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Title: Safe Marriage - A Return to Sanity
Author: Rout, Ettie A.
Language: English
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Copyright Status: Not copyrighted in the United States. If you live elsewhere check the laws of your country before downloading this ebook. See comments about copyright issues at end of book.

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[Illustration: ETTIE A. ROUT. [_Vandyk, London._]]

SAFE MARRIAGE
A RETURN TO SANITY

BY

ETTIE A. ROUT


WITH PREFACE BY

SIR WILLIAM ARBUTHNOT LANE, BART., C.B., M.S.,
(Consulting Surgeon to Guy's Hospital), etc.


LONDON:
WILLIAM HEINEMANN
(Medical Books) Ltd.
1922


      +--------------------------------------------------------------+
      |                                                              |
      |               _PREVENTION OF VENEREAL DISEASE_               |
      |                                                              |
      |              By SIR ARCHDALL REID, K.B.E., M.B.              |
      |                                                              |
      |        With an Introduction by SIR BRYAN DONKIN, M.D.        |
      |                                                              |
      |    _Crown 8vo. 447 pages. 15s. net. Weight 2 lbs. Inland     |
      |                        postage, 9d._                         |
      |                                                              |
      |  This book is addressed on the one hand to those who would   |
      | prevent venereal disease in themselves, and on the other, to |
      |         those who would prevent it in the community.         |
      |                                                              |
      |    _Lancet._--"A powerfully written and valuable volume."    |
      |                                                              |
      | _The Medical Press._--"We _positively assert_ that it is the |
      |     duty of every medical man to _master_ its contents."     |
      |                                                              |
      |          LONDON: WM. HEINEMANN (Medical Books) Ltd.          |
      |                                                              |
      +--------------------------------------------------------------+


     The French Government has bestowed the premier decoration for
     women, The Reconnaissance Française, upon Miss Ettie Rout, of the
     New Zealand Volunteer Sisters, "for work done during the war (as
     head of Anzac Soldiers' Club in Paris), and in 1919-1920 as head of
     American Red Cross Depôt and Canteen at Villers-Bretonneux, where
     she helped a great many French soldiers, and rendered precious
     service to the civilian population of the commune." The War Office
     also conveyed thanks to Miss Rout "for gallant and distinguished
     services in the field." "I have it in command from the King," wrote
     the Secretary of State for War, on 1st March, 1919, "to record His
     Majesty's high appreciation of the services rendered."



PREFACE.


It affords me great pleasure to write a short preface to this book, since
it deals with a matter in which I (in common with all those who are
intensely interested in the health of our race) am glad to take an active
part.

To no woman has it been permitted to do the same amount of good, and to
save more misery and suffering, both during and after the war, than to
Miss Ettie Rout. Her superhuman energy and indomitable perseverance
enabled her to perform, in the most efficient manner possible, a work
which few women would care to handle, and of which but an infinitesimally
small number are capable. The French Government fully recognised the great
services she rendered to the Allies, and did her honour. The book she has
written is one of very great value, in that its object is the Health,
Happiness, Morality and Well-being of the Community.

Not only has Miss Ettie Rout the qualities that characterise all great
humanitarians, but she also possesses, in a unique degree, an intimate
knowledge of the terrible troubles that arise from irregular intercourse,
and of the manner in which they can be reduced and perhaps eliminated.

In this book she deals with such simple hygienic measures as are little
known in England, though they are in common use in France and in the
United States, in both of which countries sound practical common sense
prevails.

She is persuaded that marriage is the goal to be reached by all, and that
everything possible should be done to facilitate it, and so to diminish
vice. In her efforts to bring about this happy issue she has the good
wishes and congratulations of all who have the health of the community at
heart.

W. ARBUTHNOT LANE. 21, Cavendish Square, London, W.1.

_March 25th, 1922._



CONTENTS.


                                        PAGE

     FOREWORD                           xiii

  I. INTRODUCTION                         17

 II. PRACTICAL METHODS OF PREVENTION
       A. FOR WOMEN                       32
       B. FOR MEN                         51

III. MEDICAL FORMULÆ                      59

 IV. COMPULSORY TREATMENT                 63

  V. CONCLUSION                           65

     APPENDIX I                           69

     APPENDIX II                          73

     NOTE AND ADVERTISEMENT               75



  "Knowledge comes, but Wisdom lingers, and I linger on the shore,
   And the Individual withers, and the World is more and more."

                                            TENNYSON.



FOREWORD.


This book embodies the considered opinions of twenty-five years' practical
experience of adult life--as an official reporter and journalist, as a
voluntary war-worker, and as a married woman. For many of the thoughts and
expressions used I am indebted to large numbers of men and women whom I
cannot name, and with whom I have been personally and professionally
associated in different parts of the world. I am also indebted to the
following medical journals for the publication, during the last five
years, of many letters, articles, notes, etc.: _The Lancet_, _The British
Medical Journal_, _Public Health_, _Municipal Engineering_, _Hospital_,
_New York Medical Journal_, etc., etc.

I have to thank the Society for the Prevention of Venereal Disease, the
National Birth-Rate Commission, and the Joint Select Committee (House of
Lords) on Criminal Law Amendment Bills for recording various statements
and evidence.

It remains only to state this fact: That on January 25th, 1922, Sir
Arbuthnot Lane, Sir Frederick Mott, Surgeon-Commander Hamilton Boyden, of
the Royal Navy, and Mr. Harman Freese, of Freese & Moon, manufacturing
chemists, of 59, Bermondsey Street, London, S.E.1, met at my home to
decide upon the best medical formulæ for self-disinfecting ointment for
men and contraceptive-disinfecting-suppositories for women. Mr. Freese
made up sanitary tubes and sanitary suppositories in accordance with these
formulæ, but he is prohibited by law from recommending these for the
prevention of venereal disease, and forbidden to supply printed directions
with them, whereas similar medicaments are being retailed with printed
directions in the State of Pennsylvania, and the Health Department
circularises medical practitioners thus:--

     "The self-treatment packet, obtainable at drug stores, to arrest
     venereal infection after exposure, is approved by the State
     Department of Health on the same principle as is antitoxin given to
     diphtheria contacts. Proof is lacking that the use of this packet
     lowers social standards. Reduction in the incidence of venereal
     disease is a direct result."

