New York State College of Agriculture At Cornell University Ithaca, N. Y. The Professor Dwight Sanderson Rural Sociology Library HQ31.R8 C 1°9T6 UniVerSi,yLibrary Sexual problems of to-day, 3 1924 013 890 649 The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924013890649 SEXUAL PROBLEMS OF TO-DAY BY THE SAME AUTHOR A 'Practical Treatise on the Causes, Symptoms and Treatment of Sexual Impotence and other Sexual Dis- orders in Men and Women $3.00 Treatment of Gonorrhea and its Com- plications in Men and Women 2.50 Sexual Problems of To-day 2.00 Sex Knowledge for Men 2.00 Sex Knowledge for Women 1.00 Woman: Her Sex and Love Life 3.00 Never Told Tales 1.00 Stories of Love and Life 1.00 Limitation of Offspring by the Pre- vention of Conception. l.oo Sex Morality — Past, Present and Fu- ture 1,00 Practical Eugenics: Pour Means of Improving the Human Race 1.00 The Critic and Guide Monthly: $1.00 a year ; Single Copies, 20c. The American Journal of Urology and Sexology Monthly: $4.00 a year ; Single Copies, SOc. SEXUAL PROBLEMS OF TO-DAY BY WILLIAM J. ROBINSON, M.D. President American Society of Medical Sociology, President Northern Medical Society of the City of New York, Editor of The American Journal of Urology and of The Critic and Guide, Ex-President Berlin Anglo-American Medical Society, Member American Medical Editors' Association, American Medical Asso- ciation, Fellow New York Academy of Medicine, New York State Medical Society, Medical Society of the County of New York, Harlem Medical Association, Society Moral and Sani- tary Prophylaxis, etc. t etc. No book has a right to exist that has not for its purpose the betterment of mankind, by affording either useful instruction or health- ful recreation. — W. J. R. SIXTH EDITION THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK 1916 & /3A A b YS COPYBIGHT, 1912, By WILLIAM J. ROBINSON COPYBIGHT, 1914, By WILLIAM J. ROBINSON, PEEFACE I publish this volume because I believe the world, the Anglo-Saxon world in particular, is in need of it. Only the crudest intellect and the most perverted "morality" will see anything obscene or improper in this book. The thinking and truly cultured man and woman know that there can be nothing improper ■ in discussing problems of the deepest vital importance to the individual and the race, that there is nothing obscene in the scientific treatment of questions which deal with the prevention of disease, misery and death. Everything that contributes to the joy, happiness, physical health and mental and spiritual efficiency of the individual is pure and moral. The justification for the existence of this book will be found in its pages — on every page. PEEFACE TO THE SECOND EDITION It was my intention to incorporate some new mat- ter in this edition. But the information that a new edition was needed, and at once too, came so much sooner than I expected — it is barely eight months since the first edition made its appearance — and, what with my practice and writing two other books, I am so busy just at present, that I am obliged to send out this edition a mere facsimile of the first. But ap- parently even as it is, Sexual Problems of To-day is a useful and necessary book. W. J. R. PREFACE TO THIRD EDITION The short time that has elapsed since the publica- tion of the first edition of this volume has seen some remarkable and gratifying changes in the attitude o± the public towards sexual problems. Things that were uttered with fear and hesitation then are dis- cussed freely and eagerly now. To what extent the author's propaganda by pen and word of mouth has been responsible for this change, would be difficult to determine ; but that the change has taken place, and that the author has had something to do with it, can- not be the subject of any doubt. The present edition has been enlarged by some fifty pages and we send forth this volume with the same feeling of assurance that we do our other books: that a careful perusal of it will benefit everybody and injure nobody. "W. J. R. June 1, 1914. PREFACE TO SIXTH EDITION I have really nothing to say except to express my deep satisfaction at the fact that new editions of Sex- ual Problems of To-day follow each other so rapidly. It is a good book and it seems to be satisfactorily ful- filling its mission — that of destroying sexual error and spreading sexual truth among the masses, among the men and women of average intelligence and education. They are the people who are most in need of sexual enlightenment and to them the book has proven — as thousands have written to us — a real blessing; or as some write — a Godsend. ~W. J. R. November 1st, 1916, 12 Mt. Morris Park W. CONTENTS PAGE The Importance of the Study of Sexual Disorders . . 9 The Psychology of Sex 12 The Relations Between the Sexes, and Man's Inhuman- ity to Woman 13 The Influence of Sexual Abstinence on Man's General Health and Sexual Power 53 The Double Standard of Morality, and the Effects of Continence on Each Sex 63 My Reasons for Advocating the Regulation of Offspring 73 The Woman at Forty and After 76 The Limitation of Offspring 79 Do Not Blame Us : Blame Our Vicious Laws .... 124 What to Do with the Prostitute, and How to Abolish Venereal Disease . 126 Sometimes Fear Does Not Act as a Deterrent . . . 146 The Suffragist and the Hospital for Street Women . . 150 The Question of Abortion 153 The Professional Abortionist 178 Diseases Causing the Greatest Suffering and Having the Largest Number of Victims 181 The Wrecking of Human Life and Happiness . . . 185 For Young Men 190 The Treatment of Venereal Disease Should Be Made a Felony Punishable by Imprisonment 195 What Would You Have Told Him? 199 Prostitution and Our Moral-Sanitary Prophylactors . 204 A Moral Dilemma : What Would You Do in Such a Case? 209 CONTENTS PAGE The American Federation for Sex Hygiene .... 213 Venereal Prophylaxis: a Criticism and a Reply . ■ 218 An Apparently Irrefutable Argument and Its Refutation 222 Consanguineous Marriages 224 Should Venereal Disease Be Reported? 228 Automobiling and Sexual Impotence 232 The Influence of the Prostate on Man's Mental Condi- tion 234 The Effect of Vasectomy on Human Sexuality . . ■ 236 The Double Functions of Testicles and Ovaries . . . 238 The Benefits of Prostatic Massage 239 The Effects of Strictures on the Sexual Function . . 240 Five Cesarean Sections on One Woman 241 The Price of a Kiss 244 Torturing the Wife when the Husband is at Fault . . 246 The Wife 249 No Danger of Race Suicide 251 A Wife and Her Husband 252 The Woman Pays , . . 253 Bad Odor from the Mouth and Matrimony .... 254 On the Use of Perfume 255 Neurasthenia Among School Teachers 257 The Nurse as a Focus of Venereal Infection .... 257 Women Defending Their Honor 259 The Male Prostitute 260 Common Sense Triumphs Over Prudery in the Army and Navy 261 Some Men Are Hogs 263 The Dangerous Age 266 Peculiar but Absolutely True 270 Let This Be My Answer to Many Letters 273 An Epidemic of Syphilis in a Small Village . . . .275 CONTENTS PAGE Imprisonment for a Kind Act 277 Barrie, Unfaithfulness and Forgiveness 278 Sir Jonathan Hutchinson on Syphilis and Marriage . 280 Venereal Infection in Children 281 Contraception and Abortion 282 Who Should Discuss The Sexual Continence Question? 283 The Gospel of Happiness 284 A Meeting in Germany about the Limitation of Off- spring 285 The Continence Advocates — Who They Are .... 294 The Maternal Instinct 295 The Duration of Our Passions 297 Artificial Impregnation 298 The Why of the Beneficial Effects of Prostatic Massage 302 A Story Without a Moral 304 To Lighten the Burden of the Illegitimate Mother . . 308 The Influence of the Body on the Mind 309 Demand in Germany for a Modification of the Law Against Abortion 314 A Remarkable Change in the Attitude Towards Ille- gitimacy 315 My Sex Propaganda 317 An Open Letter to Anthony Comstock and Our Other Press Censors 319 Venerophobia ; or, the Obsessive Fear of Venereal In- fection 323 A Topsy-turvy World 329 Separate Beds 333 A Refreshing Review of "Sexual Problems of To-day" 334 Gonorrhea and Impotence 337 Four Absolutely Infallible Means for the Prevention of Conception 338 The Most Efficient Venereal Prophylactics .... 340 THE IMPORTANCE OF THE STUDY OF SEXUAL DISORDERS The shadow of the Period of Darkness — the Middle Ages — is still upon us. Its cruel and perverted teachings still have us in their grip. Its monkish asceticism, which taught that our body is something worthless and that partic- ularly the genital system is something unclean, something to be ashamed of — have we not the shameful word pudenda? — is still permeating our conduct, our literature and even our med- ical schools. Men graduate, receive diplomas as physicians and licenses to practice without having heard a single lecture on disorders of the sexual system, one of the most important systems as far as the individual is concerned and the most important system as far as our social life and the perpetuation of the race is concerned. Venereal diseases are at last be- ginning to be treated in some colleges with the consideration which the importance of the sub- ject deserves; but purely sexual disorders are still entirely neglected, and the medical student graduates without having heard a lecture on the subject of masturbation, pollutions, sper- matorrhea, ejaculatio praecox, sterility, sexual 10 SEXUAL PROBLEMS OF TO-DAY perversion, etc. And on these subjects I find the average physician as ignorant as the average layman. The intelligent layman often knows more than the physician, because he is more eager for the knowledge. Should this state of affairs continue to ex- ist? Physicians make a specialty of diseases of the eye, diseases of the nose and throat, dis- eases of the stomach, etc. — why not make a sep- arate and important specialty of diseases of the sexual system? Is it perhaps because dis- eases of the sexual system are less "serious" and cause less suffering? Then listen to what I have to say. Quoad vitam they are less seri- ous ; but as far as suffering is concerned, I de- clare emphatically that there is not a disease or a whole class of diseases which is responsi- ble for so much suffering, so much misery, so much heartbreaking as are the diseases of the sexual system — and I do not except tubercu- losis. Only the suffering is of a different char- acter. Do you see yon disrupted home, where love and peace reigned before, and hell is reigning now? Do you see that business man who is steadily and unexplainably losing his grip on the details of his affairs, is losing his appetite and his sleep and will soon have to be sent up to a sanitarium for repairs? See you that re- fined woman who has every material comfort THE STUDY OF SEXUAL DISOBDEBS 11 imaginable and is nevertheless wasting away, becoming pale, irritable, melancholic, and will soon be — if nothing is done to help her — a con- firmed hypochondriac? Do you see that wan looking bookkeeper who, formerly an expert, is now unable to keep a position for any length of time, because he is mixing his figures so? Do you see that bright young boy who is losing both brightness and flesh to such an extent that the parents are afraid he is running into con- sumption? And how about that sweet young girl who was obliged to give up college for rea- sons that nobody could explain? And those hundreds of divorced couples? All this un- speakable misery and suffering due to disor- ders of the sexual system! And the pity of it is, that all of it, or the greater part of it, could have been avoided if not for two things — if the patients had not been afraid, ashamed to ask for advice, and if the physicians were not so densely ignorant of the subject of sexual disorders. THE PSYCHOLOGY OF SEX The more deeply I delve into the study of sexual psychology, the more patients I see, the more marital misery I am called upon to al- leviate, the more conjugal entanglements I am asked to disentangle, the more convinced I be- come of the tremendous importance of the sexual instinct in every sphere of our life, the more imbued I become with the idea of the ne- cessity of studying this problem thoroly, from every point of view. I have no hesitation in stating that at least half of the world's misery is in some way, di- rectly, or indirectly, connected with the sexual sphere. The people themselves may not be aware of it, but if they studied the matter deeply, they would find that the underlying trouble is of a sexual nature. And matters will not improve until we are permitted to discuss the entire domain of hu- man sexuality freely, openly, without beating about the bush, and without the spectre of a censorship before our eyes. 12 THE RELATION BETWEEN THE SEXES AND MAN'S INHUMANITY TO WOMAN My lecture to-night deals with, the relations between the two sexes. It does not contain one obscene word, it is free from any equivocal phrases, there is not a sentence in it that a ra- tional man or woman could consider objection- able. But it is not a Sunday School lecture, and it is not intended for boys and girls who have not yet attained their majority. The subject is of such a character that in discussing it one must needs use plain language. And if plain, honest, scientific language is offensive to your delicate ears, you have a chance to leave the hall now. If you prefer to remain, I shall re- quest you, and expect you, to listen with close attention, so that you may not carry away any false ideas, and may not imagine that I said things which I did not intend to say ; and I be- lieve you will be well repaid. # # # My indictment of man in his. relation to woman contains ten counts. And I will take them up seriatim, one by one. COUNT NUMBER ONE. At a recent meeting of the Association of ♦Delivered before the Sunrise Club, November 20, 1912. 13 14 SEXUAL PROBLEMS OP TO-DAY German Physicians, which has been meeting in Dr. Jacobi's house for the last fifty-five years, a doctor presented a woman who was suffering with lupus of the face. The case was of inter- est from the dermatologist's point of view, but this feature does not concern us here. What does concern us here, is the woman's marital history. She was forty-two years of age. She had given birth to fifteen children, of whom eight were alive, and had had seven miscar- riages. She married at the age of sixteen, so that at the time we saw her she had been mar- ried twenty-six years. In those twenty-six years she had been pregnant twenty-two times. When you add together the time she had been carrying the children in her womb, the time she was recovering from her natural labors and miscarriages, the time she was nursing her babies, etc., you will involuntarily ask your- self: And when did she have time to live? And while my professional colleagues were in- terested in examining the lesions on her face, this question kept on crossing my brain back and forth, and I could not help whispering to my neighbor : "What a brute her husband must be!" Of course, this is an extreme case, but It is by extreme cases that we can elucidate an5 em- phasize certain points. And so very, very ex- treme the case is really not. For cases of THE RELATIONS BETWEEN THE SEXES 15 women of forty with ten, fifteen and even seventeen or eighteen pregnancies to their credit are not so very rare. I know of a large number of them, and their pitiful tales, with prayers to help and save them from further misery, are a regular feature of my daily mail. [Unfortunately, on account of our Draconian laws, they must all go unanswered.] And this is the first count in my indictment. My first charge of brutality or inhumanity is against the man, who thinks that a woman is merely a breeding animal, who keeps on im- pregnating her every year or two, so that with gestation, childbed, and lactation, she has no time to live, no time to breathe, becomes pre- maturely old, and within a few years after mar- riage becomes a household drudge, incapable and unwilling to engage in any social or intel- lectual work, losing every trace of any ideal that she may ever have possessed. Only too true is the tragic statement that many a woman "carries within her the corpse of the woman she might have been." More than that, my charge assumes a much more serious aspect, when I tell you that this kind of man will not refrain from impregnat- ing his wife even when he knows that preg- nancy will almost certainly sound her death- knell. We physicians all know of instances when the husband of a wife who was suffering 16 SEXUAL PROBLEMS OF TO-DAY from tuberculosis, nephritis, a narrow pelvis, eclampsia (convulsions), or puerperal insanity, was told emphatically that under no account must she ever again become pregnant. In a year or two the wife comes to us in an advanced stage of pregnancy, and when the terrible tra- vail comes, she is either snatched from the jaws of death with the greatest difficulty, or she passes into the great beyond from which there is no return (and the husband is then free to marry another woman). And we know of in- stances where the sick, suffering wife wept, bc~ged and prayed to be spared another preg- nancy, but it was in vain ; the noble husband in- sisted on his marital rights. In the November, 1910, issue of the Critic and Guide I published the history of, and com- mented editorially on, a case of a woman on Whom Cesarean section was performed five times, In five successive pregnancies. And tho the husband knew after the first pregnancy that his wife, who had a very narrow pelvis, could never have a child by the natural way, he kept on impregnating her time and again, subject- ing her each time to the danger of a lapa- rotomy. Only after the last operation did the doctor have the good sense, which he should have had after the first, to sew up her Fal- lopian tubes so as to prevent any future preg- nancies. Yes, the brutality of certain men in THE RELATIONS BETWEEN THE SEXES 17 this regard, and their number is quite large, is incredible, and is known in all its revolting de- tails to physicians only. So much for Count Number One. COUNT NUMBER TWO. My second count deals with a subject with which most of you, thanks to our agitation dur- ing the past five years, are familiar. A man marries a healthy, blooming young girl. In two, three weeks or months the wife begins to ail, and in a short time she may be- come so acutely ill as to necessitate an opera- tion in order to save her life. And then she loses her feminine attributes and can never give birth to a child. Or the process may be slower, and she becomes a chronic invalid who never knows a day of health in her life. And if she has a child, the child may be born blind or deformed, or so sickly that it dies in a few days or weeks or months. Or the child may be born apparently well and develop the hor- rible symptoms of hereditary syphilis when it is ten or fifteen years old. In short, my second charge of inhumanity is directed against the man who brutally takes a healthy young woman and ignorantly or know- ingly infects her with a loathsome disease, kill- ing her outright, or converting her into a phy- sical and mental ruin, or making her life more 18 SEXUAL PROBLEMS OP TO-DAY wretched than death, by giving her sickly, de- formed, or half-witted children. It is true that now, in the large cities at least, due to the writ- ings and lectures on sexual subjects, men are beginning to be more careful, and it is becom- ing quite a common thing for men to go to a competent physician and have themselves ex- amined before entering into the state of holy matrimony. But we still see enough cases of marital in- fection to make one's blood boil. The stories that I have told in "Never Told Tales" are still being duplicated every day. And what is particularly atrocious is that many husbands, finding that they infected their ignorant and in- nocent wives, do not tell them what the trouble is, do not send them to a competent physician, for fear they, the wives, may find out the true state of affairs, but keep them in ignorance, get them something from the drug store or from some advertising quack, neglecting their cases until the disease has made irreparable inroads. I have personally had to handle a number of such cases. So contemptible some men be! And here I will relate to you a little occur- rence which throws a lurid light on our social system, on the economic helplessness of women. A middle aged man brought to me his wife aged twenty-one, whom he had infected with both syphilis and gonorrhea. When upon ex- THE RELATIONS BETWEEN THE SEXES 19 animation I told him her condition was rather serious, and that she would require long treatment, he, apparently surmising what was in my mind, said: "But, Doctor, don't blame me for it. I told her plainly that I had those diseases and that it was not right we should get married when we did. But she insisted that we should." Which statement the poor wife corroborated. "When later on during the course of treatment I asked her how she could insist or agree on getting married under such conditions, she answered that she was home- less and alone in the world, that she was tired of working, and that she was afraid that if she waited until Mr. X. was well, she might lose him, somebody else might get him. And be- sides, she did not appreciate the gravity of those diseases. If she had known what she would have to go thru, she would, perhaps, have hesitated. Now, what do you think of a society that will create conditions under which a young girl will knowingly run the risk of horrible diseases, will knowingly jeopardise her health and life only to escape the terrible drudgery of outside work and the killing lonesomeness of one who is homeless and friendless? COUNT NUMBER THREE My third charge is perhaps the most serious 20 SEXUAL PROBLEMS OF TO-DAY of all. It is certainly the most delicate of all. It deals with men who bring to the marriage- bed their burned out passions, what I might call their Sexual Ashes. To speak more plainly, it deals with men who get married when they are partially or completely impo- tent. I consider this the greatest misfortune that a man can inflict on a healthy, normal woman. It is a greater misfortune for a woman to have an impotent than a venereally infected husband. This statement which I made incidentally in my lecture before this club, just one year ago, was misunderstood and crit- icized. I repeat it now with all possible em- phasis. But in order to avoid misunderstand- ings, I will explain it in detail. I do not mean to say that venereal infection is less of a mis- fortune than unsatisfied sexual desire. What I mean to say is this : When a husband suffers with venereal disease he can, by a little instruc- tion, easily be taught how to avoid infecting his wife, but little can be done for the wife whose husband is suffering with complete im- potence of long standing, due perhaps to or- ganic causes. Nobody condemns more severely than I do the man who will enter the marriage state, when his disease is in an acute stage, when he has mucous patches on his lips, or a gonorrheal discharge ; and I would not hesitate to inform the prospective bride of such a man, THE RELATIONS BETWEEN THE SEXES 21 in spite of the law and the ethical injunction of professional secrecy. I would not permit a healthy human being to go to perdition with- out moving a finger to prevent the tragedy. But men who will enter matrimony when they know that they are in a dangerously infectious condition are not many. Such beasts exist, but they are rare and exceptional specimens of our sex. There are, however, numerous cases of an- other type. A man has been engaged to a young lady. They decide to get married. All arrangements have been made. The day of the wedding has been set. Finely en- graved invitations have been sent out. A week before the wedding the bridegroom, who is reading books on what a married man ought to know, recollects that five or six years ago he had a "touch" of gonor- rhea which after one or two months' treat- ment was apparently completely cured. Or per- haps it was a "mild" case of syphilis. He wants to be sure that he is fit to marry. He comes to us. We examine him and find a few gonococci in the prostatic secretion. Or We find the Wassermann reaction mildly positive. "What should we do? Should We sternly tell him to call off the wedding, to postpone it in- definitely, to create a scandal, to break his and his bride's heart? This would be as cruel as 22 SEXUAL PROBLEMS OE TO-DAY it would be foolish and unnecessary. No, we act differently. We tell the patient his true condition and give him a simple remedy by which he can avoid both infecting and impreg- nating his wife. That is what modern, up-to- date physicians do. I have acted in this man- ner in a hundred instances and with never a mishap. And in the meantime, the patient is taking proper treatment, until he is really well and free from danger. If the doctor in Brieux's play, "Damaged Goods," had been an up-to-date man, the tragedy would not have happened. He would have permitted George Dupont to marry, but he would have given him something to prevent Mrs. Dupont from getting pregnant, treating George vigorously in the meantime. If you will remember, Mrs. Dupont escaped infection, it was the child that was born syphilitic. That is what happens in Brieux's play, and that is what generally hap- pens in real life. I trust I have made myself clear. I consider venereal disease in a prospective husband less of a misfortune than sexual impotence, because against venereal infection the wife can be guarded readily, while there is no remedy for permanent impotence except change of hus- bands or the taking of a lover. With the exception of the sufferers them- selves, the laity has no idea how much misery THE RELATIONS BETWEEN THE SEXES 23 women undergo on account of impotence in the male; it is women's luck that so many of them are sexually frigid or anesthetic. But those who are sexually normal or — mercy on them — above the normal, how they do suffer! Even the family physician is seldom aware of the true state of affairs, for they are ashamed to tell him. It is only to the specialist that they pour out their hearts. The long sleepless nights, the restless toss- ing, the hot burning longing, the splitting head- ache, the dry throat, the pain in the ovarian re- gion, etc., etc., — have I painted the picture cor- rectly? And the lord and master who has left the wife in this unsatisfied, irritated condition lies near and sleeps peacefully, or snores sten- toriously. And if this condition of ungratified sexual desire lasts, we get anemia, a dingy com- plexion, black rings under the eyes, and gener- ally premature old age. But the husband is often blissfully unaware of all this. The wife herself often does not know what the trouble is, and if she does, she wouldn't tell him. It would be so unwomanly. It is indelicate, it is shameful for a woman to confess to possessing such an unladylike thing as a sexual instinct, a sexual desire. And so she goes on suffering, unless she happens to be- long to an aristocratic or ultra-radical circle. Bear in mind that in inveighing against 24 SEXUAL PROBLEMS OF TO-DAY impotent husbands I do not refer to the husband who becomes impotent at the age of forty-five or fifty, after having been mar- ried fifteen to twenty-five years. This afflic- tion is often physiologic and nobody is to blame; or if somebody is to blame, the wife is often more to blame than the husband. An iron-clad monogamy is responsible for impotence in some cases. No, I refer to the men who are impotent when they enter mat- rimony. Of these, we have two distinct types. To the first belongs the pure young man, who is often referred to sneeringly as goody-goody, who has no intercourse up to the date of his marriage, but who is either addicted to mastur- bation or suffers wjith frequent pollutions. He comes to the marriage-bed undefiled, he will not infect his wife with any venereal disease, but her marital life will be a hell on earth, nev- ertheless. The second type is diametrically opposite. It is represented by the man, any- where between thirty and forty-five years of age, who has led a pretty free sexual life — he may or may not have had half a dozen attacks of gonorrhea — who has become weakened by excess, for whom sexual promiscuity has there- fore lost its fascinations, and who decides to settle down and make some woman "happy." On account of the man's experience in matters sexual, that happy woman's life may not be THE RELATIONS BETWEEN THE SEXES 25 quite so miserable as that of the goody-goody's wife, but it is often wretched enough to make her pray for deliverance, and to regret bitterly that her husband did not select some other woman to make "happy." I dwell so much on the sexual relations be- tween husband and wife because I consider sexual health as the very basis of the happiness of the home. You know that I am not an ex- tremist, am not given to making sensational statements, unsupported by facts ; but I am now going to make a statement which may seem to some of you extreme and sensational. Those, however, who have given the subject a careful, deep study will corroborate and support me. I make the bold, unequivocal statement that every case of divorce has for its basis lack of sexual satisfaction. There may be numerous other causes on the surface, but the basic, un- derlying, predisposing cause is sexual impo- tence, sexual dissatisfaction, sexual mismating. If there is perfect mutual sexual satisfaction, then all those causes which in sexually mis- mated couples lead to divorce, either do not make their appearance at all, or if they do make their appearance, they are glossed over, overlooked, and forgotten. A wife who is thoroly satisfied and is treated kindly and in a comrade-like manner will overlook many things in her husband; if she knows to a cer- 26 SEXUAL PROBLEMS OF TO-DAY tainty that he occasionally breaks the so-called marriage vows, she -will either make believe that she knows nothing about it, or she will give him her blessing. The wife who sues an otherwise ideal husband for divorce simply be- cause he occasionally strays from the straight path is an exceedingly rare phenomenon; she can only be found in a perverted religious bigot, and does not deserve much of our sympa- thy. Now, why is it that so many men, who would rather chop their right hands off than marry when suffering with a venereal disease in the infectious stage, give no thought to the condi- tion of their sexual potency? It is because the opinion is still general that a woman has, or should have, no sexual desire, or at any rate, that her purely sexual life is a secondary, un- important matter, about which she herself cares little, and about which the husband needs care still less. You know my opinion on the subject. You know that I do not believe that the woman is exactly the same sexually as the man. You know that I believe that, generally speaking, the sexual instinct in the human fe- male is weaker than it is in the male, and awak- ens in full force at a much later period. But saying this is very far from denying the exist- ence of a strong sex instinct in the female; it is very far from denying that this instinct THE RELATIONS BETWEEN THE SEXES 27 needs regular natural gratification. It is not even incompatible with, the statement that many women are as passionate as any man can ever be, some of them being constantly smoul- dering volcanoes. And all these facts are cruelly ignored by a large majority of the male sex. So utterly impotent are some men, that we know of a number of cases of women who had been married several months to several years and were still retaining their virginity. There are cases of women with intact hymens after ten years of married life. We know women who have been married a number of years, ten, fifteen, twenty-five, and during the entire pe- riod have not had one natural satisfying coitus. What the nervous and physical condition of such women is, can be better imagined than de- scribed. Lucky the husband if the wife is in- nocent and unsophisticated enough not to sus- pect what the trouble is. And the misfortune is, that the man may be impotent and still keep on impregnating his wife at frequent intervals. For potentia gen- erandi does not always go hand in hand with potentia coeundi, and vice versa. One may ex- ist in strong measure without the other. Before I conclude this chapter it is well to add that in many cases it is not really impo- tence, but ignorance and awkwardness that is 28 SEXUAL PROBLEMS OF TO-DAY at the bottom of the trouble. Very often a little discreet advice given on the qniet to the husband or the wife converts an unhappy dis- enchanted couple into one full of happiness and the joy of life. A separate count could be made against the man who on his wedding night behaves so that his wife forever after shudders at the thought of intercourse, but as this is a subject on which I could not speak freely in public, even before the most radical audience, I am obliged to dis- miss it with a mere mention. COUNT NUMBER FOUR. Now I wish the radicals in the audience to sit up and take notice. "While my first three counts concerned chiefly the average conserva- tive citizen, this count is directed principally against the radicals, — radicals of all shades. This count deals with the seduction of young girls. I do not refer here to the vulgar variety of this sin, where a man seduces a girl under promises of marriage, or while she is under the influence of alcohol, of which he induced her to partake. This variety of seduction has been known for the last thirty or forty centuries, and is as common to the rich aristocrat as it is to the poorest workingman. This is common rascality based upon lying and deception, and worthy of the severest punishment of the ordi- THE RELATIONS BETWEEN THE SEXES 29 nary law 1 . But it does not concern us here. Here I refer to the insidious, persistent, sys- tematic campaign which is carried on by many of our radicals against young girls, with the ob- ject of persuading the latter to yield up to them their virginity, to make them do it, of their own free will, so to say. Before I go any further, I wish to enter an emphatic disclaimer against intending to give you a lecture on morality. Nothing is further from my mind, nothing is more distasteful to me than the role of a preacher of sexual moral- ity, which is generally sexual hypocrisy. You know well that I do not consider ante-nuptial or extra-marital relations a heinous crime ; nor do I believe that a loving union must necessa- rily be sanctioned by priest or magistrate, tho as a matter of wisdom and convenience it is better that it be so officially sanctioned. No, I have not come here to preach morality. If a young woman, mature in mind and body, has thought it all out, if she has reached the con- clusion that chastity is but an ancient super- stition, and if she has decided to lead a free sexual life, well and good. May Eros, the god of love, bless her. Her decision may not be the wisest, but no radical thinker will think of throwing a stone at her or at her male compan- ion or companions. But what I object to most strenuously, what I do condemn more strongly 30 SEXUAL PBOBLEMS OF TO-DAY than I can find words to express, is the insidi- ous seduction by persuasion of girls of sixteen, eighteen, or twenty, girls who have yet no mind of their own, who have no definite convictions on the subject, whose whole education consists perhaps in having attended a few lectures, and whose entire asset is the word "Radical." By persistently dinning into those girls' ears that chastity is but a foolish superstition, that the sexual instinct is as natural as the instinct of hunger or thirst, and that its gratification can therefore be no more sinful than is eating or drinking, by ridiculing their bourgeois moral- ity, by giving them certain kinds of literature, radical, erotic, or simply pornographic, and last but not least, by assuring them that noth- ing can "happen" to them, they succeed in gaining their point. And I am told that a num- ber of roues and debauchees who are not radi- cals, who despise radicalism, just don the rad- ical cloak in order to visit the radical gather- ings and hunt victims therein. As I said, it is generally the definite and pos- itive assurance that nothing will "happen" to them, that breaks down the final barrier. But, unfortunately, not so very rarely, something does "happen." And then, in many instances, the man proves a craven coward. He leaves the girl to bear the burden alone. Bear in mind, please, that my indictment is based not THE RELATIONS BETWEEN THE SEXES 31 on hearsay, not on what I read, but on actual personal knowledge. My fame is so great that it has reached even the lower East Side, and during the past two years I had at least a dozen young girls from down-town coming to me and weepingly, tremblingly, or with as- sumed bravado, begging me to "relieve" them. And I have had several of them from the Up- per West Side and some of them even from the Bronx. For radicalism is spreading every- where. And everywhere it was the same heart- breaking story. She was persuaded, she was assured that nothing would happen, and When it did happen the man slunk away, leaving her alone to hunt for a doctor or a midwife, and waiting for the outcome in the background. In some cases the men stood the expense, in others they didn't even do that. In a number of cases the girls who were stenographers, schoolteachers, settlement workers, etc., lost their positions on account of the time which they had to take off in order to get rid of their trouble; and many were sick for months after- wards, and some will remain invalids for life. For, as our radicals are generally poor devils they cannot afford to employ a high-class abor- tionist, as is done by the wives and mistresses of our millionaires ; they go to a cheap doctor, or what is still worse, an ignorant midwife, and the result is not infrequently life-long invalid- 32 SEXUAL, PROBLEMS OF TO-DAY ism. [Sometimes it happens that they take the girl's money, tell her that everything is all right, that they have brought it on, when they have not brought it on ; in a month or two the girl finds to her horror that she is still preg- nant.] I had occasion to examine a girl on whom an abortion had been produced several months before by an ignorant bungler. She had been bleeding and ailing all that time, and had to give up a good position. Her condition was terrible. She will remain an invalid all her life, unless she submits to a radical opera- tion, removing the ovaries, the Fallopian tubes, and the uterus. Her suffering and her general condition was pitiful. It was she who said to me: "I curse the day on which I first went to a radical meeting." To call a person a moral leper does not mean much. Often it is only begging the question. For the word "moral" means different things to different people. But I believe we, radical thinkers, can all agree as to what constitutes an anti-social act. If we can prove that a cer- tain act leaves in its trail misery, suffering, ill-health, and even death, then we have a right to call such an act anti-social, and the man ha- bitually guilty of such acts an anti-social indi- vidual, a dangerous individual if you will, or if you prefer to use commonly current terms, a Wretch or a scoundrel. And judging by this THE RELATIONS BETWEEN THE SEXES 33 standard I do not hesitate to apply these terms to the man, who, like a wolf among sheep, prowls abont among young girls, thinking only of one thing, whom he may devour next. And I believe the loud calling attention and the con- demnation of this brutal male is particularly timely now, because he is becoming very com- mon, he is spreading thruout the civilized world, he is even becoming the hero of Euro- pean novels. Some of you may be familiar with Sanin, a wonderful novel by a wonderful Russian writer. The book, which appeared about three years ago, is a very great one from a literary point of view, but it had a most pernicious influence on the youth of Russia. Soon after its appear- ance there sprang up all over the country free love or Sanin leagues, from whose member- ship even girls of fifteen or sixteen were not excluded. Venereal disease and pregnancy, which led in many cases to suicide, broke up most of these leagues. Well, the author of Sanin, Artzibasheff, has just written another book called "The Last Point," of which only the first part has appeared so far. [I read it in German, in which language it appeared even before the Russian edition, and I am told that a French and an Italian translation are being prepared now. If you know any of those lan- guages, you may read the book, as I can assure 34 SEXUAL problems of to-day you it will never appear in an English transla- tion. For outside of purely pornographic lit- erature, it is the "last point" in sexual real- ism.] In this book the author goes even a step further. His handsome hero, Jeneeff, a painter by profession, and a seducer by conviction, goes about deliberately searching for the hand- somest girls, and as he is irresistible, his vic- tims are many, and he spreads pregnancies right and left. But it does not bother him. That Nelly, one of his victims, an extremely sympathetic girl, in the sixth month of preg- nancy, was on the point of committing suicide, does not disturb his sleep or his equanimity in the least. He has had already a dozen vic- tims since he dropped her. Because he makes no false promises to the girls, because he does not promise to marry them, or even to remain constant to them for any length of time, he con- siders himself morally blameless. That he in- cites, excites, inflames and ignites those impres- sionable young girls and thereby sows ruin and destruction does not seem to rankle in his heart at all. And the worst of it is, that the author, who himself leads an extremely licen- tious, promiscuous life, seems to be on the best of terms with his hero, and fully to approve of all his rascally doings. Whether or not the hero is punished in the end for the anguish and agony which he has been scattering broadcast, THE RELATIONS BETWEEN THE SEXES 35 whether or not he is made to see that he has been acting as a contemptible, cruel egotist, whether or not he finally perceives that the con- stant gratification of one's sexual passions is not the highest ideal in the world, whether or not it dawns upon him that the purchase of one's momentary pleasures at the cost of an- other's lifelong suffering is not exactly the right thing to do, I do not know. For as I told you, only the first part of the book has made its appearance so far. But whichever way Artzibasheff's novel ends, it is a sign of the times, and should serve as food for intense thought to those of us (to the sane and humani- tarian radicals) who would not like to see the old replaced by the new, if the new is to be the cause of more misery and more wretchedness than was the old. COUNT NUMBER EIVE. My first three counts dealt principally with the newly married woman; my fourth count dealt with the unmarried girl. I am now go- ing to break a lance in behalf of the woman of forty-five; one of the most pathetic figures in society to-day. Her treatment by the male, radical as well as conservative, is nothing short of brutal. What does she amount to? Not being a man, and having, in their sapient opin- ion, ceased to be a woman, she is no longer* 36 SEXUAL PROBLEMS OF TO-DAY human being, and need not be treated with any consideration or chivalry. The husband thinks she has lived her life and she needs nothing more; the stranger or former admirer thinks that there is no longer anything feminine in her and she is no longer able to either feel or dispense any pleasure. All this is the result of ignorance, the result of misinformation which has come down to us from the ages gone by. It is high time these erroneous notions were exploded It is the general opinion of the layman and even of the not well-informed physician that a woman af- ter the menopause, or climacteric, is no longer a woman, can have no more sexual desire, and can experience no sexual pleasure. This is all wrong. A woman of fifty can be more passion- ate and can suffer more from lack of sexual gratification than a girl or woman of twenty- five. Menstruation is not essential to sexual desire. The sexual feeling does not reside in the ovaries alone. Even women whose ovaries have been removed have sexual desires. [Strange to say, in some the passion becomes even accentuated.] The same as with eunuchs. It is a mistake to think that eunuchs have no sexual desires. There are three varieties of eunuchs, and only those who have been cas- trated in infancy are free from the call of the sex. It is a mistake to think that the libidio THE RELATIONS BETWEEN THE SEXES 37 resides in the sexual organs only. In women, as well as in men, it has three centres: In the cortex of the brain, in the spinal cord, and in the sexual organs proper. And as long as one of these centers remains uninjured the libido sexualis may remain undiminished, tho the po- tentia may be absent. Because a woman has ceased to menstruate she must not necessarily have lost all sexual desire, and it is wrong to treat her as if sexually she were non-existent. Many women preserve their sexual desire and power unimpaired to the age of sixty, sixty- five, and over. And it makes me mad to see the wife so neglected merely because she has reached a certain age. I am not a blind worshipper at the shrine of Femina. I readily tho sadly grant that some wives merit all the neglect they get. It is un- fortunately only too true that there are many women who think that once they are married they need no longer take care of themselves. They neglect themselves, they become slovenly, unclean, and dilapidated. The tooth-brush, the vaginal douche, the bath-tub, is neglected. The lingerie, or in plain English, the under- wear, the most important part of a wife's toi- let, is treated with scant consideration, and is seldom of immaculate purity. They seem to forget that it is a much easier task to catch a man than it is to hold him permanently. They 38 SEXUAL PROBLEMS OF TO-DAY seem to be unaware of the fact, a fact that is very sad but true, that in spite of his growing recognition and appreciation of her intellectual powers, the brute whom we call man still con- tinues to demand that his wife or female com- panion be before all things clean, dainty and sweet. I refuse to admit that a splendid brain and high altruistic activity are incompatible with a becoming and well-fitting dress, with scrupulous cleanliness, daintiness, and sweet- ness of body. But some women seem to be of a different opinion. I have known women who within a few years after their marriage pre- sented such sights, that a man who had spent seventeen years in an uninhabited island with- out seeing a female creature would have turned away from them. Such women, I repeat, de- serve all the neglect they receive at the hands of their husbands. But it is not of such wives that I speak here. I speak here of the wife that is everything a woman should be, but who in the natural phy- siological course of events has lost her girlish freshness and beauty, and is beginning to ap- proach middle age. Her hair is not so lus- trous and abundant as formerly, a silver thread may appear here and there, her eyes have lost some of their brilliancy, the skin is not quite so velvety, crows' feet begin to make their ap- pearance, and the wrinkles behind the ears, — THE RELATIONS BETWEEN THE SEXES 39 the first heralds of approaching age, — are quite unmistakable. This is a cruel time for the woman, if the husband is not a good man. It is then he begins to neglect or even to insult his wife and to run after other women. On the quiet, if he is a conservative, openly if he is a radical. If he is the latter, he begins to talk of affinities, and soul-mates. He prates about love being free and untrammeled, and brooking no restraint. He will even tell you that continuing to live with a wife, when love has fled, is equivalent to prostitution. And if he leaves his wife, his radical friends may even applaud him ; at any rate they find no word of condemnation. The poor woman, who has lost her youth, her beauty, and perhaps her health, in the service of the man and his children, is not taken into consideration. She may end her life in solitude and desolation the best way she can. The brute man, whether he belongs to the conservative or the radical variety, needs a good "talking-to" on this subject. First, last, and all the time, let us not prostitute the sa- cred name of love. In 999 cases out of 1,000 it is not a new love that drives the man away from his middle-aged wife; it is the desire for a fresh young female body. [Not that there is anything sinful or criminal in such a desire; no, the desire is apparently a natural one, and 40 SEXUAL PROBLEMS OF TO-DAY what is natural cannot be sinful or criminal. But giving unbridled license to that desire to the complete and utter neglect of the woman to- wards whom, in spite of a few extreme and somewhat cracked radicals, we do have some duties and obligations, may be sinful and criminal.] When I discussed this subject once with a few friends, one of them, a member of the Sun- rise Club, remarked, "Oh, it is easy for Dr. Robinson to talk the way he does, when he has such a beautiful and charming wife. If he were in the place of somebody I know," — he meant, I think, himself, — "he would talk differ- ently." Of course I cannot say how I would talk if I felt and thought differently. Our thoughts are colored by our feelings much more than we suspect, and very often when we think we are absolutely objective in our utterances, we are speaking our subjective feelings, which we take for abstract thoughts. But I believe that even if I acted like one of the radicals to whom I referred above, I would still maintain that the treatment to which many wives are subjected is unjust and cruel. When a man sets up certain moral standards which he does not follow, it does not necessarily mean that the standards are wrong ; it may only mean that the man is weak. I have read over what I have written on this THE RELATIONS BETWEEN THE SEXES 41 count, and I am not satisfied. I fear this di- vision is not so clear and free from the possi- bility of misconstruction as are the other parts. To obviate, if possible, the most glar- ing misunderstandings, I would emphasize the following points : What I said under this head- ing does not mean 1. That I believe that when a woman has married a man she owns him body and soul and that he cannot maintain any friendship with other women. 