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NEO-MALTHUSIAN AND BIRTH CONTROL CONFERENCE.
195 solutions were often used as douches, where NEO-MALTHUSIAN AND BIRTH CONTROL theWatery mechanical action helped the chemical one, but CONFERENCE. the inconvenience of douching irmmediately after coitus was great. A useful solution for this purpose was 1 per cent. lactic acid, vinegar 1 drachm to the CONTRACEPTIVE TECHNIQUE. DURING the recent Birth Control Conference held in pint, or permanganate 1 in 4000, in normal saline. Kingsway Hall, London, W.C., a private session for Another means of inserting a watery solution was by medical men and women was held under the presidency means of a tampon or sponge ; if this were small it of Dr. NORMAN HAIRE, when contraceptive technique was liable to be pushed into the fornices ; if large, its
bulk caused discomfort. In any case not an animal discussed. The PRESIDENT, in his opening address on the sponge, which detied sterilisation, but a rubber or tampon should be used. technique of birth control, said that the limitation of cotton-wool Mcc/MM;’ce Tl/eMs.—A condom or French letter was in had in the been three conception past attempted (1) Abstention ; (2) " Safe-period " inter- harmless, but diminished sexual satisfaction. A ways: As to abstention, complete female sheath, including an apron over the course ; (3) artificial methods. there were people who could practise absolute absten- external genitals, was even worse in this respect ; tion without harm, but in the great majority the but in cases of venereal disease, if the patient refused attempt led to severe psychical if not to physical to abstain from intercourse, one or both methods " As to symptoms. safe-period intercourse, when should be used. The President mentioned only to condemn strongly ovulation was held to coincide with menstruation it all metal button, pin,or thimble pessaries. The very was considered that fertilisation was most likely to occur just before or just after menstruation, and that small cervical rubber caps were also condemned as the middle period was relatively safe. No definite unsuitable for general use, since they were very time relation between ovulation and menstruation difficult to adjust. The small check pessary, which had, however, been established. Moreover, sperma- was attached to the cervix by suction, was relatively tozoa were known to be able to live in the female safe, but also difficult to apply, and impossible if the genital tract for considerable periods. No " reliance cervix was at all scarred by previous pregnancies. In could, therefore, be placed on the safety of any another form of cervical cap the cap and ring were separable, but these were no more easy to apply. period. Artificial Methods. The Best Available Contraceptive. He stated at the outset that no perfect method was , According to the President, the best contraceptive yet known, none that was at once certain and devoid available was that which had been in use in Holland oi trouble. There were, however, two methods 40 years and had recently been re-introduced by recommended by him, one of which was available to for him into this country. It resembled a ring pessary all but a very few, and the other could serve for the closed in by a cup-shaped diaphragm, which fitted remainder. Before describing these. he proposed to into the vagina with the convexity of the rubber cup discuss the imperfect methods in common use. towards the cervix and the concavity towards the Coitus Inte1’l’uptus.-This involved no expense, no opening of the vagina. The spring and the walls of apparatus, and no previous preparation, but it the vagina were mutually adaptable, and the whole required self-control and was, moreover, uncertain. vault of the vagina was thus excluded. This pessary Further, it diminished, if it did not entirely destroy, was made in a dozen sizes, and had to be fitted for the sexual satisfaction for both men and women. There first time by a medical practitioner. It gave little were many failures, and in 90 per cent. of cases where inconvenience, and the male partner did not necessarily this method was habitually used it was accompanied know it was there. The pessary could be inserted by an anxiety neurosis in one or both partners. This during the afternoon and in the morning could be association was too frequent to be a coincidence ; removed after douching, and the douching repeated. moreover, it disappeared when less imperfect contra- The President had treated 200 cases during the past ceptive methods were substituted. including private, and the less intelligent patients Chemical Contraceptives.-These could affect sper- year, who attended the welfare centre to which he was matozoa only in the vagina and not in the uterus, into attached, and all had been successful. For the small which it was probable that some were injected during minority whose intelligence was too low for the the sexual orgasm. Moreover, the chemicals used method to be applicable, permanent sterilisation was were necessarily protoplasmic poisons and were likely the only practicable alternative. Those unfit for to damage body cells as well as spermatozoa, or to he considered, submit to sterilisashould, parenthood do harm through absorption. The President mentioned tion. Sterilisation by means of X rays was possibly some of the disadvantages of the commonly used the question of dosage, a method for the future ; pessary, composed of cocoa butter and quinine, which duration, and possible damage to subsequent offspring, In the had not was supposed to melt at body temperature. yet been worked out. The method used by preparation of these pessaries it was difficult to ensure him on request of the patient was, in the case of men, equal mixing of quinine and cocoa butter, and some the removal of one or two inches of each vas deferens. samples contained too little and some too much of the Evacuation still took place after this operation, but former. Some had such a high melting point that they the semen contained no spermatozoa. Steinach and did not dissolve ; others dissolved too rapidly and his followers claimed that this operation was often women with excessive secretion found them unpleasant. followed by an improvement in general health. In Some of these pessaries were deliberately supplied to women sterilisation could be best effected by cutting the public containing little if any quinine, in order to out of the Fallopian tubes. This operation increase the profit on their sale. The mixtures of oil was portions carried out in some parts of America on certain and quinine had much the same disadvantages. of criminally insane women. To his knowledge types Jellies were much used in Germany ; the composition 4500 cases had been so sterilised. In this country the of one such preparation was a mixture of starch, was legal if carried out at the patient’s operation glycerine, distilled water, and boric acid. Another expense and desire. preparation by the same makers, recommended as an In the President dealt briefly with the improvement, on analysis was found to contain theoryconclusion, of absorption through the mucous membrane no starch, a minute trace of boric acid, various of the vagina, which he considered unsupported by vegetable organisms (showing that it had been made evidence. Prof. A. Thompson’s theory that absorption with impure water), and tragacanth mucilage. In took through the mucous membrane of the place vitro, a mixture of ] per cent. lactic acid with traga- uterus was much more probable, owing to the different canth mucilage killed spermatozoa, but it was doubtful type of the mucous membrane lining this if this would work in vivo, and certainly it could have histological organ. At the welfare centre to which the President no effect on any spermatozoa that might be injected direct into the uterus. 1 THE LANCET, 1921, ii., 1003. was
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196 was attached every married woman was instructed in methods of birth control, not only with a view to relieving the over-prolific poor, but for purposes of study of birth control. The President hoped to form a medical society for investigation of this subject, and asked those interested to communicate with him.
applicable to either sex. The condom could be regarded as a safe method for the husband. She had not tried the- Dutch pessary recommended by the President, but on the analogy of the ring pessary she would doubt its complete efficacy. If an ordinary ring pessary as used for prolapse were large enough to be jammed tightly against the symphysis pubis, the Discussion. patient suffered discomfort. If it were smaller there Sir ARBUTHNOT LANE considered that the President was sometimes a gap at this point. She would have was doing magnificent work for the benefit of humanity. thought that the check pessary would have been quite In support of the theory that material is absorbed successful in many cases. At this stage a resolution was put to the meeting by the vagina, he mentioned the changes that took place in the breast on oral administration of prostatic and passed :extract.-Dr. LEONARD MYERS That this meeting of the medical members of the Fifth supported Sir
Arbuthnot Lane’s remarks.-Dr. M. I. FINUCANE asked International Neo-Malthusian and Birth Control Conference point out that birth control by hygienic contrawhy the President recommended any method, when wishes todevices is absolutely distinct from abortion in its ceptive none could be regarded as harmless ? ? legal, and moral aspects. It further records its Dr. H. B. STODDART spoke of the psychological physiological, opinion that there is no evidence that the best contraceptive effects of (1) abstinence, (2) coitus interruptus, (3) the methods are injurious to health or conducive to sterility. use of contraceptives. (1) Abstinence did no harm Lord DAWSON OF PENN disapproved of bringing in the absence of sex stimulation, but if the same the subject of venereal disease into this discussion. room were occupied anxiety neuroses might result. methods should stand or fall as between Contraceptive (2) Coitus interruptus nearly always caused anxiety normal healthy people; carriers of the gonococcus neuroses. Symptoms were due to the fact that the required separate consideration. As to methods of patients experienced a desire which they did not wish contraception, no ideal method had yet been disto feel. This desire, in colloquial language, was put covered. The best method in any individual case out of their minds but was really pushed down deeper on the degree of importance of prevendepended into their minds, that is, repressed into the uncon- tion of conception. If absolute security were desired scious, and replaced by its opposite-i.e., fear, dread, the