Chapter Eighteen
THE MENOPAUSE OR CHANGE OF LIFE
Time of Menopause—Cause of Suffering During Menopause—Reproductive Function and Sexual Function Not Synonymous—Increased Libido During Menopause—Change of Life in Men.
In the chapter on menstruation I referred briefly to the menopause. I will consider it here somewhat more in detail.
The menopause, also called the climacteric, and in common language "change of life," is the period at which woman ceases to menstruate. The average age at which this occurs is about forty-eight. But while some women continue to menstruate up to the age of fifty, fifty-two, and even fifty-five, others cease to menstruate at the age of forty-five or even forty-two. Between forty-four and fifty-two are the normal limits. Anything before or beyond that is exceptional.
Just as the beginning of menstruation may set in without any trouble of any kind, and just as some women have not the slightest unpleasant symptoms during the entire period of their menstrual life, so the menopause occurs in some women without any trouble, physical or psychic. The periods between the menses become perhaps a little longer, or a little irregular, the menstrual flow becomes more and more scanty, then one or several periods may be skipped altogether, and the menopause is permanently established. Many women, however, the majority probably, suffer considerably during the transitional year or years of the menopause. Symptoms are both of a physical and of a psychic character, but the psychic symptoms predominate. There may be headache, capricious appetite, or complete loss of appetite, considerable loss of flesh, or on the contrary very sudden and rapid putting on of fat, great irritability, insomnia, profuse perspiration; hot flashes throughout the body, and particularly in the face, which make the face "blushing" and congested, are particularly frequent. Then the woman's character may be completely changed. From gentle and submissive she may become pugnacious and quarrelsome. Jealousy without any grounds for it may be one of the disagreeable symptoms, making both the wife and the husband very unhappy. In some exceptional cases a genuine neurosis or psychosis may develop.
Cause of Suffering During Menopause. It is my conviction, and I have had this conviction for many years, that many, if not most, of the distressing symptoms of the menopause are due, not to the menopause itself, but to the wrong ideas about this period that have prevailed for so many centuries. We know the influence of the mind over the body, and the pernicious effect which wrong ideas may exercise over our feelings. The generally prevalent opinion among women, and men for that matter, and not only of the laity but unfortunately of the medical profession as well, is that the menopause is the end of woman's sexual life. Every woman is laboring under the erroneous impression that with the establishment of the menopause, with the cessation of the menses, she ceases to be a woman, and as she does not become a man, she becomes something of a neuter being, neither woman nor man. And she has the idea that after the menopause she can have no further attraction for her husband or for other men. Naturally such an idea has a very depressing effect on any human being. Any human being fights to the last to retain all its human functions, especially the function which is considered as important as is the sexual function.
Reproductive Function and Sexual Function Not Synonymous. Of course with the permanent cessation of the menses the woman's reproductive function is at an end. But the reproductive function is not synonymous with the sexual function, I must insist again and again, and naturally until this erroneous idea is dispelled much unnecessary misery will be the lot of our women. If women in general will learn that with the establishment of the menopause they do not cease to be women, if they will learn that the sexual desire in women lasts long beyond the cessation of the menopause, many women being as passionate at sixty as at thirty, if they will learn that their attractiveness or non-attractiveness to the male sex does not depend upon the menopause, but upon their general condition, if they will learn that many women at fifty and sixty are much more attractive than some women at half that age, they will not take the onset of the menopause so tragically and they will thereby avoid the greater part of their mental and emotional suffering.
The actual atrophy of the ovaries, uterus, external genitals and the breasts can, of course, not be prevented, but that atrophy is a slow and gradual process, and is not in itself the cause of the various distressing symptoms that we have enumerated.
The treatment of the menopause, if the symptoms are at all disagreeable, or distressing, should be in the hands of a competent physician. A little wholesome advice may be more efficient than gallons of medicine and bushels of pills. In general the woman should try to lead as calm and peaceful a life as possible. Warm baths daily are beneficial, constipation should be guarded against, hot vaginal douches are often efficient against the disagreeable flushes, and last, but not least, the husband should during this critical period be doubly kind and doubly considerate of his wife. It is during the years between forty-five and fifty-five that the wife is most in need of her husband's sympathy and support.
Increased Libido During Menopause. There is one rather delicate symptom which I must not pass unmentioned. Some women during the years while the menopause is being established, and for some years after the menopause, experience a greatly heightened sexual desire. In some cases this increased libido is normal, that is, no other pathologic symptoms or local conditions can be discovered. In some cases the increased libido is distinctly due to local congestion, congestion of the ovaries, the uterus, etc. In some cases, I can distinctly testify, it is psychic or autosuggestive. Because the woman thinks, and believes that other people think, that she is soon going to lose all her sexuality, she unconsciously works herself up into a sexual passion which sometimes may be of long duration and may even lead to disastrous results.
