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                             DUTCH METHODS
                                   OF
                             BIRTH CONTROL.


                                   BY

                          MARGARET H. SANGER.




                    DUTCH METHODS OF BIRTH CONTROL.


The following methods are taken from the pamphlet published by the
Neo-Malthusian League of Holland, called “Methods Used to Prevent Large
Families,” translated into English from the Dutch.

The Council of the Neo-Malthusian League calls attention to the fact
that it has for its sole object the Prevention of Conception, and not
the causing of abortion.

The Neo-Malthusian League of Holland knows nothing of this pamphlet, and
is not in any way responsible for its publication.

                                                                M. H. S.




                     A BRIEF HISTORY OF THE LEAGUE.


In the year 1877 Mrs. Annie Besant and Mr. Charles Bradlaugh, two firm
and honest advocates of the doctrine of Malthus, were prosecuted and
sentenced to imprisonment for publishing a book entitled “The Fruits of
Philosophy,” which presented the physiological aspects of birth control.

The trial lasted several days, and aroused a greater interest in the
subject than had been known since the days of Malthus. The English Press
was full of the subject; scientific congresses gave it their attention;
many noted political economists wrote about it; over a hundred petitions
were presented to Parliament requesting the freedom of open discussion;
meetings of thousands of persons were held in all the large cities; and
as a result, a strong Neo-Malthusian League was formed in London.

Interest in the subject did not confine itself to England, however, for
the following year at an International Medical Congress in Amsterdam the
subject was discussed with great enthusiasm. A paper prepared and read
by Mr. S. Van Houten (later Prime Minister) caused a wider interest in
the subject, and a year later the Neo-Malthusian League of Holland was
organised. Charles R. Drysdale, then President of the English League,
attended the Conference.

As is usual in such causes, many of the better educated and intelligent
classes adopted the practice at once, as did the better educated
workers; but the movement had as yet no interest among the poorest and
most ignorant. The League set to work at once to double its efforts in
these quarters. Dr. Aletta Jacobs, the first woman physician in Holland,
became a member of the League, and established a clinic where she gave
information on the means of prevention of conception free to all poor
women who applied for it.

Naturally, this action on the part of a member of the medical profession
aroused the animosity of many of its members against her; but Dr. Jacobs
stood firm in her principles, and continued to spread the necessary
information among the peasant women in Holland in the face of
professional criticism and gross misunderstandings.

All classes, especially the poor, welcomed the knowledge with open arms,
and requests came thick and fast for the League’s assistance to obtain
the necessary appliances free of charge. The consequence has been that
for the past twelve years the League has labored chiefly among the
people of the poorest districts. Dr. J. Rutgers and Madame Hoitsema
Rutgers, two other ardent advocates of these principles, have devoted
their lives to this work. Dr. Rutgers says that where this knowledge is
taught there is a reciprocal action to be observed: “In families where
children are carefully procreated, they are reared carefully; and where
they are reared carefully, they are carefully procreated.”

The Neo-Malthusian League of Holland has over 5,000 men and women in its
membership, and more than fifty nurses whom it endorses.


                          THE DISTRICT NURSES.

These nurses are trained and instructed by Dr. Rutgers in the proper
means and hygienic principles of the methods of Family Limitation. They
are established in practice in the various towns and cities throughout
Holland. They not only advise women as to the best method to employ to
prevent conception, but they also supply them with a well-fitted
pessary, and teach them how to adjust, remove, and care for it—all for
the small sum of 1½ guilder, or about 60 cents. They work mainly in the
agricultural and industrial districts, or are located near them; and
their teachings include not only the method of prevention of conception,
but instruction in general and sexual hygiene, cleanliness, the
uselessness of drugs, and the non-necessity of abortions.

In this country, for a nurse to dare to fit a woman with a pessary would
be considered a breach of professional rights. In Holland, they know the
poor cannot pay the physicians, and this simple adjustment is looked
upon by the medical profession much as they view the nurse administering
an enema or a douche.

I had the pleasure of attending some of the classes where Dr. Rutgers
gave this course of instruction. I also attended and assisted in the
clinics where women came to be advised, instructed, and fitted. Many of
them came for the first time, and though they were unacquainted with any
means to be employed, they accepted the instructions in a most natural
and intelligent manner. Other women came to be refitted, and many
brought the pessary previously used, to ask questions concerning its
adjustment.

There was a determined social responsibility in the attitude of these
peasant women coming into The Hague from the surrounding districts. It
seemed like a great awakening. They look upon a new baby in the family
much as they look upon the purchase of an automobile or a piano or any
other luxury where they have no room to keep it, and no means with which
to purchase it or to continue in its upkeep.

