A young girl may very well marry at seventeen or eighteen, or at any rate between eighteen and nineteen. She is then s.e.xually mature and her mentality is sufficiently developed, so that the difference in age we have required may be obtained. Young people thus united may continue their studies before procreating children, and their marriage will stimulate them to work.

When the intoxication of the honeymoon is over, the continuance of conjugal happiness depends on an intimate adaptation of the two conjoints in sentiments, intelligence and s.e.xual appet.i.te; an adaptation which purifies love on both sides. Work in common, a common ideal, mutual respect full of affection but free from flattery, and a reciprocal education which does not degenerate into pedantry nor tyranny, are the princ.i.p.al conditions for conjugal happiness.

It is absolutely necessary to avoid everything which causes reparation or exclusion, even in appearance. At the risk of appearing ridiculous in the eyes of certain superior persons, I repeat that separation of beds and bedrooms is a dangerous experiment to make in marriage, and that it may easily lead to estrangement, even when based on the highest motives.

It is the same, in a still higher degree, with s.e.xual continence in marriage, even when it does not last for years, excepting in cases of grave disease or senile impotence.

It is often stated that a woman should avoid coitus for long periods, because among certain savage races the husband does not cohabit with her during pregnancy and the two years of nursing which follow it; the woman being considered by religion as "impure" during this period. But this proves nothing, for this custom only concerns polygamists, who make up for it with other women. If our monogamous marriage is to be natural, and not satisfied with words and illusions, it is necessary for s.e.xual intercourse to be intimate and constant, and it should only be interrupted for short intervals, corresponding to the natural wants of the two conjoints, adapted to each other by mutual concessions.

Apart from this, menstruation and accouchement const.i.tute the only exceptions based on physiology. According to Gruber (_Hygiene des Geschlechtslebens_) accouchement requires an interruption of at least four weeks; I should say at least six weeks. Every husband, with the possible exception of the most horrible satyrs, can submit to this without much discomfort. Pregnancy, on the contrary, does not require continence, provided the husband takes account of his wife's condition and treats her with care.

During the last months of pregnancy all violent movements and pressure on the abdomen should be avoided during coitus, so as not to injure the embryo. This may be effected by coitus in the lateral position.

Professor Pinard of Paris advises the prohibition of coitus during the latter part of pregnancy, because it may lead to premature birth. As regards accouchement at the seventh, eighth or even at the beginning of the ninth month, this might, it is true, be proved by figures, but at this time the embryo is sufficiently protected, and with the precautions indicated above, I consider the danger as nil. As regards the end of the ninth month, the margin of errors as to the movement of conception and the signs of birth at term hardly allow of statistics which exclude subjectivism, and the danger becomes less and less. In any case a conscientious husband would run no risks under these circ.u.mstances if he was aware of the danger.

What is more important for the wife is that she should have sufficient rest between her pregnancies. A year at least should elapse between parturition and the next conception; this gives approximately two years between the confinements. This is easily managed by the aid of the preventive animal membranes we have mentioned. In this way the wife keeps in good health and can bear healthy children at pleasure.

It is certainly better to procreate seven healthy children, than to procreate fourteen of which seven die, to say nothing of the mother who rapidly becomes exhausted by uninterrupted confinements.

No rule can be given for the frequency of s.e.xual connection in marriage; this is a matter for reciprocal arrangement. Luther's rule of two or three times a week may be considered a normal average for virile persons of good const.i.tution.

Women who are s.e.xually cold and fond of children, but who have a horror of coitus, cannot, in my opinion, be regarded as types of the normal wife, nor can they expect their husbands to abstain from all coitus except that intended for procreation. On the other hand, the wife should certainly be made acquainted with the nature of s.e.xual intercourse and its consequences before marriage. Further, before engaging in a life-long union, a man and woman ought to explain to each other their s.e.xual feelings so as to avoid deception and incompatibility later on.

Without having ever experienced a s.e.xual o.r.g.a.s.m, either by coitus or by masturbation, a normal young girl, when she is sufficiently instructed in s.e.xual matters, may easily decide whether the idea of coitus with a man for whom she feels affection is repugnant or attractive to her. In the case of young men it is still easier.

A woman who had received a complete medical education and had remained a virgin, but who was well-informed on s.e.xual life, gave me very precise information on this subject. For a long time the idea of coitus with men was repugnant to her, till she made the acquaintance of the one who gained her affections. Repugnance was then replaced by desire. This case also gives a good example of the monogamous s.e.xual feeling of the normal woman.

