CHAPTER XIV

MEDICINE AND SEXUAL LIFE =General Remarks.=--Theology teaches belief in God and a future life; law represents the application of codified laws and customs, old and new; medicine is said to be an art--the art of curing sick people. At the origin of each of these three branches of human activity we find an acquired idea. Man has been led to the religious idea and to the worship of one or more gods by his terror of certain unknown and occult powers superior to his own, and by the idea that his faculty of knowledge, his power, and the duration of his life were limited. The origin of law is in moral conscience, a phylogenetic derivative of the sentiments of sympathy, _i.e._, sentiments of duty and justice, combined with the idea of the necessity for men to live in societies. As regards medicine, this owes its existence to the fear of disease, pain and death, which is modified by the acquired experience that certain substances may sometimes ease suffering. Theology, if separated from morality whose domain it has usurped, lives on mysticism, and endeavors to give it a natural and human appearance by adorning it with sonorous phraseology. Law, losing sight of its origin and object of existence, only concerns itself with comments on the text of laws, and in discussing the application of the articles of the Code. Medicine has concerned itself too much with the life of the patient, instead of the improvement of human life in general. In order to cure a physical malady, to reëstablish abnormal or damaged functions as far as this is possible, the physician must be acquainted with the vital manifestations of the body in its normal state. For this reason the art of medicine depends on the accessory sciences, chiefly anatomy and physiology. These accessory sciences have considerably developed in the evolution of medicine, and the art of medicine has become the chief motive power which urges men to research and discovery in the biological sciences, such as histology, embryology, comparative anatomy and physiology, anatomy and physiology of the brain, bacteriology, etc. Pure science now occupies such a position in medical studies that the "healing art" often remains in the background; although it must later on take the chief part, and is regarded by the public as of the greatest importance. The value of the art of medicine is subject to great variations. It is only of real value when, free from all charlatanism, it rests on a sufficiently scientific basis; for the art of an ignoramus falls into error and employs inappropriate methods; on the other hand, the art of a charlatan has for its object the purse of the patient. It is common to meet with physicians who have a good practical experience of art without possessing scientific knowledge, others who have both practical experience and science but are charlatans, others again who are very scientific but incapable in practice. The ideal is a combination of art, science and disinterested honesty; but it is not very uncommon to meet with a combination of ignorance, incapacity and charlatanism. Lastly, too many doctors, otherwise capable and intelligent, are too much influenced by authority, text-books and prejudices, instead of observing and judging each case for themselves in the true scientific spirit. Many dogmas of medical education rest on hypotheses, theories or statements which have no solid foundation, and do not represent the fruits of a true personal experience of human life. Many doctors only see through other people's glasses, without reflecting for themselves; the worst of these are those with "systems," homoeopaths, the disciples of natural medicine, etc. It is especially in the sexual question that these human weaknesses of medical practitioners often lead to the most pitiable results. We must first of all take to heart the fundamental principle of hygiene, which is at the same time that of all honest and sound medicine--_prevention is better than cure._ The modern opinions of medical men on the sexual question are still unfortunately greatly obscured by prejudice, authority, and the indirect influence of the doctrines of religious morality. The same applies to the question of alcohol. However, it is to medicine and its accessory sciences that we owe the knowledge which now renders it possible to judge of the sexual relations of man from the true and healthy point of view of social and moral science. We cannot describe here all the relations of medicine to sexual life. Chapters I, II, III, IV and VIII are entirely based on its results and on those of natural science. What we have still to consider relates especially to sexual hygiene, for we have already treated of pathology in Chapter VIII. I shall reserve the general and social part of hygiene for the last chapter of the book, and shall confine myself here to certain special points, and the criticism of current, but erroneous, medical opinions on the sexual question. =Prostitution. Sexual Hygiene. Sexual Connection Apart from Marriage.=--All regulation and medical supervision of prostitution should be rejected, not only from the moral point of view, but also from that of hygiene, as a deplorable error, incapable even of fulfilling its avowed object--protection against venereal disease. Faith in the dogmas and authority of an existing institution has led medical men to take a false view of the question. They demand from the adversaries of regulation proof of a diminution in venereal disease when regulation was not in force. This is both unjust and absurd. It is for the supporters of regulation to prove that State regulation of prostitution has led to any appreciable improvement of the social evil. Then only can it be asked if the maintenance of such vexatious measures is still justifiable. But medicine has not furnished the proof demanded from it; on the contrary, its attempts in this direction have entirely failed. After all, the system is kept up, not because it diminishes venereal infection, but because it gives satisfaction to the sexual appetite of men and their desire for change. Society, however, has no right to organize such a monstrosity as regulated prostitution and licensed proxenetism, for the special pleasure of debauchees. In virtue of the false dogma of regulation, many doctors, even at the present day, recommend young men to visit brothels, for alleged hygienic reasons. This deplorable custom perverts youth and gives it false ideas. It is a remedy much worse and much more dangerous than the evil it is supposed to cure, worse than masturbation, much worse than nocturnal emissions. Sexual anomalies and perversions are not cured in brothels; on the contrary they develop there. Moreover, it is absurd to exaggerate the effects of onanism and sexual excesses in themselves, and thus increase the anxiety of a number of unfortunates. In Chapter IV, we have already spoken of great variations which the sexual appetite presents without ceasing to be normal, and we have mentioned the rule given by Luther. In my opinion the advice given by the doctor should be as follows: As long as he does not wish to marry, a young man should remove as far as possible all sexual ideas from his thoughts. He should be contented with nocturnal emissions, which are produced spontaneously, and should avoid all the manipulations of onanism. A young girl should do the same all the more easily, because her sexual appetite is normally weaker, and is not accompanied by glandular secretions which more or less demand ejaculation. Persons unable to resist their sexual appetite should be extremely prudent in their extra-nuptial intercourse. Moreover, there is no need for this to assume the character of prostitution. =Medical Advice.