Sexual Hygiene (1902), by the Alkaloidal Clinic

In 1902, editors of the medical journal Alkaloidal Clinic Wallace C. Abbott and William Francis Waugh published Sexual Hygiene, a book about normal sexual physiology and behavior in Chicago, Illinois. Though the book includes a collection of passages from other books, speeches, and documents surrounding sexual physiology and behavior, it does not include text regarding sexual hygiene. Rather, the book contains a preface and twenty-eight chapters on topics including masturbation, incomplete or delayed intercourse, and impotence, meaning the inability for a female to achieve an orgasm or a male to achieve an erection. Though physicians and those who served as experts in the book used seemingly factual scientific evidence to back up their claims, later scientific understanding of male and female physiology disproved many of those assertions. Sexual Hygiene is an early US discussion of sex by medical authorities that provides examples of historical medical misconceptions about sexual practices, physiology, gender roles, and context for understanding reproductive medicine during the early 1900s.

The book Sexual Hygiene includes ideas that were demonstrated later in the twentieth century as medical inaccuracies. At the time of the book’s publication in 1902, not only were women unable to vote in the US, getting an abortion and using contraception were criminal offenses, and many women were often diagnosed with female hysteria, a catch-all diagnosis for women experiencing symptoms ranging from headaches and shortness of breath to abrupt language and hypersexuality. The authors of Sexual Hygiene wrote the book for an audience composed primarily of male doctors, and they sought to educate physicians on maintaining sexual health based on the ideas of that time period.

Around the time Abbott and Waugh published Sexual Hygiene in 1902, scientific and medical education was becoming more prevalent within the US, as reflected by the establishment of The Johns Hopkins University School of Medicine in Baltimore, Maryland, in 1893. More widespread education allowed for a better understanding of the human body in ways that called into question some former medical practices. At that time, physicians, including some authoring the book, considered female sexual arousal to occur only as a result of penetration. Penetrative intercourse occurs when a man inserts his penis into a woman’s vagina. Stimulation outside of intercourse, for example through masturbation by stimulating the clitoris, was thought to cause adverse mental, physical, and moral consequences for women. Masturbation is the self-stimulation of one’s own genitals with their hands or other objects. The clitoris is a sensitive region of female genitalia that is known in the twenty-first century for its ability to produce sexual arousal in women when stimulated.

The book Sexual Hygiene is mainly composed of writings related to sex taken from monthly publications written by members of the Alkaloidal Clinic and doctors that were involved with the journal at that time. According to the authors of the book, the first half of Sexual Hygiene documents speeches given during a meeting on 28 November 1898 hosted by the Alkaloidal Clinic in Chicago, Illinois. The authors state those who attended the meeting included doctors who were highly acclaimed in reproductive health. Furthermore, the authors state that under a group called the Physicians’ Club, doctors and specialists met with the goal of providing expertise on sexual hygiene and practices, which were topics considered by many, including doctors, to be inappropriate and taboo. The meeting was one of the largest attended meetings in the history of the club at that time. Expert physician speakers were assigned topics prior to the meeting, however several speakers expressed that they felt someone more competent on the subject should have been selected to speak, while also claiming that as physicians they were the only people qualified to speak with authority on matters of sex. Those speeches and writings from the meeting were published by the Alkaloidal Clinic and became widely popular, which led to republication of the first half of Sexual Hygiene.

In the first half of the book, doctors of the Physicians’ Club discuss topics they name as follows: religion and love, sexual frauds, sexual excess, the effect of coitus during pregnancy and lactation, sex problems in education, legal aspects, and educational aspects. Those topics were each given a chapter in the book, for a total of nine chapters, with the text being the transcript of a physician’s speech during the meeting. Chapters ten through twenty-eight feature information compiled by the editors on topics such as women’s sexual organs, causes of male impotence, masturbation, sexual intercourse, contraception, and posture. Throughout both portions of the book, Abbott and Waugh cite many physicians throughout the US and compare the practices of many sexual health experts during the early 1900s.

In the preface, Abbott and Waugh explain that the book’s purpose is to educate doctors on how to instruct their patients to properly engage in marital coitus, a term used to describe having sex when married. They state that the aim of the book is not to explain or invade the sacred ritual of married sex, but to treat sexual dysfunction and disease as medical diagnoses that require physician intervention. The editors state the idea that without medical intervention, untreated sexual irregularities can lead to family disagreements, self-abuse, adultery, divorce, suicide, and murder.