2. That I believe in a rigid iron-clad monog- amy. As I said before and elsewhere, a really clever woman will shut her eyes and overlook occasional peccadillos on her husband's part. 3. That I believe that a man and wife must remain living together under all circumstances. On the contrary, where there is real incompati- bility of characters, or where there is a distinct mutual aversion, then it is best for all con- cerned that they part or divorce. And the sooner they do it the better. It is best for them, best for their children, best for society. COUNT NUMBER SIX. This count deals with the treatment meted out to the wife who is childless. In former times the woman exclusively was considered at fault in every case of barrenness or sterility. When the wife failed to endow her master with 42 SEXUAL PROBLEMS OF TO-DAY an heir she was packed off to the doctor, and she was subjected to all kinds of treatment, curettings, dilatations, etc., and if the treat- ment remained ineffective, she was often di- vorced. In this man-made world it never came to the people's and even to the doctors' minds to search for the cause in the man. As a matter of fact, we know now that in a large percentage of cases it is the husband and not the wife who is to blame for sterility. In my own practice I have found the husband to be the cause in 80 per cent, of childless marriages. He is either suffering with congenital aspermia, or what is more common, azoospermia, or his ejaculatory ducts have been sealed by a bilateral gonorrheal epididymitis, or he infected her and made her sterile. And I never treat now a woman for alleged sterility until after I have examined her husband, for a five minutes' ex- amination of the husband often saves the wife months and months of useless treatment. But the world at large is still ignorant of these facts, and the wife is still made the scapegoat in cases of sterility. Sometimes the husband who is exclusively the cause of the sterile mar- riage uses the sterility as an excuse to get rid of his Wife. Luckily the women are beginning to learn something. THE RELATIONS BETWEEN THE SEXES 43 COUNT NUMBER SEVEN. My first six counts were the most important ones. The remaining four are of minor sig- nificance and will be dealt with more briefly. This count deals with the attitude of radicals on the subject of alimony. Our radicals seem to consider the payment of any kind of ali- mony a "damnable outrage." So one ex- pressed himself. Others designate it as "le- galized blackmail." Again, I must say, what selfish brutes these men be! "What would you want the woman to do after she has given up the best years of her life and is no longer beau- tiful enough to get another husband, or young and strong enough to learn a profession or trade? Shall she go begging or become a street-walker? "The woman should be eco- nomically independent." She should be, but she is not at the present time. We are deal- ing with the present, not the future. It is quite possible, or even quite probable, that in the fu- ture when women are economically on the same footing as men, many ugly and otherwise un- attractive men who can have their pick now, will have to go without wives altogether. They will stay old bachelors against their will, the same as we now have involuntary old maids. But, as I said, we are speaking of the present and not of the future. At the present time when a man marries he makes a tacit contract 44 SEXUAIi PROBUSMS OF TO-DAY to provide for his wife to the end of her days ; and if he gets tired of her and wants to dis- card her it is but right he should provide for her against destitution and starvation. Many women have excellent trades and professions when they marry. Attending to the household and caring for the children, who have a way of coming into the world once in a while even when you don't want them,, forces them soon to give up their customary work, and after ten or twenty years they are as badly off as if they never had a profession. I know women druggists, dentists and physicians who now, after several years of married life, could not earn their salt at their chosen profession. Would it be right to put them out on the street without making any provision for them? Of course, I know some radicals will say, a woman should not give up her profession when getting married. Well, I should like to see them attending to their profession, and partic- ularly to follow its progress and advanced methods, with four children dangling at their skirts. It can be done, it has been done, but I do not speak of exceptional, I speak of average, every-day cases. And so do not be cruel to the woman who needs the alimony. It is not alms you are giv- ing her — you owe it to her. Probably if you paid her in mere wages what she was actually THE RELATIONS BETWEEN THE SEXES 45 worth she would not be in need of your ali- mony. And it is a disgrace to see women mar- ried ten, twenty and thirty years working like slaves and not having a dollar which they can call their own. They have food and shelter, they can have all the clothes and jewelry they want, but they cannot dispose of a hundred dol- lars freely. They must either do it secretly, or they must beg their master's permission. A disgraceful state of affairs. COUNT NUMBER EIGHT. You know that I do not believe that a loving union needs the sanction of either priest or magistrate, and people who decide to live with- out such sanction do not on account of that fall in my opinion. In certain cases they are even raised, for it requires a great deal of courage to live such a free union. Nevertheless, I maintain that under our present social condi- tions the man who agrees to live with a woman without marrying her is a cruel man and does not love the woman. No, he does not love the woman, no matter how vehemently he may pro- test to the contrary. Under our present social conditions a woman living in officially unsanc- tioned union is subjected to so many humilia- tions, rebuffs and insults, her position is so false and precarious, especially in case of a child coming into the world, the husband dy- 46 SEXUAL PROBLEMS OF TO-DAY ing, etc., that the man who will not undergo the marriage ceremony, empty and silly as it may seem to him, in order to obviate all these dis- agreeable features, is not an ideal man and does not love the woman. Of course we are familiar with the argument of tying one's self for life, and how can one know if the love will prove lasting, etc., etc. But love which con- siders that it may at some time cease to be has ceased already. Love which has the slightest doubt of its permanency is dead already. True love does not consider the possibility of there ever being an end. True love does come to an end sometimes, but while it lasts it does not count upon such a contingency. If it looks into the future, counts, considers and calcu- lates, it is not love. It is a base, spurious imi- tation — it is not the genuine unadulterated ar- ticle. I know, of course, that there are in real life women, who like the heroines in Grant Allen's "The Woman Who Did" and Edouard Rod's "Au Milieu du Chemin" (The Middle of the Eoad) refuse to marry, valuing their im- aginary freedom so highly that they will not live with the man except in a free union. That is another story : if the woman insists, it is her privilege. But even here, the man if he really loves the woman should use his utmost powers of per- suasion to induce her to enter into a legal THE RELATIONS BETWEEN THE SEXES 47 union, as did the hero in Kod's novel, and as the hero in Grant Allen's novel tried but failed to do, leading to the unhappiness and the sui- cide of the heroine. I cannot help but believe that even the freest woman must be grateful to the man who in- duces her to get legally married to him (un- less where such a marriage is for certain rea- sons legally impossible), and I cannot help but believe that even the freest woman feels a lit- tle resentment towards the man who agrees to keep her constantly in a false, humiliating posi- tion. If I am wrong in my belief, let the radical woman get up and refute my statements. COUNT NUMBER NINE. This count applies more to the conserva- tives, tho our radicals are not entirely free from blame in the matter. I refer to the nar- row limits, to the diminutive sphere to which woman is confined. That the orthodox con- servative thinks that the kitchen and the home are all-sufficient for woman, we know well enough. But very many of our radicals are not much better in this respect. Even social- ists' wives have complained that they are kept out and away from the real lives of their hus- bands, that while abstractly granting them 48 SEXUAX. PROBLEMS OF TO-DAY equal rights, privileges, and opportunities, they (their husbands), still seem to feel that the skirt and petticoat wearers are interlopers, and things in general would be better if they did not meddle, but stuck to their own sphere. And for that reason the wives of many of our radicals lead a dull, lonesome existence, not much better than do the wives of our farmers, who contribute proportionately the greatest contingent to our insane asylums. Yes, this attitude of regarding women with secret contempt and ill-concealed ill-will has not yet entirely disappeared. Even scientists, who are supposed to be above such considera- tions as sex, color, creed and nationality, can- not help but show themselves in their true col- ors once in a while. Sufficient to mention Mme. Curie, who was refused membership in the French Institute by its trousered and suspen- dered members simply because she is a skirt- wearer, i. e., a woman. This is a shameful at- titude, and is particularly disgraceful when it makes itself apparent among radicals. One need not be a sloppy sentimentalist in the mat- ter — one may recognize that woman is inferior to man in many of her abilities, and conse- quently will never be his equal in many lines of human activity, and still demand that she be given every possible opportunity for develop- ment, that she be given at least full recogni- THE BEIATIONS BETWEEN THE SEXES 49 tion for the work she has achieved, for the tasks she has accomplished. COUNT NUMBER TEN While the double standard of sexual morality- is, taken purely in the abstract, unquestionably wrong, still, as I have shown elsewhere, there is both a physiologic and a social reason for this double standard. It was not established thru male wickedness alone. Chastity in the female is both physiologically more feasible and socially more important, and tho many of our imprudent, prurient prudes do their very ut- most they will not succeed in making the world believe that the lack of chastity in the boy or man is the same serious affair that it is in the girl or the married woman. I have a great suspicion that those who vocif- erously claim that it is, believe so only with their lips or their fountain pens — deeply in their hearts they believe no such thing. Yes, I repeat, chastity in the woman is an important thing, and I can hardly believe that there is one man in the Club here to-night who would re- gard pregnancy in his own unmarried daughter with perfect equanimity. Nevertheless, I say that man's (and here I must say, woman's also) attitude towards the woman who has yielded to man's persuasion in a moment of passion, or even with full deliberation, is extremely cruel 50 SEXUAL PROBLEMS OF TO-DAY and brutal. Of course it is especially so if she carries on her the sign of the "sin," that is, if she is unhappy enough to have become preg- nant. As a matter of wisdom, and for the sake of the happiness of the future child, no woman should, under our present social system, be an illegitimate mother ; but if it is her misfortune to be one, or if she chooses to be one, it should be nobody's business, and he who dares to throw a stone at her should himself be stoned. And before I conclude I wish to refer, with- out making a separate count of it, to the das- tardly cynicism of the man, generally conser- vative, but not infrequently radical, who after he has persuaded a woman to yield to him makes fun of her, despises her and speaks of her with contempt to his intimate friends. A peculiar phase of psychology this ! To force a person to do a thing, to tell her that she is mentally immature if she refuses to do it, and then to despise her as an immoral creature if she does do it. There is perhaps an Eleventh Count. A woman told me that the greatest inhumanity of man to woman is in not marrying her and leav- ing her to become an old maid in such large numbers. But this I consider the fault of our economic system. Under better economic and social conditions man would be only too glad to marry, and the lonely pathetic creature THE EELATIONS BETWEEN THE SEXES 51 known as the "old maid" would not be such a common occurrence, and her number would not be getting larger from year to year. I therefore refuse to lay the blame on man for this misfortune. Man has enough to answer for without charging him with social sins for which he is not responsible. EESTJME. I am thru. Let me make a brief resume of this long paper. I charge the human male with brutality and inhumanity to the human female. This brutality and inhumanity consists : In considering her a breeding animal, good only for bearing and nursing children ; In infecting her with venereal disease; In neglecting or disregarding her sexual nature ; In considering her the guilty party in child- less marriages, when the husband is to blame; In excluding her from his larger interests and confining her to a dull, narrow, monotonous sphere of life ; In condemning and ostracizing her for the same sins which he is committing from his earliest youth to his most advanced age ; In seducing her when she is young, friend- less and helpless and letting her bear the bur- den alone when she is in trouble ; and in casting her off, be she unmarried to him or married, 52 SEXUAL, PROBLEMS OF TO-DAY after she has served his purposes and has no longer the beauty and freshness of youth. This is my indictment against the male ani- mal, called man, a genus to which intellectu- ally and physically I am proud, but morally am ashamed, to belong. And it is because our radicals are as guilty of some of these charges, as are the conservatives, being the principal culprits in one important count, that I decided to speak on this subject before a radical audi- ence. And should this address of mine be in the smallest measure instrumental in causing a kindlier and more sympathetic attitude towards woman, I shall feel most amply repaid for the time and labor spent in its preparation, and also for the four or five hours spent here in this unventilated hall in an atmosphere laden with carbon-dioxide, tobacco smoke and count- less germs. THE INFLUENCE OF SEXUAL ABSTI- NENCE ON MAN'S GENERAL HEALTH AND SEXUAL POWER The question of sexual abstinence is of im- portance to millions of men — and women too. No question is asked of us more frequently than the question: Is sexual abstinence com- , patible with perfect health? And an explicit categorical answer is demanded. Explicit cat- egorical answers are out of place in medicine. They may be necessary in quiz compends and in students' manuals, but no scientific physi- cian will be guilty of laconic dogmatic state- ments or ironclad rules; no more so than of rule-of-thumb treatment. The question of the compatibility of sexual abstinence with health has two distinct divisions which must be treated separately. The first division deals with the influence of abstinence on the person's general health; the second, with its influence on his sexual health. The writer believes that he has had as much experience with sexually disordered patients and has devoted as much time to the subject of human sexuality in its normal and abnormal manifestations as any one in this or any other 53 54 SEXUAL PROBLEMS OF TO-DAY country. And he believes that his opinions on the subject of human sexuality are entitled to carry some weight. And while, as said above, we do not approve of dogmatic statements, still we believe that our conclusions based upon ex- tensive personal investigation and inquiry, may be accepted as fairly correct. We will consider each division of the subject separately. 7s Complete Sexual Abstinence Compatible with Perfect Health? In other words, can we assure our patients and the public who look to us for guidance that complete and entire abstinence from sexual in- dulgence will not in any way injure their gen- eral health? To this question the general an- swer is in the affirmative. But several specific conditions must be stated. First. It applies to normal healthy men. Second. The men must know that it is so. That is, the man who abstains must know that the abstinence will not injure him. Sugges- tion here plays a more important role than in any other sphere of human life. If the man im- agines that intercourse is a necessary factor in adult life and that abstinence is injurious, it will be injurious to him. He will imagine all kinds of ills and he may actually work himself up into a nervous neurasthenic condition. SEXUAL, ABSTINENCE 55 But convince a man that abstinence will not in any way prove injurious to him, and he will bear his deprivation with much greater equa- nimity. Third. The "patient" must not allow his thoughts to dwell upon the subject. This is a very important point. He must know that he can't or mustn't and that that settles it. If he will allow his thoughts to run loose, or will read obscene literature or witness lascivious shows, and try at the same time to lead an ab- stinent life, he will certainly injure himself. He will probably succeed in setting up in him- self a mild chronic prostatitis, which will com- plete the vicious circle, and the result may be a very unpleasant one. It is remarkable what an influence the knowledge of "I can't," "I mustn't" has on most men. For instance, there are conscientious patients afflicted with an intractable chronic gonorrhea or syphilis. They go six months, a year, two years, and syphilitics even three and four years without coitus and, as far as one can see, without the slightest injury to their general health, or even with benefit. The same is true of strongly and earnestly religious persons. Fourth. And this is the most important point — the person must be thoroly busy, he must be engrossed in some work, some study, an invention, or a hobby; the work must en- 56 SEXUAL PEOBLEMS OF TO-DAY gulf him, must occupy all his thoughts, must leave him little or no leisure. People so en- gaged have little difficulty in leading a com- pletely abstinent life; in fact abstinence seems to be essential to their work. We have known scientists devoted to original research, people engaged in writing some compendious work, revolutionists who had devoted their lives to the liberation of their country — and to them the entire subject of sexual relationship was non est. They lived a perfectly abstinent life for ten, twenty and more years, enjoying in the meantime good general health — better health, perhaps, than the average man. Fifth. An important aid is open air life, as much as possible, exercise, bathing and all other conditions tending to improve the gen- eral health. It is a very common impression — both among laymen- and physicians — that good general strength is conducive to libido sexualis, sexual excitement, etc. This impres- sion is only partly true very frequently. The strong healthy person has less frequent desire, can exercise better control and abstain longer than the weakling, who takes no exercise, leads a sedentary life, etc. The latter is very readily irritated, has no self-control and while he may suffer from ejaculatio praecox, his libido is al- ways present and he indulges frequently. Many physicians know instances of debilitated SEXUAL ABSTINENCE 57 tuberculous patients who thought that they had to have, and indulged in daily intercourse. Good health is never a danger. It is often a protection against excesses in Venere as well as in Baccho. And here, en passant, we will touch upon another popular error, and that is that superior physical development also neces- sarily means superior sexual development. This is not so. We have had in our practice several all-around athletes, whose physical de- velopment was superb; every muscle was a thing of beauty; there was not a gymnastic exercise or an athletic sport in which they did not excel; and they were totally impotent, when they came for treatment. Sixth. Alcohol in every shape or form must be cut out, eliminated absolutely, and meat must be reduced to a minimum; a moderate portion once a day, preferably in the day time. Under the above conditions, complete absti- nence is quite compatible, in the majority of men, with perfect health — mental and physical — whether it be for a year or ten, or even per- haps a lifetime. To avoid any misunderstanding, however, I will add that the above statements apply only to men who have already had some sexual ex- perience. In young men without any sexual experience another element enters into the question: the element of intense curiosity, of 58 SEXUAL PROBLEMS OF TO-DAY wildly exaggerated expectations, etc., and these feelings and longings if unsatisfied are apt to cause various unpleasant symptoms, even genuine neuroses and psychoses. In other words, statements to the contrary not- withstanding, it is easier to abstain for men who have had some sexual experience than for men who have had none. This is true of men. With women the contrary is the case. We now come to the second division of our subject. Is Sexual Abstinence Compatible with Perfect Sexual Health? In other words : Will sexual abstinence for a considerable length of time impair the sexual function or rather the sexual power — for the question is of potentia coeundi and not poten- tia generandi — or not? This last question, we regret to say, we are obliged to answer in the affirmative. Abstinence for a considerable length of time will tend to weaken a man's sexual vigor. While the length of the period cannot be specified, personal inquiries from different and reliable sources leave no doubt in our mind as to the correctness of this state- ment. Only very recently a physician thirty- five years of age, in perfect general health, ap- plied to us for treatment. He was very bitter against "the senile or senescent" fogies, who SEXUAL ABSTINENCE 59 pass false resolutions and try to persuade the people that complete abstinence is a desirable thing from every point of view. He claims that he was in perfect sexual health, practising moderate coitus ; somewhat from moral consid- erations, but chiefly influenced by the claims of some medical leaders as to the perfect harm- lessness of abstinence, he decided to lead a to- tally abstinent life. And now at the end of six or seven years he finds himself almost to- tally impotent. We always make it a point to gather information on this point. There are luetic patients who abstain for three, five years, and inquiry from them elicited the fact that both power and libido were diminished. We therefore must repeat our statement that complete abstinence for a considerable length of time will weaken the sexual power — the same as excess will. Abuse and non-use of any function will tend inevitably to weaken it. As stated or intimated, the statements made above refer to and are correct as to the vast majority of mankind. In medicine, however, there are no rules or statements which apply to every individual of the species. While the rather hackneyed phrase that every man is a law unto himself is not quite true, it is true that mankind may be divided and classified into a number of groups which are laws unto them- 60 SEXUAL PROBLEMS OF TO-DAY selves. And this is certainly true as far as human sexuality is concerned. There is a class of people, not a very large one — and we are not referring to perverts — endowed with such powerful, passionate sex- uality, that to them sexual life is an absolute necessity. Deprived of it, they are incapable of any mental work, become fretful, irritable and "good for nothing." To such people the statements made in the first division of our paper do not apply. Now, we are almost sorry that we have writ- ten the above paragraph. For there is dan- ger that some readers will imagine that they belong to the above class and that abstinence for them is an impossibility, that they will be injured by it, etc. Let us therefore hasten to add that the class just referred to is a very small one, and a good deal of a person's sex- ual necessity is purely imaginary. It is funny how many people — young, old and middle aged — like to boast of their quasi-remarkable vigor and passionateness. And when we first tell them that they will have to go four, six, or eight months, as the case may be, without in- tercourse, they protest vigorously; they could not stand it, absolutely impossible, etc., etc. But when we assure them respectfully but firmly and rather unsympathetically, that they can stand it very well, that their uncontrollable, SEXUAL. ABSTINENCE 61 unrestrained, Niagara-like passion resides chiefly in their imagination, they cool down, and we hear no more complaints. But as there are people endowed with a high sexuality, so per contra there are men to whom any kind of sexual indulgence is absolutely poisonous. This is an important point, for even physicians do not seem to be aware of it. We are not speaking of people affected with heart disease, arteriosclerosis, etc. That to them sexual intercourse is injurious is a well- known fact. But there are people who are ap- parently healthy in every respect. Examina- tion fails to detect any disease or disorder; even their libido is not diminished. And still a single sexual intercourse acts on them as if they had taken an overdose of poison, or as if somebody had hit them on the head with a club. They become completely knocked out mentally and physically and they illustrate in a superla- tive degree the old Latin adage : omne animate post coitum triste. Age does not seem to be an important factor, for our patients ranged all the way from thirty to sixty-five years of age. Such people, unless transformed by treatment, must of course abstain from sexual congress as long as they live. A brief resume of the above statements may prove useful: 1. Normal men, engaged in work which 62 SEXUAL PROBLEMS OF TO-DAY takes their time and engrosses their attention, who are determined to live abstinently and who know that such life is not incompatible with perfect health, who abstain from alcohol- ics in any form and use meat very moderately, can abstain from sexual intercourse for many years or their lifetime without injury to their health. 2. Sexual abstinence for a considerable length of time has a tendency to weaken the sexual power. It may produce impotence, par- tial or complete, temporary or permanent. 3. There is a small class of people of very high sexuality to whom sexual life is an abso- lute necessity. We have no right to counsel abstinence to such people. But we must be careful not to mistake sexual hyperesthesia, excessive irritability, for true libido sexualis. 4. There is another class of otherwise healthy normal people, to whom the most mod- erate indulgence is excessively injurious. Un- less such people can be improved by treatment, they should be forbidden sexual indulgence ab- solutely. THE DOUBLE STANDARD OF MORAL- ITY, AND THE EFFECTS OF CON- TINENCE ON EACH SEX There has been a great r deal of discussion recently about the single vs. the double stand- ard of morality for men and women. The sex- ual radicals and those who are most orthodox in sexual matters have reached one and the same conclusion: there shall be but one stand- ard of morality for the male and the female sex. Of course the opinions of the radicals and the orthodox are diametrically opposed to each other. The radicals say that the woman should have the same right that the man has: if it is all right for a man to indulge in ante- nuptial or extra-marital relations, then it is all right for the woman also. The orthodox on the other hand say: if it is wrong, if it is vi- cious and sinful for a woman to indulge in extra-marital relations, then it is just as wrong, just as vicious and just as sinful for a man to do so. But the conclusion, as you see, ia the same. Neither the radical nor the ortho- dox admits of any excuse or reason for a differ- ent morality in men and women, for neither 63 64 SEXUAL PROBLEMS OF TO-DAY admits that there is any physiologic difference sexually. Here again they both hold diametrically op- posite opinions, but the conclusion as far as the singleness of the standard is concerned is the same. The radical says: The sexual in- stinct is as strong in women as it is in men, and just as continence in men is injurious and therefore undesirable, just so is continence in women injurious and undesirable. The ortho- dox says : The sexual instinct in man is not any different than it is in woman, and just as con- tinence is easy and harmless for the woman, so it is easy and harmless for the man. It is an extremely delicate subject to handle. It does require a good deal of courage to dis- cuss the question with perfect candor and truthfulness, without paying tribute to cant, superstition or tradition, without fearing the epithets of the prudes and old maids on the one hand and the shoulder-shruggings and scold- ings of the sexual radicals and free lovers on the other. I will not occupy myself with the morality of the question. I will leave that to the profes- sional moralists. I will only deal with the physiology and hygiene of the question. If a consideration of this phase of the subject should justify one in making certain deduc- tions, I am not to be blamed for the latter. I THE DOUBLE STANDARD OF MORALITY 65 do not make the facts: I merely state them. And here are the facts, which no physiologist can deny. The libido sexualis awakens in boys at a much earlier age than it does in girls. In fact it is not commonly appreciated at what an early age the instinct awakens in many boys. And I do not refer to large-city boys who are pre- maturely stimulated by vicious companions, by vaudeville shows, by posters, by exhibitions in windows, etc. I refer to boys who have been brought up with the greatest care and caution, whose ears have never been shocked by an ob- scene word, whose eyes have never beheld an obscene book or a suggestive picture, who have never been in the proximity of a free and easy female, who do not even suspect the existence of such females. And in such boys the sexual instinct is often powerful at the age of four- teen, twelve, ten and even earlier. Without giving the subject a thought, unconscious of any such thing as a sexual problem, they have vague unexplainable desires at first, which be- come gradually stronger and more definite, un- til they become fully crystallized into an at- traction for the opposite sex. And without being enlightened on the subject by anybody, they begin to have erotic dreams, ending in emissions, and it is from those dreams that they often derive their first sexual instruc- 66 SEXXJAIi PROBLEMS OF TO-DAY tion. . . . And the initiation into the prac- tice of masturbation is not always done by a vicious companion; not infrequently nature herself is the teacher, who introduces the boy to the unnatural practice of satisfying his ar- dent desires. To repeat briefly: in the large majority of boys libido sexualis is developed at a very early age — fourteen, twelve, ten or earlier — and so strong is the desire, that when natural satisfaction is impossible, as it usually is at that age, it finds relief in emissions accompa- nied by erotic dreams, or in masturbation. A very different state of affairs obtains in girls. While for the purposes of maternity they become ripe at an early age — eleven to fourteen — their libido sexualis becomes awak- ened many years later. A large majority do not experience any libidinous desires whatever until the age of twenty, twenty-four or twenty- five. In fact many married women remain cold and indifferent to the sexual act for sev- eral years after marriage; it takes them sev- eral years to become sexually educated. And even then in many the desire is due more to an established habit than to an actual necessity. I do not make any dogmatic all-inclusive state- ments; we can make but very few statements which are applicable to all humanity, or to an entire sex. I am fully aware of the fact that THE DOUBLE STANDARD OP MORALITY 67 there are women and girls in whom the natural passions are exceedingly strong, strong to the point of nncontrollability. But they constitute a small minority. There is another class of girls in whom the passions are apparently very strong, but if ex- amined into, it would be found, that the libido is the result of an artificial stimulation, that their eroticism has been aroused by books, by certain plays, by the equivocal stories of their newly married sisters and friends, etc. It is really more a burning curiosity, than a burn- ing passion. The reason for this difference in the two sexes is not hard to find. In the male sex the testicular glands begin, at an early age, to elaborate a very highly organized fluid, which being absorbed into the blood intrinsically per se, and mechanically by distending the seminal vesicles, acts as an excitant of the sexual ap- petite. And Nature has not provided a regu- lar, periodic outlet for this testicular fluid. In the female sex there is no accumulation of a highly organized fluid acting as a stimulant and excitant, while the congestion of the uterus and the ovaries is relieved with the menstrual fluid with monthly regularity. From what has been said it is clearly evi- dent that I maintain that the sexual appetite awakens in girls several years later than it does 68 SEXTTAL PROBLEMS OP TO-DAY in boys, and that in not initiated, not artificially stimulated women the libido is considerably weaker than it is in men. I know there are some physicians who dis- agree with me. There are some physicians who maintain that the libido in the female sex is just as strong as it is in man, only it is more re- pressed. As a proof they give the frequency of masturbation in girls. But this very frequency is a disputed point. Exact reliable figures it is of course impossible to obtain. We can only go by impressions. Those who maintain that the libido is equally strong in both sexes claim that masturbation is just as common in girls as it is in boys — namely in 90 to 100 per cent. I, on the other hand, and those who believe with me, maintain that this injurious habit will be found in only about 10 per cent of girls. So this does not settle the question. If positive data could be obtained, we would have a pow- erful argument either for the one side or the other. But so far the question of masturba- tion proves nothing. We now come to the effects of continence, i. e., total abstinence from sexual intercourse. There is no question within the entire sex- ual domain which has excited so much discus- sion as has this one : is sexual intercourse neces- sary to the individual, is absolute continence THE DOUBLE STANDARD OF MORALITY 69 injurious to health? As a rule the question is asked with reference to the male sex only; the female sex is left out of account, as if it did not exist — which shows man's supreme ego- tism. "We personally have been asked the question hundreds of times. It is not a question which admits of a categorical answer, applicable to every male. Nor is it necessary. As I said many times before, in medicine we cannot make absolute dogmatic statements: that is the field of theology. There is no "always" and no "never" in medicine. There is no rule appli- cable to every human being. In many respects every human being is a law unto himself. But answering the question in a general way, I will say emphatically: Yes, absolute continence is injurious to the male. In some cases the in- jury is slight and transient, in others it is very severe and permanent. I am fully aware of the fact that people whose minds are intensely occupied with interesting problems, like in- ventors, scientists, mathematicians, or who are given over life and body to some important work like revolutionists or even religious fanatics, may abstain for years without injury. But the average of humanity is not composed of inventors, scientists, mathematicians and world saviors, and I speak of the average of 70 SEXUAL PROBLEMS OP TO-DAY humanity. But even in those who are deeply engrossed in some consuming work I am not so sure that the harmlessness is not more ap- parent than real. For I believe I can affirm with positiveness, from certain personal inves- tigations, that even in those people the po- tentia coeundi becomes considerably or totally impaired, tho their general health may appar- ently not have suffered any injury. In what does the injuriousness of continence express itself? The effects, of course, vary greatly both in kind and extent. They may range from simple nervousness, irritability, lack of appetite, inability to concentrate the mind, headache, backache and constipation up to fully developed neurasthenia with its pro- tean manifestations and complete impotence. Of course, if the continence leads to abnor- mally frequent pollutions, nocturnal and diur- nal, and to spermatorrhea, or to excessive masturbation, then the man may become a wreck, physically and mentally. A genuine psychosis may also be one of the results. Ac- cording to Freud apprehension or anxiety neurosis is due exclusively to sexual repres- sion. In women the results of continence are some- times also very disastrous, but as a rule they are much milder, begin to make their appear- THE DOUBLE STANDARD OF MORALITY 71 ance later in life, and there is one essential dif- ference: continence in the female is of course not followed by impotence. A virgin may marry at the age of thirty-five or later and she will be a normal wife, while a man who has re- mained absolutely continent up to age of thir- ty-five or forty may on marrying find himself totally unfit for his so-called marital duties. To recapitulate: 1. Libido sexualis makes itself naturally manifest in boys at a much earlier age than it does in girls. 2. The sexual instinct is much stronger, more imperative, more uncontrollable in men than it is in women. There are notable excep- tions among the latter, but they are exceptions nevertheless. 3. The results of absolute continence are much more pronounced, more pernicious, more lasting in men than they are in women. For one thing, one of the most dreaded possibili- ties, which stands specter-like before middle- aged continent men, namely, sexual impotence, leaves women entirely undisturbed. All or al- most all their disturbances disappear with mar- riage, which unfortunately is not always the case with men. If from the above statement of physiologic facts, the moralists or the unmoralists can de- 72 SEXUAIi PROBLEMS OF TO-DAY rive justification for a double standard of mor- ality in the two sexes, they are welcome to do so. I have merely stated the facts. MY EEASONS FOB ADVOCATING THE REGULATION OF OFFSPRING Every day I see examples of heart-breaking misery caused by the lack of knowledge of the proper means of prevention, and I consider the problem of limitation of offspring the most important problem affecting the welfare of hu- manity, because I know — Because I know of thousands of families who would be perfectly happy if they only knew the proper method of regulating the number of their offspring. Because I know of thousands of young men who would be glad and happy to get married, but are restrained from doing so by the fear of too many children. Because I know of thousands of young men, who, restrained from marrying by the fear of too many children, have, in consequence, con- tracted venereal disease or have become ad- dicted to dangerous sexual irregularities. Because I know of thousands of women who have become chronically invalided by too fre- quent childbearing and lactation. Because I know of thousands of women who 73 74 SEXUAL PROBLEMS OP TO-DAY have become incurable invalids by improper at- tempts at prevention. Because I know of thousands of men who are pitiable sexual neurasthenics from coitus in- terruptus, which they practice thru ignorance of better methods of prevention. Because I know of thousands of women who have actually killed themselves, have been driven into early graves by abortions or at- tempts at abortion. Because I know of thousands of children whose education has been neglected, who have been improperly brought up on account of the mother's inability to attend to too many. Because I know of thousands of children who, borne by their mothers unwillingly, in anguish and in anger, were born mentally and physically below par, only to be a burden to themselves and to others. Because I know of thousands of children, born of epileptic, syphilitic or tuberculous parents, who should not have been born at all, because they came into life handicapped, had to fight against severe odds, lived a poor life and died an early death. Because I know of many other things which on account of our prudery cannot well be spoken of, but which cause boundless misery to men, women and children; and this unneces- sary misery will disappear only when the peo- THE REGULATION OF OFFSPRING 75 pie have learned the proper method of regu- lating the number of their offspring. Human beings are not animals, and they should have a right to say how many children they will have, how frequently they will have them and when they will have them. There is no single measure that would so positively, so immediately contribute towards the happiness and progress of the human race as teaching the people the proper means' of reg- ulating reproduction. This has been my sin- cerest and deepest conviction since I have learned to think rationally. It is the convic- tion of thousands of others, but they are too careful of their standing to express it in public. I am 1 happy however to be able to state that my teachings have converted thousands; many of our readers who were first shocked by our plain talk on this important subject are now express- ing their full agreement with our ideas. And Congress may pass draconian laws, the discus- sion of this subject cannot, must not, be stopped. THE WOMAN AT FORTY AND AFTER There was a time when a woman, married or single — but particularly single — on reach- ing the age of thirty would begin to consider herself old and to feel as if she owed somebody an apology for her existence. That time is luckily passed. Now nobody would be so im- pudent or so fatuous as to apply to a girl of thirty the offensive appellation of "old-maid," while a married woman of thirty is a very young woman, and is for many reasons much more attractive, much more sought after than her sister younger in years. But now forty is considered the fatal year. As soon as a woman has crossed that Rubicon, she becomes bitterly conscious of her age. She feels herself out of the swim, she thinks she can no longer dress like a young woman, she believes she can no longer inspire in the masculine sex those feelings which a pretty, normal woman is supposed to inspire; and as to flirting, the most harmless sort of flirting — why, she thinks it would be an imposition on her part, so to say an attempt to obtain money on false pretences. In short, she thinks her- self old. 76 THE WOMAN AT FOETY AND AFTEB 77 Well, if a woman at forty thinks herself old — it is her own fault. We repeat it with em- phasis — it is her own fault. Not Nature's fault. And not being a natural, inevitable event, it can entirely or to a very great ex- tent be prevented. There is no reason why a woman at forty should not look and feel like a woman at thirty or twenty-five. Thirty or thirty-five is not the acme of a person's age and there is no natural decline after those years. On the contrary, there is a gradual rise in physical as well as in mental power, and just as a man reaches his prime at forty-five, so a woman, who knows how to take care of herself, should keep on in- creasing in attractiveness until that age. That this is not only a theoretical but a prac- tical possibility, is known to everybody who is acquainted with some of our actresses and so- ciety women. It is well known that many of our actresses do not seem to age at all, and some look more attractive now than they did ten or fifteen years ago. And this not only on, but off the stage. But it is not necessary to go to the stage for examples. We know in pri- vate life several women between the ages of forty and fifty who have preserved themselves beautifully (and whose skin has never known the touch of rouge or swan-down either). I know one little woman near forty who seems 78 SEXUAL PROBLEMS OP TO-DAY to have discovered the fountain of perpetual youth. Her skin may not have the same peachy creaminess that it had twenty years ago, but in her tout ensemble she is just as beautiful, just as attractive, just as appetizing — if you will pardon this unconventional term — as she was at the age of twenty or thirty. And she holds her husband-lover just as firmly as she did the first year he married her — or more so. All a woman has to do is to want to feel young and to observe a few hygienic rules and she can be at forty as attractive as a young girl. And more than that. There is no in- trinsic reason why a woman at fifty should not have all her physical, yes, all her sexual at- tractiveness and charms unimpaired. It is an art, and it requires some effort and persever- ance, but an increasing number of members of the lovely sex are learning the art. THE LIMITATION OF OFFSPRING* THE MOST IMPORTANT IMMEDIATE STEP FOR THE BETTERMENT OP THE HUMAN RACE, FROM AN ECONOMIC AND EUGENIC STANDPOINT. Should this paper seem somewhat unusual I beg you to remember that the entire progress of the human race has been due to unusual things. If Spinoza had not thought some unusual thoughts, we might still be cherishing the free- will fetish; if Morse, Stephenson, and Fulton had not thought some unusual thoughts, we should not have the telegraph, the railway, the steamboat ; if Edison had not thought some un- usual thoughts, we should not have the incan- descent light, or the phonograph; if Bell had not thought some unusual thoughts, we should not have the telephone; if Herz and Marconi had not thought some unusual thoughts, we should not have wireless telegraphy. If Bruno, Voltaire, Paine, Ingersoll, and others, had not said some unusual things, the world would be * Read before The American Society of Medical Sociology, March 4, 1911. 79 80 SEXUAL PROBLEMS OF TO-DAY steeped in ignorance and superstition, even much deeper than it is now. If Marx and Las- salle had not thought some unusual thoughts, we might still be groping in the dark as to the causes of our economic miseries. If Darwin and Haeckel had not thought some unusual thoughts, a much larger number than is now the case would still be hugging the childish be- lief in our descent from Adam and in the crea- tion of the world in six days some brief six thousand years ago. If Semmelweis and Holmes had not thought some unusual thoughts, our puerperal women would still be dying by the thousands ; if Mor- ton, Simpson, Long, and Wells had not thought some unusual thoughts and done some unusual things, we might still be without the blessings of anesthesia ; if Pasteur, Koch, and Lister had not thought some unusual thoughts and per- formed some unusual experiments, the millions of lives saved by preventive medicine would still continue to be sacrificed; if McDowell, Sims, Chopart, Pirogoff, Billroth, Bergmann, Czerny, Kocher, Murphy, and numerous others had not done some unusual things, surgery would still be where it was a hundred years ago; if Aronson, Behring, and Boux had not thought some unusual thoughts, we should not have diphtheria antitoxin; if Ehrlich had not gotten some unusual ideas into his head thirty THE LIMITATION OF OFFSPRING 81 years ago, we should not have salvarsan now. And so I could go on showing that it is the unusual things and thoughts that move the world. Humanity may be divided into two classes. One class thinks that this world is all right, that things are as they should be. In fact, their motto is, "Whatever is, is right." With such people, we can have nothing to discuss. Where ignorance is bliss, it is folly to be in- formed, and we can only envy them their ig- norance. The people of the other class — and let us be thankful that their number is growing larger and larger — do not think that the world, that is, the human race, is all right. They perceive the terrible misery, the degrading poverty, the cruelty, the rowdyism, the ignorance, the super- stitions, the killing drudgery and monotony all around them; their minds revolt and their hearts bleed at the spectacle, and they say: "No, this cannot be right, this cannot go on, it must not be permitted to go on" — and they look around for remedies. Not all the thinkers and sociologists agree on the remedies; if they did, we should arrive at the social reformation much sooner. This diversity of opinions cannot be helped ; perhaps it is better so : thru a diversity of opinion and thru a multiplicity of discussion, provided the 82 SEXUAIi PROBLEMS OF TO-DAY discussion be honest and sincere and not un- necessarily acrimonious, we shall arrive ulti- mately at the truth. I have my remedies for the uplift and the regeneration of humanity and for bringing happiness to every human being. This is not the place to discourse on all the remedies — it would take too long to discuss them all in de- tail. I will therefore limit myself only to one, perhaps the most important at the present time. In the very first year of my practice I had noticed that the "happy event" — the birth of a child — which is supposed to bring joy and happiness to the house, often brought gloom and misery. I have watched the gradual growth of families, and so have you. The first child was like the arrival of some great treas- ure; it was really a joyous event and all were happy. The second child was received with less joy; the third with indifference; during the fourth pregnancy, the mother came to you and timidly, hesitatingly, asked you if you could not do something for her; "it was only three weeks overdue" — etc. . . . you know the rest. In short, the fourth child was ex- ceedingly unwelcome and was merely tolerated ; and each succeeding child was more and more unwelcome. I have known cases where the child in the womb was cursed, and both the THE LIMITATION OF OFFSPRING 83 father and the mother prayed and hoped that it might he aborted or born dead! And you all know of cases where there were distinct signs of disappointment on the faces of mother and father when the child was born healthy and made its presence known by a lusty cry. And we all know families that started to live a nice, comfortable life y and whose standard of living became gradually lower with each child, until they reached the lowest depths of abject poverty — with the children dirty, ragged, un- cared for, and consigned to the streets. I have investigated the subject, and I have devoted years to its study, and I have come to the positive conclusion that excessive child- birth among the poor is one of the greatest curses that afflict humanity. It is one of the greatest causes of low wages, poverty, igno- rance, idleness, sickness, crime and death. What is the remedy against this condition? To advise the people not to marry? That would be as wrong as it would be unfeasible. Man is not only a gregarious, he is a social animal, he craves companionship, and the only little pleasure the poor man sometimes has is his wife and his little home. To advise bach- elorhood would be wrong socially as it would be useless, for the mass of the people would not follow it, and it is absurd to give advice which cannot and will not be followed. 