=--It is the doctor's duty to give friendly advice to every one who consults him on sexual questions, without posing as a judge or a moralist. He should never frighten or reprimand the poor hypochondriac who blames himself for masturbation, nor sexual perverts of any kind, unless, of course, they are absolutely dangerous, such as sadists. He should, on the contrary, calm their fears and give them encouragement; and in this way he may do much good. Hypnotic suggestion gives him a means of directly combating many cases of sexual excitation, or at least of attenuating them, by directing the cerebral activity of the patient to other subjects. Each case should be judged by itself and attention should be paid to the different points we have studied in this book. Even between husband and wife, and especially as a consequence of monogamy, certain unfortunate or delicate circumstances may raise difficulties; for example, the periods during which conception should be avoided, a certain time after accouchement and during certain morbid conditions. In this case unskillful medical advice may have unfortunate results. When a doctor forbids a husband to have sexual intercourse with his wife he exposes him to two dangers. If the husband remains continent and sleeps in a separate room for too long a time, conjugal love may become so cooled that a permanent barrier is established between man and wife; if, on the other hand, he abandons himself to prostitution, he may contract venereal disease and infect his wife. Again, the husband may become enamored of another woman and wreck the happiness of his family. The doctor who prohibits conjugal coitus thus takes a great responsibility. For this and other reasons we have now an important question to consider. Opinions differ considerably as to the effects of sexual continence. All extreme assertions are erroneous. It is quite certain that the harmful effects of continence have been greatly exaggerated. Normal persons of both sexes may remain continent, although not without some trouble and discomfort. In a general way, we may accept the statement that many morbid conditions are known to result from sexual excess, but few from continence. This, however, goes a little too far, for certain psychopaths and sexual hyperæsthetics often lapse into a state of mental and nervous excitement from forced continence, so that their neurosis becomes accentuated and may even end in insanity. I have seen this occur both in men and women, but such cases are very rare. Continence is not an easy matter for erotic individuals, and requires a heroic internal struggle, especially in men. The Canadian reformer, Chiniqui, whom we have previously quoted, relates the history of a monk who tore off his testicles in despair at being unable to conquer his violent sexual appetite. The fine preachers of morality, endowed with a cold temperament, or simply senile, who hold forth on the "immorality" of the consequences of the sexual appetite, would do well to take such facts to heart. We must not forget that among our brutal, yet human ancestors the struggle for life demanded the cruel and wanton exposure or slaughter of all weak and decrepit individuals, and that epidemic diseases, plagues, and pests ravaged the peoples without mercy. Of course our present civilization has put up a barrier against all this. Yet, for that very reason the blind and thoughtless propagation of degenerate, tainted, and enfeebled individuals is another atrocious danger to society. But then the sexual appetite cannot be legislated out of existence or killed by repressive measures. Quite recently it has been scientifically demonstrated that absolute sterilization can be produced by the application of the Roentgen Ray, but at what period of treatment this result may be obtained still remains an unsettled question, thus leaving the possibility of incurring the risk of effecting only a doubtful degeneration of the germs. We can but consider all legislation and all police measures which are intended to regulate the sexual intercourse in the human family, as absolute failures, as inhuman, in fact as down-right detrimental to the race. Exacting laws have never improved the morals of any race or nation; hypocrisy and secret evasion are the only results obtained. It would be better by far if steps were taken to enlighten the masses on the questions of sexual heredity and degeneration. Wisdom of this kind does not corrupt. It is rather the unrestricted power of capital and wealth that brings the rot into the community. Healthy people should be made to know that a large number of sound, industrious children is a blessing, in fact, riches to the family, but on the one condition only, viz.: that they are not relegated to detestable slavery through the overbearing suppression of capital. When the dignity of labor shall once have been raised on the pedestal of worship now occupied by Mammon, there will no longer be need for complaint about small families and decreasing birth-rates, such as we hear so much at the present day in France and in the United States. A few examples might throw some light on this subject. (1) Dr. Pelman of Bonn, assisted by the local authorities, made an inquiry into the progeny of a certain Ada Jurke (born in 1740, died in the beginning of the nineteenth century), who was hereditarily tainted, a drunkard and a degenerate. Her descendants down to the present time number 834 persons. The lives of 709 of these individuals have been officially recorded as follows: 106 were illegitimate children; 142 were mendicants and tramps; 64 were unable to perform any kind of work towards their own support and became a charge to the community; 181 of the women were prostitutes; 7 persons were convicted of murder and 69 of other crimes. All this within a period of 75 