Tag: abortion

  • Maternal infections in health facilities

    Maternal infections in health facilities

    A clearer picture of the global impact 

    New research from the Global Maternal Sepsis Study (GLOSS), a major WHO/HRP initiative, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.

    Logo of the Lancet Global HealthThe
    results from GLOSS, published in The Lancet Global Health, are the first to provide data on frequency of maternal infections and
    sepsis across the pregnancy and post-pregnancy period, in a large number of health facilities around the world. 

    Around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalization. 

    Urgent improvement is needed to manage this life-threatening risk faced by all pregnant and recently pregnant women, wherever they are in the world. 

    What is maternal sepsis and how does it lead to maternal death?

    Maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, child-birth, post-abortion or the postpartum period.

    The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, this only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.

    Few
    previous studies include post-abortion infections. Neither do they address indirect infections such as respiratory and meningitis, which are aggravated by pregnancy but not directly caused by it.

    A better understanding of maternal infection

    GLOSS was a massive facility-based data collection effort led by WHO, accompanied by a ‘STOP SEPSIS!’ campaign to increase awareness among healthcare providers.

    The study gathered data on women who were admitted with suspected or confirmed infection during pregnancy or post-pregnancy over a one-week period in 2017. More than 2800 women participated in the study in 52 countries.

    GLOSS included healthcare facilities that care for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but where women could be hospitalized during or after pregnancy, and data on infections
    which are not usually recorded as maternal sepsis, including post-abortion and indirect infections. 

    The result is a more complete understanding of the frequency and impact of maternal infections in health facilities. 

    GLOSS calls attention not only to the wider range of risks faced by pregnant women but also to the long period of time during which they are at risk. 

    Putting global numbers on maternal infection and sepsis

    Overall, around 70 pregnant or recently-pregnant women per 1000 live births were found to have a maternal infection needing hospital management. 

    Across the study, 11 women with either direct or indirect infection per 1000 live births developed a severe maternal outcome, but in low- and middle-income countries up to 15 women per 1000 births were affected.

    Infections were the underlying cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infections. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
    haemorrhage.

    This suggests that the contribution of infection to global maternal mortality and morbidity may be larger than current reports of maternal sepsis mortality suggest.

    Preventing, identifying and treating maternal infection and sepsis

    Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean and post-abortion infections, are largely preventable and treatable.

    GLOSS results suggest that current levels of monitoring and clinical care across health facilities are not enough to prevent, identify and treat levels of maternal infection effectively. 

    For instance, a complete set of vital signs was not reported for a third of the women in the study, on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were frequent.

    GLOSS also shows marked differences across countries, with the highest burden in low- and middle-income countries, compared with high-income countries.

    This may reflect the impact of broader health determinants in different country contexts. Challenges of overcrowding, limited access to water and sanitation and constraints to safe births by skilled birth attendants can reduce the ability of healthcare
    providers to manage the frequency and outcome of maternal infections.

    An opportunity to implement evidence-based practice

    GLOSS gives healthcare providers, policy-makers, and the public at large an opportunity: to mobilise around these data improve evidence-based practice, and save lives. 

    WHO has produced a number of resources which can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as the upcoming SAVE LIVES: Clean Your Hands campaign
    on 5 May which celebrates the central role played by nurses and midwives in clean health care. 

    In addition, WHO will publish a global sepsis epidemiology report around the 73rd World Health Assembly (WHA) in May, as requested in the
    2017
    WHA Resolution on Improving the prevention, diagnosis and clinical managementof sepsis.

    Understanding why and how infection affects women is essential for equipping healthcare providers with life-saving knowledge and enabling health care systems to bring down global maternal mortality and morbidity.

    Related publications

    WHO recommendations for prevention and treatment of maternal peripartum infections

    WHO Clinical practice handbook for safe abortion

    Global guidelines on the prevention of surgical site infection

    WHO statement on maternal sepsis

    World Health Assembly resolution on Improving the prevention, diagnosis and clinical management of sepsis

    Health Topics

    Antimicrobial resistance

    Infection Prevention and Control

    Water Sanitation Hygiene

    Other links

    Global Maternal Sepsis Study

    SAVE LIVES: Clean Your Hands 5 May 2020

     

     

    Maternal infections in health facilities
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    https://www.who.int/news-room/detail/27-04-2020-maternal-infections-in-health-facilities

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  • THE ARGUMENT FOR BIRTH CONTROL

    THE ARGUMENT FOR BIRTH CONTROL

    Let us now consider the general and special arguments advanced in favor of rational and scientific Birth Control, as stated by the advocates thereof.

    General Argument. The general argument in favor of Birth Control may well be begun by the statement that rational and scientific Birth Control is not the fixing upon the race of a new and unfamiliar practice or policy, but is rather the scientific correction of a practice and policy which is now followed by the majority of married persons in civilized countries, though in a bungling, unscientific, and frequently a harmful manner. The modern advocates of scientific methods of Birth Control seek to replace these bungling, unscientific, and frequently harmful methods by sane, scientific, harmless methods, approved of by capable physicians and other experienced and capable authorities, and under the sanction of the law rather than contrary to it.

    The advocates of Birth Control seek to place upon a scientific basis, under cover and protection of the law, a subject which heretofore has been but imperfectly known, and more imperfectly practiced in some form by the majority of married couples, and which has heretofore been under condemnation of the law so far as concerned the actual dissemination of information concerning methods of contraception. They hold that it is the veriest hypocrisy to pretend ignorance of the fact that the great majority of married couples in civilized communities know and practice to some extent contraceptive methods—usually imperfectly and bunglingly, it must be added.

    One has but to consider the families of married couples, and to count their children, to become aware that at least some form of contraception has been known and practiced in many cases. This is particularly true of the more intelligent and cultured members of civilized society, among whom we find large families of children to be the exception, and small families to be the general rule. Among the less intelligent and uncultured classes the reverse of this condition is found.

    It is hypocritical folly to assert that these small families to be found among the more intelligent classes of society are due to the fact that the husbands and wives are physically incapable of procreating off-spring—the mere suggestion produces an incredulous smile from the reader. No one who is acquainted with the habits and customs of married people would in good faith offer such an explanation. Rather is it tacitly acknowledged by all thinking persons that such married couples practice some form of Birth Control, or else commit the crime of abortion. All physicians, particularly those who practice in the large cities, are fully informed as to the appalling facts concerning the prevalence of abortion among the women of the “respectable” classes, and are likewise fully informed as to the terrible consequences so frequently arising from this criminal course.

    The question, then, to many intelligent persons is not so much that of “Should contraception be employed in order to avoid excessively large families?” as that of “Should not contraception be employed to obviate the crime of abortion with its terrible train of consequences?” And the Birth Control propaganda which is so vigorously underway in all civilized countries may be stated to be designed for the following purposes: (1) to replace abortion, and other harmful methods of restricting the size of families, with rational and scientific methods of contraception; and (2) to supply to married persons the best scientific knowledge concerning the regulation of the size of families, and the methods of producing the best kind of children, under the best conditions, and at the times best adapted for their proper care and well-being. These advocates of the Betterment of the Race face the facts of human nature and married life fearlessly, instead of trying to cover them over with pretty words and sentimental generalities. They take “things as they are,” and not as certain persons insist that “they should be”—they live in a world of facts and try to better things as they find them, instead of trying to live in a fool’s paradise and contenting themselves with denying the existence of the facts which they consider “ugly.”

    Dr. William J. Robinson, one of the leading American workers in the field of Birth Control, ably presents the main contention of the Birth Control advocates as follows:

    “We believe that under any conditions, and particularly under our present economic conditions, human beings should be able to control the number of our offspring.They should be able to decide how many children they want to have, and when they want to have them. And to accomplish this result we demand that the knowledge of controlling the number of offspring, in other and plainer words, the knowledge of preventing undesirable conception, should not be considered criminal knowledge, that its dissemination should not be considered a criminal offense punishable by hard labor in Federal prisons, but that it should be considered knowledge useful and necessary to the welfare of the race and of the individual; and that its dissemination should be permissible and as respectable as is the dissemination of any hygienic, sanitary or eugenic knowledge.

    “There is no element of force in our teachings; that is, we would not force any family to limit the number of children against their will, though we would endeavor to create a public opinion which would consider it a disgrace for any family to have more children than they can bring up and educate properly. We would consider it a disgrace, an anti-social act, for any family to bring children into the world which they must send out at an early age into the mills, shops, and streets to earn a living, or must fall back upon public charity to save them from starvation.

