Chapter 24

STERILITY.

Sterility; the Prevention of Conception and the Limitation of Offspring; the Crime of Abortion; Infidelity in Women.

"Never let yourselves do evil that good may come. If you do, you hinder the coming of the real, the perfect good in its due time."

-- PHILLIPS BROOKS.

Sterility.-- Conception is least apt to take place from the tenth day after one period until the third day before the next; but there is practically no time during a woman's sexual life when she may not be impregnated; in this connection it must be remembered that the spermatozoa stay alive in her for more than a week.

During lactation women are generally sterile, especially in the first months which follow the accouchement, because the vital forces are then concentrated on the secretion of milk.

The age of the wife at the time of marriage has much to do with the expectation of children. As the age increases over twenty-five years the interval between the marriage and the birth of the first child is lengthened. For it has been ascertained that not only are women most fecund between twenty and twenty-five years, but that they begin their career of child-bearing sooner after marriage than either their younger or older sisters.

A wife who has had children and ceases to conceive for three years will probably bear no more.

When marriages are fruitless, the wife is almost always blamed; but it is by no means the wife that is always at fault; many husbands are absolutely sterile. Every man is not prolific who enjoys good health and is vigorous. Gross states that in one case out of six the sterility was due to the male. Kehrer, after a series of carefully conducted experiments, has arrived at the conclusion that in at least a third of the cases of sterile marriages the husband was the party at fault, and that gonorrhea was the cause of the barrenness.

Venereal diseases have their share of influence, and the gonorrheal infection is a potent cause of sterility. It is by no means proved that syphilis has any unfavorable influence on conception, though abortions due to this are frequent.

Gonorrhea often prevents conception by the inflammation traveling up the womb, and along the Fallopian tubes to the ovaries, whose covering is rendered thick and dense, so that the ovum cannot escape, or if it does, the fimbriated end of the tube is so agglutinated that it cannot grasp the ovum.

Alcoholism is considered a cause of sterility. It evidently does diminish the sexual potency in the male, and for this the female is often blamed.

It does not follow because a woman has not given birth to a child that she has not conceived. The life of an infant for a long time after birth is a frail one, and before birth its existence is extremely precarious; it often perishes a few days after conception. A period coming on a few days late, and at the same time one which is unusually profuse, is the only evidence which the young wife may have of an abortion. Among prostitutes, the frequent delay of menstruation, then abundant hemorrhage, is in many cases only habitual abortion, and leads to changes in the generative organs which must result in sterility. A tendency to miscarriage may therefore be all that stands in the way of having a family; this can frequently be remedied.

Sexual incompatibility is well known to exist; prominent examples being Augustus and Livia; Napoleon and Josephine. It is also a well-known fact that frigidity is a cause of barrenness. A short separation of husband and wife is often salutary in its influence upon fertility.

It is a well-established fact that the time immediately before the period, but still more that immediately following the period, are the most favorable times for conception to take place; the remaining quiet in bed of the woman after the generative act is also favorable to conception.

The most frequent causes of sterility in women are inflammation of the lining membrane of the uterus, or of the neck of the uterus, or of both. The source of this condition in women who have had children is most frequently due to parturition or abortion. In the newly married it may be due to a previously existing slight uterine catarrh in a displaced uterus, or it may be a manifestation of a run-down state of the system. In a majority of the newly married, however, the inflammation of the endometrium is probably due to the first efforts at conjugal approach. Many young women as the result of the preparation of the trosseau, augmented by a round of gaities at the time of marriage, enter the married state in a condition bordering on physical and nervous exhaustion; and then begin engorgements and inflammations which lead to future suffering and to sterility. Displacements and flexions of the uterus also cause sterility. Such displacements of the neck of the uterus may occur that, instead of lying in a pool of semen, as it should, it is above, in front of, or away from it, and this may prevent conception.

Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue shortness of the vagina, unless great care is exercised by the husband, will induce painful coitus, and may bring about sterility by favoring the formation of a copulation sac outside of the axis of the uterine canal, and consequently misdirection of the semen.

Scrofula, probably by its effects on the general condition, leading to deficient development of the whole body, the genital organs included, may be productive of sterility.

The female being less passionate than the male, the orgasm comes on later with her, or the male orgasm occurs so soon that she may not reach that stage at all. If both were simultaneous, it is reasonable to suppose that conception would be more likely to occur.

