TO CONCLUDE these chapters dealing with the anatomy of the genital canal, I shall add a few remarks which refer more specially to the external orifices of the copulatory organs, keeping in view the micro-organisms to be found there. It is a well known fact in bacteriology that all secretions are at first sterile, but later on when reaching the exterior are invaded by all kinds of micro-organisms, among which putrefactive bacteria are to be found. If no steps are taken against them they rapidly increase and betray their presence by evil smells. We should very soon he living in a poisonous atmosphere, and indeed our body would begin to decay before we had died, if we did not counteract this tendency as far as possible by the most punctilious cleanliness. Nature very energetically assists this process from the interior by always pushing out sterile secretions,(1) which cause the other and already decaying secretions to be pushed further out.
This latter principle, the automatic cleansing by the “vis-a-tergo” at once elucidates the fact that people with a vigorous metabolism are much healthier and more active, while sluggish, torpid constitutions are vulnerable, unhealthy, and, when ill, are difficult to cure. Thus, by impeding the urine excretion, especially in paralysis of the bladder, decomposition of the stagnating urine, which is bound to occur sooner or later, may make the patient most seriously ill.
The same applies to the intestinal secretion, a mixture of all sorts of originally sterile glandular secretions, with the always non-sterile waste products of our food. Here the B. coli predominates, which regularly infects our wounds, as it is nearly always to be found on the door handles, etc., of the privy and is thus carried everywhere, as has been experimentally demonstrated.
The danger of auto-infection owing to insufficient vis-a-tergo applies least to the sperm secretion, because the urethra is thoroughly cleaned several times daily through urine excretion? This does not mean to imply that a correct and regular exercise of the function such as is proper to married people is not also a hygienic desideratum in this respect. One should remember the remark made above that the contents of the seminal vesicles are always odorless, but acquire an unpleasant smell when passing the prostate gland. In the female genital canal the cervix is usually the limit of self cleansing.
While this process of automatic cleansing is very useful, it still remains our duty to remove the secreted substances from the exterior by thorough washing. This applies to the whole surface of our skin with its countless microscopic sweat and sebaceous glands. If the ablutions are not performed regularly every day it soon becomes very difficult to make good the omission.
The thorough cleansing of a neglected skin surface is not at all easy. Firstly, a layer of air adheres to the skin, which on simple immersion shows itself in the presence of countless little bubbles, Secondly, the skin is impregnated with the fat produced by the sebaceous glands, and this is always difficult to remove. The best methods are soapy water, hot water, lysol water, e.g., 0.5% solution, i.e., 1/2 tablespoon of lysol to two pints of water or alcohol One should always aim at removing the last traces of soap with an excess of clean water or with a little alcohol, since every remainder of soap is injurious on account of its caustic action, especially in tender regions.
Finally, it is very difficult to dry the skin again once it is wet, as it is hygroscopic; one should think of the hair-hygroscope in this connection. If the skin is not properly dried, then all ablutions only tend to favour decay and decomposition, especially on the folds of the skin. Where two portions of skin lie in close contact, they become increasingly moist under normal body temperature and evaporation from the skin. One can easily convince oneself of the truth of this in summer by sleeping for a few minutes with the face on the back of the hand or on the arm. Both surfaces will soon become moist. One should not dress after a bath until all folds have become thoroughly dry again. Sometimes one may assist this process a little with powder, because then the surfaces cannot lie in intimate contact with each other. In most cases the dust derived from the towels and our clothing is sufficient for this purpose, a fact which should console us for wearing out our clothing. As, in contrast to the skin, the mucous membranes should remain moist, we should aim at keeping these dust particles out of our respiratory organs; especially at night, when we go to bed, we should avoid raising dust with our clothing, which we would then breathe throughout the night. I have often seen midwives grossly injure the lungs of newly born children immediately after birth by wielding their powder puff in the inguinal region.