    “Public opinion is stronger than any laws, and in time people would be as much ashamed of having children whom they could not bring up properly in every sense of the word, as they are now ashamed of having their children turn out criminals. Now, no disgrace can attach to any poor family, no matter how many children they have, because they have not got the knowledge, because society prevents them from having the knowledge of how to limit the number of children. But if that knowledge became easily accessible, and people still refused to avail themselves of it, then they would properly be considered as anti-social, as criminal members of society. As far as couples are concerned who are well-to-do, who love children, and who are well capable of taking care of a large number, we, that is, we American limitationists, would put no limit. On the contrary, we would say: ‘God bless you, have as many children as you want to; there is plenty of room yet for all of you.’”

    Another writer, a celebrated English thinker along these lines, has said of the general argument in favor of Birth Control:

    “It used to be thought that small families were immoral. We now begin to see that it was the large families of old which were immoral. The excessive birth-rate of the early industrial period was directly stimulated by selfishness. There were no laws against child-labor; children were produced that they might be sent out, when little more than babies, to the factories and the mines to increase their parents’ incomes. The diminished birth-rate has accomplished higher moral transformation. It has introduced a finer economy into life, diminished death, disease, and misery. It is indirectly, and even directly, improving the quality of the race. The very fact that children are born at longer intervals is not only beneficial to the mother’s health, and therefore to the children’s general welfare, but it has been proved to have a marked and prolonged influence on the physical development of children.

    “Social progress, and a higher civilization, we thus see, involve a reduced birth-rate and a reduced death-rate. The fewer the children born, the fewer the risks of death, disease, and misery to the children that are born. The fact that civilization involves small families is clearly shown by the tendency of the educated and upper social classes to have small families. As the proletariat class becomes educated and elevated, disciplined to refinement and to foresight—as it were aristocratised—it also has small families. Civilizational progress is here on a line with biological progress. The lower organisms spawn their progeny in thousands, the higher mammals produce but one or two at a time. The higher the race, the fewer the offspring.

    “Thus diminution in quantity is throughout associated with augmentation in quality. Quality rather than quantity is the racial ideal now set before us, and it is an ideal which, as we are beginning to learn, it is possible to cultivate, both individually and socially. That is why the new science of eugenics or racial hygiene is acquiring so immense an importance. In the past, racial selection has been carried out crudely by the destructive, wasteful, and expensive method of elimination, through death. In the future, it will be carried out far more effectively by conscious and deliberate selection, exercised not merely before birth, but before conception and even before mating. Galton, who recognized the futility of mere legislation to elevate the race, believed that the hope of the future lay in eugenics becoming a part of religion. The good of the race lies, not in the production of a super-man, but of a super-humanity. This can only be attained through personal individual development, the increase of knowledge, the sense of responsibility toward the race, enabling men to act in accordance with responsibility. The leadership in civilization belongs not to the nation with the highest birth-rate, but to the nation which has thus learnt to produce the finest men and women.”

    Let us now proceed to a consideration of the special arguments in favor of rational and scientific Birth Control as advanced by its leading advocates.

    The advocates of rational and scientific Birth Control have presented the strongest points of their case in their replies to those opposing the general idea, and without positively taking the stand that the burden of the proof in the argument concerning Birth Control rested upon those opposing the idea, have practically assumed that position. They claim that the right to Birth Control is so self-evident, and its application so generally recognized (though usually sought to be smothered with silence) that the case in favor of Birth Control is really quite apparent to anyone seriously considering the same without prejudice. The opposing side of the question is held by them to be represented principally by statements based on prejudice and disingenuous statements, which are capable of being turned against those advancing them.

    And, the present writer, likewise is of the opinion that the strongest possible case for Birth Control is presented in the answer to the arguments advanced by the opponents thereof. But, before proceeding to the latter phase of the argument, it may be well to examine briefly the several leading points of argument advanced by the advocates of rational and scientific Birth Control, in order to clear the way for the answers to the opposite side of the question. The reader is, therefore, invited to consider the said points, briefly presented in the following paragraphs:

    Birth Control Encourages Marriage. The advocates of Birth Control hold that a scientific knowledge of contraception would speedily result in a large increase of marriages, particularly among persons of limited incomes. Persons who have not been able to accumulate the “little nest egg” which prudent persons consider a requisite on the part of those contemplating marriage and the responsibilities of rearing a family of children, are in many cases caused to hesitate about contracting marriage, and often relinquish the idea altogether. Many of these persons are well adapted for marriage, being of the domestic temperament and having the home ideal prominent in their mental makeup.

    The increasing number of bachelors and unmarried women past thirty years of age, who are in evidence in all large centers of population at the present time, is undoubtedly due to a great extent to the fear on the part of these men and women regarding the proper support of a family of children. Many men and women feel that the man is able to earn enough to support himself and wife comfortably, by the exercise of economy, but that the said earnings are not sufficient to provide properly for a family of children. Some would be willing to have one or two children, born after the couple have well established themselves, but are appalled at the thought of bringing into the world a practically unlimited number of little children for whom they would not be able to provide properly.

    These people shrink at the idea of abortion, and doubt the efficacy of the popular so-called contraceptive methods of which their friends tell them, and they either defer the marriage until later in life, or else give up the idea altogether as being impossible for them under the existing circumstances. A scientific knowledge of the subject would give to such persons—and there are many thousands of such—an assurance of their ability to safely and properly control and regulate the size of their families, and would lead to many a marriage which would otherwise be out of the question.

    If it is agreed that the marriage state is the one normal to the average man and woman, and that marriages are in the interests of society—and few would seek to dispute this—then it would seem that anything that would tend to encourage marriage among the right kind of persons should receive the encouragement of society and be fully protected by the laws of society; and that the old prejudice against the subject, and the laws which discourage the same, and place a penalty upon the dissemination of scientific methods leading to the said result, are unworthy of civilized society and modern thought.

    Earlier Marriages and Curb on Prostitution. It is generally conceded by students of sociology that earlier marriages tend to decrease the causes of the evil of prostitution, illicit sexual relations, and general sexual morality; and the consequent spread and existence of the venereal diseases which have followed in the trail of such relations. And it is likewise conceded that prostitution is an evil, and a cancer spot upon modern social life, and that venereal diseases constitute a frightful menace to the health and physical welfare of the race. Therefore, it would seem that anything which would promote early marriages among healthy, intelligent young men and women would be a blessing to the race and to society. And as these earlier marriages are unquestionably prevented in a great number of cases by reasons of the fear of inadequate financial support for large families of children, it would seem to follow that the best interests of society would be served by the encouragement by public opinion, under the protection of the law, of the teaching by competent authorities upon the subject of rational and scientific methods of Birth Control.

    Health of Wives. The advocates of Birth Control lay considerable stress upon the fact that a scientific knowledge of Birth Control would practically obviate the state of broken-down health so common among married women, particularly among those who have been compelled to bear large numbers of children during the first few years of married life. Many a young married woman is in bad health—often reaching the state of chronic invalidism—as the result of having had to bear too many children, and in too close succession.

    Not only is the above the case, but there is to be found on all sides many cases of invalidism and shattered health caused by the horrible practice of criminal abortion. It is doubted whether anyone outside of medical circles can even faintly begin to realize the frequency of this practice of abortion among the well-to-do, and those in “comfortable circumstances”—not to speak of the countless deaths which arise from the prevalence of this curse. Were a physician to even faintly indicate the number of cases coming under his personal professional attention, in which the patient is suffering from the effects of one or more abortions, he would be accused of gross exaggeration, and would be condemned as a sensationalist.

    Without going into detail concerning these things, the writer states that it is a matter of common knowledge among physicians that in every large city there are thousands of unscrupulous (including those who call themselves physicians) who are kept busy every week in the year performing criminal operations designed to produce abortions. Some of these practitioners have many regular patients—women who visit them regularly for the purpose of having abortions produced by criminal operations. It seems almost incredible, but it is a veritable fact, that there are to be found many women in the large cities who actually boast to their friends of the number of operations of this kind they have had performed on them.

    Surely, any instruction which would prevent the physical breakdown of so many women by reason of excessive child-bearing on the one hand, and abortion on the other hand, would seem to be worthy of the hearty support of society, and the encouragement of its laws, rather than the reverse. So true does this seem, that it is difficult to realize that there are any intelligent persons who would condemn such instruction as evil and harmful to society. That such persons do exist is a striking proof of the persistence of ancient superstitions and the survival and tenacity of old prejudices.

