The most fundamental work which rests upon the medical profession is the spread of physiological truth in its practical application to the education of both boys and girls. The sexual instinct, being a primitive elementary instinct, exists alike in men and women. It is the necessary impulse leading to parentage, an impulse which the great Creative Force has laid down as a law of our present human life. But chastity and continence are not primitive instincts in either sex; they are the higher growth of reason, and of the religious and legal guidance by which in every age it has been found indispensable to direct the impulse of sex.
The way in which this instinct may be exercised to the permanent advantage of a progressive community is a gradual discovery of the human race. It is a development or differentiation of the primitive instinct; but the instinct and the wise method of educating or of exercising it are separate facts.
In the savage stage, in semi-barbarous countries, and in the slums of all great towns, both men and women are grossly unchaste.
It is by the growth and expansion of human nature under a knowledge of providential law, that the necessity of guiding the exercise of the original instinct is perceived. Thus, varying institutions gradually arise out of the varied methods employed to guide the sexual impulse. Different circumstances, different systems of education, law, and religion, produce varying results. But all these results spring from a perception that the sexual instinct requires guidance, and cannot, without danger to society, be left in its primitive ignorance.
In the gradual growth of thought which leads to ever higher forms of society, the physiologist has very important aid to render. It is his part to show how the two great forces of Habit and Heredity are the powerful physiological factors in the growth or degeneracy of the human race. In these two great facts—viz., the ability to form habits and the power of transmitting the tendencies produced by habits—the mind and body are inseparably blended, and through them a nation becomes chaste or unchaste. Habit can so change the nature as to make what was difficult easy; it can so strengthen the tendencies in directly opposite directions as to both govern, and to a great extent change, the action of the physical organization itself, and the fact of heredity will transmit these changed tendencies to succeeding generations.
It is impossible in the long-run to ignore these two facts which so powerfully govern sexual passion, because Nature has established them. Short-sighted views may exist as to the trivial character of the relations prevailing between the sexes. It may be considered of slight importance whether lust or love rule these relations. The slow or remote nature of the evils produced by the violation of Nature’s laws, and the apparent escape of some offenders from immediate penalty, confuse the short sight of the irreligious. But Nature disregards our short-sightedness, sweeps away our theories and self-indulgence, and inexorably avenges the violation of law by gradual but inevitable degeneration of the race.
The power which habit exercises over human nature depends upon the physiological character of the nervous system itself, through which our will and thought act.
It has been well said by Michel Lévy that periodicity is the law of the nervous system.[4] It is a law which both regulates its physiological action and controls the course of its diseases.
Impressions made upon the brain by external objects or by internal sensations modify the condition of the brain. This modification is slight at first, but increases by repetition. When an impression is first made upon the brain, it has to overcome the inertia or unaccustomed state of the organization to receive that kind of impression. But with each repetition this resistance diminishes and a habit is formed. Owing to the rule of periodicity which governs the nervous system, the brain tends to repeat the change which it has once experienced, to recall sensations, and solicit a repetition of changes which have been frequently impressed upon it.
Passing impressions may produce little effect in changing the condition of the brain, but when such impressions are often repeated and prolonged, when the attention is fixed upon them and the will engaged in recalling them, then the nervous system itself undergoes modification, and a new disposition of the organization itself is acquired from the continuation and frequent repetition of the same impressions.
It is in this way, through a change in the nervous system itself, that habit becomes literally a second nature; and in this way habits most opposite to the natural or rudimentary state are introduced into our human organization, and ‘nature is dominated by or absorbed in habit.’
The power of habit is seen even in the action of organs withdrawn from the will, as in the powers of adaptation to all kinds of food, to various kinds of atmosphere and climate. It is, however, in that portion of our nature directly connected with and governed by the brain that the remarkable transforming power of habit is seen, and in the sexual system this enormous power is most signally displayed.
Habits may become so much a part of our nature that they are exercised unconsciously, the impression which first excited the brain being no longer noticed, though still exerting its modifying influence.
But when the attention is constantly aroused, the brain acts with sustained and increasing energy; the senses are thus strengthened or perfected, and new and higher powers are developed in the individual, which through inheritance may be transmitted to a succeeding generation.
It is in this way that the practice of continence or of incontinence gradually forms a distinctive characteristic of social and national life.
This distinctive faculty possessed by the nervous system of modifying its own sensations, and even acquiring new aptitudes, is the physiological basis of human progress. ‘It is the foundation of education, of the power of law, of the influence of custom, and the necessary condition of hygienic improvement.’
Habits, when formed in accordance with physiological law, do not tend to indifference. By the constant repetition of impressions a new relation is gradually established between the organs or faculties affected and the cause which produces the effect. As the keenness of first sensations producing transitory pleasure diminishes, habit strengthens the important relation which grows up between faculties and the objects which modify them. It is the superior power of the new relation thus established by habit between the individual and the objects that have modified his nature, that have even caused the Swiss mountaineer to die of home-sickness, or the bereaved partner in a lifelong union to follow the beloved object to the grave.
