To deal with the subject of the _treatment_ of masturbation belongs to a medical treatise. But, a few remarks on how to prevent children from acquiring the habit of masturbation will not be out of place.

=Prevention of the Habit of Masturbation.= The keynote of preventing the habit is, carefully to watch the child from its earliest infancy.

We know that not infrequently stupid or vicious nursemaids, wet-nurses, and even governesses ignorantly or deliberately induce the habit in children under their charge. This, of course, must be prevented. Even children of the age of nine, ten, eleven years should not be left alone, but always be under supervision. Too close friendship between boys or girls, particularly of different ages, should be looked upon with suspicion.

A number of girls never should sleep in the same room without supervision by an older person.

The sleeping together of two in the same bed, whether it be two children or a grown person and a child, should not be permitted under any circ.u.mstances. I admit of no exceptions to this demand. It makes no difference whether the other person is a mother, a father, a brother or a sister. Leaving out of the question any _deliberate_ element, the thing is dangerous; for, very often, unintentionally, unwittingly, masturbation is initiated by this intimate contact.

The child--boy or girl--should sleep alone, on a rather hard mattress.

The covering should be light. A coverlet may be put over the feet. The child always should sleep with the arms out upon the cover or blanket, never _under_ the same. If this is done from childhood on, it is very easy to get used to this way of sleeping, and many a case of masturbation will thus be obviated. The child should not be permitted to loll in bed: it must be taught to get up as soon as it awakes in the morning. The general bringing-up must be of a strengthening, hardening character; and this applies both to the body and the will.

When the children reach the age of nine, ten, eleven, twelve or thirteen years (we must use discrimination and judgment, for, some children of nine are as developed as are others of thirteen), we must tell them that it is bad and injurious to handle one's genitals, and we must warn them to shun any companions who wish to initiate them into any manipulations of these parts or who show an inclination to talk about the s.e.xual organs and s.e.x matters.

Hot baths are very injurious for young children in their influence in this direction. There is no question that a hot bath has a very decided stimulating effect upon the s.e.xual desire of adults as well as of children, both male and female; in fact, I have had several patients of either s.e.x tell me that their first masturbatory act was committed while they were in a hot bath. Of course, the sensation having been pleasurable, they kept on repeating the experience.

Every factor liable to give rise to the habit should be removed. Thus, for instance, eczema about the genitals, strongly acid urine, seatworms, and the like, should be treated until cured. That anything having a tendency prematurely to awaken the s.e.xual instinct should be rigorously avoided, goes without saying.

=Mental or Psychic Masturbation.= Some girls and women will abstain from handling themselves with their hands (manual masturbation), but will practice what we call mental masturbation. That is, they will concentrate their minds on the opposite s.e.x, will picture to themselves various lascivious scenes, until they feel "satisfied."

This method is extremely injurious and exhausting and is very likely to lead to neurasthenia and a nervous breakdown. You should break yourself of it, by all means, if you can. For it is even more injurious than the regular habit.

CHAPTER TWENTY

LEUCORRHEA--THE WHITES

Misconception Regarding the Meaning of the Term "Leucorrhea"--A Common Complaint--Severe Cases--Reasons for Resistance to Treatment--Proper Local Treatment of the Disorder--Sterility Due to Leucorrhea--Causes of Leucorrhea--Tonic Medicines--Local Treatment--Formulae for Douching.

Leucorrhea means literally a "white running," and is applied by the laity to any whitish discharge coming from the v.a.g.i.n.a. This is wrong, because some white discharges may be of little importance; others may be of a serious character, and not be leucorrhea at all.

Leucorrhea is one of the banes of the modern girl and woman. It is very frequent. Probably at least twenty-five per cent, (some say fifty or seventy-five per cent.) of all women suffer with it in a greater or lesser degree. In some cases it is only an annoyance, necessitating the frequent changing of napkins, but in others it causes a great deal of weakness, backache, erosions, itching and burning. It is very resistant to treatment, particularly in girls. The reason it is so resistant to treatment is because the discharge, while coming from the v.a.g.i.n.a, _does not usually originate_ in the v.a.g.i.n.a; it originates in the neck of the womb, and the hundreds and hundreds of injections that women take for their leucorrhea only reach the v.a.g.i.n.a; they cannot penetrate into the womb. And it is only by treating the cavity of the cervix, which can only be done by a physician, through a speculum, that the root of the trouble can be reached. And, if any erosion or ulcer is noticed, it can be directly touched up with the necessary application. And it is for this reason that in girls leucorrhea is so much more difficult to treat. For fear of having the hymen ruptured the girl objects to a thorough examination and to local treatment, and the leucorrhea is permitted to proceed until perhaps a chronic inflammation of the womb and the Fallopian tubes is established. There is no doubt that many cases of sterility or childlessness in women are due to long-neglected leucorrhea in girlhood.