    Morality of Married Men. It is a matter of common knowledge among physicians, and students of sociology, that many married men, particularly those living in the large cities, indulge in extra-marital or illicit sexual relations, with prostitutes and other women of loose morals, and this not because these men are naturally vicious, depraved or licentious, but rather because they fear causing their wives to bear them more children—the wives either being in delicate or broken-down health, or else the family already too large to be reared properly in justice to the children.

    Many persons who would see only what “ought to be,” and who refuse to see “things as they are” in modern society, will be disposed to pooh-pooh the above statement, and to accuse those making it to be sensational or even morbid on the subject. But those who are brought in close contact with men and women, as are family physicians and specialists, as well as honest students of sociology, know only too well that the above is not an over-statement, but is rather a very conservative recital of certain unpleasant, but true, facts of human society.

    Justice to the Children. The advocates of scientific Birth Control hold that a scientific knowledge along the lines favored by them would prevent the gross injustice to children which is now only too obvious to anyone who candidly considers the matter without prejudice. The child brought into the world, unwanted, undesired, unprepared for, and unprovided for before and after birth, is handicapped from the very start of its existence upon earth. The present state of affairs works a terrible injustice upon countless children brought into the world in such conditions. Nothing that the present writer could put into words would state this fact more concisely and clearly than the following statement made by Dr. Wm. J. Robinson, a leading authority along these lines, who has said:

    “The responsibility of bringing a child into the world under our present social and economic conditions is a very great one. The primitive savage or the coarse ignorant man does not care. It does not bother him what becomes of his offspring; if they get an education, if they have enough to eat, if they learn a trade or a profession, well—if they don’t, also well; if they achieve a competence or a decent social position, he is satisfied—if not, he can’t help it. God willed it so. But, on the other hand, the cultured, refined man and woman look at the matter differently. The thought of bringing into the world a human being which may be physically handicapped, which may be mentally inferior, which may have a hard struggle through life, which may have to go through endless misery and suffering, fills them with anguish. * * * * *

    “We see about us millions of working men and women who go through life, from cradle to grave, without a ray of joy, without anything that makes life worth living. In the higher classes we see a constant, hard, infuriated struggle to make a living, to make a career, and the spectre of poverty is almost as unremittingly before the eyes of the middle and professional classes as it is before the eyes of the laborer. And all over we see ignorance, superstition, beliefs bordering on insanity, hardness, coarseness, rowdyism, brutality, crime and prostitution; prostitution of the body, and what is worse, prostitution of the mind, the hiding or selling of one’s convictions for a mess of pottage. And our prisons, asylums, and hospitals are not decreasing, but increasing in number and inmates.

    “It is my sincerest and deepest conviction that we could accomplish incomparably more if only a small part of the energy and money now spent on philanthropic efforts were expended in teaching the women, the married women of the poor, how to limit the number of their children; in other words, how to prevent conception. It would work a wonderful reform in the lives of the poor, and our slums would be metamorphosed in ten years. * * * It is we who are to blame now for the large families of the poor, and for this reason we are morally obligated to give them the financial and medical aid that they demand. But when effectual means are put into their hands for limiting the number of their offspring, then they, and not we, will be to blame if they do not make use of them. * * * *

    “The rich and the upper-middle classes, those to whom several children would be the least burden, are quite familiar with the various means of prevention. The poorer middle classes use preventives recommended by their friends; these preventives sometimes succeed, sometimes fail, and sometimes ruin the woman’s health. While the very poor, the wage-earners, those who can least afford to have unlimited progeny, knowing no means of prevention, go on breeding to their own and to the community’s detriment. The result, as you can plainly see, is a general lowering of the physical and mental stamina of the race. For if the cultured and the well-to-do do not breed, or have only a few children, while the poor and the ignorant go on having a numerous progeny for which they cannot well provide, and which they cannot afford to educate properly, it stands to reason that the percentage of the uneducated, the unfit and the criminal, must go on constantly increasing. And this is something that no lover of humanity can look upon with equanimity.”

    Surely the above recited special points of argument in favor of Birth Control seem to be statements of self-evident facts to the unprejudiced mind, do they not? And the person of this kind who considers them carefully for the first time usually finds himself wondering what rational argument can be fairly urged on the other side of this important question. And, when he acquaints himself with the arguments of “the other side” he usually finds himself even more established in the belief that scientific Birth Control is advisable, sane, and along the lines of the mental evolution of the race. At any rate, it is difficult to escape the conviction that the burden of proof needed to controvert a proposition so nearly self-evident as intelligent and scientific Birth Control, must be placed squarely upon the shoulders of those opposing the proposition.

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • WHAT BIRTH CONTROL IS, AND IS NOT

    WHAT BIRTH CONTROL IS, AND IS NOT

    The student of the progress of human affairs, or even the average person whose knowledge of the doings of mankind is derived from a hasty and casual reading of the daily newspapers and the popular magazines, cannot plead ignorance of the growing interest in the general subject which is embraced within the content of the term “Birth Control.”

    But while the general meaning of the term is at least vaguely grasped by the average member of the human crowd—the individual to whom we refer as “the man on the street”—we find a startling condition of mental confusion and often positive misconception concerning the essence and spirit of the general idea expressed by the term in question.

    While the fact is a reflection upon the average intelligence of the general public, it must be admitted that to the average person, or “the man on the street,” Birth Control means simply the teaching and practice of certain methods whereby men and women may indulge their sexual appetites, in or out of marriage, without incurring the liability or risk of conception and child-bearing. The average person does not stop to consider that such teachings and practices do not constitute “Birth Control” at all, but are, rather, merely the theory and practice of Birth Prevention, desirable only to those who seek sexual indulgences without being called upon to shoulder the responsibilities attached by Nature to the physical sexual union of men and women.

    The term “control” does not mean “prohibition,” or “prevention”; but, on the contrary, means “governing, regulating, or managing influence.” Birth Control, in the true meaning of the term, does not mean the prevention or prohibition of the birth of children, but rather the encouragement of the birth of children under the best possible conditions and the discouragement of the birth of children under improper or unfavorable conditions.

    Birth Control, in the true meaning of the term, does not mean theories and practices which would tend to reduce the population of the civilized countries of the world, but rather theories and practice which would inevitably result in the production of an adequate ratio of increase in the population of such countries, not only by reason of a normal birth-rate, but also by reason of a diminishing death-rate among infants—by the production of healthier children, accompanied by the raising of the standard of the average child born in such countries.

    Birth Control, in the true meaning of the term, therefore, is seen to consist not of the prohibition or prevention of human offspring, but rather of the governing, regulating, and managing of the production of human offspring, under the inspiration of the highest ideals and under the direction of the highest reason, for the purpose of the advancement and welfare of the race and that of the individuals composing the race. Instead of being an anti-social and anti-moral propaganda, Birth Control when rightly understood is perceived to be in accordance with the highest social aims and aspirations, and in accordance with the highest and purest morality of the race.

    Much of the opposition toward the general movement of Birth Control which has been manifested by many well-meaning, though misinformed, persons, has arisen by reason of the erroneous conception and understanding of the term itself, and of misleading information concerning the true nature of the best teachings on the subject. This prejudice has been heightened by certain zealous but ill-balanced advocates of the general movement who have overemphasized the incidental feature of the limitation of offspring under certain conditions, and who have appealed to the attention and interest merely of those who wished to escape the responsibilities of parenthood. This has caused much sorrow and distress to the many persons who have the highest ideals and results in view, and who deplore this unbalanced propaganda under the name, and apparently under the cloak of the general movement. Such persons have felt inclined to cry aloud “Good Lord, deliver us from our so-called friends!”

    One of the most distressing features of the popular prejudice against Birth Control, arising from a total misconception of the subject, has been the widely spread and popularly accepted notion that Birth Control is practically analogous to abortion—or, at the best, but a more refined and less repulsive and less dangerous form of abortion. In view of the fact that one of the important results sought to be obtained by a scientific knowledge of Birth Control actually is the prevention and avoidance of the crime of abortion which has wrought such terrible havoc among the women of civilized countries, it is most distressing and discouraging to the conscientious and high-minded advocates of Birth Control to have it said and believed that their teachings encourage and justify abortion.

    A reference to any standard dictionary or textbook will reveal the fact that “Abortion” means: “the premature expulsion of the human embryo or foetus; miscarriage voluntarily induced or produced,” etc. It is seen at a glance that the essence and meaning of abortion consists in the destruction of the human embryo which has resulted from conception. The embryo human child must already exist in its elemental form, before it can be destroyed by abortion. Therefore, if no such embryo form exists, it cannot be destroyed, and therefore there can be no abortion in such a case. And, it may positively be stated, no true advocate of Birth Control can possibly justify, much less advocate, the destruction of the human embryo or foetus, which act constitutes abortion. The difference between true Birth Control teachings and methods, and that of the advocates of abortion, is as great as the difference between the two poles. Instead of the two being identical or similar, they are diametrically opposed one to the other—they are logical “opposites,” each the antithesis of the other.