only way of securing it was, in his opinion, the or anxiety. Since emotion could be detached from use of the penile sheath. An important criterion by one idea and attached to others, sufferers from anxiety which to a method was whether it was troublejudge neuroses might be frightened of other things, such as some to apply, as in this case it would often be water or crowds. Dr. Stoddart described the physical imperfectly applied and would fail. Some medical signs of anxiety neuroses, largely due to abnormal women had assured him that it was possible to find a endocrine action. These included air-hunger, distur- pessary that could be fitted easily over the cervix and bances of digestion, frequency of micturition, viscero- be made secure when applied, but he could not help ptosis, and floating kidney, this latter being a result feeling sceptical on this point. Many women had an and not a cause of the neurosis, as was formerly almost sessile os uteri. The existence of tubal thought. (3) Contraceptives were in some cases pregnancies proved how small an aperture could be harmful. Occasionally the female suffered from a negotiated by a spermatozoon, and it was difficult to neurosis, even though she experienced sexual grati- imagine a pessary fitting so exactly that no crevice or fication, suggesting that the uterine membrane chink would ever allow of the passage of spermanormally did absorb semen. In answer to a question, tozoa. The incidence of conception might well be Dr. Stoddart said that he had administered prostatic reduced by this means, but some men are so fertile, or and orchitic extract by the mouth in cases of anxiety so well mated, that this method of contraception neurosis with some success. Prof. Thompson had would surely fail on occasion. mentioned that after the first coitus the thyroid Lord Dawson commented also on the strong sometimes enlarged. Sir Arbuthnot Lane had referred psychical element in the sex act, which could only be to the breasts, which were liable to become nobbly in neglected at peril. Some men considered it a pure the absence of prostatic secretion, while remaining physical act and others went so far as to convert it soft when it was administered orally. into a reflex act, but this attitude was fatal to married Dr. KILLICK MILLARD stated that the medical happiness. Many women were very sensitive and all profession as a whole knew only what was general must have their desire provoked psychically. Any knowledge about birth control. Since the large section elaborate preparation or effort would often suffice to of the public wanted information and insisted on crush out all sentiment, and some women at least having it, it was important that the medical man found the insertion of a pessary some hours before should be in a position to supply it. He had sent a anticipated intercourse distasteful enough to produce questionnaire to gynaecologists and medical women this effect. Soluble quinine pessaries had the great throughout the country and had received 65 replies : advantage that they were so easy to use. Many 37 had expressed approval of birth control in some marriages had been wrecked for want of underform, 15 expressed qualified approval, and 13 had standing of the woman’s attitude ; she needed wooing expressed disapproval. Of those answering the afresh on each occasion. The use of the sheath question re methods recommended, 18 preferred a involved a measure of sacrifice. The man had to condom and 5 a condom or some alternate method, pause before proceeding to physical consummation. 3. preferred an occlusive pessary, and 1 only advised an This effort of self-control came early enough to be occlusive pessary in conjunction with a quinine feasible, and both man and woman could without let tampon. Inasmuch as this last was the method much or hindrance or anxiety enter into that complete advertised at present by the laity, it was obvious that abandonment which was essential to the complete since doctors appeared not to approve of this method realisation of the sex act. With coitus interruptus, they should take steps to supply an alternative. on the other hand, the strain of control at the wrong The President had said that many people objected to time was bad physically and psychically. Reciprocity the condom. For those who did not, in Dr. Millard’s was impossible under these conditions and instead opinion, this was the most effective method. It was, of abandonment only, followed by satisfaction, Lord Dawson had not arrived moreover, suitable to a large class of men who were exhaustion resulted. not certain whether or not they were cured from in time to hear the President’s views, but in his gonorrhoea. All methods involved some self-control and opinion the male sheath and the use of soluble some sacrifice. Two alternate methods were really re- pessaries by the women were the most satisfactory quired, one for male and one for female persons, whose methods of contraception at present available. Dr. GOLDSTEIN (Berlin) spoke in favour of some forms partners were not prepared to use any preventive. Dr. FRANCES HUXLEY congratulated the President of metal pin which were inserted into the external os on having covered the whole ground. She agreed with and reached beyond the internal os when in place. Dr. Millard that it was desirable to have a method I Dr. ANTON NYSTROM, of Stockholm, also spoke.
