Another instalment in the Ladies’ Handbook series: “Chapter III: Outside The Marriage Circle”. The original post is here.
The madonna/whore dichotomy is hard to miss in this one. It is the polluted prostitutes that infect promiscuous men, who then carry their diseases to their innocent virgin wives – the intended audience of the piece. The women are primarily reproductive machines, who are to birth clean white babies for the Greater Good of Society. The danger that STDs pose to the wives themselves is secondary (and the danger to prostitutes completely ignored); the dangers to good wives’ reproduction capabilities and newborn babies get a much higher billing.
For a little background, this piece was written in 1905. The gonococcus was only discovered in 1879 by Dr Albert Neisser (hence Neisseria gonorrhoeae), so the specifics of germ theory were still amazing, fresh, state-of-the-art medicine. The natural history of the disease was very well known, of course, and had been for a long time. Routine silver nitrate prophylaxis for newborn eyes (Credé’s prophylaxis) was begun in the late nineteenth century, and is still used in many countries, where it hasn’t been displaced by the use of topical erythromycin or tetracycline. The most appropriate prophylaxis, if any, remains controversial.
Chlamydia was not yet discovered, and urogenital chlamydia was nowhere near being well-described. The vacuoles associated with intracellular chlamydial infection were first spotted under the microscope in 1907 and named Chlamydozoa, but not classified with other bacteria. As Chlamydia is an obligate intracellular parasite, microbiologists couldn’t use ordinary culture methods to culture it. Chlamydiae were thought to be viruses until the second half of the twentieth century, and were only properly described as a group of disease-causing agents in the 1990s. Only then were chlamydial sexually transmitted diseases separated out from the umbrella term “non-gonococcal urethritis/cervicitis”.
This turn-of-the-century guide falls well before the antibiotic era. The sulfonamide family of antibiotics were synthesised in the 1930s, and penicillin hit the market the following decade. So “treatment” options were generally metal-based: silver or mercury compounds. Salvarsan (arsenic) treatment was to be discovered shortly after publication.
Chapter III: “Outside The Marriage Circle”
Marriage was intended to hallow and safeguard the sexual relation. When, however, marriage is degraded by the wilful prevention of childbearing, which is its chief or one of its chief objects, this relation is in danger of becoming merely a compact which renders the sexual relation convenient and free from social censure. Under such circumstances it is not strange that men and women who do not recognise the sacredness of marriage should decide to enjoy what they regard as its pleasures without being bound by its contract. Unfortunately, such an arrangement is becoming more and more common, and is even advocated and defended by men and women who occupy prominent positions as teachers and moulders of public thought. As to the immorality of such alliances we shall say but little at present, feeling again that on those who disregard physical laws, moral claims have but little hold.
Considered from the physical side alone, promiscuous sexual relations result in the dissemination of diseases which are deadlier and more destructive than cholera, smallpox, or yellow fever. These diseases poison life at its source, and threaten to deteriorate their victims in tens and hundreds of thousands, not only from the ranks of the vicious and degraded, but from higher circles as well, sparing neither pure women nor innocent children.
Of what are called social, or venereal, diseases, syphilis has always been regarded as the more serious and destructive. Its prevalence, as compared with other diseases, is well shown by the figures for the United States where a conservative estimate places the number of syphilitics at two million; while the number suffering from tuberculosis in all its forms barely reaches one-half million. Tuberculosis, or consumption, is rightly called the white plague. What, then, shall we name this scourge which claims four times as many victims? Red plague is the name it well deserves. But serious as is this disease, gonorrhoea, which has long been considered a simple local infection, is gradually coming to be recognised as a greater curse to the human race than syphilis. While the tendency amongst the ignorant is to regard gonorrhoea as of no more consequence than a common cold, modern science has proven it to be the greatest social pest of the twentieth century. And this disease – this great social pest – may safely be said to be from two to five times more common than syphilis.
