Chapter 2

[Footnote E: The devastation of these diseases among the British armies abroad (in the Rhine, Black Sea, and Palestine areas, etc.) has been much worse since the Armistice than during the war. Approximately one-fourth (sometimes one-half) of these armies become infected with venereal disease every year. From 1919 to 1921 somewhat soothing statistics were issued for the army of the Rhine, but these have now been admitted in Parliament to be "_quite unreliable_" (Parliamentary Debates, House of Commons, November 3rd, 1921, p. 1952). It must be remembered that, owing to the exchange value of the £, the English soldier on the Rhine is now being paid about £8 or £10 per day; that is, he draws a far higher salary than the highest paid German official; hence there is no riotous pleasure, however expensive and extravagant, which he cannot afford. These conditions do not promote manly virtue or even sexual cleanliness.--E.A.R]

The venereal diseases are passed on from one sex to the other in a continuous chain, but the chain can be broken at any time _by either sex_. And now it is the _married women_ on whom we must rely to see that these infections are stopped. Leaving women to the chance protection of their partners is demonstrably a failure. Here is an extract from a letter sent me recently by an old and experienced medical practitioner:--

"I have had many women under treatment _who have been continually re-infected by their husbands_."

Men and women must both seek knowledge and both accept responsibility for the venereal problem. They must face this problem independently and in co-operation, and above all--face it _honestly_. There is no other way.

It is all very well to say that the man is responsible. That is only a partial truth.[F] The woman is equally responsible as soon as she is equally well informed. A woman's body is her own, and she will never be really free until she knows how to look after it properly. If she is fit to vote, fit to pay taxes, fit to hold her own estate under the Married Women's Property Act, why should she not learn to exercise intelligent and responsible control over her own self? Why do so many women _allow_ themselves to be impregnated and infected against their will? Because they do not understand the construction and functions of their own body. When they do understand this, they will guard their own health as carefully as they guard their reputation. They will then not only keep their own sexual organs scrupulously clean, but they will encourage their husbands to do the same. Sexual intercourse is far more refreshing and exhilarating in every way when both husband and wife have cleansed their parts immediately before enjoying it. It is only natural that both should wish to be sweet and clean before approaching the closest of all bodily intimacies.

[Footnote F: It would be much less untrue to say that the remedy for the venereal problem is _clean women_.--E.A.R.]

But more than this. Every well-informed woman knows that there is far more venereal disease in the world to-day, among men and among women, than there was before the war, and she should train all the members of her household in habits of strict cleanliness. Instinctively they will then avoid risking their health by contact with a possible source of defilement, or if the risk has most unfortunately been taken, they will instantly and instinctively remove and destroy the possible infection, in the same rapid and effective way as they would cleanse their boot from filth accidentally coming in contact with it. By all means let the mothers continue to inculcate virtue, but they should also teach sexual cleanliness directly and indirectly, themselves setting the example. After all, the microbes of venereal disease grow almost exclusively in the genital passages, and if these were kept sweet and clean there would soon be an end to venereal disease. It is not a matter of making _vice_ safe: it is a matter of making _marriage_ safe: a matter of restoring and maintaining physical health, family and national, and above all, of protecting innocent women and children, for if vice has its dangers so also in these days has innocence its own peculiar perils, and it is the cry of these victims--often so young and so fair--that must affect us most deeply.

More than fourteen years ago, Mr. George Bernard Shaw, in the Preface to "Getting Married," wrote the following regarding "The Pathology of Marriage":--