But not only in the clear, cool air of American State Departments of
Health is the knowledge and love of sexual cleanliness fructifying. In the
_Dublin Review_ for January-March, 1922, there is a wonderfully fine
article on "The Church and Prostitution," by the Right Rev. Monsignor
Provost W.F. Brown, D.D., V.G., in which he quotes from a very recent
Moral Theology, "De Castitate," by the Rev. A. Vermeersch, S.J., Professor
of Moral Theology at the Gregorian University, Rome, published in May,
1921. The author of "De Castitate" gives brief answers to three questions
put to him, which Mgr. Brown quotes in the original Latin, and of which
the following is a translation furnished by a Catholic priest:--

     "You ask

     1. Whether or not it is formally sinful to use antiseptic ointment
     before illicit intercourse.

     2. Whether or not the use of such ointment may be advocated.

     3. Whether or not it is lawful for chemists to sell it.

     Ad. 1. Although it seems that in England (_cf. Times_, January,
     1917) some have made a scrupulous distinction between the use of
     this ointment _before_ and _after_, and have forbidden the former
     while approving the latter, you need make no such distinction (of
     course, supposing the ointment is not used by a woman to
     sterilize). It is not wrong to seek means, indifferent in
     themselves, which will prevent the evil consequences of sin.

     Ad. 2. It would indeed be a sin to reveal such drugs or to persuade
     their use with the intention to induce a man to commit sin; but
     there is no harm in telling a man who is certainly going to sin how
     to avoid the consequences. Ad. 3. If men could be restrained from
     vice by prohibiting the sales, this should be done; but so many are
     ready to expose themselves to danger that you cannot hope for such
     a result from forbidding the sale. It is true this removes _fear_,
     but the general good, and the removal of danger to the innocent
     justifies this. Besides, it is a poor virtue which is kept from sin
     only by the fear of disease."

Having gone so far as to admit the desirability and necessity of the
medical prevention of sexual diseases, the Roman Catholic Church will
certainly find itself later unable to deny the desirability and necessity
of preventing the birth of children liable to be born diseased or unfit.
It is not practicable for a wife to take any suitable precautions against
infection by a diseased husband, which precautions will not at the same
time be effective, to a greater or lesser extent, in the prevention of
conception. There is no half-way house in the matter of sexual hygiene.

ETTIE A. ROUT.



I.--INTRODUCTION.


At present marriage is easily the most dangerous of all our social
institutions. This is partly due to the colossal ignorance of the public
in regard to sex, and partly due to the fact that marriage is mainly
controlled by lawyers and priests instead of by women and doctors. The
legal and religious aspects of marriage are not the primary ones. A
marriage may be legal--and miserable; religious--and diseased. The law
pays no heed to the suitability of the partners, and the Church takes no
regard for their health. Nevertheless, the basis of marriage is obviously
mating, or sexual intercourse. Without that there is no marriage, and with
it come not merely health and happiness but life itself. Cut out sexual
intercourse, and society becomes extinct in one generation. Every
generation must, of necessity, pass through the bodies of its women; there
is no other way of obtaining entry into the world. Hence, it is clearly
the duty of women to understand precisely the processes involved, from
beginning to end.

With the lower animals sexual intercourse is desired only seasonally, and
only for the purpose of reproduction. With the higher animals--man and
women--sexual intercourse is desired more or less continuously throughout
adult life, and desired much more for romantic than for reproductive
considerations--that is, for the sake of health and happiness rather than
for the sake of procreation only. A few women, and still fewer men, have
no sexual desires. To them sexual abstinence seems more natural than
sexual satisfaction. But for the majority of mankind and womankind--for
all normally healthy men and women--there is this continuous desire to be
happily mated.

For the sake of health and happiness there is everything to be said for
early marriage, but better late than never.[A] The chief obstacles to
early and happy marriage are financial, and these would largely disappear
if women were able to control fecundity. The chief obstacles to healthy
marriage are the venereal diseases, and these could be extirpated in two
or three generations if sexual cleanliness was properly taught to all
adults, and if promiscuous intercourse was properly regulated during the
same period. Unfortunately most women's idea of regulating promiscuous
intercourse is to have none of it. This is impossible in the present stage
of moral evolution, but it will become increasingly possible as we
succeed in extirpating the venereal diseases, particularly syphilis.
Syphilis is the one great cause of immorality, because persons born with a
syphilitic taint (and what family is entirely free from this hereditary
disease?) are apt to be mentally and morally deficient; hence, tend to
indulge in anti-social and unnatural practices, such as engaging in
promiscuous intercourse.

[Footnote A: Marriage, whether early or late, cannot of course benefit and
elevate society until the present mischievous and archaic Divorce Laws are
simplified and reformed in accordance with modern sociology and ethics.
Unhappy and unsuitable marriages necessarily foster immorality and promote
disease, and the community as a whole gains by their being dissolved in a
ready but responsible and dignified manner. The refusal of the Church to
marry diseased persons would greatly benefit the nation, whereas its
refusal to marry healthy divorced persons not only injures the nation but
dishonours the Church.--E.A.R.]

The normally healthy man is a highly selective creature, and the normally
healthy woman still more fastidiously selective in romantic relationship.
Neither man nor woman is naturally in the least attracted by promiscuous
intercourse. On the contrary, it is repugnant to both. Both regard the
elements of romance, reciprocity and permanence as essential. These
elements are present in marriage and absent in prostitution. Therefore, it
is beneath the dignity of any decent, intelligent woman to suppose that
promiscuous relationship can ever be as happy and satisfying and
attractive as marriage. This, apart altogether from the fact that marriage
is fertile and prostitution infertile. No, both man and woman desire
love-relationship, not loveless-relationship; and they are really quite
fit to be trusted with the evolution of the race through passionate love
and the worship of beauty, as soon as society makes harmonious provision
for their normal sexual needs. Until society does make early marriage
practicable for all healthy adult men and women, say between twenty and
twenty-five years of age, extra-marital relationship, however undesirable,
is inevitable, because there are many men to whom, at times, any woman is
better than no woman.

