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  • Medical Product Alert N°5/2020 – 7 May 2020

    Medical Product Alert N°5/2020 – 7 May 2020

    Falsified and contaminated Defibrotide identified in WHO regions of Western Pacific, Europe and Eastern Mediterranean

    This alert relates to falsified DEFIBROTIDE 200MG VIALS OF 2.5ML (80MG/ML) CONCENTRATE FOR SOLUTION FOR INFUSION identified in Australia, Latvia and Saudi Arabia. This product is sold under the brand name Defitelio.

    On 13 March 2020, the WHO Global Surveillance and Monitoring System on Substandard and Falsified (SF) Medical Products was informed that falsified DEFIBROTIDE 200MG vials were identified at patient level in Australia, displaying batch number 0286 (see Table 1 below for full details).

    Following enquiries with stakeholders, on 8 April 2020, WHO was informed that falsified DEFIBROTIDE 200MG vials had also been supplied to Saudi Arabia, displaying batch number 0286 and 0126 (see Table 1 below for full details).

    Following enquiries with stakeholders, on 9 April 2020, WHO was informed that falsified DEFIBROTIDE 200MG vials, displaying batch number 0126, had also been identified in Australia and Latvia.

    DEFIBROTIDE is used to treat hepatic veno-occlusive disease, in which the blood vessels in the liver become damaged and obstructed by blood clots. This can be caused by treatments prior to a stem cell transplantation.

    Laboratory analyses, conducted by national medicines regulatory authorities and the manufacturer of the genuine product, established that these falsified products do not contain any of the expected active ingredient. The solution in the vials is also contaminated with mould (Cladosporium sp. and Aspergillus niger).

    Information available to WHO indicates that both batches of falsified DEFIBROTIDE 200MG vials were present within the regulated supply chain in Latvia as early as January 2020 and were also handled by medicine wholesalers in the United Kingdom in February 2020. It is important to note that widespread vigilance is required from all countries, regardless of where the product was originally identified.

    Table 1: falsified defibrotide subject of WHO Alert n°5/2020, identified in Australia, Latvia and Saudi Arabia

    Medical Product Alert N°5/2020 - 7 May 2020 1

    The two products listed in Table 1 are confirmed falsified, on the basis that there is deliberate misrepresentation of their identity, composition and source.

    The genuine manufacturer of Defibrotide, GENTIUM S.R.L has also confirmed to WHO that:

    • They did not manufacture the above products.
    • Authentic DEFIBROTIDE 200MG VIALS with batch number 0286 were supplied to Argentina, Hong Kong, Malaysia, Singapore and Turkey.
    • Authentic DEFIBROTIDE 200MG VIALS with batch number 0126 were supplied to Australia, Jordan, Kuwait, Lebanon, New Zealand, Qatar, Singapore, Turkey and the United Arab Emirates. 

      For guidance and photographs, please refer to page 2 of this Alert n°5/2020.

    Photos of Falsified DEFIBROTIDE Batch number: 0286, with expiry date: 09/2021

    Medical Product Alert N°5/2020 - 7 May 2020 2         Medical Product Alert N°5/2020 - 7 May 2020 3
    Sample from Latvia       Sample from Latvia

    Photos of Falsified DEFIBROTIDE Batch number: 0126, with expiry date: 08/2021

    Medical Product Alert N°5/2020 - 7 May 2020 4           Medical Product Alert N°5/2020 - 7 May 2020 5
    Sample from Australia       Sample from Australia

    WHO requests increased vigilance within the supply chains of countries likely to be affected by these falsified products. Increased vigilance should include hospitals, clinics, health centres, wholesalers, distributors, pharmacies and any other suppliers of medical products.

    If you are in possession of the above products, please do not use them. If you have used these falsified products, or if you suffer an adverse reaction/event having used these products, you are advised to seek immediate medical advice from a qualified healthcare professional, and to report the incident to the National Regulatory Authorities/National Pharmacovigilance Centre.