    Even in those forms or phases of the Birth Control propaganda in which the use of “contraceptives,” or “preventatives” is considered justified in certain cases—and these forms and phases are far from being the most important, as all students of the subject know—even in these exceptional forms and phases of the general subject the idea of abortion is combatted, and never justified or encouraged. A “contraceptive” agency merely tends to prevent or obviate undesirable conception; it never acts to destroy the result of previous and accomplished conception. A “contraceptive” merely prevents the union of the male and female elements of reproduction, and consequently the process from which evolves the foetus or embryo. A leading medical authority has said regarding this distinction: “In inducing abortion, one destroys something already formed—a foetus or an embryo, a fertilized ovum, a potential human being. In prevention, however, one merely prevents chemically or mechanically the spermatozoa from coming in contact with the ovum. There is no greater sin or crime in this than there is in simple abstinence, in refraining from sexual intercourse.”

    What then must we say when we consider the higher and more advanced forms and phases of Birth Control, those phases and forms which may be said to be mental or emotional “contraceptives,” rather than physical? Surely these cannot be considered as identical with or similar to abortion. And when we consider those phases and forms of Birth Control which are concerned with Pre-Natal Culture—the culture of the child before its birth—can one, even though he be intensely prejudiced against Birth Control, assert that there is to be found here anything which in any way whatsoever can be considered as relating to the theory or practice of abortion? And what must we say of the still higher phases in which the teachings are concerned with the mental and physical preparation of the parents prior to the conception of the child, to the end that the child may have the best possible physiological and psychological basis for its future well-being? Is not this the very antithesis and opposite of all that concerns abortion or abortive methods?

    The trouble about all great movements designed for the benefit of the human race is that at the beginning there is attracted to the movement, by reason of its novelty and “newness,” certain elements which seize upon certain incidental features of the general idea, make them their own while excluding or ignoring the more important things, and then exploit these incidental features in a sensational way, thereby attracting public attention and gaining much undesirable notoriety, and as a consequence bringing discredit and disfavor, prejudice and misunderstanding, to the general movement.

    Birth Control has passed through this apparently inevitable experience, and has suffered greatly thereby. But the Light is being thrown on the Dark Places, and the more intelligent portion of the public is beginning to realize that there is another side to the shield of Birth Control. And, as a consequence, much of the original prejudice is disappearing, and a new understanding of the subject is arising in the minds of many of the best individuals of the race. It is the purpose of this book to help to dispel the ignorance and misconception concerning this great subject of Birth Control, and to aid in presenting the higher and nobler aspects of the general movement to the attention of those who are concerned with the advance and progress of the race as a whole, and of the individual members thereof.

    The student of the subject of Birth Control will fall into grievous error if he begins his consideration of the subject under the impression that the questions concerned therein are new to the world of living things. If the process of Birth Control were something which had suddenly sprung into existence in the consciousness of man, without having an antecedent activity in the history of the race, and of living creatures in general, we might well hesitate to go further in the matter without the most serious and prolonged consideration of the entire principle by the careful thought of the wisest of the race. But while such consideration is advisable, as in the case of any and all important problems presenting themselves for solution and judgment, it is found that those so considering the subject have a sound and firm foundation upon which to base their thought and to test their conclusions.

    As many thoughtful students of the subject have pointed out to us, the question of Birth Control has been with the race practically since the beginning of human history; and it has its correspondences in the instinctive actions of the lower forms of life. The chief difference is that we are now seeking to deal with these problems consciously, voluntarily, and deliberately, whereas in the past the race has dealt with them more or less unconsciously, by methods of trial and error, through perpetual experiment which has often proved costly but which has all the more clearly brought out the real course of natural processes.

    We cannot hope to solve problems so ancient and so deeply rooted as these by merely the rational methods of yesterday and today. To be of value our rational methods must be the revelation in deliberate consciousness of unconscious methods which go far back into the remote past. Our deliberate methods will not be sound except in so far as they are a continuation of those methods which, in the slow evolution of life, have been found sound and progressive on the plane of instinct. This is particularly true in the case of those among us who desire their own line of conduct in the matter to be so closely in accord with natural law, or the law of creation, that to question it would be impious.

    It may be accepted without an extended argument or presentation of evidence that at the outset the prime object of Nature seems to have been that of Reproduction. There is evident, without doubt, an effort on the part of Nature to secure economy of method in the attainment of ever greater perfection in the process of reproduction, but we cannot deny that the primary motive seems to be that of reproduction pure and simple. The tendency toward reproduction is indeed so fundamental in Nature that it is impressed with the greatest emphasis upon every living thing. And, as careful thinkers have told us “the course of evolution seems to have been more of an effort to slow down reproduction than to furnish it with new facilities.”

    Reproduction appears in the history of life even before sex manifests itself. The lower forms of animal and plant life oftener produce themselves without the aid of sex, and some authorities have argued that the presence of sex differentiation serves rather to check active propagation rather than to increase it. If quantity, without regard to quality or variation, be the object of Nature, then that purpose would have been better served by withholding sex-differentiation than by evolving it. As Professor Coulter, a leading American botanist, has well said: “The impression one gains of sexuality is that it represents reproduction under peculiar difficulties.”

    To those who find it difficult to assimilate this somewhat startling idea, we now present a brief statement of the infinitely greater facility toward reproduction manifested by living creatures lacking in sex-differentiation as compared with those possessing it. It is seen that bacteria among primitive plants, and protozoa among primitive animals, are patterns of very rapid and prolific reproduction, though sex begins to appear in a rudimentary form in very lowly forms of life. A single infusorian becomes in a week the ancestor of millions, that is to say, of far more individuals than could proceed under the most favorable conditions from a pair of elephants in five centuries; and Huxley has calculated that the progeny of a single parthenogenetic aphis, under favorable circumstances, would in a few months outweigh the whole population of China. It must be noted, however, that this proviso “under favorable circumstances” reveals the weak point of Nature’s early method of reproduction by enormously rapid multiplication. Creatures so easily produced are easily destroyed; and Nature, apparently in consequence, wastes no time in imparting to them the qualities needed for a high form of life and living.

    And, even after sex differentiation had attained a considerable degree of development, Nature seemed slow to abandon her original plan of rapid multiplication of individuals. Among insects so far advanced as the white ants, the queen lays eggs at the enormous rate of 80,000 a day during her period of active life. Higher in the scale, we find the female herring laying 70,000 eggs at one period of delivery. But in both of these cases we find the manifestation of that apparently invariable rule of Nature, viz., that a high birth-rate is accompanied by a heavy death-rate, whether that high death-rate be caused by natural enemies, wars, or disease.

    At a certain stage of the evolutionary process, Nature seems to have awakened to a realization of the fact that it was better, from every point of view, to produce a fewsuperior beings rather than a vast number of inferior ones. Here, at last, Nature discloses a heretofore hidden aim, namely, the production of quality rather than quantity; and once she has started on this new path, she has pursued it with even greater eagerness than that of reproduction pure and simple. And here we pause to note a principle laid down by the students of Evolution, viz., that advancing evolution is accompanied by declining fertility.

    This new stage of Nature’s processes is marked by a constant and invariable manifestation of diminished number of offspring, accompanied by an increased amount of time and care in the creation and breeding of each of the young creatures. Accompanying this, we find that the reproductive life of the creature is shortened, and confined to more or less special periods; these periods beginning much later, and ending much earlier, and even during their continuance tending to operate in cycles of activity. Here, we see, Nature, grown wiser by experience, herself began to exercise her power in the direction of Birth Control—the use of preventive checks on reproduction.

    A writer has said along these lines: “As reproduction slackened, evolution was greatly accelerated. A highly important and essential aspect of this greater individuation is a higher survival value. The more complex and better equipped creature can meet and subdue difficulties and dangers to which the more lowly organized creature that came before—produced wholesale in a way which Nature seems to look back on as cheap and nasty—succumbed helplessly without an effort. The idea of economy began to assert itself in the world. It became clear in the course of evolution that it is better to produce really good and highly efficient organisms, at whatever cost, than to be content with cheap production on a wholesale scale. They allowed greater developmental progress to be made, and they lasted better. Even before man began it was proved in the animal world that the death-rate falls as the birth-rate falls.”