But extra-marital relationship is never even safe, because of its
promiscuity and impermanence, except in properly conducted and effectively
supervised tolerated houses. The tolerated house is absolutely necessary
at present to protect women from disease and immorality, by confining this
kind of intercourse as far as possible in certain definite channels. The
abolition of the tolerated house spreads both disease and immorality into
classes of women who would otherwise be immune, and enormously increases
the dangers of promiscuous intercourse. Separated from their toilet
equipment the women cannot make and keep themselves clean; on the streets
they are not taught to refuse intercourse with diseased men; thus their
occupation becomes more and more dangerous as medical supervision is
removed. They inevitably become diseased; sometimes contract mixed
infections, which they pass on to their clients--the future husbands and
fathers of the nation--and "The sins of the fathers are visited upon the
children even unto the third and fourth generation." All this would be
impossible if women generally would recognise the primary fact that
because a man is immoral that it is no reason why he should become
syphilitic. We all want to abolish sin, but failing that we must cease
wanting to poison the sinner. We must actively work to save him from the
penalties of his folly, for that is the only way in which we can save his
victims and succeed ultimately in "Making Marriage Safe."

Similarly every effort should be made to prevent women becoming diseased,
no matter how immoral they may be. The prostitute is very often a woman of
peculiar mentality or overdeveloped animal instincts; and many women are
driven to prostitution by drink and poverty. The prostitute class is
largely recruited from mentally and morally deficient girls, who are
themselves the offspring of syphilitic or alcoholic parents. Prostitution
is the effect--not the cause--of anti-social acts and conditions. We must
remedy the causes of these before we can hope to remove the effects. Under
present social conditions, attempting to abolish prostitution by shutting
up tolerated houses is just as idle as attempting to lower the temperature
of a room by smashing the thermometer. All we can do is to make and keep
these women clean. If we decline to do even that, then diseased women will
succeed in contaminating our men much faster than we can instruct the men
in sexual cleanliness.[B]

[Footnote B: Diseased women will continue to cater for men so long as they
are left free to do so, but as knowledge grows their clients will tend to
be limited to _diseased men_. Once men clearly understand that _every_
casual connection is a risk of disease, they will certainly tend to run
fewer risks.--E.A.R.]

And again, just as the medical prevention of venereal disease was not
proposed, and has not been applied for the purpose of fostering or
condoning promiscuous intercourse,[C] so the conscious control of
fecundity by contraception must not be applied in such a way as to lessen
the proportion of well-born citizens in the nation taken as a whole.
Birth-control applied only by the responsible classes of the community
combined with indiscriminate fecundity among the irresponsible masses,
must inevitably lead to the lowering of the general average in character,
brains and physique. It is a form of reverse selection--the responsible
being out-bred by the irresponsible. What is wanted is the general
application of birth-control by voluntary contraception, and the
particular application of voluntary and compulsory sterilisation of the
feeble-minded and unfit.

[Footnote C: My own experience among the troops quite convinced me that
the more thoroughly and carefully self-disinfection was taught, the less
immorality there was. It was impossible to teach self-disinfection
properly without at the same time instilling a living sense of danger into
the minds of men and women; and this danger-sense certainly led to more
self-restraint.--E.A.R.]

Enthusiastic advocates of birth-control claim it as a means of _improving
the race_. It is not necessarily anything of the kind. You cannot improve
a flock of sheep or a herd of cattle by letting all the individuals breed;
whether each individual has a small number or a large number of offspring
makes comparatively little difference. The way to improve the flock or
herd is to breed only from _the best_ and eliminate the unfit as breeding
material. Changes in environment may improve or deteriorate the
individuals of one generation, but such changes are not inheritable,
excepting in the case of venereal disease. Syphilis, _e.g._, may damage
the germ-cells of a man's body, and thus lead to his procreating diseased
and damaged offspring--idiots, imbeciles, mental or moral deficients, and
so forth, who unfortunately are fertile. Thus the prevention of venereal
disease is a eugenic force. It is in fact the _only_ eugenic force in
operation at present. Generally speaking, it is the well-developed and
high-spirited and enterprising young men who travel most, and who,
therefore, are most likely to contract and spread venereal disease. They
come in contact with a much larger number of women than those who stay at
home instead of wandering abroad. These well-to-do young travellers often
marry the finest of our women, and later in life damage or sterilise them
through latent or chronic venereal disease. Hence many one-child
marriages--due not to the use of contraceptives, but to the action of the
gonococcus transferred to the body of the wife.

But there is this hope. It is among the mentally alert and well-informed
men and women that birth-control is first understood and applied, and it
is among this very same class that the medical prevention of venereal
disease is also first understood and applied. Thus, there will tend to be
less disease among this class than among the mentally torpid and
ill-informed masses of the community. This in itself will not _improve_
the race, but it will prevent the deterioration of certain classes and
increase their numbers. Nevertheless, so long as the irresponsible and
feeble-minded and diseased are permitted to multiply indiscriminately, as
at present, they must ultimately outnumber and overwhelm the classes which
are practising self-restraint or applying birth-control. This process may
even be hastened by a political enfranchisement, which enables twelve
feeble-minded persons to outvote two wise men six times over. Thus, to
succeed democracy must raise and maintain the general average of brains
and character throughout the community. In so far as it permits low-grade
individuals to be born in the homes of the masses, and high-grade
individuals in the homes of the classes, it is manufacturing a rod to
thrash its own back, successful rebellion against which mode of Government
ends in mere anarchy and chaos.[D]

[Footnote D: The present need of the white race is to increase its numbers
of fit and decrease its numbers of unfit. Over-population (except in a few
patches of the Old World) is not likely to be a problem for the white race
for centuries. They have several continents practically empty and
undeveloped, and science has as yet touched only the fringe of the
possible productivity of the earth in the matter of food supplies. The
worst feature of the British Empire is that there are too many Englishmen
and not enough Anzacs.--E.A.R.]

One duty at any rate is quite clear. No woman should run any chance of
conception unless she is certain of her own health and the health of her
partner--the man who is to be the father of the child she is to bring into
the world. If her husband's health is unsound, and she cannot avoid
intercourse, she can certainly take precautions against conception and
against infection. The control of fecundity and the control of infection
are parallel problems, and generally speaking, the measures a woman takes
to prevent conception will also prevent infection. If these precautions
are not taken, a woman may not only become seriously ill herself, but she
may blast the health of her unborn babe--or infect it herself during or
after birth. Clearly then it is her personal, as well as her maternal and
national, duty to apply preventive measures.