bulk caused discomfort. In any case not an animal discussed. The PRESIDENT, in his opening address on the sponge, which detied sterilisation, but a rubber or tampon should be used. technique of birth control, said that the limitation of cotton-wool Mcc/MM;’ce Tl/eMs.—A condom or French letter was in had in the been three conception past attempted (1) Abstention ; (2) " Safe-period " inter- harmless, but diminished sexual satisfaction. A ways: As to abstention, complete female sheath, including an apron over the course ; (3) artificial methods. there were people who could practise absolute absten- external genitals, was even worse in this respect ; tion without harm, but in the great majority the but in cases of venereal disease, if the patient refused attempt led to severe psychical if not to physical to abstain from intercourse, one or both methods " As to symptoms. safe-period intercourse, when should be used. The President mentioned only to condemn strongly ovulation was held to coincide with menstruation it all metal button, pin,or thimble pessaries. The very was considered that fertilisation was most likely to occur just before or just after menstruation, and that small cervical rubber caps were also condemned as the middle period was relatively safe. No definite unsuitable for general use, since they were very time relation between ovulation and menstruation difficult to adjust. The small check pessary, which had, however, been established. Moreover, sperma- was attached to the cervix by suction, was relatively tozoa were known to be able to live in the female safe, but also difficult to apply, and impossible if the genital tract for considerable periods. No " reliance cervix was at all scarred by previous pregnancies. In could, therefore, be placed on the safety of any another form of cervical cap the cap and ring were separable, but these were no more easy to apply. period. Artificial Methods. The Best Available Contraceptive. He stated at the outset that no perfect method was , According to the President, the best contraceptive yet known, none that was at once certain and devoid available was that which had been in use in Holland oi trouble. There were, however, two methods 40 years and had recently been re-introduced by recommended by him, one of which was available to for him into this country. It resembled a ring pessary all but a very few, and the other could serve for the closed in by a cup-shaped diaphragm, which fitted remainder. Before describing these. he proposed to into the vagina with the convexity of the rubber cup discuss the imperfect methods in common use. towards the cervix and the concavity towards the Coitus Inte1’l’uptus.-This involved no expense, no opening of the vagina. The spring and the walls of apparatus, and no previous preparation, but it the vagina were mutually adaptable, and the whole required self-control and was, moreover, uncertain. vault of the vagina was thus excluded. This pessary Further, it diminished, if it did not entirely destroy, was made in a dozen sizes, and had to be fitted for the sexual satisfaction for both men and women. There first time by a medical practitioner. It gave little were many failures, and in 90 per cent. of cases where inconvenience, and the male partner did not necessarily this method was habitually used it was accompanied know it was there. The pessary could be inserted by an anxiety neurosis in one or both partners. This during the afternoon and in the morning could be association was too frequent to be a coincidence ; removed after douching, and the douching repeated. moreover, it disappeared when less imperfect contra- The President had treated 200 cases during the past ceptive methods were substituted. including private, and the less intelligent patients Chemical Contraceptives.-These could affect sper- year, who attended the welfare centre to which he was matozoa only in the vagina and not in the uterus, into attached, and all had been successful. For the small which it was probable that some were injected during minority whose intelligence was too low for the the sexual orgasm. Moreover, the chemicals used method to be applicable, permanent sterilisation was were necessarily protoplasmic poisons and were likely the only practicable alternative. Those unfit for to damage body cells as well as spermatozoa, or to he considered, submit to sterilisashould, parenthood do harm through absorption. The President mentioned tion. Sterilisation by means of X rays was possibly some of the disadvantages of the commonly used the question of dosage, a method for the future ; pessary, composed of cocoa butter and quinine, which duration, and possible damage to subsequent offspring, In the had not was supposed to melt at body temperature. yet been worked out. The method used by preparation of these pessaries it was difficult to ensure him on request of the patient was, in the case of men, equal mixing of quinine and cocoa butter, and some the removal of one or two inches of each vas deferens. samples contained too little and some too much of the Evacuation still took place after this operation, but