It should be understood at the outset that it is practically impossible to have promiscuous sex relations without contracting one or the other of these diseases, for all prostitutes are diseased some of the time, and some are diseased all of the time. As about one-tenth of the men who marry probably infect their wives with one or the other of these venereal diseases, a knowledge of their prevalence, nature, and prevention is of the greatest personal interest to every woman.
NATURE AND CAUSE.- Gonorrhoea is a contagious disease caused by a microscopic organism known as the gonococcus. This germ is always found in gonorrhoeal discharges. It is easily destroyed by heat, sunlight, and drying; but can live for many years; in fact, indefinitely in the human body in a dormant state, latent gonorrhoea being very common in both men and woman. This characteristic of the gonococcus makes gonorrhoea a most treacherous disease, as it is impossible to say positively when it is cured. After remaining in a dormant condition for many years, these germs, when conveyed to the healthy tissues of another person, begin to multiply with great rapidity, so exciting a virulent gonorrhoeal inflammation. Thus originate in a married women years after the supposed cure of the disease in their husbands many of the inflammations of the womb and oviducts which produce sterility, and render necessary the surgical removal of these organs. Thus also arise from latent gonorrhoea in women that dreadful eye disease, ophthalmia neonatorum, to which is due so large a proportion of blindness.
COURSE AND SYMPTOMS.- The course of this disease may be divided into three stages, the first of which is known as the stage of primary infection; the second, the stage of extension through the entire genito-urinary system; while the third is known as the stage of systemic infection.
First Stage: The primary infection generally shows itself within one or two days after the disease is contracted. The infection first manifests itself in the urethra or in the neck of the womb, except in the case of little girls, in whom the more delicate external parts are first involved. The symptoms in this stage are redness and swelling of the parts, itching, burning, and pain, which is often intense on urination, and a discharge which is first mucous, but soon becomes purulent. This inflammation may lead to excoriations, abscesses, and more or less bleeding. So far as appearances go, there is little to distinguish this disease from an ordinary inflammation. When, however, the discharge is placed under the microscope, the characteristic gonococci are seen. Under appropriate treatment this discharge may soon cease, and the disease is then too often considered cured. That this is by no means the case is now known only too well.
Second Stage: The stage of extension of gonorrhoeal infection through the genito-urinary tract now begins, the gonococci entering the bladder and ascending the ureters to the kidneys, serious disease of these organs sometimes resulting. They also pass through the womb into the oviducts and peritoneal cavity, thus causing a large proportion of all cases of cystitis, salpingitis, metritis, ovaritis, and pelvic peritonitis. The gonococcus also causes similar inflammations in men.
The effect of these various inflammations is sterility, gonorrhoea being responsible for nearly seventy-five percent of all sterility in the married. About twenty per cent of this sterility is due to the condition of the men, the remaining proportion representing the sterility of the women, which is generally due to blocking of the oviducts. In many more cases, what is known as one-child sterility results, the gonococci in these cases not finding their way into the oviducts until after one child is born.
Third Stage: Ultimately, the gonococci find their way into the blood, and are carried to all parts of the body. They may lodge in the joints, causing gonorrhoeal arthritis, a most obstinate form of rheumatism. They may also cause gonorrhoeal inflammation of the lining of the heart. Other organs may be affected, including the brain, spinal cord, liver, spleen, and the covering of bones and tendons. Many women who have never been well since they were married owe their condition of semi-invalidism to system infection with the gonococcus.
BLINDNESS DUE TO GONORRHOEA.- It is not too high an estimate to say that eighty per cent of all the serious inflammations of the eyes in infants are due to gonorrhoea. More than one-third of all cases of blindness, and in some cities nearly one-half, are due to this one disease. A German physician states that in Germany alone there are no fewer than thirty thousand blind persons whose informity was caused by gonorrhoeal infection of the eyes.
GONORRHOEAL DISEASES OF WOMEN.- The estimations of the proportion of diseases of women due to gonorrhoea vary from forty to eighty per cent. At least fifty, and probably seventy-five, per cent of the operations performed on women are necessitated by gonococcus infections.
The second half of this chapter tomorrow, including “SYPHILIS” and “PERSONAL RESPONSIBILITY”.