ADDRESS TO MEDICAL WOMEN
Having been invited to speak to you on ‘The Responsibility of Women Physicians in relation to the Contagious Diseases Act,’ I have considered it a duty to accept this invitation for several reasons.
It is twenty-seven years since my attention was first imperatively called by our philanthropist, Miss Mary Carpenter, to the subject of regulating or organizing the immorality of women. Since that time I have necessarily given much thought to this subject.
I have always felt that the National Repeal Societies made a mistake in relaxing effort after the first check which the Contagious Diseases Acts suffered in 1886. The fact that, in a House of 670 members, only 245 voted on the side of a great moral question, and that 289 absented themselves, was worthy of note. It showed that the great campaign against perverted sex was then only beginning. After that first defeat the mighty forces of evil, of selfishness, of ignorance, of timidity, of hypocrisy, and of lust were sure to rally, and many genuine but short-sighted philanthropists, seeing the shocking results of unrestrained evil, would grope about for a remedy, and probably again be misled by a plausible but impossible method of cure.
On studying carefully the important Government Reports just published—viz., Representations from the Royal College of Physicians, from the Secretary of State for India, from the Departmental Committee, from the Army Sanitary Commission, and from Lord George Hamilton’s despatch—I recognised more fully than ever before the great and growing danger which is arising from sexual vice. That danger exists, not only through our army in India, but also through the present condition of all standing armies. Thus, by the systematic perversion of the sexual instinct, the gradual destruction of so-called Christian civilization is taking place.
I felt, moreover, that the reference made in these Reports to the employment and training of women in India to examine and treat Indian prostitutes in the military hospitals under the medical officer demanded the notice of women physicians.
Since 1870 a body of highly educated and reliable women physicians has grown up in Great Britain and Ireland—a body recognised by the State as of equal standing with their professional brethren. During that period also a most important and beneficent medical movement for the help of our Indian sisters has been established in India, known as the Dufferin Fund, and promoted by our European women physicians. All women physicians willingly help the most degraded persons who voluntarily seek their help. But any proposition that women should be medically trained in order to prepare the most helpless class of Her Majesty’s subjects—poor Indian women—for the use of vicious soldiers would be so gross an insult, as well as extreme folly, that I felt sure that the responsible gentlemen who authorized the Government Reports could not realize the meaning of their suggestion. But it laid upon disciplined and far-seeing medical women, who must carefully consider any practical measures which concern the relation of the sexes, the imperative duty of helping in the solution of an urgent and most difficult problem.
It is for these reasons that, as the oldest woman physician, I have thought it right to accept this invitation, and I earnestly desire to be aided in what I may suggest by the serious thought of every experienced physician.
I propose to say a few words under the three following heads:
1st. On the growing and dangerous character of this sexual evil, which produces venereal disease.
2nd. On the error of Governments in their endeavours to cope with disease.
3rd. On the right principle which must guide all practical methods of dealing with it.
I.
On the Gravity of the Evil of Venereal Disease.
The Royal College of Physicians—our highest medical authority—makes the following statement:
‘The increase of venereal disease appears to us to be a matter of serious moment, and to call for the gravest consideration. The constitutional form of the disease is one of the most serious, insidious, and lasting of all the contagious diseases that afflict humanity. Other contagious complaints—e.g., smallpox or scarlatina—are transmissible only for a limited time, and not by inheritance. With syphilitic disease it is far otherwise: it is the most lasting in its effects, and most varied in the character of its specific manifestations; it frequently gives rise to consequences far removed from its initial symptoms, most seriously implicating and affecting various organs of the body; it complicates other diseases; its contagious properties extend over lengthened periods of time, during which the sufferers are often a source of danger to innocent people, while they may be, and frequently are as parents, the source whence specific infection is transmitted to their children....