Following the preface, chapter one informs readers that the physicians who wrote the book do not enjoy talking about sex. However, the authors add, it is both a doctor’s duty and a necessity to deal with uncomfortable topics when entering the medical profession and to discuss those topics plainly, sensibly, and scientifically. In the chapter, the chairman of the meeting states that the happiness of the world is dependent on the happiness of married couples and their sexual function, which is one of the reasons why the group has met so that they can try to normalize the subject in medicine.

In chapter two, physician Charles S. Bacon presents a speech titled "The Effects of Malformation and Derangements in the Genital Organs of Woman on Her Sexual Appetite." During Bacon’s speech, he asserts that a woman’s sexual appetite has the potential to be increased through derangements causing decreased abstinence, nymphomania, meaning an overly active sexual desire in women, or perversions causing homosexuality, fetishism, sadism, and desire for masturbation. According to Bacon, after a woman goes through menopause, her sexual appetite disappears. When discussing genital malformation, Bacon claims that eighty percent of women have a condition that causes their clitoris to be excessively concealed by the prepuce, or clitoral hood, causing inability to become sexually aroused by intercourse. The clitoris is located above the vaginal opening and urethra, and is naturally covered by the clitoral hood. Bacon notes that many women had the problem surgically corrected to increase sexual appetite. He also claims that abnormalities such as congenital defects or acquired diseases like gonorrhea can cause what he understands to be an increased widening of blood vessels and itching sensations that cause women to accidentally masturbate and result in nymphomania. Those conclusions have not been upheld in twenty-first century medicine.

Chapter three features a speech by Geoffrey F. Butler who the Physicians’ Club viewed to be an expert on the topic of sexual desire as influenced by religion and emotion. During the speech, Butler claims that love is a manifestation of sexual instinct and that falling in love is a sacred aspect of Christianity. While Butler defends his belief on the sacredness of upholding religion, he also notes, and later experts in the book agree, that women are more easily influenced by religious beliefs than men about chastity and sexual modesty.

In chapter four, physician Joseph Zeisler writes to the Physicians’ Club on his assigned subject, titled "The Sexual Act: Frauds in the Conjugal Embrace." During the late 1800s, conjugal embrace was a term used as a reference to sexual intercourse between married men and women. In Zeisler’s speech, he discusses what he labeled as three main frauds. The first fraud is having sexual intercourse with a wife without the intention to create offspring, which Zeisler and his peers viewed as a violation of the vow of marriage. According to Zeisler, if a woman is not ready to have children, then she is not ready to be married. Zeisler then states the second fraud is preventing conception. He claims that neurologists would attest to the danger for both men and women when a husband withdraws his penis during intercourse to prevent childbearing. According to Zeisler, the last and most important fraud is the use of wives by husbands as an instrument of the man’s sexual enjoyment only. He mentions that it is the physician’s job to be the most informed and to educate husbands on how to sexually please their wives.

Chapter five contains a speech given by physician William T. Belfield, titled "The Results of Sexual Excess or Continence; Sexual Misinformation and Quack Literature." During his speech, Belfield states parents have a responsibility to properly educate their children about sex and not leave them susceptible to the influence of quacks, or people posing as medical specialists without a license who would encourage them to behave outside sexual norms. He also states that men are inherently sexual and that women are far more likely to be capable of remaining abstinent and growing to maturity without sexual feelings. Moreover, Belfield claims that men can suffer health consequences such as chronic inflammation of their reproductive organs when they have too much sex. He notes that it could also be connected to men having gonorrhea, a sexually transmitted infection that little was known about at the time.

In Chapter six, physician Arthur C. Cotton presents a speech titled "Coitus During Pregnancy and Lactation," in which he describes what he understands to be the harmful effects of women having sex while pregnant or lactating. According to Cotton, when women have sex while pregnant, they can experience a spontaneous abortion from overexcitement of the uterus, septic infections in sexual organs, and deterioration of the nutritional quality of their breast milk. He also claims having sex while pregnant or lactating could cause women to develop brain and nervous system conditions such as epilepsy or cerebral palsy. Additionally, Cotton advises husbands and wives to sleep in different beds while the woman is pregnant.

