The sexual question

by Auguste Forel

In women the results of gonorrhea are, if possible, still worse than in men, because it is more difficult to cure. A prostitute affected with gonorrhea may infect an enormous number of men, and in this case medical inspection of brothels is no guarantee. The gonococci are concealed in all the corners and folds of the internal genital organs of woman, where they set up inflammation of the womb, the Fallopian tubes and even the ovaries, which may lead to adhesions between the abdominal organs. Women affected with chronic gonorrhea generally become sterile. When the womb and the ovaries are affected there is much suffering and the woman may be confined to bed for some years. Stricture of the urethra and inflammation of the bladder are more rare in women than in men, as the result of gonorrhea.

But gonorrhea is not confined to the adults of both sexes. The innocent child, who at birth has to pass through its mother's vulva, when this is affected with gonorrhea, undergoes a baptism of gonococci which attack the conjunctiva of the eyes and set up a severe purulent inflammation, called ophthalmia of the newly born (ophthalmia neonatorum). This is one of the chief causes of total blindness, and if the child is not entirely blind, there are often large white patches left on the cornea which considerably interfere with sight. Gonorrheal ophthalmia may also occur in adults by conveying pus from the urethra to the eyes by the fingers.

Syphilis.—This disease is still more formidable than gonorrhea. It is caused by a microbe which has been recently discovered (Spirochæta pallida). Syphilis is much more chronic than gonorrhea and commences with a small sore indurated at its base and called the hard chancre. This is situated on the genital organs or elsewhere; in the mouth, for instance, when this has been in contact with the buccal or genital organs of a person infected with syphilis. The syphilitic poison spreads through the body by means of the blood and lymph. At the end of a few weeks eruptions appear on the body and face, and then commences a series of disasters the cause of which may be suspended over the victim for his whole life, like the sword of Damocles, even when he believes himself cured; for the cure of syphilis is often uncertain. This disease may remain latent for months and years, to reappear later on in different organs and cause fresh lesions.

Syphilis causes ulcers of the skin and mucous membranes; it sometimes causes decay of the bones; it may cause disease of the internal organs, such as the liver and lungs; it affects the walls of the blood vessels, causing them to become hard and brittle (atheroma); it causes disease of the eyes, especially of the iris and retina, tumors (or gummata) in the brain, paralysis etc. In fact, it spares none of the organs of the body.

Among the most terrible results of syphilis we must mention locomotor ataxy (sclerosis of the posterior columns of the spinal cord), with its lightning pains and paralysis of the legs and arms; also general paralysis of the insane, which by causing gradual atrophy of the brain, destroys one after the other, sensations, movements and all the mental faculties. These two diseases, which are so common at the present day, only occur in old syphilitics, five to twenty years, or more often ten to fifteen years after infection, and as a rule in persons who think they have been completely cured. Both these diseases are fatal. Before causing death, locomotor ataxy causes intolerable pain for several years. General paralysis first gives rise to grandiose ideas, and after disintegrating the human personality bit by bit, ends by transforming the individual into a being much inferior to animals, and of an aspect as miserable as it is repulsive. A general paralytic in his last stage is little more than a vegetating ruin, in whom the nervous activities are decomposed little by little, after the gradual disappearance of all the mental faculties. This is the result of slow atrophy of the brain and gradual destruction of its microscopic elements, or neurones.

The early stages of syphilis may easily pass unnoticed owing to their partly latent and completely painless character. Small eruptions may be mistaken for other affections, and mercurial treatment generally disperses the symptoms of primary and secondary syphilis. But syphilitics who are apparently cured are never safe from being attacked, after perhaps many years, with locomotor ataxy, general paralysis or the tertiary or quaternary manifestations of syphilis, such as disease of the bones, internal organs, eyes, brain, etc. The sores of the first two or three years of syphilis are contagious but painless, and hence do not prevent coitus when they occur in the genitals. After three years syphilis becomes less contagious, but there is no definite time limit and cases have been recorded in which contagious lesions occurred ten or fifteen years after the onset of the disease.

A syphilitic man may transmit the disease to his children without infecting his wife, and these children may die before birth or may be born with congenital syphilis. This is due to the spermatozoa being infected with syphilis. However, this is fortunately not always the case, for many cured syphilitics have healthy children. A child affected with congenital syphilis (from the father) may infect the mother during pregnancy; this is called "syphilis by conception." Congenital syphilis may also cause locomotor ataxy and general paralysis.

It is difficult to enumerate all the infirmities which syphilis in the parents may transmit to the children. Syphilis often renders marriage sterile. It is more frequent in men than in women, because the number of prostitutes is small compared with the number of men who go with them; a single prostitute may contaminate a whole regiment. On their part, the clients of prostitutes convey gonorrhea and syphilis to their wives, thus spreading in society this abominable plague and all the evils resulting from it.

Soft Chancre.—The third kind of venereal disease is the soft chancre, thus called in distinction to hard chancre, which is the primary sore of syphilis. Soft chancre is the least dangerous and the least common of the three diseases. It consists of an ulcer which remains localized to the genital organs (unless it is complicated with syphilis, which is frequent). The ulcerated parts are destroyed, but the sore heals generally without trouble.

Venereal diseases constitute one of the worst satellites of the sexual appetite. If men were not so ignorant and careless, it would be on the whole easy to avoid them and cause their gradual disappearance. One of the most absurd and infamous organizations which can be imagined is that of the State regulation of prostitution which, under the pretext of hygiene, compels prostitutes to be registered by the police or to live in brothels. They then undergo regular medical examination, the object of which is to prevent those who are diseased from practicing their trade, and compel them to be treated in hospital. We shall see later on that this system absolutely fails in its object, for the simple reason that the treatment of venereal diseases is by no means the panacea which many people imagine.