There is no doubt that the establishment of these clinics is one of the
most important parts in the work of a Birth Control League. The written
word and written directions are very good, but the fact remains that
even the best educated women have very limited knowledge of the
construction of their generative organs or their physiology. What, then,
can be expected of the less educated women, who have had less advantages
and opportunities? It is consequently most desirable that there be
practical teaching of the methods to be recommended, and women taught
the physiology of their sex organs by those equipped with the knowledge
and capable of teaching it.

The Neo-Malthusian League of Holland endorses, as the most reliable
means of prevention of conception, the Mensinger pessary (which differs
in construction from the French or the American Mizpah pessary). The
nurses also recommend this; but other methods are discussed with the
patient, and the husband’s attitude toward other methods considered and
discussed. The pessary is the commonest recommendation, as giving the
most satisfactory results.




                                RESULTS.


It stands to the credit of Holland that it is perhaps the only country
where the advocates of Birth Control have not been prosecuted or jailed.
This does not mean there has been no opposition to this propaganda; on
the contrary, there is to-day strong opposition by the Church, and only
a few years ago, in 1911, when a Clerical Government came into power,
laws were made against the propagation of these ideas, and much of the
freedom previously enjoyed by the League was denied it; but on the
expulsion of the Clerical Government later on, the rights of free speech
and free press were regained.

In the year 1895 the League was given a royal decree of public utility,
which again does not necessarily mean this propaganda is sanctioned by
the Government; but the laws regarding the liberty of the individual and
the freedom of the press uphold it, and it is thus that its advocates
are not molested.

The League has thirty sub-divisions, which include all the large cities
and towns and many of the smaller ones. Over 7,000 pamphlets of the kind
printed herein are sent out in the Dutch language and several hundred in
English and Esperanto each year. These are only sent when asked for by
the applicant.

There is no doubt that the Neo-Malthusian League of Holland stands as
the foremost in the world in organisation, and also as a practical
example of the results to be obtained from Birth Control teaching. Aside
from the spreading influence of these ideas in Belgium, Italy, and
Germany, Holland presents to the world a statistical record which proves
unmistakeably what the advocates of Birth Control have claimed for it.

The infantile mortality of Amsterdam and The Hague is the lowest of any
cities in the world, while the general death rate and infantile
mortality of Holland has fallen to be the lowest of any country in
Europe. These statistics also refute the wild sayings of those who shout
against Birth Control and claim it means race suicide. On the contrary,
Holland proves that the practice of anti-conceptional methods leads to
race improvement, for the increase of population has accelerated as the
death rate has fallen. There has also been a rapid improvement in the
general physique and health of the Dutch people, while that of the high
birth rate countries, Russia and Germany, is said to be rapidly
deteriorating.

The following figures will suffice to show some of the improvements
which have been going on in Holland since 1881, the time the League
became actively engaged in the work:—


                 VITAL STATISTICS OF CHIEF DUTCH TOWNS.

  Taken from Annual Summary of Marriages, Births, and Deaths in England
                       and Wales, etc., for 1912.


    AMSTERDAM (Malthusian League started 1881; Dr. Aletta Jacobs gave
                      advice to poor women, 1885).

                       1881–85. 1906–10.    1912.
 Birth Rate                37·1     24·7     23·3 per 1,000 of
                                                  population.
 Death Rate                25·1     13·1  11·2[1]          〃 〃
 Infantile Mortality        203       90    64[1] per 1,000 living
 (deaths in first                                 births.
 year)


     THE HAGUE (now the headquarters of the Neo-Malthusian League).

                       1881–85. 1906–10.    1912.
 Birth Rate                38·7     27·5     23·6 per 1,000 of
                                                  population.
 Death Rate                23·3     13·2  10·9[1]          〃 〃
 Infantile Mortality        214       99    66[1] per 1,000 living
 (deaths in first                                 births.
 year)


                               ROTTERDAM.

                       1881–85. 1906–10.    1912.
 Birth Rate                37·4     32·0     29·0 per 1,000 of
                                                  population.
 Death Rate                24·2     13·4     11·3          〃 〃
 Infantile Mortality        209      105       79 per 1,000 living
                                                  births.

Footnote 1:

  These figures are the lowest in the whole list of death rates and
  infantile mortalities in the summary of births and deaths in cities in
  this Report.


                   FERTILITY AND ILLEGITIMACY RATES.

