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used simultaneously. In a great many of such cases, however, I should advise not a temporary and continuously troublesome measure of contraception, but permanently effective sterilization (see below). This is also even more necessary in those who suffer from insanity or definite feeblemindedness.

The same applies even more explicitly to all cases of women where a fortuitous pregnancy would involve the necessity for an evacuation of the uterus (see p. 54). In such circumstances, no further risks should be taken and the woman should, therefore, be permanently sterilized.

Where the diseased or degenerate person is the man, this is of course a much easier and lighter operation by means of vasectomy than where the one to be sterilized is the woman. For women probably the cutting and double tying of the Fallopian tubes is the best of the various methods of sterilization, but as it involves rather a serious operation, the expense tends to take it out of the reach of a great many just of those women who most need it.

The old-fashioned method of sterilization which was for some time rather fashionable