In Chapter XVII we shall discuss the manner in which youth should be initiated into the s.e.xual question. Our present formality, combined with general ignorance of girls on s.e.xual matters, renders a mutual understanding prior to definite betrothal generally impossible.

Moreover, there is a sort of hysterical and pathological love, the product of the imagination, which is a.s.sociated with sentimental words and sighs as well as coquetry, but transformed into disgust or hatred by the first coitus. Although more common in women this false love is met with in hysterical men. Sometimes the illusion disappears while there is yet time to break off the betrothal. Marriage by trial and has been attempted by some, but with varied success.

For a number of reasons, both parties should be medically examined before marriage. This precaution may reveal the presence of a narrow pelvis or vaginismus in the woman, or aspermia, venereal disease, etc., in the man.

When a woman will only support coitus with a view to procreation, she would do well if she informed her _fiance_, who can then consider whether he can submit to such restriction. If the wife will not allow her husband a concubine it generally results in clandestine extra-nuptial relations and subsequent divorce proceedings.

My opinion on this subject will no doubt appear very immoral to many people, but it is natural and rational. It is needless to say that I do not intend that a man has the right to compel his wife to have intercourse whenever he pleases. The question is a very delicate one; but, by the aid of goodwill a satisfactory solution of the problem can be obtained in most cases, in the manner indicated above. Love and mutual respect will always find a way out of the difficulty. It is necessary to avoid extreme asceticism and unnatural idealism on the one hand and excessive s.e.xual indulgence on the other hand. In the s.e.xual question above all others it is the wisest course to strike a happy medium.

An extremely important question is that of the procreation of children. We have just explained how this can be regulated at will; we have now to consider how children of the best quality can be procreated.

The first condition is the good quality of the parents. Their heredity or the intellectual and physical value of their ancestry is of paramount importance. We must take into consideration, not only the intelligence and physical health, but also good sentiments, a conscientious character and energy of will. What is the use of procreating healthy and robust children if they are vain, egoistic, impulsive, crafty, wanting in will power, or perhaps criminal? Such individuals const.i.tute a social plague.

At the time of conception the parents should not be in a condition of acute or chronic alcoholism, nor affected with any disease; otherwise the progeny may be tainted by _blastophthoria_ (Chapter I).

The age of the procreators should also be taken into account. Children born of parents advanced in years are generally feeble.

The fatal error which causes the procreation of children to depend on pecuniary reasons and interests is a social misfortune. Healthy men and women ought never to avoid reproduction, even when they are poor.

Progeny of good quality grow up, so to speak, by themselves. Progeny with evil instincts, or decadent, have a pre-existing hereditary taint, or have been affected by blastophthoria in some other way.

No doubt acquired diseases or accidents may make an invalid of a child or a man, but these are exceptions which prove the rule, for here again the descendant of healthy parents is more resistant than others, if he has not artificially altered his state of health and power of resistance by alcohol or venereal disease.

Among savages, and at the present day among many peasants, children are rather an advantage than a burden, because these people have simple and healthy habits and few wants. It is our artificial and unhealthy desire for luxury, frivolity, comfort and enjoyment, our muscular weakness resulting from want of exercise, our exaggerated terror of diseases and microbes, in a word our effeminacy, which makes us so incapable of rearing large families simply and cheaply. No doubt it becomes more and more necessary to give children a good education, and this necessity complicates the question. But, in my opinion this education will in the future be conducted by the State.

=Hygiene of Pregnancy.=--This subject is too special to be fully dealt with here. We may, however, mention that idleness and overwork are equally detrimental to the pregnant woman and her child. It is needless to say that every pregnant woman requires care and good food.

Violent efforts, especially in the upright position, should be avoided (vide Bachimont: _La Puericulture intra-uterine_, 1898, Paris). But domestic work and moderate exercise of the body are beneficial.

Precautions are especially necessary during the last months of pregnancy for the general health of the mother and child, but imprudence during the early months may cause abortion in many women.

The progressive enervation of women in easy circ.u.mstances has no doubt rendered them less adapted to procreation. This failing should be corrected by progressive but prudent training.

=Medical Advice as to Marriage.=--The permission or prohibition of marriage is a delicate question at the present day, but will be less so in the future, if our propositions are realized. If one of the two candidates for matrimony has been or is still insane, or seriously affected with tuberculosis, or with active syphilis or chronic gonorrhea, it is clearly our duty to prohibit marriage.

If the situation is not so grave, and if it is only a question of hereditary taint, especially when there is a probability of the offspring being deformed in body or mind, we may content ourselves with prohibiting the procreation of children, while giving permission for marriage, provided anticonceptional measures are used. The importance of these measures is obvious in such cases. We should explain to the young people in question that the procreation of unhealthy or backward children is bad and even criminal, and warn them against such an unpardonable act of thoughtlessness. If they are very fond of children they can be recommended to adopt poor orphans.