Chapter seven contains a speech by physician Paul Carus, titled "Sex Problems in Education." During his speech, Carus encourages telling children the truth about sex without too many details to lead them to have erotic thoughts. He encourages physicians to use their best judgment when advising parents on the subject.

During chapter eight, titled "Legal Aspects," lawyer A.S. Trude comments on the temptation for men to have illicit sex with married women, stating that it is a powerful force. Although Trude states that men commit crimes like murder because of their desire for women, he does not address it as a problem or provide physicians with a solution.

In chapter nine, titled "Educational Aspects," the speaker referred to as Professor Wheeler explains that science teachers in schools could help students by teaching about sex through biology lessons without making the content erotic. As the transcript of the meeting is printed, physician Rachel Hickey Carr, one of the few female doctors at the meeting, began a discussion on the topic, expressed her concerns, and presented evidence from her experience that it is possible to educate young women on sexual hygiene without hurting them mentally and physically by encouraging them to ask questions about anatomy. Frank A. Stahl, another physician, expressed his skepticism regarding Carr’s findings, as recorded in chapter nine, and wondered if her success could be replicated among city girls, arguing that less high bred women could not handle learning information about sex. Physician Chauncey W. Courtright also commented on the subject, arguing that boys should receive an education about when they should have intercourse and how to not molest women, while also claiming that a man has the right to a woman’s body when they are married. After the physician referred to as Cotton suggested that girls should be taught how to protect themselves from a man’s moods, the chairman concluded the speeches and ended the meeting.

After the conclusion of the Physicians’ Club meeting portion of the book, the editors wrote chapter ten, titled “Editorial Resume," as a response to the popularity of Sexual Hygiene. The editors claim that spreading knowledge is important because, according to the Alkaloidal Clinic physicians, in the early 1900s less than fifty percent of married women experienced pleasure during sexual intercourse. The editors then explain their conclusive ideas on how to better bring a woman to orgasm, stating that the size of the penis does not matter and that penetration should always cause sexual excitement unless the woman’s vagina has been overused. Lastly, the editors claim when a woman gets married, she surrenders the right to approach her body sexually to her husband and if a woman’s anatomy does not permit that guaranteed right, for example with gynecological obstructions not permitting intercourse, then the editors claim it as grounds for divorce.

Chapters eleven through twenty-eight highlight individual issues selected by the editorial team and were not discussed as in depth during the meeting. Some of those include women's sexuality and the imperfect development of the female sexual organs. In those sections, the editors inform the physician readers that unhappiness at home is partially due to a sexually unsatisfied wife, and that happy sex lives lead to healthy children who are born out of love. The editors argue that illicit sexual behaviors such as infidelity and masturbation, lead to moral decomposition and female hysteria. The editors recommend that when physicians discuss the malformation of female reproductive organs in relation to irregular or absent menstrual cycles, applying electrical currents directly to the womb can help treat anemic, or iron-deficient, women by causing bleeding. That bleeding might have been viewed by doctors in the early 1900s as the return of regular menstruation, but doctors in the twenty-first century may regard it as not related to a woman’s menstrual cycle and possibly from the procedure itself. The editors also cite surgical procedures to free the clitoris from being overly hidden by the prepuce, or clitoral hood, to increase a woman’s sexual excitation, comparing the procedure to a male circumcision, as is mentioned multiple times throughout the book.

The following sections detail what the authors refer to as affections of the male sexual organs causing impotence, continence, and masturbation. Continence at that time was another term for abstinence. When discussing factors that lead to male impotence, or failure to achieve an orgasm, the editors attribute the problem to an abnormal prostate irritation that can be identified by using a metal sound, or thin metal device, passed through a man’s urethra to locate areas of irritation. Geoffrey C. Pizer, a physician who is cited by the authors, states that male sexual weakness, or impotence, usually originates in the urethra. He also claims that sources of male impotence include masturbation, being overly sexually active, or contracting gonorrhea, a common sexually transmitted infection. To treat weak erections, the physicians recommend using electrical current applied to the urethra, eating Yohimbine, a supplement originating from tree bark, as well as injecting metal-based medicines to the prostate. When discussing the ability to achieve many orgasms, Pizer claims that a woman who has had thirty orgasms a day without any harm to her body or mind did so by eating raw eggs, which he predicts supplied her with living protoplasm, or contents of a cell surrounded by a cell membrane, that enabled her to have such endurance.

