The sexual question

by Auguste Forel

There is no need, however, to be too severe. Medical men are often pessimists, and have a tendency to see disease everywhere and to give a grave prognosis. The procreation of children should not be prohibited simply because there is insanity in some member of the family, but the probabilities of hereditary transmission should be calculated in the way we have explained in the first chapter of this book.

Taking into consideration the bodily and mental health and the character of the two candidates for marriage, as well as that of their ancestry, the physician should consider what is likely to be the average quality of children from such a marriage. According as his calculation leads to a probability above or below the average of the population, from all the points of view of the social value of man, he will advise the parties concerned as to freedom or limitation in procreation.

The average of humanity must not be placed too high, and the physician should always keep in mind the great mental mediocrity, weakness of will, the low moral level and physical defects of the bulk of the population.

When persons who are intelligent and educated, but more or less psychopathic or hereditarily tainted, put questions of this kind to the doctor, because they are very conscientious and prudent, they should be recommended to lead a healthy life and avoid alcohol, but need not remain sterile, for their offspring may be morally and intellectually above the average, and if all blastophthoric influences are avoided there is a possibility or even probability of gradual regeneration. In short, the doctor must treat each case on its own merits, carefully weigh both sides of the question, and avoid being influenced by exclusive dogmas of any kind. Thus only can he give wise and useful advice.

What is of especial importance for us, is the knowledge that it is not necessary, from the point of view of social hygiene, to prohibit marriage for the sole reason that the offspring may be of bad quality. We can allow psychopaths with hereditary taints, or even invalids of both sexes, to contract sterile marriages, by requiring them to avoid conception by some means or other, in the name of social hygiene and morality. In such cases dislocation of the tubes has a definite effect, and if we consider the negligence and weakness of mind of such individuals, we should do well to recommend this proceeding whenever there is a clear indication for inducing sterility. In this way we avoid cruel measures, which, by the way, are almost impracticable, which take away all hope of love and happiness from these unfortunates, throw them into the arms of prostitution or bitter pessimism, and make them disgusted with their own existence.

Medical Secrecy.—Medical secrecy and its limitation is a very delicate question, especially in sexual matters. Opinions vary in different countries and among different individuals. In France medical secrecy is almost made an idol; the medical man may refuse to give evidence in a court of law and even conceal a crime. In Germanic countries, on the contrary, especially in German Switzerland, too little importance is attached to medical secrecy. In short, medical secrecy is an elastic idea which is open to different interpretations.

Although certain particular cases may present great difficulties, there is a middle course of moral conduct which will serve the purpose of every conscientious doctor. As a general rule the doctor's duty is to keep secret everything confided to him by his patients, except when the patients themselves speak openly of it, or authorize their doctor to do so. There are, however, exceptions to this rule.

First of all it assumes normal responsibility in the patient, and is only conditional among irresponsibles. When a lunatic, for example, relates to a doctor, under the seal of secrecy, certain things which depend on delirious ideas and which threaten the safety of others, or which render certain measures necessary in the patients' own interest, the doctor's duty is to make known the state of affairs, but only to responsible persons. It is the same as regards children. It is needless to say that the doctor should use all possible measures in the interest of the patient or child.

But even with responsible persons medical secrecy has its limits. The doctor is here only bound to secrecy so far as it does not injure the rights of other individuals, or those of society.

It is the duty of a medical man to report all cases of smallpox or cholera, etc., even against the consent of the patient, and to isolate the latter to avoid an epidemic, which is contradictory to medical secrecy. In short, he must not, under the pretext of medical secrecy, become an accomplice of harmful acts or crimes. I will mention a few examples bearing on the sexual question: