Chapter 4

"Sir Bryan Donkin's letter, which appeared in _The Times_, in January, 1917, and other communications which he published as opportunity offered, brought him an introduction from Sir J.W. Barrett, M.D., then serving as A.D.M.S. with the Australian Force in Egypt, to Miss Ettie Rout, who, by profession a journalist, had come with the Australian and New Zealand Forces with the object of ameliorating, as far as possible, the hardships of war. She had been horrified by the pestilence of venereal disease which broke out among the troops in Egypt, England, and elsewhere, and, with extraordinary resolution and courage, had embarked almost single-handed on a campaign of prevention. She furnished Sir Bryan, and later myself also, with much valuable information, and for her own part fought the battle most strenuously--living among the men, lecturing, finding and instructing lecturers, providing disinfectants, importuning authorities, writing most trenchant letters, establishing medical clubs in England and France, and the like. I think that when the names of those who opposed her are forgotten, the memory of this brave lady will still be green among the descendants of the valiant men for whose welfare she struggled"--p. 176-177.

[Footnote M: The _New Zealand Times_ daily newspaper published my first article and was severely reprimanded by the New Zealand Government for doing so, and all New Zealand newspapers were then prohibited from publishing any further articles relating to V.D. in the New Zealand Forces.--E.A.R.]

[Footnote N: See Publishers' notice.]

ALCOHOLISM.

It should be noted here that another great difficulty we had was to make men _beware of the dangers of drink_. A man who is in liquor is much more liable to contract venereal disease than a man who is sober. Alcohol increases sexual desire, lessens sexual ability, and lowers the sense of responsibility. Hence, drunkenness, immorality and disease go hand in hand: a dreadful three. But more than this. The drunken man takes much longer over the sex-act, thereby prolonging the risk of disease, and he runs risks which he would rule out instantly if the fumes of alcohol had not changed the tawdry girl into the glittering fairy. Worse than all, he neglects to apply disinfection properly and _promptly_--he falls asleep or forgets all about it till _too late_. Men who are determined to have a "night out" should use calomel ointment (or some other substitute) _before they start_; and if they have been in liquor they should disinfect instantly when they recover their sober senses. Generally speaking, _an ounce of calomel is worth a ton of salvarsan_.

As with young men, so with young girls: a few glasses of wine taken at a supper or a dance--and the first downward step is taken, not because any wrong was intended, but the simple actualities of sex were unknown, and the stimulant took advantage of the ignorance that is miscalled innocence. This kind of thing will continue till the older generation realise that morality depends--not on the maintenance of ignorance and the fear of disease, but on the spread of knowledge and the promotion of virtue.

It is not morality, but caution, that is developed by fear, and in this case caution is counteracted by the practical experience that many men are immoral without becoming diseased. One man commits many immoral acts and suffers not at all; another man becomes syphilitic by yielding for the very first time; the penalty is purely fortuitous. There is no necessary connection at all between immorality and disease. The dangers of sexual intercourse are due to dirt and promiscuity rather than to immorality, and in part to the physical conformation of the individual. Virtue has far deeper and more substantial foundations than the mere gusts of fear. It is founded on necessary and responsible guardianship of the very gates of life.

III.--MEDICAL FORMULÆ.

The medical formulæ for venereal disease preventive ointments for men, and venereal disease preventive suppositories and ointments for women, should be decided upon, after thorough investigation and test, by the Departments of Public Health, and none other should be permitted to be sold. Printed directions should be issued, duly authorised by the Departments of Public Health, and no other directions should be supplied to the public with the venereal disease preventives. In these respects, to the best of my belief, the Division of Venereal Diseases of the Pennsylvania Department of Health, co-operating with the United States Public Health Service, will play the leading part; is, indeed, already doing so. Under the direction of Dr. Edward Martin, Commissioner of Health, and Dr. S. Leon Gans, Director, Division of Venereal Diseases, specimen tubes are tested and approved (with directions and other printed matter)[O] by the Health Laboratories of the Department; and certificates are issued to manufacturing chemists authorising the manufacture of ointments made in accordance with approved formulæ. Requests are made officially by the Department to retail chemists and druggists to sell, and to medical practitioners to recommend, suitable venereal disease preventives to the general public in a proper manner. In time it will probably be found advisable to authorise only a standard type of tube--preferably the metal tube with elongated nozzle and expanded metal cap--filled with one simple self-disinfecting ointment.