former. Some had such a high melting point that they the semen contained no spermatozoa. Steinach and did not dissolve ; others dissolved too rapidly and his followers claimed that this operation was often women with excessive secretion found them unpleasant. followed by an improvement in general health. In Some of these pessaries were deliberately supplied to women sterilisation could be best effected by cutting the public containing little if any quinine, in order to out of the Fallopian tubes. This operation increase the profit on their sale. The mixtures of oil was portions carried out in some parts of America on certain and quinine had much the same disadvantages. of criminally insane women. To his knowledge types Jellies were much used in Germany ; the composition 4500 cases had been so sterilised. In this country the of one such preparation was a mixture of starch, was legal if carried out at the patient’s operation glycerine, distilled water, and boric acid. Another expense and desire. preparation by the same makers, recommended as an In the President dealt briefly with the improvement, on analysis was found to contain theoryconclusion, of absorption through the mucous membrane no starch, a minute trace of boric acid, various of the vagina, which he considered unsupported by vegetable organisms (showing that it had been made evidence. Prof. A. Thompson’s theory that absorption with impure water), and tragacanth mucilage. In took through the mucous membrane of the place vitro, a mixture of ] per cent. lactic acid with traga- uterus was much more probable, owing to the different canth mucilage killed spermatozoa, but it was doubtful type of the mucous membrane lining this if this would work in vivo, and certainly it could have histological organ. At the welfare centre to which the President no effect on any spermatozoa that might be injected direct into the uterus. 1 THE LANCET, 1921, ii., 1003. was
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"
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196 was attached every married woman was instructed in methods of birth control, not only with a view to relieving the over-prolific poor, but for purposes of study of birth control. The President hoped to form a medical society for investigation of this subject, and asked those interested to communicate with him.
applicable to either sex. The condom could be regarded as a safe method for the husband. She had not tried the- Dutch pessary recommended by the President, but on the analogy of the ring pessary she would doubt its complete efficacy. If an ordinary ring pessary as used for prolapse were large enough to be jammed tightly against the symphysis pubis, the Discussion. patient suffered discomfort. If it were smaller there Sir ARBUTHNOT LANE considered that the President was sometimes a gap at this point. She would have was doing magnificent work for the benefit of humanity. thought that the check pessary would have been quite In support of the theory that material is absorbed successful in many cases. At this stage a resolution was put to the meeting by the vagina, he mentioned the changes that took place in the breast on oral administration of prostatic and passed :extract.-Dr. LEONARD MYERS That this meeting of the medical members of the Fifth supported Sir
Arbuthnot Lane’s remarks.-Dr. M. I. FINUCANE asked International Neo-Malthusian and Birth Control Conference point out that birth control by hygienic contrawhy the President recommended any method, when wishes todevices is absolutely distinct from abortion in its ceptive none could be regarded as harmless ? ? legal, and moral aspects. It further records its Dr. H. B. STODDART spoke of the psychological physiological, opinion that there is no evidence that the best contraceptive effects of (1) abstinence, (2) coitus interruptus, (3) the methods are injurious to health or conducive to sterility. use of contraceptives. (1) Abstinence did no harm Lord DAWSON OF PENN disapproved of bringing in the absence of sex stimulation, but if the same the subject of venereal disease into this discussion. room were occupied anxiety neuroses might result. methods should stand or fall as between Contraceptive (2) Coitus interruptus nearly always caused anxiety normal healthy people; carriers of the gonococcus neuroses. Symptoms were due to the fact that the required separate consideration. As to methods of patients experienced a desire which they did not wish contraception, no ideal method had yet been disto feel. This desire, in colloquial language, was put covered. The best method in any individual case out of their minds but was really pushed down deeper on the degree of importance of prevendepended into their minds, that is, repressed into the uncon- tion of conception. If absolute security were desired scious, and replaced by its opposite-i.e., fear, dread, the only way of securing it was, in his opinion, the or anxiety. Since emotion could be detached from use of the penile sheath. An important criterion by one idea and attached to others, sufferers from anxiety which to a method was whether it was troublejudge