What to do in such cases? Where the woman's libido is normal or near normal, then naturally it should be normally gratified. But if the libido seems to be abnormally strong and the demands for sexual gratification are too frequent, then the woman should be treated and sexual gratification should not be indulged in, because in such cases, as a rule, sexual gratification only adds fuel to the fire, and the woman's demands may become more and more frequent, more and more insistent. In exceptional cases it may even reach the intensity of nymphomania. In such cases the aid of a tactful physician is indispensable.
Change of Life in Men
To people not familiar with the subject it sounds rather strange to speak of "change of life" in men.
Man, possessing no menstrual function, cannot have any menopause, but still sexologists and psychologists who have studied the subject carefully are convinced that between the ages of forty-five and fifty-five men also undergo a certain change which may be spoken of as the change of life or the male climacteric.
They become irritable, capricious, very susceptible to feminine charms, are apt to fall in love, and in many the sexual instinct is greatly increased. As in women, this increase of the sexual desire is sometimes due to pathologic causes, such as an inflamed prostate gland—in other cases it is of psychic origin.
Just as a man should be particularly kind and considerate to his wife during her menopause, so the wife, understanding that her husband is going through a critical period, will also increase her tact, patience and consideration.
Chapter Nineteen
THE HABIT OF MASTURBATION
Definition of Masturbation—Its Injurious Effects in Girls as Compared with Boys—Married Life of the Girl Masturbator—Necessity for Change in Injurious Attitude of Parents who Discover the Habit—Common-sense Treatment of the Habit—How to Prevent Formation of Habit—Parents' Advice to Children—Hot Baths as Factor in Masturbation—Other Physical Factors—Mental Masturbation and Its Effects.
Masturbation or self-abuse is a term applied to a bad habit which consists in handling and rubbing the genitals. It is a bad habit because it is apt to injure the health and future development of the girl. The more frequently it is practiced, the more injurious it is. It is more injurious than when practiced by boys, because the effects are usually more permanent. Girls who indulge in the habit of masturbation to excess not only weaken themselves, become anemic and get a dingy, pimply complexion, but they lose their desire for normal sexual relations when they grow up, and are unable to derive any pleasure from the sexual act when they get married. In fact, many girls who masturbated excessively get a strong aversion to the normal sexual act, and their married life is an unhappy one. Their husbands often have to ask for a divorce. Fortunately, the habit is much less widespread among girls than it is among boys. While about ninety per cent. of all boys—nine out of every ten—masturbate more or less, only about ten or at most twenty per cent. of girls are addicted to this habit. But whatever the percentage may be, the habit is an injurious one, and if you value your health, your beauty and proper growth and mental development, you should not indulge in it. If you are already indulging, if you are used to handling your genitals, if a bad companion has initiated you into the habit, you should give it up. And mothers should watch their children, guard them against developing the habit, and do everything possible to cure them of it, if prevention comes too late.
But while as you see I do not deny the evil effects of masturbation, it is necessary to state that a great change has taken place in our opinions on the subject, and it is but right that parents should know of this change of opinion among the medical profession, particularly among those who specialize in sexology.
Wrong Behavior of Parents. When parents make the "awful" discovery that their child is fondling its genitals or is indulging in masturbation, they feel as if a great calamity had befallen them. They could not feel worse if they learned that the child was a thief or a pyromaniac. Imbued with the medieval idea of the "sinfulness" of the habit, as well as its injuriousness, they begin to scold the child, to frighten it, to make it believe that it is doing something terrible, that it has disgraced them and itself; and they try to persuade it that, unless it stops immediately, the most direful consequences are awaiting it. The results of this mode of procedure are disastrous—much more so than is the masturbation itself.
Often the scolding and the exposure of the child are done in the presence of others. This implants in the poor girl a sullen resentment that only makes it more difficult for it to break the habit. When the child is brought to the physician, you can see by its behavior, by its downcast looks, by its sulkiness, by its attempt to refrain from tears, and other signs, that it regards the physician in exactly the same light as a youthful criminal regards the judge before whom he has been brought for trial.
It is time, high time, that this silly and injurious attitude toward a practice, which is very common, be radically changed. It is time that parents and physicians learn that the injuriousness of the habit has been greatly, grossly exaggerated. It is time that they know that the vast majority of boys and girls get over the habit without being much, or any, the worse for it. The knowledge of this fact will not only save them and the children much needless anguish and suffering, but will make it much easier to deal with the latter, make it much easier to get them divorced from the habit.