    All medical products must be obtained from licensed, authorized and reliable sources. Their authenticity and condition should be carefully checked. Seek advice from a healthcare professional in case of doubt.

    National regulatory/health authorities are advised to immediately notify WHO if these falsified products are identified in their country(ies). If you have any information concerning the manufacture, distribution, or supply of these products, please contact rapidalert@who.int.

    WHO Global Surveillance and Monitoring System for Substandard and Falsified Medical Products

    For further information, please visit our website: https://www.who.int/medicines/regulation/ssffc/en/ 

    Medical Product Alert N°5/2020 - 7 May 2020
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    https://www.who.int/news-room/detail/07-05-2020-medical-product-alert-n-5-2020

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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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  • ANATOMY OF THE FEMALE SEX ORGANISM

    ANATOMY OF THE FEMALE SEX ORGANISM

    Every woman should be given plain, practical, sane, sensible instruction concerning the sex organism of woman, its functions, its laws, its use, and its abuse. This important feature of the physical organism plays an all powerful part in the life of every woman, and particularly in the life of the married woman. It is nature’s mechanism for the reproduction of the race. Every child that is born into the world is conceived, gestated, and finally delivered as a result of the functioning of this organism. Therefore, such instruction and knowledge is vitally necessary, not only for the intelligent performance of the duties of parenthood, but also for the best interests of race-preservation, race-culture, and the physical well-being and health of the individual woman.

    And yet, custom and ancient prejudice have drawn the veil over this most important subject, so that it is difficult for the average woman to find practical, clean information concerning her own anatomy and physiological functions concerned with her sex-life. To many it has appeared that the particular organs and parts of the body concerned with the reproductive functions of the woman are base, unclean, and impure, and that any woman discussing them, or seeking information regarding them, must be immoral or at least not “respectable.” Anatomical charts and physiological treatises on the subject are tabooed outside of the doctor’s office. Women are considered immodest if they seek to acquaint themselves with the facts of life concerning one of their most important classes of physical functions. It is considered “not nice” for a young woman to know anything about her physical being in those phases which play the most important part in her life. Can there be anything more ridiculous and insane? This is a matter which excites the most intense surprise, disgust, and despair in the average person possessing a scientific tendency. But the dawn is breaking, and a better day is ahead of the race concerning these things.

    The sex organs of the woman are divided into two classes, as follows: (1) The external organs; and (2) the internal organs. Let us consider each of these classes in turn.

    THE EXTERNAL SEX ORGANS OF THE WOMAN.

    The external sex organs of the woman are as follows: The Mons Veneris; the Labia Majora; the Labia Minora; the Clitoris; the Meatus Urinarius; and the Vaginal Orifice. The term “the Vulva” is applied to the external sex organs of the woman in general, but more particularly to the Labia Majora and the Labia Minora (the larger and smaller “lips,” respectively). The term “Vulva” is the Latin term meaning “folding doors.”

    The Mons Veneris is the fatty eminence or elevation just above the other external organs, which forms a mount from which its name (literally, “The Mount of Venus”) is derived. At puberty it becomes covered with hair.

    The Labia Majora are the large “outer lips” or folds of skin which enclose the Vaginal Orifice, and which are situated just below the Mons Veneris.

    The Labia Minora are the small “inner lips” of folds of membrane, which are concealed within the Labia Majora, or “outer lips,” and are seen only when the latter are parted.

    The Clitoris is a small organ, about an inch in length, situated at the upper part of the Labia Minora or “inner lips,” and usually being partly or wholly covered by the upper borders thereof. At its extremity it has a small rounded enlargement which is extremely sensitive and excitable, and which is the principal seat of sensation in the woman’s sexual organism.

    The Meatus Urinarius is the orifice of the urethra of the woman, the purpose of which is to afford an exit for the urine. It is located about an inch below the Clitoris and is just above the Vaginal Orifice. It is a common error among uninformed women that the urine passes out through the Vagina; but this, of course, is incorrect, as the two canals and their respective orifices are entirely separate from each other, though situated closely together.

