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FAMILY LIMITATION

by

MARGARET H. SANGER

Revised

Sixth Edition

1917




INTRODUCTION.


There is no need for any one to explain to the working men and women
in America what this pamphlet is written for or why it is necessary
that they should have this information. They know better than I could
tell them, so I shall not try.

I have tried to give the knowledge of the best French and Dutch
physicians translated into the simplest English, that all may easily
understand.

There are various and numerous mechanical means of prevention which I
have not mentioned here, mainly because I have not come into personal
contact with those who have used them or could recommend them as
entirely satisfactory.

I feel there is sufficient information given here, which, if followed,
will prevent a woman from becoming pregnant unless she desires to do
so.

If a woman is too indolent to wash and cleanse herself, and the man
too selfish to consider the consequences of the act, then it will be
difficult to find a preventive to keep the woman from becoming
pregnant.

Of course, it is troublesome to get up to douche, it is also a
nuisance to have to trouble about the date of the menstrual period. It
seems inartistic and sordid to insert a pessary or a suppository in
anticipation of the sexual act. But it is far more sordid to find
yourself several years later burdened down with half a dozen unwanted
children, helpless, starved, shoddily clothed, dragging at your skirt,
yourself a dragged out shadow of the woman you once were.

Don't be over sentimental in this important phase of hygiene. The
inevitable fact is that unless you prevent the male sperm from
entering the womb, you are going to become pregnant. Women of the
working class, especially wage workers, should not have more than two
children at most. The average working man can support no more and the
average working woman can take care of no more in decent fashion. It
has been my experience that more children are not really wanted, but
that the women are compelled to have them either from lack of
foresight or through ignorance of the hygiene of preventing
conception.

It is only the workers who are ignorant of the knowledge of how to
prevent bringing children in the world to fill jails and hospitals,
factories and mills, insane asylums and premature graves.

The working women can use direct action by refusing to supply the
market with children to be exploited, by refusing to populate the
earth with slaves.

It is also the one most direct method for you working women to help
yourself _today_.

Pass on this information to your neighbor and comrade workers. Write
out any of the following information which you are sure will help her,
and pass it along where it is needed. Spread this important knowledge!

       *       *       *       *       *

The Small Family System: Is it Injurious or Immoral? by Dr. C. V.
Drysdale. B. W. Huebsch, New York City.

The Problem of Race-Regeneration, by Havelock Ellis, Moffat, Yard &
Co., New York City.

The Task of Social Hygiene, by Havelock Ellis. Houghton Mifflin & Co.,
Boston, Mass.

The Limitation of Offspring by the Prevention of Conception, by Dr.
Wm. J. Robinson, Critic & Guide Co., New York City.

"What Every Girl Should Know" by Margaret Sanger.

Paper cover, 25 cents.
Cloth cover, 50 cents.

"What Every Mother Should Know" by Margaret Sanger.

Paper cover, 25 cents.
Cloth cover, 50 cents.

The above are obtainable from Max Maisel, 424 Grand Street, New York
City.

"The Birth Control Review" Edited by Margaret Sanger.

One Dollar a Year

104 Fifth Ave., New York City.




A NURSE'S ADVICE TO WOMEN.


Every woman who is desirous of preventing conception will follow this
advice:

Don't wait to see if you do _not_ menstruate (monthly sickness) but
make it your duty to see that you _do_.

If you are due to be "sick" on the eighth of August, do not wait until
the eighth to see, but begin as early as the fourth to take a good
laxative for the bowels, and continue this each night until the
eighth.

If there is the slightest possibility that the male fluid has entered
the vagina, take on these same nights before retiring, five or ten
grains of quinine, with a hot drink. The quinine in capsule form is
considered fresher, but if this is taken do not use alcoholic drinks
directly after, as it hardens the capsules, thus delaying the action
of the quinine.

By taking the above precautions you will prevent the ovum from making
its nest in the lining of the womb.