[Footnote O: In some cases the printed matter used by the drug companies also bears the "_Official Endorsement_" of the local "_Social Purity Association_" stamped upon it in indelible ink--a magnificent tribute to the educative work of the Public Health Department, as well as to the enlightened courage of the Social Purity Associations.

The following is quoted as sample of directions authorised in U.S.A.:--

"The use of this package is not to be construed as a licence to exposure. Pro-Ven, the original preventive. _The only sure_ way to prevent infection: _Do not expose yourself._ All exposures should be considered as infections, for 90 per cent. of all "easy women" are infected. By proper use of the contents of this package disease may be prevented, as the action upon the germs is as effective as can be secured by the latest scientific knowledge; if exposed, _use within two hours_. After contact: 1st. Urinate. 2nd. Remove the cap from tube; take organ in the hand, holding the canal open; insert tip of the tube and squeeze half of the contents into the canal. 3rd. Squeeze the remainder on the outside of the organ, rubbing well into the creases and folds under and back of head and clear to the body. 4th. Leave ointment on three or four hours. Remember: It is best to use _Pro-Ven_ immediately after exposure; never delay more than two hours if possible. _Pro-Ven_ is not a cure--it is designed to keep men from getting disease; it can be used as a lubricant and preventive both before and after exposure. _Pro-Ven_ is harmless and will not cause pain or injury to the sexual organs. Insist upon having _Pro-Ven_. At all good druggists, or directly by mail, 25 cents a tube; 5 tubes, $1.00. Booklet mailed free upon request. The Pro-Ven Laboratories, Washington, D.C. This product has been tested and approved by the Pennsylvania State Department of Health Laboratories."

In addition to _Pro-Ven_, the following proprietary tubes of self-disinfecting ointment have, to my knowledge, been authorised by the Department of Health, and samples were sent to me:--

_Procaline_, manufactured by the Hawthorne Drug Speciality Co., Inc., 88-90, Reade Street, New York City.

_Cargenios_, manufactured by H.K. Mulford Company, Philadelphia.

_Andron_, manufactured by Andron Hygienic Co., 120, W. 32nd St., New York City.

_Sanitube_, manufactured by the Sanitube Co., Newport, R.I., U.S.A.

Excellent printed directions and pamphlets accompany these tubes.--E.A.R.]

It has been found that the 30 per cent. to 33 per cent. calomel ointments (and suppositories) are not suitable in all cases; and careful investigations are being made to ascertain the best germicide to use. Whatever is used must be non-irritating, odourless, stainless, and yet strongly antiseptic. It is possible, I think, that _chinosol_[P] best fulfils the required conditions. It was first suggested by Surgeon-Commander Hamilton Boyden, R.N., of the Whale Island Gunnery School, England, who was led to choose it because of its known usefulness in ophthalmic work. It does not matter to the general public what drug is finally selected; all that matters is that it should be of proven value for the purposes required. Women can help forward this great work by deciding in their own mind: (1) That the medical prevention of venereal disease is right and wise; and (2) That the authorisation by the Public Health Departments of efficient means of preventing venereal disease will consequently have their support.

[Footnote P: _Chinosol_ (C9H6NKSO4), potassium oxyquinol in sulphonate, is a proprietary disinfectant and deodoriser. After some little experience of it in ointments and suppositories, I believe it deodorises these--an important advantage. But further investigation is necessary.--E.A.R.]