neuroses might be frightened of other things, such as some to apply, as in this case it would often be water or crowds. Dr. Stoddart described the physical imperfectly applied and would fail. Some medical signs of anxiety neuroses, largely due to abnormal women had assured him that it was possible to find a endocrine action. These included air-hunger, distur- pessary that could be fitted easily over the cervix and bances of digestion, frequency of micturition, viscero- be made secure when applied, but he could not help ptosis, and floating kidney, this latter being a result feeling sceptical on this point. Many women had an and not a cause of the neurosis, as was formerly almost sessile os uteri. The existence of tubal thought. (3) Contraceptives were in some cases pregnancies proved how small an aperture could be harmful. Occasionally the female suffered from a negotiated by a spermatozoon, and it was difficult to neurosis, even though she experienced sexual grati- imagine a pessary fitting so exactly that no crevice or fication, suggesting that the uterine membrane chink would ever allow of the passage of spermanormally did absorb semen. In answer to a question, tozoa. The incidence of conception might well be Dr. Stoddart said that he had administered prostatic reduced by this means, but some men are so fertile, or and orchitic extract by the mouth in cases of anxiety so well mated, that this method of contraception neurosis with some success. Prof. Thompson had would surely fail on occasion. mentioned that after the first coitus the thyroid Lord Dawson commented also on the strong sometimes enlarged. Sir Arbuthnot Lane had referred psychical element in the sex act, which could only be to the breasts, which were liable to become nobbly in neglected at peril. Some men considered it a pure the absence of prostatic secretion, while remaining physical act and others went so far as to convert it soft when it was administered orally. into a reflex act, but this attitude was fatal to married Dr. KILLICK MILLARD stated that the medical happiness. Many women were very sensitive and all profession as a whole knew only what was general must have their desire provoked psychically. Any knowledge about birth control. Since the large section elaborate preparation or effort would often suffice to of the public wanted information and insisted on crush out all sentiment, and some women at least having it, it was important that the medical man found the insertion of a pessary some hours before should be in a position to supply it. He had sent a anticipated intercourse distasteful enough to produce questionnaire to gynaecologists and medical women this effect. Soluble quinine pessaries had the great throughout the country and had received 65 replies : advantage that they were so easy to use. Many 37 had expressed approval of birth control in some marriages had been wrecked for want of underform, 15 expressed qualified approval, and 13 had standing of the woman’s attitude ; she needed wooing expressed disapproval. Of those answering the afresh on each occasion. The use of the sheath question re methods recommended, 18 preferred a involved a measure of sacrifice. The man had to condom and 5 a condom or some alternate method, pause before proceeding to physical consummation. 3. preferred an occlusive pessary, and 1 only advised an This effort of self-control came early enough to be occlusive pessary in conjunction with a quinine feasible, and both man and woman could without let tampon. Inasmuch as this last was the method much or hindrance or anxiety enter into that complete advertised at present by the laity, it was obvious that abandonment which was essential to the complete since doctors appeared not to approve of this method realisation of the sex act. With coitus interruptus, they should take steps to supply an alternative. on the other hand, the strain of control at the wrong The President had said that many people objected to time was bad physically and psychically. Reciprocity the condom. For those who did not, in Dr. Millard’s was impossible under these conditions and instead opinion, this was the most effective method. It was, of abandonment only, followed by satisfaction, Lord Dawson had not arrived moreover, suitable to a large class of men who were exhaustion resulted. not certain whether or not they were cured from in time to hear the President’s views, but in his gonorrhoea. All methods involved some self-control and opinion the male sheath and the use of soluble some sacrifice. Two alternate methods were really re- pessaries by the women were the most satisfactory quired, one for male and one for female persons, whose methods of contraception at present available. Dr. GOLDSTEIN (Berlin) spoke in favour of some forms partners were not prepared to use any preventive. Dr. FRANCES HUXLEY congratulated the President of metal pin which were inserted into the external os on having covered the whole ground. She agreed with and reached beyond the internal os when in place. Dr. Millard that it was desirable to have a method I Dr. ANTON NYSTROM, of Stockholm, also spoke.