Symes, of Christchurch, New Zealand, I
heard by personal correspondence steadily and wisely all through the war.
Much later came the following tribute, in a most valuable book written by
Sir Archdall Reid and Sir Bryan Donkin ("Prevention of Venereal Disease,"
published by William Heinemann (Medical Books) Limited)[N]:--
"Sir Bryan Donkin's letter, which appeared in _The Times_, in
January, 1917, and other communications which he published as
opportunity offered, brought him an introduction from Sir J.W.
Barrett, M.D., then serving as A.D.M.S. with the Australian Force
in Egypt, to Miss Ettie Rout, who, by profession a journalist, had
come with the Australian and New Zealand Forces with the object of
ameliorating, as far as possible, the hardships of war. She had
been horrified by the pestilence of venereal disease which broke
out among the troops in Egypt, England, and elsewhere, and, with
extraordinary resolution and courage, had embarked almost
single-handed on a campaign of prevention. She furnished Sir Bryan,
and later myself also, with much valuable information, and for her
own part fought the battle most strenuously--living among the men,
lecturing, finding and instructing lecturers, providing
disinfectants, importuning authorities, writing most trenchant
letters, establishing medical clubs in England and France, and the
like. I think that when the names of those who opposed her are
forgotten, the memory of this brave lady will still be green among
the descendants of the valiant men for whose welfare she
struggled"--p. 176-177.
[Footnote M: The _New Zealand Times_ daily newspaper published my first
article and was severely reprimanded by the New Zealand Government for
doing so, and all New Zealand newspapers were then prohibited from
publishing any further articles relating to V.D. in the New Zealand
Forces.--E.A.R.]
[Footnote N: See Publishers' notice.]
ALCOHOLISM.
It should be noted here that another great difficulty we had was to make
men _beware of the dangers of drink_. A man who is in liquor is much more
liable to contract venereal disease than a man who is sober. Alcohol
increases sexual desire, lessens sexual ability, and lowers the sense of
responsibility. Hence, drunkenness, immorality and disease go hand in
hand: a dreadful three. But more than this. The drunken man takes much
longer over the sex-act, thereby prolonging the risk of disease, and he
runs risks which he would rule out instantly if the fumes of alcohol had
not changed the tawdry girl into the glittering fairy. Worse than all, he
neglects to apply disinfection properly and _promptly_--he falls asleep or
forgets all about it till _too late_. Men who are determined to have a
"night out" should use calomel ointment (or some other substitute) _before
they start_; and if they have been in liquor they should disinfect
instantly when they recover their sober senses. Generally speaking, _an
ounce of calomel is worth a ton of salvarsan_.
As with young men, so with young girls: a few glasses of wine taken at a
supper or a dance--and the first downward step is taken, not because any
wrong was intended, but the simple actualities of sex were unknown, and
the stimulant took advantage of the ignorance that is miscalled innocence.
This kind of thing will continue till the older generation realise that
morality depends--not on the maintenance of ignorance and the fear of
disease, but on the spread of knowledge and the promotion of virtue.
It is not morality, but caution, that is developed by fear, and in this
case caution is counteracted by the practical experience that many men are
immoral without becoming diseased. One man commits many immoral acts and
suffers not at all; another man becomes syphilitic by yielding for the
very first time; the penalty is purely fortuitous. There is no necessary
connection at all between immorality and disease. The dangers of sexual
intercourse are due to dirt and promiscuity rather than to immorality, and
in part to the physical conformation of the individual. Virtue has far
deeper and more substantial foundations than the mere gusts of fear. It is
founded on necessary and responsible guardianship of the very gates of
life.
III.--MEDICAL FORMULÆ.