years at a cost to the state, according to the public records, of five millions of marks (about $1,250,000) in the shape of monetary support, jail and law expenses, claims for damages, etc., etc. (2) Dr. Jörger, Director of the Insane Asylum at Waldhaus, by Chur, in Switzerland, followed up in a similar fashion the history of a family of vagrants. The full report may be found under the title of "The Zero Family," in the _Archiv für Gesellschaft's-u. Rassenbiologie_, 1905, Heft 4, page 494 et seq. It is sad to read of the untold misery, profligacy, and distress spread broadcast by this family, not to speak of the many crimes committed by its members. It is depressing to witness how sheer ignorance and callousness to the interests of the human race at large allow such people to multiply without let or hindrance. The unfortunate part about it all is that this species of humanity is on the steady increase. They really form the principal hearths whence emanate our criminal classes, that fill our jails, our Charity Homes, our Hospitals, our Sanatoria, our Insane Asylums. They breed and multiply not because it affords them a special pleasure to procreate crime, insanity, and degeneracy, but because no one takes the trouble to instruct them in the perniciousness of bringing into this world offspring that can only find and themselves again disseminate misery, want, and wretchedness; or to teach them how to prevent this calamity. (3) Still another category of dangerous elements is becoming more numerous every day. I refer to the _neurasthenics_. Heredity is an important factor here, too, as every neurologist is able to attest from his own daily observations. The worst feature about this peril is the fact that neurotics as a rule suffer from excess of sexual appetite, whilst they are sorely lacking the power of self-control, circumstances which often enough lead to crime, insanity, and suicide. Untold thousands of them, unaware of the fearful consequences of hereditary impairment, go on bringing into this world children destined to unhappiness and suffering. It is noteworthy too that these nervous wrecks generally intermarry. Does not this account to a large extent for the great number of unhappy marriages recorded nowadays? Of course, it is quite evident that under such pitiable conditions, the hereditary taints become increasingly aggravated. If the patients have money, which is very often the case, they prove profitable customers of the "nerve-specialist," and likewise of the endless chain of private sanatoria for nervous diseases. It is a sad spectacle indeed. My own experience has taught me that nine out of ten of these unfortunate beings have families, because they are ignorant of the dangers of heredity, and unfamiliar with the safe and proper means for preventing conception. Why not teach them? A few cases may suffice. (_a_) An hysterical woman, whose father was a lascivious, egotistical crank, married a man absolutely devoid of will power and energy. She was gifted; the marriage a failure. Of the two children, one was an indolent, thoroughly useless, good-for-nothing boy, whose only thought was of wasting money on pretty neckties and the like and of flirting with the girls, of which art he was a past-master. The other one, a girl, betrayed the same characteristics and disposition. The mother was in despair and inconsolable, cursing her offspring and the marriage alike. Too late, alas! (_b_) The son of a neurasthenic father and an hysterical mother, although of a good-natured disposition, had the vilest, uncontrolable temper, which would suddenly carry him away to acts of violence only to be bitterly regretted immediately afterwards. Whilst drunk he became excited and drawing a revolver wounded several innocent bystanders. As an officer in the army he was insulted by a tipsy student, whom he shot down on the spot, although he was sober himself at the time. On another occasion he shot himself in the breast, but recovered. Presently he fell in love most desperately with an hysterical woman and married her. The mother-in-law, who was an eccentric, mischievous person, started a bitter feud between the two families. He became greatly wrought up over the affair and demanded of his wife to stop the quarrel at once. As she demurred, he ended her life with a bullet from a pistol. Of course, he was arrested and languished in jail in utter agony and despair. What a future for those two unfortunate children that sprang from this union! I may point out here that at the time when he killed his wife, whom he loved passionately, he was not under the influence of strong drink, for he had given up the use of alcohol altogether for quite a number of years. (_c_) A very religious lady had married a man who became insane. He, too, was a devout churchman. There were 8 children. Under treatment the father improved and was dismissed from the asylum. I urged them both to prevent further conception, having in view the dangers of hereditary taint in the possible offspring. The wife indignantly told me that her church demanded of her to bear as many children as she could. They had several more, all of them candidates for the insane asylum or the institute for nervous patients. And that is called religion and morality! (_d_) A heavily tainted couple, desperately enamored of each other, came to me in great distress to ask: "May we get married?" I answered: "It does not strike me as being the wisest thing for you to do. But if you cannot exist without each other, by all means get married; but think what a calamity it would be, if two beings tainted as you both are, were to beget offspring." "But we are so fond of children." "Well, that is easily mended. There are plenty of healthy orphans whose parents were strong and sound both in body and in mind, but who are strangers to a father's and mother's love, and are craving for a good education. Make your own choice, but take only the very best. Then you will have a family and enjoy all the pleasures of parenthood. As for the rest, heed my advice. Avoid pregnancy." The law of heredity winds like a red thread through the family history of every criminal, of every epileptic, eccentric and insane person. And we should sit still and witness our civilization go into decay and fall to pieces without raising the cry of warning and applying the remedy? However, this is by no means all. Tuberculosis is the white plague of to-day. It is considered an established fact that every living human being inhales and swallows tubercle bacilli by the millions every day, and it is even claimed that every one of us harbors somewhere in the economy this dreadful poison to a larger or smaller degree. Whilst the pure, immune blood in a sound, robust constitution is able to resist the