If we look at the matter in a sensible, common-sense way, and do not tell the child caught in the practice that it has done something disgracefully vicious and criminal, but speak to it kindly and tell it that it is doing something that may injure it greatly, that may interfere with its future mental and physical health and development, then we shall have far greater success in our endeavors to break the boy or the girl of the habit of masturbation. As I have said in another place:
"In my opinion, stigmatizing even the most moderate indulgence in masturbation as a vice has a deleterious effect upon the people who so indulge and makes it harder for them to break off the habit. Every thinking physician and sexologist can tell you that picturing the masturbatory habit in too lurid colors and stigmatizing it with too strong epithets has, as a rule, the contrary effect to the one expected. The victims of the habit consider themselves degraded, irretrievably lost. They lose their self-respect, and it is, on account of that, harder for them to break themselves of the habit."
We shall accomplish a good deal more with our youthful and older patients if we leave alone, altogether, the moral side of the question—if there be any moral side to it—and emphasize the physical injuriousness of the habit. We do not want to diminish the self-respect of our boys and girls, we want to increase it; and we can not do this if we make them believe that a masturbator is a vicious criminal. Inspire your patients with confidence, tell them that indulgence in the habit jeopardizes their future growth, both physical and mental, their health and happiness, and you will find them easier to control.
I am not trying to minimize the danger of masturbation, for, if indulged in from an early age and to great excess, the results may be disastrous. But, even if I were to minimize the evil consequences, that would be less of a sin than to exaggerate them the way it has been done for so many years, by so many people in the profession and out of it. The evil results of exaggerating the influence of masturbation have been so great in the past that, if now the pendulum were to swing to the other extreme, I am sure it would not be a bad thing at all.
To deal with the subject of the treatment of masturbation belongs to a medical treatise. But, a few remarks on how to prevent children from acquiring the habit of masturbation will not be out of place.
Prevention of the Habit of Masturbation. The keynote of preventing the habit is, carefully to watch the child from its earliest infancy. We know that not infrequently stupid or vicious nursemaids, wet-nurses, and even governesses ignorantly or deliberately induce the habit in children under their charge. This, of course, must be prevented. Even children of the age of nine, ten, eleven years should not be left alone, but always be under supervision. Too close friendship between boys or girls, particularly of different ages, should be looked upon with suspicion.
A number of girls never should sleep in the same room without supervision by an older person.
The sleeping together of two in the same bed, whether it be two children or a grown person and a child, should not be permitted under any circumstances. I admit of no exceptions to this demand. It makes no difference whether the other person is a mother, a father, a brother or a sister. Leaving out of the question any deliberate element, the thing is dangerous; for, very often, unintentionally, unwittingly, masturbation is initiated by this intimate contact.
The child—boy or girl—should sleep alone, on a rather hard mattress. The covering should be light. A coverlet may be put over the feet. The child always should sleep with the arms out upon the cover or blanket, never under the same. If this is done from childhood on, it is very easy to get used to this way of sleeping, and many a case of masturbation will thus be obviated. The child should not be permitted to loll in bed: it must be taught to get up as soon as it awakes in the morning. The general bringing-up must be of a strengthening, hardening character; and this applies both to the body and the will. When the children reach the age of nine, ten, eleven, twelve or thirteen years (we must use discrimination and judgment, for, some children of nine are as developed as are others of thirteen), we must tell them that it is bad and injurious to handle one's genitals, and we must warn them to shun any companions who wish to initiate them into any manipulations of these parts or who show an inclination to talk about the sexual organs and sex matters.
Hot baths are very injurious for young children in their influence in this direction. There is no question that a hot bath has a very decided stimulating effect upon the sexual desire of adults as well as of children, both male and female; in fact, I have had several patients of either sex tell me that their first masturbatory act was committed while they were in a hot bath. Of course, the sensation having been pleasurable, they kept on repeating the experience.
Every factor liable to give rise to the habit should be removed. Thus, for instance, eczema about the genitals, strongly acid urine, seatworms, and the like, should be treated until cured. That anything having a tendency prematurely to awaken the sexual instinct should be rigorously avoided, goes without saying.
Mental or Psychic Masturbation. Some girls and women will abstain from handling themselves with their hands (manual masturbation), but will practice what we call mental masturbation. That is, they will concentrate their minds on the opposite sex, will picture to themselves various lascivious scenes, until they feel "satisfied." This method is extremely injurious and exhausting and is very likely to lead to neurasthenia and a nervous breakdown. You should break yourself of it, by all means, if you can. For it is even more injurious than the regular habit.
Chapter Twenty
LEUCORRHEA—THE WHITES
Misconception Regarding the Meaning of the Term "Leucorrhea"—A Common Complaint—Severe Cases—Reasons for Resistance to Treatment—Proper Local Treatment of the Disorder—Sterility Due to Leucorrhea—Causes of Leucorrhea—Tonic Medicines—Local Treatment—Formulæ for Douching.
Leucorrhea means literally a "white running," and is applied by the laity to any whitish discharge coming from the vagina. This is wrong, because some white discharges may be of little importance; others may be of a serious character, and not be leucorrhea at all.
Leucorrhea is one of the banes of the modern girl and woman. It is very frequent. Probably at least twenty-five per cent, (some say fifty or seventy-five per cent.) of all women suffer with it in a greater or lesser degree. In some cases it is only an annoyance, necessitating the frequent changing of napkins, but in others it causes a great deal of weakness, backache, erosions, itching and burning. It is very resistant to treatment, particularly in girls. The reason it is so resistant to treatment is because the discharge, while coming from the vagina, does not usually originate in the vagina; it originates in the neck of the womb, and the hundreds and hundreds of injections that women take for their leucorrhea only reach the vagina; they cannot penetrate into the womb. And it is only by treating the cavity of the cervix, which can only be done by a physician, through a speculum, that the root of the trouble can be reached. And, if any erosion or ulcer is noticed, it can be directly touched up with the necessary application. And it is for this reason that in girls leucorrhea is so much more difficult to treat. For fear of having the hymen ruptured the girl objects to a thorough examination and to local treatment, and the leucorrhea is permitted to proceed until perhaps a chronic inflammation of the womb and the Fallopian tubes is established. There is no doubt that many cases of sterility or childlessness in women are due to long-neglected leucorrhea in girlhood.
What Is the Cause of Leucorrhea? We can answer simply: the cause of leucorrhea is catarrh in any part of the female genital tract. But this is no real answer. What are the causes of the catarrh? The causes of catarrh are many: the most common cause is a cold. Wetting the feet and getting chilled, particularly during the menses, may set up a catarrh in the cervix. Long standing on one's feet, lifting and carrying heavy bundles, dancing in overheated rooms and then going out scantily clad in the chill night air, prolonged ungratified sexual excitement, lack of cleanliness in the external genitals—all these are factors in setting up a catarrh of the cervix with a resultant leucorrhea. A general rundown condition, worry, overwork, too hard study, lack of fresh air, and a general scrofulous condition also favor the development of catarrh of the womb and leucorrhea. It will therefore be seen that the treatment of leucorrhea to be successful must be general and local.
General Treatment. The general treatment consists in general hygienic measures and in common sense. The patient should not be on her feet more than she can help, and she should not walk until exhausted or fatigued. It is better to take several short walks than one long one. The corset she wears, if she wears any at all, should be of the modern kind: not one that presses the womb and the other abdominal organs down, but one that supports the abdominal walls, and rather raises the abdominal organs up. The lacing or buttoning must be from below up, and not from above down. That it should not in any way interfere with the freedom of respiration goes without saying. Constipation if any, to be treated, must be treated intelligently, by mild measures (see Constipation, in the chapter on pregnancy), and care must be taken that the bowels move at regular hours. Where the leucorrhea is due to or is aggravated by anemia and general weakness, a good iron preparation, such as one Blaud's five-grain pill three times a day, or a tonic of iron, quinine and strychnine, will do good. A daily cold bath or cold sponge, followed by a brisk dry rubbing with a rough towel, is also useful.
Local Treatment. Local measures consist of painting or swabbing the vagina and cervix with various solutions, of tampons, suppositories and douches. Local application to the vagina and uterus can be done satisfactorily by the physician or nurse only. The insertion of a suppository or douching can be easily done by the patient herself.
While it is always best and safest to consult a physician, and, while self-medication is generally inadvisable, there are occasions when a physician is not available; in some small places a woman may, for various reasons, have a strong objection to gynecological examination and treatment; and some women may be too poor to pay the doctor. In such circumstances self-treatment is justified and there can be no objection to it if the remedies are harmless and are sure to do some good; that is, to improve the condition where they do not effect a complete cure.
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 for twenty-four hours. Then pull it gently by the string and syringe yourself with a quart or two quarts of warm water. Such a tampon may be inserted every other day or every third day, and I have known many cases 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 teaspoonfuls 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 tablespoonfuls 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 lying 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 night time 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.