Women of intelligence who refuse to have children until they are ready
for them, keep definite track of the date of their menstrual periods.
A calendar should be kept, on which can be marked the date of the last
menstruation, as well as the date when the next period should occur.

Women must learn to know their own bodies, and watch and know
definitely how regular or irregular they are: if the period comes
regularly every twenty-eight days (normal) or every thirty days as is
in the case of many young girls.

Mark it accordingly on your private calendar; do not leave it to
memory or guess work.

Only ignorance and indifference will cause one to be careless in this
most important matter.

A very good laxative (though it is a patent medicine) is Beechams
Pills. Two of these taken night and morning, four days before
menstruation, will give a good cleansing of the bowels, and assist
with the menstrual flow. Castor oil is also a good laxative.

The American Physicians may object to this advice because Beechams
Pills are a patent medicine. But until they are willing to give open
advice on this subject, we must resort to such as the least harmful,
until such time as they do.

If a woman will give herself attention BEFORE the menstrual period
arrives, she will almost never have any trouble, but if she neglects
herself and waits to see if she "comes around," she is likely to have
difficulty.

If the action of quinine has not expelled the semen from the uterus,
and a week has elapsed with no signs of the menstrual flow, then it is
safe to assume conception has taken place.

Any attempt to interfere with the development of the fertilized ovum
is called an abortion.

No one can doubt that there are times where an abortion is justifiable
but they will become _unnecessary when care is taken to prevent
conception_.

This is the _only_ cure for abortions.

There is current among people an idea that conception can take place
only at certain times of the month. For instance: ten days after the
menstrual period, and four or five days before the next period. This
is not to be relied upon at all, for it has been proven again and
again that a woman can conceive at any time in the month. Do not
depend upon this belief, for there is no reliable foundation for it.
There is also the knowledge that nursing after child-birth prevents
the return of the menstrual flow for several months and conception
does not take place. It is well not to depend upon this too much,
especially after the fifth or sixth month, for often a woman becomes
pregnant again without having "seen anything" or without her realizing
that she has become pregnant. She thus finds herself with one at the
breast and another in the womb. Use some preventative.

Again, it is believed that conception cannot take place if the woman
lies upon her left side at the time of the act. It makes no difference
which side she lies upon; she can become pregnant if the semen is not
prevented from entering the womb.

Perhaps the commonest preventive excepting the use of the condom is
"coitus interrupts," or withdrawal of the penis from the vagina
shortly before the action of the semen. No one can doubt that this is
a perfectly safe method; and it is not considered so dangerous to the
man as some authorities have formerly viewed it, but it requires a man
of the strongest willpower to be certain that he has withdrawn before
any of the semen has been deposited in the vagina. It is very
difficult to determine exactly whether this has been done. The
greatest objection to this is the evil effect upon the woman's nervous
condition. If she has not completed her desire, she is under a highly
nervous tension, her whole being is perhaps on the verge of
satisfaction. She is then left in this dissatisfied state. This does
her injury. A mutual and satisfied sexual act is of great benefit to
the average woman, the magnetism of it is health giving. When it is
not desired on the part of the woman and she has no response, _it
should not take place_. This is an act of prostitution and is
degrading to the woman's finer sensibility, all the marriage
certificates on earth to the contrary notwithstanding. Withdrawal on
the part of the man should be substituted by some other means that
does not injure the woman.


DOUCHES AND THEIR IMPORTANCE.

The most important part which every woman should learn in the methods
of preventing conception, is to cleanse herself thoroughly by means of
the vaginal douche.

After the sexual act go as quickly as possible to the bath room and
prepare a douche. Lie down upon the back in the bath tub. Hang the
filled douche bag high over the tub, and let the water flow freely
into the vagina, to wash out the male sperm which was deposited during
the act.

Do not be afraid to assist the cleansing by introducing the first
finger with the tube and washing out the semen from the folds of the
membrane. One can soon learn to tell by the feeling when it is
sufficiently clean. It is said, that the French women are the most
thorough douchers in the world, which helps greatly in keeping the
organs in a clean and healthy condition, as well as preventing the
male sperm from reaching the womb to mate with the ovum.