84 SEXUAL PROBLEMS OF TO-DAY "Let them abstain." To advise married people to abstain for months and years at a time is as hypocritical, as insincere, as dishon- est, as it is pernicious. It is hypocritical, in- sincere and dishonest, because the one who gives such advice knows that it is impossible of being followed. It is pernicious, because if it were followed, its effect on the health of its followers, on their nervous equilibrium, on their affections even, would be in the highest degree disastrous. Advice to the poor — including in this term workingmen, small business men, struggling professional men — to remain single, or if mar- ried to abstain from intercourse, being un- worthy of consideration, what other remedy is there to help them out of the difficulty? There is a simple remedy, and that remedy is to teach the people how to regulate the num- ber of their offspring, so that they may have only as many children as they want, and only when they want them ; in other words, the rem- edy is to teach the people the proper means of the prevention of conception. And, while I may touch upon various other points, the chief object of this essay is to ad- vocate that the teaching of the prevention of conception be considered, not only perfectly legitimate, but that it be considered the duty of the medical profession to impart this infor- THE LIMITATION OP OFFSPRING 85 mation to their patients. Our present laws' regarding the imparting of information of the prevention of conception are in the highest de- gree brutal and infamous. These are the only adjectives that will characterize them properly. Introduced and dragged thru by puritanical in- quisitors, they are a blot on our country and a disgrace to our nation! Do you know what the punishment is for sending by mail or express any kind of infor- mation on the subject of prevention, be it a formula, a method or simply a suggestion? The punishment is five years at hard labor plus five thousand dollars fine. And there are con- temptible spies whose office it is to write to physicians, inducing them to break the law, so as to get them into their clutches. I get hun- dreds of such requests every year. Of course the writers disguise their identity and the let- ters are supposedly from poor women who have already nine children and can't afford to have any more, or whose husbands are mildly in- sane or epileptic, and so forth. But you may think, things cannot be so bad. You may think the law would not be so cruel with a physician as to confine him in prison be- cause he sent a formula to some poor man or woman. Ah, that is just the trouble. We are all interested in our own little af- fairs; what happens beyond our noses we do 86 SBXUAIi PROBLEMS OF TO-DAY not know and do not care to know, and we are, therefore, often incredulous when we are told of the cruelties, of the brutalities, that are practised two steps away from us. Let me read you a letter. Dr. William J. Boiinson. My Dear Doctor: Quite well knowing that re- ceipt of a letter from a man in the penitentiary would cause you surprise, I write you with a feeling that I am fulfilling a long-deferred obligation. An obli- gation in as much as I have always had a desire to express my appreciation of your high standing in the medical profession, and I take this opportunity of expressing my greatest thanks and at the same time extending my hand in congratulation of your high and noble ideals as to the welfare and better- ment of the human species. With the expiration of my subscription to that harbinger of light and truth, your Critic and Guide, I am now without medical literature of any kind. My conviction was secured upon that clause of the statute which refers to the giving of information whereby or whereat a remedy can be procured for the prevention of conception, and upon conviction I received a sentence of ten years and a fine of ten thousand dollars. The evidence consisted of two de- coy letters written by an aide to the secret service department, and at the trial her own testimony brought forth the facts that she had passed the meno- THE LIMITATION OF OFFSPRING 87 pause ten years previous. Owing to the tender pleadings of this woman's letter my sympathies were aroused, and I replied and gave said information gratis and, as I believed, consummated a most hu- manitarian act. After a Federal Grand Jury returned an indict- ment against me, I sold my property, and the at- torney's fees for my defense at the ensuing trial drained me of every dollar which I possessed. Trusting that I may soon have the great pleasure of hearing from you, I am, Sincerely yours, 6. Alfred Elliott, M. D., Box 7, Leavenworth, Kan. I have corresponded with Dr. Elliott, and asked him why he got double the maximum sen- tence, and he wrote me that they gave him the maximum penalty for each offense, i. e., for each reply to the two decoy letters. Do you see the brutality of the thing? Ten years at hard labor and ten thousand dollars fine — or a day for every dollar — for having sent two prescriptions in response to two de- coy letters ! Let us assume that the law against the sending of anticonceptional information is not a stupidly fiendish law, let us assume that it is a perfectly proper law, and that Dr. El- liott broke it. Would not imprisonment for six months or one year have been sufficient as 88 SEXUAL, PROBLEMS OF TO-DAY a punishment? Why destroy a man's life for- ever? Even the maximum penalty of five years and five thousand dollars was not suffi- cient to satisfy the revengefulness of his pros- ecutors; they gave him the maximum penalty for each offence, making it ten years and ten thousand dollars. I wonder at their generos- ity; they should have tried to catch him on twenty offenses and then given him one hun- dred years and fined him $100,000. I tell you, my friends, the Torquemadas, Philip the Seconds and Alexander the Sixths are not all dead yet. We have now among us puritans and ignorant fanatics who would crush us and burn us if they had the power. And remember, there is no cruelty like religious cruelty and there is no brutality like the bru- tality of the hypocritical pharisaical puritan of the type of Anthony Comstock. Having shown that there is an extremely drastic, nay brutal, law against the dissemina- tion of any information about the prevention of conception, and having shown you that the law is not a dead letter, but is applied merci- lessly, revengefully, let us now consider whether there is any justification for such a law. In other words, let us consider whether the knowl- edge of the prevention of conception is likely to lead to dire results, whether it would tend to lead to physical or moral injury of the peo- THE LJMITATION OF OFFSPRING 89 pie, or not. If yes, if the knowledge is likely to have disastrous effects, then the law against the dissemination of such information is justi- fiable, drastic as it may be; if, however, the knowledge of prevention of conception is go- ing to lead only to beneficial results, then the presence of such a law on our Federal statute books is an infamy, and every thinking man, every humanitarian, should protest against it with all his might, and we should not rest un- til it has been repealed; we should not rest un- til this infamous blot, which is a menace to every physician and every advanced thinker, has been wiped off our penal code. The first objection we encounter when we ad- vocate the limitation of offspring is the buga- boo of race suicide. Our dear opponents are in mortal fear that if people learn how to pre- vent conception, they will stop having children altogether and in half a century or so the race will die out. This is a groundless fear and a silly calumny on the human race. The parental instinct is a pretty strong in- stinct and is implanted in the breasts of the majority of normal people. The couples are rare, indeed, who do not wish to have at least one or two children. Those who have seen the anguish of some wives who have remained sterile for several years after marriage, those who have seen mothers with contracted pelves 90 SEXUAL PKOBLEMS OP TO-DAY knowingly subjecting themselves to the dan- gers of a cesarean section only to have a liv- ing child, those who have seen married men undergoing all kinds of treatment in order to be able to have an heir, will not share the fear that when the knowledge of the means of pre- vention has become common property, the hu- man race will cease to breed. No ! there will be fewer children, they will be conceived deliberately at opportune periods, but they will be carried in their mothers' wombs with gladness and joy, they will be brought into the world with pleasure and hope- ful expectation, and they will be brought up with care, zeal and love. But, our opponents say, we will admit that the human race will not be extinguished, but, surely, you must admit that it will increase in numbers much more slowly than it does now. Yes, we admit that. But is this such a calam- ity? Is it really necessary that the human race should increase in numbers rapidly? In fact, is an increase in numbers so very desir- able? Is it at all desirable? Ask yourself that question, if it never oc- curred to you before. Is there any greatness or any happiness in numbers alone? Is China with its more than four hundred millions any happier than we, who can boast of only ninety millions ? And does China from any and every THE LIMITATION OF OFFSPRING 91 point of view amount to as much as does the United States, which has only about one-fifth of its population? And are we with our ninety millions any happier, or are we accomplishing any more (or even as much) in literature, in art, in science, in philosophy, in economics, in social welfare, in short, in everything that makes life worth living, than does Germany with her fifty millions or France with her forty millions? And would not any one of , you pre- fer to be a citizen of Italy, or Norway, or Sweden, or the little Eepublic of Switzerland, which has fewer inhabitants than has New York City, than be a subject of the brutal, murder- ous Russian czar who reigns over one hundred and thirty millions? No! there is no honor, and there should be no pride in numbers merely. I prefer a commonwealth of five million peo- ple, all of them, healthy and contented, all do- ing congenial work, all having work to do, all materially comfortable, all educated and cul- tured, all free to think and free to express their thoughts, with high ideals of a greater fu- ture and a higher humanity, to an empire or a republic of a hundred millions, all fighting, all struggling, all cutting each other's throats, all in fear of starvation, with senseless luxury on one hand and shameful poverty on the other, with killing idleness on one hand and killing 92 SEXUAL PROBLEMS OP TO-DAY overwork on the other, with bursting oversa- tiation on the one hand and exhausting starva- tion on the other; with millions tramping the streets and highways naked and hungry, with millions of human beings illiterate, held in the clutches of superstition, selfishness and brutish- ness; with thousands and thousands of imbe- ciles, criminals, perverts, grafters, prostitutes — female prostitutes who sell their bodies and male prostitutes who sell their minds, their 1 ideas and convictions — I prefer, I say, the above-described small to the above-described larger commonwealth. No, numbers alone, I repeat, do not count. With Spencer, I despise that vulgar conception which considers a large population, large ter- ritory, and big commerce as its highest ideal, its noblest aim. With Spencer, I would say that, instead of an immense amount of life of low type, I would far sooner see half the amount of life of a high type. But I am not thru yet, even with this side of the question. It is not even true that a diminu- tion of the birth-rate would cause a proportion- ate diminution in the increase of the population. For there is one point which those who have not given the subject any study often leave out of consideration. The point is this: The in- fantile mortality-percentage increases with the increase of the birth-rate. If the mother has many children, she cannot attend to them as THE LIMITATION OF OFFSPRING 93 properly, nurse them as carefully as when she has but few. And, besides, exhausted by too frequent childbearing, her vitality is lower, and the child is born weaker and less able to fight the battle of life. Hence, the percentage of the children who die in families of many chil- dren is much higher than in the families with few children. As a rule, I do not give statistics, for statis- tics have often been abused, and statistics are often fallacious. In my addresses and writ- ings I prefer to depend on my own arguments and on common sense. I have always main- tained that, if common sense won't convince a person, statistics surely will not. But an in- teresting study on this point has recently been made, and I will permit myself just a few fig- ures. The study was made by Dr. Alice Ham- ilton, was read before the American Academy of Medicine and is published in its Bulletin for May, 1910. Sixteen hundred families (1,600) of wage earners were investigated, and the results are contained in the following ta- ble: Deaths per 1,000 births in Families of 4 children and less, 118 Families of 6 children, 267 Families of 7 children, 280 Families of 8 children, 291 Families of 9 children and more, 303 94 SEXITAIi PROBLEMS OF TO-DAY Dr. Hamilton sums up her results as fol- lows : Our study of 1,600 families of the poorer working class shows that child mortality in- creases proportionately as the number of chil- dren per family increases, until we have a death-rate in families of 8 children and over, which is two and a half times as great as that in families of 4 children and under. In short, in families that have few children a much larger proportion remain alive, so that the balance is kept up fairly well. There is still another point. A study by Prof. Theodate Smith, of Clark University, seems to show that very large families tend to be extinguished by the fourth or fifth genera- tion. So you see that even from the standpoint of the race-suicide alarmist excessive childbirth is not an unmitigated blessing and defeats its own object to a large extent. But in the mean- time, it causes lots of suffering, lots of time- waste, lots of economic loss to parents, and deprives the surviving children of the proper chance. In short, excessive childbirth is a crime from every point of view: it is a crime, first and foremost, against the mother; it is a crime against the father, tho he is himself the involuntary author of the crime; it is a crime against the first-born children; it is a crime against society. THE LIMITATION OF OFFSPRING 95 But our opponents are still not satisfied and they are apt to ask the following question, "Do you not admit that there are people without the parental instinct — people who, if they knew unfailing means of prevention, would shirk the responsibilities of parenthood altogether?" Yes, I admit that there are such people. But I will at once add that it is better for the RACE THAT SUCH PEOPLE SHOULD REMAIN CHILD- LESS. Involuntary parenthood is not a lovely thing to contemplate, and from the bottom of my heart I pity the children that are born into the world accidentally, against their parents' distinct wishes. Another apparently formidable objection to the dissemination of the knowledge of anti- conceptional measures in the fear of the effect that such knowledge would have on the virtue of our girls and even on married women. You know there is a class of people that be- lieves that we are all essentially wicked, and the only thing that restrains us from commit- ting all the crimes on the calendar is the fear of consequences, the fear of punishment. The good people belonging to this class believe that the only thing that preserves the chastity of our unmarried women is the fear of pregnancy. The fear of breaking a certain commandment, they hold, is also a factor, but a minor one. 96 SEXUAL PROBLEMS OF TO-DAY Take away the fear of pregnancy, those good men and women say, and there will not be a chaste girl left. They will all rush headlong into never ending sexual orgies. I wonder whether those good, pious people judge others by themselves. No, I do not believe that the mere taking away of the fear of pregnancy would under- mine the chastity of our young girls. There are other and very important factors which keep the girls, under present social conditions, from giving themselves to men before mar- riage. A certain number of girls will go astray under any circumstances, are going astray now, in spite of the specter of preg- nancy and in spite of the terrible social ostra- cism that faces them. But I will grant you that it is possible, that, after the knowledge of the prevention of con- ception has become common property, there will be an increase in what you call illicit sex- ual intercourse. Even if this should be the case, it would be preferable to the conditions that obtain now. It would be preferable that a girl or woman bent on illicit intercourse use a preventive than that she should haunt the offices of the abortionists, male and female; better than that they should ruin their health or kill themselves with poisonous abortifa- cients; better than that they should end their THE LIMITATION OF OFFSPRING 97 existences with carbolic acid or by jumping into the river. Illicit sexual intercourse is not such a hein- ous crime that its punishment must be Death. That is my opinion. If this opinion is im- moral, heretical or treasonable, make the most of it. The foregoing two are the really serious ob- jections to the dissemination of anticoncep- tional knowledge. There are some minor objections. One is that, with such knowledge, married people will indulge to excess, thus ruining their constitu- tions. Here is again the same idea: that we abstain from moral crimes and physical sins only thru fear of the consequences. I stamp this medieval idea as false. Some people will commit sins, crimes and bestialities in spite of consequences; others will lead a healthy, moral, rational life just for its own sake, because they can't help being decent, be- cause they have been brought up to be decent. And I am sure that when the study of sexual hygiene has become universal, when men know that excessive indulgence is injurious, they will abstain from it, the same as they abstain from excessive alcoholic indulgence or excessive eat- ing. It is true, as Shaw says, that married life offers the maximum of temptation with the maximum of opportunity, but as the variety is 98 SEXUAL. PROBLEMS OP TO-DAY lacking, things equalize themselves and the vast majority of married couples settle down after the first few months to a temperate exist- ence, sexually speaking. The other minor objection, which comes from the medical profession exclusively, is of such a character that I am actually ashamed to men- tion it. But for the sake of completeness we will have to include it. Several physicians quite seriously objected to my agitation, on the ground that a dimin- ished birth-rate would mean a very much di- minished income for the medical profession. A great part of the income of many physicians is derived from confinements; and then it is not only the confinements alone; infantile ill- ness during the first two or three years consti- tutes quite an item. Said one doctor to me: "Mrs. X asked me to give her some remedy, as she had four children already. I told her I didn't know any, and last week I delivered her and got thirty dollars for the confinement. The same thing in the case of Mrs. N. From her I got fifty dollars for the confinement. And thru the year I make on an average fifty dollars on each child I deliver. Where would we be without confinements ? " I fully acknowl- edge the justice of this argument of my med- ical friends and I confess my inability to an- swer it. Perhaps the language in which I THE LIMITATION OP OFFSPRING 99 should answer this argument would not be quite parliamentary. Then there is the theologic argument, the statement that our religion forbids the preven- tion of conception. While I do not know which commandment or which other divine injunction lays down the law as to prevention, still, I have nothing to reply to this argument. When theology comes in at the door, reason flies out of the window. You must never discuss any religious questions, unless you and your op- ponent are ready to discuss the very funda- mentals of religion, the very origin and es- sence of religious faith. You know, faith has been defined as believing in something which your reason tells you cannot be so, and with such a state of mind no profitable discussion is possible. The more absurd, the more impos- sible a belief is shown to be, the more te- naciously will the person cling to it. So what is the use? We will, therefore, leave the the- ologic point of view out of the discussion. I have considered every possible objection to my advocacy of the dissemination of the pre- vention-of-conception knowledge. Whether I have answered every point satisfactorily is a different question. But I have considered them all. I asked my various opponents at various times, and they could find no other objections. 100 SEXUAL PROBLEMS OF TO-DAY I have secluded myself in my editorial sanctum and tried to think of any other objections which might enter the minds of some peculiar people, but could find none. I am therefore justified in thinking that I have considered every pos- sible objection. We will now go over to the positive side and see what the universal knowledge of the pre- vention of conception will do for mankind. If you have given the matter but little thought, you will be astonished at the tremendous bene- fits which such knowledge is capable of confer- ring upon the human race. You will be amazed and grieved — as you should be — that this mo- mentous question, this question of the most vi- tal importance — has until now received prac- tically no consideration at the hands of the med- ical profession, or in the pages of the medical press. One of the most serious problems that con- fronts us to-day is the constantly growing num- ber of bachelors, and the more and more ad- vancing age at which marriages take place. For many reasons, this is to be considered a serious evil. Late marriage on the part of the man often means burned-out passions, ex- hausted vitality, impaired or destroyed sexual power, and very frequently it also means half- cured or latent venereal disease. The result for the woman is humiliation, suffering and often THE LJMITATION OF OFFSPRING 101 life-long misery and premature death, while for the progeny it means physical and mental disease, or at least a lowered vitality and a diminished resistance. In short, for the race as a whole it spells: degeneration. But what is the chief cause of our late mar- riages ? Investigate, and you will find that the chief cause is the fear of having children, of having too many children, of having them too soon. You will find that it isn't the fear of supporting a wife — for two often can live as cheaply as one, and if the wife is a good one, even cheaper — but it is the fear of the chil- dren, whose possible number is indefinite. It is not the fear of supporting two, it is the fear of the possible ten. The universal dissemina- tion of the knowledge of contraception would have a wonderful effect in this respect. Let us see: 1. Such knowledge would induce many men to get married much earlier than they other- wise would, and it would decidedly diminish the number of bachelors and of old maids ; and this would have a decided effect on the diminu- tion of prostitution and, consequently, on venereal disease. 2. Numberless women exhaust their vital- ity and become chronically invalided by too fre- quent child-bearing and lactation. Prevention would obviate this evil. 102 SEXUAL. PROBLEMS OP TO-DAY 3. Numberless women are to-day chronic invalids on account of employing improper means of prevention. Freedom to discuss this question would put the proper means into the hands of married women and this evil would be obviated. 4. Numberless women have killed them- selves, have been killed, have been driven into premature graves by abortions or attempts at abortion. This is a terrible evil. And when- ever I hear of a case of a woman dying from an abortion, I blame not the woman, I blame so- ciety or the State, and I feel like sending those responsible for our brutal laws concerning the prevention of conception to the whipping post. Prevention would obviate this terrible evil, this terrible crime which society commits against the female sex. 5. Numberless men are to-day pitiable sex- ual neurasthenics from coitus interruptus, which they practise through ignorance of bet- ter methods of prevention. The knowledge of prevention of conception would do away with this evil. 6. Many men, knowing no means of pre- vention, and fearing to impregnate their wives, are forced to go to prostitutes. In fact, I know and you know of wives who encourage their husbands in this practice — only to avoid the terrible ordeals of repeated pregnancies, THE LIMITATION OF OFFSPRING 103 labors, lactations, and bringing up of children. Wbat the results of such practices may be it is easy to foresee. A knowledge of the preven- tion of conception would do away with this evil. 7. This point may seem trivial to you. It does not seem trivial to me. How many women have you known, who had talent for singing, for painting, for poetry and litera- ture, and in whom the arrival of children in rapid succession crushed out every ambition, deadened every desire, shattered every illu- sion? Children are a great thing — in measure — but their arrival at inopportune times or at too frequent intervals has rapidly metamor- phosed many a high-strung, high-spirited girl into a spiritless, apathetic drudge. You who consider women good for nothing else except for child-breeding, may consider this of little importance. To me this is one of the greatest tragedies of life. 8. There are thousands of women whom to impregnate is almost equivalent to murder. I refer to women with advanced heart or kidney disease, with a tendency to eclampsia, with narrow and deformed pelves. I say, to make such women pregnant often means pronouncing the death-sentence upon them. The knowledge of prevention would save many such women from premature graves. Isn't it worth while? 104: SEXUAL PROBLEMS OF TO-DAY 9. Thousands and thousands of children, be- ing borne by their mothers unwillingly, in an- guish and in anger, are born into the world with an unstable mental and physical equilib- rium, and being besides improperly brought up, on account of the mother's inability to attend to too many, forever after remain a burden to themselves and to others. The knowledge of prevention would obviate this evil. 10. We now come to an extremely important point. There are millions of married couples of whom either the husband or the wife, or both, are afflicted with some disease of a hered- itary character. As examples of such hered- itary diseases may be mentioned syphilis, epi- lepsy, insanity, perhaps also cancer. And people with such diseases, or with tendencies to such diseases, for a long time yet will con- tinue to marry. (It will be centuries before people will be so imbued with the welfare-of- the-race idea that they will be ready to sacri- fice their individual happiness and give up the object of their love and remain single when- ever the abstract good of the race may demand it.) "What shall we do with such couples? Shall we permit them to breed syphilitic, epileptic and insane children? Shall we still further in- crease the burden of humanity, and shall we permit the number of defectives and degen- THE LIMITATION OF OFFSPRING 105 erates to increase without any restriction? Surely not. So, what else can we do with such couples except to teach them fully how to avoid having children? When I discussed this subject recently with some friends, one of them said: "Why, you are simply preaching Malthusianism." Now, first, if I were, that would be nothing against it. There will be a time when Malthus' essay on population will be taken down from the dusty shelves where it has been relegated for a cen- tury and will again be studied with care and attention. And it would do you no harm to read it now and try to learn something at first hand, and learn something about Malthus, who has been lied about and misrepresented as all reformers and intellectual pioneers are. And, second, I am not preaching Malthusian- ism. Malthus cared chiefly for the future. While I also care for the future, I care more for the present, and if we take care of the pres- ent, the future will take care of itself. Then, the only remedy that Malthus proposed or con- sidered permissible was self-restraint, absti- nence. We know now that, from a practical point of view, that remedy is worthless, while the remedy we propose is an efficient one, in fact the only one that would be readily accepted by the vast mass of the people. Bear in mind that the chief theme of my dis- 106 SEXUAL PROBLEMS OF TO-DAY course are the poor, the relatively poor, and those who on account of certain mental or phys- ical disabilities are unfit for parenthood. It is they who should he taught the heavy responsi- bility of parenthood and the means of avoiding it. Those who are rich or well-to-do and are free from transmissible mental or physical taints may have just as many children as they wish. Not only as many as are considered proper by Prof. Emeritus Eliot, namely, eight, but three times that many. So long as the mother has no objection to almost continuous pregnancies and lactations and so long as the parents are able and willing to care for and bring up a large progeny, nobody will say them nay. Later on, when the earth is really popu- lated to its limit, the State may have something to say even to the rich, that is, if there still be rich and poor at that time; but that is not our concern. We are dealing with the now and here and not with the future or the hereafter. I have answered the objections to the pre- vention-of-conception teachings and have shown the great benefits which the knowledge of pre- vention would confer upon mankind, the great evils it would obviate. We will now discuss the general ethics of small families, the ethics of having few children or none at all. Of course, I take decided issue with one of our energetic, but somewhat superficial and THE LIMITATION OP OFFSPRING 107 somewhat blatant national leaders, who would stamp every childless couple as villains of the deepest dye, as men and women deserving the execration of all right-thinking people. I ad- mit that there are people in whom the decision not to have children arises from selfish and perhaps ignoble motives. They don't want any children because they don't want any trou- ble, they don't want their social pleasures dis- turbed, they want fun and material comfort. We cannot respect such people very highly, but, as stated previously, the race is better off with- out their children; for, if they had children, they would not be properly brought up and the children themselves would probably grow up selfish, ignoble prigs. But in the vast major- ity of couples the determination to have one or two children only or even none at all arises from very high motives, and a low birth-rate is, in general, not a sign of a low morality, but of a high morality, of a high intelligence, high sense of responsibility. You will find that the stupidest, the most ig- norant, the most wretched nations have the highest birth-rate, while the most advanced, the most civilized nations have the lowest birth- rate. As examples, it is sufficient to mention China and Russia on the one hand and Prance on the other. And in parentheses I will say that, if you have become imbued with the puri- 108 SEXUAL PROBLEMS OF TO-DAY tanical idea, that France is degenerating, de- caying, you should get that idea out of your head, for it is a false idea, and you certainly do not wish to harbor false ideas. In every- thing that makes life worth living — I have said this before — in general culture, in advanced, liberal ideas, in sculpture, in painting, in lit- erature in all its ramifications, in science, France still stands at the head of nations. There is only one other country that stands fully abreast of France, and that country is — no, not the United States, not England — that country is Germany. And in Germany the birth-rate is also diminishing. For instance, in a recent issue of the Journal of the American Medical Association (January 21, Vol. 56, p. 208) we find an item entitled "Beduction of the Birth-rate in Prussia." From that highly significant item we learn that the ratio per 1,000 child-bearing women, i. e., between the ages of 15 and 45, has declined (leaving out fractions) from 174 in the quin- quennium from 1876 to 1880, to 161 for 1896 to 1900, and 154 in the period from 1901 to 1905. In the cities the ratio has declined from 160 to 129. In the rural districts, the ratio of fertility for the same period was 182, 183 and 178, respectively. As you see, it is the falling birth-rate in the cities which occasions the marked diminution THE LIMITATION OF OFFSPRING 109 of the general fertility. This phenomenon is especially notable in Berlin and the cities of the Province of Brandenburg. The fertility ratio in Berlin sank from 149 in 1876 to 1880 to 88 in 1901 to 1905, a reduction of more than 40 percent. In short, you can take it for granted that the higher the civilization, the lower the birth-rate ; and, within limits, this will continue to be the case until our social-economic system has un- dergone a definite radical change. And it is natural it should be so. For the responsibility of bringing a child into the world under our present social and economic condi- tions is a very great one. The primitive sav- age or the coarse ignorant man does not care. It does not bother him much what becomes of his offspring: if they get an education, if they have enough to eat, if they learn a trade or a profession, well ; if they don't, also well ; if they achieve a competence or a decent social posi- tion, he is satisfied; if not, he can't help it. God willed it so. But, on the other hand, the cultured, refined man and woman look at the matter differently. The thought of bringing into the world a hu- man being which may be physically handi- capped, which may be mentally inferior, which may have a hard struggle thru life, which may have to go thru endless misery and suffering, 110 SEXUAL PROBLEMS OF TO-DAY fills them with anguish. For this is not a beau- tiful world. Let the softheads, the unthinking, the reactionaries repeat that this is a kind world, a good world, the best of all possible worlds. We who have thrown off all illusions, we who despise the untruthful fairy tales, we who demand to know the truth as it is, we who dare to face the facts as they are, know that this is not so. We know that we have evolved from the jun- gle, and we know that this is a mean world, a cruel world, a hard world, a world full of tears, of heartaches, of degradation, of weariness, of neverending drudgery; for many it is a world of misery without beginning and without end. It may be a beautiful world to some, but their number is so small as to be almost inexpressi- ble in percentages. He who can not see should not be blamed for his disability. A person should not be blamed for being affected with congenital or acquired blindness. But neither should they, who can see, be blamed for their clear vision. And what do we, who have clear eyes — and feeling hearts — see when we look about us? We see about us millions of working men and women who go through life, from cradle to grave, without a ray of joy, without any- thing that makes life worth living. In the higher classes we see a constant, hard, infuri- THE UMITATION OP OFFSPRING 111 ated struggle to make a living, to make a ca- reer, and the specter of poverty is almost as unremittingly before the eyes of the middle and the professional classes as it is before the eyes of the laborer. And all over we see ig- norance, superstition, beliefs bordering on in- sanity, hardness, coarseness, rowdyism, bru- tality, crime and prostitution; prostitution of the body, and what is much worse, prostitution of the mind, the hiding or the selling of one's convictions for a mess of pottage. And our prisons, asylums, and hospitals are not decreasing, but increasing in numbers and in inmates. And the standing armies and na- vies that crush the nations' backs are not signs of sanity, of goodness, of a high order of civ- ilization. And as we look beyond, into the eastern part of Europe, we see a huge empire, presided over by a brutal and imbecile tyrant, supported by a blood-thirsty pack of grand dukes and their satellites ; and this czar and his hirelings hold in chains one hundred and thirty million human beings, whom they exile, imprison, crush and trample upon at their pleasure; the very best and noblest of Eussia's sons and daughters — her scientists, her writers and her thinkers — are pining away or going insane in subterranean dungeons, are knouted or delib- erately starved and frozen in the mines of Si- 112 SEXUAL, PROBLEMS OF TO-DAY beria or are dangling from a thousand and one gibbets — and the so-called civilized nations of the world, the United States, England, and France included — sit by and say nothing. When with your physical or mental eye you see those things, you cannot say that this is a good, a beautiful world — not if you are sane. And still I am an optimist. An optimist as to the future. For when I compare the present with the past, there is not the slightest ques- tion in my mind as to the wonderful progress we have made. And our progress in the fu- ture will go at a much more rapid ratio. But while very hopeful for the future, I do not deceive myself, as I said, as to the present ; and this brings us back to the point from which I fear I made a rather too wide digression. It brings me back to the point that while the world is as full of misery as it is, we cannot blame people for refusing to bring additional sufferers into it. In fact, I am almost ready to believe that it would be an excellent thing if all the women thruout the world went on a strike for ten or twenty years and refused to bring a single child into the world during that period. The idea really appeals to me. The labor market would not be glutted, people would not have to cut each other's throat for a little business or a position, and we would perhaps get a sem- THE LIMITATION OP OFFSPRING 113 blance of peace of mind or independence. And the alarmed monopolists and statesmen would perhaps then decide to do something real for the people. A few words about our philanthropic organ- izations and social agencies in their relation to this problem. Good men and excellent women are depicting to us the horrors of the slums. We are being shown how many people are hud- dled together in one small room. We are be- ing told how many dozens of willow plumes, of buttonholes, how many pairs of trousers and shirtwaists, of artifical flowers, etc., the poor working child has to produce in order to gain a beggarly few cents. We justly shudder at the injustice and horror of child labor. We often receive harrowing letters from charity- organization societies asking aid for a poor mother with six or seven little starving chil- dren. The New York Association for Improv- ing the Condition of the Poor, for instance, sends out a picture depicting a mother with a newborn babe in bed and a poor workman sit- ting by and holding his hand despondently to his head. The legend under it reads as fol- lows: "Father a crippled street-cleaner out of work with six children. Youngest, three days old." And he is asking the question, "What am I to do?" In the New York newspapers of recent date 114 SEXUAL, PROBLEMS OF TO-DAY there was a heartrending story of a starving family of nine: father, mother and seven chil- dren. An extract from the paper is as follows : . . . The man while working as a painter's helper fell from a scaffold. He injured a leg se- verely. But when it got well he could get no work and his savings were soon exhausted. Neighbors almost as poor as himself saved scraps of food from their own scantily supplied tables for the destitute family, and on this they existed. During one snowfall the man worked for two days at shovelling — worked in cracked shoes and thin clothing. He lay for a week afterward on a pallet on the floor stricken with pneumonia. "When he got out again, there was another snowfall, and he sought work again. But he was so weak he could not raise a shovel and he was discharged. He said last night, wringing his hands, that he had sometimes begged from door to door, and prayed and prayed for work. The eldest child is a boy of fourteen, but he has been a cripple since birth and he could not get work. The youngest is four months old. Reporters found the children lying with rags on top of them in a room heated only by an oil stove. One of the children had found half a stale loaf of rye bread on the sidewalk earlier in the day and this, soaked in water, had been the only food for the family of nine. The reporters themselves made up a THE LIMITATION OP OFFSPRING 115 purse to give temporary subsistence, and the man and woman and elder children went down on their knees to ask blessings on the young men who had succored them. Such, harrowing stories could be presented by the thousand. Vast amounts of time, energy, labor, and money are expended to alleviate the intolerable sufferings of the poor. And we now help them, not only with food, clothing and money, but we teach them how to take care of their health. Physicians and district nurses go about teach- ing the poor how to live hygienically, how to take care of their children so as to decrease the infant mortality, and hospitals and dispensa- ries are always open and ready to provide med- ical aid whenever needed. Far be it from me to sneer or to speak in any way disparagingly of our numerous philan- thropic enterprises. I sincerely respect every honest endeavor to alleviate the lot of man- kind, even if personally I may consider the at- tempt ineffectual. I do not sneer even at the Salvation Army, for I know that they reach certain dregs of humanity which no other agency can reach. Yes, all the organizations and agencies which have for their purpose the alleviation of suffering, the easing of pain, the stilling of the pangs of hunger, the clothing of 116 SEXUAL PROBLEMS OF TO-DAY the shivering body, have my respect and sym- pathy. I know that they do not go to the root of the evil, I know that they will not cure or permanently relieve our ills, I know that they are only palliatives, but as a physician I know that when a disease is established it is often too late to speak of removing the cause, and I know that there are many conditions where pal- liatives are not only useful and necessary, but the only remedies that we can use. But, nevertheless, it is my sincerest and deepest conviction that we should accomplish incomparably more if only a small part of the energy and money we spend now on philan- thropic efforts were expended in teaching the women, the married women of the poor, how to limit the number of their children; in other words, how to prevent conception. It would work a wonderful reform in the lives of the poor, and our slums would be met- amorphosed in ten years. Instead of trying to patch up the results of an evil system, let us try to remove its princi- pal cause. Instead of trying to enlist our sym- pathies for a poor woman with nine children, let us see that that poor woman does not have nine children. A poor woman should have no children, or not more than one or two. And I venture to say that very few in this audience will disagree with me if I state that instead of THE MMITATION OF OFFSPRING 117 sending that poor, crippled street-cleaner, who is out of work and who has brought six chil- dren into the world who will most probably also be poor, starving devils, I say, instead of send- ing him ten dollars, it would have been much better to have impressed it upon him and upon his wife that they had no right to have ' six children, and to have given them the means of avoiding having such a large progeny. And one of the central thoughts of my dis- course to-night, one of the thoughts that I would like you to carry away with you and to ponder at your leisure is this : Let the district physicians and district nurses who visit the poor be not only permitted, but instructed to teach the poor mothers how to avoid having more children than they can properly support and care for. And let us also institute a propa- ganda which will work a change in public opin- ion, so that it may not be considered a matter of pride, but a matter of shame to give birth to children for which the parents must invoke public aid. We have no right to blame the poor now, as long as large families are encouraged and praised by some of our so-called "foremost citizens," and as long as the only remedy we offer them is self-restraint. It is we who are to blame now for the large families of the poor, and for this reason we are morally obliged to 118 SEXUAL PB0BLEMS OF TO-DAY give them all the financial and medical aid that they demand. But when effectual means are put into their hands for limiting the number of their offspring, then they, and not we, will be to blame if they do not make use of them. And if we did that, if we succeeded in re- ducing the childbirth-rate among the poor to the proper and desirable limits, we should not have to be brutal and inhuman to those seeking the hospitality of our shores. We should not have to send back from American opportunity, in deepest despair, to the conditions largely produced by this very thing against which I am contending, a strong, clean, able-bodied man be- cause he has only $18 in his pocket instead of $25, as we read in the newspapers. "We should not send back intellectual men suffering from a mild conjunctivitis which the overzealous, but not overcompetent, doctor diagnosed as tra- choma. In short, we should not be forced by our overcrowded condition to pass inhuman laws to drive back people who are every whit the equal of those who, coming in former years, have helped to build up this country, helped to make it what it is materially and intellectually. Is the propaganda for smaller families mak- ing progress? There are many people who will not adopt a belief unless they know that it is shared by thousands ; will not join a movement unless they know that it has or will have thou- THE LIMITATION" OF OFFSPRING 119 sands of adherents. And if a belief is shared by thousands or millions, that is in itself proof to them that the belief must be correct. It is needless to say that the writer does not belong to this class. On the contrary, the very fact that a belief is readily accepted by the masses — and intellectually the vast majority of those who live in brownstone houses belong to the masses or the rabble — would make him look upon such a belief with critical suspicion. And he does not wait for the approval of the multi- tude before announcing his opinions. If he, after a thoro, careful, painstaking and per- haps painful consideration, should consider a thing right, he would advocate it, even if he knew that he were the only person among the fifteen billion inhabitants of the globe to hold such views. He did not wait for his views on small families and the prevention of conception to become popular, before he began to advocate them to the medical profession and to the pub- lic. But it is pleasing to note that these views are now gaining adherents among thinkers everywhere, and are beginning to be expressed by men holding high positions in highly re- spectable institutions. For instance, our daily papers have just printed statements from an address made by Prof. Thomas Nixon Carver, of Harvard. Such statements from such a 120 SEXUAL PROBLEMS OF TO-DAY source would have been unthinkable ten years ago. Dr. Carver is the Wells Professor of Po- litical Economy at Harvard and Secretary- Treasurer of the American Economic Society, and one paragraph in his remarks is very hap- pily expressed. He said: "Foxes think large families among the rabbits highly commendable. Employers who want large supplies of cheap labor, priests who want large numbers of parishioners, mili- tary leaders who want plenty of cheap food for gunpowder, and politicians who want plenty of voters, all agree in commending large families and rapid multiplication among the poorer classes." This coming from a Harvard professor is certainly a happy sign of the times, and I would recommend to a certain strenuous Harvard graduate to commit this paragraph to memory. Yes, our propaganda is bearing fruit. All earnest, truthful propaganda will bear fruit, and will make converts. At first the people are shocked, antagonistic, and call you names; gradually they become tolerant, then they adopt your ideas, and then they say, "Why, we have always thought like that." And so this world goes. But if we have a message to deliver to the world, we must deliver it, and if in order to make an impression it is necessary that we harp on one string, we must THE LIMITATION OP OFFSPRING 121 not shirk the unpleasant task. I know that some people are impatient at mere talk: "Do something," they say, "act!" But before we can act, we must talk; just as before we talk, we must think. That there may be no misunderstanding, let me just add this : I do not offer my remedy as a panacea for all our ills. It will not revolu- tionize society, it will not abolish the wage sys- tem, it will not bring about the cooperative com- monwealth, it will not change human character, but that it will do very much toward accom- plishing all these things I have not the slightest doubt. And I will, therefore, repeat the paragraph which I have printed so often in The Ckitio and Guide: "There is no single measure that would so positively, so immediately contribute toward the happiness and progress of the hu- man race as teaching the people the proper means of the prevention of conception." This has been my deepest and sincerest conviction since I have learned to think rationally. It is the deep and sincere conviction of thousands of others, but they are too cowardly to express it in public. In conclusion, I should like you to carry away this thought. It isn't that what I advocate is something entirely novel, something that is not practised at all. You know very well that pre- 122 SEXtTAl. PKOBLEMS OF TO-DAY vention of conception is practised in millions of homes, only it is practised in a bungling man- ner, and it is not practised by those who are in most need of it. The rich and the upper-mid- dle classes, those to whom several children would be the least burden, are quite familiar with the various means of prevention. If oc- casionally they do get caught, they know an ac- commodating gynecologist who takes care of them — for the price. I understand there are rich women who visit their gynecologists with monthly regularity. The poorer middle classes use preventives recommended by their friends ; these preventives sometimes succeed, sometimes fail, and sometimes ruin the woman's health. While the very poor, the wage earners, those who can least afford to have an unlimited prog- eny, knowing of no means of prevention, go on breeding to their own and to the community's detriment. The result, as you can plainly see, is a general lowering of the physical and men- tal stamina of the race. For if the cultured and the well-to-do do not breed, or have only few children, while the poor and the ignorant go on having a numerous progeny, a progeny for which they cannot well provide and which they cannot afford to edu- cate properly, it stands to reason that the per- centage of the uneducated, the unfit and the criminal must go on constantly increasing. THE LIMITATION OF OFFSPBING 123 And this is something that no lover of human- ity can look at with equanimity. It is because I am deeply, painfully inter- ested in the welfare of every individual family, as well as in the welfare of the entire human race, that I so persistently, unremittingly, per- haps to some even obnoxiously, advocate the dissemination of the knowledge of the preven- tion of conception. And should I succeed in converting at least some of you to my way of thinking, the time and labor spent on the prep- aration of this essay will have been repaid a hundredfold. DO NOT BLAME US: BLAME OUR VICIOUS LAWS We are often accused of advocating some- thing with which many of our readers agree, but when it comes to giving the means of put- ting that something into practice, we are si- lent. We stop short just at the most interest- ing point. We are therefore charged either with lack of courage or with inconsistency. In making this charge against us, our readers show an amount of naivete which is really de- lightful. Is it possible that our readers do not know that if we printed some explicit method for the prevention of conception it would ren- der this book unmailable and would subject us to a severe penalty? And not only in print, if we gave the information in any other way — by mail or by express — the penalty would be the same — 5,000 dollars fine and 5 years hard labor. Are they not aware of this? If not, it is time they were. Even to impart the in- formation orally is a crime — the only differ- ence being that for oral information it is hard or impossible to get evidence to convict. Our readers will therefore not blame us, but our stupid, brutal laws passed by ignorant leg- 124 BLAME OUR VICIOUS LAWS 125 islators, at the instance of narrow-minded big- ots and stone-hearted hypocrites. But this being the case, i. e., the imparting of any information about the prevention of conception either by mail or by express being impossible, what is the use of all the talk? Why waste hundreds of good articles on a sub- ject, for which in practice you can do nothing? The answer to this is easy. We have to talk and to write in order to create a public senti- ment against such laws. Let the sentiment become strong enough, and then these brutal laws will become a dead letter, and eventually they will be repealed. Talking, and particu- larly writing, does have a tremendous influ- ence. The effect, for instance, can be seen in the public attitude on venereal prophylaxis. People used to throw hysterical fits whenever the subject would be mentioned. Now vene- real prophylactics are sent freely thru the mails and our Government orders them by the tens of thousands for our soldiers and sailors. First thinking, then expressing the thought by word or pen, then acting — this is the se- quence of processes in all progress, in all hu- man advancement. WHAT TO DO WITH THE PEOSTITUTE AND HOW TO ABOLISH VENEEEAL DISEASE * I have brought you ideas, not words; I have come to instruct, not to amuse. I am speaking here to-night, not as a matter of pleasure, not in order to hear myself talk, which I distinctly dislike, not for the purpose of creating ,a sensation, which I despise, not for the sake of notoriety, which I detest; I am speaking here to-night because of a sense of deep-felt duty.. Venereal disease is sappingj the vitality of the nation. Its ravages are ter- rible. The public has no conception of the? enormity of the damage done to the present and future generations by the two principal venereal diseases, gonorrhea and syphilis. And nobody is offering or suggesting an effec- tive remedy. I had hoped that our societies for the prevention of venereal disease, euphon- iously called societies of Moral and Sanitary Prophylaxis, would attack the problem radi- cally. But they only skim the very surface of it; they refuse to go to the root of the evil; * Delivered before the Sunrise Club, November 21st, 1910. WHAT TO DO WITH THE PEOSTITTJTE 127 they refuse to suggest a remedy, except the old and admittedly inefficient remedy of preaching continence. I have therefore felt it my duty to bring the subject prominently before the public and to offer what I consider the only ef- fective remedy for the abolition of venereal disease. Before I commence with the subject proper I wish to touch upon a few points. First, I beg to state that if you expect any elocution- ary pyrotechnics you will be disappointed. I am not an orator. I am spending my life in the study and not on the platform, and I always prefer sense to sound and logic to alliteration. Yes, I prefer the plainest truthful statement to the cleverest but untruthful epigram. Second, I shall speak to you to-night as a physician, as a hygienist, as a sociologist, and not as a moralist. Not because I am ready to subscribe unqualifiedly to the dictum, that mor- ality is merely a matter of geography and chronology, but because morality, equally with religion, has failed signally in dealing with the problem. We must therefore look to medical sociology for a solution. Third, I want you to notice that I am speak- ing of