=What Is the Cause of Leucorrhea?= We can answer simply: the cause of leucorrhea is catarrh in any part of the female genital tract. But this is no real answer. What are the causes of the catarrh? The causes of catarrh are many: the most common cause is a cold. Wetting the feet and getting chilled, particularly during the menses, may set up a catarrh in the cervix. Long standing on one's feet, lifting and carrying heavy bundles, dancing in overheated rooms and then going out scantily clad in the chill night air, prolonged ungratified s.e.xual excitement, lack of cleanliness in the external genitals--all these are factors in setting up a catarrh of the cervix with a resultant leucorrhea. A general rundown condition, worry, overwork, too hard study, lack of fresh air, and a general scrofulous condition also favor the development of catarrh of the womb and leucorrhea. It will therefore be seen that the treatment of leucorrhea to be successful must be general and local.

=General Treatment.= The general treatment consists in general hygienic measures and in common sense. The patient should not be on her feet more than she can help, and she should not walk until exhausted or fatigued. It is better to take several short walks than one long one. The corset she wears, if she wears any at all, should be of the modern kind: not one that presses the womb and the other abdominal organs down, but one that supports the abdominal walls, and rather raises the abdominal organs up. The lacing or b.u.t.toning must be from below up, and not from above down. That it should not in any way interfere with the freedom of respiration goes without saying.

Constipation if any, to be treated, must be treated intelligently, by mild measures (see Constipation, in the chapter on pregnancy), and care must be taken that the bowels move at regular hours. Where the leucorrhea is due to or is aggravated by anemia and general weakness, a good iron preparation, such as one Blaud's five-grain pill three times a day, or a tonic of iron, quinine and strychnine, will do good.

A daily cold bath or cold sponge, followed by a brisk dry rubbing with a rough towel, is also useful.

=Local Treatment.= Local measures consist of painting or swabbing the v.a.g.i.n.a and cervix with various solutions, of tampons, suppositories and douches. Local application to the v.a.g.i.n.a and uterus can be done satisfactorily by the physician or nurse only. The insertion of a suppository or douching can be easily done by the patient herself.

While it is always best and safest to consult a physician, and, while self-medication is generally inadvisable, there are occasions when a physician is not available; in some small places a woman may, _for various reasons_, have a strong objection to gynecological examination and treatment; and some women may be too poor to pay the doctor. In such circ.u.mstances self-treatment is justified and there can be no objection to it if the remedies are harmless and are sure to do some good; that is, to improve the condition where they do not effect a complete cure.

One of the simplest things is an alum tampon. You take a piece of absorbent cotton, about the size of a fist, spread it out, put about a tablespoonful of powdered alum on it, fold it up, tie a string around the center, insert it in the v.a.g.i.n.a as far as it will go, and leave it in for twenty-four hours. Then pull it gently by the string and syringe yourself with a quart or two quarts of warm water. Such a tampon may be inserted every other day or every third day, and I have known many cases where this simple treatment alone produced a cure. In some cases, however, douches work better and the two best things for douching are: tincture of iodine and lactic acid. Buy, say, four ounces of tincture of iodine, and use two teaspoonfuls in two quarts of hot water in a douche bag. This injection should be used twice a day, morning and night. Of the lactic acid you buy, say, a pint, and use two tablespoonfuls to two quarts of water. The lactic acid has the advantage over the tincture of iodine that it is colorless, while the iodine is dark and stains whatever it comes in contact with. Sometimes I order the use of the tincture of iodine and the lactic acid alternately: for one douche the tincture of iodine, for the next the lactic acid, and so on. When the condition improves, it is sufficient to use one teaspoonful of the tincture of iodine and one tablespoonful of the lactic acid to two quarts of water. These injections are quite efficient and have the advantage of being perfectly harmless. One point about the injections: they should be taken not in the standing or squatting position (in which position the fluid comes right out), but while lying down, over a douche pan. The douche bag should be only about a foot above the bed, so that the irrigating fluid may come out slowly; the patient, after each injection taken in the daytime, should remain at least half an hour in bed (in the night time she stays all night in bed). This gives the injection a better chance to come in contact with all the parts of the v.a.g.i.n.a, and a portion of it comes in contact with the cervix, where it exerts a healing effect. Avoid the use of patent medicines.

CHAPTER TWENTY-ONE

THE VENEREAL DISEASES

Derivation of Word "Venereal"--Three Venereal Diseases--Innocent Contraction of Syphilis Through Various Objects--The Hygienic Elimination of Common Sources of Venereal Infection--Measures for Prevention After s.e.xual Relations.