    The Vaginal Orifice is the outer entrance to the Vagina, or Vaginal Canal or Channel. This orifice is located just below the Meatus Urinarius. In the virgin it is usually partly closed by what is known as “The Hymen,” (vulgarly known as the “maiden head”), although in many cases the latter is absent even in the case of young girl infants. It was formerly regarded as an infallible sign of virginity, and its absence was regarded as a proof that virginity was lacking. But this old superstition is passing away, for science has shown that the Hymen is often absent even in the case of young children and infants, and, on the other hand, is sometimes present after several years of married life, and even during pregnancy. Much unhappiness has been caused in some cases where the husband has doubted the virginity of his wife because of the absence of the Hymen, but consultation with a capable physician usually removes this misunderstanding.

    The Hymen is a membranous fold, sometimes circular in shape, with an opening in the center, though in other cases it extends only across the lower part of the orifice. The opening in the center is for the purpose of allowing the menstrual blood and the other secretions of Uterus and Vagina to flow through. In a few cases this opening is absent, the Hymen being what is called “imperforate”; in which case the girl experiences difficulty when menstruation begins, and a physician is required to make a slit or opening in it. In some girls and women the Hymen is quite tough, while in others it is very thin and is easily broken. In the latter cases the young girl frequently breaks the membrane during vigorous exercise, such as jumping rope, etc. And, as has before been said, in some cases infant girls are born without even a trace of the Hymen. Under the circumstances, it is seen that the presence or absence of the Hymen is far from being an infallible proof of the presence or absence of virginity, and the belief in the same is now regarded as almost a superstition of the past.

    THE INTERNAL SEX ORGANS OF THE WOMAN.

    The internal sex organs of the woman are as follows: The Vagina; the Uterus and its appendages; the Fallopian Tubes; the Ovaries, and their ligaments, and the round ligaments.

    The Vagina is the canal or channel leading from the Vaginal Orifice to the Uterus or womb. It is situated in front of the rectum, and behind the bladder. In length, it averages from three to five inches; and it curves upward and backward, reaching to the lower part of the neck of the womb, or Uterus, which part of the neck is enclosed by it. It is a strong fibro-muscular structure, lined with mucous membrane; and is not smooth inside, but is arranged in inner folds or rings which are capable of great extension.

    On either side of the Vagina, near the outer orifice, are two small glands, about the size of a pea, which secrete a peculiar fluid, and which are known as the Glands of Bartholine. The office of the Vagina is that of a complementary to the male organ during the copulative process; to also sustain the weight of the Uterus; to also afford a passage for the infant at the time of its birth; and also to serve as a passage for the menstrual fluid.

    The Uterus, or Womb, is the internal sex organ of the woman which serves to hold the fertilized ovum, or egg, from the time of impregnation, during the period of pregnancy during which the ovum develops into the young child, and until the time of the delivery of the child.

    The Uterus is a hollow pear-shaped muscular organ, about three inches in length, nearly an inch thick, and about two inches broad across its upper part, or fundus; the lower part, or cervix, being much narrower. The cervix, or “neck” of the womb, projects into the Vagina, forming the “os uteri,” or “mouth of the womb,” at that point. The Uterus is composed chiefly of a muscular coat, its walls consisting of strong muscular fibres which contract independently of the will, as do similar muscles in the stomach and bladder. These muscular walls are capable of enormous distention during pregnancy. The muscles of the healthy womb are capable of a tremendous pressure and resistance, and are capable of expelling the child with but slight labor at the time of delivery.

    The Uterus is located just behind and slightly above the bladder, and is supported by eight ligaments which, in a healthy condition, hold it firmly and easily in place. Displacements of the Uterus are due to the weakening or relaxing of some or all of these ligaments, generally caused by general weakness or else by excessive physical exercise or labor. The principal Displacements of the Uterus are as follows: Prolapsus, or lowering of the womb in the vagina; Antroversion, or the bending forward of the womb; Anteflexion, or the “doubling up” of the womb forward on itself; Retroversion, or the bending backward of the womb; and Retroflexion, or the “doubling up” of the womb backward on itself. Extreme degrees of the last four mentioned forms of displacement often interfere with impregnation.

