years of age, in whom the vagina was like that of a newborn child; no uterus could be discovered by an examination per rectum.28 Dr. Rüttel had under his care a woman twenty-seven years old, of small stature. The external genitals were like those of a child nine or ten years of age; the vagina was smooth, very narrow, and hardly two inches long; the mouth of the uterus hardly perceptible, and the uterus itself of the size and shape of an olive. The breasts were undeveloped.29 A curious case is quoted by Siebold, in which, although there were no external sexual organs whatever, nevertheless the woman became pregnant. The impregnation was effected through the rectum, in which a small orifice communicated with the vagina. At the approach of labor, this opening was widened by the knife, and the woman was delivered of a child which lived six hours.30 Mr. Hunt related to the Medical Society of London, the case of a lady, aged thirty, of refined mind and feminine development, who consulted him for stricture of the rectum. The meatus urinarius was more capacious than usual, and there was no vaginal aperture, the perineum being continued from the anus to the meatus. No trace of the fundus uteri cr of ovaries could be felt by the rectum. The clitoris and labia were normal, the mamma well developed, and sexual feeling was normal. She had never menstruated or had any periodical inconvenience. 162f. Psychical causes.- Other cases of sterility, of a psychical nature, are sometimes as operative as the physical impediments. For the most part they are exceedingly intangible. In the Causes Célèbres an amusing instance of want of sexual harmony is given by Pitaval. Two gentlemen of rank, very much of the same age and personal appearance, were both married to wives who proved unfruitful after several years of marriage. The two couples at last determined to proceed to a celebrated watering place in the hope of deriving some benefit from the change, and the use of the springs. On the way they put up at an inn and retired for the night. But the two wives had preceded their husbands to bed, and each of the latter mistook his friend's room for his own. In consequence of the mistake both of the ladies proved with child. 162g. Physical inaccessibility. A certain number of other cases of sterility are due to the inaccessibility of the woman. Such conditions are seen in large herniæ, elephantiasis, possibly in bony deformity of the pelvis, making the separation of the thighs impossible. Also Handbuch, p. 91. "Handbuch, p. 88. in the absence of a vagina, an imperforate hymen, congenital or acquired stenoses of the vagina, or adherent labia. Temporarily, also, in prolapse of the uterus. One of the most absolute bars to intercourse is seen in the extreme sensitiveness of an acutely inflamed vestibule, a urethral caruncle, or the peculiar condition with no physical evidence, called vaginismus. Here the lightest touch to the external genitals produces such pain and spasm of the vulvar muscles that even the entrance of an examining finger, most carefully approached, is debarred. 162h. Constitutional disturbances.-One more group of causes of sterility in woman must be mentioned. These are the constitutional disturbances which affect the nutrition of the woman and the child. Such are seen in typhoid fever, cholera, scarlet fever, diabetes, nephritis, anemia, and obesity. 163. Sexual disability in man, in general.-In the man the sexual disability may be due to the absence of the spermatozoa, which would be sterility in the broad sense of the word; or to inability to copulate, or impotence. The word "impotence" is frequently used to mean inability to procreate, in which sense it would include also sterility. 164. Normal virile period, in general. Normally, the essential male elements, the spermatozoa, are produced first at puberty, which, in the temperate climates, occurs at about fifteen years of age, and continues indefinitely until the atrophy of the testes. 165. Precocious virility. Cases of precocious virility are rather more rare than those of precocious menstruation. The establishment of puberty is marked by the well-known signs: the development of the genital organs, the appearance of the hair on the pubes and in the axilla, the growth of the beard, and the change in the voice. Curious instances have been reported of sexual precocity. The most astonishing of these is one related by Professor Stone, of Washington.31 The child was only four years old; he was four feet and a quarter of an inch in height, and weighed nearly seventy pounds. His bones and muscles were developed in an extraordinary degree, his voice was grave, and the pubes were covered with a luxuriant growth of hair. The penis measured, in a semi-flaccid state, four and a quarter inches in length, and when perfectly flaccid three and a half inches. The prepuce was short, leaving exposed a perfectly formed glans penis. The papilla of the corona glandis were salient, and exquisitely sensitive. In the scrotum were two firm, apparently well-developed testi "Amer. Journ. Med. Sci., Oct. 1852, p. 561. cles, perhaps rather under the average size of those organs in the adult. The spermatic cords were distinct, and, under the finger, gave the impression of perfect organs. His father having observed "during the night, when he had slept, with him for the first time, a constant erection of the penis, accompanied by a nickering, like an excited stallion," consulted Dr. Stone concerning him. The boy was said to be extremely fond of embracing the opposite sex, and on one occasion, when in bed with a near relative, a married lady, the latter was aroused by finding him closely clasped to her back, and her nightdress saturated with glutinous material-very different from what she expected, as she supposed he had emptied his bladder upon her. The reporter had no opportunity of examining the secretion with the microscope. Dr. Rüttel32 observed a case in which a girl of fourteen became pregnant by a boy of the same age. Mr. Ruelle, of Cambria, has recorded an example of precocious virility. A child three and a half years of age, muscular and strong as one of eight, had all his male organs of the full adult size, with long black hair on the pubes, and, under excitement, discharged semen four or five times daily. He had also a full male voice, and dark short hair on the cheek and upper lip.33 Pryor3 speaks of a boy of three and a half years who masturbated, and who, at five and a half, had a penis of adult size, hair on the pubes, and was known to have had seminal emissions. 