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 assertions 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 practicalpurposes, 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 instituted. If the gonorrhea is limited only to the cervix, the vulva 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 arsenic 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 moderntreatment 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.
Necessity for Douching Before and After Suspicious Intercourse—Formulæ for Douches—Precautions Against Non-venereal Sources of Infection—Syphilis Transmitted by Dentist's Instruments—Manicurists and Syphilis—Promiscuous Kissing a Source of Syphilitic Infection.
Necessity for Douching Before and After Suspicious Intercourse—Formulæ for Douches—Precautions Against Non-venereal Sources of Infection—Syphilis Transmitted by Dentist's Instruments—Manicurists and Syphilis—Promiscuous Kissing a Source of Syphilitic Infection.
In his book,Sex Knowledge for Men, the author treated the subject of prevention of venereal disease very thoroughly. Men need this knowledge. As menwillindulge in illicit relations, we must teach them to guard themselves against venereal infection. We must do it not only for their own sake, but for the sake of their wives and children. For, infection in the man may mean infection in his wife and children. But as women readers of this book are not likely to indulge in promiscuous relations with strangers, a detailed discussion of the subject would be out of place.
I will merely say, that where the woman has a suspicion that her husband is in an infectious state, she should abstain from relations with him until she is sure that he is safe. But where for some reasona suspicions intercourse is indulged in, the woman should use an antiseptic douchebeforeandafterintercourse. Where it is inconvenient to use a douche both before and after, a douche after will have to suffice, but it is much safer and surer to use the douche both before and after. When you use a douche there is always some of the solution left in the vagina and that destroys wholly or in part the infective germs. The following makes an effective douche: Dissolve a tablet of bichloride (they come on the market of the weight of about 7½ grains) in two quarts of water—hot, lukewarm or cold. Use before intercourse a small amount—about a pint or half a pint, and use the balance after intercourse. Instead of the bichloride you may use a tablespoonful of carbolic acid, or two tablets of chinosol, or a tablespoonful of lysol, or two tablespoonfuls of boric acid.
Instead of the douche an antiseptic jelly in a collapsible tin tube with a long nozzle may be used.
But besides the venereal sources of infection the woman must guard against the non-venereal sources. Do not ever, if you can avoid it, use a public toilet. If you are forced to use it, protect yourself by putting some paper over the seat.
Do not use a public drinking cup. If you have to use one, keep your lips away from the rim. Onecan learn to drink without touching the rim of the glass or cup with the lips.
Do not under any circumstances use a public towel. The roller towel is a menace to health and should be forbidden in every part of the country.
If you have to sleep in a hotel or in a strange bed, make sure that the linen is clean and fresh. Never sleep on bed linen which has been used by a stranger.
Never use a public brush or comb.
Be sure that your dentist is a careful, up-to-date man, and sterilizes his instruments carefully. Many a case of syphilis has been transmitted by a dentist's instrument. A syphilitic who goes to a dentist to be treated generally conceals his disease, and if the dentist is not in the habit of sterilizing his instruments after each patient, disaster may result.
Be sure that your manicurist is not syphilitic, or at least that her hands are healthy, clean and free from any eruption.
And, last but not least, do not indulge in promiscuous kissing. This is a particularly important injunction for young girls. This is a real peril and there are thousands of cases of syphilis that are known to have been contracted directly from kissing. People suffering with syphilis often have little white sores (mucous patches) on their lips, tongue andinside of cheeks. These sores are very infectious, and by kissing the disease is readily transmitted. Kissing games have been responsible in more than one case for the spread of syphilis to many persons. I have now under treatment a girl of nineteen who contracted syphilis on her summer vacation from having kissed a man once. Avoid promiscuous kissing! It is a bad practice for more than one reason.
Alcoholic Indulgence and Venereal Disease—A Champagne Dinner and Syphilis—Percentage of Cases of Venereal Infection Due to Alcohol—Artificial Stimulation of Sex Instinct in Man and in Woman—Reckless Sexual Indulgence Due to Alcohol—Alcohol as an Aid to Seduction.
