The above figures, you see, differ materially from the statements found in so many s.e.x 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 s.e.x 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 Princ.i.p.al Seats of Disease--Symptoms in Men and in Women--v.a.g.i.n.a Seldom Attacked in Adults--n.o.body 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--Formulae for Injections.

The subject of gonorrhea and syphilis is treated pretty fully, from a layman's point of view, in the author's _s.e.x Knowledge for Men_. I do not intend to devote much s.p.a.ce 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 _s.e.x 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_.

[Ill.u.s.tration: 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 princ.i.p.al 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 v.u.l.v.a. The v.a.g.i.n.a is seldom attacked in adult women, because the mucous membrane of the adult v.a.g.i.n.a 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 princ.i.p.ally or exclusively from the neck of the womb. In little girls, however, in whom the lining of the v.a.g.i.n.a is tender, gonorrhea of the v.a.g.i.n.a and the v.u.l.v.a 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. n.o.body 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 ca.n.a.l gets into the child's eyes while it pa.s.ses through the uterus and v.a.g.i.n.a. This is not heredity; this is simple infection, and can be avoided by keeping the mother's birth ca.n.a.l clean by antiseptic douches before childbirth. In short, I repeat gonorrhea is essentially a local and not a const.i.tutional disease, and is not hereditary. In which two respects it differs from syphilis, which is the most const.i.tutional 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 ca.n.a.l from the v.a.g.i.n.a, 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 s.e.xual 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 s.e.xual Maturity--Vulvovaginitis a Cause of Permanent Sterility--Measures to Prevent the Disease--Toilet Seats and Vulvovaginitis.

The mucous membrane, or the lining of the v.u.l.v.a and v.a.g.i.n.a, in little girls is very tender, and therefore very readily subject to infection.

An infection of the v.u.l.v.a and v.a.g.i.n.a 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 inst.i.tutions 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 princ.i.p.al symptom in little girls thus afflicted--the discharge. This discharge may be very profuse, covering the v.u.l.v.a, v.a.g.i.n.a, 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 v.u.l.v.a and a.n.u.s, 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 Sequelae 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 v.a.g.i.n.al 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 s.e.xual 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 s.e.xually mature considerably earlier than normal girls of the same cla.s.s, stratum and climate, and their demand for s.e.xual 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 circ.u.mstances 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 a.s.sociating or playing with adults or other children who are known to have gonorrheal infection goes without saying. The child's genitals should be frequently inspected by the mother, and scrupulous cleanliness by frequent bathing, sponging with warm solutions and powdering, should be maintained. The toilet seats in school should receive special attention. The wooden seat is a menace because it often harbors gonorrheal pus from either the female or male genitals, while the only proper seat is one of the so-called U-shaped style, that is, one in which the front is entirely open, like the letter U.

CHAPTER TWENTY-FIVE

SYPHILIS

Syphilis Due to Germ--Syphilis a Const.i.tutional Disease--Primary Lesion--Incubation Period--Roseola--Primary Stage--Secondary Stage--Mucous Patches--Tertiary Stage--Gumma--Hereditary Nature of Syphilis--Milder Course in Women Than in Men--Obscure Symptoms in Syphilis--Necessity for Examination by Physician--Locomotor Ataxia--Softening of the Brain--Chancroids.

Syphilis is a disease caused by a germ called spirocheta; the full name is spirocheta pallida--a pale, spiral-shaped germ. Though the disease has been ravaging Europe and America for centuries, the germ of it has been discovered only a few years ago, namely, in 1905, and, like the gonococcus, also by a German scientist, Fritz Schaudinn.

Syphilis is a const.i.tutional disease. In ten days to three weeks after a person has contracted syphilis, he (or she) develops a sore (at the spot where the germs got in). This sore is called _chancre_ or _primary lesion_. But when this sore makes its appearance the spirochetae and the poison which they elaborate are already circulating in the blood, all over the system. The disease is already systemic, or const.i.tutional, and the chancre is the local expression of a const.i.tutional disease. Cutting out the chancre will not cure the disease, because, as stated, the germs are already in the system. The time between the contraction of the disease (the infectious intercourse) and the appearance of the chancre is called the _Incubation Period_. The time between the appearance of the chancre and the appearance of the rash on the body (the rash looks like a measles rash and is called roseola, which means a rose-colored rash) is called the _Primary Stage_. It lasts about six weeks. With the appearance of the rash commences the _Secondary Stage_. This stage is characterized by all sorts of _eruptions_, mild and severe, by white little patches (called mucous patches) in the throat, mouth, tonsils, v.a.g.i.n.a, by falling out of the hair, etc. The length of this secondary stage depends a good deal upon the sort of treatment the patient gets.

Improperly treated, or not treated at all, it may last two or three years or more. Properly treated, it may be cut short at once, in a few days, so that the patient may never again in his or her life get an eruption. The third or _Tertiary Stage_ is characterized by _ulcerations_ in various parts of the body and by _swellings_ or tumors. The name of a syphilitic swelling or tumor is gumma (plural, gummata). The tertiary stage is the most terrible stage and it used to be the terror of syphilitic patients. But at the present time, under our modern methods of treatment, patients, if properly treated, _never have a tertiary stage_. We have seen many patients who considered syphilis a trifling disease, because all they knew of their disease was the chancre and the first eruption, i.e., the roseola, and perhaps a slight falling out of the hair. They then put themselves under energetic treatment, the _activity_ of the disease was checked, and they never had another symptom afterwards, though a Wa.s.sermann test showed that the disease was not entirely eradicated. It was merely held in check--which is the second best thing.