inroads of, and even to kill, sterilize, and eliminate these bacilli, the weaker and hereditarily tainted individual falls a prey to the attacks of this dire disease by the thousands. True, serum therapy and open-air treatment are accomplishing many cures, but the hereditary disposition remains in the system all the same, and may be transmitted to the coming generation, or at any rate may impair the power of resistance in the offspring. Moreover, the sexual appetite is very pronounced in phthisical patients. They marry and beget children in the most wanton fashion. The law cannot and does not prevent them, and the carnal instinct is not to be killed. What is to be done when law and religion forbid the application of preventive measures and even prosecute the person that recommends them? Local disease and pathological conditions in the woman (at times in man also), within wedlock, may render parturition an immediate danger to the life of the mother or of the child or of both together, for instance, cancer of the womb or other affections of the uterus, kidney disease, a deformed pelvis. Surely in such cases it is the bounden duty of the physician to intervene and council against, nay, absolutely forbid impregnation. Well, how is it to be done? Must husband and wife, who love and esteem each other, be separated? It would be unnatural, in fact it is quite impossible. Or should they abandon sexual intercourse all together and live like brother and sister? Well, a few exceptionally cold natures may have will power enough to carry into effect such a pact. But in 99 out of 100 cases the interdict of the sexual act sends the husband to satisfy his cravings elsewhere and contract disease, or he falls in love with another woman and wrecks home and family. Similar conditions may be brought about by other causes as well. Take, for instance, the poor workingman or mechanic who has already six or seven children and whose wife is unusually fertile, giving birth to children year after year. The wages of the father do not suffice to properly support them all. The food that can be purchased with the slender means is not at all adequate. Rent and other bills fall behind and the man gets in debt. They are both young yet. What is to be done? If they follow the natural law there will be an increase in the family every year. Moreover, these ever-recurring labors weaken the constitution of the woman and sap away her strength. Starvation? Sexual continence in wedlock? It is strange, indeed, to hear rich men, well-fed clergymen, pious zealots and reformers, leaning back in their comfortable chairs after a sumptuous meal and smoking an expensive Havana cigar, discuss this burning question and bewail the immorality of the common people. Statistics prove that these very people, who extol to the poor all the blessing of a big family, never live up to their teachings either in theory or in practice. The majority of these apostles of morality have no children at all, or at the utmost two or three. Why should that be so? What interesting reading it would make if the sexual history of these persons were followed up and printed. Money, hygiene, reason, and the most elementary laws of humanity demand that the wife, who is fertile above the average, should have a rest of at least 18 months between each succeeding pregnancy. But this cannot be achieved in the natural course of events, except in very rare cases, without wrecking the marriage. If we crystallize this sexual, social question, we arrive at the following conclusions: There are a great many cases, especially of a pathological character, but none the less also in normal and sound individuals, in which procreation, within wedlock or without, is dangerous either definitely or temporarily, either for the mother or the child, or for both, and for that reason should be interdicted. Very few men and a very small proportion of women--no matter how firmly they may be resolved--are capable of effectually suppressing their sexual needs. And even if they succeed, the consequences are generally of a disastrous nature, loss of marital love, secret illicit relations with others and subsequent infidelity, nervous disorders, impotence, etc. In all these cases we are confronted with the following dilemma: (1) In the unmarried person: onanism or prostitution, or both. Is that morality? Such people must either forever forego love, marriage, and normal, lawful sexual intercourse, or face sterility in wedded life. (I do not recognize prostitution--see chapter X--as normal intercourse.) (2) Within marriage: onanism, prostitution, and infidelity, or the adoption of rational preventive measures. I leave it to the reader and to the lawmakers to pick out the correct alternative and to arrive at the one possible, decent, and ethical solution of these conflicting questions. I do not admit that constitutionally frigid natures or those who find it easy to control their sexual appetite, have any right whatsoever to pose as normal samples of the human race and to simply ignore the existence of temperaments, characters, and constitutions so widely differing from their own. This world's history teaches us that nothing good has ever come from such vain assumptions, unless it be empty phrases and dead letters. These righteous, frigid, and strong natures ought, indeed, to be grateful to their ancestors for having handed down to them that happy disposition, and to prove their gratitude by making particular efforts to help those that are yet to come, in obtaining and sharing the same benign blessing. It seems almost incredible that in some countries medical men who are not ashamed to throw young men into the arms of prostitution, blush when mention is made of anticonceptional methods. This false modesty, created by custom and prejudice, waxes indignant at innocent things, whilst it encourages the greatest infamies. =Hygiene of Marriage.