Alcoholic Indulgence and Venereal Disease—A Champagne Dinner and Syphilis—Percentage of Cases of Venereal Infection Due to Alcohol—Artificial Stimulation of Sex Instinct in Man and in Woman—Reckless Sexual Indulgence Due to Alcohol—Alcohol as an Aid to Seduction.
That Bacchus, the god of wine, is the strongest ally of Venus, the goddess of love, using love in its physical sense, as the French use the wordamour, has been well known to the ancient Greeks and Romans, as it is well known to-day to every saloon-keeper and every keeper of a disreputable house. And all measures to combat venereal disease and to prevent girls from making a false step will be only partially successful if we do not at the same time carry on a strong educational campaign against alcoholic indulgence. Of what use to young men is the knowledge of the venereal peril and familiarity with the use of venereal prophylactics, when under the influence of alcohol the mind is befuddled, they forget everything and do things that they never would do in the sober state? Of what use arewarnings to a girl, when under the influence of a heavy dinner and a bottle of champagne, to which she is unaccustomed, her passion is aroused to a degree she has never experienced before, her will is paralyzed and she yields, though deep down in her consciousness something tells her she shouldn't? Yields, becomes pregnant, and is in the deepest agony for several months, and has a wound which will probably never heal for the rest of her life? Of what use have all the lectures, books and maternal injunctions been to her?
Or this case. Here is a young lawyer, twenty-eight years of age, engaged to a fine girl, and with everything to look forward to. He always was very moderate and circumspect in his sexual indulgence, and, though careful in choosing his partners, he never failed to use a venereal prophylactic after intercourse. There was too much at stake for him, and he did not care to take any chances, even if the chances were one in a thousand. For a period of one year during which he had been engaged he abstained from sexual intercourse altogether, though it cost him a great deal of effort to do so. He was to be married very shortly. But ill-luck made him accept an invitation to a bachelor dinner, where champagne and smutty stories were flowing freely, too freely. He left about midnight, and as the night wasbeautiful he decided to walk home. He met a siren, who invited him to accompany her. Under other circumstances he would have sent her on her way, or at least he would have stepped into a drugstore for a prophylactic. But, excited by the wine, the smutty stories and the year's abstinence, he went along like a sheep, as a matter of course, without trying to reason or interposing any objections. He remembers distinctly his feelings and the state of his mind. He was not drunk, only exhilarated, but nevertheless the whole thing seemed to him so normal, so natural, so expected, so matter-of-course, that he couldn't think of acting otherwise than accept her invitation. And he stayed two or three hours; and he used no prophylactic. And as a result—three weeks later he had a typical primary syphilitic lesion. How he felt and what it all meant to him the reader can imagine. This is far from being an isolated, an exceptional case.
From my own practice I could cite a number of cases of venereal infection in which alcohol was the direct, primary factor. How many such cases there are altogether in the period of a year nobody can say, but that they constitute a considerable percentage of the total venereal morbidity every investigating sexologist will testify. Forel claims that 76 per cent. of all venereal infection takes placeunder the influence of alcohol; Notthaft is more moderate, more discriminating in his statistics and his claims are—30 per cent. An analysis of 1,000 cases of venereal infection, just published by Dr. Hugo Hecht (Venerische Infektion und Alkohol, Z.B.G., Vol. XVI, No. 11) gives over 40 per cent. And the saddest part of it is that among the infected were 75 married men (the author thinks there were more, but only 75 confessed to being married), and of these, 45, equivalent to 60 per cent., were under the influence of alcohol when they contracted their venereal disease (extra-matrimonially, of course).
Alcoholic indulgence contributes to the spread of venereal disease directly and indirectly. First and foremost it increases enormously the amount of intercourse indulged in. I certainly do not belong to those who believe that the sex instinct is merely a vicious appetite, like the appetite for alcohol or drugs, which can easily and completely be suppressed by the exertion of will-power. I believe that the sex instinct can be suppressed only within reasonable limits; if an attempt is made to exceed these limits dire results are apt to follow. But I also believe that the sex instinct can be stimulated artificially beyond the natural needs, and among the artificial stimulants of the sex instinct alcohol occupies first place. And bear in mind that alcohol produceseven a stronger effect on women, in exciting the sexual passion, than it does on men. Women are more easily upset by stimulants and narcotics, and that is the reason why it is more dangerous for women to drink than it is for men.