166. Precocious paternity.-Cases of early paternity are, however, the best evidence of the procreative ability of the man. Hirst35 reported the case of a girl fourteen years of age who became pregnant from a boy of thirteen years; and two cases are on record, one from Boecher and one from Klose,37 in which the father was a boy of nine years. In the case reported by Klose the mother was a girl of fifteen. 167. Late virility. The old age limit at which spermatozoa are no longer produced is very indefinite. From the examination of the cadaver, Dieu found38 spermatozoa present as follows: "Henke's Zeitsch., 1844, p. 249. "Brit. and For. Med. Rev., Jan. 1844, p. 277; and Bull de l'Acad. de Méd., Paris, Feb. 28, 1843. 24 Transactions of the Obstetrical Society of London, Vol. XXII., p. 521. For other cases, see Gould and Pyle's Anom. alies and Curiosities of Medicine, p. B. C. Hirst, St. Louis Med. and Surg. Journ., Dec. 7, 1891. 36 Boecher, Gericht. Med., p. 258, quoted by Brouardel. "Klose, Syst. den gericht. Physik. p. 250. Journ. de l'Anat. et de la Phys., 1867, p. 449. Curling 39 has found spermatozoa in the secretion of a man eightyseven years of age. Montgomery40 cites the case of Sir Stephen Fox, who was married at seventy-eight, and after that had four children, the last when he was eighty-one years old. Gooch11 mentions the case of a man eighty-years old, who was the father of four children. at one birth. Rüttel42 cites the case of a man marrying at ninety-two and having two children. And Harvey43 gives an account of Thomas Parr, who lived to the age of one hundred and fifty-two years and nine months, and in his description of the autopsy says that the testes were large and sound, so that it seemed not impossible that the common report was true,-namely, that he was convicted of rape after his hundredth year; and his wife, whom he married in his hundred and twentieth year, said that he had intercourse with her frequently until twelve years before his death. John Gilley, who died at the age of one hundred and twenty-three, was married at seventy-five, and after that had eight children. He was virile until three years before his death. Baron Baravicino de Copelis44a died in 1770, at the age of 104 years. He was married for the fourth time at the age of eighty-four, and by that wife had seven children. Moreover, his wife was pregnant at the time of his death. Baily cites two other cases, one of Francis Augé who died in Maryland in 1767, at the age of one hundred and thirty-four, and had a son born to him after his hundredth year; and Setrasch Czarten (Petratch Zarten) who was born in Hungary in 1537, and died at the age of one hundred and eighty-seven, when a son ninety-seven years of age was still living. This son must have been born when the father was ninety years of age. On the other hand, potency may continue after fertility has ceased, so that, in spite of the absence of spermatozoa, the lust may be present. Hofmann16 mentions the case of a man seventy-four years of age, who died during coitus with a prostitute. No trace of spermatozoa could be found in the cadaver. 168. Causes of sterility in man; testes atrophic or diseased.-Sterility during this period of ordinary functional ability may, however, be present, due to nondevelopment of the testis, in which condition the testis remains in the abdomen, and does not descend into the scrotum. Not all cases of undescended testes have atrophic testes. In fact, one of the most striking cases of precocious development was in a boy of three years and ten months. His weight was eighty-two pounds; height, four feet and one half inch; girth of chest, twenty-seven and a half inches; thigh, nineteen inches; length of penis, four inches; circumference, three and a half inches; testes not descended; whiskers and hair in the axilla were present. Nor, on the other hand, does the apparently feminine habitus indicate sexual incapacity. Sterility may also be due to atrophy of a testicle which has descended into the scrotum and even been functionally active. Such atrophy is associated with either local disease of the testis or the scrotal contents, as in the case of varicocele or scrotal hernia; or to some more distinct disturbance. Atrophy of the testis may sometimes be produced by mechanical injury to the spinal cord or brain. Both Larrey and Hennen mention cases in which, from a blow with a saber upon the occiput, impotence followed. Atrophy of the testes has also been described after the use of certain drugs. That after the persistent use of iodine or potassium iodid is well known;48 and Larrcy states that many of the French soldiers in the French expedition to Egypt became impotent from atrophy of the testes, which he ascribed to the use of date brandy sophisticated with pseudo-capsicum. Disease of the testis, if both organs are involved, which is not usually the case, may also cause sterility. In such cases the extent to which the glandular structure of the testes is involved can not be determined without the removal of the organs; and hence it would not be possible to say positively that the disease was the cause of the sterility, for as long as a portion of the glands remains functionating, spermatozoa may be produced. Hofmann, Gericht. Med. 8te. Aufl. 1902, p. 59. Two thirds of the cases having or chitis after mumps are followed by atrophy of the testes, according to Brou ardel. (Le Mariage, p. 124.) He gives a table of 562 cases of mumps, followed in 163 instances by orchitis. Of these 103 had atrophy of the testis which was involved. H. C. Wood's Therapeutics, 9th ed. 1894, p. 583. Case in Phil. Med. Times, Vol. IV., p. 661. |