                        1880–2.  1890–2.  1900–2.
 Legitimate Fertility     306·4    296·5    252·7 Legitimate Births per
                                                  1,000 Married Women
                                                  aged 15 to 45.
 Illegitimate              16·1     16·3     11·3 Illegitimate Births
 Fertility                                        per 1,000 Unmarried
                                                  Women aged 15 to 45.


                               THE HAGUE.

                                 1880–2.         1890–2.         1900–2.
 Legitimate Fertility              346·5           303·9           255·0
 Illegitimate Fertility             13·4            13·6          7·7[2]


                               ROTTERDAM.

                                 1880–2.         1890–2.         1900–2.
 Legitimate Fertility              331·4           312·0           299·0
 Illegitimate Fertility             17·4            16·5            13·1

Footnote 2:

  Lowest figure for the Continent.

The Neo-Malthusian propaganda in Holland is founded on feministic and
economic grounds. Birth Control is the pivot around which both of these
important movements must swing. Mr. S. Van Houten, late Minister of the
Interior of the Netherlands, says: “Wage-slavery exists as a consequence
of the carelessness with which the former generation produced
wage-slaves; and this slavery will continue so long as the adult
children of these wage-slaves have nothing better to do than to
reproduce wage-slaves.”

There has been marked improvement in the labor conditions in Holland
during these last ten years especially, wages having increased and hours
of labor decreased, with the cost of living taking a comparatively very
small rise.

There is perhaps no country in Europe where the educational advantages
are so great as in Holland. Many English women and widows with children,
living on small incomes, move to Holland on account of the splendid
education to be obtained in the public schools.

That the Birth Control propaganda has been a success in Holland any one
travelling through that delightful, clean, and cheerful country can
testify. There is no doubt that at first there were objections and
abuses, but, in the words of Dr. Rutgers, “Certainly there are abuses,
but the abuses of knowledge are never so enormous as the abuses of
ignorance. And hygiene is the highest form of morality.”

Following are the methods, reprinted from the practical pamphlet given
out by the Neo-Malthusian League of Holland:—

  _Confidential._


                          MEDICAL INFORMATION.

  Considerations of health, and uncertainty as to the rearing of her
  children, or any other personal cause may urge the mother of a
  family to avoid frequent births. For this purpose precautions are
  required by the married partners; and these means may be employed by
  the wife as well as by the husband. These methods are not absolutely
  infallible. (The only infallible methods are operations: viz., the
  obstructing by a ligature or by compression of the Fallopian tubes;
  the extirpation of the uterus or the ovaries in the female, and of
  the testes in the male.) They must be made use of very carefully and
  perseveringly if the couple wish to reduce to a minimum the chances
  of increasing the number of children. We shall give the minutest
  details about each of the methods known at the present day,
  insisting, last of all, upon the _injections_, for the essential
  part of every preventive method consists in cleanliness.

  It is in the case of women who have had children that the methods
  about which we have to speak are most easily applied; for the
  narrower the female passage, the greater is the difficulty in making
  use of them. Of course, we shall not speak here of sexual
  satisfaction such as masturbation, which may be dangerous to health,
  consisting in an artificial excitation rather than in the appeasing
  of a physiological need.

  When the accoucheur or midwife who examines a woman in labour pushes
  the finger, moistened with a little soap, as far as possible into
  the vagina, a small protuberance is felt like the tip of the finger,
  which is the lower end of the womb. The womb, the mouth of which is
  felt with some difficulty in the centre of the protuberance, is the
  little nest in which the human egg is hatched.

  As soon as the male fluid (sperm) has arrived within the orifice of
  the womb the woman can no longer prevent impregnation, even if she
  immediately use vaginal injections with the most sedulous care; and
  to inject fluid into the womb or to make any other attempt to
  destroy the ovulum within the womb is more or less dangerous, as it
  may produce fever or hæmorrhage. These operations are in the
  department of medicine or surgery, and are only permissible for the
  prevention of some dangerous disease, or danger of sudden death. The
  medicines or poisons recommended for re-establishing menstruation
  are rarely of any effect, and are dangerous to life.

  The following methods have simply the aim of preventing the male
  fluid from entering into the mouth of the womb; they in nowise
  injure the health, and are not forbidden in any civilised country
  either by moral codes or by law.


                  MEANS TO BE EMPLOYED BY THE HUSBAND.