=--When marriage is consummated on the basis of free reciprocal consent, when both parties know exactly to what they have pledged themselves, when the corrupting influence of money is eliminated, when all unnatural regulation is suppressed, when the superfluous blending of religion and legislation have been abolished from the bonds of matrimony, when woman has finally obtained equal rights with man--then love and mutual respect, combined with the sexual appetite, will constitute the intimate and personal ties of marriage. At the same time, instinctive sentiments and legal duties toward the offspring will furnish it with a complementary and lasting cement. Among men whose nature is true, the instructive sentiment of altruism or conscience urges them to the performance of social duties without the necessity of any legal obligation. A few medical points now require our attention. The husband should be older than the wife, on the average from six to twelve years. This point is very important if a monogamous union is to be lasting. Woman matures earlier than man, both mentally and sexually; her personality becomes more rapidly adult than his; she ages more quickly and loses her faculty of procreation sooner than man. Certain savage races solve the problem by marrying as boys and girls, casting off their wives when they grow old, to marry younger ones. Among civilized races, man manages his affairs by making use of prostitution. From his youth he succumbs to physical and moral corruption, often complicated with venereal infection, and then often regards marriage as a kind of hospital for incurables, where the wife plays the parts of housekeeper and nurse combined! It is not easy to steer clear of these rocks, nor to formulate a rule for lasting monogamy. The old style of polygamy is brutal, and prostitution is still more disgusting. The sentiments of the egoist are summed up in the maxim, "After me the deluge!" To this the preacher of morals replies that "man should curb his passions." But this eternal dialogue does not help us in the least. I propose a middle course, as follows: The young man who possesses sufficient strength to overcome his sexual appetite, or whose sexual appetite is so moderate that he can remain continent till the age of about twenty-five years, so as to enable him to avoid prostitution, promiscuous sexual intercourse or masturbation--this young man, I maintain, has the best chance of gaining the first prize in life. If he is free from prejudice and is not afraid of using anticonceptional measures for a certain time, he may then marry a young girl, to whom he may become permanently attached, if their two characters suit each other. A young girl may very well marry at seventeen or eighteen, or at any rate between eighteen and nineteen. She is then sexually mature and her mentality is sufficiently developed, so that the difference in age we have required may be obtained. Young people thus united may continue their studies before procreating children, and their marriage will stimulate them to work. When the intoxication of the honeymoon is over, the continuance of conjugal happiness depends on an intimate adaptation of the two conjoints in sentiments, intelligence and sexual appetite; an adaptation which purifies love on both sides. Work in common, a common ideal, mutual respect full of affection but free from flattery, and a reciprocal education which does not degenerate into pedantry nor tyranny, are the principal conditions for conjugal happiness. It is absolutely necessary to avoid everything which causes reparation or exclusion, even in appearance. At the risk of appearing ridiculous in the eyes of certain superior persons, I repeat that separation of beds and bedrooms is a dangerous experiment to make in marriage, and that it may easily lead to estrangement, even when based on the highest motives. It is the same, in a still higher degree, with sexual continence in marriage, even when it does not last for years, excepting in cases of grave disease or senile impotence. It is often stated that a woman should avoid coitus for long periods, because among certain savage races the husband does not cohabit with her during pregnancy and the two years of nursing which follow it; the woman being considered by religion as "impure" during this period. But this proves nothing, for this custom only concerns polygamists, who make up for it with other women. If our monogamous marriage is to be natural, and not satisfied with words and illusions, it is necessary for sexual intercourse to be intimate and constant, and it should only be interrupted for short intervals, corresponding to the natural wants of the two conjoints, adapted to each other by mutual concessions. Apart from this, menstruation and accouchement constitute the only exceptions based on physiology. According to Grüber (_Hygiene des Geschlechtslebens_) accouchement requires an interruption of at least four weeks; I should say at least six weeks. Every husband, with the possible exception of the most horrible satyrs, can submit to this without much discomfort. Pregnancy, on the contrary, does not require continence, provided the husband takes account of his wife's condition and treats her with care. During the last months of pregnancy all violent movements and pressure on the abdomen should be avoided during coitus, so as not to injure the embryo. This may be effected by coitus in the lateral position. Professor Pinard of Paris advises the prohibition of coitus during the latter part of pregnancy, because it may lead to premature birth. As regards accouchement at the seventh, eighth or even at the beginning of the ninth month, this might, it is true, be proved by figures, but at this time the embryo is sufficiently protected, and with the precautions indicated above, I consider the danger as nil. As regards the end of the ninth month, the margin of errors as to the movement of conception and the signs of birth at term hardly allow of statistics which exclude subjectivism, and the danger becomes less and less. In any case a conscientious husband would run no risks under these circumstances if he was aware of the danger. What is more important for the wife is that she should have sufficient rest between her pregnancies. A year at least should elapse between parturition and the next conception; this gives approximately two years between the confinements. This is easily managed by the aid of the preventive animal membranes we have mentioned. In this way the wife keeps in good health and can bear healthy children at pleasure. It is certainly better to procreate seven healthy children, than to procreate fourteen of which seven die, to say nothing of the mother who rapidly becomes exhausted by uninterrupted confinements. No rule can be given for the frequency of sexual connection in marriage; this is a matter for reciprocal arrangement. Luther's rule of two or three times a week may be considered a normal average for virile persons of good constitution. Women who are sexually cold and fond of children, but who have a horror of coitus, cannot, in my opinion, be regarded as types of the normal wife, nor can they expect their husbands to abstain from all coitus except that intended for procreation. On the other hand, the wife should certainly be made acquainted with the nature of sexual intercourse and its consequences before marriage. Further, before engaging in a life-long union, a man and woman ought to explain to each other their sexual feelings so as to avoid deception and incompatibility later on. Without having ever experienced a sexual orgasm, either by coitus or