Contraception/Chapter 4

THE Contraceptives at present in use are numerous and their classification might be based on various principles. For convenience I will group them in the following way, numbering each type of contraceptive so that they may be easily followed up in the next chapter where I deal with each in some detail.

True Contraceptives include only methods of procedure which retain potential fertility, and imply control over the inseminating power of individual acts of coitus.

In contradistinction to these are methods of sterilization, temporary and permanent (see pp. 53 and 196) and abortion (see p. 54). True Contraceptives alone will be considered in detail in this book.

True contraceptives may be grouped as follows:

1. Actions or modes of procedure by ​either sex not involving the use of chemical substances or appliances of any sort.
2. Actions or modes of procedure involving the introduction of chemical substances with the supposed intention of incapacitating the spermatozoa so that they do not fuse with the ovum.
3. The use of appliances by either sex to prevent the spermatozoa coming in contact with the ovum.

Under these various headings I shall include descriptions of all important methods in which reliance is placed by any one, even if some of them may appear valueless to a modern trained mind: for all have some social, psychological, legal or medical significance and interest.

A.—Actions or modes of procedure by either sex not involving chemical substances. or appliances of any sort: many of these are mistakenly described as "natural" by persons prejudiced against the application of science to human breeding:—

1. Actions by the female:
   1. Extreme passivity in order to control her own orgasm so that it does not take place (see p. 56).
   2. Placing the body in positions likely in her individual case to prevent ​ contact of the penis with the cervix (see p. 60).
   3. Sitting upright the moment after ejaculation has taken place and coughing violently, or taking some other exercise to contract the pelvic muscles (see p. 61).
   4. Prolonged suckling an infant or child (see p. 64).

The above methods (all presumably dating from prehistoric antiquity) are still used even in this country, and sometimes relied upon by individual women without failure. It is doubtful whether such women would not prove to be of a naturally infertile type. They offer, however, no general and reliable security to the average woman.

1. Action of the Male:
   5. Extra-vaginal union without normal penetration (see p. 68).
   6. Vaginal stimulation consummating the ejaculation after withdrawal, commonly called "coitus interruptus," sometimes called onanismus conjugalis (see p. 69).
2. By both Parties:
   5. Control of the coital act so that ejaculation shall not take place even ​ after prolonged union. Known as "Male Continence," "Karezza," and by a variety of other names (see p. 79).
   6. Seasonal fertility.
   7. Coitus intermenstruus, or restriction of the coital act to certain specified dates in the month, commonly called the "safe period," or tempus ageneseos (see p. 84). Mutual and complete abstention from the coital act (see p. 90.

In addition to the above there are still more aberrant practices and the use of other female and male openings which are entirely to be deprecated as pernicious and abnormal and will not be discussed here, although practitioners should be on their guard against their use by their patients and warn them of the nervous and other harmful effects likely to accrue from their use.

B.—Chemical substances introduced with the intention of incapacitating the spermatozoa:—

(Note: So far as I am aware such substances are never introduced into the male organ, but are always introduced into the vagina in one form or another. I make this ​apparently obvious comment because one man approached me with an absurd thing he wanted to patent which should inject destructive chemicals up the male urethral tube! Needless to say I did all I could to discourage him from proceeding with his patent).

The commonest chemical substances introduced into the vagina are:—

11. Quinine compounds in a variety of forms (see p. 104).
1. As a powder (see p. 104).
2. As ointment on a sponge, plug, cap, or merely rubbed round the cervix (see p. 105).
3. In a pessary or suppository contained in a matrix of low melting point wax, such as cocoa butter, or gelatine (see p. 105).
4. Dissolved in or mixed with oil which is injected by a small specially constructed syringe (see p. 113).
5. Various suppositories (see p. 114).
12. Alum in powdered form (see p. 114).
13. Common salt in solution as a douche (see p. 119).
14. Vinegar and water, or lactic acid, &c., as a douche (see p. 119).
​
15. Disinfectants of one sort or another in the form of a douche (see p. 120).
16. Plain cold water in the form of a douche (see p. 122).

C.—Appliances used by either sex to prevent the spermatozoa coming in contact with the ovum:—

1. By the Male:—
   17. Condoms (popularly called "French letters") (see p. 125 and p. 184).
   18. Pin or stud-like apparatus supposed to close the urethra in case unpremeditated ejaculation took place before coitus interruptus was accomplished (see p. 132).
2. By the Female:—
   19. The sponge, used with or without chemical solutions, soap powder, or other potential spermaticide (see p. 132).
   20. Soft plugs (see p. 135).
   22. Special tampons (see p. 136).
   24. Dome-shaped cap-like pessaries designed to fit over the cervix in a great variety of designs and construction (see p. 138). ​
   23. Cap-like pessary similar to above, but covered with sponge on the convex surface (see p. 157).
   24. Flat lens-shaped cap (Dumas') designed to close the end of the vaginal canal (see p. 158).
   25. Hemispherical-shaped caps with spring rim designed to close the end of the vaginal canal: the "Dutch" cap (see p. 160).
   26. Cap-shaped pessary with separate ring and soft detachable cap, called the "Mizpah" (see p. 166).
   27. "Matrisalus" pessary, rubber cap of turtle-back shape (see p. 168).
   28. Balls of soft rubber (see p. 168).
   29. Large membranous or rubber sheath, or "Capote Anglaise," calculated to cover the internal female organs completely, acting like the male sheath in preventing contact of the seminal fluid with the vaginal surface (see P. 169).
   30. Springs, studs, metal buttons, the "Gold Spring" or "Wishbone" pessary, metal cigar-like structures in a great variety of shapes and forms, designed to enter the cervical canal, and some also to ​ fill the cavity of the uterus (see p. 170).

In individual cases and for individual circumstances any one or other of the above may be found from time to time advisable, but for regular use, particularly for general use on the part of healthy and normal persons, only one or two of the above methods are required. Many are actually harmful, and in the next chapter the relative uses, values, faults of and objections to the various methods will be considered.

It should perhaps be mentioned that although castration of necessity involves sterilization, the best modern methods of sterilization do not involve castration.

For men sterilization is an easy and simple matter, best achieved by vasectomy, though it may be accomplished in other ways; and the general use of X-rays seems imminent, for experiments have shown that the properly applied X-rays prevent the maturation of the spermatozoa but do not do any general harm (see p. 199).

For women operative sterilization is a ​rather more serious business, and the best method is the double tying of the Fallopian tubes and excision of the segments between the ties. Though generally reliable this method is not absolutely safe owing to the spontaneous power of the ovum to wander, reported now and then as resulting in unexpected pregnancy.

In women excision of ovaries or womb leads to sterility, but these operations are now seldom undertaken by doctors except to combat definite disease. A decade or so ago, however, removal of the ovaries tended to be rather a fashionable operation in some circles.

The subject of sterilization is a separate and very large theme and will not be dealt with fully in this volume, though some further notes will be found on p. 196.

Methods of abortion are most frequently used by poor and ignorant women who are denied the necessary contraceptive knowledge, and many and various as they are, all can fairly be described as physiologically harmful as well as legally criminal.

Medically necessary "evacuation of the uterus" or therapeutic abortion is suffi​ciently dealt with in ordinary books of medical practice and will not be considered at all in this volume. Particularly valuable information will also be found in Taylor's "Medical Jurisprudence."^[1]