    The internal surface of the Uterus is lined with mucous membrane thickly studded with minute hairlike cells which manifest continuous motion. This motion, in the lower part of the womb, is in the direction of the fundus or upper part of the womb; in the upper part of the womb, the motion is in the opposite direction; the purpose of these opposing movements being to carry the male elements toward that portion of the womb into which the Fallopian Tubes discharge the products of the Ovaries, as we shall see presently.

    The Uterus is supplied with follicles around its neck which secrete a very firm, adhesive mucus substance, which serves as a gate or door across the mouth of the womb during the period of pregnancy, and which also serves to prevent the accidental displacement of the ovum or egg. During and just after menstruation, the Uterus becomes enlarged and more vascular. During pregnancy, it largely increases in weight. After delivery, it resumes its normal size, but the cavity is larger than before conception. In old age, it becomes atrophied and denser in structure.

    The Fallopian Tubes are the ducts of the Ovaries, and serve to convey the ova, or eggs, from the Ovaries to the cavity in the Uterus. They are two in number, one on each side, each tube being about four inches in length. They extend from either side of the fundus of the womb, through the broad ligaments which hold them and the Ovaries in position until they communicate with the Ovaries. They are lined with a membrane composed of the same kind of peculiar hair-like cells which are found in the lining of the womb, the purpose in this case being to urge forward the ova or eggs toward the Uterus.

    At the ovarian end of the tubes the latter expand into a fringed, trumpet-shaped extremity, the fringe being known as “the fimbria.” The tubes are only about one-sixteenth of an inch in diameter, and their small caliber makes it easy for them to clog up as the result of slight inflammation, or to become clogged up or sealed at their mouths or openings, thus causing sterility or inability of the woman to conceive. If the tubes are clogged, or sealed up, it of course is impossible for the ova or eggs to reach the uterus.

    The Ovaries are the two oval-shaped bodies lying one on either side of the Uterus. In them the ova, or eggs, are formed. They are each about one and one-half inches long, about one inch wide, and about one-half an inch thick. In addition to their attachment to the broad ligament, they are held in position by folds or ligaments running to the fundus of the Uterus and to the fimbriated extremities of the Fallopian Tubes. The Ovaries are covered by a dense, firm coating which encloses a soft fibrous tissue, abundantly supplied with blood-vessels, which is called the stroma. Imbedded in the mesh-like tissue of the stroma are found numerous small, round, transparent vesicles, in various stages of development, known as the Graafian follicles, which are lined with a layer of peculiar granular cells. These Graafian follicles are the receptacles or sacs which contain the ova, or eggs, which constitute the female reproductive germ. Each vesicle contains a single ovum or egg.

    Summary.

    From the foregoing, it is seen that we may enumerate the sex organs of the woman as follows, proceeding from the external to the internal organism: First, the Mons Veneris, or prominent eminence above the more important external sex organs; then the Labia Majora, or large outer “lips” or folds, which are plainly discernable to the ordinary view; then the Labia Minora, or smaller inner “lips” or folds, and the Clitoris or small sensitive organ, and the Meatus Urinarius or urinary orifice, all of which are discernable only when the folds of the Labia Majora are parted or opened. Then, proceeding upward and backward from the Vaginal Orifice, we find the Vagina, or channel or canal leading to the Uterus or Womb; then we find the Uterus or Womb at the upper end of the canal or channel of the Vagina. Then extending from either side of the Uterus or Womb we find those two important sets of organs known as the Fallopian Tubes, and the Ovaries, respectively. The Ovaries discharge their ova, or eggs, into the Fallopian Tubes, from whence they are conveyed to the Uterus or Womb, with which the tubes are connected and into which they open at its upper and large end.