Women should understand that there is _always_ a great deal of venereal
disease--millions of fresh cases every year in the British Empire. During
the war there were about half-a-million fresh infections per annum among
the soldiers in the British armies alone--about two million men infected
altogether at the very least.[E] Some were cured, others patched up; some
very badly treated; some not treated at all; many demobilised while in an
infective condition, and thus liable to come home and sow in the bodies of
clean women the seeds of diseases picked up in foreign lands in moments of
excitement and folly. Blame these men if we must, but in all fairness let
us ask ourselves: _Who infected them?_ And the answer is: _Diseased
women._

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

_Why don't we?_

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

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

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



II.--PRACTICAL METHODS OF PREVENTION.

A. FOR WOMEN:

SEXUAL REPRODUCTION.


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

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


PREVENTION OF CONCEPTION.

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

There are _two methods_ of preventing fertilisation:--

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

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

[Illustration: INNER SIDE OF THIGH.

DIAGRAM 1.--Female organs of generation in normal condition. This shows
diagrammatically the position of the organs if a woman were cut in two
between the thighs. The rubber pessary is shown in position, slightly
distending upper end of vagina (or front passage), and covering the
opening into interior of womb. A suppository introduced beforehand will
dissolve and occupy the dotted space above rubber pessary, forming a pool
around the mouth of the womb. The walls of the vagina are elastic and
collapsible. Infection with gonorrhoea may occur in the female urethra (or
water passage) or in the vagina, etc. Syphilis may infect internal and
external parts of female organs; also breasts, mouth, tongue, etc., and
other openings of the body.]

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

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

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

[Illustration: UTERUS, OVARY AND FALLOPIAN TUBE.

DIAGRAM 2.--The Fallopian tubes and ovaries are not shown on Diagram 1.
There are two ovaries and two Fallopian tubes, one on each side of the
uterus. The female cells or ova are formed in the ovaries and discharged
into the Fallopian tubes, along which they travel into the uterus. It is
believed that the union of the male with the female cell usually occurs in
the Fallopian tubes, but that it may occur in the uterus.]

[Illustration: DIAGRAM 3.--This diagram shows the male urethra or passage
down the male organ as somewhat distended. Generally, the walls of this
passage are collapsed together. The seminal fluid is discharged down the
urethra and emitted at orifice marked "meatus." The small glands indicated
are especially liable to be infected with gonorrhoea germs, but infection
may occur almost throughout the entire length of the male passage.
Infection with syphilis may occur on the outside of the male organs and
elsewhere.]

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


UNATTAINABLE CONDITIONS.

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


SEXUAL TOILET OUTFIT.

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

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

[Illustration: Diagram 4]


GENERAL CONDITIONS.

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

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

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

4. _Soluble Suppositories and Rubber Pessaries._--It is quite true that
the use of a suitable soluble suppository alone may be sufficient to
protect against impregnation, but the protection by this means does
undoubtedly fail at times, and therefore, by itself, the soluble
suppository is unreliable. Still it eliminates the majority of the chances
of impregnation. The use of the rubber pessary is also sometimes
unsuccessful because it does not fit properly, or because it is porous, or
because in removing it some of the seminal fluid from the under-surface
may be accidentally spilt in the vagina, and in this way the spermatazoa
may later find their way upwards to an ovum. Therefore, the soluble
suppository and the rubber pessary should be used in combination. A woman
should first push up, as far as possible, a suitable suppository, and then
insert the rubber pessary (slightly soaped--with soap-suds), so as to
occlude the whole of the upper part of her genital passage and thus cover
the mouth of the womb and effectively prevent entrance of the spermatazoa.
The rubber pessary _must_ in the first instance be fitted by a doctor,
because if it does not fit properly it will be ineffective. The seminal
fluid may pass by its loose rim and impregnation may result. If the rubber
pessary has been properly fitted, and _it is not porous_, the protection
should be complete; but if, by any accident, spermatazoa should get beyond
the rubber pessary, they will be destroyed and tangled in the melted
suppository--provided, of course, that a suitable suppository has been
used. It is all a question of getting the right articles to begin with and
using them intelligently. But there is this chance--a bare chance--of
accidental impregnation, and we want to eliminate all chances, if
possible. Assuming the rubber pessary fits properly, as it will if
skilfully selected and applied in the first instance by a competent
medical practitioner, then the seminal fluid must remain in the lower part
of the vaginal passage. An hour or two after intercourse, or next morning,
this seminal fluid can all be washed away by the use of syringe and bidet.
It is far better to sit over the bidet and syringe in that position than
to squat down over a basin--an uncomfortable and unsuitable position for
douching, because the walls of the vagina in that position may be pressed
hard together. The fluid should be retained in the vagina for a minute or
two, by pressing the flange of syringe closely against the orifice of the
vagina. _After syringing, but not before_, the rubber pessary should be
removed (to be washed with soap and water, dried carefully, and put away
till required again), and immediately after removing the rubber pessary it
is a good plan to facilitate the ejection of the surplus fat of the
suppository by urinating and re-syringing. It is quite easy for a woman to
insert and remove these rubber pessaries for herself as occasion requires,
provided that whilst inserting and removing the pessary she has placed her
body in a suitable posture--say, lying on the back with knees drawn up,
sitting on bidet, or standing with one foot on a chair, or whatever other
position she finds suitable. A doctor's help is needed only when first
selecting the right size of pessary. The pessaries are made in ten
different sizes, each size being numbered, and the right size can always
be obtained on order. No harm may come from wearing the pessary for a day
or two, but it is highly desirable as a matter of cleanliness and
otherwise to remove the pessary in the morning when performing the sexual
toilet. The pessary should, of course, never be worn during the menstrual
period. A good rubber pessary should last from three to four months, and
it should be tested occasionally by filling it with water to see that
there is no hole in it. If it has been fitted shortly after a miscarriage
or confinement, refitting is desirable at the end of a few months. But in
normal circumstances refitting is not necessary.

[Illustration: DIAGRAM 5.--Scale: One-sixth actual size.]