‘About 13,000 soldiers return to England from India ever year, and of these, in 1894, over 60 per cent. had suffered from some form of venereal disease.’[7]
Lord George Hamilton’s despatch quotes from a War Office Report:
‘Of the fatal character of this form of disease’ (syphilis) ‘the committee, after a visit to the military hospital at Netley, where invalids from India are sent for treatment, have drawn a dreadful picture. During their short term of military service a great part (in some cases more than half) of their time has been spent in hospital, either in India or at home. Before reaching the age of twenty-five years these young men have come home presenting a most shocking appearance: some lay there having obviously but a short time to live; others were unrecognisable from disfigurement by reason of the destruction of their features, or had lost their palates, their eyesight, or their sense of hearing; others, again, were in a state of extreme emaciation, their joints distorted and diseased. Not a few are time-expired, but cannot be discharged in their present condition, incapacitated as they are to earn their livelihood, and in a condition so repulsive they could not mix with their fellow-men. Their friends and relatives refuse to receive them, and it is inexpedient to discharge them only to seek the asylum of the poor-house, so they remain at Netley in increasing numbers.’
The Government Departmental Committee (p. 11) uses almost the very words of the French surgeon Diday, who, in writing some years ago of the dangerous prevalence of venereal disease, so widespread in Paris, warns his readers how this most insidious disease may be spread by ordinary contact, by wet-nurses to infants, or by infants to nurses, by public conveniences, by unsuspected touch, and even by the kiss of relations.
These reports show that wherever a standing army exists, either in Europe or America, whether in temperate or tropical climates, at home or abroad, there exists a focus of the most insidious and dangerous diseases that afflict human beings—diseases which specially injure the procreative power, and which are annually spread in varying amounts amongst the civil population, notwithstanding the most rigorous measures which the wit of the military mind has been able to devise—measures which often trample under foot every principle of justice and mercy.
When we consider also that not only are the standing armies of every civilized country nurseries of the various forms of venereal disease, but that the same dangerous diseases prevail in all our large towns, the gravity of this scourge, which is sapping the vitality of Christendom, is evident.
The more careful study of venereal disease in its two forms of gonorrhœa and syphilis is especially incumbent upon women physicians, on account of the result of important modern researches. These show that many of the female complaints which have so largely increased, and which we are naturally called upon to treat, are now considered by experienced and clear-headed physicians to be often due to gonorrhœal infection derived from husbands of former loose life—infection conveyed either directly or from recrudescent and insidious forms of trouble hitherto unsuspected.[8]
II.
The Errors of Official Bodies in dealing with this Subject.
Before I venture to criticise any procedure or suggestion of the Government, I ask your consideration of certain scientific axioms which must be laid down as necessary data before any wise course of practical action can be initiated with rational hope of success. The first refers to the causes of disease.
Axiom 1.
‘In combating serious disease it is essential to ascertain the chief cause of the disease, which must be directly attacked and steadily removed, or no cure is possible.’
We may as well expect to cure typhoid fever whilst allowing sewer gas to permeate the house, or cholera whilst bad drinking-water is being taken, as try to cure venereal disease whilst its chief cause remains unchecked.
I shall show later that Promiscuous Intercourse, or the resort of many men to one woman, is a prolific source of venereal disease.
The second axiom refers to the physiological rank and scope of our human faculties.
Axiom 2.
‘The sexual organs are not essential to individual life, although they are essential to the continuance of the race. Neither is their full exercise by sexual congress indispensable to individual health.’
The blind obstinacy with which these scientific facts are ignored in education, in social sentiment, and in Government organizations, is a potent cause of national degeneracy, of impaired procreative power, and enfeebled offspring.
Hunger is the primary instinct and indispensable condition of human life. It is that which insures the continuance of the individual. The sexual instinct, with all its grand power to perpetuate the race, is only a later development, growing with the unfolding of the intellectual and moral nature. It is shared equally under varying aspects by each of the two necessary factors in procreation, woman as well as man.
This fact of the powerful sexual attraction necessarily existent and dominating in woman, as mother of the race, seems to be quite overlooked. In any true meaning of the word ‘strength,’ this potent social force in women demands far more serious study than it has yet received, although it may exhibit itself in less spasmodic form than in men.[9]
There are two branches of the medical art which urgently require fuller consideration. These are:
1st. The physiological life of the organs of generation in both men and women.
2nd. The immense influence which the mind can exercise over the body in controlling disease.