So this, then, is count number one: The man and the woman who in a sober condition would easily abstain, with their libido stimulated and their will-power paralyzed by alcohol, indulge unnecessarily, with the risk of venereal infection to the man and the double risk of venereal infection and pregnancy to the woman. Count two: The man who in the sober condition would use care and discrimination, under the influence of alcohol soon loses all his judgment and sees an angel and a Helen of Troy in the worst and most impudent harlot; with the result that the chances of venereal infection are greatly increased. Count three: Where under ordinary circumstances the man would stay a few minutes to half an hour, under the influence of alcohol he stays several hours, or all night, thus increasing his chances of infection a hundredfold. Count four: Alcohol increases the congestion in the genital organs of both man and woman and renders them much moresusceptibleto infection. All other factors being equal, a connection which will under strict sobriety remain without bad results, may when oneor both partners are under the influence of alcohol be followed by infection. Count five: The man who is in the habit of using venereal prophylactics under the influence of alcohol becomes both careless and reckless; he looks with contempt at preventive measures and the result is—venereal disease.
It is impossible to give statistics and exact or even approximate figures. But there is no question in my mind, in the mind of any careful investigator, that if alcoholic beverages could be eliminated, the number of cases of venereal infection would be diminished by about one-half. And what is true of venereal disease is also true of seduction of young girls. Alcohol is the most efficient weapon that either the refined Don Juan or the vulgar pimp has in his possession.
You cannot hope for complete success in eliminating venereal disease and seduction unless you also eliminate alcoholism. For Bacchus is the ally not only of Venus Aphrodite but also of Venus vulgivaga.
Decision of Physician Regarding Marriage of Patients Infected with Gonorrhea or Syphilis—Advisability of Certificate of Freedom from Transmissible Disease—Premarital Examination as a Universal Custom—When a Man Who Had Gonorrhea May Be Allowed to Marry—When a Woman Who Had Gonorrhea May be Allowed to Marry—Antisepsis Before Coitus—Question of Sterility in the Man Who Has Had Gonorrhea Easily Answered—Impossibility of Determining Whether the Woman is Fertile or Not.
Decision of Physician Regarding Marriage of Patients Infected with Gonorrhea or Syphilis—Advisability of Certificate of Freedom from Transmissible Disease—Premarital Examination as a Universal Custom—When a Man Who Had Gonorrhea May Be Allowed to Marry—When a Woman Who Had Gonorrhea May be Allowed to Marry—Antisepsis Before Coitus—Question of Sterility in the Man Who Has Had Gonorrhea Easily Answered—Impossibility of Determining Whether the Woman is Fertile or Not.
For a man or a woman who has once suffered from gonorrhea or syphilis to enter matrimony without having secured a competent physician's opinion is a great responsibility. And a great responsibility rests upon the shoulders of the physician who is called upon to give such an opinion. For, a wrong decision—a wrong decision either way—that is, permission to marry when permission should not have been granted or refusal to give permission when permission should have been granted—may be responsible for much future unhappiness and much disease: disease of the mother and of the offspring. It may even be responsible for death.
There is no easy, short road to a positive opinion.It requires a thorough, painstaking examination at the hands of an experienced physician, one thoroughly familiar with all the modern tests, to tell whether it is safe for a man who once suffered from venereal disease to enter the bonds of matrimony. Sometimes one examination is not sufficient, and several examinations may be necessary; but, the opinion of a conscientious, experienced physician may be relied upon, and, if all men and women who once suffered from venereal disease would seek for, and be guided by, such an opinion, there would be no cases of marital infection, there would be no children afflicted with gonorrheal ophthalmia, there would be no cases of hereditary syphilis.
I firmly believe that a time will come when all venereal disease will have disappeared from the face of the earth. But, until that time comes, it would be for the benefit of the race and of posterity if people had to present a certificate of freedom from transmissible venereal disease as a prerequisite to a marriage license. Custom is often more efficient than law, and, if a premarital examination should become a universal custom (and there are indications in this direction), no law would be needed.
