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CONTRACEPTION AND FERTILITY
462
psychosis is prevented from remaining equilibrium. Insulin and cardiazol offer a pre-eminently potent means of disturbing the psychosis as often as may be necessary. Their value
treatments the an
effortless
is therefore incontestible, even if at a later date it be proven that their effect is not specific. (2) The cases which do best are those in which there is still some reaction against the psychosis, in which there is not yet utter unremitting apathy. The more florid the psychosis, the better the outlook. Good results are sometimes obtained in apparently demented cases of some years’ standing. These cases
during treatment gradually uncover a psychopathological picture showing delusional and hallucinatory material which had been conscious originally and which was still attaining expression in the mannerisms, attitudes, and behaviour generally of the so-called dement. We speak from an experience of sixty insulin and forty cardiazol cases treated in the male and female wards of this hospital since October, 1936. We are convinced that, whatever the rationale may be, more remissions are procured with these treatments than are ordinarily observed, and that these treatments should be available in every mental hospital. Weare, Sir, yours faithfully, EDWARD LARKIN, HUNTER GILLIES. West Ham Mental Hospital, Feb. 13th.
CONTRACEPTION AND FERTILITY
of THE LANCET medical subcommittee of the National SiR,-The Birth Control Association has ventured to contest Mr. Green-Armytage’s statement that contraceptive measures in the early days of marriage are inimical to pregnancy at a later date, and has declared its inability to find evidence in support of his statement. May I assist this subcommittee’? In the gynaecological and obstetrical monograph " Sterility and Conception" by Gardner Child (1931), it is stated on p. 89 that " where artificial means are used to prevent conception and are indulged in for any length of time they are quite liable to create a habit of sterility." In the Trccnsactions of the Medical Society of London (1936, 59, 120) Mr. Lane-Roberts says that " at times the endocervical secretion becomes hostile to spermatozoa because of the mechanical viscosity resulting from either poor cervical drainage or an endocervicitis," and on p. 130 he adds : "to take at random some infertility factors found in one series of one hundred cases, in the woman, in 28 per cent. endocervicitis was the factor." James Young, in the third edition of his gynaecology text-book (1933), states that chronic endocervicitis is a cause of sterility of uncertain importance ; " it may prevent insemination by leading to an inflammatory blockage of the canal or by producing discharges which are hostile to the spermatozoa." Beckwith Whitehouse, in the fourth edition of Eden and Lockyer’s book, writes : " There can be little doubt that the lesion (erosion), accompanied as it is with alteration in the amount and character of the cervical secretion, is a cause of diminished fertility." It can hardly be disputed that the practice of contraception, with all its mechanical, chemical, and infective possibilities, is capable of causing chronic changes in the cervix uteri. Contraception involves finger insertion and handkerchief contamination The cervical canal is the must sometimes occur. Dardanelles of the genital tract, and any alteration in its state is inevitably brought to bear on the sperm attempting to win entrance. To the Editor
One is led to wonder whether the National Birth Control Association, which can so lightly dismiss the expressed opinion of an experienced gynaecologist, has sufficient title to its discriminating function. I am, Sir, yours faithfully, GEORGE H. ALABASTER. Welbeck-street, W., Feb. 14th.
To the Editor
of THE secretary of
LANCET
the National Birth Sm,—When the Control Association submitted her apologia in your last issue she picked out one line of a verbatim report and neglected to refer to the answer which I courteously supplied when she wrote to me on Jan. 25th. In equity I am enclosing for publication a copy of my letter to her which explains the reasons for the opinion held, with which many will agree, including an eminent gynaecologist who was present at the meeting and was also one of the official
speakers. The views of the medical subcommittee
are
not
impressive for (a) presumably they deal mostly with patients who do not want more children, (b) statistics can be made to prove anything, and (c) they naturally are biased ; whereas I was only speaking of the use of contraceptives before or in the early days of matrimony-clinical experience being of greater value than supposition. I am, Sir, yours faithfully, V. B. GREEN-ARMYTAGE. Harley-street, W., Feb. 14th. *** Mr. Green-Armytage encloses his reply to the secretary of the Association. It runs as follows : " In answer to your letter of the 25th instant I did use the words which you quote at the meeting of the West London Medico-Chirurgical Society, and my conviction is as stated for the following reasons : (a) That if the hymen is unruptured at the time of marriage, insertion of jellies or medicated pessaries upsets the physiological pH of the vagina with the result that the cervix is bathed in an acid medium far The result is lower than pH 4 for some hours. irritation of the external os with subsequent erosion and endocervicitis. (b) Should in the early years or months of matrimony rubber caps with a containing soluble pessary be applied to the cervix for a matter of 12 hours or longer, the resulting effect is the same as in (a). (c) I have noted this particularly during the last twenty years during which time I have seen A large number of these over 800 cases of sterility. have used (a) or (b). (d) In the discussion I stated that if for medical or other reasons contraception was necessary in the early months of matrimony, it should be relegated to the use of a condom by the husband and not by the insertion of chemicals of (e) It is of course well any kind by the woman. and recognised taught psychologically that the early and continued use of contraceptives, either by husband or wife, diminishes libido and orgasm in both parties. (f)I also referred to the statement by Prof. Miles Phillips which appeared in the British Medical Journal a few weeks ago, under the heading of’Endometrioma’ in a discussion at the North of England Gynaecological Society, stating the opinion that the early use of contraceptives was responsible for the increasing number of cases of endometrioma which are seen to-day in young people. (g) There are other moral and minor factors with which I need not detain you, but I think you will find that experienced gynaecologists, male or female, will agree with my statement that contraceptive measures in the early days of marriage are inimical to pregnancy at a later date."-ED. L.