The susceptibility of our sexual nature to mental control and direction to noble ends is a great and encouraging scientific truth.
From these data of true physiology the possibility of continence is evident. With further physiological study, its great advantage, up to the full consolidated adult age, can be proved. By scientific study of the biological facts that underlie these data, it can be shown from positive medical experience that promiscuous intercourse between the sexes, or the resort of many men to the same woman, cannot be made physically safe. The gradual elimination of this destructive practice is essential to the progress of the race.
These statements are supported both by historical experience and sound medical knowledge.
The human race, in advancing through lower stages of development, passes from polygamy and concubinage to the higher state of Christian marriage. The scientific basis which underlies this advance has not yet been realized.
Polygamy, although morally degrading to both parties from its injustice, tyranny, and impairment of vigour, does not produce the special physical curse of syphilitic disease.
But promiscuous intercourse inevitably tends to give rise to varying forms of venereal disease, no matter what precautions may be taken.
In the female subject, irritation, congestion, or inflammation of the parts are the result of unnatural repetition of the sexual act. By such irritation the natural and healthy secretions of those organs are rendered morbid.
The natural secretions of the male organs also become morbid in licentious men, developing into blennorrhagia, or purulent gonorrhœa, and thus the danger of promiscuity is intensified.
Neither is it possible, when such injurious practices are allowed, to cleanse or disinfect the female parts as if they were a plane surface. The woman’s structure is designed for the passage of a child’s head. It is consequently composed of immensely distensible or elastic tissue, forming folds or rugæ, which may retain diseased products. It is also abundantly supplied with active secretory and absorbent glands, whose action may become unhealthy.
The special danger of specific disease also arising from the congress of different races is a well-known fact. The alarming epidemic of venereal disease, which spread like the plague through Europe in the fifteenth century, was brought from America by the licentious conquerors of Peru. This gravest form of racial injury is now being emphasized by the contrast between the condition of our white and coloured troops in India.
Although medical investigation has failed to determine precisely the originating cause of the specific virus which produces the form of venereal disease named syphilis, yet it is always connected more or less directly with promiscuous intercourse, especially with the advance of armies.[10]
We know, however, that morbid changes may take place in the natural secretions of the male and female organs under impure sexual intercourse, leading to advanced forms of degeneration in the various results of gonorrhœa, producing, particularly when the epidermis is abraded, sores, ulcers, etc. And the poison of diseased secretion is thus conveyed from one to the other partner in vice.
Nor can the presence of infectivity, once acquired, be detected by inspection; and no infected immoral person, still carrying on impure sexual relations, can ever be pronounced healthy or ‘sound’ by means of examination or ocular investigation. Neither can the absence of the so-called venereal germ gonococcus be relied on as proving health. Its specific significance is denied by many competent investigators, and it is absent in some of the worst forms of disease.
‘Mediate contagion’ is also an important and well-established medical fact. Thus a famous French harlot, called ‘Casse-noix,’ presented none of the grosser signs of venereal disease, yet continued to infect the men who resorted to her.
When to the difficulty of pronouncing the parts with their secretions healthy, is added the existence of uncleanliness, of drunkenness, etc., in either party, the danger of these promiscuous relations is evident.
Now, these positive medical facts appear to be unknown in their full significance to our Government advisers, judging from the latest reports and proposals with regard to disease in the Indian army, which seemed designed to allay national panic rather than to reach the source of the evil. A mistake was certainly made by Government in withdrawing a subject of such vital importance to the nation, from full consideration by our Parliamentary representatives, on account of its painful character. The consequence is that an active but irresponsible Press has thrown a mass of unsifted and shocking statistics broadcast amongst the people, creating widespread alarm.
The army statistics imperatively demand a far more searching examination, both into facts and their causes, than has yet been given, before rational or permanent legislation can be adopted. Any thoughtful person examining the reports referred to, will see that such facts as the following require elucidation: the actual number of individuals affected (not the repeated return of the same soldier) and the varying category of their complaints; the variations in different cantonments, with the causes of such difference; the effect produced by the introduction of the short-service system and by increased restrictions on marriage; the closure of voluntary hospitals and dispensaries; the influence of malaria and tropical climate on the constitution; the mixture of different races; and the causes which have produced the improved health results which are obtained in the army in England.