by masturbation, a normal young girl, when she is sufficiently instructed in sexual matters, may easily decide whether the idea of coitus with a man for whom she feels affection is repugnant or attractive to her. In the case of young men it is still easier. A woman who had received a complete medical education and had remained a virgin, but who was well-informed on sexual life, gave me very precise information on this subject. For a long time the idea of coitus with men was repugnant to her, till she made the acquaintance of the one who gained her affections. Repugnance was then replaced by desire. This case also gives a good example of the monogamous sexual feeling of the normal woman. In Chapter XVII we shall discuss the manner in which youth should be initiated into the sexual question. Our present formality, combined with general ignorance of girls on sexual matters, renders a mutual understanding prior to definite betrothal generally impossible. Moreover, there is a sort of hysterical and pathological love, the product of the imagination, which is associated with sentimental words and sighs as well as coquetry, but transformed into disgust or hatred by the first coitus. Although more common in women this false love is met with in hysterical men. Sometimes the illusion disappears while there is yet time to break off the betrothal. Marriage by trial and has been attempted by some, but with varied success. For a number of reasons, both parties should be medically examined before marriage. This precaution may reveal the presence of a narrow pelvis or vaginismus in the woman, or aspermia, venereal disease, etc., in the man. When a woman will only support coitus with a view to procreation, she would do well if she informed her _fiancé_, who can then consider whether he can submit to such restriction. If the wife will not allow her husband a concubine it generally results in clandestine extra-nuptial relations and subsequent divorce proceedings. My opinion on this subject will no doubt appear very immoral to many people, but it is natural and rational. It is needless to say that I do not intend that a man has the right to compel his wife to have intercourse whenever he pleases. The question is a very delicate one; but, by the aid of goodwill a satisfactory solution of the problem can be obtained in most cases, in the manner indicated above. Love and mutual respect will always find a way out of the difficulty. It is necessary to avoid extreme asceticism and unnatural idealism on the one hand and excessive sexual indulgence on the other hand. In the sexual question above all others it is the wisest course to strike a happy medium. An extremely important question is that of the procreation of children. We have just explained how this can be regulated at will; we have now to consider how children of the best quality can be procreated. The first condition is the good quality of the parents. Their heredity or the intellectual and physical value of their ancestry is of paramount importance. We must take into consideration, not only the intelligence and physical health, but also good sentiments, a conscientious character and energy of will. What is the use of procreating healthy and robust children if they are vain, egoistic, impulsive, crafty, wanting in will power, or perhaps criminal? Such individuals constitute a social plague. At the time of conception the parents should not be in a condition of acute or chronic alcoholism, nor affected with any disease; otherwise the progeny may be tainted by _blastophthoria_ (Chapter I). The age of the procreators should also be taken into account. Children born of parents advanced in years are generally feeble. The fatal error which causes the procreation of children to depend on pecuniary reasons and interests is a social misfortune. Healthy men and women ought never to avoid reproduction, even when they are poor. Progeny of good quality grow up, so to speak, by themselves. Progeny with evil instincts, or decadent, have a pre-existing hereditary taint, or have been affected by blastophthoria in some other way. No doubt acquired diseases or accidents may make an invalid of a child or a man, but these are exceptions which prove the rule, for here again the descendant of healthy parents is more resistant than others, if he has not artificially altered his state of health and power of resistance by alcohol or venereal disease. Among savages, and at the present day among many peasants, children are rather an advantage than a burden, because these people have simple and healthy habits and few wants. It is our artificial and unhealthy desire for luxury, frivolity, comfort and enjoyment, our muscular weakness resulting from want of exercise, our exaggerated terror of diseases and microbes, in a word our effeminacy, which makes us so incapable of rearing large families simply and cheaply. No doubt it becomes more and more necessary to give children a good education, and this necessity complicates the question. But, in my opinion this education will in the future be conducted by the State. =Hygiene of Pregnancy.=--This subject is too special to be fully dealt with here. We may, however, mention that idleness and overwork are equally detrimental to the pregnant woman and her child. It is needless to say that every pregnant woman requires care and good food. Violent efforts, especially in the upright position, should be avoided (vide Bachimont: _La Puericulture intra-uterine_, 1898, Paris). But domestic work and moderate exercise of the body are beneficial. Precautions are especially necessary during the last months of pregnancy for the general health of the mother and child, but imprudence during the early months may cause abortion in many women. The progressive enervation of women in easy circumstances has no doubt rendered them less adapted to procreation. This failing should be corrected by progressive but prudent training. =Medical Advice as to Marriage.