    Let us compare the lowly herring with the highly evolved elephant. The herring multiplies with enormous rapidity and on a vast scale, and it possesses a very small brain, and is almost totally unequipped to grapple with the special difficulties of its life, to which it succumbs on a wholesale scale. A single elephant is carried for about two years in its mother’s womb, and is carefully guarded by her for many years after birth; it possesses a large brain, and its muscular system is as remarkable for its delicacy as for its power, and is guided by the most sensitive perceptions. It is fully equipped for all the dangers of life, save for those which have been introduced by the subtle ingenuity of modern man. Though a single pair of elephants produces so few offspring, yet their high cost is justified, for each of them has a reasonable chance of surviving to old age. This contrast, from the point of view of reproduction, of the herring and the elephant, well illustrates the principle of evolution previously referred to. It brings clearly into view the difference between Nature’s earlier and her later methods—the ever increasing preference for quality over quantity. Unless we grasp this underlying principle of Nature in its wider aspects we may fail to perceive its operations in the case of man, which latter we may now consider.

    It is, of course, impossible to speak positively regarding the birth-rate and death-rate of the pre-historic primitive races of mankind, for there is not data upon which to base such a report. But reasoning upon the basis of conditions existing among the primitive tribes of the present time we are justified in holding that in the early stages of the evolution of the race there was manifested a high birth-rate and a correspondingly high death-rate. Upon the basis of conditions now existing among savage tribes it would appear that primitive man has a higher birth-rate than the average of mankind today, and likewise a higher death-rate. The rapidly increasing number of children born to the tribe was counteracted by deaths among children caused by neglect, poverty, and disease. In some cases the population was prevented from becoming larger than the means of subsistence justified by the practice of infanticide.

    As to the condition of the race in the early stages of “modern” civilization, we have modern Russia as a surviving instance of this stage. In modern Russia we find, side by side with the progress in neighboring nations, conditions which a few centuries ago existed all over Europe. Here we have an enormous birth-rate, and a terrible death-rate caused by ignorance, superstition, insanitation, filth, bad food, impure water, plagues, famines, and other accompaniments of overcrowding and misery. We find a mortality among young children which sometimes destroys more than half of the children born before they have attained the age of five years. As high as is the Russian birth-rate, it is a matter of record that at times the death-rate has actually exceeded it. And among the survivors there is found a startlingly large percentage of chronic and incurable diseases, with a large number of cases of blindness and other defects.

    Similar results follow in China, where the birth-rate is exceptionally high, and the death-rate correspondingly large; and where there is a large percentage of inferior physical development and pathological defects, the evil conditions which produce death also tending to produce deterioration in the survivors. In both of these countries we have an example of the result of unrestricted reproduction, and unrestricted destruction—as among herrings, so among men. And yet this condition of unrestricted reproduction is the logical goal of certain persons who, inspired by the best possible intentions, in their ignorance and criminal rashness would dare to arrest that fall in the birth-rate which is now beginning to spread its influence in every civilized land.

    In Western Europe before the nineteenth century the population increased very slowly. The enormous birth-rate was nearly equalled by the exceedingly heavy death-rate caused by plagues, pestilences, and famine, and by the frequent wars large and small. The mortality among young children was particularly heavy. Writers have pointed out that the old family records show frequently two or three children of the same Christian name, the first child having died and its name given to a successor.

    During the last quarter of the eighteenth century, when machinery was introduced and a new industrial era opened, the birth-rate rose rapidly. Factories springing up gave increased support to many, and as children were employed as “hands” in the mills at an early age, the richest family was the one with most children. The population began to increase rapidly. But soon disease, misery, and poverty arose from filth and insanitation, immorality and crime, overcrowding and child-labor, drink and lack of sane courses of conduct.

    In time, however, progress set in, and social reformers began the great movement for the betterment of the environment, sanitation, shorter hours of labor, and restriction of child-labor, factory regulation, etc. And when the environment is bettered, the death-rate drops, and the birth-rate accompanies it on its downward progress. As Leroy-Beaulieu says: “The first degree of prosperity in a rude population with few needs tends toward prolificness of reproduction; a later degree of prosperity, accompanied by all the feelings and ideas stimulated by the reduction of such prolificness.”

    The law of the reduction of reproduction in response to the improvement of environment is a natural law, arising from fixed biological principles. This is because when we improve the environment we improve the individual situated in that environment; and the improvement of the individual has always resulted in a check upon reproduction. We must remember, however, that this change is not the result of conscious or voluntary action; instead it is the result of unconscious activities and instinctive urge. As Sir Shirley Murphy has said: “Birth Control is a natural process, and though in civilized men, endowed with high intelligence, it necessarily works in some measure voluntarily and deliberately, it is probable that it also works, as in the evolution of the lower animals, to some extent automatically.”

    Science shows us that even among the most primitive micro-organisms; when placed under unfavorable conditions as to food and environment, they tend to pass into a reproductive phase and by sporulation or otherwise begin to produce new individuals rapidly. This, of course, because of the fact that their death-rate is increased, and an increased birth-rate must be manifested in order to maintain a balance. If the environment be improved, the death-rate decreases, and this is followed by a fall in the birth-rate, according to the constant laws of Nature manifesting in such cases.

    The same law is seen to be manifested in the case of Man. Improve his environment, and his death-rate drops, which is accompanied by a falling birth-rate. Here, once more we see the application of the scientific axiom “Improve the environment and reproduction is checked.” As Leroy-Beaulieu has said: “The tendency of civilization is to reduce the birth-rate.” And as Professor Benjamin Moore has said: “Decreased reproduction is the simple biological reply to good economic conditions.” And as Havelock Ellis has said: “Those who desire a higher birth-rate are desiring, whether they know it or not, the increase of poverty, ignorance, and wretchedness.”

    Among men, Birth Control has now evolved from the unconscious and instinctive phase, and is now unfolding and manifesting on the plane of conscious and voluntary activity. The influence of deliberate intention and conscious design is now one of the important factors in the process. Here at this point we reach a totally new aspect of reproduction. In the past stages of evolution the original impetus toward reproduction has been checked and directed by Nature, working along instinctive and unconscious lines; and the result has been an extreme diminution of the number of off-spring; a prolongation of the time devoted to the breeding and care of each new member of the family, in harmony with its greatly prolonged life; a spacing out of the intervals between the offspring; and, as a result, a vastly greater development of each individual, and an ever better equipment for the task of living. All this was slowly attained automatically, without any conscious volition on the part of the individuals, even when they were human beings, who were the agents.

    Now, however, we are confronted with a change which we may regard as, in some respects, the most momentous sudden advance in the whole history of reproduction, namely, the process of reproductive progress now become conscious and deliberately volitional. Birth control, no longer automatic, is now being directed by human mind and will precisely to the attainment of ends which Nature has been struggling after for millions of years; and, being consciously and deliberately directed, it is now enabled to avoid many of the pitfalls into which the unconscious method fell.

    Havelock Ellis says: “The control and limitation of reproductive activity by conscious and volitional effort is an attempt by open-eyed intelligence and foresight to attain those ends which Nature through untold generations has been painfully yet tirelessly struggling for. The deliberate co-operation of Man in the natural task of Birth Control represents an identification of the human will with what we may, if we choose, regard as the divinely appointed law of the world. We can well believe that the great pioneers, who, a century ago, acted in the spirit of this faith may have echoed the thought of Kepler when, on discovering his great planetary law, he exclaimed in rapture: ‘O God! I think Thy thoughts after Thee!’”

    The following brief general history of the modern Birth Control movement is quoted from Havelock Ellis, and will be of interest to students of the subject: “The pioneers of modern Birth Control were English. Among them Malthus occupies the first place. That distinguished man, in his great and influential work, ‘The Principles of Population,’ in 1798, emphasized the immense importance of foresight and self-control in procreation, and the profound significance of birth limitation for human welfare. Malthus, however, relied on ascetic self-restraint, a method which could only appeal to the few; he had nothing to say for the regulation of conception in intercourse. That was suggested twenty years later, very cautiously by James Mill, the father of John Stuart Mill, in the ‘Encyclopaedia Britannica.’ Four years afterwards, Mill’s friend, the Radical reformer, Francis Place, advocated this method more clearly. Finally, in 1831, Robert Dale Owen, the son of the great Robert Owen, published his ‘Moral Physiology,’ in which he set forth the ways of preventing conception; while a little later the Drysdale brothers, ardent and unwearying philanthropists, devoted their energies to a propaganda which has been spreading ever since and has now conquered the whole civilized world.