When May a Man Who Had Gonorrhea Get Married?For a man who once suffered from gonorrheato be pronounced cured and a safe candidate for marriage, the following conditions must be present:
1. There must be no discharge.
2. The urine must be perfectly clear and free from shreds.
3. The secretion from the prostate gland, as obtained by prostatic massage, and from the seminal vesicles, as obtained by "milking," or "stripping," the vesicles, must be free from pus and gonococci. To make sure, it is best to repeat such examination at three different times.
4. There must be neither stricture nor patches in the urethra.
5. What we call the complement-fixation test, which is a blood test for gonorrhea similar to the Wassermann blood-test for syphilis, must be negative.
Referring to conditions 1 and 2, it sometimes happens that the patient has a minute amount of discharge or a few shreds in the urine, and I still permit him to marry; but this is done only after the discharge and shreds have been repeatedly examined and have been found to be catarrhal in character and absolutely free from any gonococci or other germs.
It sometimes happens that a patient comes to me for an examination a few days before the date setfor the wedding. I examine him and find that he is not in a safe condition to marry, and so advise him to delay the wedding. Sometimes he follows the advice, but in some cases he is unable to do so. He claims the wedding has been arranged, the invitation-cards have been sent out, and to delay the wedding would lead to endless trouble and perhaps scandal. In such cases I, of course, assume no responsibility; however, I do advise the man to use an antiseptic suppository or some other method that will protect the bride from infection for the time being, while he, the husband, has an opportunity to take treatment until cured. Of the many cases in which I advised this method, I do not know of one in which infection has taken place.
When May a Woman Who Once Had Gonorrhea Be Permitted to Marry?In the case of a woman, the decision may be harder to reach than in that of a man. Of course, the urine must be clear and the urethra must be normal; however, we cannot insist that there must be no discharge. This, because practically every woman has some slight discharge; even, if not all the time, then at least immediately prior and subsequent to menstruation. Of course, the discharge must be free from gonococci and pus. Also the complement-fixation tests must be negative. But, even so, we cannot be absolutely sure, becausegonococci may be hidden in the uterus or in the Fallopian tubes.
Here, we have to go a good deal by the history given us. If the woman, during the course of the gonorrhea, had salpingitis, that is, an inflammation of the Fallopian tubes, then we can never say positively that she is cured; all we can say, at best, is: presumably cured. And, further, if she has no pains in the uterine appendages, either spontaneous or on examination, and, if several examinations made within a day or two following menstruation are negative, then we may assume that she is cured. It is important, though, that this examination be made on the last day of menstruation or on the first or second day following; for there are many cases in which no pus and no gonococci will show in the inter-menstrual period, but will appear on those particular days, because, if the gonococci are hidden high up, they are likely to come down with the menstrual blood and portions of mucous membrane that are shed during menstruation.
At best, it is a delicate problem, so that whenever there has been the least suspicion that the woman may harbor gonococci I have always advised (as is my custom, to be on the safe side) and directed the woman to use either an antiseptic suppository or an antiseptic douche before coitus. With theseprecautions adopted, I have never had an accident happen.
The Question of Probable Sterility.Thus far I have considered the problem of marriage from the standpoint of infectivity. But, we know that, besides the effect on the individual, gonorrhea has also a far-reaching influence on the race; in other words, that it is prone to make the subjects—both men and women—sterile. And a candidate for marriage may, and often does, want to know whether, besides being noninfective, he or she is capable of begetting or having children.
In the case of man, the problem is, fortunately, a very simple one. We can easily obtain a specimen of the man's semen and determine, by means of the microscope, whether it contains spermatozoa or not. If it does contain a normal number of lively, rapidly moving spermatozoa, the man is fertile, regardless of whether he ever had epididymitis or not. If the semen contains no spermatozoa, or only a few deformed or lazily moving ones, then he is sterile.