Following are some of the solutions to be used for the douche, which,
when carefully used will kill the male sperm or prevent its entering
the womb:

Lysol--is a brown oily liquid which added to water forms a clear soapy
solution.

One teaspoonful of Lysol to 2 quarts of water (warm) makes a good
solution for douching. Mix into a pitcher or vessel before placing it
in the bag.

Bi-chloride--Get the tablets blue or white from the druggist; the blue
are less dangerous to have about because of the color. Always mix this
solution thoroughly in a glass or pitcher before turning it into the
bag. Never drop the tablet directly into the bag. One tablet to two
quarts of water makes a splendid solution for preventive purposes.

Potassium Permanganate--This also makes a good solution, especially
where there is a vaginal discharge. The special objection to this is
that it stains the skin and clothing. This can be purchased in crystal
form, and one teaspoonful dissolved in two quarts of water is the
proper strength.

Chinosol is highly recommended as a vaginal douche, as being less
injurious to the membranes than bi-chloride.

Salt solution--Mix four tablespoons of table salt in one quart of
warm or cold water and dissolve thoroughly. This is good and cheap.

Vinegar solution--Many peasants in Europe use vinegar as an antiseptic
almost exclusively. One glassful to two quarts of water is the
strength usually desired. Cider vinegar is preferred. Douche afterward
with clear water.

Cold water douche--This will sometimes remove the semen quite
effectively without the aid of an antiseptic. But as the semen can
hide itself away in the wrinkled lining of the vaginal cavity, the
cold water will only impede its progress for a time. As soon as the
warmth of the body revives its activity, the semen continues on its
journey to meet the ovum.

Every woman should possess a good two quart rubber douche bag called
fountain syringe. Hang it high enough to insure a steady direct flow.

Bulb syringes, such as the whirling spray syringes, have been found
satisfactory by many women for the purpose of injecting antiseptic
solutions. Directions with syringe.

[Illustration: Fountain Syringe.]

Some women use the douche before the sexual act as a preventive. If
this is done, any astringent such as boric acid, alum, citric acid,
hydro-chlorate of quinine used in the solution will do. Only a pint of
solution is needed for this purpose, following the act a larger douche
is used as a cleanser. This can also be allowed with the regular
antiseptic douche.


THE USE OF THE CONDOM OR "COTS."

There is little doubt that a thorough douching of the genital passage
with an antiseptic solution performed by skilled hands immediately
after the sexual act would destroy the male sperm, and nothing else
would be necessary. But there is always the possibility that the sperm
has entered the womb before the solution can reach it.

It is safer therefore to prevent the possibility of the contact of the
semen and the ovum, by the interposition of a wall between them. One
of the best is the condom or rubber "cot."

These are made of soft tissues which envelope the male organ (penis)
completely and serve to catch the semen at the time of the act. In
this way the sperm does not enter the vagina.

The condoms are obtainable at all drug stores at various prices. From
two dollars a dozen for the skin gut tissues to one fifty a dozen for
the rubber tissue. These are seamless, thin and elastic and yet tough;
if properly adjusted will not break. Fear of breaking is the main
objection to their use. If space has not been allowed for expansion of
the penis, at the time the semen is expelled, the tissue is likely to
split and the sperm finds its way into the uterus. The woman becomes
pregnant without being conscious of it. If on the other hand care is
given to the adjustment of the condom, not fitting it too close, it
will act as one of the best protectors against both conception and
venereal disease. Care must be exercised in withdrawing the penis
after the act, not to allow the condom to peel off, thereby allowing
the semen to pass into the vagina.

It is desirable to discard the condom after it has been used once. But
as this is not always done, care must be taken to wash the condom in
an antiseptic solution before drying it and placing it away for
further use.

The condom is one of the most commonly known preventatives in the
United States. It has another value quite apart from prevention in
decreasing the tendency in the male to arrive at the climax in the
sexual act before the female.

