The wife may prevent conception by passing into the vagina the
_occlusive pessary_ of _Dr. Mensinga_; if this do not remain in its
place, she may rather use that named _Matrisalus_, which is more
curved. If this also does not remain in its place, the husband
should use the French Letter or condom. If, finally, the husband
will not use these means, the wife may use the _tubular pessary_,
or, for want of a better, the _sponge_. (This is the only method
available in countries where there are no medical practitioners or
other persons who know the business, and can choose and teach women
how to place the pessaries.)
These instruments, designed to cover the mouth of the womb, are not
worn in the daytime. The wife may introduce them every evening (and
by preference before the return of her husband). During the night
they all may remain untouched, unless there be danger of the
instrument being ill-placed. On the morrow, or in uncertain cases
immediately after connection, a small injection should first be
made, in order to cleanse away the greater part of the sperm, then
the instrument should be withdrawn standing upright or kneeling;
finally a full injection should be made use of to clear out
thoroughly every corner of the organ. The pessary must then be
cleaned carefully, and inspected to see that it is in good
condition, wiped gently and put away in a drawer without wrapping it
up.
During menstruation the woman should entirely abstain from sexual
relations. When, however, it should chance that, withdrawing the
instrument she sees that the flow appears, it will be necessary for
her to use energetic injections if she had sexual relation.
The method which we mention for the use of women has the great
advantage of permitting her to be free from care during the night;
and it is also an essential point that the husband need not be
consulted in the matter.
If these instruments are well placed, the husband cannot perceive
their employment by the wife. It is also requisite that the method
does not at all annoy the wife; if they produce the slightest pain,
it is because they are either ill-chosen or misplaced.
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.