As long as it is only the secretion which is decomposing, thorough washing may still he sufficient. In time, however, the decomposition increases in extent and attacks the underlying skin, especially in moist situations, e.g., one should recall the feet, where the skin may decay between the toes until the physician may find the whole sole macerated and decayed, and with a smell as of carrion. It may happen thus in all folds of the body. Ablutions alone are no longer sufficient, and the skin has first of all to be thoroughly disinfected. The above mentioned solution of lysol which is not very poisonous, is eminently suited for this purpose. For smaller surfaces of skin the poisonous sublimate may be used, e.g., a tablet or one gram (15 grains) to two litres (4 pints) of water, or if the smell is very pronounced, one should use formalin, e.g., 10 gm. (one small tablespoonful) dissolved in half a litre (one pint) of water. The latter solution is painful, however, if the skin is sore or has even minute excoriations and tears. For injections, far more dilute solutions should be used.
All that has been said applies to the whole skin surface, but most particularly to the lower part of our body, where besides the small glands of the skin and mucous membrane, the large excretory organs have their orifices. Here are found the most pungent odours; one need only think of musk, castoreum, hyraceum, amber, civet in the animal kingdom. Similar malodourous substances are not wanting in our own male and female genital organs. They are found especially where small wrinkles most easily produce a stagnation of secretions, i.e., in the vulva, the prostate and, last though not least, in the preputial cavity,
It is difficult to reach the prostate, and to this is probably due the fact that in advanced age operations are so often required. For vulva and vagina, injections of water, or preferably mildly astrintgent or disinfecting solutions, are required. This is especially important after menstruation, even in young girls. By this means not only all auto-intoxications but also later on all external infections may be counteracted. With reference to the preputial cavity I will once more recall the anatomical structure.
One is only too inclined to consider the preputial cavity as lined with mucous membrane. We have, however, shown above that the glans is covered with skin, and that the foreskin is a real fold of skin, as the name indicates. In contrast to the mucous membranes, these two surfaces should be kept dry as possible because the danger of infectious diseases is considerably reduced, as the skin becomes firmer and more resistant the drier it is kept.
It may easily happen that one may be exposed to the danger of infection. We live in a society where danger of infection threatens us from all sides: in hotels, in strange beds, strange w.c.’s. It is not even necessary to leave one’s family for that. How many infants are infected by servant girls and midwives, and vice versa, parents by children, etc.
In the most faithful marriage and with the highest moral standards, cleanliness and sexual hygiene should be strictly practiced, so that it may not be said to our detriment that the children of darkness are more sensible than the children of light. It might finally ensue that in extra-marital relations, hygiene would be more insured than in marriage. One does not find venereal disease only among prostitutes and drunkards, where it is always present. We physicians often see behind the scenes how frequently venereal disease is brought into the marriage as a dot or is later on brought in by husband or wife. The evil has so often scaled the walls of the old fortress, marriage, where one thought oneself safe.
If one or both partners are ill with venereal disease, sexual abstinence becomes a duty, but for how long? Even the most experienced doctor is unable to answer this. In such desperate cases the physician will order the use of contraceptives (condoms) as a protection, in order to act in accordance with his responsibility. They act better than the prepuce, which is Nature’s safeguard. It will also be his sacred duty to teach the uses of antiseptic precautions to the two partners.
Everybody should be educated on hygienic lines from childhood onward. Then he will spontaneously avoid the unclean. And if he should get into danger, he will not go under helplessly. A careful conscientious education during childhood is the first step towards self-control, with which we shall deal in Parts II and III, and towards ideal love, with which we shall deal in Parts IV and V.
1 Similar to the secretion of sperm-cells.
2 This natural aseptic irrigation, comparable to the best surgical irrigation, is absent in the female. On the contrary, the female genital canal becomes much wider towards its external opening, so that the female easily suffers from fluor albus after even the most harmless infections, whereas the male genital canal will suppurate only after a virulent gonorrheal infection.
3 However injurious alcohol may be, when taken internally, it is of the greatest value from the hygienic point of view, and also in inflammatory processes, especially in moist skin eruptions, where one aims at repelling the leucocytes.