[Illustration: DIAGRAM 6.

Two FORMS OF SUPPOSITORIES. ACTUAL SIZE.

These melt rapidly after introduction and provide a pool of antiseptic
fluid around mouth of womb.]

[Illustration: DIAGRAM 7.

COVERED SPIRAL SPRING RUBBER PESSARY. SEEN IN PROFILE.

It is understood that this is circular. The thickened rim retains this
circular shape by means of enclosed spiral spring when the pessary is in
position. To insert conveniently, the thumb and forefinger are placed on
opposite sides of rim, and the spring pressed into a long oval shape.]

5. _Antiseptic Douching._--If antiseptics of any kind are used, such as
lysol, they should always be used in _very very weak solutions_, and
should be varied from time to time. There is no necessity ordinarily to
use anything but plain warm water, with perhaps a little table-salt in it,
for internal cleansing, and soap and water for external cleansing; then
dry parts carefully. But some women prefer a weak antiseptic vaginal wash,
as they do a weak antiseptic mouth wash. If a woman is unfortunate enough
to be married to a man liable to infect her, then she should follow the
same practice as detailed here (every effort, of course, being made for
her husband to be cured as soon as possible), and she should use a
_special suppository_, as prescribed by her doctor or otherwise
authoritatively recommended, and should douche and urinate _immediately
after each sexual connection_. She should also, before douching with weak
disinfecting lotion, wash thoroughly--internally and externally--with
suitable soap and water. This will certainly help to prevent infection in
the vagina and elsewhere. The rubber pessary and the suppository will give
her a very real measure of protection against the worst of all forms of
infection, viz., uterine and ovarian. She can also protect herself against
infection in the female urethra--that is, the passage from the bladder--by
urinating _immediately after each connection_, as advised. A good deal of
nonsense is still talked by some medical practitioners about the alleged
harmfulness of douching. The same kind of distracting and misleading
statements were made a few years ago regarding antiseptic mouth-washes,
which were similarly condemned. Fortunately, we are passing out of these
dark ages! Soon it will be regarded as quite as natural and necessary and
desirable to cleanse the genital passages as to rinse out the mouth or
wipe the nostrils.

It is important to remember that the "_personal equation_" counts for
something in choosing a disinfectant, some substances suiting one person
and some suiting others. "One man's meat is another man's poison." It is
also very desirable to "_ring the changes_" by using, say, lysol one day,
something else the next, and so on. Using three or four simple
disinfectants alternately on different days of the week tends to make the
disinfectants less irritating and more efficacious, as well as adding a
fresh interest to the toilet performance. On this and other points
_personal instruction_ is far the best--provided you can find a good
instructor. Every man and every woman should seek an opportunity of
learning, from competent authority, precisely what to do in the matter of
prevention, and what it all means. Reading books is all very well, but
personal tuition as well is a great advantage.


SUMMARY.

Finally, the following briefly summarises the recommendations for women:--

1. _Before Intercourse, Wash and be Clean._--Insert soluble suppository,
and then place rubber pessary in position, concave side downwards. This
will slip up more easily if slightly soaped. No harm can possibly come
either to husband or wife from these appliances, and neither party will be
conscious of the presence of the occlusive rubber pessary (some other
kinds of rubber pessary have not these advantages). The pessary can be
inserted some hours before intercourse, and need not be removed till some
hours afterwards. _The rubber pessary should not be worn continuously._ If
you have mislaid the rubber pessary, a small sponge, a piece of clean
cotton-wool, or even a piece of soft tissue paper can be used. Native
women in different countries use seaweed, moss, sponge, etc., and Japanese
women use rice-paper. But these articles are not so clean or effective as
the occlusive rubber pessary. If sponge or cotton-wool is used, it should
be saturated in contraceptive lotion or smeared with contraceptive
ointment before insertion. But always remember--the rubber pessary is
cleanest and safest.

2. _After Intercourse._--Douche next morning (or earlier), remove rubber
pessary, wash and dry it and put it away slightly powdered. Where there is
any chance of venereal infection, the woman should urinate _immediately_
after _each_ connection, wash with soap and water, and then _at once
douche with weak and warm disinfecting lotion_. If medically directed, she
should also use a little calomel ointment for anointing parts that have
been touched in any way.

3. _Daily._--Cultivate in yourself and in the members of your household
habits of sexual cleanliness. _Wash and be clean._ Apply this to all the
openings of the body, but in particular to the vagina, urethra and anus,
which should all be cleansed night and morning. This practice is not
simply cleansing and refreshing, but it is preventive of many forms of
disease, such as piles, etc., etc., and

4. Always remember that the spread of this kind of knowledge has been made
possible by the long and patient efforts of hundreds of doctors, many of
them unknown and forgotten, and that women will best be able to apply this
knowledge efficiently by working in loyal co-operation with medical
practitioners who have made a special study of these matters.[H]

[Footnote H: The chief pioneers in teaching Birth-Control in England were
Mrs. Annie Besant, Mr. Charles Bradlaugh, and Dr. Drysdale, Senior.]


DIGEST OF BEST PREVENTIVE PRECAUTIONS.

_Before Connection._

1. Douche with warm water or weak antiseptic
lotion (warm).

2. Insert suitable suppository.

3. Place rubber pessary in position

_After Connection._

4. Douche.

5. Remove rubber pessary. (Urinate to facilitate
ejection of surplus fat.)

6. Douche and dry parts.

The use of rubber pessary does _not_ do away with desirability of
douching, but it does enable the woman to douche at her own convenience
with safety.


ANTISEPTIC LOTIONS.

Dr. K.R.D. Shaw, of 144, Harley Street, London, W.1, who has had a very
wide experience of "prevention" in different parts of the world during the
last twenty-five years, has named the following as suitable disinfecting
lotions:--

    Half a teaspoonful of Lysol in 5 pints of warm water;
_or_ One teaspoonful of Sanitas       "          "
_or_ One quarter teaspoonful of Bacterol         "
_or_ 2 grains of Sulphate of Copper   "          "

N.B.--Where there is grave danger of venereal infection, it is an
excellent additional precaution to douche first with soap and water, and
douche again with antiseptic lotion. The sooner this is done the better.