These points have not been sufficiently investigated by unprejudiced inquiry. The well-meaning effort of Government to meet a very serious state of things must inevitably fail, because the necessary bases for legislation are not yet established.
It is clear that, until all these essential facts have been carefully looked into by a competent Commission and the results presented to Parliament, no legislation—which apparently destroys the foundations of morality, which perverts and weakens our youth, and which, under the misleading phrase ‘voluntary submission,’ reduces our helpless Indian sisters to virtual slavery of the most destructive character—can be permanently accepted by the British nation. We must look forward, therefore, to a longer and more arduous struggle than the one that was prematurely quieted in 1888. Neither can the struggle between right and wrong methods of practical action be confined to our Indian army. It concerns our work in Great Britain as well as in India and in Africa. The dire diseases in question are connected with all large towns as well as with every military station, and as physicians we must study them in these two relations.
III.
On the Principle which must guide all Practical Methods of dealing with Venereal Diseases in the Army.
On this vast subject I can only refer to-day to two practical methods of gradually extirpating venereal disease from our army in India.
The first is the steady discouragement by Government of promiscuous intercourse.
The second is the removal of the idleness which curses our soldiery in an army of occupation.
The first indispensable condition in the prevention of disease is the steady discouragement of promiscuous intercourse.
Now, I assert positively that such discouragement has never been seriously and steadily tried in the army by Government, but only by unofficial efforts—efforts which are most valuable, but which are entirely lacking in the force of organization and in the important recognition and help which Government alone can afford.
In the ‘Memorandum of the Army Sanitary Commission,’ No. 2, published this year, on the first page appears the following noteworthy statement—so utterly misleading as to amount to virtual falsehood:
‘The efforts to teach the soldiers habits of self-control having so signally failed, those responsible for the maintenance of the efficiency of the army in India may well be excused if they look about for some effective means of arresting the progress of the disease and preserving their battalions fit for service.’
Now, what are the Government efforts here referred to which are said to have failed?
In examining the circulars issued from the Quartermaster-General’s Department from 1870 to 1884 for the adoption of stringent measures ‘to reduce the chances of venereal disease,’ it is found that the recommendation consists in instructing the soldiers how to cleanse themselves after dangerous sexual indulgence! No circular is issued from the Quartermaster’s Department requiring that the soldier shall be taught how to control his ignorant instincts and honouring such control (that is left to scattered individual effort), but official instruction is confined to the vain endeavour of teaching him how to satisfy lust without extreme risk! Surely this is adding hypocrisy to culpable disregard of the national welfare.
It is encouragement to continence which the young soldier needs; and remember that numbers of these soldiers are enlisted between eighteen and twenty-five years of age—an age when every physician knows that the male organization is being consolidated, and when continence is invaluable in helping the physical forces to build up a fine strong manhood. Encouragement to self-control, therefore, must be afforded from the soldier’s first introduction to Her Majesty’s service.
It must begin with the recruiting sergeants, who should be moral men, and understand that continence in the soldiers will be regarded with the highest honour, as preservative of physical efficiency and moral bravery.
The inspectors of recruits, and especially the medical staff, must give the important instructions needed by soldiers of how to restrain their passions.
The sexual organs are not a permissible subject of trade, and purchase of the female body should be discouraged in all the manifestations that official influence or human law can legitimately reach. The army surgeons must themselves know the physical reasons why the practice of immorality can never be rendered safe, and by object-lessons taken from the military hospitals they can teach ignorant soldiers that no death is to be feared in comparison with the shocking results of incontinence. They can indicate the rational means of physical exercise and mental discipline by which the eager passions of youth can be controlled, whilst at the same time they insist upon the necessity of a non-stimulating diet in tropical climates.
The chaplains of the army have the next and still higher duty to perform towards each undisciplined youth who is given up body and soul to the absolute direction of the army authorities. No chaplain should be appointed to our Indian army who is not only himself a moral man, but who has also learned the physical possibility and immense advantage of self-control, and is thus able from the basis of physiological knowledge to rise to the higher plane of religious instruction. Without such physiological knowledge, as a sound support of well-grounded spiritual faith, his sacred calling may seem a badge of hypocrisy, more deadly and destructive from the profound responsibility of the position which he has ventured to fill.