There are few men and women so perfectly mated that the climax of the
act is reached together. It is usual for the male to arrive at this
stage earlier than the female, with the consequence that he is further
incapacitated to satisfy her desire for some time after. During this
time the woman is in a highly nervous condition, and it is the opinion
of the best medical authorities that a continuous condition of this
unsatisfied state brings on or causes disease of her generative
organs, besides giving her a perfect horror and repulsion for the
sexual act.

Thousands of well meaning men ask the advice of physicians as to the
cause of the sexual coldness and indifference of their wives. Nine
times out of ten it is the fault of the man, who through ignorance and
selfishness and inconsiderateness, has satisfied his own desire and
promptly gone off to sleep. The woman in self defense has learned to
protect herself from the long hours of sleepless nights and nervous
tension by refusing to become interested.

The condom will often help in this difficulty. There are many girls
who have had no education on this subject, no idea of the physiology
of the act, who upon any contact of the semen have a disgust and
repulsion, from which it takes some time to recover. Much depends upon
the education of the girl, but more depends upon the attitude of the
man toward the relation.


THE PESSARY AND THE SPONGE.

Another form of prevention is the pessary (see cut). This is one of
the most common preventive articles used in France as well as among
the women of the middle and upper class in America. At one time the
cost of these ranged up to seven dollars, as they were imported into
this country from France. Today they are manufactured in this country,
and may be had from fifty cents up to two dollars. The Mizpath is the
name of one of the best and costs one dollar and a half at any
reliable drug store.

They come in three sizes--large, medium and small.

It is well to get the medium size, as the small ones are only for very
small boned women and easily get out of place.

[Illustration: French Pessary--slightly different from the American.]

In my estimation a well fitted pessary is the surest method of
absolutely preventing conception. I have known hundreds of women who
have used it for years with the most satisfactory results. The
trouble is women are afraid of their own bodies, and are of course
ignorant of their physical construction. They are silly in thinking
the pessary can go up too far, or that it could get lost, etc., etc.,
and therefore discard it. It can not get into the womb, neither can it
get lost. The only thing it can do is to come out. And even that will
give warning by the discomfort of the bulky feeling it causes, when it
is out of place.

Follow the directions given with each box, and learn to adjust it
correctly; one can soon feel that it is on right. After the pessary
has been placed into the vagina deeply, it can be fitted well over the
neck of the womb. One can feel it is fitted by pressing the finger
around the soft part of the pessary, which should completely cover the
mouth of the womb. If it is properly adjusted there will be no
discomfort, the man will be unconscious that anything is used, and no
germ or semen can enter the womb.

[Illustration: a--womb; b--pessary covering mouth of womb; c--vagina;
d--bladder.]

If the woman should fall asleep directly after no harm can happen, and
it is not necessary to take a douche until the following morning.
Take part or about a quart of an antiseptic douche BEFORE the pessary
is removed; after removing it continue the douche and cleanse
thoroughly.

[Illustration: Finger touching mouth of womb.
a--womb; b--mouth of womb.]

Wash the pessary in clear cold water, dry well and place away in the
box. One should last two years, if cared for.

I recommend the use of the pessary as the most convenient, the
cheapest and the safest. Any nurse or doctor will teach one how to
adjust it; then women can teach each other.

It is not advisable to wear the pessary all the time. Take it out
after using, and wear it only when needed. A little experience will
teach one that to place it is a simple matter.


SPONGES.

Sponges can also be had at the drug store. They have a tap attached to
them to be conveniently removed. They should be soaked in an
antiseptic solution for a few minutes before coitus and then
introduced into the vagina far up as they can be placed. Some
physicians have recommended the use of the cotton plug, instead of the
sponge, to be soaked in a solution of three per cent carbolic and
glycerine, before the act. The male sperm is destroyed by the weakest
solution of carbolic acid. Some of the peasants in Europe use the
cotton plug soaked in vinegar for the same purpose and find it
satisfactory. In this country a boric acid solution has been used for
the same purpose and with satisfactory results. Of course this
requires a saturated solution, as, for instance, one teaspoonful of
the powder to a cup of water stirred until dissolved.