There is no need, however, to be too severe. Medical men are often pessimists, and have a tendency to see disease everywhere and to give a grave prognosis. The procreation of children should not be prohibited simply because there is insanity in some member of the family, but the probabilities of hereditary transmission should be calculated in the way we have explained in the first chapter of this book.

Taking into consideration the bodily and mental health and the character of the two candidates for marriage, as well as that of their ancestry, the physician should consider what is likely to be the average quality of children from such a marriage. According as his calculation leads to a probability above or below the average of the population, from all the points of view of the social value of man, he will advise the parties concerned as to freedom or limitation in procreation.

The average of humanity must not be placed too high, and the physician should always keep in mind the great mental mediocrity, weakness of will, the low moral level and physical defects of the bulk of the population.

When persons who are intelligent and educated, but more or less psychopathic or hereditarily tainted, put questions of this kind to the doctor, because they are very conscientious and prudent, they should be recommended to lead a healthy life and avoid alcohol, but need not remain sterile, for their offspring may be morally and intellectually above the average, and if all blastophthoric influences are avoided there is a possibility or even probability of gradual regeneration. In short, the doctor must treat each case on its own merits, carefully weigh both sides of the question, and avoid being influenced by exclusive dogmas of any kind. Thus only can he give wise and useful advice.

What is of especial importance for us, is the knowledge that it is not necessary, from the point of view of social hygiene, to prohibit marriage for the sole reason that the offspring may be of bad quality.

We can allow psychopaths with hereditary taints, or even invalids of both s.e.xes, to contract sterile marriages, by requiring them to avoid conception by some means or other, in the name of social hygiene and morality. In such cases dislocation of the tubes has a definite effect, and if we consider the negligence and weakness of mind of such individuals, we should do well to recommend this proceeding whenever there is a clear indication for inducing sterility. In this way we avoid cruel measures, which, by the way, are almost impracticable, which take away all hope of love and happiness from these unfortunates, throw them into the arms of prost.i.tution or bitter pessimism, and make them disgusted with their own existence.

=Medical Secrecy.=--Medical secrecy and its limitation is a very delicate question, especially in s.e.xual matters. Opinions vary in different countries and among different individuals. In France medical secrecy is almost made an idol; the medical man may refuse to give evidence in a court of law and even conceal a crime. In Germanic countries, on the contrary, especially in German Switzerland, too little importance is attached to medical secrecy. In short, medical secrecy is an elastic idea which is open to different interpretations.

Although certain particular cases may present great difficulties, there is a middle course of moral conduct which will serve the purpose of every conscientious doctor. As a general rule the doctor's duty is to keep secret everything confided to him by his patients, except when the patients themselves speak openly of it, or authorize their doctor to do so. There are, however, exceptions to this rule.

First of all it a.s.sumes normal responsibility in the patient, and is only conditional among irresponsibles. When a lunatic, for example, relates to a doctor, under the seal of secrecy, certain things which depend on delirious ideas and which threaten the safety of others, or which render certain measures necessary in the patients' own interest, the doctor's duty is to make known the state of affairs, but only to responsible persons. It is the same as regards children. It is needless to say that the doctor should use all possible measures in the interest of the patient or child.

But even with responsible persons medical secrecy has its limits. The doctor is here only bound to secrecy so far as it does not injure the rights of other individuals, or those of society.

It is the duty of a medical man to report all cases of smallpox or cholera, etc., even against the consent of the patient, and to isolate the latter to avoid an epidemic, which is contradictory to medical secrecy. In short, he must not, under the pretext of medical secrecy, become an accomplice of harmful acts or crimes. I will mention a few examples bearing on the s.e.xual question:

A s.a.d.i.s.t or a s.e.xual pervert addicted to a.s.saults on children consults a doctor and confides to him his morbid appet.i.te. It is obvious that the doctor has to do with a dangerous individual and is at the same time in a difficult position. In this case extreme measures are bad.

The doctor who simply treats the patient without concerning himself about the possible victims, contravenes his duties. The one who replies to the patient, "you are a beast; go away or I shall denounce you," acts in a still worse manner. The one who simply denounces the patient also puts himself in the wrong. In my opinion, the doctor should first of all make a thorough examination of the mental and s.e.xual condition of the patient, so as to establish the degree of perversion and satisfy himself whether he has to do with an honest individual worthy of pity, who strives to overcome his morbid appet.i.te; or, with a crafty egoist with no conscience, who only consults the doctor to escape from temporary difficulties into which his perversion has led him, and who indulges his morbid appet.i.te without scruple, const.i.tuting a perpetual danger to society.