We must all of us first learn to separate the moral from the medical campaign. Both are necessary, but they must be conducted independently. America is doing this; England is not. In England venereal disease is still officially regarded as something to be discussed; in America--as something to be destroyed. Thus America is winning and England losing the battle against the venereal microbe. The Overseas British Dominions will undoubtedly follow the lead of America--particularly that of Pennsylvania. Hence, these newer countries may have a glorious future, England--only a splendid past.[Q]

[Footnote Q: In England the Ministry of Health refuses to authorise the sale of v.d. preventives; refuses to authorise suitable printed directions; recommends immediate and thorough cleansing but refuses to explain methods or name disinfectants; and claims that persons who sell v.d. preventives as such, with directions, are liable to police prosecution and imprisonment. (_Vide_ Circular 202, Ministry of Health, May 31st, 1921.) This may be mere "politics," but it looks uncommonly like fooling with death.--E.A.R.]

IV.--COMPULSORY TREATMENT.

All women should be in favour of reasonable measures for ensuring the voluntary, and failing that the compulsory, treatment of venereal disease among men and among women.[R] It is troublesome to prevent a man getting disease if he is running into a pool of infection, and such cesspools should be cleaned up or cleared out of the community--_i.e._, cured or quarantined. Similarly, it is even more troublesome to prevent a woman becoming infected if she is having relationship with an active gonorrhoeic or syphilitic man, and such men should be treated voluntarily, or compulsorily if they refuse or neglect voluntary treatment. Free treatment should be available to poor persons only; providing free treatment for all and sundry, whether they can afford to pay for it or not, is simply encouraging men and women to trust to luck rather than to disinfection. This presupposes that the teaching of self-disinfection has been done confidently and authoritatively. When prevention has been properly taught, then it is fair to penalise those who wilfully neglect to take precautions. It was a great misfortune to the Anglo-Saxons when the Contagious Diseases Acts were abolished; instead they should have been improved and extended to both sexes. Their abolition was the worst blow ever struck at marriage. Fortunately, their main principles we are now beginning to re-enact in various Sexual Hygiene Acts. The more "drastic"--_i.e._, the more efficient--these are, the more they should be supported by those who honestly desire to _make marriage safe_.

[Footnote R: The argument that compulsory treatment would "drive the disease underground" is absurd. Venereal disease is underground now.--E.A.R.]

Apart from voluntary and compulsory treatment for venereal diseases, we certainly need voluntary and compulsory sterilisation of the unfit--diseased and feeble-minded and otherwise unfit persons, who, whatever their other qualifications may be, are unsuitable as parents. But whatever operation is decided upon, for men and for women, must in no way interfere with ordinary sexual activity; otherwise it will be promptly turned down by the general public, no matter what its medical advocates may say. In marriage the partner to be sterilised is obviously the one who is unfit for parenthood.[S]

[Footnote S: Towards the end of last year, extraordinary interest was aroused throughout the United States by a decision of Judge Royal Graham, of the Children's Court of Denver. He had ordered Mrs. Clyde Cassidente to submit to an operation to make further motherhood impossible, because of the under-nourishment of her five children and the habitual insanitary condition of her home. This was the first time any American court had imposed such conditions. Judge Graham could not legally compel the mother to agree to the operation, but he told her that if she refused he would commit all her children to a home. She then agreed. Judge Graham was much influenced by the testimony of Dr. Sunderland, who described the progressive insanitary environment as more children came, and declared that in his opinion the home condition was not due to poverty but to too frequent child-bearing.

In the February, 1922, issue of _The Birth Control Review_ (New York) edited by Mrs. Margaret Sanger, the Medical Officer of a London Welfare Centre (Dr. Norman Haire, M.B., Ch.M.) definitely advocates contraception and sterilisation as a result of his experiences in a very poor part of London. Medical officers of many welfare centres now hold similar views. In _The New Generation_, the official organ of the Malthusian League, Dr. Barbara Crawford, M.B.E., M.B., Ch.B., strongly urges birth-control, and says:--

"I would go further and say that all those with incurable transmissible disease, all addicted to drugs or alcohol in excess, those habitually criminal or vicious, and the mentally defective, should be rendered sterile by operation, for such as these cannot or will not use control, and their children tend to inherit their parents' taint and to lead maimed and vicious lives."--Vol. I, No. 4, p. 3. _The New Generation._--E.A.R.]