    “It was not, however, in England but in France, so often at the head of an advance in civilization, that Birth Control first firmly became established, and that the extravagantly high birth rate of earlier times began to fall; this happened in the first half of the nineteenth century, whether or not it was mainly due to voluntary control. In England the movement came later, and the steady decline in the English birth-rate, which is still proceeding, began in 1877. In the previous year there had been a famous prosecution of Bradlaugh and Mrs. Besant for disseminating pamphlets describing the methods of preventing conception; the charge was described by the Lord Chief Justice, who tried the case, as one of the most ill-advised and injudicious ever made in a court of justice. But it served an undesigned end by giving enormous publicity to the subject and advertising the methods it sought to suppress. There can be no doubt, however, that even apart from this trial the movement would have proceeded on the same lines. The times were ripe, the great industrial expansion had passed its first feverish phase, social conditions were improving, education was spreading. The inevitable character of the movement is indicated by the fact that at the very same time it began to be manifested all over Europe, indeed in every civilized country of the world.

    “At the present time the birth-rate (as well as usually the death-rate) is falling in every country of the world sufficiently civilized to possess statistics of its own vital movement. The fall varies in rapidity. It has been considerable in the more progressive countries; it has lingered in the more backward countries. If we examine the latest statistics for Europe, we find that every country, without exception, with a progressive and educated population, and a fairly high state of social well-being, presents a birth-rate below 30 per 1,000. We also find that every country in Europe in which the mass of the people are primitive, ignorant, or in a socially unsatisfactory condition (even although the governing classes may be progressive or ambitious) shows a birth-rate of above 30 per 1,000. France, Great Britain, Belgium, Holland, the Scandinavian countries, and Switzerland are in the first group. Russia, Austro-Hungary, Italy, Spain, and the Balkan countries are in the second group. The German Empire was formerly in the second group, but now comes within the first group, and has carried on the movement so energetically that the birth-rate of Berlin is already below that of London, and that at the present rate of decline the birth-rate of the German Empire will before long sink to that of France. Outside Europe, in the United States just as much as in Australia and New Zealand, the same progressive movement is proceeding with equal activity.”

    The same authority sums up the present attitude of the advocates of scientific and rational Birth Control, as follows: “The wide survey of the question of birth limitation has settled the question of the desirability of the adoption of preventing conception, and finally settled those who would waste out time with their fears that it is not right to control conception. We know now on whose side are the laws of God and Nature. We realize that in exercising control over the entrance gate of life we are not fully performing, consciously and deliberately, a great human duty, but carrying on rationally a beneficial process which has, more blindly and wastefully, been carried on since the beginning of the world. There are still a few persons ignorant enough or foolish enough to fight against the advance of civilization in this matter; we can well afford to leave them severely alone, knowing that in a few years all of them will have passed away. It is not our business to defend the control of birth, but simply discuss how we may most wisely exercise that control.”

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • GENERAL ADVICE TO WOMEN ON SEX SUBJECTS

    GENERAL ADVICE TO WOMEN ON SEX SUBJECTS

    In this lesson the writer seeks to direct the attention of his women readers to certain subjects upon which the average woman is not well informed, and upon which she usually requires sound, sane, clean, frank information. In many cases women hesitate to ask even their family physicians for such information, and, although there is no rational reason for it, they even shrink from consulting better informed and capable women concerning these subjects.

    Sexual Feeling. Owing to erroneous teachings, and irrational prejudices arising from ancient distorted and perverted ideals of sex, many women have grown to maturity under the erroneous belief that it is a sign of immorality, or at least low ideals and depraved nature, for a woman to experience sexual emotions or feelings, wishes or desires. So true is this that even many married women seek to withhold from their husbands the knowledge that any sexual feeling is experienced by the wife.

    Such a belief is of course absurd. It is as natural for a woman to experience normal sexual feeling as it is for her to experience any other feeling aroused by natural instincts and organism. Without such instinct and the feelings arising therefrom, there would be no mating or marriage, and no perpetuation of the race. The woman experiencing such feelings should not allow herself to imagine that she is depraved or perverted, or immoral in thought and feeling. Incredible as it may appear to a normal, healthy-minded man, it is true that thousands of young women have lost self-respect, and have lapsed into a morbid state of mind, because of the occasional manifestation of their normal sexual feeling.

    This does not, of course, mean that the woman must necessarily manifest into action the feeling experienced by her. On the contrary, she must acquire self-mastery and self-control, just as she must in other phases of her life. It may help some women of this kind to realize that the sex feeling and impulses, arising unbidden (and often unwelcomed) from the depths of their subconscious mentality, are essentially creative impulses. If the woman be unmarried, or if married and placed under conditions in which the marital relation with the husband is impossible or undesirable, then she can transmute this creative energy in some form of creative work—in work which leads to the creation, manufacture, building-up, or composing something. There is a hint here which will prove a great blessing to the woman who will understand and apply the principle suggested—for many other women have found it so.

    As for the married woman, there is no reason whatsoever why she should seek to withhold from her husband the knowledge that she is possessed of normal, natural, healthy sexual feeling. In fact, the withholding of such information, and the concealment and deception arising therefrom, has often done much to bring marital inharmony between husband and wife. If there is any deception to be practiced in the marital association of husband and wife, it should rather be in the opposite direction, i. e., in the direction of pretending the emotional feeling when it exists only partially or is absent. The last matter, however, is one for the exercise of the judgment and conviction of each individual woman; but the first mentioned admonition is one which should be observed, as it is based on honesty, truth, and good judgment as well.

    Alcohol and Sexuality. It needs no extended argument to convince the average person that an individual will do things when under the influence of drink that he or she would not do when perfectly sober. It is an old saying that “When the wine is in, the wits are out.” But there is a deeper connection and relation between alcoholic drink and sexual indiscretions than is usually realized by the average person. Besides the commonly known weakening of will-power and self-control arising from the influence of strong drink, there are certain influences concerning the sexual nature and arising from the presence of alcohol in the system, which are not known to most persons. So true is this that the writer has thought it well to utter a few words of warning to his women readers concerning these things.

    In the first place, there is an exhilarating effect arising from certain kinds of liquor, wines, and other forms of alcoholic drinks, which manifests directly in an excitement of the sexual centers and organism. In many cases a strong sexual excitement, absent at other times, is aroused, and the person is carried away with the force of passion unknown under other circumstances. Added to this the weakened will-power arising from too much drink, and we have an explanation of many cases of “mistakes” of women. It would appear that women are even more susceptible than are men to unusual sexual excitement arising from alcoholic drinks; and that, therefore, they should be especially cautious in the indulgence in such drinks, particularly when in the company of strange men, or men careless in regard to sexual morality and respect for women in their company.

    But there is still a deeper reason, based upon the latest discoveries in psychology, why caution in this respect should be observed by women. We allude to the discovery that alcohol first affects the mental and emotional tendencies of more recent racial acquirement, acting so as to paralyze and inhibit the activities thereof, and to thus release the activity of the more primitive emotions and motive activities. Thus, the woman under the influence of alcohol finds that the more recent racial traits, such as sexual control, restraint, sexual morality, conventional observations, etc., are practically temporarily paralyzed in inhibitual—or to use the current slang phrase, are “put out of commission” for the time being; and, at the same time, the old elemental, savage, barbaric, “cave man” instincts, habits, and methods of action, are brought to the surface, and proceed to manifest their activity if opportunity be granted for the same—and the opportunity is usually granted. This being seen to be true, it is seen that the woman so under the influence of liquor is, for the time being, little more than a “cave woman,” or barbarian, with all the lax sex morality of the latter, and with all the tendencies to manifest into activity the primitive impulses arising in her nature and demanding expression. Added to this the weakening of will-power always accompanying the alcoholic influence, it is seen that the woman under the influence of strong drink is an easy prey to designing men, and a willing victim to her own lower passions.

