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.