V. CONCLUSION.

With the moral and social aspects of birth-control there is no need to deal further, except to say that they have recently been endorsed in England, with fine grace and high authority, by Lord Dawson of Penn (one of the King's Physicians), in an address given before the Church Congress at Birmingham, on October 12th, 1921, which has since been republished by Messrs. Nisbet at a shilling, under the title of "Love--Marriage--Birth-Control." The following short extract may be quoted here:--

"Generally speaking," says Lord Dawson, "birth-control before the first child is inadvisable. On the other hand, the justifiable use of birth-control would seem to be to limit the number of children when such is desirable, and to spread out their arrival in such a way as to serve their true interests and those of their home."

As to the prevention of venereal disease, as I have said, what we must aim at is not merely the prevention of sin, but the prevention of the poisoning of the sinner; for, if not, we shall have blind babies, invalid wives, and ruined husbands: broken-hearted and broken-bodied mothers adding one fragment after another to the Nation's pile of damaged goods.

To the great-hearted public this is becoming intolerable. But they know so little, and they wait so long for what the wise ones fear to tell. Not all these fears are sordid; there is a kind and gracious reluctance to shatter ideals. It is hard at times to combine beauty and duty. The way of the truth-teller is not made easier by charges of iconoclasm. "To know all is to forgive all"; that is not paganism but Christianity. So also, "Let him that is without sin cast the first stone." "To err is human: to forgive divine." Humanity, wisdom, tolerance, are wrapped up in these sayings. Yet when we think, as think at times we must, of the romantic faith that once was ours, contrasted with the realities of present experience, sex seems to have lost something of its soul of loveliness. And yet--can it ever regain this till men and women are at least _clean_?

If not--if the immoral man cannot be made better but rather worse, much worse, by needlessly infecting him with syphilis, then clearly the ideals of beauty and duty demand that we should apply effective sexual sanitation to the Nation until such time as we are all, every one of us, free from venereal disease. That time is not yet--and this is the essence of the whole problem. But victory is within sight. When it comes--then, and not till then--sex will regain its soul of loveliness. To this end--

"Let knowledge grow from more to more, But more of reverence in us dwell, That mind and soul, according well, May make one music as before, But vaster."

_Tennyson._

NOTE.

_The Author will reply personally to any serious question concerning the subject matter of this book, provided stamped and addressed envelope is sent to her, c/o the Publishers._

APPENDIX I.

OTHER METHODS OF CONTRACEPTION.

1. _Withdrawal._--Immediately before emission the male organ is quickly withdrawn, to avoid emission of seminal fluid in the vagina. Many men and women feel this to be unromantic and nerve-racking, and otherwise objectionable. The method is quite commonly practised, but it is unreliable in multiple connections, and where the man has not complete control over himself. It leaves the woman at the mercy of the man for protection against impregnation.

2. _Sheath or Condom_ ("French Letter").--This prevents both conception and infection (excepting in parts not covered by the sheath), but sheaths are apt to break, and sometimes a man infects himself whilst removing the sheath. Sheaths impose an impermeable medium between husband and wife, destroy contact, and may thereby prevent the joy of sexual intercourse. In some cases both husband and wife become nervous wrecks, recovering their health when the sheaths are discarded; in other cases it is claimed that no harm has resulted.

3. _Antiseptic Syringing._--This is generally successful, but not entirely reliable by itself, because seminal fluid may enter the womb during connection. This method is unreliable unless applied _immediately_ after each connection, and syringing at that time is inconvenient and unromantic.

4. _Douche Can._--This is better than syringing in some ways, because the irrigation can be so arranged as to let the lotion flow into the vagina faster than it can flow out--hence distension of walls of vagina and thorough cleansing. But the arrangement of a runaway for outflowing lotion is inconvenient in most households.

5. _Quinine Pessaries, etc._--By themselves these are unreliable, no matter what the makers claim on the label. There is usually not enough quinine in them; or if there is enough, it proves irritating.