    An authority of sex subjects says: “That Bacchus, the god of wine, is the strongest ally of Venus, the goddess of love, using the term Love in its physical sense, as the French use the word ‘amour,’ has been well known to the ancient Greeks and Romans, as it is well known today to every saloon-keeper and every keeper of a disreputable house. And all measures to combat venereal diseases and to prevent girls from making a false step will only be partially successful if we do not at the same time carry on a strong educational campaign against alcoholic indulgence. * * * Of what use are warnings to a girl, when under the influence of a heavy dinner and a bottle of champagne, to which she is unaccustomed, her passion is aroused to a degree she has never experienced before, her will is paralyzed and she yields, though deep down in her consciousness something tells her she shouldn’t? She yields, becomes pregnant, and is in the deepest agony for several months, and has a wound which will probably never heal for the rest of her life. Of what use have all the lectures, books, and maternal injunctions been to her? * * * I believe that the sex instinct can be stimulated artificially beyond the natural needs, and among the artificial stimulants of the sex instinct alcohol occupies the first place. And bear in mind that alcohol produces even a stronger effect upon women, in exciting the sexual passion, than it does on men. Women are more easily upset by stimulants and narcotics, and that is the reason why it is more dangerous for women to drink than it is for men. It is impossible to give statistics and exact or even approximate figures. But there is no question in my mind, in the mind of any careful investigator, that if alcoholic beverages could be eliminated, the number of cases of venereal infection would be diminished by about one-half. And what is true of venereal disease is also true of the seduction of young girls. Alcohol is the most efficient weapon that either the refined Don Juan or the vulgar pimp has in his possession.”

    Our advice to the woman who is asked to drink liquor when in the company of a man outside of her immediate family circle is emphatically this: DON’T DO IT!

    The Menstrual Period. As strange as it may appear to those women who have had the advantage of intelligent maternal advice, it is a fact known to all physicians that many mothers permit their young daughters to enter into the stage of puberty, with the accompanying menstrual flow, without having first instructed the daughter as to the meaning and character of this phenomenon of her nature, and without having given her advice concerning the proper care of herself during this period.

    Physicians constantly experience cases in which the young girl to whom the first menstrual flow having come, without previous knowledge on her part, has supposed it to be the result of a wound, or of a diseased condition, and has attempted to stop the flow by the application of cold water. Even where a partial knowledge has been attained by the girl, she is found to lack the knowledge of the proper hygienic care of herself during the period. The mothers in such cases are criminally negligent, and have alluded a false modesty or prudery to interfere with a natural and necessary maternal duty.

    The approach of the first menstruation is often accompanied by unusual physical, mental and emotional changes in the young girl. Her nervous system is affected, and she is apt to become irritable or morbid, or even somewhat “flighty.” Her appetite may become irregular, and there is often present a craving for indigestible food. A physical languor is often experienced, and there may be pains in the back and legs, chilliness and headaches, and a general upsetting of the usual physical condition, accompanied by a manifestation of peevishness and irritability. These unpleasant symptoms usually disappear when the periodical menstrual flow is permanently established. In fact, they are frequently superseded by the awakened energy and heightened spirits of healthy, normal adolescence.

    The time of the beginning of the menstrual period varies according to climate, race, condition of health, and temperament. In the tropical countries, menstruation begins from the tenth to the fourteenth year; in temperate countries, from the thirteenth to the sixteenth; in cold countries, from the fifteenth to the twentieth year. The Italian, Hebrew, Spanish, or French girl is apt to menstruate earlier than the English, German, or Swedish girl. The Negro girl menstruates early, as a rule. The full-blooded girl usually menstruates earlier than the anemic one.

    Normally, menstruation should proceed naturally and without pain or suffering. When pain or suffering is experienced in connection with menstruation, it is simply because of some lack of health in the general system; and when such general health is restored, the trouble ceases. Painful menstruation is called “dysmenorrhea,” and arises from several causes, principal among which are the following: Errors in diet, errors in dress, undue exposure, constipation, lack of proper exercise, or to a contracted or congested condition of the Uterus or the Fallopian Tubes. The pain, however, cannot be considered as a feature of normal menstruation, for the latter is no more painful than a normal movement of the bowels—the painful condition results from abnormal conditions, the removal of these conditions resulting in the cure of the complaint.

    Dysmenorrhea should be treated by the discarding of all unhygienic clothing, tight shoes, etc., and their replacement by rational clothing; the dietary should be carefully scanned, and improper articles replaced by nourishing elements of food—discard the pastries, pickles, confections, and stimulants, and substitute sensible articles of diet; if constipation is present, remove it by eating articles of food which promote free movements of the bowels, and drink more water each day; take a proper amount of exercise—housework is as good a form of exercise as any; many authorities advocate the free drinking of water prior to and during the menstrual period—some going so far as to say that where there is painful menstruation there is always a lack of a proper amount of water taken into the system. In some cases Dysmenorrhea is due to disorders of the general nervous system, and treatment therefore should be sought at the hands of a capable physician.

    Amenorrhea, another disorder arising in connection with the menstrual process, consists of the retention or suppression of the menses, or of “scanty” menses, or occasional “skipping” of the periods. This condition is apt to be manifest in cases of extreme obesity or “fatness;” the nervous system being burdened with superfluous flesh, its menstrual rhythm is often affected. Suppression of the menses also sometimes results from exposure and disturbing mental emotions. The most approved treatment is that of remedying the abnormal general physical condition, proper diet, and the use of hot drinks, hot sitz baths, and hot enemas about the time of the beginning of the normal period.

    Menorrhagia, another menstrual-period disorder, consists of very profuse flowing—it is, in fact, a mild form of hemorrhage. It usually arises from general debility, shocks, too violent exercise or labor, and also in many cases from undue and too frequent sexual intercourse. Sometimes the excessive flow occurs during the regular menstrual period, while in other cases it may manifest itself out of season—sometimes as often as two or three times a month. The duration of the normal period of menstrual flow, however, varies greatly among different women; the normal period may be said to last from two to six days, so what might be an excessive flow for one woman would be only normal for another—temperament plays a large part in determining the quantity of the menses.

    Some of the accompanying symptoms of Menorrhagia, or profuse flow, are lassitude, shortness of breath, faintness, dizziness, headache, irritability and nervousness, and often also leucorrhea between periods. The general treatment consists in measures calculated to bring the general health of the woman back to the normal. The building up of the general system, by means of nourishing food, proper exercise, etc., will almost always result in curing this disorder.

    A well-known authority has well said: “The hygiene of menstruation can be expressed in two words: Cleanliness and Rest.”

    So far as Rest is concerned, the woman need not be urged to take it at this period—that is, if she is able to do so. Care should be taken not to exercise unduly at this time, and under the head of exercise may be included dancing, horseback riding, and automobiling, as well as the more common forms of athletic work.

    It would seem that common sense and the general desire for cleanliness and daintiness would cause all women to observe the plain hygienic laws of Cleanliness at the time of the menstrual period. And, indeed, it is probable that such would be the case were it not for the fact that some ancient superstitions still exert their power over the mind of many women, in regard to the use of water during the menstrual period. While it is true that cold baths, or cold-water bathing, are not advisable for the average woman during the menstrual period (although some especially robust women bathe and swim as usual during this period), this prohibition does not apply to the use of warm water during the period. Lukewarm baths are permissible at this time; and the woman should wash the external genital parts with warm water, with soap if desired, every morning and evening of the period. A vaginal douche of lukewarm water is an excellent adjunct to the bathing of the parts.

    It is astonishing to meet with the superstitious prejudice existing in the minds of some women concerning the use of the vaginal douche; these good creatures seem tothink that it is either unnatural and unhealthy, or else is something “not respectable,” and fit only for the use of immoral women. These women should get in touch with modern hygienic methods, and learn to use the douche at least during their menstrual periods. At this time, if the plain rules of cleanliness are not observed, there often occurs a decomposition of the blood which has gathered in or about the genitals, and an offensive odor is manifested. Some women, while feeling distressed about this odor, are afraid to use lukewarm water in washing themselves, owing to some old unexplored superstition handed down from the great-grandmother’s time.

    The napkins should be changed at least every morning and evening. Unclean napkins may lead to infection, and it is probable that many cases of leucorrhea have their origin in lack of cleanliness concerning the napkins, cloths, or rags, used during menstruation. It may seem almost incredible to the average woman reader, but physicians know of cases (usually among the poorer and more ignorant foreign classes) in which the girl is instructed by her mother, grandmother, or aunts, that she must wear the original cloth or rag during the entire period, as she will “catch cold” by a change to a clean, fresh cloth while the flow continued. Imagine the result of such a practice! This last is an extreme instance, of course, but it will serve to show the absurd and harmful notions prevalent concerning this important natural function, and its incidents.

    Leucorrhea. A very common disorder among women is that known as Leucorrhea, or “the whites.” It consists of a discharge from the Vagina, or the Uterus through the Vagina. It is, in fact, of a catarrhal nature, and results from an over-secretion of the mucus fluids which, in proper quantity, keep the mucus membrane of the said organs in good condition. The discharge manifests in various shades and degrees of consistency. From the character of the discharge, physicians are able to determine whether it comes from the Vagina or the Uterus. The discharge from the Vagina usually is a light creamy fluid; that from the neck of the Uterus is a sticky, thick fluid flowing rather freely; that from the lining of the Uterus is alkaline, and generally precedes and follows menstruation; and that accompanying ulceration of the womb is semi-purulent and offensive in odor.