Unfortunately, the latter cases are very common, and the doctor is usually consulted from interested motives only. Under these circ.u.mstances medical secrecy renders the doctor the accomplice of the criminal.

Between the honest patient and one who is absolutely perverse, there are many transitional stages. In these cases the doctor should always make a careful examination before forming an opinion. If he feels uncertain, he should call in a specialist in mental disease, and then act accordingly. If he is convinced that the patient has made the resolution to overcome his morbid appet.i.te, and has so far resisted the temptation to injure any one, he should strengthen the patient's resistance by doing everything possible (except marriage) to rid him of his malady; he should make him aware how dangerous his condition is to himself and to others; he may even recommend either castration or masturbation in case of urgency, in order to avoid crime; he should make him promise to come immediately for internment in an asylum, as soon as he can no longer resist. Under these conditions he may respect medical secrecy and at the same time save the existence of the unfortunate patient, while protecting society.

In more severe cases, when the doctor is convinced that the patient is incapable of controlling himself or does not wish to, or that he has already committed crimes, he should act as follows: He must explain to the patient that it is impossible for him to take the responsibility and that he must be immediately sent to an asylum, in default of which information will be given against him. We must make him understand that he is a danger to society and goes beyond the limits of what is licit, but that if he voluntarily submits to rational treatment, offering all requisite guarantees on both sides, he (the doctor) is disposed to avoid any legal action.

The duty of medical secrecy ought never to go so far as to render the medical man an accomplice of dangerous individuals or criminals. The lunatic asylum in such cases is the natural refuge for the patient, as the lazaret is for cases of smallpox or cholera. These cases, however, require public asylums which are not too large, well organized, with divisions for different cases, and provided with a sufficient medical staff.

I have chosen as the first example one of the worst kind of cases which endanger the public safety. But there are other cases such as that depicted by Brieux in "_Les Avaries_." A syphilitic subject wishes to marry before he is cured, and consults his doctor. Does the whole duty of the doctor consist in dissuading the patient from marriage? Has he actually the right to be silent when the patient will not listen to him, and thus allow an innocent young woman to be contaminated, through respect--or rather idolatry--for medical secrecy? Is it not rather his duty to say to the patient: "Beware! If you do not promise to obey me, I will immediately denounce you to your _fiancee_ and her parents, and will tell them the state of affairs."

It seems to me that this is his duty. In this case the doctor does not denounce the patient without his knowledge; he threatens him face to face, and may speak to him as follows: "You have confided in me. I am, it is true, under the obligation of medical secrecy toward you, so long as you do no harm to any one. But if, in spite of all my explanations and warnings, you attempt to marry in your present state, rendering yourself guilty of infamous deceit toward a family and an unfortunate young woman whose health you will ruin, trusting in the obligation of secrecy which ties my tongue, I must inform you that I have a much higher duty than that of a doctor toward his patient--my duty toward society, which I shall fulfill, and so prevent an innocent person from becoming your victim."

This is my view of the duty of a conscientious doctor who upholds the dignity of his profession. An a.n.a.logous case came under my observation: A young tuberculous subject affected with several "white swellings" wished to marry. He refused to listen when I declared that he would be guilty of a crime toward his _fiancee_. Thereupon I told him that I should tell everything to the young girl. I did this at once and so prevented the marriage. This egoist succeeded later on in capturing the heart of another young girl, whom I also warned, but who married him out of pity. At any rate I consider that I did my duty.

In my opinion, this is also our duty in cases of chronic gonorrhea, insanity, and hereditary or const.i.tutional s.e.xual perversions, etc.

Formerly, when s.e.xual inversion was regarded as an acquired vice, it was attempted to cure it by marriage. Such a social monstrosity is even seen at the present day, and certain ignorant doctors recommend it. We sometimes meet with inverts who desire to procreate h.o.m.os.e.xual beings like themselves. As s.e.xual intercourse with the objects of their perverted pa.s.sion cannot give them this pleasure, they marry in order to procreate children by some poor woman whom they have victimized, without in the least renouncing their h.o.m.os.e.xual orgies.

Their wives play the part of housekeeper or servant, whose accessory function is to breed young inverts! Is it necessary to say that any self-respecting doctor who is aware of this state of affairs should never countenance such marriages? Here again, his duty is to threaten the invert with immediate denunciation to his _fiancee_, when he appears determined to accomplish his crime.