If all or most of these hygienic measures are widely made known to women,
it can rightly be claimed that women have been released from the twin
terrors of unwanted pregnancy and venereal infection, which are at the
present time ruining their marital health and happiness in so many cases.
Even if _some_ only of these measures are adopted, the nation as a whole
cannot fail to benefit mentally, morally and physically. The success of
the measures, of course, depends to some extent on their being taken _in
time_, but in this, as in many other directions, the old proverb holds
good: _Better late than never._



II.--PRACTICAL METHODS OF PREVENTION.--(_Contd._)

B. FOR MEN:


Marriage cannot be made safe, of course, so long as men are permitted to
contract venereal diseases, and spread them. Early marriage will greatly
lessen the chances of this; tolerated houses under _effective_ medical
supervision (such as we had in Paris during the War)[I] would enormously
lessen the chances of infection, even where marriage was delayed or
interrupted; prophylactic depots where disinfection was properly applied,
_and efficiently taught on request_, would be invaluable; but it is at
present from self-disinfection, properly understood and efficiently
applied, that the community can hope for the greatest and most immediate
gain in sexual cleanliness.[J] The following were the directions I gave
the Anzacs during the war, distributing these with prophylactics for men
and for women (the directions for women being printed in French and
English); this action was endorsed by all the leading British, American
and French military and medical authorities, from the Commanders-in-Chief
downwards, and the effort undoubtedly saved many thousands of men from
damage and ruin:--

     "AVOID INFECTION.

     "If you become infected with V.D., the fault is really your own.
     Either do not risk infection at all, or, risking infection, take
     proper precautions. These are quite simple. If you take the
     following precautions _without delay_ you are very very unlikely to
     contract disease:--

     1. Use vaseline or some other grease (such as calomel ointment)
     _beforehand_, to prevent direct contact with the source of
     infection.*

     (* Note: Any personal discomfort or unpleasantness grease causes is
     counteracted by the woman's having douched beforehand, as should
     always be done for the sake of cleanliness. A mere film of grease
     is sufficient to fill up pores of the skin, cover over abrasions,
     and prevent penetration of microbes, and it greatly facilitates
     subsequent cleansing.)

     2. Urinate _immediately_ after _each_ connection to wash away all
     infective material, and to prevent the invasion of the urethra by
     the microbes of V.D.

     3. Wash thoroughly with soap and water, because ordinary soap is
     destructive to germs--of syphilis and of gonorrhoea--and bathe
     parts with weak solution of pot. permang.

     You had far better carry a blue-light outfit with you as a "town
     dressing," in the same way as you would carry a "field dressing."
     If you cannot get an outfit, carry a tiny bottle of pot. permang.
     lotion and a scrap of cotton wool. If you swob yourself _carefully_
     with this, you will not become diseased. Remember always _it is
     delay that is dangerous_. If there has been delay, use a syringe
     sufficiently large for the contents to flood the urethra and
     slightly distend it, so that every nook and cranny is cleansed.

     Whatever you do, make certain of _going home clean_. Be sure of
     your health and doubly sure before you embark. While you are in the
     army and on this side of the world you can be cured easily and
     privately. If you go home infected, there will be embarrassment and
     expense to yourself and _great danger_ to the women and children
     you love.

     _Get cured NOW._" (Paris, April, 1919).[K]

[Footnote I: The following is taken from a paper read by Captain H.L.
Walker, Canadian Medical Service, O.C. Report Centre (British), Paris, at
Conference on V.D., organised by the American Red Cross in April, 1918:--

     "Speaking in regard to licensed houses, Captain Walker said that he
     _had not found one case of venereal disease_ contracted in a
     licensed house in the City of Paris, and he could only suppose that
     the people who were responsible for putting the licensed houses in
     Paris out of bounds knew nothing at all about the real facts of the
     case.... In the licensed houses in the City of Paris, during the
     year 1917, _only five cases of venereal disease_ were contracted;
     and in 1918, up to April 20th (the day he was speaking), _there had
     not been one case of venereal disease contracted in a licensed
     house in the City of Paris_. But out of 200 women arrested on the
     streets of Paris during the month of April, _over twenty-five per
     cent. were found to be infected with venereal disease_. In the
     months of November and December, 1917, the French authorities had
     made a round-up on one boulevard of seventy-one women, of whom
     _fifty-five were infected with venereal disease_; a few days later
     the French authorities repeated the same procedure on another
     boulevard; something like _one hundred women_ were arrested, _and
     ninety-one per cent. were infected with venereal disease_."--p.
     134, _Public Health_ (England), September, 1918.

I supervised a tolerated house in Paris for over twelve months
(1918-1919), and had no cases of disease either among the women or the
men. The women attended from 2 p.m. to midnight and resided in their own
homes.--E.A.R.]

[Footnote J: Among the first medical men in Great Britain to recognise the
importance and effectiveness of self-disinfection was Mr. Frank Kidd,
M.A., M.Ch. (Camb.), F.R.C.S. (Eng.), etc., of the London Hospital. A full
statement of his evidence before the Royal Commission on Venereal Diseases
is given in Mr. Kidd's book, "Common Diseases of the Male Urethra"
(published by Longmans, Green and Co., 39, Paternoster Row, London, etc.,
in 1917). The diagram of male organs of generation I have used on page 36
was taken in outline from Mr. Kidd's frontispiece, and during the war I
found all the illustrations he gave most helpful with the soldiers,
although the book itself was written for the purpose of enabling doctors
in outlying districts to treat patients on modern lines with success. Mr.
Kidd designed prophylactic tubes, which have been sold in England on his
order for more than fifteen years. He tells me they have been used all
over the world by his patients, and that as far as he can ascertain "_they
have never failed, when used properly and intelligently_."--E.A.R.]

[Footnote K: Since this was written, a large number of experiments have
been made with the single treatment tube, containing an ointment
destructive of all forms of venereal disease microbes, whether used before
or after connection. The Pennsylvania Department of Health is within
measurable distance of finding a solution of this problem--the production
of a cheap, portable, easily applied and thoroughly efficient
self-disinfecting ointment.--E.A.R.]