Ovulation is doubtless more frequently performed in some women than in others. Some women conceive with more or less regularity every fifteen or eighteen months, and others at intervals of several years.

The effect of repeated coition, provided that impregnation does not take place at once, is to engorge the uterine vessels, to alter the nature of the glandular secretions, to cause profound reflex disturbances, and thus to produce such changes in the endometrium as to lead to local inflammation and to general nervous exhaustion. Backache, leucorrhea, and irritable bladder are the first symptoms of this disorder; but frequently there are added to these, headache, indigestion, rectal tenesmus, painful and profuse menstruation. In many cases the disease continues in a mild catarrhal form, giving the woman little inconvenience besides the slight leucorrheal discharge which stains her clothing; but often this is indicative of such a change of the lining membrane of the uterus as to render it unfit for the fixation and development of the ovum, even should impregnation take place.

Under normal conditions, during the intermenstrual period, a plug of clear viscid mucus, which is secreted by the glands of the cervical canal, blocks up that passage, but is washed away each month by the menstrual discharge. Under ordinary conditions this obstruction must seriously interfere with the entrance of the spermatozoa into the cavity of the uterus, and renders the former theory, recently revived by Bossi, quite tenable, that impregnation is most likely to occur just after the menstrual epoch.

The vaginal secretion under certain pathologic conditions may become so acid that it induces sterility. Women who suffer m severe vaginal catarrh are frequently sterile, the spermatozoa being found dead in the vagina some hours after copulation, although an examination a shorter time afterward revealed them still alive. In cases where conception takes place in spite of a very acid condition of the vaginal secretion, it is probable that some of the spermatozoa enter the uterus before the secretion has had time to act on them, or possibly the spermatozoa being injected in a mass, the acid secretion is unable to penetrate and kill them all.

The reaction of the normal vaginal mucus is always acid, that of the cervix alkaline; but as the result of the inflammatory condition, the reaction of each is often intensified, especially that of the vagina, which has an exceedingly sour and penetrating odor. This acid discharge, bathing the neck of the uterus, penetrates more or less into the cervical plug and causes coagulation of the alkaline mucus.

The chief constituent of the semen is albumin; agents which affect albuminous substances influence the functional activity of the spermatozoa-- heat, concentrated acids, and probably concentrated alkalies. In normal conditions the alkalinity of the seminal fiuid seems to be sufficient to neutralize the acidity of the vaginal secretions, so that the spermatozoa may remain seventeen days or more (Bossi) within the vaginal canal, even during a menstrual period, without having their vitality destroyed.

When hyperacidity of the vaginal secretion is present, it is probable that the fertilizing element is at once rendered inert; but should some of the spermatozoa succeed in reaching the interior of the cervical canal, the increased alkalinity of the secretion there would in all probability put an end to all further progress.

The conditions, then, which appear to prevent fecundation are: First, the absence of the proper nidus for the ovum; second, the obstruction of the cervical canal by a mucus plug; third, increased alkalinity of the cervical secretion, often accompanied by the increased acidity of the vaginal secretion. Three conditions must, then, be determined: First, are there spermatozoa in the semen? Second, do they get into the uterocervical canal? Third, do the secretions in the canal poison the spermatozoa?

"For those who are very anxious for offspring," wrote Marion Sims, "I usually order sexual intercourse on the third, fifth, and seventh days after the flow has ceased; and on the fifth and third days before its return. For the most obvious reasons this would always be before going to bed at night, instead of just before rising in the morning. The horizontal position favors the retention of semen; the erect its expulsion. I am satisfied that too frequent sexual indulgence is fraught with mischief to both parties. It weakens the semen; in other words, that this is not so rich in spermatozoa after too frequent indulgence; and when carried to the extent of a debauch, the fiuid ejaculated may be wholly destitute of spermatozoa. Thus it will be seen that it will be much better to husband the resources of both man and wife."

The Prevention of Conception and the Limitation of Offspring.-- Some of the contraindications to procreation are when either parent suffers from a disease which is transmissible, and such diseases frequently manifest themselves only after marriage; when the pregnancy would endanger the mother's life, or even where the pregnancy is a nine months' torture to her; where either parent is suffering from ill health; or where for economical reasons no more children are desired.

If there exists no condition in either parent or in their circumstances why they should not have children, the next consideration due to their children, is how the same may be procreated under the most favorable conditions possible; this condition can only be secured by making the circumtsances such that the mother shall be able to choose the time for their conception when both parents are in the best physical condition. That children should be brought into the world haphazard, as the result of accident, is to degrade the human race below that of the lower animals, where the female admits the male only at the time of the rut, which in the majority of cases occurs only once a year.