the present day and present day condi- tions. To say that we can abolish prostitu- tion by changing our economic conditions in such a manner that everybody will live in com- 128 SEXUAL PROBLEMS OF TO-DAY fort and luxury is probably true, but such a statement would be absurd, and beyond tbe pale of discussion. For we cannot change our en- tire social system in a year or in balf a cen- tury, and I speak of remedies which could be adopted and put into practice to-morrow. Fourth, I generally speak to and write for medical audiences only, and I am therefore used to calling things by their right names. I should be sorry to shock a single person in the audience, but I should be still more sorry to mask, to hide or to pervert the truth, as I see it, for fear of shocking every one of you." He who is afraid of wolves should not venture into the woods. He who is afraid of plain language should not attend scientific discussions on sex- ual or venereal subjects. There are certain questions which must either be left alone altogether, or if handled they must be handled with absolute frankness, with absolute sincerity, with perfect openmind- edness, and with perfect indifference as to where the results of such investigation may lead us. The question I am to discuss to- night concerns the very life and health of so- ciety, concerns your life, your health, and be- longs to this category. And one thing I can promise you : Whether you are shocked or not, whether at the conclusion of the lecture you shower blessings or anathemas on my head, WHAT TO DO WITH THE PROSTITUTE 129 Gpon one thing you will all agree: You will agree that the speaker was frank and open, that he did not hide behind generalities and cir- cumlocution, that he did not beat about the bush, that he did not leave himself any loop- hole, and that he spoke so plainly that nobody in the audience, of ordinary intelligence and a grammar school education, could help but un- derstand him. With this introduction we may proceed. Prostitution has been in existence from the earliest beginnings, from the very inception of our civilization, and it will be in existence as long as our civilization lasts; if you think (I don't) that our present system of civilization will exist forever, then prostitution will exist forever. The severest measures of municipal- ity and king, the strictest edicts of the church at a time when the church could not only curse but crush, imprison and burn, the crudest and most humiliating punishments, such as brand- ing, public exposure, special costumes, exile, etc., etc., have failed to abolish or even to diminish prostitution. And as chronologically we can find no period in which prostitution did not exist, so geographically we can find now no spot where it does not thrive. In the frozen villages of Siberia, in the flowery Kingdom of Nippon, on the luxurious shores of the Granges, in Moscow and in London, in Calcutta and 130 SEXUAL PROBLEMS OF TO-DAY Madrid, in Berlin and Cairo, in lovely and warm Paris and in severe and cold Boston- town, you will find a plentiful supply of the so- called daughters of joy. Yes, you can find them at the very walls of the Vatican, and I have met them in the vestibule of the greatest Church in Christendom, St. Peter's in Eome. And only persons of extremely infantile minds can believe that, leaving social and eco- nomic conditions as they are, prostitution, the oldest profession in the world, as Kipling calls it, can be abolished. It cannot be done. You can annoy the prostitute, you can hound her, you can persecute her, you can make her life more miserable than it is, you can scatter her, but you cannot abolish her. You might as well try to abolish the law of gravitation. But not only is the abolition of prostitution impossible ; the abolition of prostitution if pos- sible, would, under our present social condi- tions, be undesirable. When men on account of our social and economic conditions are com- pelled to marry at the age of twenty-five, thirty- five and even later, then prostitution becomes not only a useful, but an absolutely necessary institution. For I do not belong to those who believe, or think they believe, that the average man can remain continent to an advanced age, without grave injury to his sexual system and often WHAT TO DO WITH THE PEOSTITUTE 131 serious injury to his general and nervous sys- tem. And I believe I can say without egoism that I have had as much experience with this particular class of patients as any physician living. This subject of the necessity or non-neces- sity of sexual intercourse is of extreme impor- tance and I should like to discuss it to-night, because it is indissolubly, organically connected with the question of the necessity or non-ne- cessity of prostitution. But the subject is so large that it itself would require an entire evening for proper discussion ; I therefore must limit myself to a few remarks. I firmly believe with Freud and his school that the cause of numerous nervous and men- tal diseases, neurasthenia, psychasthenia, va- rious phobias and obsessions, is to be looked for in a too long repression of the sexual in- stinct. I firmly believe — and my belief is based upon actual knowledge — that in many cases sexual abstinence is the sole cause of sexual impotence. And sexual impotence in a married man is a terrible calamity. During the last few years we have heard a good deal about the misery caused by venereal disease; we have pitied the innocent unsuspecting wife whom her lord and master infected with gon- orrhea or syphilis; but not a word have we heard of the terrible suffering caused the wife 132 SEXUAL PROBLEMS OP TO-DAY by an impotent husband. And I tell you, there is more gloom, wretchedness, suffering, misery, disruption and divorce caused by sexual impo- tence than by venereal disease. And if I were a woman and were obliged to choose for a hus- band either a venereally infected or an impo- tent man, I would choose the former. First, because it takes less time to cure venereal dis- ease than it does to cure impotence, and second because, against venereal infection we can easily protect the woman, while against impo- tence we can do nothing while it lasts, except to advise the woman to get another husband — or lover. "Which is of course not the proper thing to do. And I further believe that with the abolition of prostitution sexual immorality of all kinds, cases of rape and particularly cases of incest, would increase enormously. In fact cases of the latter are now more common than is sus- pected by the public. I know of numerous cases, but I will refer to only one, because it is of very recent occurrence. It was an ideal family. The mother, a widow, devoted her entire life to the proper bringing up of her children. She watched their steps, and did not permit them to stay out nights. The son, twenty-two years old, was a model boy. He never drank, never stayed out with the boys, worked faithfully in WHAT TO DO WITH THE PROSTITUTE 133 the office and altogether was the joy of his mother. Unfortunately his sister, a beautiful girl of seventeen became pregnant, and in spite of the poor girl's obstinate refusal to say a word, it was found out that it was the model brother who impregnated her. I will spare you the recital of the tragedy that followed. And I believe that with the total abolition of prostitution and other free relationships, such cases would become quite frequent. In SHOUT, PROSTITUTION' AT THE PRESENT TIME IS AN INSTITUTION, OR AN EVIL IP YOU WDLL, WHICH WE COULD NOT ABOLISH IP WE WOULD, AND WHICH WE WOULD NOT ABOLISH IP WE COULD. Granting, then, that prostitution is a neces- sary institution and that its abolition is both absolutely impossible and undesirable, what can we do to mitigate or perhaps do away en- tirely with its concomitant evil results? Prostitution drags two evils in its wake: one is the seduction of immature boys, the other is the spread of venereal disease. Scattered thruout the city, living in various tenement or apartment houses, walking the streets freely, the priestesses of Venus, by their solicitations, importunities and other practices, excite the libido sexualis in young, innocent boys, and many of the latter, who would perhaps remain chaste for several years longer, are thus drawn into intercourse at a very early age, often to 134 SEXUAL PROBLEMS OF TO-DAY their permanent physical ruin. The principal responsibility for this evil rests upon the shoul- ders of our prudes and purists. The remedy for it is a simple one: segregation. Let all prostitutes be segregated in certain quarters, as they are in Hamburg, as they are in Bremen, for instance. Then they cannot injure the un- sophisticated young boy ; they cannot tempt the passer-by. Only men and boys will go there who want to go there. As to the prevention of venereal disease, that problem, formidable as it seems, cap be solved successfully, provided we approach it honestly, boldly and are willing to use a little common sense. What are the requirements necessary for the solution of the problem? 1. The first requirement, and a requirement that is a sine qua non, is Registration. Every prostitute should be registered and licensed. Prostitution is a business or a trade that deeply affects the health of the people and we have a right to regulate all trades which affect our health as we have the right to supervise all sanitary problems. 2. Hygienic Instruction. After a prosti- tute has been registered and licensed, she should be given instruction in sexual hygiene. She should be warned of the dangers of vene- real infection, instructed in the course, symp- WHAT TO DO WITH THE PROSTITUTE 135 tomatology and superficial diagnosis of the three venereal diseases and their terrible ef- fects on health and life, and she should be shown how to guard herself against infection. Inci- dentally she should also be taught how to guard against impregnation, for our remedies for the prevention of conception are now pretty sure and certain, and society certainly does not care to have its prostitutes bear children. I am sure that not even Theodore the First and William the Second would object to the non- fertility of our prostitutes. All this can be done in an hour's talk, or a suitable pamphlet can be prepared for the purpose. The meth- ods and remedies for the prevention of infec- tion are so simple, that it is absurd to think for a moment that any prostitute would not use them if told how. It is to her own inter- est. She certainly does not want to suffer the pain and disfigurement caused by gonorrhea and syphilis. She certainly does not want to be deprived for several weeks of the means of making a living, she certainly does not want to be imprisoned in a lock hospital for several weeks or months. In short, her "career," her livelihood, depends upon her being healthy. 3. Inspection. The prostitute should have to undergo a medical examination twice a week, (or at least once a week), at the hands of com- petent and highminded physicians, fully con- 136 SEXUAL PROBLEMS OF TO-DAY scions of their delicate task and heavy respon- sibility. I should prefer female physicians for this purpose. Whether the physicians should attend the prostitute at her home, whether the latter should be forced to go to the physician's house, or to the police office, or to a special dis- pensary, is a minor detail, which would be worked out by experience. 4. Venereal Hospital. A venereal hospi- tal is a logical corollary of medical inspection. If disease or suspicion of disease is discovered, the prostitute should at once be rendered harm- less, she should be rendered harmless by being conveyed to a hospital and kept there until every possibility of infection on her part has been removed; whether it takes weeks or months is immaterial. But the hospital should have nothing of the prison atmosphere about it. The prostitutes should not be treated like criminals or prisoners. They should be treated with the same delicacy, care and scrupulous- ness that we treat patients suffering from ty- phoid fever or pneumonia. The prostitutes are the victims of our social system, their lot is miserable enough and we should not make it more wretched than it is. And altogether, whether in the hospital or out of the hospital, the prostitute should be treated like any other human being. As long as she behaves herself and is not diseased, she WHAT TO DO WITS THE PROSTITUTE 137 should feel that nobody has any right to harass or annoy her, and that she has no more to fear from any grafting policeman or crafty poli- tician than has any respectable woman. 5. Last but not least, in fact as important as all the above measures taken together, is the Instruction of the Young Man in Sexual Hygiene. And by instruction I mean not only teaching him the necessity of constantly occu- pying the mind and body in order to avoid or to be able to overcome sexual desire; I mean not only teaching him the dangers of infection ; I mean not only teaching him the course, symp- tomatology and superficial diagnosis of vene- real disease ; I mean not only impressing upon him the pernicious effect of alcohol as the greatest enemy to sexual continence and the greatest factor in venereal infection; I mean also teaching him plainly and frankly how to prevent infection, telling him what the best venereal prophylactics are and how to obtain them. This measure alone would in two dec- ades do more towards limiting and eventually stamping out venereal disease, with all its mis- ery, with all its sickness and mortality, with its insanity, with its invalided, disfigured and desexualized women, blinded, deformed and still-born children, than all our chastity preach- . ing has done in two thousand years. Within the last five year? we have learned 138 SEXUAL PROBLEMS OF TO-DAY more about the nature and prophylaxis of venereal disease than we have in the previous five hundred years, and we possess now rem- edies which may be called infallible prevent- ives. So efficient are they in preventing venereal infection, that in the army and in the navy it is proposed to consider the contraction of venereal disease a military offense ; not be- cause sexual intercourse is objected to, but be- cause the contraction of venereal disease is taken as prima facie evidence that the soldier or sailor was careless and disobeyed orders, and did not use the prophylactics which the authorities had given him. And I say it with all the emphasis I am ca- pable of: Not to put those means, which every enlightened government, including the govern- ment of the United States, is now beginning to put into the hands of its soldiers and sailors with such remarkable results, within the reach of our young men, is a crime. It is a stupid, useless, blundering, inexcusable crime. What is the reason our "good" men and women object to letting young men know how to prevent infection? The reason is this: Ac- cording to them the fear of venereal infection acts as a deterrent of illicit sexual indulgence. But does it? If it does, who supports the 50,000 prostitutes and half-prostitutes in New York City? Who supports in ease and com-. WHAT TO DO WITH THE PROSTITUTE 139 fort and even in luxury the thousands upon thousands of the filles de joie in all the large cities of the world? The fear of venereal in- fection is not a sufficiently strong deterrent. Even men who were caught once and who suf- fered the agonies of acute urethritis, epididy- mitis, buboes, strictures, etc., and who swear that they would never, never expose themselves again, forget their vows, when they are fairly cured, and, when the voice of the libido sex- ualis calls strongly, subject themselves to the same risk. And even medical students, and yes, sad to relate, even physicians thoroly fa- miliar with the dangers of venereal infection and the terrible consequences of venereal dis- ease, have been known to expose themselves once in a great while; once in a very great while. And even Catholic priests who firmly be- lieved that they would be damned forever have been known to suffer from gonorrhea and syphilis. No, fear of infection is not a suffi- ciently effective deterrent — otherwise we would not have several million gonorrheics and syph- ilitics in the United States. But assuming even that fear of venereal in- fection does act as a deterrent in some people, and assuming that a diffusion of knowledge of efficient venereal prophylaxis would tend to- ward an increase in sexual intercourse, that 140 SEXTJAli PROBLEMS OF TO-DAY would be far preferable to venereal disease. At least it seems so to me. Of all evils we al- ways choose the lesser one, and if illicit sexual intercourse is an evil, it is so infinitely a lesser evil than the venereal plague, that in my hum- ble opinion there can be no hesitation as to the choice. To permit you to orient yourselves I will summarize briefly what I have said so far : 1. The complete and too long repression of the sexual instinct is fraught with danger and may be the cause of various neuroses, psy- choses and sexual impotence. 2. I have nothing but contempt and pity for the debauchee, whose whole life is centered on sexual matters, but from a biologic point of view, the natural satisfaction of the imperious demands of a natural instinct is neither crim- inal nor sinful, nor immoral, and I regret to say that the words licit or illicit, marital or extramarital are not to be found in Nature's dictionary. 3. Under our present social conditions pros- titution is a necessary evil and its abolition IS both impossible and undesirable. 4. The real evil of prostitution lies in its being the source of venereal disease. But practically all danger of venereal infection can be avoided by adopting the following measures : a. For the woman: Segregation, registra- WHAT TO DO WITH THE PROSTITUTE 141 tion, sexual instruction, medical inspection, and in case of disease, hospitalization. b. For the man: Instruction as to the ef- fects of alcohol in increasing sexual desire and the liability to infection, instruction as to the dangers of venereal infection, and instruction in the best and most efficient means of prophy- laxis. With these means, which are, and in a sen- sible community should be, easy of adoption and execution, venereal disease could be abol- ished, or at least reduced to a negligible quan- tity, in two decades. This is particularly true now, when we have in our possession that wonderful discovery of Prof. Ehrlich, paradioxydiamidoarsenobenzol dihydrochloride, commonly known as "606" or Salvarsan. With that remedy, syphilis, one of the most horrible of human scourges, loses many of its terrors and becomes much more amenable to treatment than it was before. It is impossible to estimate the number of lives this remedy will help to save, the amount of suffering, misery and insanity it will prevent, the number of homes it will save from disrup- tion — in short it is impossible to compute how much this remedy will contribute to the health and happiness of the human race. I cannot refrain from remarking, en passant, that the discovery of this remedy would have been abso- 142 SEXUAL PROBLEMS OF TO-DAY lutely impossible without animal experimenta- tion, viciously miscalled vivisection. Yes, if our friends the antivivisectionists — and I hope we have some of them with us to-night — had their way, the discovery of "606" would have been impossible. Any progress in medicine would become impossible. The pity of it! But we confidently hope that they will not have their stupid vicious way. DOES REGULATION DIMINISH VENEREAL DISEASE? When we make a plea for the control and regulation of prostitution, we are sure to be confronted with the statement of the anti-reg- ulationists to the effect that "regulation does not prevent or diminish venereal infection"; that "it has been tried in many cities and has proved a failure." That regulation does not entirely prevent venereal infection we all know ; but to state that it does not diminish it, is un- true. Only a person with a somewhat dense mind, a mind with a peculiar kink in it, can make such an assertion. I should like to take such a person on an hour's visit to one of the venereal lock hospitals, say, in Vienna. I could show that good person during that hour, two or three hundred women affected with gonorrhea, syphilis and chancroids in various stages of intensity — from mild to horrible. The condition of some of the women would, I wager, make my visitor faint — sick at heart WHAT TO DO WITH THE PROSTITUTE 143 and sick at the stomach; and he or she would probably not be able to enjoy a meal for several days to come. I am somewhat callous to the sight of venereal disease in all its beautiful manifestations, and still I confess that a visit to one of the European venereal hospitals al- ways makes me slightly ill. The ill-smelling discharges, the condylomata, the ulcerating chancroids and phagedenic chancres, the mu- cous patches and papules and pustules are not pleasant sights to contemplate, nor pleasant subjects to talk about. But on leaving the hos- pital, after getting a little fresh air, and per- haps spraying ourselves with some perfume. I would ask my kind visitor: What would all these prostitutes do to-night, if they were not under control, i. e., if they had not been regis- tered and obliged to appear for a medical ex- amination? What would they do to-night if they were not locked up in the hospital? They would be plying their trade — all of them with the exception of those who are too ill to walk, or who are in so nasty a state that not even a blind man could fail to become aware of their horribly diseased condition. Yes, they would be plying their trade to-night and to-morrow night and every other night. And do you know how many new cases of gonorrhea, chancroid and syphilis that would mean? And not only disease to the sinful, wicked man, but disease 144 SEXUAL PKOBI/EMS OP TO-DAY perhaps to his future wife and children. It is horrible to contemplate. We know of a case where one prostitute infected six men in one night; there is a case on record where one woman infected 28 soldiers in 24 hours; there are cases where one prostitute infected an en- tire village or town. There is a class of low degenerate creatures among the prostitutes who take particular delight in infecting men; they say, "the nasty men gave it to me, I will give it to them." Should not such creatures be rendered harmless? I could give you lots of statistics on the sub- ject, but of what use are they? You know how statistics; are abused and how they can be per- verted to serve almost any purpose. You have all heard of the three kinds of lies: lies, damned lies and statistics. No, my friends, no statistics are necessary to prove that regulation, medical inspection and hospitalization are important factors in diminishing venereal infection. 7/ common sense does not show you that it must be so, no statistics will convince you. None so blind as those who will not see. That regulation does not do away entirely with venereal infection is true ; but this is due to the fact that the ex- aminations are not frequent enough, there are not enough inspectors and therefore the ex- aminations are too hurried sometimes; also to the fact that up to very recently the methods WHAT TO DO WITH THE PROSTITUTE 145 of diagnosis and treatment were not so perfect as they are now. We also must remember that a good deal of venereal disease comes from secret, clandestine prostitution — but reg- ulation is certainly not to be blamed for that. If we had a method by which we could reduce the number of cases of typhoid fever or pneu- monia to one-quarter or even to one-half of their present incidence, we would consider it a wonderful method and no expense would be considered too great. By regulation alone we can reduce venereal infection fifty per cent; by regulation combined with the other acces- sory measures indicated by me (sexual in- struction, including the instruction in the means of venereal prophylaxis), venereal dis- ease can be abolished or at least reduced to a negligible quantity. Are we not criminals if we refuse to adopt these measures which would save thousands and thousands of men from horrible disease, from locomotor ataxia, gen- eral paresis and insanity, thousands of inno- cent wives from pain, humiliation, chronic in- validism, involuntary abortions, sexual muti- lation, and millions of children from illness, deformity, premature death, and what is worse than death, idiocy? I ask again : Are we not criminals if we re- fuse to adopt such hygienically beneficent, life- saving measures? I leave the answer to you. SOMETIMES FEAE DOES NOT ACT AS A DETEEEENT N. N., employed in a bank, was twenty-four years old when he first applied for treatment. An examination showed an exceedingly severe acute gonorrhea, complicated with epididy- mitis and prostatitis. His history was, briefly, as follows: He masturbated, but not to ex- cess, from the age of thirteen. He abstained from all sexual intercourse until about five weeks previously. He was then induced by some friends to visit a house of prostitution. Ten days later he noticed the first symptoms. He went to a druggist, then to a physician ; both prescribed some capsules and a hand injection. But under this treatment he was gradually getting worse, until, on account of the epi- didymitis, he was unable to work and had to lay off his work in the bank. He was penitent and very disgusted. He considered it a direct punishment for his sin and a warning against future indulgence. And he swore that never, never, never would he in- dulge again. But he was displeased with fate all the same. He could not get reconciled to the fact that so many of his friends indulged 146 FEAR AS A DETERRENT 147 frequently without bad consequences, while he was caught the very first time. Well, he had a very hard time of it. His epididymitis and prostatitis compelled him to stay in bed for over two weeks, and he nearly lost his position in the bank. It took three months before he was perfectly well. Yes, it was a terrible lesson to him. The excruciating pains, the loss of time and money, the fear of discovery by his parents, the dan- ger of losing his position, etc., — all these facts impressed themselves strongly on his mind, and made him see, as he said, that the game was not worth the candle. And of course it was natural that he should swear that never, never would he have anything to do with prosti- tutes. Five months later he came again, with a fresh gonorrhea and a crop of chancroids. This time also after intercourse with one woman, but it was an all night's debauch. I told him that he probably had a hypersuscepti- bility to venereal infection, just as some men seem to possess a sort of immunity, and cau- tioned him against ever again indulging in in- tercourse with prostitutes. He laughed at my caution: it was so superfluous. Of course he would abstain forever and ever. His chan- croids were cured in ten days, the gonorrhea required three and a half months. Six months later N. N. appeared again. I 148 SEXUAL PBOBLEMS OF TO-DAY was disgusted when I saw him. This time he got at last the most terrible of venereal dis- eases, syphilis, for which he was under treat- ment for a long time. And still N. N. is not a bad man, as men go. He is not dissolute in his habits, he is not a debauchee, he is not addicted to alcohol. But apparently he has a weak will. And in his case fear did not act as a deterrent. This happened twelve years ago. I had forgotten of N. N.'s existence, but I remembered him when he came in last month with a gummatous ulceration of the leg. And I also recollected that his case was the case that impressed upon my mind the futility, the stupidity, the hypocrisy of preach- ing continence, when we know that our preach- ing is listened to only out of politeness and is disregarded by our patients often as soon as they leave our office. I recollect that it was while treating him that I thought how much better it would be if instead of preaching, or in conjunction with it, we gave our patients good venereal preventives, and it was then I began to investigate the subject and search for the best gonorrheal and syphilitic prophylac- tics. That fear acts as a deterrent in a certain percentage of cases is unquestionably true. How large that percentage is, it is impossible to say. But that it is not very large, the enor- FEAR AS A DETERRENT 149 mous prevalence of gonorrhea, chancroids and syphilis seems to demonstrate conclusively. This being so, would it not be more honest, more humane, really to protect our patients, protect them by efficient physical means, in- stead of trying to safeguard them by inefficient spiritual preachments? THE SUFFRAGIST AND THE HOSPI- TAL FOE STREET WOMEN It is too bad, too bad. Physicians and sani- tarians have been advocating detention hospi- tals for venereally infected disreputable women for ever so long. Now we are on the point of having our wishes realized. A clause in the new Inferior Courts law provides for the commitment of diseased street women to a hospital and their staying there until they are cured. This is a measure of the greatest benefit both to the prostitute herself and to the public. One would think that such a sanitary measure would meet the approval of every woman, and particularly of the suffragist woman, who is supposed to do something on her own account. Instead of that what do we see? Hysteria, senseless ranting about a dou- ble standard of morality, vociferations about unconstitutionality, etc. It is sad. It is dis- couraging. The chief burden of the dear ladies' com- plaint is that if the women are arrested the men should be arrested also. Now, with all due respect to the dear ladies, I will say, that only a cretin can fail to see the difference be- 150 THE HOSPITAL FOE STREET WOMEN 151 tween the man and the woman in the case. Let ug see. Perhaps we will succeed in instilling some common sense into our friends' fair heads. Here is a case. Mr. A., a man of average respectability, has had relations with Miss B., an ordinary street walker, and has become in- fected. What does he do? Be he workman, business man or professional man, he at once goes to a physician; and if he is a conscien- tious man he abstains from all intercourse un- til he is absolutely cured, or at least until the danger of transmitting disease has passed. If he is a man with an easy conscience, he keeps away at least as long as intercourse is painful or is apt to injure him. In other words either permanently or temporarily Mr. A. is rendered innocuous. But what does Miss B. do? Whether treated by a physician or not, she goes right on distributing infection — for it is her business and she has to make a living. And in one week she may infect several dozen men. Cases are known where one prostitute has infected a dozen men in 24 hours. In short, the real danger, the real disseminator of venereal disease is the woman, not the man. And it is she who must be rendered harmless as much as lies in our power. Morally the procedure is fully justified. We are taking care now that no tradesman sells in- 152 SEXUAL PROBLEMS OF TO-DAY jurious or adulterated goods. Prostitution is the street walker's trade, and we have a per- fect moral right to prevent her from dealing out disease and death to her customers. But even for the sake of the prostitute her- self, detention in a hospital is a justifiable and a beneficial procedure. And she should be grateful, instead of grumbling. For if left free to pursue her trade while diseased, the disease gets a deeper and deeper foothold, un- til a cure becomes impossible. Taken away in time, given rest and proper treatment, a per- fect cure is possible. And when dismissed from the hospital she is less of a menace to society and less of a burden to herself. Alto- gether the detention of diseased prostitutes in a hospital is a measure of great value and highly commendable both from a sanitary and moral point of view. And we pity those who would wantonly obstruct the wheels of hygiene and humanitarianism. The world is watching every step of the suf- fragettes. Let them be careful not to make any more blunders than is absolutely neces- sary. THE QUESTION OF ABORTION CONSIDERED IN ITS ETHIOAli AND SOCIAL ASPECTS A clever word has recently been coined by Prof. Gumplovicz of the University of Gratz. The word is " acrochronism, " and it refers to the belief which is shared by the majority of people, that the period they live in is the best of all periods, superior to any period that has preceded it. And right here let me say that I believe, in spite of the fact that humanity is not advanc- ing in a straight line, but in zigzag; in spite of the fact that occasionally we take a decided step backward; in spite of the fact that some periods are poorer in great men, in philos- ophers, in writers, than some preceding pe- riods, I believe, I say, that, with the exception of the dark middle ages, which for a thousand years hung like a pall over the world, acroch- ronism is justifiable, and I am willing to be classed among the acrochronists. For we are making progress, and if we make up the bal- ance sheet at the end of every ten or twenty- five years, we shall find the sum total decidedly in our favor. "We have not yet solved all the questions in 153 154 SEXUAL PROBLEMS OF TO-DAY philosophy, in morals, in religion, in economics that confront us. Eegarding some of the ques- tions, we are no nearer solution than we were a century ago ; hut one point we have reached : we are no longer afraid to discuss any ques- tion. There are no sacred subjects any more, the mere discussion of which is considered a crime. We have passed the childish stage in which we were told that certain questions must not be touched, that it was a sin to think of certain- things or try to analyze them, to find out the why and wherefore. We recognize no barrier to any discussion. We recognize no closed doors which we must not attempt to open with the key of critical analysis. In short, in the arena of discussion we recognize no forbid- den ground. We recognize but one danger — the danger of silence, the danger of repression. No matter how wrongly a question may be dis- cussed, it is by far better to consider it openly, even if erroneously, than not to discuss it at all. If we discuss a question wrongly, some- one is sure to point out our error, but if for fear of appearing unconventional, of being crit- icized by Mrs. Grundy, we hide our opinions, smother our convictions, how can we ever ar- rive at the truth? The question of abortion is of great interest from a philosophic, biologic, moral, and social standpoint. Unfortunately it has always been THE QUESTION OF ABORTION 155 surrounded with, so much bigotry, so much hypocritical cant, that the issue has been en- tirely obscured. There is no reason why this question could not be discussed calmly, judicially, without bias and without fear. This I will attempt to do to-night. And I can do this the more readily, because, strange as this statement may sound to you, I personally have never produced an abortion. Yes, it is twenty years since I received my M. D. degree, and during that time I have not committed one single abortion. I know this sounds strange in a large audience of physi- cians, but it is so. But, pray, do not for one moment imagine that it was on moral grounds that I refused the hundreds of pleading, weeping, heart- broken, distracted women, married and unmar- ried, who begged and entreated to be freed of the fruit of their womb. No, I repeat, it was not moral superiority; it was pure cowardice, principally. I may have contempt for a law, but I prefer to obey it as a matter of wisdom — as a matter of egotism, if you will. I have always felt that I have something important to do in this world ; I felt that I had a message for humanity, and I therefore thought it best not to endanger my peace of mind and not to run the risk of getting into the clutches of the 156 SEXUAL PBOBLEMS OF TO-DAY law. Yet there is no particular merit in such an attitude. It is a policy of wisdom, hut it has nothing to do, I wish to emphasize, with high moral courage. Another reason for my keeping shy of abor- tions is that it is hard to shake off the feelings or prejudices engendered by early training; and I have always had a personal dislike for the abortion business; and I have always been taught as a youth to despise the abortionist. And the professional abortionist, it must be confessed, is not a high-class individual. True, he may prove, and often does prove, a great benefactor, but the fact must be borne in mind that the professional abortionist is not in the business for altruistic purposes; he does not do the work out of pity's sake, as physicians sometimes do; he does it only for the money. If you don't believe it, ask a professional abor- tionist to bring on an abortion on a poor girl, without charge. So you see what my personal views are. But I have always had deep contempt for the hypo- crite, and likewise great pity for the muddle- minds who would get up in a medical society and brand the commission of an abortion as a crime exactly equivalent to that of murder, and would, with eyes raised to heaven, stigmatize the one guilty of an abortion, whether it be the aborter or abortee, as a murderer. THE QUESTION OF ABORTION 157 Gentlemen, if every physician who even once in his career — under the stress of tragic cir- cumstances, in order to save the life and repu- tation of a young girl and the happiness of her parents — performed an abortion, is a mur- derer, then seventy-five percent, nay, probably ninety percent of the medical profession are murderers. And if every woman who had an abortion performed on her is a murderess, then millions of our child-bearing women are mur- deresses. And I tell you that some of them are beautiful murderesses, sweet, gentle, kind, attached to their husbands and children, de- voted to charitable work, and altogether lov- able. A peculiar kind of murderess. Should any of my utterances appear to you too radical, should any of my friends think that some of the things I say might better be left unsaid, then I can only reply, paraphras- ing slightly the young genius, the lamented author of "The Martyrdom of Man": In the matter of speaking or writing I listen to no re- monstrance, I acknowledge no advice, no de- cision save that of the monitor within me. My conscience is my adviser, my audience, and my judge. It bids me write and speak as I write and speak, without evasion, without disguise; it bids me go on as I have begun, whatever the result may be. If my opinions should be con- demned, without a single exception, by every 158 SEXUAL PROBLEMS OF TO-DAY one in the audience here, it will not make me re- gret having expressed them, and it will not pre- vent me from expressing them again. That the question of abortion is of tremen- dous importance will be acknowledged by ev- erybody who has given the subject any consid- eration. The number of abortions performed annu- ally in this country is so appallingly large that the uninitiated cannot be blamed for being somewhat skeptical when the figures are men- tioned. I have gone on record with the state- ment that about a million abortions are brought about every year in the United States. Exact statistics are not and never will be available; but I am sure that my estimate is a very con- servative one, and that three millions would be nearer the truth. Justice John Proctor Clark stated that one hundred thousand abortions are performed annually in New York City alone, and if these figures are correct, then the num- ber for the United States would be in the neigh- borhood of two and a half millions. Can you form any conception in your minds as to what this means, in shame, in humilia- tion, in anguish, in economic loss, in time and money, in chronic invalidism, in permanent sterility, and in premature graves? No, I fear you can not. And the worst of it is, that abortion and the demands for abortion are not THE QUESTION OF ABORTION 159 diminishing but increasing from year to year, as can be testified to by all general practition- ers. And as far as the immediate future is concerned, the evil is sure to keep on the in- crease. The reason for this is a two-fold one : First, married women are beginning to rebel against an unlimited number of children, they are be- ginning to refuse to be drudges, good for noth- ing except breeding and nursing; they are be- ginning to feel the tremendous responsibility of bringing children into the world for whom they cannot provide, and having failed, on ac- count of ignorance, in preventing pregnancy, they will try to interrupt it. No physician in this room will deny that the demand from mar- ried women for bringing on abortions is becom- ing greater from year to year. The second reason is that our unmarried women are beginning to look at sexual rela- tions from a different point of view. Of course I do not speak of all women, but I speak of a large, constantly growing number of educated, thinking, independent women. These women — it is shocking, but it is true — do not regard chastity as the greatest treas- ure of woman, or the greatest honor of woman. They are not like the ancient Eoman or Jewish women, who were always ready to give up their lives for their honor. No. Many of our 160 SEXUAL PROBLEMS OF TO-DAY women of to-day regard chastity as but an empty virtue, a hollow shell. They have been taught the injustice of a double standard of morality. If a woman can remain chaste un- til marriage they have been told, so can a man. But as they saw that men do not remain chaste, they decided that they themselves need not do so either. In other words, they turned the proverb around and declared that what was sauce for the gander was also sauce for the goose. And there is no use denying that there is a constantly growing number of unmarried women who indulge in sexual intercourse ha- bitually, without considering it any more wrong than do men. And, of course, when these self- same women get into trouble, they will demand relief. And you cannot blame them. As long as illegitimate pregnancy is considered the blackest of crimes, as long as maternity unhal- lowed by priest or magistrate is considered the deepest and most shameful sin of which woman is capable, so long you can not blame the un- married woman for wanting and demanding to get rid of the fruit of her passion, of the evi- dence of her "sin." These women are not low and debauched, as our puritans and theologians would have us believe. They would prefer to get married, to live like true, faithful wives, for unlike men, THE QUESTION OF ABORTION" 161 who by nature are polygamous, women are by nature monandrous. But on account of social- economic conditions, marriage is all the time becoming a harder and harder proposition; it is becoming more and more difficult to make a career, and therefore the age at which men get married is getting further and further ad- vanced ; many never arrive, while others, when they are ready financially, find themselves so old that they decide to end their lives in single blessedness. Many old bachelors means many old maids. The old bachelors have no diffi- culty in satisfying their sexual needs. What should the old maids or the relatively young but prospective old maids do? Remain old maids, crabbed, soured old maids to their last day? Well, thousands and thousands are doing it. Thousands and thousands of women are ruining their health, destroying their beauty, stifling their desires, renouncing the greatest joy and pleasure of life, the compan- ionship and embraces of the opposite sex, are bringing all these sacrifices for the sake of a principle which is very dear and very real to them, tho others consider it but an empty bau- ble. But those women who have thrown off the restraint of religion and are not hampered in their acts, by what is to them a fictitious morality, are not willing to sacrifice their lives to a myth, to a symbol, and with these women, 162 SEXUAL PROBLEMS Of TO-DAY unless, as I said before, they acquire the knowl- edge of the prevention of conception, the med- ical profession will have to count. Some of our esteemed friends have an in- fallible remedy for all this world's ills. Teach the people morals or religion (which terms to them are, by the way, synonymous), they tell us, and all will be well. "Teach the people that abortion is a crime equivalent to murder, that the mother who has an abortion performed on her is a common murderess. Excoriate the abortionist in the press and in the pulpit — and the evil will disappear." How naive, how childish, or shall we use a stronger word and say, how stupid? Here they have been teaching, preaching, cursing and excoriating for two thousand years; yet the evil, instead of diminishing, is increasing. And still they have not the perspicacity to see that the remedy they propose is an ineffective one. The same thing with the prevention of vene- real disease. We all know the terrible rav- ages of venereal disease. "We see the incalcu- lable damage it is doing to the individual, to the family, to posterity. But when it comes to remedies we differ. Our conservative friends who have not succeeded in freeing themselves from the thraldom of custom, tradition and su- perstition have but one remedy to offer: Preach THE QUESTION OP ABORTION 163 morality, preach chastity, frighten the people with the specter of syphilis and gonorrhea. That this preaching and frightening process has been going on for two thousand years without any effect whatever seems to have no influence on them. They keep on repeating the same vapid, tho undoubtedly in most instances sincere, platitudes, year in and year out. We, radical thinkers, who are not afraid to look at every question from a broad philosoph- ical viewpoint, who combine with our idealism and hope for the future a desire for practical results in the present, have seen the inefficiency of moralistic preaching, and have decided that if we wish to diminish venereal disease under our present social conditions, the only thing to do is to show the people how to use real pre- ventive measures. And where preaching and cursing have proved worthless, protargol and calomel have shown themselves marvelously ef- fective. Our Government puts these prevent- ives into the hands of our soldiers and sailors, and everywhere there is a marked diminution in the incidence of gonorrhea and syphilis. And we cannot see why the means that are used with such good effect by the army and navy, by the student bodies of Germany and France, cannot be put into the hands of the general public with similarly good results. To return to the abortion question, which 164 SEXUAL PBOBLEMS OF TO-DAY presents a similar aspect. Becognizing abor- tion as an evil, and recognizing that the most thunderous anathemas of the church, the most horrible threats of eternal punishment have failed to do any perceptible good, we turned to more practical, more efficient measures. There is one measure, and one only, which will quickly and positively do away with the evil of abortion, and that is, teaching the peo- ple how to prevent conception. This is but one of the evils which the knowledge of the pre- vention of conception will do away with, but it is an important evil. Of course our so-called moralists and thinkers who belong to the kin- dergarten class object to this — but this we can- not help. We shall have to accept their op- probrious epithets, face their displeasure, and go on with our work. And our motto will re- main: No undesirable pregnancies, no forced childbearing, no children brought into the world as accidents. We now come to the other part of the pa- per: Is abortion ever justifiable? Particularly, is abortion ever justifiable when the mother's health is not threatened? There is a religion which considers abortion unjustifiable, under any and all circumstances ; even when the mother's life is at stake; even when the mother is sure to lose her life, unless abortion be induced. These views are to us THE QUESTION 0E ABORTION 165 so medieval, so inhuman, that we cannot dis- cuss them. We can only condemn them as un- worthy of an enlightened humanity. The more liberal religions and the vast majority of the public in general recognize that abortion is jus- tifiable whenever the mother's life is threat- ened, and our textbooks on obstetrics give a number of indications where the physician is justified in inducing abortion. Such are: un- controllable, pernicious vomiting of pregnancy, severe albuminuria, tendency to eclampsia, puerperal insanity in previous labors, de- formed pelves, certain cases of heart disease, tuberculosis, and a few other conditions. Let us now see whether abortion is ever jus- tified when the mother's health or life is not at all threatened. To make an argument carry conviction, to make it strike the nail on the head, it is a good thing, at least it is often necessary, to take a striking illustration. Let us take the following example: A beautiful girl, of a fine family, barely 16 (and, by the way, this is an actual and not a hypothetical case), is assaulted and raped by a brutal negro. To the indescribable horror of the girl and of the parents, her menses fail to appear at the expected time, and the horrible fear of pregnancy becomes a certainty, corrob- orated by a physician, in another month. The girl's health, however, strange to say, has not 166 SEXUAL PROBLEMS OF TO-DAY suffered in the least. Nature, as you know, does not know the words licit and illicit. Now I am asking you this clearcut, unequiv- ocal question, to which I would like to have a clearcut, unequivocal answer: Is abortion per- missible in that girl's case? If you answer un- equivocally, without beating about the bush, without any hesitation, as one catholic priest did, "No!" then I am satisfied. I simply stop all further discussion, because I can see that we live in different centuries, different blood courses in our veins, different feelings dwell in our hearts, radically different thoughts are pro- duced by our cerebral cells. You would no more understand me than a Hottentot would understand Shelley's poems, or a blind man ap- preciate Murillo's Madonna, or a deaf man be thrilled by Beethoven's symphony. But if you say, as I imagine most of you will, "Yes, in the above case abortion is justifiable," or, perhaps, "not only justifiable but imperative," then we can proceed further. Yes, the thought is revolting to have that beautiful refined girl bear within her womb for nine months and then give birth to a child the father of whom is a brute. It is perfectly bru- tal and outrageous to have a girl become an unwilling mother under the circumstances. Yes, I agree with you that producing an abor- tion in the above case is perfectly justifiable. THE QUESTION OF ABORTION 167 Nay, I am willing to go even further with you and agree that not to produce one would be a crime against the girl and against humanity. Let us now go a step further. Let us as- sume a case (and this case is also an actual and not a hypothetical one ; in fact, all the ex- amples I am citing here are actual cases from life) in which the assaulter was a white brute, not a colored one. Should the girl be com- pelled to bear and become the mother of the child of a man whom she detests arid loathes? And what love will she be able to give the child when it is born? And what future will the child have? No, for even tho the rapist may be a white man, abortion is justifiable. Now let us take a different case. I know of several cases of incest, where brothers were liv- ing with their sisters. I know of two cases where the sisters became pregnant. In one in- stance an abortion was produced ; the other was permitted to go to term, and the child is now in a foundling asylum. In which case do you think was the proper course pursued? In the first one, of course ; and it is a damnable shame that abortion was not produced in the second one. The girl-mother's life is blasted forever, for she has the specter of the child in the foun- dling asylum before her eyes all the time; she will, of course, not be able to get married; in short, she will have to drag out a miserable 168 SEXUAL, PROBLEMS OF TO-DAY existence to the end of her days. And how about the child? If he ever grows up, he is sure to be miserable, unhappy, living under constant insults and humiliation, and cursing his fate and the day he was born. We now come to the ordinary run of cases that infest the offices of physicians and the abortionists. Cases of girls who became preg- nant under the promise of marriage or who lost their reason in a moment of uncontrollable passion. Here is the problem: What should you do with those girls who come to you with their frightened eyes swollen from sleepless' nights and worry and red from weeping, with anguish engraved in every feature of their face; who trembling tell you their heart-breaking tales; who plead with you that it would kill their mother (and it sometimes does kill the mother, and the father too) ; who swear to you that un- less you help them out they will throw them- selves into the river or under an elevated or subway train, or they will take a dose of car- bolic acid? (And quite often, more often than you think, they fulfill their threat.) What