"As to the evils of disease and contagion, our consciences are sound enough: what is wrong with us is ignorance of the facts. No doubt this is a very formidable ignorance in a country where the first cry of the soul is, 'Don't tell me: I don't want to know,' and where frantic denials and furious suppressions indicate everywhere the cowardice and want of faith which conceives life as something too terrible to be faced. In this particular case, 'I don't want to know' takes a righteous air, and becomes 'I don't want to know anything about the diseases which are the just punishment of wretches who should not be mentioned in my presence or in any book that is intended for family reading.' Wicked and foolish as the spirit of this attitude is, the practice of it is so easy and lazy and uppish that it is very common, but its cry is drowned by a louder and more sincere one. We who do not want to know, also do not want to go blind, to go mad, to be disfigured, to be barren, to become pestiferous, or to see such things happening to our children. We learn, at last, that the majority of the victims are not the people of whom we so glibly say, 'Serve them right,' but quite innocent children and innocent parents, smitten by a contagion which, no matter in what vice it may or may not have originated, contaminates the innocent and the guilty alike, once it is launched, exactly as any other contagious disease does; that indeed it often hits the innocent and misses the guilty, because the guilty know the danger and take elaborate precautions against it, whilst the innocent, who have been either carefully kept from any knowledge of their danger, or erroneously led to believe that contagion is possible through misconduct only, run into danger blindfold. Once knock this fact into people's minds, and their self-righteous indifference and intolerance soon change into lively concern for themselves and their families."

The facts seem so plain, and yet there is still great opposition to the promotion of a knowledge of sexual cleanliness and self-disinfection. Only a short time ago (the end of 1920), Sir Frederick Mott, the great authority on syphilis, felt obliged to oppose some opponents of self-disinfection at a public enquiry in London in this fashion:--

"The point is that large numbers of innocent women have suffered from disease. They are rendered sterile, have miscarriages and abortions, and large numbers have been ruined. I have been connected with the London County Asylums for twenty-five years, and I have seen in those asylums people from all states of society, and I have seen them die of general paralysis. Five per cent. of the people who get syphilis, in spite of treatment, develop this disease. That is only one aspect of it. I was on the Royal Commission on Venereal Disease, and Sir William Osier, who was a great authority, said that he could teach medicine on syphilis alone, because every tissue in the body is affected by it, and that the diseases of blindness, deafness, insanity and every form of disease may be due to syphilis. You have only to consider the effect that it had upon the army, and I understand that more than two army corps were invalided during the war on account of venereal disease. What have you to say to that? Does not that create some anxiety?"

It is difficult even to read this eloquent appeal--the more eloquent perhaps because it was quite unpremeditated--without being deeply moved. Yet the witnesses opposing Sir Frederick Mott were apparently unaffected. Of them, as of men of old, it might justly be said:--

"He hath blinded their eyes, and hardened their heart; that they should not see with their eyes, nor understand with their heart, and be converted."

And now large numbers of hospitals all over the Empire are issuing appeals for the means to treat venereal disease.

"It is tragic," says one London hospital, "to see the sufferers--men, women and even little children--innocent little mites, knowing not from what they suffer or why they should. It is thought by many that venereal disease is a sign of guilt, but large numbers of our patients are innocent victims."

Is it not time then that we all stopped repeating timid platitudes about making vice safe, and did something practical to _make marriage safe?_

_Why don't we?_

Is it because we are afraid to define the terms we use so glibly? We talk of promoting chastity, for example. _What is chastity?_ Surely chastity is happy, healthy sexual intercourse between a man and a woman who love one another; and unchastity is sexual intercourse between those who do _not_ love one another. No sexual intercourse at all is neither chastity nor unchastity; it is the negation of both, and it ends in extinction. Why trouble so much about a negation that inevitably means racial death? Why not devote ourselves to life and love; to the building of a happy healthy human family--a family that instinctively realises that the clean blood-stream of a nation is its most priceless possession?

But the national blood-stream can never be clean until there is a complete knowledge of sexual control and sanitation among all of us, and especially among women. One of the very first things which women must learn to understand is the control of conception and the control of venereal diseases. They must learn how to prevent the birth of the unfit; how to secure the birth of the fit; and even though their husbands are infective they must learn how to break the chain of infection in their own bodies, so that what is bad for the race does not become worse. If women are brave enough and wise enough, they can in most cases _wipe out the scourge of venereal diseases from their own hearths and homes_, and ensure that every child born is at least physically fit. But this cannot be done without _knowledge_, and that knowledge is at present lacking.