Sponges and plugs can be recommended as perfectly safe, if followed by
an antiseptic douche before the removal of the plug or sponge, thus
preventing the sperm from entering the womb. The problem is: to kill
the male sperm upon entering the vagina, or to wash it out or to kill
it directly afterwards. A weak solution of alum may also be used for
cotton plugs and sponges, _also carbolated vaseline on plugs_.


VAGINAL SUPPOSITORIES.

Suppositories are becoming more generally used in U. S. A. than any
other method of prevention.

These may be found at any reliable pharmacy. The majority of them are
made from cocoa butter or gelatine, which makes it necessary that they
be deposited in the vagina several minutes before the act, in order
for them to melt. Special ingredients negate the effect of the male
seed.

Vaginal Suppository

Acid citric, 6 grains
Acid boracic, 1 dram
Cocoa butter, 90 grains

Make into 12 suppositories.

Another suppository, which is the same as the well-known Aseptikon, is
the following:

Salicylic acid, 2 grains
Boric acid, 10 grains
Quin, purol (alkal), 1 grain
Chinosol, 2 grains
Cocoa butter, 90 grains
M. f. supos, glob No. 1

(Introduce into vagina three minutes before act.)

Still another found reliable is:

Boric acid, 10 grains
Salicylic acid, 2 grains
Quinine bisulphate, 3 grains
Cocoa butter, 60 grains

Practically all vaginal suppositories act as preventives but the most
commonly used is the Aseptikon, manufactured by the Chinosol Company.
They are to be secured at any reliable druggist's upon demand. They
should be kept in a cool place. They are not poisonous and cause no
injury to the membranes. They are distributed into a box costing 85
cents. The prescription quoted above can be made up more cheaply
however.

It is interesting to note that in the rural districts in France the
peasant women make up their preventive suppositories themselves,
placing them carefully away in glass jars. This is one of the recipes
which has been used:

Gelatine, 1 part
Water, 2 parts
Glycerine, 5 parts
Bisulphate of Quinine--one-half a part

Make this into a paste. Allow to spread out and solidify, then cut
into pieces of 2 grammes each, wrap separately and put in a cool place
(air-tight).

I have given in the foregoing pages the most commonly known means of
prevention. Personally I recommend every woman to use a well fitted
pessary and learn to adjust it.

     Carbozine Tablets, obtainable from The Carbozine Laboratory,
     3121 South Broadway, St. Louis, Mo., are highly recommended
     as an antiseptic and cleanser by farmer's wives and others
     residing in rural districts.

     A highly recommended suppository, similar to those made and
     used successfully in Germany for over twenty years, is now
     obtainable from the Alotan Manufacturing Company, 2 Rector
     Street, New York City, at the rate of one dozen for sixty
     cents and two dozen for one dollar.

     Condoms, pessaries, syringes, douche bags, and other rubber
     articles are obtainable from Riker-Hegeman Drug Company, 15
     West 34th St., New York City.

Birth control, or family limitation, has been recommended by some of
the leading physicians of the United States and Europe. The movement
can no longer be set back by setting up the false cry of "obscenity."
It has already been incorporated into the private moral code of
millions of the most influential families in every civilized country.
It will shortly win full acceptation and sanction by public morality
as well.

In cases of women suffering from serious ailments, such as Bright's
disease, heart disease, insanities, melancholia, idiocy, consumption,
and syphilis, all a physician is allowed to do is to tide these women
through their pregnancies if possible. Even though the life of the
woman is positively endangered, he cannot relieve her without calling
a colleague in consultation. Therefore, the mortality of mothers
suffering from these diseases and their infants is very high, and
premature births common.

To conserve the lives of these mothers and to prevent the birth of
diseased or defective children are factors emphasizing the crying need
of a sound and sane educational campaign for birth control.



***