The immense influence which commanding officers may exert by their own example and sympathy cannot be enlarged on here. But until such influences are brought to bear on the recruits by the Government, it is not true to state that efforts to teach self-control have signally failed, for they have not been made.[11]
Our responsibilities to the people of India, where England has become the paramount Power, are very weighty. These responsibilities are due to its women as well as to its men. It is stated that, according to the last census, there were the enormous number of 38,047,354 girls under fifteen years of age in our Indian Empire. What is the duty of a Christian Government to this helpless mass of human beings? The formation of poor young Indian women into a class purchasable by white soldiers—a class despised by their own people, with no refuge before them, but when used up turned out to die—is a dire and dastardly disgrace to any Government calling itself civilized. The removal of temptation by forbidding our soldiers to purchase our young Indian sisters, and, if necessary, excluding them entirely from the cantonment, is a distinct duty on the part of any Government that seriously means to banish venereal disease from our army.
The second urgent preventive measure which should engage our military authorities is the removal of that dangerous idleness which is a constant temptation to the soldiers through so many weary hours of every day. This subject can only be referred to here, for, although of extreme importance, its practicability and adaptations must first of all be thoroughly discussed by military men intimately acquainted with the exigencies of army life. But it is a paramount duty to provide constant useful employment and healthy recreation for our soldiers in every army of occupation, during the cooler hours of the evening in tropical climates, when such employment becomes possible as well as imperative.
The remarkable organization of an army is the most powerful training-school, in good or evil, for the poorer classes of men, that we possess. The conversion of an army of occupation into a school of the industrial arts needed in its maintenance—with rewards for industry, sobriety, and self-control—must surely be in the power of any Government that resolutely determines to accomplish such a noble transformation. The saving in health and even in money would be a great economic gain. The Government that carried out such a grand result would be a mighty benefactor to our race.
It is impossible now to go fully into the various branches of this vital subject, but I would say to my younger medical sisters, who will carry on here the grand work of medicine when I have entered upon another sphere of life, that I most earnestly counsel them to recognise that the redemption of our sexual relations from evil to good, rests more imperatively upon them than upon any other single class of society. It will be a cowardly dereliction of duty to refuse any longer to study this grave subject of venereal disease now again forced upon our attention, because the subject—which concerns both sexes equally—is a repulsive one.
To us medical women, the special guardians of home life, has been opened the path of scientific medical knowledge, which, as science, embraces both mind and body; and it is by our advance, independently but reverently, in that path, guided by our God-given womanly conscience, that we shall be able to detect clearly the errors in relation to sex, which lie at the root of our present degeneracy.
It is not conspicuous public action that is required from us, but the thorough realization of true physiology.
We must ourselves recognise the truth, and instruct parents, that it is a physiological untruth to suppose that sexual congress is indispensable to male health. We must warn our young men that no loose woman picked up in the streets, or in a brothel, or in her own house, can be pronounced physically safe, no matter how attractive she may seem to be. We must warn our poor young women patients that yielding to the solicitations of a supposed lover may unfit them to become healthy wives and mothers. We must persistently arouse the conscience of parents to the very grave risks that their daughters run in uniting themselves to men of former loose life.
This is the confidential but imperative duty of true physicians. It is by quiet but never-ceasing effort to spread the true view of scientific medicine amongst our patients, and wherever the opportunity occurs, that our influence as Christian physicians will gradually permeate society, and cause truth to prevail over error.
If you perceive that the principles I have laid down are sound, then hold to them firmly as the most precious truth.
Meet together to mature practical applications of those principles by intercommunication of experience and mutual encouragement, feeling sure that where two or three meet together in the everlasting Spirit of the Christ, you will find, as I have found during a long life, that light and strength will be given you, and as earnest followers of the Great Physician you will take part in that mighty work of regeneration, which from our present small beginnings will, I fully believe, grow and transfigure the twentieth century.