In the case of woman, it isabsolutelyimpossible to determine whether the gonorrhea has made her sterile or not; because there is no way of expressing an ovum from the ovary. The woman may not have had any pain or inflammation in the Fallopian tubes,and yet there may have been sufficient inflammation to close up the orifices of the tubes. On the other hand, she may have had a severe salpingitis onboth sides and still be fertile. Nor is there any way of telling whether the ovaries were so involved in the process as to become incapable of generating healthy ova, or any ova at all. In short, there is absolutely no way of telling whether a woman is sterile or fertile—we can only surmise. And our surmise in this respect is liable to be wrong just as often as right. The only way the question can be decided is by experience. If the prospective husband is willing to take a chance, well and good.
While just as many girls marry as do young men, still, in practice, we always shall have to examine an incomparably larger number of male than of female candidates. This is due, not only to the fact that an incomparably larger number of men suffer from venereal disease, but also because very few women will confess to their fiancés that they ever entertained antematrimonial relations and—what is still worse—were infected with venereal disease. This, of course, is owing to our double standard of morality, which looks upon as a trivial or no offense in the man what it condemns as a heinous crime in the woman. I have known hundreds of men who confessed freely to their fiancées that they had hadgonorrhea, but I have known only two girls who made a confession of the fact to their future husbands. They got married, however, and lived happily with their husbands ever after.
Rules for Permitting a Syphilitic Patient to Marry—Rules More Severe in Cases Where Children Are Desired—Where Both Partners Are Syphilitic—Danger of Paresis in Some Syphilitic Patients—A Case in the Author's Practice.
Rules for Permitting a Syphilitic Patient to Marry—Rules More Severe in Cases Where Children Are Desired—Where Both Partners Are Syphilitic—Danger of Paresis in Some Syphilitic Patients—A Case in the Author's Practice.
The problem of the syphilitic differs from the problem of the exgonorrheal patient. When a gonorrheal patient is cured, so far as infectivity is concerned, and is not sterile, there is no apprehension as to the offspring. Gonorrhea is not hereditary, and the child of a gonorrheal patient does not differ from the child of a nongonorrheal person. In the case of syphilis, it is different. The patient may be safe so far as infecting the partner is concerned, but yet there may be danger for the offspring.
The rules for permitting a man or a woman who once had syphilis to marry, therefore, are different from those applied to the gonorrheal patient. Here are the rules:
1. I would make it an invariable rule that no syphilitic patient should marry or should be permitted to marry beforefiveyears have elapsed from theday of infection. But the period of time alone is not sufficient; other conditions must be met before we may give a syphilitic patient permission to marry.
2. The man or the woman must have received thorough systematic treatment for at least three years, either constantly or off and on, according to the physician's judgment.
3. For at least one year before the intended marriage, the person must have been absolutely free from any manifestations of syphilis; that is, from any eruptions on the skin, from any mucous patches, swelling in the bones, ulcerations, and so on.
4. Four Wassermann tests, taken at intervals of three months and at a timewhen the patient was receiving no specific treatment, must be absolutely negative.
If these four conditions are fully met, then the patient may be permitted to marry.
It is important, however, to state that, in permitting or refusing syphilitic persons to marry, we are guided to a great extent by the fact as to whether theyexpect to have children soon or not.
In the case of a couple who are anxious to have children soon after their marriage, the conditions for our permission must be more severe than when the couple are willing or anxious to use contraceptive measures for the first years of their marriedlife. For, if a man is free from any skin lesions and from any mucous patches, his wife is safe from infectionas long as she does not become pregnant. But, if she does get pregnant, she may become infected through the fetus; and, of course, the child also is liable to be syphilitic. Hence, much stricter requirements for syphilitics who expect to become parents are necessary than for those who do not.
In case both the man and the woman are or have been syphilitic, permission to marry may be granted without hesitation, as the danger of infection is absent, but permission to have children must be refusedabsolutelyandunequivocally. Regardless of the time that may have elapsed from the period of infection, regardless of treatment, regardless of Wassermann tests, the danger to the child is too great if both parents have the syphilitic taint in them. A healthy childmaybe born from two syphilitic parents who have undergone energetic treatment, but we have no right to take the chance. I, at least, never wanted to, nor ever will want to, take such a responsibility.