It was clearly proved that so long as men took these simple precautions
(which I always explained _personally_) they were very unlikely to
contract disease; most cases of disease came from multiple connections
with the women of the cafes, etc. It was difficult to impress on ordinary
men's minds the fact that _each and every connection was a danger_; that
the danger of infection began immediately there was any contact, and that
it continued until disinfection, and was renewed as well with each fresh
connection during the night. If the danger had continued for several hours
in this way, the men were told to go to the medical depot or report to a
doctor as soon as possible. When they did so they were saved from disease
in the vast majority of cases, even up to twenty-four hours afterwards or
a little longer.[L]

[Footnote L: In 1915-1916 Colonel Sir James Barrett, then A.D.M.S. of the
Australian Force in Egypt, had successfully applied prophylaxis, but
unfortunately he was invalided for a time to England in November, 1916,
and with the evacuation of the Dardanelles there was a severe outbreak of
v.d. in Egypt. Prophylaxis was then steadily applied during 1917 by
Colonel Sir James Barrett and others, and at the end of 1917 v.d. had been
reduced to small proportions. In December, 1917, Colonel P.G. Elgood, Base
Commandant of Port Said, wrote:--

"Fortunately, however, at this stage, I came into contact with Colonel Sir
James Barrett, K.B.E., R.A.M.C, and Miss E. Rout, New Zealand Volunteer
Sisterhood. The first suggested that the solution of the problem would not
be found in police measures or in medical examination, but in prophylaxis;
while the second, in correspondence relating to her own experiences gained
in England, encouraged me to advocate this remedy."

The successful results of the Port Said efforts are quoted in full by
Colonel Sir James Barrett in his book, "A Vision of the Possible" (Lewis),
and Colonel Barrett had early in 1917 sent me to London the following
tremendously valuable letter of advice and warning:--

     "I suppose my instinct is rather more in the moral direction than
     many people, but I recognise, as you will see from these articles
     (published by _Lancet_), that it is by direct prophylaxis, and
     direct prophylaxis alone that we are likely to get rid of this
     abomination. I should never in any campaign exclude all the
     additional aids--proper soldiers' clubs, such as I have established
     in Egypt, the influence of decent women, and the one hundred and
     one factors that go to make a decent and reputable life; but you
     have, in the long run, to recognise the fact that a percentage of
     men are certain to seek women who are prepared to cater for them.
     If the steps indicated are taken, the proof is absolute that the
     disease can be practically extirpated and without great difficulty.
     The failure of prophylaxis depends on two factors--firstly, it
     requires someone charged with responsibility, earnestness and high
     character to explain to men precisely what they are doing and what
     it means; and secondly, prophylaxis is of very little use to
     drunken men. My experience has been that when these precautions are
     properly used venereal disease may disappear."

That proved to be exactly my own experience in the army. Failures in the
army were due to the absence of proper personal instruction of the men and
the laxity of control, and these conditions can always be assumed to exist
in any army having a high v.d. infection rate.--E.A.R.]

Nevertheless, the people who would put sacerdotalism before science, and
the still meaner minds who would substitute legality for morality, raised
storms of objection to my work, in the midst of which came a few strong,
clear calls of understanding and encouragement.

One Scotch padre wrote me in 1918:--

     "It is a magnificent adventure for a woman to go practically alone
     on the very edge of things, and I salute you, and congratulate you,
     and wish you _God-speed_."

An old family doctor, then with a colonial ambulance, wrote:--

     "Many women ... will owe their health and happiness to you, and not
     a few will be indebted to you for their lives."

The editor of the Sydney _Bulletin_ (Australia) was continually publishing
helpful articles and paragraphs--after my letters and articles were
censored;[M] and from Dr. W.H. Symes, of Christchurch, New Zealand, I
heard by personal correspondence steadily and wisely all through the war.
Much later came the following tribute, in a most valuable book written by
Sir Archdall Reid and Sir Bryan Donkin ("Prevention of Venereal Disease,"
published by William Heinemann (Medical Books) Limited)[N]:--

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

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

[Footnote N: See Publishers' notice.]


ALCOHOLISM.

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

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

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



III.--MEDICAL FORMULÆ.


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

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

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

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

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

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

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

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

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

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

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

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

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

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



IV.--COMPULSORY TREATMENT.


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

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

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

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

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

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



V. CONCLUSION.


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

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

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

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

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

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

  _Tennyson._



NOTE.

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



APPENDIX I.

OTHER METHODS OF CONTRACEPTION.


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

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

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

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

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

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

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

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

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

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



APPENDIX II.

MEDICAL SUPPLIES.


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

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

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

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

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

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



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


_This book is endorsed by the Society for the Prevention of Venereal
Disease and contains the evidence and arguments on which the Society bases
its policy, and is addressed to all who would prevent venereal diseases in
themselves or in the community._


Children may be taught any system of morals--sexual or other; Christian,
Mahomedan, Hindoo, Papuan, or other. They are intensely imitative and
acquire a bias towards local ideas of right and wrong through association
with intimate companions. A bias once acquired tends to persist. For that
reason parents choose good companions and schools. On the other hand, it
is difficult or impossible to convert "hardened sinners," for example,
adult non-Christians. Children, therefore, may be really taught; adults,
as a rule, can only be preached at. Any man may test the truth of all this
by examining his own consciousness. Would any amount of preaching cause
him to change his present ideas of right and wrong? As little can he alter
the bias of other men. As the twig is bent so the tree grows.

In various times and places, almost everything from promiscuous sexual
intercourse to absolute abstinence from all intercourse has been held
holy, or permissible, or damnable. Even among Christians the widest
differences have prevailed as regards the local and contemporary tone.
Among them, especially among the English speaking peoples, a convention
forbids the familiar discussion of sexual matters between children and
adults. This convention may be right or wrong. In any case it exists, and
is likely to persist for ages. But a knowledge of sex is traditional among
boys, and to some extent among girls of the school age. For good or evil,
therefore, children are the real teachers of sexual morals in England.
Children deal with the impressionable age and give the early bias. Adults
stand aside, and teach only extreme reticence. The discussions of boys are
often obscene. As a consequence vast numbers grow up with the idea that
unchastity is a gallant adventure, or, at worst, only a peccadillo. Even
in old age such men look back to past intrigues with satisfaction. After
marriage another tradition, or bias, also taught by English boys, comes
into action--the tradition to keep the plighted word, to "play the game."
The great majority of married Englishmen, therefore, are chaste.