=--The permission or prohibition of marriage is a delicate question at the present day, but will be less so in the future, if our propositions are realized. If one of the two candidates for matrimony has been or is still insane, or seriously affected with tuberculosis, or with active syphilis or chronic gonorrhea, it is clearly our duty to prohibit marriage. If the situation is not so grave, and if it is only a question of hereditary taint, especially when there is a probability of the offspring being deformed in body or mind, we may content ourselves with prohibiting the procreation of children, while giving permission for marriage, provided anticonceptional measures are used. The importance of these measures is obvious in such cases. We should explain to the young people in question that the procreation of unhealthy or backward children is bad and even criminal, and warn them against such an unpardonable act of thoughtlessness. If they are very fond of children they can be recommended to adopt poor orphans. There is no need, however, to be too severe. Medical men are often pessimists, and have a tendency to see disease everywhere and to give a grave prognosis. The procreation of children should not be prohibited simply because there is insanity in some member of the family, but the probabilities of hereditary transmission should be calculated in the way we have explained in the first chapter of this book. Taking into consideration the bodily and mental health and the character of the two candidates for marriage, as well as that of their ancestry, the physician should consider what is likely to be the average quality of children from such a marriage. According as his calculation leads to a probability above or below the average of the population, from all the points of view of the social value of man, he will advise the parties concerned as to freedom or limitation in procreation. The average of humanity must not be placed too high, and the physician should always keep in mind the great mental mediocrity, weakness of will, the low moral level and physical defects of the bulk of the population. When persons who are intelligent and educated, but more or less psychopathic or hereditarily tainted, put questions of this kind to the doctor, because they are very conscientious and prudent, they should be recommended to lead a healthy life and avoid alcohol, but need not remain sterile, for their offspring may be morally and intellectually above the average, and if all blastophthoric influences are avoided there is a possibility or even probability of gradual regeneration. In short, the doctor must treat each case on its own merits, carefully weigh both sides of the question, and avoid being influenced by exclusive dogmas of any kind. Thus only can he give wise and useful advice. What is of especial importance for us, is the knowledge that it is not necessary, from the point of view of social hygiene, to prohibit marriage for the sole reason that the offspring may be of bad quality. We can allow psychopaths with hereditary taints, or even invalids of both sexes, to contract sterile marriages, by requiring them to avoid conception by some means or other, in the name of social hygiene and morality. In such cases dislocation of the tubes has a definite effect, and if we consider the negligence and weakness of mind of such individuals, we should do well to recommend this proceeding whenever there is a clear indication for inducing sterility. In this way we avoid cruel measures, which, by the way, are almost impracticable, which take away all hope of love and happiness from these unfortunates, throw them into the arms of prostitution or bitter pessimism, and make them disgusted with their own existence. =Medical Secrecy.=--Medical secrecy and its limitation is a very delicate question, especially in sexual matters. Opinions vary in different countries and among different individuals. In France medical secrecy is almost made an idol; the medical man may refuse to give evidence in a court of law and even conceal a crime. In Germanic countries, on the contrary, especially in German Switzerland, too little importance is attached to medical secrecy. In short, medical secrecy is an elastic idea which is open to different interpretations. Although certain particular cases may present great difficulties, there is a middle course of moral conduct which will serve the purpose of every conscientious doctor. As a general rule the doctor's duty is to keep secret everything confided to him by his patients, except when the patients themselves speak openly of it, or authorize their doctor to do so. There are, however, exceptions to this rule. First of all it assumes normal responsibility in the patient, and is only conditional among irresponsibles. When a lunatic, for example, relates to a doctor, under the seal of secrecy, certain things which depend on delirious ideas and which threaten the safety of others, or which render certain measures necessary in the patients' own interest, the doctor's duty is to make known the state of affairs, but only to responsible persons. It is the same as regards children. It is needless to say that the doctor should use all possible measures in the interest of the patient or child. But even with responsible persons medical secrecy has its limits. The doctor is here only bound to secrecy so far as it does not injure the rights of other individuals, or those of society. It is the duty of a medical man to report all cases of smallpox or cholera, etc., even against the consent of the patient, and to isolate the latter to avoid an epidemic, which is contradictory to medical secrecy. In short, he must not, under the pretext of medical secrecy, become an accomplice of harmful acts or crimes. I will mention a few examples bearing on the sexual question: A sadist or a sexual pervert addicted to assaults on children consults a doctor and confides to him his morbid appetite. It is obvious that the doctor has to do with a dangerous individual and is at the same time in a difficult position. In this case extreme measures are bad. The doctor who simply treats the patient without concerning himself about the possible victims, contravenes his duties. The one who replies to the patient, "you are a beast; go away or I shall denounce you," acts in a still worse manner. The one who simply denounces the patient also puts himself in the wrong. In my opinion, the doctor should first of all make a thorough examination of the mental and sexual condition of the patient, so as to establish the degree of perversion and satisfy himself whether he has to do with an honest individual worthy of pity, who strives to overcome his morbid appetite; or, with a crafty egoist with no conscience, who only consults the doctor to escape from temporary difficulties into which his perversion has led him, and who indulges his morbid appetite without scruple, constituting a perpetual danger to society. Unfortunately, the latter cases are very common, and the doctor is usually consulted from interested motives only. Under these circumstances medical secrecy renders the doctor the accomplice of the criminal. Between the honest patient and one who is absolutely perverse, there are many transitional stages. In these cases the doctor should always make a careful examination before forming an opinion. If he feels uncertain, he should call in a specialist in mental disease, and then act accordingly. If he is convinced that the patient has made the resolution to overcome his morbid appetite, and has so far