should we do with those unfortunate girls, whose tears are salty enough to eat thru a heart of stone, and with whom not to feel any sympathy it would be impossible, except for a man utterly devoid of any human feeling? THE QUESTION OF ABORTION 169 What should we do with them? Should we, concealing our sympathy for them, politely but firmly show them the door, as I, for reasons of which I am not particularly proud, have always done, or should we help them out of their mis- ery? Let us see what becomes of the girls whom we, the respectable doctors, put out of our of- fices. Some of them get into the hands of the professional medical abortionist — they are the luckiest. For, as a rule, the doctor who makes abortion his business, nefarious as it may be, does his work carefully and aseptically. Another portion gets into the hands of the midwives and other ignorant abortionists, male and female. Here the poor girls sometimes come out all right, sometimes they pay with their lives, sometimes they become invalids for life. In another portion the girl goes to some home or maternity hospital, stays until the child is born, which is then given to some foundling asylum or farmed out to some poor woman, the mother paying for its board. What becomes of the child, you can imagine. How the mother feels with the knowledge of her hated or loved (which latter is still worse) child in the asylum, I also leave you to imagine. And still another portion of these girls, ig- norant of how or unable to find anyone to help them go thru the tortures and humiliations of 170 SEXUAL PROBLEMS OP TO-DAY an illegitimate pregnancy and childbirth, has recourse to one of the means mentioned be- fore : the river, the noose, the train, or carbolic acid; sometimes it is paris-green or corrosive sublimate or the heads of matches soaked in water. Well do I remember little Beatrice. She was twenty, but she hardly looked it. She got into trouble and she came to me. I knew her. She knew me and knew I was kind, and she hoped that I would help her out of her misery. Wasn't I kind and good? But she did not know how cruel the kind can sometimes be, how selfish the good often are. When I as gently as I could, but none the less positively, refused her, I saw that had I hit her on the head with a sledge-hammer I could not have hurt her more. She looked stunned. She did not say much. She did not make any threats of sui- cide, she gave me one reproachful look with her tear-filled eyes and left. And next morn- ing they carried her mangled little body from under the elevated train into the hospital. She gave my name, and wanted to see me. It was hard for me to go and see her, but I could not refuse her dying wish, and came. She had sustained severe internal injuries, and one could see that she had but a few hours to live. But she was fully conscious. She asked me to hold her hand. And then she said, "Forgive THE QUESTION OF ABORTION - 171 me. Good-bye." And I went. But were I to live a hundred years more, I should not forget her liquid, veiled eyes. I see them now, just as if she stood before me. I could relate many, many sad heart-break- ing cases of disgrace, financial ruin s and pre- mature death of entire families, brought about by the misstep of a young daughter, which no- body would relieve — but the paper is getting too long, and, besides, you probably are all familiar with such cases. What is the upshot of all this ? What is the underlying principle of this paper? Do I ad- vocate abortion? No. Not a bit of it. And I do trust that none of you will go away with that wrong impression or will attempt to mis- represent me and make me say things which I did not say. Abortion is a disagreeable business, a ne- farious business, if you wish; at least it is to me, tho I may be suffering from ancient preju- dices which I cannot shake off. And it is an unhealthy, unhygienic, even dangerous busi- ness. There is always a slight element of risk connected with it. It may give rise to patho- logic conditions, many women become chronic invalids, and it may cost the poor girl or woman her life. No, I do not advocate abortion. But I do most emphatically advocate something which 172 SEXUAL PBOBLEMS OF TO-DAY will render abortions unnecessary. I advocate legalizing the teaching of the people how to pre- vent conception. I advocate that this knowl- edge be made common property; it will then obviate the necessity for abortions, as it will obviate hundreds, and hundreds, and hundreds of other evils — as I have demonstrated, I be- lieve conclusively, in the chapter on the Lim- itation of Offspring. Once more I repeat: I do not advocate abor- tion — I advocate the prevention of conception. But as, when you are called to a case of typhoid fever, it is hollow mockery to tell the patient that he should have taken care of himself and prevented the attack, so when little Beatrice, or Fanny, or Jennie comes to you and tells you that her periods have not come around, that she is two weeks overdue, it is too late to add salt to her wound and tell her that she should have looked out. And in cases where a life, a reputation, the happiness of several people are at stake, we are justified, I believe, in sanction- ing the induction of abortion. On the one hand we have a mass of unformed or not fully formed, nonsentient matter, which is only po- tentially a human being; on the other hand we have a living, palpitating human being, we have several other human beings, who can all suffer, the parents and the brothers and the sisters, we have shame, disgrace, social ostracism, and THE QUESTION OF ABOKTION 173 perhaps death of one or more persons. Which shall we choose? If it is still difficult for you to arrive at a con- clusion, let me ask you this question: Suppose a young woman comes to you and tells you that unless you relieve her of her trouble she will on leaving your office commit suicide. Suppose you know the young woman, know her high- strung character, know her high-mindedness and truthfulness, and know that she never ut- ters empty words; that whenever she says something she means it. Suppose you are ab- solutely convinced in your mind that she will carry out her threat and that within twenty- four hours she will not be among the living. What then? Are you then morally justified in inducing an abortion? If not — that is, if you answer no — then let us go further. Why do you say that, if that woman suffers from uncontrollable vomiting or develops eclampsia, you are justified in producing an abortion? You say that her life is in danger, and you are justified in trying to save it. Isn't in the former instance the woman's life in still greater danger? I may be mistaken, but it seems to me that our ideas on the sub- ject are rather coarse and muddled up and need a thoro overhauling. If it is a purely physical condition that threatens the patient's health or life, such as 174 SEXUAL PROBLEMS OF TO-DAY vomiting, eclampsia, a contracted pelvis, a fi- broid tumor of the uterus, rapidly developing Bright 's disease or consumption, then we are justified in interfering; but if it is an inde- scribably horrible mental anguish, if it is the fear of shame and disgrace that we know will positively hurl the woman into the jaws of death, then we must not interfere. We must sit with our arms folded and show the dying victim the door. I may be wrong, but it does not seem right to me. People must be taught to perceive that there are conditions of mental anguish which are a million times worse than any physical ailment or disability can be. Worse than death itself. I feel very deeply on the subject, for I have passed many sleepless nights in self-accusa- tions — not for having performed abortions, but for not having performed them. I am not very successful as a sophist and I could not avoid the conclusion that I was almost as guilty of the death of little Beatrice as if I had pushed her under the wheels of the locomotive. SUMMARY AND POINTS OF EMPHASIS. Permit me now to make a brief summary of what I have said, emphasizing a few points: 1. Abortion is an unpleasant business ethi- cally, has always a slight element of risk in it, and, if improperly performed, often leaves the woman an invalid. THE QUESTION OP ABORTION 175 2. The best way, the only proper way, of dealing with abortion is to obviate the neces- sity for it. 3. The best way, the only proper way, of obviating the necessity for abortion is to teach the people the proper means of preventing con- ception. 4. To be able to teach the people the proper means of preventing conception, it is necessary to change the brutal and stupid law making the imparting of such information a crime punish- able by five years in prison and five thousand dollars fine. 5. To call a physician who, under certain special circumstances, found himself obliged to induce an abortion a murderer, to call every woman who has undergone an abortion a mur- deress, is silly and hypocritical ; and those that apply these terms generally know that it is so. 6. I should like to see the term criminal abortion applied with more discrimination than it is now. I know that the induction of abor- tion is legally a crime, but that does not mean that it is always morally a crime. Just as there are many actions which are not at all punishable by law, but are nevertheless the blackest of crimes from a moral point of view. 7. As long as our social system remains as it is at present, as long as marriage remains an unattainable ideal for many women, as long 176 SEXUAL PROBLEMS OP TO-DAY as the vast majority of people remain ignorant of any means of preventing conception, as long as illegitimate pregnancy is a matter of the greatest shame, as long as illegitimate mother- hood is the greatest disgrace for the mother and illegitimate childhood the direst calamity for the child, so long will there be a tremen- dous demand for abortions, and so long will the demand be satisfied. If not by those in the profession, it will be satisfied by those out of it — and satisfied in a bungled, sometimes dangerous manner. 8. We can hardly escape the conclusion that under the conditions enumerated in the preced- ing paragraph the induction of abortion is often morally justifiable, and sometimes mor- ally imperative. 9. It is a very serious question with me whether the physician who under certain cir- cumstances induces an abortion is not morally a better man than he who closes his ears, his eyes and his heart to the tearful pleadings of these most unfortunate victims of our false social system and false morality, and tells them either gently or roughly to get out of his of- fice, and not dare to insult him with the pro- posal to commit a crime. 10. Under the conditions enumerated in par- agraph 7, the abortionist is a necessary evil. And while I heartily approve of the activity of THE QUESTION OP ABOETION 177 our medical societies in prosecuting unlicensed practitioners and quacks, I have no sympathy with the work of spying upon and hunting down and prosecuting the abortionists. Our socie- ties could have their time employed to better advantage. I may find very few people to agree with me on this point, but it is my opin- ion, and I must express it, for I have promised myself either not to speak at all, or when I do speak, to speak the truth as I see it, and the whole truth. 11. For certain purposes in the discussion of the question, it is well to bear in mind that he who cries out most loudly against the ne- farious crime of abortion in public is occa- sionally quite an industrious abortionist within the four walls of his office. 12. The last word has not yet been spoken on the subject. I do not claim it has. But whatever the opinions may be, it is time that the question of the justifiability of abortion un- der certain nonpathologic conditions be freed from cant and hypocrisy, hysteria, theologic and traditional bias, and be discussed in a calm, judicial, scientific, and above all, humane spirit. THE PROFESSIONAL ABORTIONIST Our radical friends are inclined to look with benign eye on the professional abortionist. By some of them he is even regarded as a kind of philanthropist, a sort of hnmanitarian benefactor. He saves yonng girls and their families from disgrace, they tell us; he saves poor mothers from excessive maternity. In short, he is a necessity at the present stage of our civilization. Well, as far as we are con- cerned, democratic, tolerant and liberal as we are, we should not care to have the acquaint- ance of, or to shake hands with, a profes- sional abortionist. He is a necessity? Perhaps. The prosti- titute is also a necessity in the present stage of our civilization. We agree with Lecky, that "but for her the unchallenged purity of countless happy homes would be polluted," and he is right in asserting that "she is ulti- mately the efficient guardian of virtue." And, nevertheless, we would not care to have any- thing to do socially with those poor creatures, victims of our civilization and necessary scav- engers tho they are. We have no objection X78 THE PROFESSIONAL. ABORTIONIST 179 to treat them, but we would not care to be on familiar terms with them. Detectives occasionally serve a very useful purpose, and in our present stage of civiliza- tion they are sometimes a necessity, and still we would not care to have anything to do with them. The same with the abortionist. He may be a necessity, he may do some, or even a good deal of good ; he may save many homes from disgrace and many mothers from exces- sive fecundity. But he is not in the business for that purpose. He is in the business to make money. He has no high ideals, no philan- thropic leanings, no humanitarian aims. He is in the business, we repeat, for the sole pur- pose of making money, and as much of it as possible, and ninety times out of a hundred he is apt to be a thoroly unprincipled fellow. And we fear that sometimes he (or she) comes pretty close to committing murder. For he who daily produces abortions in the second and third month will not hesitate very much to pro- duce an abortion in the eighth and ninth month of pregnancy, when the child is capable of in- dependent life ; and he will induce it, of course, in such a manner as to deliver the child still- born. If this is not murder, it is something very much akin to it. Eecognizing as we do that the induction of abortion is sometimes a necessary, sometimes 180 SEXUAL PBOBLEMS OF TO-DAY a very humane act, nevertheless the profes- sional abortionist has always filled us with aversion and disgust. And the reason we so strongly and persistently advocate the regula- tion of conception is because we want to do away with the abortionist; we know that only when the people are able to control the num- ber of their offspring will the dangerous busi- ness of the unprincipled abortionist become ex- tinct. DISEASES CAUSING THE GREATEST SUFFERING AND HAVING THE LARGEST NUMBER OF VICTIMS The disease that has the most victims and causes the greatest amount of suffering and un- happiness should naturally enlist the greatest sympathy and should claim the greatest care and attention on the part of the medical pro- fession. It is our firm belief, based upon many years' practice and upon knowledge derived from ex- tensive reading and confidences of many men and women, that diseases of the sexual func- tions are more widespread and cause more mis- ery and suffering than any other disease of the human body, barring none. And for this rea- son these diseases should receive immeasur- ably more attention than they are receiving now. To those who have not given the subject any thought this statement may seem, at first glance, strange or extreme. Perhaps they will change their opinion after they have read this article to the end. By the name sexual diseases we understand all diseases caused by the exercise or the non- 181 182 SEXUAL PROBLEMS OF TO-DAY exercise of the sexual function and by the va- rious deviations of that function. First we have the endless list of venereal dis- eases and their complications. Let us enumer- ate them briefly. Gonorrhea with its complica- tions, phimosis, pariphimosis, epididymitis, orchitis, cystitis, prostatitis, stricture, pyelitis, gonorrheal rheumatism, gonorrheal ophthal- mia, ophthalmia neonatorum, endocarditis, general septicemia, cervicitis, endometritis, salpingitis, etc., etc. Chancroids and chan- croidal buboes. Syphilis with its terrible rav- ages from which not one organ in the human organism is absolutely safe ; syphilis which dis- figures the body, may destroy the eyesight and the bones of the face, which attacks the liver, the heart, the kidneys, the nerves, etc., etc., which may many years after the patient had thought himself cured give rise to locomotor ataxia, paralysis, general paresis, etc., etc., which is transmitted to the first and even the second generation and gives rise to so many still-born children. Then we have the purely sexual disorders; masturbation with its resulting disturbances, pollutions, spermatorrhea, premature ejacula- tion, relative and absolute impotence, sterility, marital incompatibility (referring to the purely sexual variety), vaginismus, frigidity, nymph- DISEASES CAUSING THE GREATEST SUFFERING 183 omania, the numerous sexual perversions (not moral, but pathologic) which we do not care to enumerate here, and the frightfully preva- lent sexual neurasthenia. Take all these diseases and consider the ter- rible suffering caused by them — suffering botK physical, mental and moral — consider the blasted careers, the shattered hopes and ambi- tions, the disrupted homes, the separations and divorces, the disgrace and shame, the insani- ties and suicides caused directly and indirectly by these diseases and see if you will not agree with us, that in their multiplicity, in their wide-spread prevalence, in the number of peo- ple affected by them, they constitute the most important class of diseases. It is therefore right that our medical colleges and practicing physicians should pay more attention, a good deal more attention to them, than they are pay- ing now. "More than they are paying now." For now they are paying very little attention to these diseases indeed. It will be said that these diseases are not very fatal. True. But fatal diseases are not always the worst. Death is often preferable to a long life of suffering, invalidism, disfigure- ment, incapacity, mental weakness and insan- ity. 184 SEXUAL PBOBLEMS OP TO-DAY And for this reason those who devote their lives to shedding light on the complex myster- ies of our sexual life, are doing a great, useful, humanitarian work. THE WRECKING OF HUMAN LIFE AND HAPPINESS Deab Db. Robinson : — You will remember the case of Mr. whom I sent to you for diag- nosis six months ago, which you pronounced as unquestionably one of syphilis, and which you feared, as you wrote to me in a note, would pursue a rather severe course. The course of events has justified both your diagnosis and prognosis. Under the treatment outlined by you, he is getting along* very well, but naturally he is very far from being cured. His system is still saturated with the poison. Not only inter- course, but his kiss will convey infection, for unfortunately he has some bad mucous patches on his lips. I told him so right along. And nevertheless he had the hardihood to tell me last month that he was going to get married during Thanksgiving week. I argued with him — but to little purpose. It was hard to make him understand the enormity of his offense. He said that everything was arranged. Then it would have to be disarranged, I told him. He should have thought of it before he sub- jected himself to the danger of infection. Then he spoke of his love for the girl. I told frim that only a blackguard could talk of love, 185 186 SEXTJAli PEOBLEMS OP TO-DAY while intending to wreck the life of a pure young girl. He was not convinced. I made him a present of a copy of your "Never-Told Tales" and asked him to read the sixth story. He did not return and I heard that the prep- arations for his wedding were going on. I then wrote to him to come and see me on some important husiness ; he did. I told him that if he did not at least postpone his wedding for a year or two, I would in some way put a copy of "Never-Told Tales" into his fiancee's hands and let her know that the man whom she was about to marry, was in the condition of Mr. Brannigan; and if after this she still agreed to marry him, it was her affair. But to permit a young life to be ruined forever without my lifting a finger — this I could not permit. And I told him several other things. He went away angry and disconcerted, but the wedding, I hear, is postponed indefinitely. I thought you might be interested to hear of the case. Another young life saved, to be added to the credit of "Never-Told Tales." With fraternal greetings, Sincerely yours, The above letter needs hardly any comment. One point in it, however, deserves discussion — the young man's determination to marry in THE WRECKING OP HUMAN LIFE 187 spite of the knowledge that he was in a dan- gerously infectious condition. That many- men marry, who are not cured, but who think they are, we well know, and everybody well knows, physician and layman alike. But that people, who know that they are diseased and are quite certain that they will infect their wives and most probably wreck their lives, should nevertheless be willing, ready and anx- ious to marry, seems to us impossible or at least improbable. People who have a strong moral sense cannot believe that human beings can be so low, so bestial, so utterly devoid of every sense of decency and honesty, as to be willing to risk and wreck the health and lives of their future wives and children. But un- fortunately such is the case. There are many such brutes, many such un- thinking creatures. We know of cases of men who married while having a profuse gonorrheal discharge, while suffering from chancroids, or even before the initial sore of syphilis was healed. And since the publication of "Never- Told Tales ' ' many physicians from all parts of the country have written to us of similar cases, of cases where the men were warned, were as- sured that their disease was as dangerous and as infectious as smallpox, and who nevertheless went and got married; and in a few days to a few weeks their wives were infected and often 188 SEXUAL PROBLEMS OF TO-DAY became but shadows of their former selves. The excuse is always the same: Everything is "arranged," prepared, the trousseau is ready, cards have been sent out, and to delay the wed- ding would lead to an awful lot of inconven- ience and annoyance. And to avoid "incon- venience," human life is sacrificed. The reason so many men go to the marriage bed with a loathsome venereal disease in full activity, in the acute stage, is a peculiar one. It is not the nicest thing to discuss, but the truth must be told; it may perhaps act as a preventive. Many fellows intend to lead a de- cent life after marriage. They promise them- selves to be truly monogamic and not to stray from tbe path of virtue. And so they want to finish up their bachelor life in a good debauch. And they have their bachelor suppers, they drink and have the last "good time." And not infrequently it is then when they acquire their first infection. We have known men who went to other women on the eve of their wedding night. As it takes several days for either gonorrhea or syphilis to develop, they married, thinking there was nothing the matter with them. And in a few days the disease made its appearance in both husband and wife. Another reason why men indulge in intercourse a short time before marriage is to try their sexual powers THE WRECKING OF HUMAN LIFE 189 — whether they are potent or not. This is true of men who have led a perfectly continent life ; a few weeks before marriage they get fright- ened, the specter of impotence begins to haunt them, and they decide, tho very reluctantly and with sharp conscience-prickings, to try. They do, and often with disastrous results. For somehow or other this class of people seems to have particularly bad luck. We should like to conclude this article with an admonition to the physician to be as firm as adamant and to do all that lies in his power to prevent his patients from entering into mar- riage relations when in a dangerous infectious condition. We must keep the professional se- cret sacred, but when the question is of human life and human happiness, we must use moral suasion, and when necessary, we must not shrink from using a threat. "FOE YOUNG MEN" The Secretary of the Committee on Sex Hygiene of the Massachusetts Association of Boards of Health requested me to edit and cor- rect their Sex Hygiene Circulars. The most important one is No. 1, For Young Men, and I will confine myself to that.' The circular is not at all bad — it is superior to a great many of the circulars issued for the purpose — and if it is agreed upon that it is best to use all means to discourage the young men of the country from any illicit intercourse, and if it is further agreed that the end justifies the means, then the circular is all right, and there is hardly anything in it to correct. But if the scientific truth is the primary object, then the circular can stand a few corrections. The paragraph that deserves the greatest criticism and is most in need of correction is the following: "The testicles are glands that, like the tear glands or the sweat glands, pro- duce a fluid peculiarly their own. The sexual power is never lost thru abstinence from co- habitation, any more than is the ability to weep lost thru not weeping." The "analogy" is as absurd as it is disingenuous. One must cer- 190 FOE YOUNG MEN 191 tainly be extremely anxious to make out a case for abstinence, if be will compare a gland upon which depends tbe perpetuation of tbe race and wbicb contributes so powerfully to tbe phy- sical and mental bealtb of tbe individual witb a gland tbe complete extirpation or destruction of wbicb would bave no effect on either tbe race or tbe individual. To compare a function for tbe satisfaction of wbicb men sacrifice tbeir bealtb, tbeir lives, tbeir reputations ; for whicb blood was sbed, wars declared and kingdoms thrown away; to compare such a resistless overpowering function witb the insignificant function of tear-secreting or weeping, is witb all due respect, 'a little far-fetched. And even with the tear glands we are not so sure that our abstinence preachers are correct. Isn't it rather a fact that women who are used to frequent weeping, weep much more readily and always shed a larger amount of tears than persons who are not used to weeping? Yes, even tbe lacrimal glands undergo a certain amount of atrophy, if seldom or never called into use. Analogies' are dangerous things, but if we are to compare the testicles with any other glands, we should compare them with tbe female breasts or mammary glands, for they are also sexual glands. And what happens to the mam- mary glands, if they are not given a chance to 192 SEXUAL PROBLEMS OF TO-DAY functionate until a late age? Are our conti- nence preachers not aware of the fact that when old maids marry and bear children they often have not a drop of milk? The most per- sistent stimulation often proves unavailing. [And why do the breasts of old maids become flat, flabby and atrophied? The reason is ap- parent. And isn't it true as a general thing that disuse of an organ causes its atrophy? And if to go by analogies, isn't it fair to as- sume that the same thing that happens to the disused breasts is apt to happen to the testi- cles? As to the assertion that, "the sexual power is never lost thru abstinence from cohabita- tion," that is a mere assertion, and we con- sider it a distinctly untrue assertion. I am fully convinced that the sexual power — not the potentia generandi, but the potentia coeundi — is often lost thru long abstinence. I have seen many cases of impotence in which no other etiologic factor could be discovered, and which the patients themselves — some of them physi- cians — traced distinctly to their abstinence. And let us hope that this comparison of the testicles to the lacrimal glands, which has been copied from one pamphlet into another ad nauseam, will now be given a rest. "Few men who take plenty of outdoor exer- cise, eat moderately, and keep their thoughts FOR YOUNG MEN 193 on sex matters open and clean, will need med- ical treatment for seminal emissions." This sounds nice and proper, but it isn't so. There are very, very many men who live a most hygi- enic, nay an abstemious life, and who, if com- pletely abstinent, are tortured with frequent erotic dreams and emissions. "Every prostitute, public or private, ac- quires venereal disease sooner or later, hence all of them are diseased some of the time, and some of them practically all of the time." As a deterrent, this is all right. But strictly true it is not. There are now many prostitutes in many lands, who are so versed in prophylaxis, that they escape disease altogether. I would not object to the above statement but for the fact that all exaggerated statements defeat themselves and injure the cause in the behalf of which they are uttered. A young man is taught that all prostitutes are diseased. In spite of that he is persuaded by his friends to visit one of them. He escapes. He indulges a few more times and finds there is nothing the matter with him. He is then apt to think that all the teachings were false, and he throws all caution to the winds. No, let us not exagger- ate. Let us always tell the truth — and we will accomplish better results. And the statement often met with that the average life of the pros- titute, after she enters upon her career, is four 194 SEXUAL PEOBLEMS OF TO-DAY to five years is also bosh. Many of them live to a good old age, many of them save some money, give up their old life and become even respectable members of some community. "Even the most painstaking examination may fail to detect such a woman's lurking dis- ease." We take issue with this statement. The most painstaking examination will dis- cover any condition of gonorrhea, syphilis or chancroids which may be infective. ' ' The many antiseptic washes, lotions and in- jections upon which some men rely for protec- tion from disease are ineffective." But they are not. Thousands of men have been using them for years without ever a mishap. And the experience with venereal prophylactics in our army and navy seems to be just as favor- able. In the above criticism I have abstained from touching upon the essential point: is the ad- vice to remain absolutely continent good advice or injurious advice? But that is another story, which is discussed in another part of this book. THE TREATMENT OF VENEEEAL DIS- EASE SHOULD BE MADE A FELONY PUNISHABLE BY IMPRISON- MENT The depths of the human mind are unfath- omable, its labyrinthine paths unexplorable. Sometimes in your explorations of the mind you think you have reached the lowest depths of silliness, of unreasonableness. But, no, you explore further and you find still lower depths. The discussions which followed the discov- ery of Salvarsan (606) are illustrative of the latter statement. To the ordinary sane mind it seems incredible, but it is true that many peo- ple, physicians among them, have deplored the discovery of 606, for fear that it might tend to increase immorality. "What we said in our October issue as a joke, is said by others in real earnest. For instance a Doctor Sperry, of whom we confess we never heard (probably some pious humbug), but whom the newspapers describe as "Dr. Lyman B. Sperry, a widely known medical author and lecturer of Pasa- dena, Cal.," has relieved himself of the follow- ing gem of wisdom : "If such a chemical has been discovered, and 195 196 SEXtTAI, PROBLEMS OF 10-DAY I don't believe it has, it will be the greatest curse mankind has been given since Adam and Eve were driven from the Garden of Eden. If sucb a cure has been discovered, it will have a very harmful effect on all mankind, as it will be the means of more loose living than is now prevalent. I hate to think of the moral influ- ence it will have." And what is more, at least two editors of medical journals, whom for the sake of peace in the family we will leave unnamed, have been guilty of similar outrageous opinions. We say outrageous ; perhaps the simple adjective stupid would be more appropriate. Let us analyze them a bit. First of all you will notice that Dr. Sperry and the other pious idiots who consider the discovery of 606 a curse all assume that mankind is thoroly de- praved or what they call debauched; that they take it for granted that the people think of nothing but sexual intercourse, and would rush into excessive and never-ceasing indulgence, but for the fear of venereal infection. Take away that fear, and everybody will throw up his or her work and will plunge into uninter- rupted bacchanalian orgies. To this we would reply, first, that it is a lie : that mankind is not debauched; that the illicit intercourse that is indulged in is indulged to satisfy natural needs ; that the taking away of TREATMENT OF VENEREAL DISEASE 197 the fear of infection would not materially in- crease the amount of sexual indulgence; and if it did, it would be so much a lesser evil than venereal disease, that it would not be worth considering. And we would reply, second, that a man who is virtuous merely because he is afraid is not virtuous at all. Involuntary vir- tue is no virtue. This is what we could reply. But let us assume for the moment that the pious idiots above referred to are right; let us take it for granted that the discovery of effi- cient curative agents for gonorrhea and syphilis would prove a curse by undermining the people's morals. If this be so, then do not those pious humbugs see, that every physician who is treating venereal disease is a criminal against our morals ? If it is wrong to discover a remedy which will cure syphilis in a week, then it is wrong to cure syphilis in a year or in three years. We should refuse to treat vene- real disease at all ! Let the wretches, who are the victims of their own debauchery and im- morality, suffer forever! By curing them, by perfecting our methods of treatment, we en- courage immorality. The wretched sinner knows that if he gets a disease he will go to a specialist, who in the space of a few weeks or a few years will cure him. But if he knew that no doctor would want to treat him, that once he got a loathsome disease he would have 198 SEXUAL PROBLEMS OF TO-DAY to keep it to the end of his days, he would keep away from vicious indulgence in illicit inter- course. Isn't our logic perfect? Yes, the more we think of it, the more convinced we are that all search for effective antivenereal rem- edies, all treatment of venereal disease is im- moral. Yes, we are going to give up our pres- ent specialty and we are going to plead with our genito-urinary surgeons and syphilologists to cease treating venereal patients, because by doing so they contribute indirectly, but none the less positively, to the spread of immorality. And should we fail by moral suasion to make them give up their nefarious work, we shall in- troduce a bill making the treatment of vene- real disease a felony; and we shall also intro- duce a bill making the manufacture of any drug or chemical for the prevention or cure of any venereal disease a felony, punishable by twenty years at hard labor. And we would urge the judges to show no mercy to venereal specialists even of the highest standing, nor to druggists or manufacturers who traffic in anti- venereal drugs. Our morals must be safeguarded at all haz- ards. Fiat virtus, pereat coelum. WHAT WOULD YOU HAVE TOLD HIM? AN INTERESTING CASE INVOLVING A MORAL QUESTION. Mr. X. Y. Z. came under my care in 1900 — eleven years ago. He was suffering acutely from a double epididymitis, of gonorrheal origin. He was then twenty-five years old. Four weeks before he sought my advice he con- tracted gonorrhea — the first attack. He was very well to do, and could have well afforded to consult a specialist. But he did not. He thought it was a trifling affection. He did not even consult an ordinary physician. But he consulted a good friend of his, a druggist, with whom he had been dealing for several years, and in whom he had very much confidence. They belonged to the same masonic lodge. Druggists are accused of many things of which they are not guilty, and of all profes- sional men they certainly work the longest hours for the least remuneration, and they will always have my sympathy. But for one thing they will have to answer before Humanity's Tribunal, and that is for their undertaking to treat venereal diseases. It is sad but true, 199 200 SEXUAL PROBLEMS OF TO-DAY that in spite of everything that has been writ- ten by the highminded pharmaceutical jour- nals against the practice, very many druggists still continue to hand out across the counter internal medicines and injections for gonor- rhea. And they do it with a nonchalance, with an insouciance, as if they were the greatest specialists in this line. • Neisser himself would not deliver his advice with such positive as- surance. Many druggists go to the length of themselves administering the injections and of charging a regular fee for the service. The number of cases of epididymitis, orchitis, pros- tatitis, the number of cases of acute and cur- able cases converted into chronic and almost incurable cases by their ignorant treatment can well be imagined. Yes, the druggists will have to answer for their meddling with ven- ereal diseases, of which they know absolutely nothing. They make too many sexual cripples, the lives of too many people are ruined for- ever. But to return to our patient. His druggist "friend" gave him some copaiba and santal oil and a hand injection. The discharge at first diminished considerably under the use of the injection, but very soon he began to de- velop symptoms of posterior urethritis, pros- tatitis, vesico-cystitis and epididymitis. When I was consulted, he was in "very bad WHAT WOULD YOU HAVE TOLD HIM? 201 shape"; the treatment was long and tedious, but I finally succeeded in bringing him to a practically normal condition. I warned him, however, that in view of the fact that his epididymitis was bilateral and of a very se- vere character, he would probably never be able to have any children. I told him that when he was ready to get engaged, he should come in for a thoro examination. Three years later X. T. Z. again made his appearance. He was engaged to "the best little girl in the world" (they all are before marriage), was soon to be married, and to make sure wanted to be examined. He had exposed himself a number of times, but always used precaution- ary measures. I examined him, and pro- nounced him well as far as any danger of in- fection was concerned. The urine was free from shreds, several specimens of the pros- tatic secretion presented nothing abnormal, the prostate was neither enlarged nor painful, etc. But the examination, as well as several subsequent examinations, failed to reveal a sin- gle spermatozoon. The semen for examina- tion was obtained by stripping the seminal vesicles, and in a "natural" way per condom. I told him that in my opinion he was abso- lutely sterile and that he could not hope ever to be a father. It was a blow to him, but still he married, for he loved "the best little girl 202 SEXUAL PROBLEMS OE TO-DAY in the world," and children did not constitute everything there was to married life. I did not see X. Y. Z. for nearly eight years. He appeared at my office about two months ago. He told me about his happy married life. "She" was still the best little girl in the world to him. And he had two beautiful children! One six years, one ten months old. And he remembered what I told him about his non-abil- ity ever to become a father. And he said that in spite of the fact that I had proved a poor prognostician, he had great confidence in me as a therapeutist, and he wanted me to treat him. And his present trouble was impotence, which had begun to make its appearance some ten months before. This is not an infrequent oc- currence after a severe gonorrhea compli- cated with bilateral epididymitis. I examined him once, I examined him several times, and just as sure as I am of anything in medicine, so sure am I that my good patient X. Y. Z. is not the father of the two beautiful children. I stripped his seminal vesicles several times, once obtained the semen in a "natural" man- ner, and on no occasion was there a trace of spermatozoa. And while both the right and left epididymis remain swollen and indurated, the testicles show decided signs of atrophy (as often occurs after a double epididymitis). He recently referred to the subject again. He WHAT WOULD YOU HAVE TOLD HIM? 203 asked how it happened that I, who he heard was so careful and circumspect, made so posi- tively gloomy a prognosis in his case. Well, what was I to answer? Should I have, by an equivocal answer, cast a doubt in his trustful soul, and thus perhaps have jeopardized the happiness of a family? I an- swered him, unhesitatingly, that none of us was infallible, that mistakes were apt to hap- pen after the most careful examinations, and that I was sorry for the mistake I made in his case. I acknowledged I had made a mistake and apologized for it. What would you have told him? PROSTITUTION AND OUR MORAL-SANI- TARY PROPHYLACTORS We believe the societies for moral and sani- tary prophylaxis should be encouraged. They can do no harm and they do do some good. But how very little that good is! And why? Because even they cannot shake off our Anglo- Saxon prudery ; they do not speak frankly, and they do not go to the root of the evil. For this reason we do not attend the meetings often. But we did attend one meeting recently. If one original or valuable idea was promulgated by any one of the speakers during that even- ing, it must have escaped us. And we usually listen with attention. There was the same beating about the bush, the same fear to call things by their right names, the same unwill- ingness or inability to look at facts as they are, in short, the same .insincerity and circum- locution that we meet so often in other socie- ties, but which we thought would be noticeable by their absence in a society, whose object is the preventing of venereal disease, and the reg- ulation of prostitution. "We got tired of the inanity of the discussion and we discoursed somewhat like this. We 204 OUB MORAL-SANITARY PROPHYLACTOBS 205 said: prostitution has always existed and will continue to exist, until our economic system has undergone a complete and radical change. So long as girls have to fight with starvation or with beggarly wages or haven't any recrea- tion or diversion that makes their life worth living, and so long as men are unable to marry sufficiently early on account of their inability to support a family and so long as some mar- ried men will remain polygamous in their tastes, so long will prostitution exist. At- tempts at repression of prostitution without changing our economic conditions will always result in a most dismal failure. But even should repression or the total suppression of prostitution be possible, it would be undesir- able. For prostitution at the present time is a necessity. Call it an evil, but a necessary evil. It serves the purpose of a safety valve. Without it there would be much more secret domestic prostitution and cases of rape would increase a hundred or a thousandfold. No homes would be safe. Must I quote to you the oft quoted remark of Lecky regarding this sub- ject? Well here it is: "There has arisen in society a figure which is certainly the most mournful and in some re- spects the most awful, upon which the eye of the moralist can dwell. That unhappy being that is scorned and insulted as the vilest of her 206 SEXUAL PBOBLEMS OF TO-DAY sex and doomed to wretchedness and an early death, appears in every age the perpetual sym- bol of the degradation and sinfulness of man. Herself the supreme type of vice, she is ulti- mately the efficient guardian of virtue. But for her the unchallenged purity of countless happy homes would be polluted, and not a few, who in the pride of their untempted chastity, think of her with an indignant shudder, would have known the agony of remorse and despair. On that one ignoble and degraded form are con- centrated the passions that might have filled the world with shame. She remains, while civ- ilizations rise and fall, the eternal priestess of humanity, blasted for the sins of the people." In poetic and somewhat high flown language Lecky tells you what I have just told you in plain prose. And yet, as Mrs. Elizabeth Cady Stanton so well said, "these high priestesses of humanity, while their profession is consid- ered a necessity, have no protection in church or state, under the canon or civil law. Tho the victims of men they are hounded like wild beasts from one shelter to another, dragged into the courts, robbed of their property, shunned by society at large, and left then to perish on the highway." What would I say should be done with the fallen women? I would say: Leave them alone ! Let, them know that as long as they be- OTTR MOEAL-SANITABY PKOPHYLA.CTOKS 207 have themselves they will not be insulted, both- ered, dragged and driven. Let them know that as long as they behave themselves, they have nothing to fear and they do not have to pay half or three-quarters of the blood-earned money to corrupt politicians or grafting police captains. And above all, let the parsons keep their hands off. They make a mess of it whenever they attempt to interfere. Our respected fellow-citizen, Eev. Parkhurst, has done more to scatter and to increase pros- titution than a thousand cadets or white slave traffickers could ever have done. It is the driving of the prostitutes from pillar to post, from one street to another that is actually harmful — for wherever they move there is a new focus of prostitution to act as an example and as a temptation. And this brings me to the only sensible suggestion made during that meeting. Deputy-Commissioner Woods said, tho with much hesitation, that if we wish to minimize the bad effects of prostitution, we should segregate it. And we should assure the women that if they confine their activities within the indicated boundaries, if no com- plaints reach the police about robberies or as- sault, they will not be molested. And with this suggestion of Mr. Woods I fully agree. The streets would be free ; only a certain area would be infested, and men who would go there would 208 sexual problems of to-day go there deliberately. The poor innocent men would not have to fight temptation at every corner. As to the licensing of prostitution- houses and official medical inspection, that is too large a subject to go into to-night in de- tail, but the last word has not yet been spoken, and in general I am in favor of the system. Medical inspection may not be capable of pre- venting all venereal disease, but if it can pre- vent fifty or even twenty-five per cent., then its introduction is justifiable and highly desirable. And before I conclude, I would like to repeat and to emphasize one thing: Let our good par- sons of all denominations keep their hands off the social evil problem. It is one of our deep- est medico-social problems and of such our dear brethren of the cloth understand nothing. Only physicians and sociologists can grapple with it. A MORAL DILEMMA: WHAT WOULD YOU DO IN SUCH A CASE? Hebe is a case for all moralists and casuists to ponder at their leisure hour. We have just examined a patient, sent to us for treatment by Dr. J. T. Morehouse, of Or- ange, N. J. The young woman had been treated by an old doctor for over two months, but getting constantly worse, she applied to Dr. Morehouse. The doctor seeing the nature of the case, thought he would rather not have anything to do with it, advised her to seek a specialist and sent her to us. She came with the diagnosis of "clap." I examined her, and found one of the worst cases of gonorrhea that I have ever had the good or bad fortune to treat in a woman. Ev- erything that could be gonorrheal — was. She had a gonorrheal urethritis, cystitis, vulvo- vaginitis, cervicitis, and, what is more, she had a well developed and unmistakable case of gon- orrheal proctitis. Well authenticated cases of gonorrheal proctitis are rare, but she had it — and no wonder. She was, as she confessed to me, of exceedingly loose morals, often receiv- ing a number of visitors in one night, and in- 209 210 SEXUAL PBOBLEMS OF TO-DAY dulging, I fear, in unnatural practices. From everywhere sanious pus was oozing, and the examination was neither easy or pleasant to myself, nor free from pain to the patient. I was about to tell her to get up from the examining table, when certain appearances around the anus made me suspicious and on closer examination I discovered that the woman was suffering not only with a bad case of gon- orrhea, but also with a very bad form of syph-, ilis. There were anal condylomata lata, a chancre on the labia well defined and numer- ous mucous patches in the mouth, on the ton- sils, fauces, etc. In short, this young woman was a horribly dangerous carrier of virulent infection. A smallpox case was no circum- stance to her. What was her occupation? Was she a professional prostitute? No. She was a servant girl in a well-to-do family work- ing for fifteen dollars a month. She was, how- ever, well provided with money, which she ap- parently received from her gentlemen friends. And I learned to my horror that in the family in which this woman was working, there were four small children. Now what was I to do? To permit the woman to work in that family and allow two adults and four babes to run the risk of in- fection with gonorrhea and syphilis and be ruined for life? Every fiber of my moral na- A MORAL DILEMMA 211 ture revolted against such a criminal laisser alter policy. To report to the family, that a dangerous person is in their midst, and that they should at once discharge her? This was the first impulse, but the law distinctly forbids us to do any such thing. The law distinctly prohibits us from betraying the confidence of any patient, from giving any information about any patient, obtained in a professional way in the course of treating our patients. And it is not only the statute law that is in the way. The moral law is superior to statute law, and where the two conflict, we should not hesitate a moment in obeying the former in preference to the latter. But the moral law is not very clear on this point. If it were, we would not be in a dilemma. The moral law also defends and protects the patient. The pa- tient comes to us in perfect confidence. What he or she tells us, or what we find out in our professional capacity, should be kept sacredly confidential, as much so as the avowals made to a priest in the confessional, and under no circumstances should we use such knowledge to the patient's detriment. This being so, have we the right to act the part of informer, have we the right to give information to her employers, which will cause her to be chased in disgrace, and prevent her from getting another position, probably for a long time to come? 212 SEXUAL PROBLEMS OP TO-DAY Have I got such a right? No? And how about the four innocent children? I shall undoubtedly get out of the dilemma, but the subject is an interesting one for dis- cussion, and I should like to know what my readers think about it. THE AMERICAN FEDERATION FOR SEX HYGIENE The societies for instruction in sex hygiene and for the prevention of venereal disease are increasing in number, and are gaining in mem- bership and in influence. They have our ut- most good will. While they do not come up to our ideal of what such societies should be, they are nevertheless doing a vast amount of good, and Dr. Prince A. Morrow, who may be considered the pioneer of the movement in this country, deserves the gratitude of every thinker and sociologist. The various societies thruout the country have now become feder- ated into one society under the name "The American Federation for Sex Hygiene" and Dr. Morrow has very properly been elected president of the new organization. We will look forward with interest to the activities of the new federation and we trust that, besides its important and necessary propaganda, it will accomplish some real tangible good, will be instrumental in instituting some really im- portant reforms. We regret however that at its very incep- tion the federation passed a resolution which 313 214 SEXUAL PROBLEMS OP TO-DAY is unscientific in character, is very ambigu- ously and loosely worded, and does not express the truth. The resolution was offered by Dr. Eobert N. "Willson of Philadelphia and was adopted for presentation to the House of Del- egates of the American Medical Association, with the request that it be adopted also as the public attitude of that body. It reads as fol- lows: Whereas, The necessity daily appears more imperative of protecting innocent American women and children against infection by the social diseases, syphilis and gonorrhea; and, Whereas, There is ample evidence of a be- lief deeply grounded among the laity that sex- ual indulgence