The Danger of Locomotor Ataxia or Paresis.There is still one more point to consider in dealing with a syphilitic patient. In patients who did not receive energetic treatment from the very beginning of the disease as also in patients whose treatmentwas only desultory and irregular, we never can guarantee, in spite of lack of external symptoms, in spite of a negative Wassermann reaction, that some trouble may not develop later in life.
What shall we do in such cases and what particularly shall we do if, from a general examination of the patient, we carry away the impression that, while free from the danger of infection, the man is not a good risk? Under these circumstances, we must refuse all personal responsibility, leaving the assumption of the responsibility to the prospective wife.
Here is a case in point. About five years ago a man came to me for examination; he came with his fiancée. He had contracted syphilis ten years previously, received irregular treatment by mouth, off and on. For five years, he had had no symptoms of any kind. Heconsideredhimself cured, but wanted to know, and his fiancée wanted to know, whether he really was cured. There were no symptoms of any kind and the Wassermann test was negative. Nevertheless, I could not give him a clean bill of health. I noticed what seemed to me a slowness in thinking and just the least bit of hesitation in his speech.
I told the girl (the man was thirty-five, she was thirty-two) that I could not render a definite decision in the matter, that everything might be all right,and then again it might not; but, that the question about children she would have to decide definitely, once for all, namely, that she was not to have any children. She was fully satisfied so far as that part was concerned; she said she herself objected to children and did not intend to have any and knew how to take care of herself. All she wanted to know was, whether she was in danger of being infected. I told her no, but that in my opinion there was some danger of her husband developing general paresis or locomotor ataxia.
The girl had been a teacher for about twelve years, and she was so sick at heart of the work, was so anxious for a home of her own, that she decided to take the risk. And they got married. The marriage remained childless. The man developed general paresis (softening of the brain) three years later and died about a year afterward. The woman, now a widow, I understand, is not sorry for the step she had taken. This shows what things our social-economic conditions and our moral code are responsible for.
The Physician Often Consulted as to Advisability of Marriage—Venereal Diseasethe Most Common Question—Tuberculosis—Sexual Appetite of Tubercular Patients—Effect of Pregnancy Contraceptive Knowledge for Tubercular Wife—Heart Disease—Serious Bar to Marriage—Influence of Sexual Intercourse—Cancer—Fear of Hereditary Transmission—Exophthalmic Goiter—Most Frequent in Women—Simple Goiter—Exceptions to Rule—Obesity—Family History—Obesity and Stoutness Not Synonymous—Arteriosclerosis—Danger in Sexual Act—Gout—Real Causes of Gout—Mumps—Parotid Glands and Sex Organs—Mumps and Sterility—Oöphoritis Due to Mumps—Hemophilia—Hemophilic Sons May Marry—Hemophilic Daughters May Not Marry—Anemia—Chlorosis—Epilepsy—Hysteria—Symptoms of Hysteria—Marriage of Hysterical Women—Alcoholism—Effect on Offspring—Alcoholics and Impotence—Feeblemindedness—Evil Effects on Offspring—Sterilization of Feebleminded Only Preventive—Insanity—Functional Insanity—Organic Insanity—Hereditary Transmissibility of Insanity—Fear Resulting in Insanity—Environment versus Heredity in Insanity—Neurosis—Neurasthenia—Psychasthenia—Neuropathy—Psychopathy—Nervous Conditions and Genius—Sexual Impotence and Genius—Drug Addiction—External Causes—Consanguineous Marriages—When Consanguineous Marriages are Advisable—Offspring of Consanguineous Marriages—Homosexuality—Homosexuals Often Ignorant of Their Condition—Sexual Repression and Homosexuality—Sadism and Divorce—Masochism—Sexual Impotence and Marriage—Effect Upon the Wife—Frigidity—Marital Relations and Frigid Woman—Excessive Libido and Marriage—Excessive Demands Upon Wife—Satyriasis—The Excessively Libidinous Wife—Nymphomania—Treatment—Harelip—Myopia—Astigmatism—Premature Baldness—Criminality—Crimeas Result of Environment—Legal and Moral Crime—Ancestral Criminality and Marriage—Rules of Heredity—Pauperism—Difference Between Pauperism and Poverty.