It will thus be seen how the idea and the practice of chastity have grown up from a physiological basis, and may be inseparably interwoven with the essential structure of our physical organization. Chastity is the government of the sexual instinct by the higher reason or wisdom—i.e., by our perception of the providential law which governs our human nature. Customs, and the laws concerning marriage and the relations of the sexes which represent them, are checks or guides imposed upon the blind sexual impulse by the enlightened common-sense of mankind. These customs and laws, acting slowly but persistently upon society, generation after generation, modify the habits of thought in the adult, and the methods of education in the child. It is thus that the idea of chastity arises, and its practice becomes possible and easy. It springs as a physiological habit from the effects for good and evil which are produced by the modifications of our nervous system through education and custom.
The universal experience of the world has proved that directly human beings join in societies, they are compelled to impose guides upon the exercise of the sexual powers, in the interest of society itself. This check upon the blind, unrestrained use of the sexual impulse is a necessity imposed by our physiological structure for the well-being and continuance of the race.
The most important practical results flow from obedience to the physiological law of chastity thus imposed upon our sexual nature. The necessary mutual aid and respect of the sexes, procreative vigour and the production of a fine race, and the extirpation of the loathsome disease caused by promiscuous intercourse, are all subject to the guidance of chastity.
The tremendous power of creative law, which is quite beyond our reach, demands that the blind instinct of sex be governed and enlightened by this inevitable higher control, and that human law be moulded upon Divine law.
The mighty and transforming physiological power of habit, with its tendencies transmitted by both men and women to their offspring, shows the method by which the law of chastity must gradually extend its sway over the human race. The choice between inevitable degeneracy and sure improvement is left to our relatively free will, but the law which governs results is beyond our reach. Race after race has perished from blind or wilful ignorance, or neglect of the inexorable moral law bound up with our physiological structure.
The importance of the truths now insisted on can be more fully realized in their wide bearings by experienced and religious physicians than by any other class in the community. If they will learn to trust to the sacredness of the maternal instinct, and instruct mothers, as well as fathers, in these vital truths concerning our sexual structures, they will exercise a mighty influence in the elevation of our race.
To the younger members of the profession I wish to offer some farther hints on the direct practical bearing of the foregoing truths. The facts of our human organization should not only guide the medical advice given in the consultation-room, but caution us respecting the methods to be adopted in dealing with the poor, and suggest the direction in which national sanitary measures should proceed.
The immense power of this passion of sex in the human race must never be ignored in relation to either men or women. The beneficent control which the human mind can exercise over the passion points out that item in the human materia medica, which more than any other the physician must strive to secure for the benefit of his patient, viz.—force of will. He is bound to declare the sovereign efficacy of this natural specific, and enforce the methods of securing it. All physical and hygienic means must be called upon to develop and support that power of will and that mental purity which alone can govern wisely the human sexual nature.
There is another point which cannot be too strongly insisted on. The personal modesty of patients—that elementary virtue in Christian civilization—must be carefully cherished by the physician, who, more than any other, is acquainted with its influence on the sexual nature. The common resort to sexual examination is an evil grown up in medical practice of comparatively modern date. The use of the speculum should be strictly limited by absolute necessity. Its reckless use amongst the poor is a serious national injury. I know from fifty years’ medical experience amongst the poor, as well as the rich, that this custom is a real and growing evil. It should be a last resort of medical necessity, and it is so regarded by thoughtful physicians. That it is sometimes necessary is unhappily true; and when a poor sufferer learns from her trusted adviser that such investigation is quite unavoidable, acceptance of such judgment is the part of wisdom and true modesty. But it is essential that the medical judgment thus rendered should be final—the result of age and special experience. The wise custom of many physicians to decline practice in which a very special training has not given them the positive knowledge of an expert should be a universal rule. It is a social wrong when the serious character of this branch of medicine is not conscientiously acknowledged. The natural sentiment of personal modesty is seriously injured amongst respectable people by the resort to a succession of incompetent advisers.
A really serious and national evil results from the thoughtless treatment of the poor. In dispensary and hospital, and wherever medical assistance is rendered to the exposed and helpless classes, the first duty of the physician is to respect personal modesty, or to instil it if the habit has been lost. Every physician, man or woman, is bound to cherish with reverence the great conservative principle of society, personal modesty and self-respect. This is a point on which the medical practitioner cannot avoid a moral responsibility. Physicians are the special guardians of health from infancy onward. They possess the means of acquiring the fullest knowledge of the double elements of human nature—the interaction of mind and body. From their culture, their social position, and the authority which they legitimately exercise, the weighty responsibility of rightly guarding the human faculties rests chiefly upon them. In all those points where the physical health of a nation is inseparably connected with its moral health, they are more responsible than any other class of the community for the moral condition of their country.
All medical advice and all medical measures must, therefore, be guided by the positive fact that human sex differs from brute sex in the possession of a mental element which is capable of elevating and controlling it, and which must never be lost sight of in dealing with human beings.
To the rising members of our noble profession I earnestly present the foregoing facts for their Christian and patriotic consideration, believing that when they fully realize these great truths they will embrace them with the generous enthusiasm of youth. Thus, while guiding their future practice by sound principles in relation to the care of our human organization, they will enforce these truths by the strongest of all arguments—the true manliness of their own lives.