    The Pelvis is that bony arch in the cavity of which are contained the internal sex organs of the woman. The Pelvis is a bony basin which holds and supports the pelvic organs, and is composed of three important parts, as follows: (1) The Sacrum, consisting of five sections of the vertebral column, or spine, fused together so as to constitute the solid part of the lower spine and the back of the Pelvis; (2) the two Hip-Bones, one on each side of the Pelvis; (3) the Pubic Arch, or the front part of the Pelvis, formed by the junction of the two Hip-Bones in front. Attached to the Hip-Bones are the thighs, and also the large Gluteal Muscles which constitute the buttocks, or “seat.”

    The Pelvis of the woman is quite different from that of the man. It is shallower and wider, and lighter in structure than that of the male, and the margins of the Hip-Bones are more widely separated, thus making the hips of the woman far more prominent than those of the man. Also, the Sacrum is shorter than that of the man, and the Pubic Arch wider and more rounded than his. This difference in the bony structure is made necessary by the demand for larger space in the female Pelvis required for the purposes of childbirth. These differences are not so perceptible in childhood, but become marked and pronounced at puberty.

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

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

    Sex Advice to Women

    In this book the writer thereof seeks to convey to women—particularly to young wives and women expecting to be married—certain important facts of knowledge, certain necessary information, which all such women should possess, but which few are given the opportunity to acquire.

    It would seem to require no argument to convince a rational individual that before a woman is capable of intelligent motherhood she should be made acquainted with the physiological processes which are involved in the sexual functions leading to the state of motherhood; but we are confronted by the fact that few young women are given such instruction.

    It is a strange thing that while even the ordinary school child is made acquainted with the physiological processes concerned with the processes of digestion, respiration, circulation, elimination, etc., and while such education is highly commended, yet at the same time not only are the young of both sexes reared as if there was no such thing as sexual functions in existence, but even full-grown adults are left to pick up their instruction on sexual subjects from chance sources—often polluted sources.

    Even those about to enter into the important offices of matrimony and parenthood are permitted to assume those duties and responsibilities without intelligent and scientific information or knowledge being given them. What would we think of expecting a woman to cook, without previous experience and without even the most elementary instruction on the subject? What would we think of expecting any person to undertake any important task or duty without experience or instruction regarding the same? And yet we seem content to allow young women to enter into the important relationship of marriage, and to undertake the important office of motherhood, often in absolute ignorance of the physiological processes involved, and the physical laws governing the same.

    All this absurd practice and custom results simply from the antiquated notion that it is “not nice” to speak or think of the subject of the sex functions. The subject has been considered “taboo” by our particular section of the human race since the Middle Ages, because the ascetic ideals of that dark period of human history brought forward a totally false and unnatural conception of sex as fundamentally impure. If the results were not so deplorable and often tragic, this condition of affairs would be a fit subject for laughter and scornful ridicule. But, alas! on the part of the thoughtful observer of this state of things there is rather great wonder and amazement accompanied by the feeling of deep sorrow.

    It cannot be honestly denied that in our present age, and period of modern civilization, and particularly among the Anglo-Saxon branch of the race, the question of the sex functions is associated with impurity, at least so far as the popular mind is concerned. In previous civilizations the subject was accorded its proper place, and was discussed sanely and thoughtfully, without any sense of shame or impurity. The Middle Age ideals of celibacy and asceticism brought about the public conception of the human body as a thing impure—something to be modified, tortured, subdued and reviled; and a corresponding conception of sex as a vile, impure thing above which the pure in heart rose entirely and completely, and which those of a lesser spiritual ideal were permitted to indulge with a due sense of their degradation and weakness. It was considered a most worthy thing to lead an ascetic life with its accompaniment of disdain and punishment of the body. It was considered most pious and spiritual to forego the ordinary human relations of sex, marriage and parenthood. From these distorted conceptions naturally evolved the idea that sex, and all connected with it, was a subject unclean and impure in itself, and to be avoided in thought, conversation and writing. Not only the ordinary sex relations of human life were placed under this taboo, but also the phenomena of birth and parenthood. Not only did these incidents of life grow to be considered impure, but they became that which to many was still worse, that is to say, they became to be regarded as “not respectable.”