  The principal anti-conceptional method is, of course, _absolute
  continence_ maintained for a long period, and this is needed in some
  cases, when the wife is ill, for instance, or when she requires
  perfect repose. The wife who wishes to remain free by this means
  ought nevertheless to take great care as to cleanliness, and if the
  husband forget himself for a moment, she should immediately give
  herself energetic injections; but this may be too late.

  Some physicians think that _periodical abstention_ during
  menstruation and for a week before and after the period would
  suffice to prevent conception; but this cannot be trusted to. It is
  true that women are less apt to be impregnated at these times; but
  cases have been known of numbers of pregnancies taking place in
  spite of this precaution.

  During the period of lactation the chances of pregnancy also are
  less; but there is no certainty in this case.

  By the effort of the will and by practice, it is possible for
  certain men to practice connection frequently without expulsion of
  the male fluid; just as it is possible for civilised persons who are
  intelligent to keep back their tears even when deeply moved. This
  kind of special faculty of prevention has been called _karezza_ (to
  be dealt with in full in the next pamphlet).

  When the husband can employ no other method, he can always practise
  _withdrawal_ out of the female passage before emitting; but it might
  suffice for the male fluid to moisten the exterior genital parts of
  the wife to cause impregnation.

  This method is simple, without expense and requiring no preliminary
  preparation, but the wife should inject herself immediately with
  care if she suspects any negligence on the part of the husband. He
  too ought to wash himself thoroughly (pushing back the prepuce)
  before recommencing relations with his wife within 24 hours.

  When the effort is not too violent for the man, and if the wife is
  more or less satisfied, this method is not injurious to the health.
  At any rate occasionally another method may be used.

  When the male organ is covered by an indiarubber _French Letter_,
  condom, or Malthus sheath, a little bag with thin walls, there is no
  chance of the woman being impregnated if the bag be not torn. In all
  instrument-makers’ shops they are sold at from two to three
  shillings the dozen. One rather too large is to be preferred, for
  these bags contract if used more than once.

  When the husband makes use of the French Letter, it must be
  unrolled, pushing it up not quite to the end, expressing with the
  hand the air bubbles which may remain in its cavity; the bottom may
  also be moistened inside with a little soapy water or saliva.

  If, after using it, the French Letter be empty, it is evident that
  it must have been torn, in which case the wife should immediately
  use careful injections; but this may be too late.

  One letter may suffice for several times; in this case, it must each
  time be carefully wiped off or washed and dried and inflated in
  order to remove the folds, and to see that it has not been torn; and
  lastly, it may be powdered with a little powder inside and outside.
  The best powder is that of lycopodium, which is obtainable at a
  cheap rate in druggist shops. After having powdered it, the French
  Letter may be opened by means of two fingers, and be rolled up again
  when required for further use.

  The same French Letter should not be too often used, perhaps two
  weeks or six times, and it should not be too old, for in the lapse
  of time it loses its properties. Like all things made of
  indiarubber, it is well to keep it in a rather damp, cool place, and
  shield it from light or frost, it must not be touched by greasy
  substances, such as oil, fat, vaseline, paraffin, etc., nor with
  carbolic acid or other substances which act upon indiarubber.

  There are also French Letters or condoms of gut, called _Skin
  Letters_, made from the cœcum of sheep. These are sold at higher
  prices, and are more durable and stronger than the indiarubber ones.
  They have the fault that they become somewhat hard after frequent
  use. They are not elastic, and therefore cannot be rolled up, so
  that they cannot be used if they are too narrow. Before use, it
  should be carefully examined against the light to see that it is not
  made of pieces glued together, which fall asunder as soon as the bag
  is moistened, and then it must be blown up gently to see that there
  are no holes in it. When good, it may be used for a month. Their
  employment is quite like that of indiarubber letters.

  The French Letter is the only preventive which diminishes a great
  deal the chances of contracting venereal diseases.

  When there is any chance of venereal contagion, it is necessary to
  wash the French Letter with a solution of corrosive sublimate
  (perchloride of mercury), one in 10,000 parts of water; then it
  should be dried and powdered. By using this solution immediately
  after connection, it is seen at once whether the French Letter has
  been torn; in this case, the man must wash himself, and the woman
  should use an injection with the same solution, not only to prevent
  contagion to both of themselves, but she also to prevent the birth
  of an infected infant.

  When the husband is drunk, and his wife, fearing that a miserable
  child will be born, has no other preventive at hand, she can perhaps
  apply the French Letter as if caressing him, when he does not know
  what he is doing. At all events, she should always take care that
  one or two French Letters be ready for use.


                  MEANS THAT MAY BE USED BY THE WIFE.

  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.


                              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.

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                          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=.