psychosis is prevented from remaining equilibrium. Insulin and cardiazol offer a pre-eminently potent means of disturbing the psychosis as often as may be necessary. Their value
treatments the an
effortless
is therefore incontestible, even if at a later date it be proven that their effect is not specific. (2) The cases which do best are those in which there is still some reaction against the psychosis, in which there is not yet utter unremitting apathy. The more florid the psychosis, the better the outlook. Good results are sometimes obtained in apparently demented cases of some years’ standing. These cases
during treatment gradually uncover a psychopathological picture showing delusional and hallucinatory material which had been conscious originally and which was still attaining expression in the mannerisms, attitudes, and behaviour generally of the so-called dement. We speak from an experience of sixty insulin and forty cardiazol cases treated in the male and female wards of this hospital since October, 1936. We are convinced that, whatever the rationale may be, more remissions are procured with these treatments than are ordinarily observed, and that these treatments should be available in every mental hospital. Weare, Sir, yours faithfully, EDWARD LARKIN, HUNTER GILLIES. West Ham Mental Hospital, Feb. 13th.
CONTRACEPTION AND FERTILITY
of THE LANCET medical subcommittee of the National SiR,-The Birth Control Association has ventured to contest Mr. Green-Armytage’s statement that contraceptive measures in the early days of marriage are inimical to pregnancy at a later date, and has declared its inability to find evidence in support of his statement. May I assist this subcommittee’? In the gynaecological and obstetrical monograph " Sterility and Conception" by Gardner Child (1931), it is stated on p. 89 that " where artificial means are used to prevent conception and are indulged in for any length of time they are quite liable to create a habit of sterility." In the Trccnsactions of the Medical Society of London (1936, 59, 120) Mr. Lane-Roberts says that " at times the endocervical secretion becomes hostile to spermatozoa because of the mechanical viscosity resulting from either poor cervical drainage or an endocervicitis," and on p. 130 he adds : "to take at random some infertility factors found in one series of one hundred cases, in the woman, in 28 per cent. endocervicitis was the factor." James Young, in the third edition of his gynaecology text-book (1933), states that chronic endocervicitis is a cause of sterility of uncertain importance ; " it may prevent insemination by leading to an inflammatory blockage of the canal or by producing discharges which are hostile to the spermatozoa." Beckwith Whitehouse, in the fourth edition of Eden and Lockyer’s book, writes : " There can be little doubt that the lesion (erosion), accompanied as it is with alteration in the amount and character of the cervical secretion, is a cause of diminished fertility." It can hardly be disputed that the practice of contraception, with all its mechanical, chemical, and infective possibilities, is capable of causing chronic changes in the cervix uteri. Contraception involves finger insertion and handkerchief contamination The cervical canal is the must sometimes occur. Dardanelles of the genital tract, and any alteration in its state is inevitably brought to bear on the sperm attempting to win entrance. To the Editor
One is led to wonder whether the National Birth Control Association, which can so lightly dismiss the expressed opinion of an experienced gynaecologist, has sufficient title to its discriminating function. I am, Sir, yours faithfully, GEORGE H. ALABASTER. Welbeck-street, W., Feb. 14th.
To the Editor
of THE secretary of
LANCET
the National Birth Sm,—When the Control Association submitted her apologia in your last issue she picked out one line of a verbatim report and neglected to refer to the answer which I courteously supplied when she wrote to me on Jan. 25th. In equity I am enclosing for publication a copy of my letter to her which explains the reasons for the opinion held, with which many will agree, including an eminent gynaecologist who was present at the meeting and was also one of the official
speakers. The views of the medical subcommittee
are
not
impressive for (a) presumably they deal mostly with patients who do not want more children, (b) statistics can be made to prove anything, and (c) they naturally are biased ; whereas I was only speaking of the use of contraceptives before or in the early days of matrimony-clinical experience being of greater value than supposition. I am, Sir, yours faithfully, V. B. GREEN-ARMYTAGE. Harley-street, W., Feb. 14th. *** Mr. Green-Armytage encloses his reply to the secretary of the Association. It runs as follows : " In answer to your letter of the 25th instant I did use the words which you quote at the meeting of the West London Medico-Chirurgical Society, and my conviction is as stated for the following reasons : (a) That if the hymen is unruptured at the time of marriage, insertion of jellies or medicated pessaries upsets the physiological pH of the vagina with the result that the cervix is bathed in an acid medium far The result is lower than pH 4 for some hours. irritation of the external os with subsequent erosion and endocervicitis. (b) Should in the early years or months of matrimony rubber caps with a containing soluble pessary be applied to the cervix for a matter of 12 hours or longer, the resulting effect is the same as in (a). (c) I have noted this particularly during the last twenty years during which time I have seen A large number of these over 800 cases of sterility. have used (a) or (b). (d) In the discussion I stated that if for medical or other reasons contraception was necessary in the early months of matrimony, it should be relegated to the use of a condom by the husband and not by the insertion of chemicals of (e) It is of course well any kind by the woman. and recognised taught psychologically that the early and continued use of contraceptives, either by husband or wife, diminishes libido and orgasm in both parties. (f)I also referred to the statement by Prof. Miles Phillips which appeared in the British Medical Journal a few weeks ago, under the heading of’Endometrioma’ in a discussion at the North of England Gynaecological Society, stating the opinion that the early use of contraceptives was responsible for the increasing number of cases of endometrioma which are seen to-day in young people. (g) There are other moral and minor factors with which I need not detain you, but I think you will find that experienced gynaecologists, male or female, will agree with my statement that contraceptive measures in the early days of marriage are inimical to pregnancy at a later date."-ED. L.