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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 illicit7 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.
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.
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.
Self-treatment. I do not believe in self-treatment because it is 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.