The following pages are written with the object of imparting useful, practical knowledge to sensible and serious women. The women who accept and apply this knowledge can rest calm in the sure and certain faith that it is their offspring who will build up the coming race.

II.--PRACTICAL METHODS OF PREVENTION.

A. FOR WOMEN:

SEXUAL REPRODUCTION.

To understand the practical methods of birth-control, or the control of conception, we must first have a clear view of the processes involved when the reproductive organs are in activity, and of the nature and situation of the sexual organs themselves. The diagrams on pages 34, 35 and 36 show in general outline the reproductive organs of man and woman.

Now fertilisation does not necessarily occur whenever the male organ comes in contact with the female organ. Fertilisation occurs only when a male-cell (spermatazoon) unites with a female-cell (ovum); in other words, when the spermatazoa in the seminal fluid of a man meet and unite with the germ or ovum in the body of a woman. That is the beginning of the child. This union of the two cells need not take place during or immediately after sexual intercourse. It may occur many hours, or even two or three weeks, after connection, because the spermatazoa have motion of their own. They are tiny threadlike bodies, which may work their way towards the ovum long after they have left the body of the man and been placed in the body of the woman, and the uterus has a searching movement, and may by its pulsations draw the spermatazoa upwards. For these reasons a woman cannot be quite sure of the exact time of fertilisation, and hence cannot predict exactly the date of the child-birth. Generally the pregnancy lasts nine months, but it may last longer--say ten months on rare occasions; and it may be extended apparently by a delay in fertilisation.

PREVENTION OF CONCEPTION.

For many reasons which I need not enumerate here, the precautions against impregnation can most easily and effectively be taken by the _woman_, rather than by the man. She is the one fertilised, and therefore she is the one to guard herself against fertilisation.

There are _two methods_ of preventing fertilisation:--

(1) _The chemical method_, that is, the destruction of the male cells (spermatazoa) by means of a suitable germicidal substance, such as many of the disinfectants; and

(2) _The mechanical method_, that is, the adoption of measures which keep the male and the female cells apart from one another.

Neither of these two methods in practical application by ordinary women can be said to be _completely certain_. Both are apt to fail at times. The chemical method, that is, the application by the woman of a suitable soluble contraceptive suppository before connection, or of a germicidal douche (such as a dilute solution of lysol) after connection, or both these measures taken consecutively, may fail because of some fault in application, or because the seminal fluid actually enters the womb during intercourse; that is to say, when emission takes place, the end of the male organ may be exactly opposite and close to the mouth of the womb, and the spermatazoa in the seminal fluid enter directly into the womb, and cannot then be removed or destroyed by douching or contraceptives of any kind. Now if the physical conformation of the reproductive organs of the husband and the wife render this event possible or probable, then soluble suppositories and contraceptive douching are alike unreliable, by themselves or in combination. On the other hand, the mechanical method, that is, the use of a rubber protector, preferably the spiral-spring occlusive[G] "Dutch" pessary, by the woman may also fail, because the protector is porous or ill-fitting. But--_if the two methods are combined_, the chemical method and the mechanical method, _then the protection against fertilisation may be regarded as almost absolute_. The completeness of the protection depends, of course, upon the proper application and combination of the measures advised.

[Footnote G: Judging by certain original letters (dated December, 1888, to November, 1892), which I have seen myself, by the courtesy of Messrs. E. Lambert & Son, of 60, Queen's Road, Dalston, London, E.8, the rubber spring pessary was first suggested here by an English doctor, and manufactured for him by Mr. E. Lambert Sen. Under date December 23rd, 1888, the doctor wrote:--

"I think highly of the watch-spring rim. There will be very little fear of conception with one of these new pessaries properly adjusted, as the rim will press equally all round. The inflated pessary would be the most perfect, however, if you could only contrive some method to prevent escape of air and consequent flattening. Such a pessary would be most comfortable."]

I have discussed the various measures fully with leading medical authorities in London and Paris and elsewhere during the last five years, and have gradually evolved the recommendations made here, and these recommendations have the highest medical and scientific support and approval. Other methods than those recommended are referred to in Appendix I; to enumerate here those that have been eliminated would be purposeless and confusing. We are satisfied that we have selected the least harmful and most reliable methods known to science yet. These methods and these only will be explained and recommended. Everything possible has been done to make the methods _acceptable to women_.