resisted the temptation to injure any one, he should strengthen the patient's resistance by doing everything possible (except marriage) to rid him of his malady; he should make him aware how dangerous his condition is to himself and to others; he may even recommend either castration or masturbation in case of urgency, in order to avoid crime; he should make him promise to come immediately for internment in an asylum, as soon as he can no longer resist. Under these conditions he may respect medical secrecy and at the same time save the existence of the unfortunate patient, while protecting society. In more severe cases, when the doctor is convinced that the patient is incapable of controlling himself or does not wish to, or that he has already committed crimes, he should act as follows: He must explain to the patient that it is impossible for him to take the responsibility and that he must be immediately sent to an asylum, in default of which information will be given against him. We must make him understand that he is a danger to society and goes beyond the limits of what is licit, but that if he voluntarily submits to rational treatment, offering all requisite guarantees on both sides, he (the doctor) is disposed to avoid any legal action. The duty of medical secrecy ought never to go so far as to render the medical man an accomplice of dangerous individuals or criminals. The lunatic asylum in such cases is the natural refuge for the patient, as the lazaret is for cases of smallpox or cholera. These cases, however, require public asylums which are not too large, well organized, with divisions for different cases, and provided with a sufficient medical staff. I have chosen as the first example one of the worst kind of cases which endanger the public safety. But there are other cases such as that depicted by Brieux in "_Les Avariés_." A syphilitic subject wishes to marry before he is cured, and consults his doctor. Does the whole duty of the doctor consist in dissuading the patient from marriage? Has he actually the right to be silent when the patient will not listen to him, and thus allow an innocent young woman to be contaminated, through respect--or rather idolatry--for medical secrecy? Is it not rather his duty to say to the patient: "Beware! If you do not promise to obey me, I will immediately denounce you to your _fiancée_ and her parents, and will tell them the state of affairs." It seems to me that this is his duty. In this case the doctor does not denounce the patient without his knowledge; he threatens him face to face, and may speak to him as follows: "You have confided in me. I am, it is true, under the obligation of medical secrecy toward you, so long as you do no harm to any one. But if, in spite of all my explanations and warnings, you attempt to marry in your present state, rendering yourself guilty of infamous deceit toward a family and an unfortunate young woman whose health you will ruin, trusting in the obligation of secrecy which ties my tongue, I must inform you that I have a much higher duty than that of a doctor toward his patient--my duty toward society, which I shall fulfill, and so prevent an innocent person from becoming your victim." This is my view of the duty of a conscientious doctor who upholds the dignity of his profession. An analogous case came under my observation: A young tuberculous subject affected with several "white swellings" wished to marry. He refused to listen when I declared that he would be guilty of a crime toward his _fiancée_. Thereupon I told him that I should tell everything to the young girl. I did this at once and so prevented the marriage. This egoist succeeded later on in capturing the heart of another young girl, whom I also warned, but who married him out of pity. At any rate I consider that I did my duty. In my opinion, this is also our duty in cases of chronic gonorrhea, insanity, and hereditary or constitutional sexual perversions, etc. Formerly, when sexual inversion was regarded as an acquired vice, it was attempted to cure it by marriage. Such a social monstrosity is even seen at the present day, and certain ignorant doctors recommend it. We sometimes meet with inverts who desire to procreate homosexual beings like themselves. As sexual intercourse with the objects of their perverted passion cannot give them this pleasure, they marry in order to procreate children by some poor woman whom they have victimized, without in the least renouncing their homosexual orgies. Their wives play the part of housekeeper or servant, whose accessory function is to breed young inverts! Is it necessary to say that any self-respecting doctor who is aware of this state of affairs should never countenance such marriages? Here again, his duty is to threaten the invert with immediate denunciation to his _fiancée_, when he appears determined to accomplish his crime. Again, the doctor may be consulted with regard to certain hereditary taints, or possibly only a bad ancestral history, and whether marriage is advisable under the circumstances. In some cases there may be some doubt and it is necessary to know the opinion of the other party concerned, and whether this party is also affected in a similar way, etc. The first duty of the doctor is to demand absolute frankness and to say, "under this or that condition and in such and such circumstances, you may perhaps marry, but under no pretext have you the right to conceal the truth from your betrothed. It is to your own interest to be frank, for no marriage founded on deceit can be happy. Give me permission to discuss the matter with your _fiancée_ (or _fiancé_). We shall then see what is best to be done." In my experience, the person who consults a doctor usually accepts this proposal, and we can thus avoid many misfortunes and do much good. It is impossible to fix a general rule. According to the degree of hereditary taint or the nature of the infirmity, we allow marriage with or without children, or do not allow it. In such cases it is rarely necessary to have recourse to the threat of denunciation, but this may be required in the case of egoistic or vicious individuals. On several occasions a betrothed couple have come to me for advice as to their proposed marriage, and have freely disclosed their most intimate relations and antecedents. This is as it always should be, if men were more loyal in sexual matters and understood better their true interests. In this way the doctor's task is greatly facilitated. When the public is more enlightened on the whole question it will become more and more easy to arrive at a just conclusion, even without the doctor's help. =Artificial Abortion.=--We have already spoken of another question which is often put to doctors--that of artificial abortion. (Vide