In November 1937 the health department of the city of Nashville opened a contraceptive clinic for indigent women. Health and economic conditions among the underprivileged of Nashville accentuated the need for lessening the high frequency of conception in this group. Appreciation of the difficulties of prescribing diaphragm and jelly for indigent multiparas led to the decision to provide a substitute method for women difficult to fit or otherwise unable to employ the diaphragm. Foam powder was chosen for its apparent simplicity, its low cost and its reported effectiveness in early trials elsewhere. Although the physician in charge of the clinic exercised no rigorous selection of cases, he did tend to prescribe foam powder for the apparently less intelligent and for patients having a relaxed pelvic floor or presenting other conditions prejudicial to successful fitting, insertion or retention of the diaphragm in situ. The first clinic admitted only white patients, but