    Leucorrhea has many causes, among which may be mentioned the following: getting chilled feet or body, particularly during the menstrual period; over exertion and overwork standing on one’s feet; chills following dancing in overheated rooms; excessive worry or emotional strain, etc. It is a quite common complaint, and some assert that fully twenty-five per cent (perhaps more) of all women suffer from it to at least some extent.

    The general treatment of Leucorrhea consists of the building up of the entire system by the proper hygienic methods. Constipation should be removed, and the system is built up by the proper articles of food, exercise, etc. The use of the proper douches are also advised by the best practitioners. Physicians also treat inflamed areas by local treatments consisting of painting the Vagina or neck of the Uterus with certain medicinal solutions. Certain suppositories and douches are also employed in some cases. It is always better to consult a good physician in these cases, particularly where the trouble is aggravated or of long standing.

    A popular writer on the subject gives the following prescription for a vaginal injection: White Fluid Hydrastics, 2 ounces; Borax, 1/2 ounce; Distilled Witch Hazel Extract, 1 pint. Use of this preparation one ounce, diluted in a pint of lukewarm water, as a vaginal injection, taken twice each day.

    A well-known authority gives the following advice concerning treatment of Leucorrhea: “One of the simplest things is an alum tampon. You take a piece of absorbent cotton, about the size of a fist, spread it out, put about a tablespoonful of powdered alum on it, fold it up, tie a string around the center, insert it in the vagina as far as it will go, and leave it in twenty-four hours. Then pull it gently by the string and syringe yourself with a quart or two of warm water. Such a tampon may be inserted every other day or every third day, and I have known where this simple treatment alone produced a cure. In some cases, however, douches work better, and the two best things for douching are: tincture of iodine and lactic acid. Buy, say, four ounces of tincture of iodine, and use two teaspoonsful in two quarts of hot water in a douche bag. This injection should be used twice a day, morning and night. Of the lactic acid you buy, say, a pint, and use two tablespoonsful to two quarts of water. The lactic acid has the advantage over the tincture of iodine that it is colorless, while the iodine is dark and stains whatever it comes in contact with. Sometimes I order the use of the tincture of iodine and the lactic acid alternately: for one douche the tincture of iodine, for the next the lactic acid, and so on. When the condition improves, it is sufficient to use one teaspoonful of the tincture of iodine and one tablespoonful of the lactic acid to two quarts of water. These injections are quite efficient and have the advantage of being perfectly harmless. One point about the injections: they should be taken not in the standing or squatting position (in which position the fluid comes right out), but while laying down, over a douche pan. The douche bag should be only about a foot above the bed, so that the irrigating fluid may come out slowly; the patient, after each injection taken in the daytime, should remain at least half an hour in bed (in the nighttime she stays all night in bed.) This gives the injection a better chance to come in contact with all the parts of the vagina, and a portion of it comes in contact with the cervix, where it exerts a healing effect. Avoid the use of patent medicines.”

    Uterine Displacement. The woman suffering from Uterine Displacement should, of course, consult a competent physician and be governed by his advice. The following suggestions, however, will be found to be of service in many cases:

    In the case of Prolapsus, or falling of the womb, many women have found great relief, and in many cases permanent improvement, by taking occasional rests in bed for an hour or so, with the feet and lower part of the legs raised at least eight inches above the level of the head. In this plan, the Uterus is replaced by gravitation. Some authorities advise practicing waist-breathing while lying in this position, thus exercising the abdominal muscles. Dr. Taylor says: “Increase the pump-like action of the chest, and it will be found that the displaced viscera will return to their normal position.” Some have also found relief from the use of alum-water vaginal injections once or twice each day. The alum-water is prepared by dissolving one heaping teaspoonful of powdered alum in a pint of lukewarm water. This last treatment often strengthens the vaginal muscles whose yielding has at least partially been the cause of the falling womb.

    In cases of Retroversion, in which the Uterus is turned or bent backward, the “knee and chest” position will often aid in causing the organ to regain its normal position. In this position the woman kneels, and rests her chest upon the bed, thus causing the hips to be elevated.

    In cases of Antroversion, in which the Uterus is turned or bent forward, relief is often obtained by the woman resting upon the back, using a pillow to elevate her hips.

    Intercourse During Menstruation. It would seem that the natural esthetic repulsion to the exercise of the marital relations during the menstrual period should be sufficient to deter men and women from indulgence at this time; but many seem to have overcome this instinctive repulsion, and to these a stronger reason must be given—and the reason is at hand. The reasons in question are as follows: first, that congestion of the Uterus and Ovaries sometimes results from this unnatural practice; second, that the man may possibly contract an inflammation of the urethra by infection from the degenerated membrane, tissue, blood, etc., of the menstrual flow; and third, that such practices may result in the aggravation of discharges from the woman, such as leucorrhea, etc.

    Intercourse During Pregnancy. The best authorities advise total abstinence from sexual intercourse during the period of pregnancy; but in view of the fact that such abstinence is very difficult for most men, and that few will persist in it, it is thought well to point out the fact that at least an extreme moderation is desirable in such cases. A leading authority says on this point: “During the first four months of pregnancy, no change need be made in the usual sex relations; their intensity should be moderated, their frequency need not. During the fifth, sixth, and seventh months, intercourse should be indulged in at rarer intervals—once in two or three weeks—the act should be performed without any violence or intensity. During the eighth and ninth months relations had best be given up altogether. And this abstinence should last until about six weeks after the birth of the child. During this period the uterus undergoes what we call involution; that is, it goes back to the size and shape it had before pregnancy, and it is best not to disturb this process by sexual excitement, which causes engorgement and congestion.”

    Sterility in Women. Sterility, or barrenness, i. e., the inability to bear children, is frequently met with among married people. It is usually blamed upon the woman, whereas in at least one-half of the cases the fault is with the man.

    The causes of sterility in women are usually one or more of the following: Inflammation of the Fallopian Tubes, which may have been caused by gonorrhea or ordinary inflammation—in some rare cases childbirth has been known to set up an inflammation in this region, which has prevented the woman from future childbearing—the inflammation causes the tubes to clog up or become closed, so that no more ova can pass through them from the ovaries to the womb; in some cases, also, severe cases of leucorrhea have caused sterility, as the discharge is sometimes fatal to the life of the spermatozoa and destroys them; in other cases misplacement of the womb causes sterility; also severe inflammation of the neck or mouth of the womb operates in the same way, in some cases. In cases of sterility, the woman should have an examination made by a competent physician, and it often will be found that the cure of the disorders above noted will work a cure of the sterility.

    But, in all cases of sterility, it will be found that the husband should be examined as well as the wife—in fact, many authorities insist that the husband should be examined first. Venereal diseases frequently produce sterility in the man, although he is loath to admit this and is apt to place the blame entirely upon the woman.

    Miscarriage and Abortions. The terms “miscarriage,” and “abortion,” respectively, mean the expulsion of the fetus from the womb before its natural time of delivery. In common usage, the term “miscarriage” is usually employed to indicate instances in which the premature delivery has occurred without any voluntary act on the partof the woman, or other persons acting with her permission; the term “abortion” being reserved for instances in which the miscarriage has been voluntarily produced.

    When the fetus dies within the womb of the mother, it is usually expelled spontaneously within a few days or even a few hours. Some women suffer from certain weakness which result in habitual miscarriage; such women seem unable to carry the child for the full natural term, and lose it at some time during the period of gestation. Like results often arise from certain diseases, principal among which is syphilis. In some cases the physician produces what is known as “therapeutic abortion,” for the purpose of saving the life of the woman—this is sanctioned by medical custom and by law. Other forms of abortion, performed for the purpose of preventing the progress of the gestation, and designed for the destruction of the embryo or fetus, are known as “criminal abortion,” and are punishable by several legal penalties.

    Abortions are frequently followed by severe illness, invalidism, or even death for the woman. Many women have had their entire lives ruined by this evil practice. It is one of the curses of modern civilization, and one which must be removed by means of rational instruction and education along the lines of sexual science if the race is to be prevented from deterioration. The subject will be further considered in the subsequent lessons in this book.

    The best advice to those who have contemplated the performance of abortion is simply this: Don’t; Don’t; DON’T!

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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