ancy ▁was ▁a ▁distinct ▁possibility ▁since ▁there ▁were ▁no ▁commonly ▁available ▁contra cept ive ▁dru gs ▁or ▁appar atus . ▁ ▁The ▁alternatives ▁with ▁an ▁unw anted ▁pre gn ancy ▁were ▁back ▁room ▁abort ion ▁or ▁giving ▁birth ▁and ▁raising ▁an ▁il leg it imate ▁child ▁of ▁often ▁uncertain ▁parent age . ▁D ise ase ▁was ▁a ▁constant ▁problem ▁difficult ▁to ▁escape ▁since ▁sy ph ilis ▁was ▁common ▁among ▁a ▁lot ▁of ▁men ▁and ▁women . ▁If ▁discovered ▁in ▁time , ▁there ▁were ▁treat ments ▁for ▁sy ph ilis ▁but ▁it ▁was ▁cost ly ▁and ▁pain ful . ▁Communic able ▁dise ases , ▁like ▁ch ol era , ▁meas les , ▁t uber cul osis , ▁di ph ther ia , ▁etc . ▁were ▁a ▁constant ▁threat ▁as ▁knowledge ▁of ▁how ▁they ▁were ▁spread ▁or ▁how ▁to ▁treat ▁them ▁was ▁unknown . ▁Germ s ▁would ▁remain ▁unknown ▁for ▁another ▁ 3 0 ▁years ▁and ▁effective ▁treatment ▁for ▁over ▁a ▁century ▁in ▁many ▁cases . ▁San itation ▁practices ▁were ▁expensive ▁and ▁not ▁understood ▁so ▁clean ▁water ▁and ▁se w age ▁collection ▁and ▁treatment ▁were ▁just ▁starting ▁to ▁develop . ▁Ep ide m ics ▁like ▁ch ol era ▁and ▁yellow ▁fe ver ▁killed ▁thousands . ▁Medical ▁treat ments ▁were ▁of ▁very ▁une ven ▁quality ▁as ▁almost ▁anyone ▁could ▁call ▁themselves ▁a ▁doctor ▁and ▁treat ▁patients — prof essional ▁medical ▁training ▁and ▁cert ification ▁was ▁just ▁starting ▁to ▁be ▁developed . ▁Medical ▁knowledge ▁was ▁so ▁poor ▁that ▁training ▁often ▁did ▁little ▁or ▁no ▁good . ▁If