    Ignorance regarding the plain elementary facts of sexual physiology is undoubtedly the cause not only of much immorality among young people of both sexes, but also of many unhappy and inharmonious marriages. The intelligent portion of our race is now beginning to realize very keenly the fact that the first requisite of sane marital relations and intelligent parenthood is a practical and clear knowledge of the physiology of sex; education concerning the sexual organism, its laws, its functions, its normal and healthy conditions, its anatomy, its physiology and hygiene.

    The average physician of experience in general or special practice can tell tales of almost incredible ignorance on the part of young women who have recently entered into the relationship of marriage. In some cases the ignorance is more than a mere absence of knowledge—it consists too often of false-knowledge, untruthful ideas concerning matters of the most serious import. It is sad enough to think how such persons may work results harmful to themselves, but it is even sadder still to realize that these same ignorant young women must eventually gain their real knowledge through sad experience—experience paid for not only by themselves but also by their children. It is a hard saying, but a true one, that the knowledge of many young wives and mothers is to be gained by experience paid for by their (as yet) unborn children.

    The writer of the present work is one of the rapidly growing number of thinking persons who believe that the time has come to educate the race concerning the importance of sane instruction concerning the functions of sex. He, and those who think as he does, believe that the time has come to “Turn on the Light!” They believe that the importance of the subject will be realized by all intelligent persons, once that their attention is directed to the subject, and once they have considered it apart from the old prejudices and distorted customs. When public opinion on this subject is reformed, then will the taboo fall away from the body of truth; then will the subject take its place among the “respectable” topics which may be considered, discussed, and taught, without loss of caste or prestige.

    In a few decades, perhaps even much sooner, it will be regarded as quite reprehensible to permit young persons to enter into the relationship of marriage without a sane, practical knowledge of their own reproductive organism and the functions thereof, and of their physiological duties to themselves, to their companions in marriage, and to their children born or to be born. We may even see the practical application of the somewhat startling prophecy of Newell Dwight Hillis, D. D., who said: “The State that makes a man study two years before a license as druggist is given; that makes a young lawyer or doctor study three years before being permitted to practice; ought to ask the young man or young woman to pass an equally rigid examination before license is given to found an American home, and set up an American family.”

    While the information above alluded to should be given alike to the young husband and the young wife, it cannot be doubted that the latter is the one of the pair who is most in need of this kind of instruction. While both the young man and the young woman require this instruction, the need is the greater in the case of the young woman, by the very nature of the case. The sex functions and processes play a much more important part in the life of the woman than in that of the man, the protests of some of the modern feminists to the contrary notwithstanding. The careful student of the sex life of men and women frankly confesses that in both the physical and the psychical realm the sex offices make a greater demand upon the time and attention of the woman than of the man.

    The love-life of the woman is far fuller and more absorbing than is that of the man. Unhappiness concerning her love-life renders the remainder of the life of the average woman of comparatively little account; while, with a happy love-life she will put up cheerfully with the absence of many other things which are usually regarded as necessities for happiness. As a writer has said: “Essentially, a woman is made for love—not exclusively, but essentially; and a woman who has had no love in her life has been a failure.”

    The same rule operates on the physical plane. As the same writer has said: “Physically, the woman is also much more cognizant of her sex and much more hampered by the manifestation of her sex nature than man is.” The manifestation of the incidents of menstruation is a constant reminder to the woman that she is a creature of sex. The phenomenon of pregnancy is, likewise, something from which the man is free. And, finally, the menopause, or “change of life,” with its incidents greatly influencing the physical, mental, and emotional well-being of the woman, is Nature’s final word to the woman that she is the active pole of sex-life. As the above-quoted writer has said: “Altogether it cannot be denied that woman is much more a slave of her sex-nature than man is of his. Nature has handicapped woman much more heavily than she has man.”

    And so, in this book, the young woman—the young wife—is directly addressed, her companion and mate being referred to only indirectly.

    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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