[Ill.u.s.tration: SPIROCHETA PALLIDA, OR TREPONEMA PALLIDUM, THE GERM OF SYPHILIS AS SEEN UNDER THE MICROSCOPE.]

As stated before, syphilis is the most hereditary of all diseases.

Fortunately, if the disease is still very active in the parents, particularly in the mother, the child is generally aborted. Some syphilitic mothers will have half a dozen or more miscarriages in succession. When the disease has become "attenuated," either by treatment or by itself--many diseases lose their virulence in time--the child may be carried to term. It then may be born dead, or it may be born strongly syphilitic, and die in a few days or weeks, or it may be born without any signs of syphilis and be apparently healthy and then develop the disease at the age of ten, twelve, fourteen, or later, or it may be born healthy and remain healthy. But no woman who had syphilis, or whose husband had syphilis, should _dare_ to conceive or to give birth to a child unless she has been given permission by a competent physician. I mean just what I say. It is not a personal matter. A woman has a right to marry a syphilitic husband if she wants to and run the risk of contracting syphilis. Her body is her own, and if she does it with her eyes open it is her affair. But a woman has no right to bring into the world syphilitic or syphilitically tainted children. Here society has a right to interfere.

Syphilis runs a milder course in women than it does in men. But this milder course is not an unmixed blessing; it may be considered a misfortune, because, the same as gonorrhea in women, syphilis is often present for months and years until it has made such inroads that it is but little amenable to treatment. In many women the disease runs such a mild course, as far as definite symptoms are concerned, that they are sure they never had anything the matter with them, and they are perfectly sincere in their denial of ever having had any infection. Often it is only when they complain of obscure symptoms, for which we can find no explanation, and then take a Wa.s.sermann test, that we discover what the real trouble is. And then the internal organs are sometimes found so deeply affected that it is hard to do anything. So it is seen that the mildness of the course of the disease, while a good thing in itself, is bad in that respect that it prevents timely treatment. It is therefore important that whenever a woman is in any way suspicious that she may have the disease that she have herself examined; and if she has reasons to suspect that her husband or partner has the disease, she should persuade him to have himself examined.

Locomotor ataxia, one of the most terrible sequelae of syphilis, is much more rare in women than it is in men. So is general paresis, also called general paralysis of the insane, or softening of the brain.

=Chancroids=

There is one other minor disease belonging to the venereal diseases; that is chancroids. Chancroids are little ulcers on the genitals; they are purely local and do not affect the system. They are due largely to uncleanliness, and are found only among the poorer cla.s.ses of prost.i.tutes and therefore among the poorer cla.s.ses of men. One sees them now and then in public dispensaries, but in private practice they are now quite rare. They used to be quite common, which shows that the general level of cleanliness has been raised considerably among all cla.s.ses of people. At any rate, chancroids are of little significance, as compared with syphilis and gonorrhea, and when speaking of the venereal peril, these are the two diseases we have in mind.

CHAPTER TWENTY-SIX

THE CURABILITY OF VENEREAL DISEASE

Gonorrhea May Be Practically Cured in Every Case in Man--Extensive Gonorrheal Infection in Woman Difficult to Cure--Positive Cure in Syphilis Impossible to Guarantee.

Just as the usual statements in regard to the extent of venereal disease have been found untrue or greatly exaggerated, so do the statements regarding the curability or rather incurability of venereal disease need careful revision. The picture usually painted of the hopelessness of gonorrhea and syphilis is too sombre, too black, and, contrary to the a.s.sertions made by laymen and laywomen and physicians who do not specialize in the treatment of venereal disease, I wish to make the statement that every case of gonorrhea in man, without any exception, if properly treated, can be perfectly cured, _as far as practical purposes are concerned_. I add the last phrase because the cure may not be perfect in the scientific sense of the word; that is, the man may not be brought back into the condition in which he was before he got the disease. But, for all practical purposes, as far as he himself is concerned, as far as his wife is concerned, and as far as the future children are concerned, every case may be cured, without any doubt. And I say this, basing myself upon a varied professional experience extending over nearly a quarter of a century.

As to gonorrhea in women, that depends to a great extent upon the virulence of the disease and the promptness with which treatment is inst.i.tuted. If the gonorrhea is limited only to the cervix, the v.u.l.v.a and the urethra, then prompt treatment will usually bring about a cure in a comparatively short time. But if the gonorrheal inflammation has extended to the body of the uterus, or still worse, to the tubes, then the treatment may become a very tedious one, and some cases may not be curable without an operation.

With syphilis the matter is different. Since the introduction by Ehrlich of the various a.r.s.enic preparations, we have much better success in the treatment of syphilis, and we can positively render every case non-infectious to the partner. But, as to guaranteeing a positive cure, that is, guaranteeing that the patient will never have an outbreak or relapse of his disease in the future, and that the children will be perfectly free from any taint, this we can do no more now than we could before the modern treatment of syphilis was introduced. The decision, therefore, as to whether we may or may not permit a once syphilitic patient to marry will depend a great deal upon whether or no the husband or the wife or both desire to have children. If this is the case, we must often withhold our permission; but if the man and woman agree to get married and to get along without children, we will grant permission to the marriage in the vast majority of cases. The subject of venereal disease and marriage will be further discussed in separate chapters.

Venereal disease, I have to repeat, is terrible enough in itself, without any exaggeration, without picturing it in too black colors.

And it is necessary that people should not have too black an idea of it. It is necessary that they know that there are thousands and tens of thousands of patients who suffered with gonorrhea or syphilis and who were perfectly cured, who married, and whose wives remained perfectly well, and who gave birth to perfectly healthy untainted children.