The Physician Often Consulted as to Advisability of Marriage—Venereal Diseasethe Most Common Question—Tuberculosis—Sexual Appetite of Tubercular Patients—Effect of Pregnancy Contraceptive Knowledge for Tubercular Wife—Heart Disease—Serious Bar to Marriage—Influence of Sexual Intercourse—Cancer—Fear of Hereditary Transmission—Exophthalmic Goiter—Most Frequent in Women—Simple Goiter—Exceptions to Rule—Obesity—Family History—Obesity and Stoutness Not Synonymous—Arteriosclerosis—Danger in Sexual Act—Gout—Real Causes of Gout—Mumps—Parotid Glands and Sex Organs—Mumps and Sterility—Oöphoritis Due to Mumps—Hemophilia—Hemophilic Sons May Marry—Hemophilic Daughters May Not Marry—Anemia—Chlorosis—Epilepsy—Hysteria—Symptoms of Hysteria—Marriage of Hysterical Women—Alcoholism—Effect on Offspring—Alcoholics and Impotence—Feeblemindedness—Evil Effects on Offspring—Sterilization of Feebleminded Only Preventive—Insanity—Functional Insanity—Organic Insanity—Hereditary Transmissibility of Insanity—Fear Resulting in Insanity—Environment versus Heredity in Insanity—Neurosis—Neurasthenia—Psychasthenia—Neuropathy—Psychopathy—Nervous Conditions and Genius—Sexual Impotence and Genius—Drug Addiction—External Causes—Consanguineous Marriages—When Consanguineous Marriages are Advisable—Offspring of Consanguineous Marriages—Homosexuality—Homosexuals Often Ignorant of Their Condition—Sexual Repression and Homosexuality—Sadism and Divorce—Masochism—Sexual Impotence and Marriage—Effect Upon the Wife—Frigidity—Marital Relations and Frigid Woman—Excessive Libido and Marriage—Excessive Demands Upon Wife—Satyriasis—The Excessively Libidinous Wife—Nymphomania—Treatment—Harelip—Myopia—Astigmatism—Premature Baldness—Criminality—Crimeas Result of Environment—Legal and Moral Crime—Ancestral Criminality and Marriage—Rules of Heredity—Pauperism—Difference Between Pauperism and Poverty.
In former years, nobody thought of asking a physician for permission to get married. He was not consulted in the matter at all. The parents would investigate the young man's social standing, his ability to make a living, his habits perhaps, whether he was a drinking man or not, but to ask the physician's expert advice—why, as said, nobody thought of it. And how much sorrow and unhappiness, how many tragedies the doctor could have averted, if he had been asked in time! Fortunately, in the last few years, a great change has taken place in this respect. It is now a very common occurrence for the intelligent layman and laywoman, imbued with a sense of responsibility for the welfare of their presumptive future offspring and actuated, perhaps, also by some fear of infection, to consult a physician as to the advisability of the marriage, leaving it to him to make the decision and they abiding by that decision.
As a matter of fact, as often is the case, the pendulum now is in danger of swinging to the other extreme; for, a little knowledge is a dangerous thing, and the tendency of the layman is to exaggerate matters and to take things in an absolute insteadof in a relative manner. As a result, many laymen and laywomen nowadays insist upon a thorough examination of their own person and the person of their future partner, when there is nothing the matter with either. Still, this is a minor evil, and it is better to be too careful than not careful enough.
I am frequently consulted as to the advisability or nonadvisability of a certain marriage taking place. I, therefore, thought it desirable to discuss in a separate chapter the various factors, physical and mental, personal and ancestral, likely to exert an influence upon the marital partner and on the expected offspring, and to state as briefly as possible and so far as our present state of knowledge permits which factors may be considered eugenic, or favorable to the offspring, and dysgenic, or unfavorable to the offspring.
The questions concerning the advisability of marriage which the layman as well as the physician have most often to deal with are questions concerning venereal disease. On account of the importance of the subject, these have been discussed rather in detail under the headings "Gonorrhea and Marriage" and "Syphilis and Marriage." Other factors affecting marriage, either in the eugenic or dysgenic sense, will be discussed more briefly in thepresent chapter, and more or less in the order of their importance.