UNATTAINABLE CONDITIONS.

Before detailing these methods, I want to ask every woman to rid her mind of certain false hopes and impossible demands. It is no use asking for something which gives no trouble at all, which costs nothing, and which is at the same time absolutely certain to prevent conception. These conditions are unattainable. But almost absolute control of her reproductive functions is most certainly attainable by every careful, intelligent woman willing to spend a good deal less time and money over her sexual toilet than she now spends over the care of her teeth, for example.

SEXUAL TOILET OUTFIT.

To begin with, it is necessary to obtain suitable sexual toilet outfit, and the requirements for this are as follows:--

Enamel bidet, soluble suppositories, suitable syringe, and properly-fitting rubber pessary. These are illustrated on pages 38 and 43.

GENERAL CONDITIONS.

1. _Cleanliness._--Sexual control is largely a matter of sexual cleanliness. We must all learn to keep the genital passages cleansed in the same way as we keep all the other openings of the body clean. The ears, eyes, nostrils, mouth, anus, orifice to the urethra, and the vagina should be appropriately cleansed daily. The openings of the body which stand most in need of daily cleansing are the anus and the vagina, and yet many women fail to cleanse these properly at all. Every home should have a suitable bidet (preferably fitted into the bath-room, with hot and cold water attached), and every member of the family should be trained from childhood to use the bidet, night and morning, with the same care and regularity as they use their sponge or toothbrush. All over the Continent and in the United States of America this is done in well-ordered households nowadays, but hardly anywhere in the British Empire is it done at all.

2. _Soluble Suppositories._--Generally speaking, the soluble quinine pessaries or suppositories which are sold in the shops are unreliable. Several brands have recently been analysed and found to contain no quinine at all--or particular pessaries have been without sufficient quinine. Quinine is fatal to the spermatazoa, and without it these pessaries are simply pieces of soluble cocoa-butter. Cocoa-butter is the substance generally chosen for cheap soluble pessaries, because it is easily obtainable, and has what is called a sharp melting point--that is, it dissolves or melts very suddenly and readily at body-heat, but is solid below that heat. Cocoa-butter in itself is quite harmless--usually non-irritating (unless it is "rancid")--and it gives some mechanical protection, in the same way as vaseline or any kind of fat or oil would do, provided, of course, it is in the right place to catch and entangle the spermatazoa and thus prevent their uniting with the ovum. Research and experiment have proved conclusively that no spermatazoa--indeed, _no microbes or germs of any kind--can pass through a film of oil_. But if the protective covering of grease is incomplete at any point, it may there prove ineffective, and there is no chemical protection whatever if the particular germicide relied upon, such as quinine, has been omitted. Quinine is sometimes omitted on the ground of expense, and sometimes because it proves irritating to many women. Only really suitable suppositories, guaranteed to be made in accordance with accredited medical formulæ, should be used. These suppositories should be composed of specially selected and tested fats, should be soothing and cleansing, as well as protective; should be stainless, odourless, and quite non-irritating. If they do cause any woman discomfort temporarily, vaseline or soap-suds could be substituted, but might not be quite so certain to prevent conception.

3. _Syringe._--The ordinary enema is not a particularly suitable appliance for the purpose of douching. The kind of syringe required is one which will not only flood the vaginal passage with warm water or very weak antiseptic lotion (such as dilute solution of lysol), but one which is sufficiently large for the contents on injection to distend slightly the walls of the vagina, straighten out their folds and furrows, and thus let the cleansing and protecting lotion touch every part as far as possible. A movable rubber flange is necessary to act as a stopper at the mouth of the vagina, and thus enable the woman to retain the lotion for a minute or so. Care should be taken, when filling the syringe, to express all the air from it--by filling and refilling it two or three times with the nozzle under water; otherwise the first thing put into the vagina would not be warm water or antiseptic lotion, but simply a large bubble of air.