Part 2

Should the wife have any special disease of her organs, she should refrain from all connection until cure is effected; when there is doubt, she ought to consult a physician before employing such methods.

The first instruction and choice of the instrument should be pointed out to the wife by a practitioner or by a midwife or by any other person acquainted with the matter. If such assistance be unobtainable, she may herself try to act under the following directions:—

The _pessary Mensinga_ (price 50 cents) is a simple ring closed by an indiarubber membrane curved like a hemisphere; it is but of little importance whether the convex side be directed upwards or downwards. These instruments are made of different sizes, and are numbered corresponding to their diameters in centimeters. The greatest number that can be introduced without discomfort gives the most security. (We advise engaged women to choose their pessary some weeks before marriage, in order that the discomfort which results for the first moment may have passed away on the marriage day; 6¾ or 7 will generally be suitable; soon after marriage they should choose higher numbers. The external orifice of the genitals may be very narrow, and yet the vagina rather large). It is good to commence by trying No. 7¾.

Generally the pessary is moistened with the same liquid which is used as an injection; but on the first occasion, and always when the pessary is introduced with difficulty, the genital parts may be moistened with white soap to render them slippery. When a wife is measured for a pessary she should be at her ease, undressed, without her stays, in the stooping or cowering posture, and thighs apart. She should have been to the watercloset before.

To place the pessary, it is pushed vertically into the longitudinal opening of the vulva. The ring may be slightly pressed into a figure of 8, but not forcibly so as to break the spring which is in its walls. The part first introduced ought to be directed backwards; the last inserted part should disappear behind the os pubis which is felt in front. By hooking the finger behind this bone, the pessary may be pushed up as far as it will go.

It is necessary to choose the pessary with care. The essential conditions are: (1) that there should be no space between the pessary and the os pubis, nor that any should remain when it is pushed as far as possible backwards. (A very small space may perhaps be left, on condition that the husband take care not to enlarge it during connection.) (2) We should feel the inferior tip of the womb covered by the membrane of the pessary when the finger is introduced as far as possible. As a rule, we should try the largest number that can enter, and then higher numbers, until the pessary is found which satisfies these conditions.

If the membrane of the pessary does not cover the mouth of the womb, the pessary must be introduced not in the direction of the abdomen, but backwards towards the anus (bottom); this method of operating may fail if the woman is stooping; it will succeed better if she is lying down.

When a pessary is found which realises the conditions above described, care must be taken that the instrument remains in its place when the woman is standing up with the thighs apart, and making at the same time pressure of the abdomen. If in such conditions the pessary descends so that a space is left between the pessary and the os pubis, a larger number must be tried. If no number of the Mensinga pessary fits, recourse must be had to the _pessary Matrisalus_ (price 75 cents), which is more difficult of application, for with this instrument care must be taken that the convex side is placed above, and the curved part in front, in correspondence with the curved part of the os pubis. This pessary has the great advantage that it does not descend so easily. Besides, this pessary is treated like the others.

If this pessary does not suit either, the husband must make use of the French Letter, and if he objects, the wife might use the _tubular pessary_ (price 25 cents), which, not serving as an obturator of the vagina, covers the end of the womb like a cap. The wife at first introduces her finger to find out the tip of the womb, she then slides the tubular pessary up until it adheres like a sucker to its tip. The higher part of the pessary should enter first, and the instrument should be placed so that during connection the husband should scarcely touch the bottom of the pessary. After the first connection, the wife should see that the pessary remained in its place.

Injections should be used as in former cases. If none of these methods are applicable, the wife may make use of a fine _sponge_. This sponge ought to be as large as an infant’s fist, and be rather too large than too small, so as to block up the vagina.

A thin ribbon is attached to the sponge, in order to withdraw it easily. The sponge must be renewed after a time, as it loses its elasticity with use. It should, before it is introduced, be moistened with the same solution as the fluid injection, and then pushed up so that the womb is well covered. Injections should be used with the sponge before it is introduced and immediately after connection, before and after removing the sponge. It is not as certain a preventive as the pessaries.

Yet this sponge is preferable to certain plans spoken of in the newspapers, and which cost a good deal, such as _soluble pessaries_, containing quinine or some acid substance. These are pushed up five or ten minutes before connection, and as near as possible to the mouth of the womb, with the hope that they may melt at the right moment and at the right place to destroy the vitality of the male fluid.

The _Atokos_ or other syringes with powder. They contain an acid powder which is blown up into the vagina. If either of these methods be used, energetic injections should be taken immediately after connection.

_Injections_, made immediately after connection, even with the most splendid syringes, are not of themselves sufficient; they always can come too late.

Dr. HINZ has invented a small syringe with an indiarubber ball at each end of a tube, recommended by Dr. FISCHER-DUCKELMANN, to inject a spermicide liquid, which is warmed, at the moment of the emission. This syringe is called _Facilitas_, but it is neither easy nor secure.

With these syringes the liquids mentioned in the following chapter may also be used.

For the success of any of these methods, it is indispensable that the wife should be acquainted with the position of the mouth of the womb.

INJECTIONS.

Injections are an essential point of the sexual hygiene of the wife; but they are not sufficient alone: they complete the other preventive methods.

As injection, any acid solution may be used; for instance, _vinegar_ with equal parts of water, or a solution of 1 per cent. of citric or tartaric acid, etc. Any astringent solution, which is also useful in the case of white discharges: _sulphate of zinc_ or _alum_, of either 1 per cent. (a dessertspoonful of the powder in a litre or in a large bottle of water). Or _corrosive sublimate_ (perchloride of mercury), a decigramme dissolved in a large bottle of water.

This last solution is also very powerful against venereal contagion; but, if too frequently employed, it may prove poisonous.

Solutions of copper or nitrate of silver may be used; but these solutions stain the linen. Copper, if long used, is poisonous.

Now, what syringe should be used?

The simplest instrument is the _glass syringe_, not curved, of large size (containing 60 cmc. of liquid), which costs 25 cents. The solution is poured into a cup and drawn up into the syringe; the piston should be so carefully fitted that no fluid will escape when the syringe is held downward. The most efficacious method of using the injection is to lie on the back, on a vessel receiving the fluid, the thighs drawn up and separated. The syringe is pushed up into the vagina as far as possible, and then this piston is rapidly pushed down; when this has been done, the syringe is moved from right to left, in order to wash out all the folds of the vagina.

Other instruments may as well be employed if it be only a syringe with a long tube, that it may reach all vaginal folds—the _clysopompe_, which acts by means of a spring; the _clysior_ or oblong bulb, with a tube at each end; the _irrigator_, which is hung up on a nail high up on the wall.

These latter instruments require a much greater quantity of the solution than the glass syringe requires. Therefore the fluid, almost a litre, should be warmed when the weather is very cold, or when the woman is very sensitive.

The tube ought not to be too curved, and ought to be pushed up as far as possible and to be energetically moved in all directions, so as to be sure that nothing remains in the vaginal folds.

The least useful syringes are the indiarubber pears, by means of which it often happens that nothing more than the air contained in the pear is introduced into the vagina.

Two important Books by MARGARET H. SANGER—=What Every Girl Should Know=, price 25 and 50 cents, paper and cloth bound; =What Every Mother Should Know=, paper cover, price 25 cents.—Address, M. MAISEL, 422 Grand Street, New York City.

TRANSCRIBER’S NOTES

1. Silently corrected typographical errors and variations in spelling. 2. Archaic, non-standard, and uncertain spellings retained as printed. 3. Enclosed italics font in _underscores_. 4. Enclosed bold font in =equals=.