In the section titled "Masturbation," the editors warn parents against letting their children eat lots of meat and eating late at night. The editors also note that torn clothes, bloody noses, and black eyes are an essential part of a young boy’s development and without them a boy will suffer from being raised like a girl. As stated throughout the book, the editors claim that masturbation causes deterioration of the mind, body, and morals of young men, but they do not go into detail about the effects of masturbation in young women.

In the following section, the editors comment on incomplete or delayed intercourse. The editors state some women attempt to prevent completion of intercourse out of fear of pregnancy, and comment that it is wrong for women to seek pleasure without paying for it, as they say, or not assuming their responsibility to procreate. The editors claim that women who have never experienced an orgasm spread those beliefs that not completing intercourse inside a woman’s body prevents pregnancy, and the editors claim preventing or delaying proper intercourse can cause physiological problems for sex organs. As a solution, the editors recommend adequately preparing wives for sex with genital caressing before intercourse, though the authors do not elaborate on why or how that is beneficial.

When discussing frequency of intercourse, the physician editors of the book argue that frequent sexual activity is healthy because it allows for the emptying of men’s semen. The editors comment that sex should be an organic and spontaneous act to satisfy both men and women’s natural sexual appetites and not involve the fear of childbirth. The authors claim to have written the section in response to sex-less women who claimed that sex should be limited to procreation when wanted and intended.

The section on prevention of conception details how married couples could prevent becoming pregnant, which the editors claim is only acceptable when another pregnancy will cause a woman’s health to deteriorate. The physician editors claim that condoms are unbearable and physically injurious to both men and women because they could cause electrical hindrance by being made of rubber and not conducting electricity. After the authors state that preventing conception is vile, disgusting, and morally debasing, they claim that when it is absolutely necessary it is permitted as the choice of a lesser evil. The editors cite letters published in The Medical World in 1897 listing contraceptive options such as an aluminum button placed on the cervix, a sponge with a string attached soaked in acid and placed in the vagina, castration, limiting and timing intercourse, and lastly, getting a divorce and vacating the position for another woman who is willing and able to fulfill a wife’s responsibilities and enjoy her privileges.

In the next chapters, the editors discuss what they refer to as married courtship. When discussing marriages in which the husband and wife have stopped having sex, the physician editors recommend that men clean their beards, brush their teeth as to not smell like tobacco and alcohol, and do what they can to not seem repulsive to their wives by appearing more desirable. They recommend physicians tell their female patients to observe what time of the month they feels most erotic and to take advantage of that time.

On the topic of posture, or sex positions, the editors state their ideas that certain sexual positions can speed up a wife’s orgasm while delaying that of a husband. They rationalize that when men are positioned on top, gravity causes men to achieve orgasm faster than if they were laying on their back or side. The physicians also state their understanding that anatomical defects can cause sexual problems with positions. They comment that if a woman’s uterus is located too low in the vaginal canal, it could cause the penis to become embedded in loose, bagging folds of the vagina away from the mouth of the uterus. That could prevent semen from making contact with the woman’s uterus and cause infertility. They also state that if a woman’s vaginal canal is too long for the penis, that could also prevent pregnancy. The physicians provide sixteen examples of sexual problems that can be corrected through a change in posture.

In the final chapters of the book, the editors discuss marriage, pregnancy, and labor. They provide information about the perceived dangers of artificial fecundation, or when a woman becomes pregnant by artificial insemination without having sex. The editors conclude the book with a chapter titled "Sexuality Must Not Dominate," where they make the argument that men and women need to somewhat suppress their sexual urges and behaviors for the sake of their health, without explaining how those are connected.

According to the editors, Sexual Hygiene was one of the first attempts made by US physicians to discuss sex in medicine in a frank and factual way without speaking modestly surrounding a controversial topic. During the early 1900s, new medical advancements and innovations occurred in Illinois after the founding of several medical schools in Chicago, Illinois. Some of those medical schools include the creation of Northwestern University Feinberg School of Medicine in 1859 and The University of Chicago Pritzker School of Medicine in 1898, which brought many doctors to the area. The editors of the Alkaloidal Clinic made claims in the book that may be considered by some groups in the twenty-first century to be sexist and oppressive towards women and men, and many of the authoritative statements provided in Sexual Hygiene were later disproved in medicine.