Judging from history, the world, and in particular England, is not
more--or less--immoral to-day than at any time during the last 2000 years.
During all that time children have taught and adults have preached.
Doubtless there have been many campaigns of purity in the past--mere
campaigns of preaching to adults. They were ineffectual and are forgotten.
Epochs of licence have almost invariably followed epochs of austerity.
Modern campaigns of purity never arise except as consequents on medical
attempts to prevent venereal disease, and always cease when the attempt to
procure sanitation has ceased. In effect, they have been merely campaigns
to secure the poisoning of sinners and their victims.

The extent of current immorality may be judged from the prevalence of
venereal disease. The Royal Commission of 1913-16 found that ten per cent.
of the urban population suffered from syphilis. Eighty per cent. of the
population of the United Kingdom is now urban, and gonorrhoea is six or
seven times as prevalent as syphilis. It follows that at least every other
person in the Kingdom has suffered from venereal disease. Probably not a
family has escaped infection. In proportion to its prevalence syphilis is
not very deadly, yet it has been reckoned as the fourth killing disease.
The victims of gonorrhoea are incalculable. Venereal diseases fill our
hospitals, asylums, and workhouses. They are the principal causes of heart
disease, apoplexy, paralysis, insanity, blindness in children, and of that
life of sterility and pain to which so many women are condemned. It is
said that chastity is the only real safeguard against venereal disease.
But this is always said by people who have never stirred a finger to teach
chastity, but who have only preached it. At any time there are at least a
million of perfectly innocent sufferers, principally women and children,
in the United Kingdom.

During the war a disloyal faction in every Dominion endeavoured to prevent
the sending of help to the Mother Country. A principal cry of this faction
was, "Do not let us send our clean lads to that cesspool, England."
England is more than the world-cesspool. Since Englishmen are the greatest
travellers, she has been the principal source of infection for the world.
At one time during the war the Australasian Governments threatened to
withdraw their forces unless measures were taken to protect them.

When the German offensive was impending a sanitary method was published,
so effective that the venereal rate was reduced from 92 to 15 per thousand
per annum. The Government proposed to bring the method into general use in
the Army, but was prevented by influences which preferred to see the
country poisoned and the British Army defeated. While the opponents of
sanitation sat snugly at home hundreds of thousands of British soldiers
were killed or maimed, enormous material was lost with territory which
other hundreds of thousands of brave men had died to win, the war was
prolonged, thousands of millions were added to the National Debt, and half
trained boys and elderly fathers of families were hurried into the firing
line. At that time there were in hospitals or in depots, convalescent from
venereal disease, enough fully-trained allied soldiers to furnish, not an
army corps but a great army, complete almost from G.O.C. to trumpeter.

Fear of disease does not prevent immorality, as may be judged from the
immense prevalence of venereal disorders. But it does drive baser
characters to the pursuit and seduction of "decent" girls. In this way
nearly all prostitutes begin their careers. Prostitutes are much more
diseased than other women, who, though often diseased, are seldom
suspected of disease. Yet, since it has been found statistically that
three out of four men acquire their maladies from amateurs, it is manifest
that prostitutes only hang on the fringe of a vaster immorality. Men, who
know more of these diseases than women, are, on the average, much less
chaste. Medical students who know most are not more moral than other men.
Plainly venereal diseases are causes, not preventives, of immorality.
Nothing, therefore, is gained from their prevalence except a flood of
death, disability, and misery, which falls alike on the just and unjust.

During the war Sir Archdall Reid, employing very simple means, reduced the
incidence of disease among the large body of troops in his charge almost
to the vanishing point. He could not make them more moral, he did not make
them less moral, but at any rate he preserved their services for the
country in its hour of need. And he preserved their future wives and
children from unmerited death and suffering. Other doctors were equally
successful. The town authorities of Portsmouth and many other boroughs are
about to employ these methods for the prevention of disease among the
civil population. This book describes them and tells the story of the
fight against a wicked and cruel fanaticism. Its policy is endorsed by
many of the leading men and women in the Kingdom--members of both Houses
of Parliament, town authorities, doctors, authors, sociologists and
others.

     +--------------------------------------------------------------+
     |                PREVENTION OF VENEREAL DISEASE                |
     |   By Sir ARCHDALL REID, K.B.E., M.B. With an Introduction    |
     |                  by Sir BRYAN DONKIN, M.D.                   |
     |                     Crown 8vo, 15s. net.                     |
     |                                                              |
     |                    SEX-PROBLEMS IN WOMEN                     |
     |         By A.C. MAGIAN, M.D. Demy 8vo, 12s. 6d. net.         |
     |                                                              |
     |                     THE SEXUAL QUESTION                      |
     |    A Scientific, Psychological and Sociological Study. By    |
     |            Dr. AUGUST FOREL. Royal 8vo, 25s. net.            |
     |                                                              |
     |                 THE SEXUAL LIFE OF OUR TIME                  |
     |    In its Relation to Modern Civilization. By IWAN BLOCH,    |
     |                  M.D. Medium 8vo, 25s. net.                  |
     |       Sold only to the Medical and Legal Professions.        |
     |                                                              |
     |                   THE SEXUAL LIFE OF WOMAN                   |
     |     A Physiological, Pathological and Hygienic Study. By     |
     |       Professor HEINRICH KISCH. Super royal, 25s. net.       |
     |       Sold only to the Medical and Legal Professions.        |
     |                                                              |
     |                    PSYCHOPATHIA SEXUALIS                     |
     |   With special reference to Antipathic Sexual Instinct. A    |
     |     Medico-forensic study by the late Dr. R. VON KRAFFT      |
     |                 EBING. Royal 8vo, 25s. net.                  |
     |       Sold only to the Medical and Legal Professions.        |
     |                                                              |
     |                                                              |
     |           WILLIAM HEINEMANN (Medical Books) Ltd.,            |
     |             20, BEDFORD STREET, LONDON, W.C.2.               |
     +--------------------------------------------------------------+


PRINTED IN GREAT BRITAIN BY
WOODS AND SONS, LTD., LONDON, N.1.





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