Tuberculosis, which carries off such a large part of humanity every year, is caused by the well-known bacillus tuberculosis, discovered by Koch. The germ is generally inhaled through the respiratory tract, and most frequently settles in the lungs, giving rise to what is known as pulmonary consumption. However, many other organs and tissues may be affected by tuberculosis.
Tuberculosis used to be considered the hereditary diseasepar excellence. Entire families were carried off by it, and, seeing a tuberculous father or mother and then tuberculous children, it was assumed that the infection had been transmitted to the children by heredity. As a matter of fact, the disease was spread by infection. In former years, little care was exercised about destroying the sputum; the patients would spit indiscriminately on the floor, and the sputum, drying up, would be mixed with the dust and inhaled. Often the children crawling on the floor would introduce the infective material directly, by putting their little fingers in their mouths.
It is now known that tuberculosis is not a hereditary disease, that is, that the germs are nottransmitted by heredity.The weak constitution, however, which favors the development of tuberculosis, is inherited. And children of tuberculous parents, therefore, must not only be guarded against infection, but must be brought up with special care, so as to strengthen their resistance and overcome the weakened constitution which they inherited.
That a person with an active tuberculous lesion should not get married goes without saying. But, it is a good rule to follow for a tuberculous person not to marry for two or three years, until all tuberculous lesions have been declared healed by a competent physician. As a rule, a tuberculous patient is a poor provider, and that also counts in the advice against marriage. Then sexual intercourse has, as a rule, a strong influence on the development of the disease. Unfortunately the sexual appetite of tuberculous patients is not diminished, but, rather, very frequently heightened; and frequent sexual relations weaken them and hasten the progress of the disease.
As to pregnancy, that has an extremely pernicious effect on the course of tuberculosis, and no tuberculous woman should ever marry. If such a one does marry or if the disease develops after her getting married, means should be given her to prevent her from having children. During the pregnancy,the disease may not seem to be making any progress—occasionally the patient may even seem to improve—but after childbirth the disease makes very rapid strides and the patient may quickly succumb. In the early days of my practice I saw a number of such cases. If precautions are taken against pregnancy, then permission to indulge in sexual relations may be given, provided it is done rarely and moderately.
If a patient who has tuberculosis conceals the fact from the future partner, a fraud is committed, and the marriage is morally annullable. It has been declared legally annullable by a recent decision of a New York judge.
Heart disease also is no longer considered hereditary. Nevertheless, heart disease, if at all serious, is a contraindication to marriage. First, because the patient's life may be cut off at any time. Second, sexual intercourse is injurious for people having heart disease; it may aggravate the disease or even cause sudden death. It is more injurious even than it is in tuberculosis. Third—and this concerns the woman only—pregnancy has averydetrimental effect upon a diseased heart. A heart that, withproper care, might be able to do its work for years, often is suddenly snapped by the extra work put upon it by pregnancy and childbirth. Sometimes a woman with a diseased heart will keep up to the last minute of the delivery of the child and then suddenly will gasp and expire. In the first year of my practice I saw such a case, and I never have wanted to see another. Women suffering from heart disease of any serious character should not, under any circumstance, be permitted to become pregnant.
No man will knowingly marry a woman, and no woman will marry a man, afflicted with cancer. However, this question often comes up in cases where the matrimonial candidates are free from cancer, but where there has been cancer in the family.
Cancer is not a hereditary disease, contrary to the opinions that have prevailed, and, if the matrimonial candidate otherwise is healthy, no hesitation need be felt on the score of heredity. The fear of hereditary transmission of the disease has caused a great deal of mischief and unnecessary anxiety to people. Scientifically conducted investigations and carefully prepared statistics have shown that many diseases formerly considered hereditary are not hereditary in the least degree.
Should it, however, be shown that in one family there weremanymembers who died of cancer, it would indicate that there is some disease or dyscrasia in that family, and the contracting of a marriage with any member of that family would be inadvisable.