6. _Solid-Ring Check Pessary._--These are reliable only when carefully adjusted over the mouth of the womb, and many women find it very difficult to adjust this kind of pessary correctly; hence numbers of failures.

7. _Vaseline and Soap-and-Water._--Using vaseline beforehand, and urinating and using soap-and-water _immediately_ after _each_ connection, is a fairly safe way of avoiding conception and infection. But the vaseline needs to be inserted fairly high up--if possible over the mouth of the womb, and the subsequent washing needs to be very thoroughly done (internally and externally). This method is commonly used by Continental women, but it is not entirely reliable by itself.

8. _Gold Spring Check Pessary._--This is an instrument, the arms of which spread out inside the womb, and the gold spring keeps the mouth of the womb open, thus facilitating infection and conception. It is claimed as a "preventive"; it is really an abortifacient, and cannot be too strongly condemned, as causing septic miscarriage (authentic records of this are available). A woman can neither insert nor remove this instrument herself.

9. _Safe Period._--It is often supposed that sexual intercourse midway between the menses is unlikely to result in pregnancy. There is no such "safe period."

NOTE.--The method of "self-control" is not referred to here, because one marital relationship per annum might lead to an annual child. In the matter of limitation of offspring, therefore, "self-control" has no value.

APPENDIX II.

MEDICAL SUPPLIES.

_Rubber Pessaries._--Medical practitioners can obtain sets of occlusive rubber pessaries from Messrs. E. Lambert & Son, of 60, Queen's Road, Dalston, E.8. This firm has been manufacturing such articles in England since 1888, and now makes them in a wide range of sizes, and of special shape where required.

_Bidets and Syringes._--Syringes are easily procurable, but bidets in England at present are sometimes difficult to obtain. Good strong enamel bidets can be obtained from Messrs. E. Lambert & Son, of 60, Queen's Road, E.8., and they also keep the contraceptive suppositories made by Mr. Harman Freese in accordance with medical directions mentioned in Foreword.

_Soluble Suppositories (for women)._--These are now being manufactured by Mr. Harman Freese, of Freese & Moon, 59, Bermondsey Street, S.E.1, from whom they can be obtained. These suppositories are disinfective as well as contraceptive, but they are at present sold for the ordinary purposes of birth-control.

_Sanitary Tubes (for men)._--These tubes are also manufactured by Mr. Harman Freese, of Freese & Moon, 59, Bermondsey Street, S.E.1, in accordance with medical directions mentioned in Foreword. It is quite possible to manufacture an ointment which, if properly used, would be a preventive of all forms of venereal disease. The sale of such an ointment is authorised by the State Health Department of Pennsylvania.

_Information_ as to the medical prevention of venereal disease may be obtained from the Hon. Sec., Society for the Prevention of Venereal Diseases, 143, Harley Street, W.1. Information regarding birth-control has been made available to adults in England for the last half-century by Dr. Drysdale, Sen., and his family and supporters, through the Malthusian League, whose present address is 124, Victoria Street, London, S.W.1., and these pioneers have made a most self-sacrificing effort for the benefit of poor women by establishing a welfare centre at 153a, East Street, Walworth, London, S.E.17, where free advice is given in birth-control and sexual hygiene, and where medical supplies are available at nominal prices. This centre is supported entirely by voluntary subscriptions and at present stands in dire need of financial help.[T]--E.A.R.

[Footnote T: At my personal request the publishers have agreed to name the firms and societies mentioned in Appendix II. These notifications are made gratis for the benefit of the medical profession and the general public, and not by way of advertisement.--E.A.R.]

NOTE.--Every thoughtful woman is urged to buy and study carefully the great work entitled: "PREVENTION OF VENEREAL DISEASE," by Sir Archdall Reid, K.B.E., M.B., C.M., F.R.S.E., with an introductory chapter by Sir Bryan Donkin, M.D., F.R.C.P., in order that she may understand the nature of the problems involved and the strength of the opposition to _cleanliness_.