is necessary to the health of the normal man; and, Whereas, There exist in consequence widely differing and double standards of morals and of physical health for the male and female sexes, that lead directly to disease and death of many of our women and children; Be it resolved, That the American Medical Association thru its House of Delegates, hereby present for the instruction and protec- tion of the lay public the unqualified declara- tion that illicit sexual intercourse is not only unnecessary to health, but that its direct eon- sequences in terms of infectious disease con- FEDERATION FOR SEX HYGIENE 215 stitute a grave menace to the physical integ- rity of the individual and of the nation. For a high class organization to adopt a res- olution like the above — well, it does seem that we will have to pay tribute to the shrivelled and dried up goddess of puritanic prudery for quite some time to come. That there exists a double standard of mor- als we are well aware ; and there is a good rea- son for it. But it is news to us that there exist widely differing and double standards of physical health for the two sexes. "We have never yet heard anybody condone venereal disease in the male; we have not come across any attempt to minimize the crime of the male carrying venereal disease to the marriage bed. No, as far as venereal disease is concerned there is no double standard. But this is a minor point. It is with the "Besolved" that we are chiefly concerned. That is indicative of a confused, of a muddled state of mind. "Besolved . . . that illicit sexual inter- course is not only unnecessary to health" . . . Now what has the word illicit to do in such a resolution? Illicit means unlawful — unlawful according to man-made standards — theologic or legislative. "What has "unlaw- fulness" to do with hygiene, with the laws and instincts of Nature? If illicit, i. e., unsanc- tioned by priest or magistrate, intercourse is 216 SEXUAL. PROBLEMS OP TO-DAY unnecessary to health, then licit intercourse is also unnecessary. There can not be the slight- est difference between the two kinds as far as necessity to health is concerned. That illicit intercourse is dangerous, because exposing one to the risk of venereal disease, nobody would deny — and no resolution is nec- essary to that effect; but that is an entirely different proposition. And we repeat, it be- trays a confused state of mind in the resolvers to jumble up in one sentence the questions of the healthfulness or unhealthfulness of inter- course, its necessity or non-necessity, with the dangers of venereal infection which lurk in the "illicit" variety. In our humble opinion the Federation has stultified itself by adopting this resolution and the attempt to have the House of Delegates adopt it as the expression of The American Medical Association was not a happy one. As Havelock Ellis so well states, we might as well say that a meal becomes good or bad, digestible or indigestible, according as grace is or is not pronounced before the eating of it. Is sexual intercourse necessary to the adult male (and female), in other words, is absti- nence apt to lead to disease? If not absolutely necessary, does it contribute to the physical health and mental vigor of the adult male (and female) ? FEDERATION FOR SEX HYGIENE 217 If neither necessary nor in any way con- tributory to the health of the individual, is it injurious per se? In other words, would the race be better off if intercourse, except for procreation, were abstained from? Those are the problems which the Federa- tion should take up, and should try to solve in an honest, scientific spirit, disregarding all moralizing, all theologic dogmas and statutory laws. Licit or illicit cannot enter in the pro- gram. They can only enter when we discuss the danger of venereal infection, and that, as we stated before, is an entirely separate prob- lem. VENEREAL PROPHYLAXIS: A CRITI- CISM AND A REPLY Some good people, whose morals are all right, but who are not blessed with an excess of logic, are opposed to our advocacy of "in- dividual" prophylaxis. The fear of infection is the only thing that keeps many men in the paths of rectitude and virtue. By giving them a remedy that will positively prevent infection, you take away the wholesome fear, and men will indulge more than they otherwise would. Theoretically this seems plausible, but the fault with this, as with so many other plausible arguments, is that it is not true. "We will leave "virtue" out of the argument. For virtue that is such by virtue of fear is not virtue at all. ("That virtue which ever requires guard- ing is scarcely worth the sentinel" used to say our good friend Oliver Goldsmith.) But we deny emphatically that fear of infection acts as a deterrent, except in an insignificant, we might say negligible, number of cases. We specialists all know of instances where not fear, but even certain knowledge that infection would follow did not act as a deterrent. We all know people who while suffering with say 218 VENEREAL PROPHYLAXIS 219 a severe gonorrheal epididymitis or suppurat- ing bubo, swear that never again would they ex- pose themselves. A year passes, or two per- haps, and the same patient shamefacedly comes to you with a brand new infection. We thus see that fear is but an insignificant re- straining agent. And when one considers what an indescribable amount of suffering, misery, pain and death would be avoided if the use of efficient prophylactics against gon- orrhea and syphilis became universal, one can- not help thinking — and saying — that those who object to the use of venereal preventives are intellectual mollycoddles. They need some cerebral exercise. I have no hesitation in declaring that the dis- covery, introduction and popularization of ef- fective venereal prophylactics belongs to the domain of the greatest human benefactions. For preach as we may, there is not the slight- est question that for many, many years to come illicit sexual intercourse is going to be on the increase, and not on the decrease. Our economic conditions are such that for many years to come marriages will be contracted at a later and later age, and we all know what the consequences are of such a state of affairs. The greatest European scientists and lead- ers of the Societies of Venereal Prophylaxis seem to think likewise, for the energies of many 220 SEXUAL PBOBLEMS OF TO-DAY of the noblest men are engaged in the discov- ery and introduction of venereal prophylactics. It is sufficient to mention such men as Neisser and Metchnikoff. We had finished this article when the Boston Medical and Surgical Journal for October 24 came to our desk. Speaking of Metchnikoff 's work on the abortificaents and preventives of syphilis, the Journal's Paris correspondent says: "There can be little question as to the prac- tical importance of this discovery. [Calomel ointments as a preventive against syphilis.] In spite of the meritorious efforts of the many well-intentioned people who are striving to open the eyes of the young to the dangers of irregular life, and to stem the tide of the so- cial evil, I question whether their results will amount to much. At most will they frighten a few timid neurasthenics away from the Scylla of vice into the Charybdis of self-abuse. For they have here to deal with the greatest factor in life : the whole world revolves about the sex- ual pivot, and there is no use of shutting the eyes to this fact; what then can their feeble voices really hope to accomplish in face of a problem of such magnitude as this? "So long as human nature remains as it is, and we continue to be no more than the de- scendants of father Adam, so long will such VENEREAL PROPHYLAXIS 221 men as Metchnikoff be necessary for the pub- lic weal. The ingenuity of man will continue to extract different kinds of alcohol from the fruits of the earth, each race according to its climate; and frequentation of the society of Bacchus leads inevitably to a search after other members of the ancient theogony, — Mars, and Venus in particular, — with the results that always have followed, do follow and will continue to follow, in saecula saeculorum, — the lock-up hospital, and physician's office! This is why, at least till further notice, we can- not be provided with too many remedies of the order of Hydrarg., KI, atoxyl [instead of atoxyl we would now say arsenobenzol] and calomel. "In fact, so far from improving, the world's morality seems likely to grow worse, on account of the steadily increasing difficulty of marriage among civilized people. Life is now not easy; to most men the expense of maintaining a fam- ily grows apace, and marriage occurs at a point in life that is steadily receding. It would seem, then, that illicit intercourse between the sexes can do nothing but increase progres- sively." Let our intellectual babies read the above paragraphs 'seven times. They may then, per- haps, see the light. AN APPAEENTLY IBKEFTTTABLE AR- GUMENT AND ITS EEFUTATION One of the principal arguments of the anti- regulationists is the "sex-in-sanitation" argu- ment. If the prostitutes are to be examined, then all the men should be examined as well. In the many letters that I receive, and in the discussions following my papers read before various societies, the same argument is iterated and re-iterated. And they all think they have me completely squelched when they ask the fol- lowing questions: "Would you dare to publish an article advocating the segregation of fe- male tuberculous patients only? And if a ship came in carrying passengers infected with scarlet fever, would you dare to advocate the quarantining of the female passengers only, letting the men go free?" (This argument is used also by Dr. Morrow.) To these questions I reply as follows : If the conditions were the same, i. e.: 1. If the female tuberculosis or scarlet fe- ver patients were one hundred times more in- fectious than the male patients; and 2. If the female patients made a trade of it, of spreading tuberculosis and scarlet fever ; and AN ARGUMENT AND ITS REFUTATION 223 3. If the female patients were easily got at — both from a legal and practical point of view — while the male patient could be got at only with great difficulty or not at all; then I would certainly dare advocate — I dare advocate anything which I believe is true and of benefit to humanity — that the female pa- tients alone be segregated, quarantined and treated. Because we cannot attack all the foci of infection is no reason why we should not at- tack ninety per cent of them. This is my reply, and no stronger reply is needed. CONSANGUINEOUS MARRIAGES The question of consanguineous marriages seems to be of great interest to a great num- ber of people. It possesses apparently not only a theoretical, but a practical interest as well, for marriages between relations, particu- larly between cousins, are not at all rare. In discussing such a question, we must look at things from the biologic viewpoint only; re- ligious bias or theologic dogma can only ob- scure the issue and can have no place in our discussion. As a rule beliefs shared by a large proportion of mankind have some foundation in fact. But there are exceptions. There are beliefs and opinions that have no foundation whatever and are based merely upon ignorance, misinterpreted facts or false premises. To which class of beliefs does the belief in the injuriousness of consanguineous marriages belong? When we examine the question his- torically, we find that the ancients had no such dread of consanguineous marriages as we have now. The ancient Egyptians put no obstacles in the way of marriage whatever. Similarly the Persians. In both these nations, marriages between brothers and sisters, in the royal fam- 224 CONSANGUINEOUS MARRIAGES 225 ilies particularly, were quite common. And this fact alone is sufficient to arouse a doubt at least as to the injuriousness of consanguine- ous marriages per se. For if the injurious effects were clearly ap- parent, they certainly would have been to a su- perlative degree in such close marriages as those of brother and sister. The children should have been monsters, cripples, imbeciles. Had this been the case, such marriages would speedily have been forbidden by law or would have been discountenanced by the people them- selves. In every nation, even a savage one, the instinct of race preservation is strong enough to forbid any practice which leads to racial degeneration. The fact that the prac- tice of close intermarriage existed for many centuries is rather in favor of the supposition that the children of such consanguineous mar- riages were normal. History tells us of one such child, that was anything but a weakling, imbecile or cripple. We refer to Cleopatra, whose father and mother were brother and sis- ter; and so were her grandparents. And Cleo- patra was not physically deformed or mentally deficient, or she would not have been able to lead Anthony such a beautiful dance, as she did. Among the ancient Persians not only brother and sister, but even father and daugh- ter, and mother and son entered into the mar- 226 sexual peoblems op to-day riage relations. Marriage between the closest relations was also permitted in Athens, and certainly nobody would characterize the Athen- ians as a degenerate race either physically or mentally. And still there is a foundation for the oppo- sition to consanguineous marriages. The foun- dation is to be found in the fact, that a defect present in both parents is likely to, be intensi- fied in the offspring. Let us assume that one parent is suffering from or has a disposition to insanity, epilepsy, cancer, tuberculosis, or Bright 's disease. If the other parent is per- fectly healthy, the child may and often does es- cape entirely. But if both parents suffer with any, more or less hereditary, affection, the chances of the child inheriting that affection are very much greater. And of course mem- bers of the same family are more apt to suffer with the same affection than strangers are. The disease may be hidden, dormant, yet it may be there all the same. But assuming a family that is perfectly healthy, that presents no evi- dences of physical disease or of mental disor- der, or moral peculiarities, there is no reason to fear that the children will in any way be af- fected, merely because they are the offspring . of consanguineous parents. But great care and circumspection is neces- sary, and each case is to be decided on its in- CONSANGUINEOUS MABBIAGES 227 dividual merits, with a careful consideration of all factors entering into the case. On the whole we would say that marriages between near relatives should be discouraged, tho we know personally children of marriages between first cousins who are absolutely nor- mal in every respect. Charles Darwin's par- ents were first cousins. And we guess he was rather normal. SHOULD VENEREAL DISEASES BE RE- PORTED? This subject is now of great importance, be- cause it has passed the stage of mere discus- sion: in several States the reporting of ven- ereal diseases to the board of health is an ac- complished fact. We regret to say that on this subject we dif- fer from many of our over-enthusiastic friends. We are emphatically, unalterably opposed to the compulsory registration and notification of venereal diseases, if the latter are to be put in the same category as other contagious com- municable diseases: that is, if the patient's name is to be given with the report. It is hardly necessary to state that we have considered this question from every point of view. Every proposed measure should be con- sidered from the point of view of its possible effects, and there can be no question that the result of the passing of such a measure would be disastrous. The stigma applying to ven- ereal disease is still unfortunately very great, and a man having gonorrhea or syphilis, knowing that, if he went to a reputable physi- cian, he would have his name reported to the SHOULD VENEKEAL DISEASE BE REPORTED? 229 board of health, that he would run the risk of being publicly exposed, would simply avoid the reputable physician. He would delay treat- ment, he would use patent nostrums, he would consult the neighboring druggist, or he would go to quacks like Dr. Gray, Dr. Grindle, Dr. Regan, Dr. Landers, etc. Yes, the rascally quacks would reap a rich reward, for, for an extra fee, they would not report their cases. Of course, they would be breaking the law, but they would take their chances, the same as the abortionists do now. Where much money is at stake, the unscrupulous will always be will- ing to take their chances. And suppose the Department of Health did know the name of the venereal patient — what good would it do? Would the patient in- fected with syphilis and gonorrhea be quaran- tined, like a case of scarlet fever or smallpox? As to mere hygienic rules, how to prevent in- fection and autoinfection, there is not a physi- cian worthy of the name who does not instruct his patients in this respect now. There could be no valid objection to report- ing cases to the Department of Health, with- out giving the patient's name, merely for sta- tistical purposes. But the statistics would be apt to be erroneous, for a venereal patient might change his physician ten times, and one case would be reported as ten separate cases 230 SEXUAL PROBLEMS OP TO-DAY (no name or address being given, there would be no way to identify any case). When it comes to voluntary, optional noti- fication, the matter assumes an entirely differ- ent aspect. There are cases where it would be a blessing for the community, if the physi- cian could send in a report to the public author- ities. To give but one example from our per- sonal experience. A patient came in a florid condition of syphilis. The palms of his hands were covered with scaly eruptions — typical syphilitic psoriasis. He was a barber. "We showed him that he was a danger to all his cus- tomers. He had one answer: he had to live. And he continued to work at his trade, work- ing in with his fingers the lather into the faces of his customers. We told him he should give up work for a time ; but his answer was : What will I and what will my wife and children eat? And we were helpless to do anything. Had this happened in Germany, we would have called up police headquarters, he would have been taken to a hospital and kept there until his condition was no longer infectious. Had we been able to threaten him with a report to the Department of Health, he would certainly have given up his position until fully improved. And a venereal hospital where all needy ven- ereal patients can go for thoro humane treat- ment is a sine qua non. SHOULD VENEREAL DISEASE BE REPORTED? 231 After all, the principal thing is to prevent ig- norant or unscrupulous men from infecting their unsuspecting wives. And this can be ef- fectively prevented by demanding a certificate of health, signed by a reputable non-advertis- ing physician, from every candidate for a mar- riage license. This would prevent or reduce to a negligible quantity cases of marital in- fection, and is a point after which we must strive with all our might. But a general re- porting of venereal diseases is neither advis- able nor desirable. It would do more harm than good. And such "reforms," reforms which are theoretically right, but practically pernicious, we must oppose with all our influ- ence. AUTOMOBILING AND SEXUAL IMPO- TENCE There is an inclination in some quarters to make fun of von Notthafft's claim that auto- mobiling speed mania is apt to result in sex- ual impotence. He has had five such cases in his own practice — four of the patients were rich men, while the fifth was a chauffeur. And he claims that he knows of similar cases in the practice of other physicians. Of course it is easy to draw wrong conclusions, and we never miss an occasion to call attention to the danger of the post hoc, propter hoc pitfall. The sexual weakness in Dr. von Notthafft's cases developed in from three months to three years after the addiction to the speed mania. It is possible that there were other causes. Sexual impotence is a very common affliction and is not rare in people who have never en- joyed an automobile ride. Still there is noth- ing grotesque or improbable in Dr. von Nott- hafft's declaration. We know that two of the greatest causes of sexual debility are worry and strain, and the strain of the person who drives a car at the rate of thirty or forty miles an hour is certainly very great. The strain, 333 ATTTOMOBILING AND IMPOTENCY 233 the anxiety combined with the jar of the car tend to induce cerebral neurasthenia, which causes sexual impotence. Dr. von Notthafft states that his patients improved when they gave up speeding and ran their cars at a mod- erate rate, which of course speaks for a causal relationship. Yes, we are quite ready to believe in an eti- ologic relationship between automobile speed- ing and impotence. And what is more, we should do our utmost to spread this knowledge among the automobilists. We know how con- scienceless and foolhardy some of them are. Human life is nothing to them. Of fines they are not afraid. Even the fear of a prison sen- tence does not deter them : they know that with money and with good lawyers they can get out of any scrape. But spread the knowledge among them that reckless speeding may result in a diminution of their sexual power, and you will see how quickly the mania for speeding — and killing and maiming innocent passers-by — will go out of fashion. There is no surer way of making a man give up smoking than convincing him that the weed has a deleterious effect on his sexual capacity. And the same would undoubtedly hold true of automobiling. THE INFLUENCE OF THE PEOSTATE ON A MAN'S MENTAL CONDITION It is unfortunately only too true that even the medical profession is not fully aware of the important influence of the prostate gland on the physical and mental condition of the hu- man male. We have encountered a number of patients, who were suffering from head- aches, anorexia, constipation, dyspepsia, in- somnia, etc., and on whom the pharmacopeia had been exhausted to no avail. Eecognition of the true etiologic factor — a diseased pros- tate^ — and proper treatment directed to that or- gan brought about prompt alleviation and ulti- mately a cure of all the symptoms. Particu- larly remarkable is the influence of a diseased, inflamed or simply irritable prostate on a man's nervous and mental condition. Here for example is the case of Mr. X., a newspa- per writer. When he came to us he com- plained of being nervous — and he looked it — and irritable ; he was unable to concentrate his mind for any length of time, and he could not sit in one place longer than twenty or thirty minutes. He had to jump up and walk about. 234 IISTELTJENCE OF PROSTATE 235 Ejaculatio precox was marked and contrib- uted considerably to his nervousness and de- pression. He suffered with constipation for which he took all possible cathartics, and with headaches, for which he stuffed himself with antikamnia, orangeine, etc., etc. (Newspaper men are great consumers of patent medicines, and are as gullible in this respect as old women.) When he put himself under medical care, the results, we regret to say, were not much better, for none of the physicians thought of examining the prostate, and all satisfied themselves with treating the symptoms. On examination we found a distinct diffuse pros- tatitis, and in four weeks' treatment directed exclusively to the prostate all the physical and mental symptoms disappeared. He began to look so bright and buoyant that friends re- marked the change at once and commented on it; and his mental power of concentration re- turned, and this could also be noticed in his ar- ticles. This is simply one example, and an ordinary one, out of many. Whenever a man complains of vague symp- toms, of nervous irritability, of heaviness in the perineum, of a heavy coated tongue, of heaviness or heat in the legs, of forgetfulness, of lack of power of concentration, etc., his prostate should be examined. It may be found 236 SEXUAL PROBLEMS OP TO-DAY to be the sole cause of all his troubles, and a prostate examination can certainly do no harm under any circumstances. THE EFFECT OF VASECTOMY ON HU- MAN SEXUALITY In considering the effect of the operation of vasectomy on man's sexuality, the fear is ex- pressed that the shutting up of all possible exit to the semen may cause atrophy of the testicles, affect the general health, etc. Vasec- tomy has not yet been performed on a suffi- ciently large number of individuals, nor have its effects been watched for a sufficiently long period, to warrant an absolutely dogmatic statement. But from all data available up to the present time the statement is justified that the operation has no injurious after-effects. The testicles are not affected, the secretion of semen goes on, tho to a greatly diminished ex- tent, but instead of finding an exit outside, it is reabsorbed, partially at any rate. And physicians who have had experience with hundreds of prison inmates and with pri- vate patients assert that the operation far from being injurious has a distinctly beneficial ef- fect. The people operated on feel stronger, calmer, have more self-control, and are less THE EFFECT OF VASECTOMY 237 subject to bodily and mental fatigue. The highly vital fluid instead of being wasted is, partially at least, reabsorbed and acts as a tonic to the entire system. About one thing there is no question : in people addicted to mas- turbation the operation cannot but exert a highly beneficial effect. THE DOUBLE FUNCTIONS OF TESTI- CLES AND OVARIES It was formerly assumed that the sole func- tion of the testicles was the elaboration of semen. Advanced investigators think so no longer. "We now know that besides the sperm- atozoa and spermatic secretion fluid, the tes- ticles are engaged in the manufacture of an internal secretion which is absorbed by the sys- tem and which contributes to the specializa- tion of the sex, i. e., to the formation of the male characteristics, both physical and mental. And what is true of the testicles is also true of the ovaries: besides the ova, the ovaries elaborate an internal secretion which is ab- sorbed by the system and which is necessary to the physical and spiritual well being of the woman. Hence the disastrous results which generally follow the total removal or the path- ologic non-functioning of both ovaries. 938 THE BENEFITS OF PROSTATIC MASSAGE "While we were among the first to protest against indiscriminate, too frequent or too violent prostatic massage, we are not unaware of the benefits of this measure when properly applied in indicated cases. On the contrary, "wonderful" is the only adjective we can ap- ply to the results which frequently follow the performance of gentle massage of the prostate gland. It is remarkable what an effect this procedure often has on a person's general well- being, his spirits, his buoyancy, not to speak of more material conditions, such as improve- ment in urination, improvement in the quality of the urine, disappearance of pains on urina- tion and defecation, disappearance or diminu- tion of that heavy dragging-down sensation and of the sense of heat in the legs, and last but not least the great improvement in sexual intercourse, both as far as libido and ejacu- latio are concerned. Yes, prostatic massage is an exceedingly valuable measure, but it must be used understandingly, discriminatingly and always gently. Ne quid nimis holds good of this as of all other therapeutic measures. THE EFFECT OF STEICTUEES ON THE SEXUAL FUNCTION It is difficult to explain the reason why a stricture in the anterior urethra should have a deleterious effect on the sexual function, but that such a causal relationship exists, there is not the slightest doubt. The effect on the sexual function may vary from a more or less premature ejaculation to complete impotence. And on cutting or dilating the stricture the sexual disability often disappears at once. Even temporary dilatation has a beneficial ef- fect. "We have a number of cases of strictures of large caliber, where a cutting operation is not indicated, but, where dilatation, each time it is performed, has a good effect not only on the urinary, but on the sexual function as well. And we might add that many people know the beneficial effect of passing a steel sound on the sexual function, and are themselves in the habit of passing one, every once in a while. If it is done aseptically by an intelligent person there is no danger. 940 FIVE CESAEEAN SECTIONS ON ONE WOMAN In the November, 1910, issue of The Critic and Guide there is printed a report of an ex- ceedingly interesting case. The report shows what a human being may go thru and still live. And we rejoice at the continuous improvement in surgical technique and the skill of our ab- dominal surgeons, who can perform a Cesar- ean section with about as little danger to mother and child as is entailed by an ordinary delivery. And we agree with the author of the report that the case fully and convincingly il- lustrates the possibility of repeatedly empty- ing the full-term uterus, successfully for both mother and child, by the Cesarean method. But to our mind this case illustrates some- thing more. It illustrates the low moral stand- ard of our society. It illustrates that many men are detestable brutes, and that many women are pitiable, miserable, abject, slaves. Here is a young woman, who was unable to give birth to a living child by the natural way, because her pelvis was so narrow and con- tracted. The first child had to be killed and its skull crushed, before it could be delivered. 241 242 SEXUAL PROBLEMS OF TO-DAY Craniotomy is a serious operation for the mother and her life was in jeopardy. Did she object to become soon pregnant again and did the husband take care not to risk her life? No. Five months after the craniotomy, she was already pregnant again, and nine months later her abdomen and womb had to be cut open in order to deliver her of a living child. We are very skillful nowadays, but a Cesar- ean section is a capital operation, the woman's life is always in jeopardy, and a man who will subject his wife to the dangers of such an ope- ration more than once (or even once, if he knows beforehand that it would become neces- sary), is unqualifiedly a brute. We know of cases where the wife was fully aware of the danger and insisted on taking it — so strong was the maternal instinct, the desire to have a child; that is a different matter. But even then the husband has no right to risk his wife's life more than once. But this poor woman, besides having to undergo one delivery by craniotomy, besides having one abortion pro- duced on herself, had to submit five times to the opening of her abdomen and uterus, had to undergo five capital operations. And all for what? Only after the fifth Cesarean section did the doctor decide that it would be unsafe for her to bear any more children, and therefore at- FIVE CESAREAN SECTIONS ON ONE WOMAN 243 tempted to suture up the Fallopian tubes. He stitched up the left one, but did not succeed in getting hold of the right tube, and the woman is still in danger of another pregnancy and an- other Cesarean section. In our opinion the doctor should have closed the tubes after the first or second section. But this is an indi- vidual opinion, the opinion of a man who con- siders the life of the adult woman infinitely more important, more precious than the life of the prospective and problematical child. Yes, the report, which is very interesting from a medical point of view, gives rise to many reflections, and the reflections are not of a very inspiring character. THE PRICE OF A KISS Since my return from Europe I have had three cases almost identical in all their heart- breaking features. To report one will there- fore suffice: A nice young lady, from a good respectable family, goes away to the mountains for a short vacation. She is a strict Catholic, chaste and virtuous; but a little flirting, when away on a summer vacation, is not considered very sin- ful; and submitting finally to the entreaties of a gay young fellow she permits him to kiss her — once or twice. Whether he kissed her more than once or twice I do not know. The patient insists that only once or twice. Be the num- ber of kisses what it may, four weeks later, the young, 18 year old girl — really a child — devel- ops a sore on the lip, which her family physi- cian, not suspecting the nature of the trouble, treats with zinc oxide ointment and similar worthless applications. The sore does not heal ; on the contrary it gets worse, the glands in the neck swell, the throat becomes sore, and when she is sent to me for treatment, the diag- nosis is so plain, that a blind man could make it. The poor girl presents a fully developed case of syphilis, with all its terrible character- istics. The girl's life is ruined, probably for- 244 THE PRICE OP A KISS 245 ever. Her mother's heart, of whom she is at present almost the sole support, will break. . . . And all for a kiss. Certainly a dear price to pay for one or even for a dozen kisses. (That she is virtuous, there is no question, for I examined her and found her a virgin.) Whether the young man knew that he was in- fectious or he thought himself cured and harm- less, there is no means of knowing. Confron- tation is not so easy and feasible in this coun- try as it is in Europe. If he knew that he was infectious (there are such wretches) he ought to be in prison ; if he did not know, he ought to be in a hospital. In any case the advice to girls away on a vacation is: Be careful whom you kiss or whom you allow to kiss you. And the same advice may be given to young men. And another thing: We believe the time has come to make the transmission of venereal disease a criminal offense. When it can be shown that the person, male or female, who transmitted the infection was aware of the na- ture of the disease, the offense should be pun- ished as a felony. P. S. I wonder how many hundreds of men and women — old, middle aged and quite young — return from their vacations, domestic and European, with physical and moral blemishes? Chaperons who really chaperon are not alto- gether a superfluity. In some cases they are an absolute necessity. TORTURING THE WIFE WHEN THE HUSBAND IS AT FAULT A woman was sent to me to be treated for sterility. Her history in brief is this : She has been married six years, and has never been pregnant. And she so wanted to have a child. The tears came to her eyes when she spoke about it. The first year they didn't mind it, but with each year their anguish increased. About eight months ago she went to a doctor to see if he could not do something for her. He examined her, thought she had some retro- flexion of the uterus and erosion of the cervix, and told her that he thought he could cure her. And he had been treating her ever since: painting, dilating the os, tampons, etc. No re- sult. And the good woman came to see if I could not cure her barrenness. I told her that I would not treat her, that I would not even examine her, until I had examined her hus- band. I explained to her that the fault might be his, and not hers, and an examination of Mm might render an examination of her un- necessary. She- pooh-poohed the idea : He was a splendid man, very strong, never sick in his life, and he attended to his marital duties in a highly satisfactory manner. 246 THE HUSBAND AT FAULT 247 Still I insisted. Three days later the hus- band made his reluctant and, as he was sure, superfluous appearance. He was a strapping fellow, had never had any venereal disease* — which statement the subsequent examination proved to be correct — and as for intercourse, he practiced coitus every night, and sometimes twice a night, abstaining only during his wife's menses. Both his libido and his potentia were perfect. A physical and microscopic examina- tion disclosed the unexpected fact that not only was he a monorchid, but that he was ab- solutely azoospermatic. Several specimens failed to show a single spermatozoon. Know- ing that spermatozoa sometimes disappear after excessive indulgence, I ordered him to abstain absolutely for a month and then come to the office. An examination at that time yielded the same results: not a single sperma- tozoon. To make doubly sure and at his in- sistent request I gave him some irritant and strongly aphrodisiac treatment, having him abstain at the same time; at the end of two weeks the findings were the same. I then told him that in his case treatment was useless, that there was nothing to be done. Had the doctor examined the husband first, the wife would have been saved eight months of useless, unnecessary and painful treatment; they would also have saved about two hundred 248 SEXUAL PB0BLEMS OF TO-DAY dollars, but this is another story. Under our present social conditions, one man is not anx- ious to save the other man's money. This case illustrates another point, besides the one indicated in the title. Our great think- ers are afraid, that if the knowledge of the prevention of conception became universal, no- body would want to have children. Of course I always maintained that that was a false and silly assumption. The parental instinct is too strong in the human heart. And perhaps if those aforesaid great thinkers saw the genuine and deep despair of people when they find out that they can have no hope of having children, they would not be so afraid for the future of the race. The people would have fewer chil- dren, they would have them when most con- venient, but children they would have. The quantity might be diminished, but the quality would be improved. THE WIFE Theee is a conspiracy to hammer The Wife. In the drama, in the novel, at radical meetings, at stag parties the wife is hammered. She is a hindrance, she is a drag, she is a millstone around the neck of the Lord of creation; it is she who prevents Man from spreading his wings and soaring to the sky, it is she who hin- ders him from reaching the Heights; it is she who crushes his aspirations, and shatters his Ideal. It is sickening. It is untrue. No man strong enough to stand up straight was ever dragged down by a wife, and no man strong enough to fly was ever held back by a wife. It is true that people with mediocre abilities and jelly fish backbones are often dragged down by their wives; but it is also true that just as often such men are held up, pushed up, supported and inspired by their wives. And for every case of a husband be- ing dragged down by his wife, we could present a case of a wife being dragged down by her husband. Those who are down on the wife seem to forget, that women also have their am- bitions, aspirations, their ideals, their hopes, which are not infrequently crushed by their 249 250 SEXUAL PBOBLEMS OF TO-DAY coarse, common, prosaic husbands. It is pretty well evened up. Here the anti-marriage advocate might in- terpose. If it is true that in many instances the husband is dragged down by the wife, and the wife by the husband, why marry at aE? Because the instances in which the husband is helped by the wife and the wife by the husband are incomparably more numerous than the in- stances in which the dragging down process takes place. It is the author's conviction, that millions of men and women would not reach the same level, would not attain the same de- gree of happiness and success, remaining sin- gle, that they do when in the married state. Hence the raison d'etre of marriage. The author has a suspicion that a good deal of the knocking of the wife is due to man's de- sire for a change, for variety. But if this is so, if man is polygamous in his tastes, then let us say so frankly, let us be honest in stating the cause of our dissatisfaction, and let us cease hammering the poor wife, who is as a rule better than her husband is, who is as a rule a real helpmate to her husband, who is as a rule ready for any sacrifice and who is al- ways more sinned against than sinning. The Wife is all right. Three Cheers for The Wife. NO DANGER OF RACE SUICIDE Those who advocate the intelligent regula- tion of reproduction, those who claim that in the human race quality is far superior to quan- tity, are overwhelmed with arguments: most of them trivial, some of them apparently plaus- ible. We have answered the arguments in other places. We wish to touch here just on one point. The fear is expressed that if the mass of the people be taught the means of regulating the number of offspring, too persist- ent use will be made of this knowledge, and the race will finally die out. We have stated more than once that the fear was altogether groundless ; that things would straighten them- selves out; that as soon as it would be felt that there was work and a comfortable living for everybody, the population would again in- crease. And so forth. At this stage of the argument, the anti-regulationists are sure to bring in France, as the horrible example. But France only proves our contention. For a while the death rate did exceed the birth rate, but now again the reverse is true. In the first half of 1907 the deaths exceeded the births by 55,000. This was becoming alarm- 251 252 SEXUAL PBOBLEMS OP TO-DAY ing, with) the result that in the first half year of 1908 — as recently published statistics show — the births exceeded the deaths by 11,000. There is no danger. The parental and ra- cial instinct is too strong to ever permit the race to die out, even with the most perfect means of the regulation of reproduction in the hands of the people. A WIFE AND HER HUSBAND Quite often, when a married woman is ail- ing, has a pasty, dingy complexion, lusterless eyes, suffers from lack of appetite and insom- nia, is irritable and cranky, wants she-does- not-know-what, is in a mood varying from black to the deepest azure, has been given doz- ens of kinds of drugs, and treated by massage, baths, electricity, etc., and has not been im- proved in the least, quite often we say, such a woman needs no treatment at all — it is her hus- band who needs it. And very often he needs no treatment either — merely a little advice. And just a little advice frankly and plainly given does the work. The wife's complexion clears up, her eyes acquire a luster, her walk has a spring to it which it did not possess be- fore, her appetite is fine, she is jolly and happy, life has a new interest which it did not possess THE WOMAN PAYS 253 before — in short, she is thorolyi permeated with the joie de vivre. And what did it all? The cognoscenti know; as to the others, we must let them do some guessing, for we regret to say, our censors will not let us discuss such things frankly in print. THE WOMAN PAYS I have been referred to, with slight irony, as a woman-champion. I am. But I stand up for women on every occasion, not because I con- sider them better than or superior to men. In fact if I were not mortally afraid of my suffra- gette friends, I would say, that on the whole I consider the men superior and that I do not think that woman will ever be quite the equal of man — for anatomic and physiologic reasons. I stand up for woman, because under our pres- ent social and economic conditions woman car- ries the heaviest burden. She pays more dearly than man does. Sweetheart or old maid, wife or widow, mistress or street-walker, she pays more dearly, she has the worse end of the bargain. And she is more sensitive, she is capable of deeper feelings and deeper suf- fering. And this is why I stand up for woman. Of course some cynic man will tell us some 254 SEXUAL PROBLEMS OP TO-DAY stories to show that he was the heavier payer, that she broke his heart, that she and not he was the vampire, etc., etc. I do not deny that there are exceptions. There are always excep- tions. But ninety-nine times out of a hundred it is the other way. [BAD ODOR FROM THE MOUTH AND MATRIMONY No woman has a right to marry who has a bad odor from her mouth. It will end disas- trously. It may not end in divorce — it often does — but it will surely cause coolness and mar- ital infelicity, and the husband will be very apt to stray into by-paths. For which we should not be inclined to blame him too severely. There is no excuse for anybody, and particu- larly for a member of the lovely sex, to have a bad odor from the mouth (or from anywhere else). The worst and most obstinate case of bromopnea can be cured if the causes are dili- gently sought for and properly treated. ON THE USE OF PERFUME It is natural that the independent thinker who sees so many customs, which have not the slightest justification and the uselessness or even injuriousness of which is beyond question, should assume a critical attitude toward all customs and habits, the raison d'etre of which is not clearly apparent. And it is natural that the independent thinker or radical should oc- casionally go to extremes. We see it in the matter of the corset. The corset was the cause of multitudinous evils, without a particle of good in its favor. Now we are beginning to see that it is not exactly so. An ill-fitting corset, the abuse of the corset is bad; but a properly constructed and well fitting corset is of great advantage to a very large class of women. Of course some women have no need of corsets of any kind, but these happy speci- mens of the female sex are very few in number. The same with perfume. We know people who look down superciliously upon any woman who uses perfume, considering it a vulgar habit. To use bad perfume, to use good per- fume in excessive quantities is vulgar. But there is nothing wrong or vulgar in the use of 855 256 SEXUAL PROBLEMS OF TO-DAY fine perfume in the proper amounts. It is pleasant to those around and what is more we consider it distinctly hygienic. Most perfumes are strongly antiseptic and there is no question that in many instances their use may aid in warding off infection. Bacteria do not like the Cologne spirits and the strong essential ex- tracts of which perfumes consist. Then again in some women the peculiar "female odor" is rather accentuated, and here the use of per- fume is not only permissible, but very wise in- deed; while some women during their men- strual periods should never permit themselves to go in company without an effective dose of some good and charitably masking perfume. NEUKASTHENIA AMONG SCHOOL TEACHEES Teaching in public schools must be a very exhausting occupation, for in no profession is neurasthenia so prevalent as it is among pub- lic school teachers. In the year ending Feb- ruary 28, 1909, ninety-five New York teachers applied for permanent relief from duty and of these nearly one-half gave neurasthenia as the cause of their inability to continue in the blessed work of educating our citizens and cit- izenesses. We are not surprised. The sur- prise is that not more teachers become neuras- thenic. The "sweetness" of many of our school boys is enough to drive a strong man, let alone a delicate little woman, crazy. THE NUESE AS A FOCUS OF VENEEEAL INFECTION It is not a nice tale to tell and it is a sor- rowful fact to relate, but as it is true we must not shirk: The nurse, trained and untrained, is becoming quite an important factor in the spread of venereal disease, principally gonor- rhea. "We, of course, always question our pa- 257 258 SEXUAL PROBLEMS OF TO-DAY tients as to the source of their infection and lately we more and more often get the reply: "From a nurse." And we might add that con- ditions here are rapidly approaching those in Germany. Statistics in Germany have shown that there is more danger of infection in clan- destine prostitution than in open one, that the salesgirls, typewriters, waitresses, seam- stresses, etc., more often transmit infection than do the street walkers; the same condition of affairs is making itself manifest here. The reason is not shrouded in mystery; the latter know how to take care of themselves, and it is important that they do so take care of them- selves, for their living depends upon their good health. The former do not know how to pro- tect themselves from infection — doing the thing secretly they cannot ask advice from their friends — and have not the time nor the proper conveniences. WOMEN DEFENDING THEIR HONOR And let me say here with a full considera- tion of the importance of the words: The woman who becomes very boisterous in the defence of her honor has no honor to de- fend. The woman who makes a fuss and a scandal when a man ogles her or accosts her is very generally a "bad" woman. A good re- fined woman replies with a look of contempt, or says nothing and passes on. The woman who strikes the man with her fist or hits him over the head with an umbrella or has the man arrested and appears in court against him is generally a loose woman, or a sexual pervert, or a virago, with a hatred towards men wbich old maids who have never had their sexual in- stinct satisfied, so often exhibit. Sometimes she is a blackmailer or a notoriety seeker. No man, except when in a state of intoxica- tion, ever persists in accosting or otherwise "insulting" a woman, who really wants to go her own way. And if I were a judge I would never pay any attention to women's complaints against men for attempts at flirting or verbal "insults." I know that many men and women will vio- 259 260 SEXUAL PROBLEMS OF TO-DA? lently disapprove of the above remarks, but that is because they do not know as much of these cases as I do. I have no confidence in women who are too fussy about their honor. "THE MALE PROSTITUTE" I shall soon object very strenuously to the loose way in which the phrase "male prosti- tute" is being used by thoughtless men or hys- terical women. To designate a man who in- dulges occasionally in extra-marital inter- course as a "male prostitute" is prostituting the English language. The Standard Diction- ary defines prostitute as "a woman who prac- tices indiscriminate lewdness for hire." The dictionary does not even recognize the exist- ence of male prostitutes. We know that they exist; there are men who sell themselves to any woman who will pay the price. There are quite a few of these despicable specimens in Paris ; there are some in New York. They are real prostitutes, on exactly the same level as the women prostitutes, for they "practice in- discriminate lewdness for hire," and of course to them the epithet is justly applicable. But to bestow this opprobrious name upon respect- able, temperate unmarried men who visit pros- titutes occasionally, is as unfair and disingen- uous as it is etymologically wrong. The ele- COMMON SENSE IN THE ARMY AND NAVY 261 meat of indiscriminate hire for money is a sine quo non. Ladies and gentlemen, above all, not too much zeal. COMMON SENSE TRIUMPHS OVER PRU- DERY IN THE ARMY AND NAVY Common sense is triumphing, in spite of the pernicious opposition of both sexes, who will not see things as they are.' Our army and navy officers are energetically introducing prophylactic measures, and while they still con- sider it their duty, quite properly, to advise abstinence to the soldiers and sailors, they do not neglect at the same time to provide them with protargol tubes and calomel ointment, in case they should expose themselves. And ev- erywhere where the prophylactic measures are introduced the incidence of venereal infection is reduced 50 to 100 per cent! So sure and so unfailing are our present remedies for prevention that it is proposed to make venereal disease among soldiers and sailors a punish- able offense. In some parts it is already so considered. For instance, Dr. C. F. Morse, in a paper entitled The Prevalence and Prophy- laxis of Venereal Diseases at One Military Port (Military Surgeon, September, 1910) says that "men who, having failed to report, were 262 SEXUAL PBOBLEMS OF TO-DAY later found with acute infections, were tried by Summary Court, not for contracting disease, but for failure to comply with post orders re- quiring reporting for prophylaxis, and the moral effect of the fines imposed has materi- ally assisted in the success of the plan." Syphilis and gonorrhea can be entirely pre- vented in the army, and if we were given the means and the power, we would eradicate ven- ereal disease from the civilized portions of the globe in less than two decades. SOME MEN AEE HOGS Men are hogs. Of course, not all men. Oh, no. But some men are. As this case will demonstrate: A. B. is 52 years old. And he looks it. Every bit of it. He came to be ex- amined and treated. Not only does he give a history and show evidences of syphilis; not only has he had gonorrhea at least a dozen times, giving evidences of it by the presence of gonococci, by numerous shreds in the urine and by two strictures, which will not admit a larger sound than No. 18 French ; not only has he an enlarged liver, due probably both to his syphilis and to his alcoholic excesses; but he also has Bright 's disease, also an enlarged heart, and also sclerotic arteries (arterioscle- rosis). In short, speaking generally, unless the man changes his entire mode of life, and provided his organs are not yet beyond repair, he has only a very limited number of years to live, say three to five; and he may be carried off in a few days. Any extra strain put on his heart or arteries might carry him off — heart failure or apoplexy. In short, he is in a condition when he ought to think of the next world and try to make his peace with his Maker, as the theologians say. But, no. 263 264 SEXUAL PBOBLEMS OF TO-DAY You know what he came to see me for? To treat his syphilis, his gonorrhea, his kidney trouble? Oh, no. Those things don't bother him. Not much. At any rate, they are of minor consideration. What gives him really great anxiety and concern is this: For some time he has noticed that he has been losing his "manhood." He neither cares for women, nor does he enjoy coitus when he does indulge. It is this that is troubling him, it is this fact and this fact only, that makes him feel uncom- fortable and unhappy. There are thousands of men who are ani- mals, pure and simple. They have no ideas of any kind, they have no decent interests in life ; all their pleasures are of a purely physical character. The enjoyment of food they lose early by excesses in eating and thru gastric catarrh or dyspepsia, and when they are no longer able to enjoy sexual intercourse, life loses all interest for them. Associated with this is the false belief shared by the common and the ignorant, that with the decay of the sexual powers there goes inevitably the decay of all mental power. When I told my patient that he was much more likely to lose his men- tal faculties on account of his syphilis, if he left that untreated, he was very much sur- prised, and he was still more surprised when I told him that practically every case of loco- some men abe hogs 265 motor ataxia and every case of softening of the brain or paresis was due to syphilis. I had to impress these things on his mind, for if there is a thing I cannot see with equanimity, it is a man ignorantly or stupidly neglecting his syphilis. And, then, I saw the man stand- ing with one foot in his grave — he didn't — and as he came to consult me, it was my duty to apprize, without unduly frightening him, of the true state of affairs. He was impressed and he promised to attend to his syphilis; but I could see that what was uppermost in his mind and what touched him most deeply, was — his waning sexual power, which leads me to the remark I made at the beginning: Some men are hogs. ''THE DANGEROUS AGE" Before I left New York, I was told not to fail to read The Dangerous Age, by the Danish authoress, Karin Michaelis, translated into German and into French — into the latter by no less a personage than Marcel Prevost. I tried to procure the book in New York, but couldn't. In Brentano's they were all out of it and the salesman volunteered the information that if they had three hundred copies they could sell them in a day. So great was the demand. In Germany the book is one of the topics of dis- cussion — of heated discussion. Whether or not the book will be translated into English, and whether, if translated, it will achieve success, remains to be seen. I procured a copy of the book in Naples, and read it while the steamer was peacefully sail- ing up from Naples to Genoa. To me the book is a distinct disappointment, and I can't see why so much fuss is being made over it. From a literary viewpoint, it is far from be- ing a masterpiece. As to the important "new" truths it contains, I couldn't find any. To me they have been commonplaces, oh, for ever so long. And still it is possible that for the lay- man the book contains something new, some- THE DANGEROUS AGE 267 thing valuable. I may not be an impartial judge, for what may appear trite and common- place to the student of sexual psychology, may appear very novel, very original, very striking, and even very shocking to the men and women who have never given the subject a thought. The book, which is written in the first per- son, deals with a woman of forty-two, who suddenly, without any apparent reason, decides to get divorced from her husband, and to se- clude herself in a lonely villa — away from any male creature, the sight of which is very dis- agreeable to her. A cook (female) and a maid constitute her entire entourage. Her divorce from her husband with whom she had lived for twenty years and who is rich and occupies a prominent position, is not so mysterious after all. It transpires that she has never loved him — neither physically nor spiritually — in fact she has distinctly disliked him, and she has been for the last ten years deeply in love with a young architect, eight years her junior. The architect loved her very deeply, but she remained "faithful" to her husband, i.e., physically she never broke her marriage vows. But now at the age of forty- two — and note that this is what she calls woman's dangerous age, from forty-two say to forty-eight — she can bear her husband no longer and she decides to become a hermit. 