The word "venereal" means pertaining to s.e.xual intercourse: venereal excess--excess in s.e.xual intercourse; venereal disease--a disease acquired from s.e.xual intercourse with an infected person. The word is derived from Venus (genitive--veneris), the Roman G.o.ddess of spring, flowers and Love.

There are three venereal diseases: gonorrhea, syphilis and chancroid.

Of these, gonorrhea is the most widespread, syphilis the most serious.

Chancroid is of comparatively little importance.

While by far the greatest amount of venereal diseases--probably ninety per cent, of the total--is contracted from illicit[7] intercourse, it is well to bear in mind that some of it is contracted innocently, either from a kiss, or from using a sponge or a towel which has been used by an infected person, etc. While the gonorrheal germ is generally transmitted directly, the syphilitic poison may be transmitted through various objects. Syphilis contracted not during intercourse, but in an innocent manner, from a kiss, a towel, a toothbrush, a razor, etc., is called syphilis of the innocent, or syphilis insontium. In former years doctors would not very rarely contract syphilis from examining syphilitic women with their bare fingers. Now since gloves have come into use for examining purposes, the number of infections has considerably diminished. And no doubt that as the people become more familiar with the danger of venereal infection from non-venereal sources, the number of innocent infections will greatly diminish. The dangerous roller towel and the no less dangerous common drinking cup are being gradually eliminated as factors of _non-venereal_ infection; and we may confidently expect that in a decade or two the amount of venereal disease from _venereal_ infection will be greatly lessened in all civilized countries. The general increase in cleanliness in all strata of society and the universal use of antiseptics after suspicious s.e.xual relations will const.i.tute the chief factors in this diminution of venereal disease.

FOOTNOTES:

[7] Illicit--illegal, non-permissible, outside of marriage.

CHAPTER TWENTY-TWO

THE EXTENT OF VENEREAL DISEASE

Former Ban on Discussion of Venereal Disease and Its Evil Results--Present Reprehensible Exaggerations of Extent of Venereal Disease--Erroneous and Ridiculous Statements of "Reformers"--Senseless Fear of Marriage in Girls Due to Lurid Exaggerations--Study by Woman Psychologist Reveals Harmful Results of Exaggerated Statements--Truth in Regard to Percentage of Men Afflicted with Venereal Disease.

=Former Silence.= Only a very few years ago respectable women, by which I mean all women outside of the women called "fallen," did not know of the existence of venereal disease. It was considered a prohibited, disgraceful subject, not to be mentioned or even hinted at in conversation, in books or magazines, in lectures, or on the stage.

When I say that they did not know of the _existence_ of such a thing as venereal disease, that the very words gonorrhea and syphilis were unknown to them, I use these expressions not as figures of speech, but in their literal meaning. All avenues of acquiring such knowledge being closed to them--lay people don't usually now and they surely didn't then purchase and read strictly medical works--where could they obtain the information? The result was that when a woman was so unfortunate as to contract a venereal disease from her husband, she did not understand its character and did not suspect its source. Which was a rather good thing--for the husband. Family peace was more secure.

=Present Exaggerations.= Now a change has taken place in this respect, and, as is often the case with recent changes, the pendulum has swung to the other extreme. The silence of former days has given place to shouting from the housetops. The last phrase is also used almost in its literal sense. Many men and women, deeply stirred by the venereal peril, and sincerely anxious to guard boys and girls from venereal infection, have been indulging in very reprehensible exaggerations.

Particularly lurid have been the exaggerations as to the prevalence of the disease in the male s.e.x, 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 prost.i.tutes 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 prost.i.tute, without exception, was diseased at one time or another. If venereal disease exists among prost.i.tutes 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 s.e.x, 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 prost.i.tution 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 _s.e.x antagonism_ (italics mine), directly traceable to this knowledge. Eleven of the girls interviewed developed a p.r.o.nounced repulsion for men, although prior to their 'knowledge'

they had enjoyed men's company. They now avoid a.s.sociation 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 s.e.xes, 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, un.o.btainable anywhere; but results obtained from unbiased investigations of _different_ cla.s.ses 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 cla.s.ses, but because the cheap cla.s.s of prost.i.tutes that they are obliged to patronize are frequently diseased and because they cannot afford expert treatment, or any treatment at all. Among these cla.s.ses 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 cla.s.ses of men in whom gonorrhea exists only to the extent of five or ten per cent., and we have large cla.s.ses of wives among whom the victims of gonorrhea will come up only to a fraction of one per cent.