Another requisite to bearing healthy children is that the pregnancies shall not follow each other too rapidly. Aside from the consideration for the health of the mother herself, she must be in good physical condition to bear the healthiest children she is capable of giving birth to; and for this there must be from two and a half to three years between the successive pregnancies. The results of overproduction on the children are frequently, that they are sickly, short-lived, or suffer from rickets, cerebral paralysis, idiocy, or imbecility.

And last, but certainly not least, many women become chronic invalids, or are hastened to premature graves, by having children as fast as they possibly can.

The most natural and moral way for the artificial prevention of conception, when on account of ill health or for economic reasons no more children are desired, is to abstain from sexual intercourse. But in the majority of cases the husband will not agree to this, and so the greatest number of methods have come to be used to prevent conception.

Perhaps the most frequent method use to prevent conception is withdrawal before the ejaculation of semen. While this is most injurious to the husband-- debility, nervous prostration, and even paralysis are said to ensue-- the health of the wife also suffers. If, this interrupted sexual congress is continued for years, there develop gradual nervous disturbances on both sides, and a serious disease of the uterus makes itself felt. The generative organs become engorged with blood, but are not permitted to enjoy relaxation consequent upon the full completion of the act. This engorgement may lead to undue local nutrition, and diffuse growth and proliferation of the connective tissue may take place. Hence the uterine walls become dense and thickened and the nerves compressed. Of course, pain and tenderness and a sense of bearing down will be the result. Flexions and versions may be consequent upon the engorgement. The nerves become shattered, and the woman will be fortunate if she contracts no serious womb trouble.

"It is strange," says John Stuart Mill, "that intemperance in drink or any other appetite, should be condemned so readily, but that incontinence in this respect should always meet not only with indulgence, but with praise. Little improvement can be expected in morality until the producing of too large families is regarded with the same feeling as drunkenness, or any other physical excess."

Sismondi writes: "When our true duties toward those whom we give life are not obscured in the name of a sacred authority, no man will have more children than he can properly bring up. If a woman has a right to decide any question it is how many children she should bear. Whenever it becomes unwise that the family should be increased, justice and humanity require that the husband should impose on himself the same restraint which is submitted to by the unmarried."

In the opinion of Dr. Edward Reich, it is very much to be wished that the function of conception should be placed under the domain of the will. But the strongest appeal has been made for the sake of morality itself; namely, to prevent the crime of abortion. Dr. Raciborski, of Paris, took the position that the prevention of offspring to a certain extent is not only legitimate, but it is to be recommended as a means of public good.

Continence, self-control, and a willingness to deny himself-- that is what is required of the husband. But suffering women assure us that this will not suffice; that men refuse to restrain themselves; that it leads to loss of domestic happiness, to illegitimate amours; or that it is injurious physically and mentally; that, in short, such advice is useless because it is impracticable.

Dr. Napheys writes: "Is it amiss to hope that science will find resources, simple and certain, which will enable a woman to let reason and sound judgment, not blind passions, control the increase of her family?"

The Crime of Abortion.-- From the moment of conception a new life begins, a new individual exists; another child is added to the family. The mother who deliberately sets about to destroy this life by want of care, or by taking drugs, or by the use of instruments, commits a great crime, and is just as guilty as if she strangled her new-born infant. The crime she commits is child-murder. Women in their frenzy at finding themselves in this condition, and with no slightest idea of the sin that they are committing, are constantly guilty of committing abortions on themselves, or going to professional abortionists to have this crime of child-murder committed. This is another of the sins due to the ignorance of the sex in all matters pertaining to reproduction; and it is a fearfully prevalent one.

Infidelity in Women.-- "We have now reached the last infernal circle of the divine comedy of marriage; we are at the depths of the inferno. There is something, I do not know what, terrible in the situation in which a married woman finds herself when an illegitimate love has ruined her for the duties of a wife and mother. As has been so well and strongly expressed by Diderot, infidelity in woman is like incredulity in a priest; it is the last step in human forfeitures; it is for her the great social crime, for it implies all the others.

"Weigh the sufferings of the future, the agonies of years by the ecstasy of half an hour. If this conservative sentiment of the creature, the fear of death, does not stop her, what could be expected of laws? Oh, sublime infamy!"-- (Balzac). _________________