268 SEXUAL PROBLEMS OP TO-DAY She also has a terrible fear of becoming old. Empty-headed, empty-hearted, without any social or humanitarian interests, her fear of becoming old becomes a real obsession with her. And this is another reason for her seclu- sion — she does not want the men to see her wrinkles and her gray hair. She lives in her dreary solitude for about a year, but then her nature asserts itself, and the voice of the purely sexual animal desire becomes imperative, irre- sistible. She writes to her architect to come. He comes at once. But he leaves in the even- ing of the same day. The reason? During the year of her solitude she has not taken any care of her body, she had no massage, no exer- cise, etc. And her figure became plumper, her wrinkles and gray hair more conspicuous. And for that reason her architect ceased to love her! (A nice kind of a love that must have been.) She knew what passed in his mind after the first critical glance he gave her. Their interview became painful, and he left soon. What she felt after this affront can be easily imagined. As she wants a man and she can no longer bear her solitude, she decides to write to her husband; for he took a promise from her to write to him whenever she thought she had had "enough." He really loved her, and he hoped that they might perhaps come to- gether again. She writes him a sweet seduc- THE DANGEROUS AGE 269 tive letter. But in the meantime he became engaged to a girl of 19, and instead of visiting her at her villa, he has to inform her of the fact. Bebuff number two. The end is, she shuts up the villa and goes with her maid, who has had many sexual experiences and who has become attached to her, for a trip around the world. Whether she intends to utilize the op- portunities, which offer themselves on trips abroad, and make up for her year's solitude and for her two rebuffs, she tells us not. But it is permissible to infer that she does. Such is the synopsis of the book. It contains some good bits of psychology, it contains some frank information about woman's sexual na- ture — the authoress among other things main- tains that a woman may love two men at the same time, loving each for certain qualities which the other one lacks — and on the whole it is worth reading. But the book has been over- rated. Too slushy, too laudatory criticism, is apt to act as a boomerang. PECULIAK, BUT ABSOLUTELY TEUE Some time ago a symposium was read before a Society on the ever important subject of al- cohol. One man maintained that alcohol had a distinct value in certain diseases, particu- larly of a septic character; and he further maintained, that even as a beverage, if used in moderation, with the meals, it would not cause the terrible damage which the fanatics are apt to ascribe to it even in the smallest amounts. Three other gentlemen also spoke on the sub- ject, and they expressed themselves emphat- ically against the use of alcohol in any amount, in any shape or form. Both as a medicine and as a beverage, it was not only useless, but dis- tinctly injurious. It was a poison which should be entirely eliminated from the Phar- macopeia and one even went so far as to state that its sale should be prohibited by the State. That was in the afternoon. In the evening, the four gentlemen who spoke met in the hotel and they spent the evening together. They discussed various medical problems. They also drank. The gentleman who maintained that alcohol had a distinct place in medicine and was not injurious in mod- 970 BUT ABSOLUTELY TRUE 271 eration as a beverage, drank nothing but seltzer. The gentlemen who condemned alco- hol unequivocally, so as to call forth the en- thusiastic approval of the president of the W. C T. U., drank brandies and sodas, and Scotch high-balls. And they drank plenty of them. The moral? I don't know. True stories need no morals. And here is another analogous story, abso- lutely true in every detail. Four medical gentlemen discussed before a large audience the necessity or non-necessity of sexual gratification. One doctor maintained that in his opinion such an important instinct as the sexual function, upon which the perpet- uation of the race depended, could not be sup- pressed indefinitely with impunity. He be- lieved that too long a repression would result in various nervous disorders, in partial or com- plete impotence, and perhaps in an impairment of the general health. The other three doctors combated his ideas as pernicious, un-American (whatever that may mean), false, immoral, etc. They firmly asserted that absolute con- tinence no matter up to what age would not in- jure the system in any way. In fact, asserted they, such continence would result in great benefit only. The first gentleman, who t Sieved in the ne- cessity of gratification of th« physiological in- 272 SEXUAL PROBLEMS OF TO-DAY stinct, was known to lead a very straight, very moderate sexual life. Of the three other gen- tlemen, one was beyond any temptation. He was too old. But it is known that in his younger days he led a tempestuous riotous life. The other two, tho married, often indulged in extra-matrimonial ventures; and it is rumored had more than platonic relations with a num- ber of nurses. And when doctor No. 1 chided them gently for the divergence of their practice from their preaching, the answer was, that preaching be- fore the public was one thing, and practicing in private was another thing. And, besides, as- suming even that his ideas were right, it was a dangerous thing to preach them — for such preaching might have a pernicious effect on the youth of the country. In order to save the youth of the country, it was necessary upon occasions to dissimulate, to lie, to be a hypocrite. Perhaps. LET THIS BE MY ANSWER TO THE MANY LETTERS I receive a number of letters, as is but nat- ural, attacking my position on the sex question. To those who discuss the question from a purely scientific standpoint I reply in detail. Many people, however, discuss the question from a theologic standpoint, giving quotations from the Bible, etc. With such I cannot enter into any discussion. Faith cannot be reasoned with. Let one reply that I sent to an estimable lady serve as my reply to all my Tenth Century friends. My dear Madam: — Your letter received. I shall not argue with you or attempt to convince you, as you would probably not understand me. You speak the language of the tenth century; I speak the language of the twentieth, or per- haps rather the twenty-fifth, century. You speak the language of gloom and reaction; I speak the language of joy and progress. You speak the language of the shackled theologian; I speak the language of the free scientist. You infuse theology and a man-made or rather statute-made morality into your discussion; I claim that theology and statute-made morality have no more place in a discussion of biologic 873 274 SEXUAL PROBLEMS OF TO-DAY or physiologic problems than they have in the study of anatomy, chemistry or physics. You believe that the sexual instinct given to man and woman should be used by them for pro- creation purposes only. I believe that such a belief is ridiculous in the highest degree, for it limits the man and the woman to but one or a dozen acts during their lives. For nobody would care, of course, to have more than a dozen children. You believe that extra-marital relations are a sin and a crime. I believe they are dangerous on account of the fear of infec- tion and may be unwise for many reasons, but are not more sinful or criminal per se than the gratification of any other natural instinct. When Nature implanted that instinct in man and in woman she did not know that laws would be passed rendering the gratification of the in- stinct sinful and criminal. As you see, we differ on so many points, and our difference is so fundamental, that a real discussion would be neither possible nor profit- able. I therefore beg to remain, Very truly yours, Dr. William J. Robinson. AN EPIDEMIC OF SYPHILIS IN A SMALL VILLAGE At the last annual meeting of the Vermont State Medical Society, Dr. Wm. Warren Town- send related his experience with an epidemic of syphilis in a Vermont village of 2000 in- habitants. He traced the epidemic to two young women who visited Burlington; while there they met some soldier boys who had re- turned from service in the Philippines. They accepted the attentions of many of them, and returned to their homes "flushed with the en- thusiasm of the good time they had had and in due course of time became flushed with a maculopapular eruption and other lesions." When examined they were found to be in full bloom of secondary syphilis. Indulging in promiscuous intercourse, it is not to be won- dered that they infected their partners in many instances, until, as stated, syphilis became epi- demic in the village. The doctor personally had under active treatment 16 cases of syphilis, traceable to these women, and had seen in con- sultation as many more ; the physicians located in the village were treating a number while others were taking advertised cures. Of course where there is such an epidemic, 2TS 276 SEXUAL PROBLEMS OF TO-DAY cases of innocently acquired syphilis are almost sure to occur, and Dr. Townsend did come across one such case. A man, a husband and father, "went out with the boys," as he expressed it, and after drinking heavily wound up a night's debauch by cohabiting with one of these women. In due time he developed a chancre which was im- properly diagnosed as a soft sore and cauter- ized. It was of the chancrous erosive type, and healed rapidly. About the time of its healing, mucous patches appeared in the mouth. Not much importance was attached to them by the medical attendant or patient, so he had no warning of their infective character, and hence had no hesitation in kissing and fondling, as was his custom, his four year old baby girl, with the result that when the doctor saw the child it presented a typical chancre of the lip. What this child's future may be, only phy- sicians with a practice in this class of diseases can conjecture. The history of this little epidemic in a re- spectable God-fearing New England commu- nity is full of different kinds of morals, but we will leave the elucidation of these morals to our readers. It is not good always to have the editor do the thinking for his readers. Let them think once in a while for themselves. IMPRISONMENT FOR A KIND ACT A girl, employed in the telephone service in Berlin (which in Prussia is a government mo- nopoly), recently became pregnant, but had a spontaneous miscarriage. She called in a phy- sician to treat her and when she got well and had to return to work she had to bring a medi- ical certificate, stating the cause of the ab- sence and the nature of the disease. Nat- urally the poor girl asked the doctor not to re- veal the true nature of her trouble, as if that became known, she would at once lose her po- sition. The doctor did what every decent doctor would do — he filled out a certificate stating that the patient had suffered from in- fluenza. Unfortunately, the truth became known to the dragons of the law, the doctor was arrested and tried for knowingly giving a false certificate. Tho it was shown that the doctor gave the certificate not for pecuniary reward, but out of good nature to save the girl from disgrace and from losing her position, and tho the press and his professional col- leagues asked for clemency, still the judges were adamant and sentenced the poor "cul- prit" to one month's imprisonment. It is a bad thing to get into the clutches of Prussian 877 278 SEXXJAIi PROBLEMS OF TO-DAY judges. The Aertzekammer (the Medical Chamber) will petition the Kaiser for pardon, but whether he is pardoned or not, all honor to our confrere, who only did what any decent physician and man would do. BARBIE, UNFAITHFULNESS AND FOR- GIVENESS Many newspapers are making a lot of fuss and giving expression to a lot of drivel and rot, because Barrie, the well-known novelist, is willing to forgive and to continue to live with his wife, who he discovered loved and had re- lations with another man. "We cannot see how Barrie could have acted otherwise if he really loved his wife. And there is no heroism or altruism in Barrie 's action whatsoever; he simply finds it more painful to live without his lovely wife than to live with her, even with her "unfaithfulness." And if Barrie is a hero on account of his willingness to forgive, then we have millions of such heroines among all classes of women. For the number of women who know of the unfaithfulness of their hus- bands and nevertheless continue to live with them is very large indeed. It might be said that the women do it because they have to, be- cause they are economically dependent upon their husbands. But in our opinion, this is UNFAITHFULNESS AND FORGIVENESS 279 taking a narrow view of the question. It is un- questionably true in some cases, but in the ma- jority of instances, the real cause lies else- where. The real cause is love, the love of the wife for the husband. And I think d little of the "love" of a husband, who will disgrace and cast out into the street a wife, with whom he lived for years, who bore him children, who shared with him his trials and tribulations, merely because (perhaps for irresistible physiologic reasons) she happened to make a "misstep." Such a man never loved his wife. He merely had her as a convenience. And tho such a man may have all the legal rights on his side, tho Mother Grundy may encourage and society may ap- plaud him, in our eyes such a man is a com- mon brute. He never knew the meaning of Love. Love understands all, gives all and, above all, forgives all. SIR JONATHAN HUTCHINSON ON SYPH- ILIS AND MARRIAGE Among the lenient and optimistic syphilolo- gists Jonathan Hutchinson occupies first place. He still believes that gray powder is the best and most efficient method of treating syphilis and that an interval of two years between the active manifestations of the disease and mar- riage is sufficient. He says that this two years ' rule has never given him cause for regret, and in an experience of over fifty years he has not yet seen a case of congenital syphilis as a re- sult of marriages which were contracted with his sanction. "I most unhesitatingly record my convic- tion," he says, "that of an old man who has had much social experience — that, provided the two years' interval be observed, the dangers to society from needlessly prolonged celibacy infinitely exceeds the risks of the communica- tion of syphilis. Such diseases as insanity, tuberculosis, and even gout are far more real dangers to the race than is syphilis. If in reference to them, like rules as regards mar- riage were enforced as those which some would impose in reference to syphilis, it would be dis- 880 VENEBEAL INFECTION IN CHILDREN 281 astrous to social progress and would greatly; reduce the sum of human happiness." VENEREAL INFECTION IN CHILDREN That venereal infection in children is not merely a specter, but a horrible reality, will be seen from a paper by Dr. F. Pollack, published in the Johns Hopkins Hospital Bulletin (No. xx, p. 142). According to the author, there are about 1000 cases of acquired venereal infec- tion among children in Baltimore every year. If a city of the size of Baltimore has 1000 cases yearly, it is a perfectly safe and rather con- servative estimate to say that there are one hundred thousand cases in the United States every year. And this is a terrible, terrible number. The cause of a large number of out- rages on children is due to the wretched su- perstition still prevailing among the low and uneducated classes that a person suffering with either gonorrhea or syphilis may get cured by having intercourse with and transmitting his infection to an untouched virgin. Thousands of cases of gonorrhea and syphilis in young girls are caused by this savage belief. Dr. Pol- lack has personally seen 189 such cases in the last six years. A terrible condition of affairs indeed, and still our puritans would like to suppress pros- 282 SEXUAL PBOBLEMS OF TO-DAY titution entirely. They do not want to see what every sane person sees, that rape in vari- ous forms would increase a hundredfold. CONTEACEPTION AND ABORTION The man who sees no difference between the advocacy of the prevention of conception and the induction of abortion, between the sale of contracepts and the sale of abortifacients, is a man of such infantile mentality, that it is hardly worth while to enter into any discus- sion with him. That type is almost hopeless. Almost but not quite. For we have been suc- cessful in admitting some rays of light into the crania of apparently hopeless cases — and then jthey wondered how they could be so stupid as not to see the difference between merely pre- venting a thing from happening and destroy- ing a thing after it has happened. WHO SHOULD DISCUSS THE SEXUAL CONTINENCE QUESTION? In order to reach a proper solution of the sexual continence question, we must eliminate from the discussion certain classes of people. We must eliminate the man who is so old that he no longer remembers that he ever was young ; we must eliminate the impotent or per- vert, who never experienced any normal desire ; we must eliminate the bigoted theologian and the narrow-minded moralist, who consider ex- tra-marital intercourse a crime, about on a par with burglary or murder; we must eliminate — this by all means — the asexualized old maid, who has no conception of the power of the libido in normal man (or in normal woman, for that matter) ; and — last but not least — we must also eliminate the debauchee who puts an absurdly exaggerated value on the sexual function, and who believes that life without sexual gratification is not worth living. In short, the question should be discussed by normal, healthy, free thinking, scientific men, ranging in age between thirty and fifty. They may be older, provided they have good memories. 283 284 SEXTJAIi PROBLEMS OF; TO-DAY Only then will we have an honest and scien- tifically valuable answer to this tremendously important question: The existence or non-ex- istence of the sexual "necessity." THE GOSPEL OF HAPPINESS If we had a century more to live and had no other work to do, we would devote every minute of it to preaching the gospel of joy and happiness. That is the apostolic work that we are in the greatest need of now. Our life is so short, and so full of (partly unavoidable) woe and disappointment, that to take away the few joys nature did grant us is nothing short of criminal. The ascetic, diied up in body and soul, is an enemy of mankind. A MEETING IN GEEMANY ABOUT THE LIMITATION OF OFFSPRING The evening of August 29, 1913, will remain strongly impressed upon my memory, probably for years to come. I had read in the Berlin Vorwarts that on that evening a mass meeting under the auspices of the Social Democratic Party would take place, at which the subject of the limitation of offspring would be discussed. This was to be the second meeting dealing with this subject. Another meeting had taken place the week before, August 22, at which several eminent socialist women, among them Eosa Luxemburg and Clara Zetkin, spoke very strongly against the limitation of offspring among the poor. In fact the title of the dis- cussion was "Gegen den Geburtstreik!" — against the birth strike. They and others were to speak again, and I decided to be present at that meeting, be the difficulties what they may. Had it been announced that the speakers would be in favor of the limitation of offspring, I would not have thought of going. For I believe — don't you — that I am fairly familiar with all the arguments that can be brought for the limi- 285 286 SEXUAL PBOBLEMS OP TO-DAY tation of offspring among the poor, and the speakers could tell me nothing new. But I was deeply interested to hear what apparently cul- tured, freethinking people, and socialists at that, could have to say against limiting the num- ber of children among the working people of Germany. That being a socialist was not al- ways an absolute guarantee against being a fool — on some occasions at least — that I always knew. But I was determined not to depend upon any newspaper reports — neither capital- istic nor socialistic, one is apt to be just as biased as the other — but to go and hear for myself. And well that I did so. I happened to mention to Prof. Blaschko that I intended to go to that meeting ; he said he also expected to be present, but if I expected to get in and have some kind of seat, I ought to be there an hour before the meeting was called to order. Tho the hall was an immense one, hold- ing several thousand people, still the previous week thousands were turned away. When I got there, at 6.40, thousands of German Ar- beiter and Arbeiterinnen were standing packed like sardines, patiently waiting for the doors to open. At 7 sharp they opened — it was like the opening of sluices holding back a rapid torrent. It seemed as if in one instant the immense hall, holding over 5,000 people, was filled to its capacity. But no, the people kept LIMITATION OP OFFSPRING 287 on pouring in until nearly 8 o'clock, when the police locked the doors to prevent dangerous overcrowding. As an Editor I was permitted on the plat- form, where chairs and tables were reserved for the reporters, and from that vantage ground I could comfortably observe what was going on before me and listen to every word of the speak- ers. It was a full hour before the speechmak- ing was to begin, so the people in the meantime made themselves comfortable. The reporters took out sandwiches and cold lunches from their pockets, and so did the men and women in the audience. I was told that they always did that. When they got thru with their work it was too late for them to go home, and eat or tidy up a bit, so they had their suppers with them and went directly from the factory to the meeting hall. Waiters soon appeared with trays on which there were tall glasses of a liquid which looked like beer, and for a while the room looked more like a cheap eating place than a meeting hall. The number of people was estimated to be over 5,000, women predominating; probably three-fifths were women and two-fifths men; some thought the proportion was higher — as two to one. The audience looked a good deal like any of our radical audiences — except that there was more uniformity in the faces. They were practically all German, while in New York 288 SEXUAL PROBLEMS OF TO-DAY a radical audience is composed of seventeen and a half nationalities. The chairman of the meeting was a hig bearded fellow, one Eugen Ernst, an old, faith- ful, hard working party member and he is to be congratulated on the manner in which he pre- sided. At times the meeting became quite stormy, and it was hard to make out what the hundreds of contradictory voices demanded, but he remained cool, firm, earnest, and not once did he lose his sang-froid. The enthusiasm or rather the interest of the audience was intense ; one could see that with them it was not merely a dialectic question — as it was with their lead- ers — but a matter of life and death. I came to attend a meeting against the limi- tation of offspring; it soon proved to be a meet- ing very decidedly for the limitation of off- spring. For every speaker who spoke in favor of the artificial prevention of conception or undesired pregnancies was greeted with vocif- erous, long-lasting applause; while those who tried to persuade the people that a small num- ber of children is no proletarian weapon and would not improve their lot were so hissed that they had difficulty in going on. One time when an anti-speaker, one Pieck by name, made a particular ass of himself (I will give his "argu- ment" later on), the tumult became so great, and the demand that he shut up so persistent, LIMITATION OF OFFSPKING 289 that the chairman had to appeal earnestly to the sense of fair play of the audience, to their idea of free speech, before the speaker was permitted to finish. The speakers who were against the limitation of offspring idea soon felt that their audience was against them, and then they did the one foolish thing against which speakers should al- ways guard — they began to scold the audience, call them stupid, ignorant, egotistic, mentally lazy, etc., and they began to reproach them over and over again. I could not help laughing out right loud — why there was such small attend- ance at the regular socialistic meetings, while the meetings of this character were packed to suffocation. It did not apparently penetrate the leaders ' heads that the reason was a simple one : those meetings were evidently of no inter- est to them, while these which dealt with the lim- itation of offspring were of personal, vital, pres- ent interest. It does occasionally happen that the people are ahead of their leaders. This meeting certainly showed that the German masses see more clearly — perhaps it is because they feel their own misery more deeply — than do some of their eminent would-be leaders. The principal anti-speaker of this as of the previous meeting was Clara Zetkin. She is a fine, fluent, earnest, perhaps slightly hysterical orator, but real arguments against the limita- 290 SEXUAL PEOBLEMS OP TO-DAY tion of a too numerous progeny among the poor she gave none ; and for a very simple reason — there aren't any. She spoke with deep content of everything bourgeois, but everyone of her ar- guments was strictly reactionary and bourgeois. Yes, the individual family might be benefited by few children ; but we must not pay any attention to the individual ; what concerns us is the class. The proletariat cannot improve its condition by having few children; it can only improve it by the class struggle, by revolution. And for a successful revolution we must have many chil- dren ; the more children we have the more fight- ers. In revolutions it is not quality that is im- portant, but quantity, etc. The good lady over- looked here a very important thing. It is not at all certain that every child born to a pro- letarian family becomes a fighter for the pro- letariat and for freedom. The chances are more than even — especially if he belongs to a family with many hungry mouths — that he may become a member of the slum or bum prole- tariat, a class which has always furnished hire- lings to the ruling classes, strike-breakers, thugs, etc. What particularly amused me — and pained me — in the anti-limitationists was the ease and equanimity with which they advised the poor women to keep on bearing children. The LIMITATION OF OFFSPRING 291 woman herself was not taken into considera- tion, as if she were not a human being, but a machine. "What are her sufferings, her labor pains, her sleepless nights, her inability to read, to attend meetings, to have a taste of life? What does she amount to? The proletariat needs fighters — go on, females, and breed like animals. May be of the thousands you bear a few will become party members. In what re- spect are such lovers of the people superior to the old tyrants and blood spillers, who bade the people breed because they needed soldiers for their armies? Those who are comfortable and well-off, and those who have few or no children must have limitless cheek to advise the poor devils to breed like rabbits. The speaker who was hissed most was one Pieck whom I mentioned before. He was one of the typical hot air speakers, who by the loud- ness of their voice tried to make up for the paucity or measliness of their ideas. He threw epithets at the advocates of limitation and his own arguments against few children consisted in the following: If we advocate limitation of offspring, we thereby reproach and insult our own parents who bore us ! And further : if to be a good proletarian one must have few chil- dren, then to be a better proletarian one must have none; and if so we should abolish mar- 292 SEXUAL PBOBLEMS OE TO-DAY riage, for marriage is only for the sake of hav- ing children! And this from a "class-con- scious" socialist. One plain workman elicited a great deal of applause with his blunt brief remarks : ' ' They frighten us with the threat that if we do not have many children we will go to the devil, cease to exist. I wish I had ceased to exist long ago or had never been born, ' ' was the cry of this plain worker, which one felt came from the depths of his heart. To report, however briefly, the remarks and speeches of those who spoke in favor of the limi- tation of offspring among the poor is unneces- sary. My readers are familiar with them. It was, however, a source of satisfaction to find that wherever the subject is investigated in an unbiased manner the same conclusions are ar- rived at. Two points the speakers emphasized repeatedly : that not only absolutely but propor- tionately the largest number of prostitutes comes from the large families (as well as strike- breakers) and that the women who are the moth- ers of many children can but rarely and with greatest difficulty be gotten to interest them- selves in the "cause," or even in ordinary cul- ture or literature. They have neither the time nor the inclination. When the meeting was over at 11 :30, the mat- ter seemed to stand as follows: Whether the LIMITATION OF OFFSPRING 293 limitation of offspring is to be considered a revolutionary weapon against militarism and capitalism is questionable ; but that it is a won- derful measure in improving the condition of individual families, in guarding the health of the woman, and in generally strengthening the working classes in their political and economic battles, about this there could be no question. And the feeling was that though Clara Zetkins and Eosa Luxemburgs and all other literal and figurative old maids could talk and scold until doomsday, the diminishing birth rate will go on diminishing still further, until such a time when the people will feel that by bringing a child into the world they are increasing the sum total of human misery, ill health, and wretchedness. Give the people assurance that their children will be brought up decently, will receive a proper education, will be assured of a congenial occu- pation, or of employment at any rate, and the women will be glad to bear children. The ma- ternal instinct will not die out. Take away the specters of crime, disease and poverty, and the specter of race-suicide will vanish also. THE CONTINENCE ADVOCATES— WHO THEY ARE. Those who preach absolute continence from illicit intercourse at all hazards, under all cir- cumstances, belong to two classes: 1. Those who do so from a religious or moral point of view; and 2. Those who claim to be free from the theologic or moralistic bias, and base their advocacy on presumably purely hygienic grounds. With the first class we have no quar- rel : a religious or moral code admits of no argu- ment. You believe a certain way, and that's all there is to it. But with the people of the sec- ond class I do have a quarrel, for while pretend- ing to speak as scientists and hygienists, if you examine their arguments you will at once dis- cover the theologic or conventional twist. Let us be honest, and let us not mix or confound theology or a man-made morality with biologic necessity. As far as my personal experience goes, the men who preach absolute continence to the young generation at all costs, belong to either one or several of the following cate- gories : 1. Men with a congenitally weak or absent ?94 THE CONTINENCE ADVOCATES 295 sexuality. 2. Old or middle-aged men who have become sexually impotent, and who have for- gotten that they ever were young and that red blood ever coursed in their veins. 3. Men who have married at a very early age. 4. Men who while believing in the sexual necessity still think that the danger of venereal infection and of moral degradation is so great that it over-shad- ows the possible harm of continence, and that public policy and the good of the rising genera- tion therefore demand the advocacy of con- tinence. 5. Simply and plainly hypocrites, who while preaching continence from the platform lead a very free and active sexual life. To this class belong some of the professional lec- turers who are expected to preach in a certain way at so much per lecture. The people of cate- gory five need not be taken into consideration, as they are unworthy of respect. The men of the first four categories are perfectly sincere in their opinions; but those belonging to cate- gories one, two and three are not competent judges in the matter. THE MATERNAL INSTINCT Is the maternal instinct more pronounced in the poor and ignorant or in the cultured and civilized? We believe it is more pronounced in the former. At any rate a case like the fol- 296 SEXUAL PBOBLEMS OP TO-DAY lowing would hardly be found among the women of the "Four Hundred." The case is reported by Dr. S. J. Scardon (N. T. Med. Jour. Sept. 23, 1911). The patient was a woman thirty-one years of age, married thirteen years. She had had one miscarriage and seven children. The first child died eight days after birth, the second was stillborn, the third died soon after birth, the fourth died three days after birth, the fifth also died on the third day after birth. When she was pregnant with the sixth child she decided to have a live child no matter at what cost, and she was delivered by abdominal Cesarean section. The child is now one year and four months old. One would think that by this time the woman would have had enough, but apparently neither she nor her husband was satisfied, because she became pregnant again. She registered at the Maternity Hospital, and there was consid- ered the desirability of inducing labor in the eighth month to avoid the possibility of another Cesarean section, but she would not consent to any procedure which might endanger the life of the child. And so when normal labor came on and the head of the child refused to engage, and there was danger of the uterus rupturing at the site of the old scar, another Cesarean sec- tion was performed and she was delivered of a living child and made an uneventful recovery. THE CONTINENCE ADVOCATES 297 Incidentally this again shows that the fear of our prudes that knowledge of the means of the prevention of conception would depopulate the earth is unfounded. The maternal instinct is still strong enough in the breasts of a suffi- ciently large number of women to keep the race satisfactorily replenished, the only difference being, as we have said so many times before, that the people would have their children when they wanted them and only as many as they wanted. THE DURATION OF OUE PASSIONS "La duree de nos passions ne depend pas plus de nous que la duree de notre vie" — The dura- tion of our passions no more depends upon our- selves than does the duration of our life. So says La Eochefoucauld. But our author is mis- taken. For the duration of our lives does to a great extent depend upon ourselves. Under strict hygienic living and by avoiding foolhardy dangers, we can prolong our life considerably. By excesses, dissipation and carelessness we can shorten it. And so with our passions, by which the author means love. With careful solicitude love can be made to last a lifetime ; under brutal manipulation, it will soon wither and die. For Love is a tender plant requiring loving care. ARTIFICIAL IMPREGNATION Abtificial impregnation is just now the sub- ject of considerable interest and discussion among medical and lay circles in Germany. Not that there is really anything new in the subject — but it is all due to our daily press, which is constantly on the hunt for new sensations. In the Munchener medizinische Wochenschrift Prof. Doderlein reported a case of pregnancy following the artificial injection of semen into the uterus. There was nothing essentially new in this, for our own Marion Sims did the same thing some 45 years ago. But the daily press — not only in Germany, but thruout the world — reported this case as one of the wonders of modern medicine, and now sterile couples are besieging the offices of the German physicians with the demand to give them a baby. With the unsophisticatedness of the layman and lay- woman they believe that the thing must be in- fallible in each and every case, and if they are told that under the most favorable circum- stances the procedure is successful only in a certain percentage of cases, when they are fur- ther told, after an examination, that the man's 298 ARTIFICIAL IMPBEGNATION 299 semen is worthless, and even if brought in di- rect contact with the woman's ova would fail to impregnate them, they go away disgusted, thinking that the vaunted science of medicine is after all a good deal of a humbug. Poor lay- men. A remedy or method must cure or be suc- cessful in one hundred per cent, of all cases, or it is no good. We physicians are more modest in our demands. At a meeting of the Berlin Medical Society, Dr. Joseph Hirsch read a paper on Artificial Impregnation which elicited considerable dis- cussion. He tried the method in 16 cases, in 6 of which it proved successful, i. e., the women, who had been sterile for many years, became pregnant. He thinks that if he had been per- fect master of the technic from the beginning his results would have been better still, because all the first seven cases were failures, the six successes being among the nine last ones. The technic is very simple. The fresh semen is drawn directly from the condom into a ster- ilized syringe with a long nozzle, warmed up to about 99° F. The cervix is drawn down and a small quantity (a few drops) of the semen is injected into the uterus. The rest of the semen is put on a tampon of cotton which is pushed up against the cervix. The woman remains in bed several hours. No douches or antiseptic appli- cations are to be made. It is important to in- 300 SEXUAL PROBLEMS OF TO-DAY ject only a few drops, as a large quantity of semen may cause uterine colic, inflammation and perhaps even extrauterine pregnancy. The question if impregnation with the semen of a strange man, provided both husband and wife, agree, is ever permissible is a ticklish one and is answered differently by different physi- cians. It is a well known fact that the wives of sterile husbands are sometimes so fearfully anxious to become mothers, that their husbands agree to their artificial (and sometimes even natural !) impregnation by the semen of another man. Prof. Fiirbringer stated that he had in his practice many such cases. He knows the case of a sterile physician, who himself injected the semen from another man into his wife 's uterus. Dr. Emil Engel stated that he has been employ- ing artificial impregnation for a long time. Prof. Strassmann stated that he employed the method three times and only once successfully, but in this case the value of artificial impregna- tion was proven beyond a doubt. It was the woman's second marriage. Her first marriage was also childless. He injected 1 Gm. of semen ; the woman had no intercourse thereafter and she became pregnant. Afterwards she had two more children without artificial aid. It is a curious fact that the first reported case of artificial impregnation is by a clerical man. In 1767 the Abbott Spalanzani reported the sue- ARTIFICIAL IMPREGNATION 301 cessful artificial impregnation of two bitches. In 1790 John Hunter reported a successful case of artificial impregnation, the husband being af- flicted with hypospadias. Eohleder in his ex- cellent book Die Zeugung beim Menschen has a special appendix on artificial impregnation. Lutaud in his textbook on Gynecology published in 1889 has a special chapter on Fecondation Artificielle. As is seen the whole subject is not by any means new. But our newspapers are not supposed to know it. But — no harm done. They have served to bring to public attention a rather interesting subject. Also — some phy- sicians' incomes will be increased thereby, and the human race will be augmented by some mem- bers. Tho not produced in the conventional way, they are just as good. THE WHY OF THE BENEFICIAL EF- FECTS OF PROSTATIC MASSAGE The beneficial effects of prostatic massage on the sexual and urinary function, on the gen- eral health and the psychic condition of the pa- tient are admitted by all who have had exten- sive experience with this procedure. But it must be confessed, that if we were asked to give the rationale of the beneficial action of massage of the prostate, to explain the why, we would have to answer largely with guesses and hy- potheses. Why should massaging the gland and expressing some secretion from it improve a person's appetite, improve his sexual desire and power, relieve him from his depression, and make him feel hopeful and buoyant, when before he was blue and despondent? The rapidity with which the beneficial effects manifest them- selves often gave rise to the thought of some toxic substance being generated by the prostate, which toxic substance is removed by the mas- sage and subsequent irrigation, just as the curetting or even simple douching of an infected uterus, or the washing out of a purulent cavity is often followed immediately by a fall in the 302 EFFECTS OF PEOSTATIC MASSAGE 303 temperature and improvement in all the symp- toms. The recent experiments of Legueu and Gail- lardot seem to give support to this idea. They experimented on dogs and horses and found that an extract prepared from hypertrophied prostates possessed marked toxicity. And they believe that the removal of a hypertrophied prostate has a doubly beneficial effect. It re- moves the obstruction to urination and removes a gland which manufactures toxic products. And we are justified in believing that mas- sage of an enlarged or simply congested pros- tate does good not only because it improves the circulation in that gland, not only because it stimulates the extremely rich nerve supply, but also because it mechanically removes toxic prod- ucts which would otherwise be absorbed into the blood and lymph stream. A STORY WITHOUT A MORAL The case is about the well-known Mr. X. He is a very nice young man. From what follows it might appear that I am using the word "nice ' ' sarcastically, but I am not. He was really a nice, conscientious young man. He is just past thirty. He had a gonorrheal infection at the age of twenty. He was treated very energetic- ally and was completely cured. He remained continent for about two years. And then he could stand it no longer, or thought he couldn't. But ill-luck pursues some people. A year later, at the age of twenty-three, he had the misfor- tune to contract syphilis. He had the good sense to go to one of the best specialists in the country, was actively treated for two years, and was pronounced clinically cured. For four years no symptom had made its appearance. His disease became a vague shadowy memory to him. He was in good health in every respect. The physician who had treated him told him he was all right, he had nothing to fear. He began to keep company with, say, Marion, a splendid young lady whom he had known for some years, and who, he knew, was not indiffer- 304 A STORY WITHOUT A MORAL 305 ent to him. They became engaged. And in two or three months the day for the wedding was set. And they were as happy as a loving, congenial and healthy couple can be. Accident- ally our young man read in a medical paper that there was a new test, the "Wassermann, by which it could be postively determined whether a per- son's blood still contained syphilis or was ab- solutely free from any taint of the disease. He was, as I said, a very nice conscientious young man. And forthwith he decided to have a "Wassermann test made. And he read with a pang in his heart that the result was positive, that is that there still was some syphilis in his system. And again there began a series of in- jections and inunctions in addition to internal medications. In three months another "Wasser- mann — and again positive. He was now given an intravenous injection of 606. In a month an- other test — again positive. As he was a very nice young man and loved his Marion dearly, he did not lose patience and took another injection of 606. And once more the report was that the "Wassermann reaction was positive. He thought and brooded over the matter for some days and then his course seemed to him perfectly clear. There could be no two opinions on the subject. It cost him a good deal of effort, but it had to be done. He had no right to endanger the health and life of a pure healthy girl. He 306 SEXUAL PBOBLEMS OF TO-DAY wrote to her that he could not go into details, but for valid and irremovable reasons, be was obliged to give her back ber word, and it would be best if tbey never met again. He hoped she would understand that this decision was irrevoc- able and that she would have enough considera- tion for him not to ask him for an explanation. In former days this would have ended the matter. Marion or Maud or Elizabeth or Irene or whatever her name happened to be would cry her eyes out, would break her heart and would pine in solitude — either forever or until some other man would take pity on her. And it would form the plot of a very pretty sentimental novel. But times have changed. Girls do not pine their lives away on account of some prob- able or improbable misunderstanding, without asking for an explanation. In two hours after the receipt of the letter Marion was in his office. She had a right to know the reason. She did not intend to change his decision, but she was not a child that could be fobbed off with a fabri- cated story, or asked to demand no explanation in a matter which affected her whole future life. She came to know the real reason and she would know. And in ten minutes she knew every- thing. The same day she was at the doctor's. She wanted to know if marrying Mr. X would endanger her health and if the offspring would be diseased. She was told that she ran no risk A STORY WITHOUT A MOBAL 307 as long as she did not become pregnant. If she became pregnant she ran some, tho not very great, danger of becoming infected. The off- spring, however, was apt to be diseased, or at least below par. She asked me if there "was any possibility of Mr. X being cured com- pletely. She was told there was. Her com- ment was that children were not everything there was to married life. And they would guard against having children for some years to come. They were married. And they have been living an unmarred, unclouded, happy life. The last two Wassermann tests have both been negative, and if after six months more no symptoms whatever make their appearance and the blood test remains negative, permission will be given them to have a child. The health of both parents is perfect and there is no fear about the future child's health. TO LIGHTEN THE BURDEN OF THE ILLEGITIMATE MOTHER The heartless cruelty that characterized the treatment of the "illegitimate" mother in former times is giving way to gentleness and consideration — in some communities at least. In the city of Toulouse, France, a girl or woman about to become a mother may enter a matern- ity hospital, with a mask on her face, which she need not remove until after she has left the hospital. Nor need she give her name or any other information. In order to make it possible to fill out a death certificate in case an accident happens, she writes down some personal data which she seals and which she takes along with her and may destroy, after the confinement is happily over. That certainly shows tenderness for the feel- ings of the poor illegitimate mother; quite dif- ferent from the times when she was hooted, spat upon and practically stoned to death. It may be of interest to add that officially the municipality of Toulouse is strongly socialis- tic. 308 THE INFLUENCE OF THE BODY ON THE MIND We have been deluged and nauseated with articles and sermons, with tracts and treatises and magazines dealing with the influence of the mind on the body. Though this influence has been exaggerated and though certain sects have used perverted claims about the omnipotence of this influence to serve their selfish purposes, still the fact of the existence of such influence nobody will question. But while we have heard much, much too much, about the influence of the mind on the body, we hear very little about the influence of the body on the mind. And still the observant physician sees examples of this in- fluence very frequently. Not only will a slight bodily disorder influence a man's viewpoint, his psyche, but it may actually produce a radical change in his conduct, in his morals, making a conventionally moral man commit very immoral actions. — A few illustrations. Mr. A. is a successful druggist, doing a good business, and always of a rather cheerful tem- perament. Of late those about him and he him- self have noticed a marked change in his char- 309 310 SEXUAL PBOBLEMS OF TO-DAY acter. He is constantly grumbling and occasionally breaks out in a fit of temper — a luxury he never indulged in before. And more- over of late he has become obsessed with the idea that his business is or will be going to the dogSi His wife shows him that the daily re- ceipts, are the same — but that has no effect on him. He is sure the Eiker trust will probably open another store in- the neighborhood, etc. An examination shows that the underlying cause is probably nothing more than autointoxication due to constipation, lack of exercise and, in general, defective metabolism. The treatment corroborates the correctness of the diagnosis. It consists in a daily saline laxative in the morn- ing and a brisk walk of an hour's duration in the afternoon. Ten days of this treatment works a wonderful change in the patient. He has lost his grouch and is not a bit anxious as to the future of his business. On the contrary, he is as cheerful and optimistic as he ever was. Mr. B. has been given of late to fits of passion. He makes everybody in the house miserable. Constantly squabbles with his wife and chil- dren, and scolds the servants and quarrels with friends on the slightest provocation. An ex- amination shows a very rapid irritable heart. He is suffering with paroxysmal tachycardia. The affection is of recent origin only. Treat- ment brings about improvement in the condi- INFLUENCE OP THE BODY ON THE MIND 311 tion of the heart with resulting marked improve- ment in the condition of the man 's temper. And whenever the heart condition is aggravated, his temper becomes worse. Improvement in the heart is invariably accompanied by improve- ment in his behavior. Mr. C, a successful literary man, has been gradually becoming melancholy, disinclined and unable to work, and confesses to having enter- tained thoughts of suicide. He is happily mar- ried, loves his wife and children, ' his financial condition is secure and he knows of no reason for his depression and dark thoughts. After painstaking questioning he reluctantly discloses the fact that for the last two years his potency has been failing, so that now he is practically impotent. Treatment, continued for several months, having completely restored his potency, all his melancholy symptoms have completely disappeared, and he looks at life as cheerfully as he did at the age of twenty-five. Mr. D.'s case is perhaps the most interesting and the most significant. Mr. D. is 52 years old, has been married twenty-five years, and has three grown up children. Is the owner of a large manufacturing business. Has always led a conventional life and has been a model hus- band, tho he does not deny occasional stray- ings from the path of matrimonial rectitude — al- ways however with extreme care and caution, 312 SEXUAL PBOBLEMS OF TO-DAY so as not to offend the proprieties and not to pain his wife. For six or eight years prior to ten months ago, he has been altogether faith- ful to his wife. He did not feel the need of any extramatrimonial satisfaction. About ten months ago, however, a complete change seems to have come over him. He began to run after women in a most disgraceful manner. At first he tried to conceal it from his wife, but soon he gave up the attempt. And though his behavior pains her to the death, he does not change his conduct. From a kind considerate husband, he seems to have become utterly brutal. No, this would not be correct. He seems to regret his actions, he is sorry for causing his wife pain, but that does not make him change his actions. That's what his wife says. For it was she who first came to consult me about her husband's behavior. Lately he has often stayed out all night. His wife has found out that he visits the lowest resorts — white and colored. She induced him to come for a consultation. It is a well- known fact that in people of 45, 50 and over a sudden flaming up of the sexual passion is often due merely to some prostatic irritation. In some old men this, what I would call, libido prostatica may reach the proportion of a mania, of satyriasis. I suspected that in my patient the cause was a purely physical one, and an ex- amination of his prostate, to which he consented INFLUENCE OE THE BODY ON THE MIND 313 readily, showed an enlarged gland, with several extremely sensitive spots. He volunteered the information that his behavior was painful to him, that his relations did not cause him any pleasure or satisfaction, but that he could not help himself: he was driven by an irresistible force. Several prostatic massages, combined with rectal injections of cold saline solution, with codeine suppositories and large doses of brom- ides internally, brought about a remarkable im- provement. While, at the present writing, he can not be pronounced cured, his condition is so much improved that there is no doubt that ten or fifteen additional treatments will complete the cure. His libido is still exaggerated, but he can control it now. He is a different man — and his wife feels a different woman. Many similar and perhaps more striking ex- amples could be given. The physician psycho- logist sees them frequently. Let us therefore bear in mind that while the mind exercises a powerful influence on the bod- ily functions, that while a cheerful hopeful atti- tude has an unmistakably beneficial influence on the course of disease, the reverse of the proposi- tion is just as true. The condition of our body, the poor despised material shell, has a remark- able influence on our feelings, our thoughts, our hopes and aspirations, our behavior towards our fellowmen — and fellowwomen — , our con- 314 SEXTJAL PEOBLEMS OF TO-DAY duct, our morals. A penny's worth, of medicine will sometimes do more towards a cheerful out- look of life than a library of Christian unscience or socalled new thought. DEMAND IN GERMANY FOE A MODIFI- CATION OF THE LAW AGAINST ABORTION Thbuout Germany voices are heard more loudly and more and more frequently, demand- ing a change in the present law against abortion. Physicians, jurists and sociologists unite in this demand. Before me is a pamphlet, containing a "memorial" presented by Dr. Ferdinand Goldstein, a practicing physician in Berlin, to the Commission of Revision of the Penal Code. Dr. Goldstein would like to have the present law changed to the effect that abortion should not be at all punishable if produced by or on a woman who had already given birth to three children, or by or on an unmarried woman who had been seduced or raped. This is a desirable change and most people will agree that the pen- alties against abortions in all civilized countries are unduly severe and brutal. But the doctor's reason for demanding len- iency in all cases (maximum one year prison, and not as now 5 years penitentiary) and free- dom from any punishment under the above men- THE LAW AGAINST ABORTION 315 tioned conditions is a peculiar one. As a rule people demanding a change in the laws against anticonceptional measures and abortion are radical thinkers. This doctor, however, is a conservative. His reason is : he is afraid of the constantly increasing proletariat and of the socialists! He refers to the well known fact that everywhere in the world the poor have more children than the rich ; and if this is permitted to go on, the number of the poor, the proletariat will keep on increasing. Now the chief strength of the socialist party is in the proletariat. Con- sequently we must teach the poor the means how to limit their offspring, and we must not punish them even if they produce abortions on themselves, provided they have contributed to the preservation of the race by giving birth to at least three children. Well, well, politics certainly makes strange bedfellows. The fear of socialism sometimes makes a hidebound conservative a rabid radical — on some points. A EEMAEKABLE CHANGE IN THE ATTI- TUDE TOWARD ILLEGITIMACY Several times we referred to the fact, and pointed to it as a gratifying sign of the times, that in some European countries the attitude of- the community toward the illegitimate mother 316 SEXUAL PBOBLEMS OF TO-DAY was undergoing a radical change ; formerly bru- tal and barbarous it was now becoming consider- ate and humane. And the father, who up to recently was generally let go scot-free — free from any financial and moral responsibility, is not going to have it quite so easy in the future. People are beginning to see that it is not quite right that the man, who is in most cases the aggressor, should have no responsibility at all, while the weak woman should bear not only the pains and annoyance of gestation, of labor, of lactation, but also the moral disgrace and os- tracism and the financial burden of bringing up the child. The greatest change in the attitude towards the whole subject of illegitimacy — toward the illegitimate father, illegitimate mother and illegitimate child, is taking place in that fine little country, Norway. Even illegitimate mothers who have committed infanticide they are beginning to treat with charity and mercy. In several instances within the last few months the jury refused to convict illegitimate mothers who had killed their children, even when there were no specially extenuating circumstances. They said they did not feel justified in convict- ing the mother when the father, who was cer- tainly morally at least equally guilty, was to be let go scot-free. In the last case of this kind the foreman of the jury said that if the father ATTITUDE TOWARD ILLEGITIMACY 317 and mother were both on trial they would feel obliged to convict, but that they preferred to act against the law and let the mother go free than to commit the injustice of convicting her alone. MY SEX PROPAGANDA On March 7, 1913, two hundred friends and admirers of Dr. Robinson's work celebrated the tenth anniversary of the foundation of the "Critic and Guide" by a banquet, at which the venerable Dr. A. Jacobi presided (See "Critic and Guide," April, 1913). A number of speeches reviewing Dr. Robinson's activity were delivered and Dr. Robinson responded. The following are the concluding words of his ad- dress : I should be untrue to myself, and I could justly be accused of cowardice, if I did not say a few words to-night on that part of my work which has created most animosity and condem- nation on the one hand, and most praise and commendation on the other. I refer, of course, to my writings on sexual subjects and my sex propaganda. A good many people are asking why I devote so much of my energy and time to sexual sub- jects. There are many reasons, but the two 318 SEXUAL PBOBLEMS OF TO-DAT principal ones are the following: With every year of practice I become more and more con- vinced of the tremendous influence of the mani- festations of the sex instinct on every one of our functions, mental and physical. It is re- markable how intricately interwoven the sex instinct is with every one of our thoughts, feel- ings and actions. Many years ago I became convinced that the sex instinct is a tremendous factor .for the weal or woe of every human be- ing, and I believe that everything that concerns the health and the happiness of human beings should be the concern of the true physician. My second reason is that in spite of the tremendous importance of the sex instinct to the human race, its study has been practically neglected — nay, completely neglected — by the medical pro- fession. In the medical colleges they say not a word about it, the textbooks contain little or nothing about it, and even those who attempt to write on the subject do so in a vague, indefinite manner, and as a rule do not state the facts as they are, unvarnished and unexpurgated, but are influenced by their bias and theologic be- liefs and current morality, and attempt to fit scientific truth on the Procrustean bed of their antiquated notions. These two reasons, the tremendous impor- tance of the sex instinct and its utter neglect by the medical profession — who, with all due MY SEX PROPAGANDA 319 respect, are almost as ignorant on sexual sub- jects as the layman is — are sufficient excuse for any specialist to devote himself to the study of the subject, to make sexology his life work. And whatever posterity may think of my ac- tivity as a whole, of one thing I feel certain: For my sex propaganda, for my attempt to bring some enlightenment to the medical profes- sion and to the laity on the extremely intricate and complex problems of sex, it will call me blessed, and will say: "Well done!" A PROPHECY— There will come a time — and it is not so far off — when the prevention of undesired preg- nancy will be as proper, as respectable and as much the function of the medical practitioner as is now the prevention of typhoid fever, diph- theria or tuberculosis. — W. J. R. AN OPEN LETTEE TO ANTHONY COM- < STOCK AND OUE OTHER PEESS CENSORS Me. Anthony Comstock: Dear Sir — She has been married just eleven years, and in these eleven years she has not menstruated even once. That's all. Yes. But do you glimpse the horrible trag- 320 SEXUAL PROBLEMS OP TO-DAY edy contained in that simple statement? No? It means that she became pregnant on the wed- ding night or very soon after, and that since then she has been constantly either bearing a child or nursing one. She gave birth to seven chil- dren; that is, she was pregnant for sixty-three months or five years and three months. She nursed them, on an average, ten months each; that is, she nursed for seventy months, or nearly six years. And so the eleven years passed. She would have nursed the children still longer, though it used to weaken her so, but during the ninth, tenth or eleventh month she would be- come pregnant anyway, in spite of the lacta- tion, and so she had to give it up. She begs, she implores — her letter is truly heartrending — to help her, to give her some ad- vice which will save her from having any more children, or at least from having them so fre- quently. She herself knows no remedy what- ever. She lives in a small town and her doctor is either as ignorant as she is herself, or is un- willing (perhaps for sordidly selfish reasons; he may want the confinement fee: there are such ; I have known them myself) to give her the information. Her husband is either unwilling or unable to abstain for any length of time. She resisted him a few times and they had vio- lent quarrels, and he threatened to go else- where. OPEN LETTER TO ANTHONY COMSTOCK 321 She begs for advice. Her letter, as I said, is one bitter, heartbreaking cry. Now, dear Mr. Comstock, shall I give her that advice, or shall I tell her that there is a law on the federal statute books (I shall refrain from saying what I think of that law) which imposes a penalty of five years at hard labor and a $5,000 fine for any information about limiting the num- ber of children? Shall I tell her that sorry as I am for her, and tho my heart bleeds for her as for the thousands and thousands of her sisters, I can not afford to take the risk of such a brutal punishment? How shall I act in the matter ? Which is the finer, the nobler way? You see, she married at 21, and she is now only 32. If no help is given her she may give birth to eight or ten more children — unless she is carried off before by some disease (she is very much run down now), or by an attempt at abortion by some careless bungler or ignorant midwife. Her horror of another pregnancy is intensi- fied by the fact that recently her husband has taken to drinking rather heavily, and she fears the hereditary influence on the future children. Now, what shall I do ? ' It seems so cruel, so inhuman, so positively brutal to leave that woman to her fate, without offering her a helping hand. 322 SEXUAL PBOBLEMS OF TO-DAY Despise as we may the asininity of lawmakers who will confuse the prevention of conception with its interruption, i. e., abortion ; scorn as we may the stupid statute with its draconian punishment, still we do not care to take any chances. So what shall we do ? I ask this question in the name of a hundred thousand physicians. Will you vouchsafe us an answer? Yours very truly, William J. Robinson, M.D. VENEEOPHOBIA; OE, THE OBSESSIVE FEAE OF VENEEEAL INFECTION The fear of venereal diseases is a wise and well justified fear. It is a fear that teaches us care and caution and may save us from an end- less amount of suffering and misery. And I do not wish to ridicule or disparage the fear of veneral disease. But there is a difference be- tween a fear and a phobia. A phobia is a sense- less, exaggerated or utterly groundless fear, a fear that reaches in some cases the degree of an insanity. I knew it was coming. Every new movement is bound to lead to extremes, to cause disagree- able sequelae and dangerous reactions. Up to a few years ago the laity knew nothing of venereal disease and its terrible dangers. Wives were infected by the hundreds, with either gonorrhea or syphilis, chiefly with the former, ailed for years, remained chronic invalids or were oper- ated on, and never knew what was the matter with them until the end of their days. Syphili- tic children were born, puny and sickly, grew up weak, feeble minded and below par, or died after a few weeks — and the mother never sus- 323 324 SEXUAL PROBLEMS OF TO-DAY pected the true cause. From a mere kiss girls would sometimes become infected and pay the penalty with their lives, or with pain and dis- figurement. All this was terrible, and it was necessary to tear the veil of secrecy which sur- rounded the subject of venereal disease, it was necessary to smash the taboo of silence, it was necessary to arouse the public — and the medical profession — from their lethargy. But I knew that our lecturers, both lay and medical, in their new zeal for a noble cause, would overdo the matter, would paint the picture in too lurid colors — this seems unavoidable when we desire to attract attention — would exaggerate things, and that the result would be, if not exactly dis- astrous, at least disagreeable and ludicrous. "We come across some funny things. Some have become so frightened that they are under the impression that every man they meet has either syphilis or gonorrhea or both. I have heard the statement made in all seriousness that 100 per cent, of all men and women have or have had gonorrhea, and that 80 or 90 per cent, of the population are infected with syphilis. Of course, it is absurd. Tho a specialist is supposed to become "dippy" on his specialty and begins to believe that the whole world is suffering from the disease he is specializing in, still I do not believe that there is more than 5 per cent, of syphilis, in this country at least, anc FEAR OF VENEREAL INFECTION 325 not more than 20 per cent, or 25 per cent, of gonorrhea. Which is, of course, bad enough, but not so bad as some would have us believe. But this is not the point I started to bring out. The point that I do wish to bring to public no- tice is that as a result of the sex hygiene pro- paganda we have now cases of actual venero- phobia, cases afflicted with an obsession that they and those around them are suffering from venereal disease. There may not be the slight- est symptom, foundation or excuse for such a belief, but you cannot convince them that they are wrong. You can talk as long as you want to, you can prove by all scientific tests that they have not and never had the disease ; they remain of this opinion. They may be convinced for a while, but when they get home the obsession again takes hold of them and they make them- selves and all those around them miserable. I have had three such cases recently within a very short time, and as I had not seen just such cases before, I am inclined to ascribe their etiology to the recent somewhat hysterical sex discussions, on the platform and in the press. A few weeks ago a lady telephoned to me to make an appointment. It was on a Monday, I asked her whether she could not wait until Wednesday, one of my regular office days, but she said she could not wait so long ; it was very important that she should see me at once. I ac- 326 SEXUAL, PEOBLEMS OF TO-DAY ceded to her request ; she came, and when I asked her what the trouble was she said she was sure she had syphilis. What was it that made her sure ? It was an article that she read the previ- ous day, and from that article she was sure that she had all the symptoms of syphilis. On in- vestigating matters it was found that she did not have even a single symptom even in the faintest degree indicative of syphilis. I soon saw that the syphilis was on her brain — no, I mean on her mind — not anywhere else, and I told her so. She would not believe me at first, but finally she seemed to be convinced. A week later she came with her evidently somewhat henpecked husband and made him undergo a complete examination. I saw that there was nothing the matter with him. He assured me that he never had any trouble, but as she gave him no rest and as she seemed to be very much worried, for the sake of the peace of her mind he would undergo an examination. There was absolutely nothing the matter with him. He was as free from any venereal infection — I would not say as a new born baby, because a new born baby may not be free from venereal infection — but as free as a marble statue. After talking with her and persuading her I thought I had finally succeeded in dislodging the idea from her mind, but about two weeks later she came with her two children, a boy and a FEAB OF VENEREAL INFECTION 327 girl, both in good blooming health, and she said that she was sure that they were infected with syphilis, and that I must give them something. The boy had fat, ruddy cheeks, and she thought that they were too fat and that this was one of the symptoms. I told her that it was absurd, that I would not waste my time and her money in examining the children, and told her to go home, but she begged me to have a look at them — with naturally negative results. "When I showed her that she never had any of the symp- toms of the disease, which she admitted, I thought that I had her persuaded. But no, she had read in the meantime some semi-popular book, and she came back at me with the question whether she could not have had it in an hered- itary form and thus infected both her husband and her children. She asked whether it was not true that in some cases hereditary syphilis pre- sented practically no symptoms. I told her, yes. To my inquiry she replied that both her parents were living and in good health. Her brother and sister were healthy, but, she said, wasn't it possible that her father was infected when he was circumcised? She had read that some children were thus infected during the orthodox circumcision, and she asked me whether I would not do her the favor of examin- ing her father. I told her that she was crazy, and that it would be useless for her to attempt 328 SEXUAL PKOBLEMS OF TO-DAY to come again, as she would not be admitted. I do not say that the article in the newspaper was the sole cause of her getting the obsession. She was neurotic and she would probably have got some other obsession or phobia under other circumstances, but that was the exciting cause which made her obsession take the form of a syphilophobia. We have now a number of cases of men and women demanding to have their Wassermann reactions taken when there is absolutely no cause or reason for it. And assuring them that it is useless does no good. They do not rest satisfied until a blood test is made. I have also had some people coming to me with the most in- nocent little pimples, no larger than a pin head, and with fears in their heads that they were chancres. Of course, it is better to be too careful than too careless, and between neglecting oneself al- together and giving a ravaging disease a chance to develop it is better to run to the doctor on the slightest provocation. But it is a bad tendency all the same, and it is rather sad to destroy the romance of the thing and make every girl see in every young man a possible syphilitic and re- fuse to kiss or embrace him until he has brought a certificate from his physician. I suppose it cannot be avoided. There is no good without its evil, and I thought it a good thing to call FEAR OF VENEREAL INFECTION 329 attention to this tendency, to this exaggerated obsessive fear of venereal disease. The trouble is that we can never regulate the pendu- lum just right. If it has gone too far in one direction, it is bound to go just as far or still farther in the other direction. And I have no doubt that Brieux's "Damaged Goods," which is being played now to such large audiences, while of tremendous social and sanitary value, will also have its bad effect. It will contribute still further to the spread of venerophobia, and many an innocent fiance or husband will be looked upon with suspicion if he has a little inno- cent pimple on his face and will be driven to the physician for examination and certificate if he be unfortunate enough to have a little eczema or acne. What are you going to do about it? Nothing. It is only by blundering, first in one direction, then in another, that we arrive at the correct at- titude. A TOPSY-TURVY WORLD He was as weazened and measly a specimen of humanity as one wanted to see. He was sent to me for examination by his lodge doctor and he asked me to reduce my fee, because he was making only eight dollars a week. He was thirty-two years old and weighed about a hun- 330 SEXUAL PEOBLEMS OP TO-DAY dred pounds. His face was somewhat asym- metrical, and a lop-sided Lombrosian would undoubtedly have marked Mm as an abnormal type. But I only saw bis timid face with the frightened doglike eyes. What did he come for? He had been married three years and he had no children. And this made him and his wife intensely unhappy, and he wanted to see if I could not do something for him. "What is life to a poor man without children? It is the only pleasure he has in the world," said he in his broken English. "Yes, but what pleasure have the children?" I felt like saying, but I saw that the question would be above his head. And as I was examining him I could not help think- ing that if I could do something to enable him to have children it would be a sin on my part to make it possible for him to have any— a sin against humanity, and a sin or even a crime against his children. Fairy tales and improbable miracles aside, what kind of a life are the children of such a man likely to lead? Puny, sickly, brought up in a noisome tenement, under-nourished, poorly dressed, hardly able to read and write, they will — that is if they do not die in childhood — start to work in a shop or factory as soon as the law permits or even before then; just some more wretches to swell the army of wage-slaves or the A TOPSY-TURVY WOULD 331 unemployed. And I saw as in a panorama their lives, after they grew up to be men and women. Nothing but misery from the cradle to the grave. And there was quite a conflict within me as to whether I had a moral right to help that sickly, poor devil to bring children into the world. Of course, one voice told me: he is your patient and you have to do the best you can for him; and he is the judge of what is best for him. But another voice said: Yes, if he were the only party to be considered. But how about his chil- dren? They do not ask to be born; and if they knew what they had to go thru, they would positively refuse to be born. What right have I to help bring into the world people destined for suffering and misery? Suppose the man were a syphilitic ; would it not be my duty to pre- vent him from bringing syphilitic children into the world? And is syphilis the only condition of this kind? How about tuberculosis? And is not wretched poverty and general sickliness as bad for children as is syphilis and tuberculo- sis ? But I was not quite satisfied with my own arguments, either pro or con. Fortunately, I did not have to decide this moral question, for fortunately, that is fortunately for the man's prospective children, I found that he could never have any (Isn't this a neat bull?). For I found that he was suffering with complete as- 332 SEXUAL PROBLEMS OF TO-DAY permatism. And his previous quasi-treatment and the treatment of his wife were a waste of time and money. I had to tell the man the truth, that treat- ment in his case was quite useless, and he limped away a very dejected, a very unhappy man. Most likely his wife will demand a divorce, for women of that class are literally crazy to have a child; the maternal instinct burning in them in all its primal intensity, and to them there is no greater disgrace, no greater misfortune than that of barrenness. Perhaps it is not the primal instinct, but their primitive religious and superstitious bringing up. Be it as it may, the fact remains as stated. And as he went away, I thought again. That same morning a gentleman came in whom I had treated for prostatitis and discharged cured about three months previously, with full permission to marry. He came in to tell me that he was going to get married in about a week, wanted a final examination to make sure that everything was all right and at the same time he wanted to get something to prevent conception. "They could not afford to have any children, not the first two or three years, at any rate." He was a fine specimen of healthy, jovial manhood, was thirty-five years old and was getting fifty dol- lars a week, having what he considered a per- manent position with a firm of architects. A TOPSY-TURVY WORLD 333 What a topsy-turvy world we live in. A wretched specimen of humanity earning eight dollars a week is insanely desirous of having children ; healthy men and women with fifty to a hundred dollars a week cannot "afford" to have, any. What a topsy-turvy world. Lucky for mankind that the average man and woman still constitute a respectable percentage of our pop- ulation. SEPAEATE BEDS The author is often consulted on some very intimate points. The most delicate questions can be answered only in person or by letter. But the question of one or two beds for husband and wife has been asked so often, that we per- mit ourselves to answer it. My answer is: Decidedly two beds. Where the economic con- ditions permit, it is often even advisable to have two separate bedrooms. But whether this is feasible or not, two separate beds by all means. Into a discussion of the reasons, I do not care to enter here, but they may become clear enough to any intelligent mind 7 after just a little think- ing. A REFRESHING EEVIEW OF "SEXUAL PROBLEMS OF TO-DAY." "In the good old times many dangerous books were burned solemnly by the public executioner. Such a fate is richly deserved by Dr. William J. Robinson's 'Sexual Problems of To-day,' a much be-penciled copy of which has been sent to ameeica for review. The shameless immor- ality that the author unblushingly teaches makes one wonder how he found a publisher, and marvel even how his work has escaped suppression by the authorities. 'No book,' quotes * Dr. Robinson, on the title page, 'has a right to exist that has not for its purpose the betterment of mankind by affording either useful instruction or healthful recreation.' By these words his own foul book is unre- servedly condemned." The above review appeared in America, a Catholic Review of the Week. It is certainly unique and refreshing. In our degenerate days, when people are straddling and sitting on the fence, when books are seldom ripped up as they deserve to be, when review- • This is not a quotation. This is my original motto. 334 "sexual pboblems of to-day" 335 ers are too cowardly to give their real opinion, it is pleasant to see people who have the courage of their convictions. Of course, I do not agree with "America's" reviewer, though I do not question his sincerity. I sent the following letter to the Editor. To the Editor of America, 59 East 83rd Street, City. Dear Sir: I have received a marked copy of America for September 21st, and I very much enjoyed your review of my book, "Sexual Problems of To-day." In the year of our era 1912 it is certainly unique and refreshing. But would it not have been better to criticise the book and to show wherein it is wrong or immoral, instead of advocating its suppression or destruction by burning? And is it possible that the re- viewer has completely missed the high moral and humanitarian tone which permeates the en- tire book, in spite of the radical and unconven- tional opinions expressed therein! Do not for a moment think that I bear the slightest grudge against you for your review. On the contrary by again demonstrating the terrible darkness that still surrounds some good souls, it convinces me of the great importance of my work and encourages me to persevere in my not always grateful task. 336 SEXUAL PBOBLEMS OP TO-DAY And, besides, I believe I bave reacbed a stage wben tbe severest criticism of my books or my work no longer affects me, for I fully recognize tbat we are no more responsible for our views and opinions tban we are for tbe color of our eyes or tbe size of our bead. All our opinions and feelings are tbe result of tbe structure of our cerebral cells, our beredity, our environ- ment, our studies and reading, our friendsbips and acquaintances ; and you are no more to be blamed for your dark anti-social views, tban I am to be praised for my mild humanitarian opinions. I do not even doubt for a moment tbat you may be sincere believers in tbe usefulness of your work and may be fully convinced of tbe perniciousness of mine. But so it is. We are in tbe arena of tbougbt and every conscientious man must battle for wbat be considers rigbt. But isn't it a pity tbat we good Cbristians can no longer burn beretical books and inci- dentally tbeir autbors also ! Isn't it a pity tbat tbe inquisition can no longer apply tbe rack and tbe tbumbscrew, pierce out tbe eyes and tear out tbe tongues of tbose wbo dare to show tbe least bit of intellectual independence? Times bave certainly degenerated. To sbow you tbat I bear no grudge against you, I take pleasure in mailing you, for review (I do not know wbo is responsible for having "sexual, peoblems of to-day" 337 mailed you "Sexual Problems") a copy of "Never Told Tales." I believe that that book is so necessary, so important and withal so moderate and unobjectionable, that even your tenth-century conscience will find nothing to condemn in it. Yours sincerely, Wiluam J. Robinson, M.D. GONORRHEA AND IMPOTENCE When certain measures or reforms are sug- gested, such as the segregation of the unfortu- nate women, or teaching the use of venereal prophylactics, we are told that they are un- American — whatever that may mean. To hint that there is such a thing as sexual necessity is immoral and unmanly. American manhood would not stand for such a thing. The young American is manly and chaste. And in the very next breath we are told that 80 per cent, of our male population is suffering from gonorrhea! Whether 80 per cent, of our male population is, or has been at one time or another, suffering with gonorrhea is a question. I believe the number is greatly exaggerated. But whether the number of gonorrhea victims is 80 or 30 per cent., of one thing I am quite certain (tho of course no exact statistics are or ever will be available) ; at least 50 per cent, of our male pop- 338 SEXUAL PROBLEMS OF TO-DAY illation are suffering from sexual impotence in some form or another : complete or partial, per- manent or temporary. And this is a sad state of affairs, for the misery that it causes is quite incalculable. It is much greater than that caused by gonorrhea. FOUR ABSOLUTELY INFALLIBLE MEANS FOE THE PREVEN- TION OF CONCEPTION I know that the dissemination of any in- formation regarding the prevention of concep- tion carries with it the extremely severe penalty of $5000 fine or five years hard labor or both, but I receive so many requests from all over the country for this information (among which re- quests there is undoubtedly a respectable pro- portion of decoy letters from respectable and non-respectable spies) that I have decided to run the risk of the penalty and to impart the in- formation broadcast. Somebody must be will- ing to be a martyr. Here then are the four remedies : 1. Complete and absolute abstinence from any sexual relations. But the abstinence must be absolute in the literal meaning of the word, there must be no relations from the day of marriage to the day of death. This remedy is infallible, simple and cheap. THE PREVENTION OP CONCEPTION 339 2. Marry a woman who has passed the meno- pause. 3. In the case of the man, castration. Some might say that vasotomy or vasectomy would suffice, but I believe in radical measures and once you are about it you might as well be thoro. 4. In the case of the woman, oophorectomy. Here also the timid ones might suggest that sal- pingectomy would be sufficient, but I believe, as I said, in thoroness. And as the Fallopian tubes and uterus become useless in the absence of the ovaries, these two organs might be re- moved too. Each one of the above mentioned four reme- dies is infallible but personally I recommend the first or the second. There are other reme- dies, but to enter into a discussion of them might lead us too far (to Joliet or Leavenworth.) P.S. — Oh, what a stupid world we live in! THE MOST EFFICIENT VENEREAL PROPHYLACTICS The most efficient prophylactic against gon- orrhea is protargol; the most efficient prophy- lactic against syphilis is calomel or mercuric chloride (corrosive sublimate). The protar- gol is used in the form of a 2 per cent, solu- tion or suspension; the calomel is used in the form of a 30 per cent, ointment ; the mercuric chloride in the form of a 3 to 1000 solution, the vehicle consisting of tragacanth, starch, glycerin, alcohol and water. The packet used by our army and navy consists of a collapsible conical shaped tube with a partition in the cen- ter; the conical half of the tube is filled with a 2 per cent, protargol solution; the pointed end is inserted in the urethra and a few drops of the solution squeezed out. The other half of the tube is filled with a 30 per cent, calomel ointment; when wanted for use, the cap is re- moved, a portion of the ointment is expressed and the organ anointed. Both the protargol and the calomel ointment are used post coitum. Prophylactics are now prepared * which con- tain one preparation both against gonorrhea and syphilis. They are more convenient to use. *Such as the well-known Sanitubes. 340 A Practical Treatise on the Causes, Symptoms, and Treatment of Sexual Impotence And Other Sexual Disorders in Men and Women BY WILLIAM J. ROBINSON, ED. Chief of the Department of Genito-Urinary Diseases and Dermatology, Bronx Hospital and Dispensary; Editor The American Journal of Urology, "Venereal and Sexual Diseases; Editor and Founder of The Critic and Guide ; Author of Sexual Problems of Today; Never Told Tales; Practical Eugenics, etc. BRIEF SYNOPSIS OF CONTENTS. Part I — Masturbation. Its Prevalence, Causes, Varieties, Symptoms, Besults, Prophylaxis and Treatment. Coitus Interruptus and its Effects. Part II — Varieties, Causes and Treatment of Pollutions, Spermator- rhea, Prostatorrhea and Urethrorrhea. Part III — Sexual Impotence In the Male. Every phase of its widely varying causes and treatment, with illuminating case reports. Part IV — Sexual Neurasthenia. Causes, Treatment, case reports, and its relation to Impotence. Part V — Sterility, Male and Female. Its Causes and Treatment. Part VI — Sexual Disorders in Woman, Including Frigidity, Vaginis- mus, Adherent Clitoris, and Injuries to the Female in Coitus. Part VII — Priapism. Etiology, Case Beports and Treatment. Part VIII — Miscellaneous Topics. Including: Is Masturbation a Vice? — Two Kinds of Premature Ejaculation. — The Frequency of Coitus. — "Useless" Sexual Excitement. — The Relation Between Mental and Sexual Activity. — Big Families and Sexual Vigor. — Sexual Per- versions. Part IX — Prescriptions and Minor Points. Third edition revised and enlarged. THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK THE DISOEDEES OF THE SEXUAL SYSTEM "He who throws light on the dark and intricate problems of sex, helping to unravel the mysteries of and to cure the complex sexual disorders, does indeed a signal service to humanity." We believe that in bringing out our latest work, Sexual Impotence and Other Sexual Disorders in Men and Women, we have given the profession one of the most useful, one of the most valuable books that have ever been published. A gratifyingly large num- ber of physicians have told us that the book not only helped them to treat successfully sexual weakness and other disorders in their patients or in themselves, but that it opened their eyes to the significance of many things which they did not understand before. Those who have read the book know its value and importance ; those who have not may be interested to read what the medical journals have to say about it. Here are a few extracts: No American authority has given more serious thought to the subject of sexual diseases than the author of this volume; he has given to us in it the best that in him lies. No physician who has had to combat this distressing condi- tion, and those conditions dependent upon it, has any doubt of its serious importance. And we all recognize the weak- ness of the literature on the subject. Dr. Robinson takes SEXUAL IMPOTENCE a sensible view of things which have not been sensibly con- sidered; nowhere has he shown this to better advantage than in this volume on a difficult subject. — Medical Fortnightly. Dr. Robinson discusses the numerous phases of this sub- ject, in both sexes, clearly and in detail. He tells no lies to conform to moral, social and religious ideals, and con- sequently those who differ with him in beliefs or in pre- tensions may censure him as immoral. In some of these points there is opportunity for difference of opinion, but on the whole we think that Dr. Robinson has expressed what the majority of physicians believe, tho not necessarily the opinion most frequently published. Pretty nearly every conceivable sexual abnormality, physical or psychic is at least alluded to. If we were to select any one feature of this work for special mention, it would be the uniform common sense of the author. — Buffalo Medical Journal. This book is not by any means a rehash of some other book or a resume of several. This treatise is interesting and valuable, and the author is absolutely honest and fear- less in his opinions. A unique and helpful feature is the case reports which illustrate every phase of sexual dis- order. — Indianapolis Medical Journal. Dr. Robinson deals with the subject in a dignified, scien- tific way, that will be helpful to the physician who has judgment enough to realize that he is as responsible for functions around which a modem, sham, conventional modesty has thrown a hiatus of folly as he is for the ap- petite, eliminative powers or nutritive functions of the same persons. And the science of eugenics can never be worthy of medical consideration until the people are taught that it is as much the duty and Dusiness of physicians to in- quire about the sexual habits of patients as of their habits of eating and drinking. This book will do much good, and that good will be as extensive as its reading. — Texas State Journal of Medicine. SEXUAL IMPOTENCE In this book we have a complete treatise on sexual dis- orders and their treatment, with descriptions of actual individual cases, giving the individual symptomatology and individual treatment. When given in this manner the de- scription becomes indelibly impressed on the memory and enables a physician when he gets a case to understand and classify it without a great amount of difficulty. — Charlotte Medical Journal. The name of the author is ample assurance that this treatise is not a rehash nor lacking in honest opinions fear- lessly expressed. The style of the writer is notably per- sonal, clear, straightforward and conversational. The ex- haustion of the first edition in less than two months from the day of publication shows unmistakably the need of a book of this character. It also shows that, the profession is at last becoming alive to its shortcomings in the matter of sexual disorders and is beginning to be willing to learn. — Southern California Practitioner. Perhaps no subject pertaining to human ills has been so neglected by medical teachers or medical text-books as the subject discussed in this volume. While legitimate medical literature was indiscreetly silent on sex teachings, the quack literature was teeming with misinformation, which, as the author intimates, did more real harm than did sexual ignorance or sex abuse. The doctor will find this work instructive. — Illinois Medical Journal. As is to be expected Eobinson goes into the subject thoroly, and calls a spade a spade, with the result that he has evolved a volume lull of meat and of great value to the physician, whose ingenuity is often taxed to the ut- most to discover the whys and wherefores at the bottom of impotence. The racy Robinsonesque style adds interest to the text matter of the volume. — Medical Times. SEX MORALITY PAST, PRESENT AND FUTURE Will monogamy or variety prevail in the future ? Is continence injurious ? Are extra - marital relations ever justifiable ? Should there be one moral stand- ard for men and women ? Will our present moral code persist? These and similar questions are here discussed by original and unbiased thinkers as well as by orthodox conservatives. No matter what your opinion on the subject may be, no matter whether your ideas on the relations of the sexes are those of the 1 5th, 20th or 25th century, you should read this book. Nobody who is earnestly inter- ested in the sex question has a right to have any opinion on it without having read this volume, the price of which, in cloth, is $ 1 , including postage. THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK AN EPOCH-MAKING BOOK Never-Told Tales GRAPHIC STORIES OF THE DISASTROUS RESULTS OF SEXUAL IGNORANCE By WILLIAM J. ROBINSON, M.D. Editor of the American Journal of Urology and of The Critic and Guide Every doctor, every young man and woman, every newly-married couple, every parent who has grown-up children, should read this book. Every one of the tales teaches a distinct lesson, a lesson of vital importance to the human race. _ . We knew that we were getting out a useful, a NECESSARY book, and we expected it would meet with a favorable reception, but we never expected the reception would be so extravagantly and so unanimously enthusiastic. There seems to have been a long-felt but dormant want for just such a book. One reader, who has a fortune running into the millions, writes: "I would have given a good part of my fortune if the knowledge I obtained from one of_your stories to-day had been imparted to me ten years ago." Another one writes: "I agree with you that your plain, unvarnished tales from real life should have been told long ago. But better late than never. Your name will be among the benefactors of the human race for having brought out so forcibly those important, life-saving truths. I know that I personally have already been benefited by them." Fine Cloth Binding. One Dollar per Copy NINTH EDITION THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK A New Book by Dr. Robinson The Limitation of Offspring by the Prevention of Conception BY WILLIAM J. ROBINSON, M.D. With an Introduction by A. JACOBI, M.D., LL.D. Ex-President of The American Medical Association All the arguments for and against the voluntary limitation of offspring or birth control concentrated in one book of 250 pages. The Limitation of Offspring is now the burning question of the day. It has been made so by Dr. William J. Robinson, who was a pioneer in this country to demand that people be permitted to obtain the knowledge how to limit the number of their children, how to prevent con- ception when necessary. For many years he fought practically alone; his propaganda has made hundreds of thousands of converts — now the ground is prepared and the people are ready to listen. Written in plain popular language. A book which everybody interested in his own welfare and the welfare of the race should read. PRICE ONE DOLLAR THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK JUST OFF THE PRESS! A New Book by Dr. Robinson Sex Knowledge for Men. By WILLIAM J. ROBINSON, M.D. ILLUSTRATED. An honest, unbiased, truthful, strictly scientific and up-to-date book, dealing with the anatomy and physi- ology of the male sex organs, with the venereal diseases and their prevention, and the manifestations of the sex instinct in boys and men. Absolutely free from any cant, hypocrisy, falsehood, exaggeration, compromise, or any attempt to conciliate the stupid and ignorant. An elementary book written in plain, understandable language, which should be in the possession of every adolescent boy and every parent. Dr. Robinson believes that fear should have no place in our life, for morality based upon fear is not morality at all, only cowardice. He believes there is a better method, and that method he uses in his book. Price, cloth bound, $2.00. THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK It is the book you have been waiting for. At last we have a clear, plain, concise book on the treat- ment of Gonorrhea and its various complications, written expressly for the general practitioner. No Physician who has occasion to treat Gonorrhea can do justice to his Patient without a study of this latest and clearest volume on the subject. THE TREATMENT OF GONORRHEA And Its Complications in Men and Women. For the General Practitioner. By WILLIAM J. ROBINSON, M.D. An idea of the scope of this work may be gained from the Chapter Headings! i. Extent and Seriousness of Gonorrhea. 2. Classification of Urethral Inflammations. 3. Gonorrheal Urethritis in the Male. 4. The Germ and the Diagnosis of Gonorrhea. 5. Course and Symptomatology of Acute Gonorrhea. 6. Treatment of Acute Gonorrhea. 7. Case Reports. S. Common Bacterial Ure- thritis. 9. Chancroidal Urethritis. 10. Syphilitic Urethritis. n. Chemical Urethritis. 12. Prophylactic Urethritis. 13. Traumatic Urethritis. 14. Toxic Urethritis. 15. Urethritis from Excess and Masturbation. 16. The Widely Vary- ing Conditions Known as Chronic Gonorrhea. 17. Treatment of Chronic Gonor- rhea. 18. Length of Time Required to Cure Chronic Gonorrheal Conditions. 19. Instruments Used in Treatment. 20. Abortive Treatment. 21. Prevention of Gonorrhea. 22. Minor Complications of Gonorrhea (Phimosis, Paraphimosis, Balanitis, Adenitis, Painful Erections and Chordee, Retention of Urine). 23. Acute Prostatitis. 24. Chronic Prostatitis. 25. Epididymitis. 26. Seminal Vesiculitis. 27. Gonorrhea of the Rectum. 28. Gonorrhea of the Mouth. 29. Stricture. 30. Gonorrheal Rheumatism. 31. Gonorrhea vs. Tobacco, Alcohol and Sexual Intercourse. 32. Gonorrhea in Women. 33. Vulvovaginitis in Little Girls. 34. Gonorrheal Ophthalmia. 35. Minor Points. Part II. — Materia Medica of Gonor- rheal and Non-Gonorrheal Urethritis and Their Complications. 36. Silver Salts — Inorganic and Organic. 37. Miscellaneous Antiseptics and Astringents. 38. Vegetable Astringents. 39. Local Anesthetics. 40. Anti-Gonorrheal Remedies for Internal Use. 41. Urinary Antiseptics. 42. Lubricants. 43. Formulary. 315 pages, cloth, $2.50 postpaid iJMNnr'oci THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK A UNIQUE JOURNAL THE CRITIC and GUIDE Dr. Robinson's Famous Little Monthly It is the most original journal in the country. It is the only one of its kind, and is interesting from cover to cover. There is no routine, dead matter in it. It is one of the very few journals that is opened with anticipation just as soon as it is received and of which every line is read with real interest. Not only are the special problems of the medical profession itself dealt with in a- vigorous and progressive spirit, but the larger, social aspects of medicine and physiology are discussed in a fearless and radical manner. Many problems untouched by other publications, such as the sex question in all its varied phases, the economic causes of disease and other problems in medical sociology, are treated boldly and freely from the standpoint of modern science. In discussing questions which are considered taboo by the hyper-conservative, the editor says what he wants to say very plainly without regard for Mrs. Grundy. The Critic and Guide was a pioneer in the propaganda for birth control, venereal prophylaxis, sex education of the young, and free discussion of sexual problems in general. It contains more interesting and outspoken matter on these subjects than any other journal. While of great value to the practitioner for therapeutic sugges- tions of a practical, up-to-date and definite character, its editorials and special articles are what make The Critic and Guide unique among journals, read eagerly alike by the medical profession and the intelligent laity. PUBLISHED MONTHLY ONE DOLLAR A YEAR THE RACE BETTERMENT LEAGUE 263 FIFTH AVENUE, NEW YORK I I lllli|l|