168a. Castration. The result of castration, of course, must be sterility; but the removal of a single organ does not interfere with the procreative ability of the man. How soon after castration the man loses his power is still an unsettled question, for the seminal vesicles retain, for a certain time, the spermatozoa that have been secreted before the castration.49 The erectile faculty of eunuchs, if they have been castrated after the age of puberty, is retained for an indefinite number of years, but in itself, even when attended with sexual desire, is not indicative of procreative power. Nor is the ejaculation of a fluid having some of the sensible qualities of the semen sufficient evidence of such power. Unless a microscopical examination shows the presence of spermatozoa, which alone are characteristic of the fruitful semen, or unless pregnancy can be attributed unquestionably to the act, there can be no certainty that the secretion is more than the liquor prostaticus, or a mucous discharge. Instances of such proof of the procreative power after castration have been reported in several instances. Otto found the seminal vesicles still full of semen in a man who died nine months after he castrated himself.50 One case is on record in which a man, both of whose testicles had been carried off by a gunshot wound, is said to have retained the power to impregnate his wife after the healing of the wound 51 168b. Obliteration of vas deferens.- A man may be sterile, also, when the testes are normal, if the vas deferens, which is the channel from the testes to the urethra, is blocked. Such an obstruction of the vas is probably the most frequent cause of sterility in men,52 being the usual sequence of gonorrheal inflammation of the testicle and epididy mis. It leaves but little trace by which it can be identified after the acute stage has passed, there being sometimes only a small nodule to be felt in the epididymis, sometimes nothing at all to be found. The "Sturgis, in an article in the Medical News, New York, October 8th, 1898, Vol. LXXVIII., p. 449, cites a number of instances in animals in which intercourse immediately after castration has been productive. And two cases in men, where, after castration, the wives became pregnant. He also cites the case of Princeteau from the Ann. des Maladies des Organes Génit. Urin., 1890, where a man who had been castrated for tuberculosis of the testicles had frequent coition and ejaculations which, on microscopical examination, showed the presence of spermatozoa; but he does not say how long after the castration these specimens were obtained. Pelikan, in his Untersuchen über das Skopzenthum in Russland, 1876, p. 93, says that a man may be able to procreate for several weeks after castration, but only on the first attempt. 50 Handbuch d. path. Anat. p. 344. Kriegelstein, in Henke's Zeitschrift, 1842, pp. 348 and 352. 52 The sterility after a gonorrheal epididymitis may be only temporary. Gosselin reports two such cases where, after ten years of sterility, the wife bore a child, and spermatozoa were found in the husband's semen. (Quoted by Brouardel, Le Mariage, p. 123.) man's organs appear perfectly sound, and yet there are no spermatozoa in the ejaculation, even on repeated examination. Winterfrom the statistics of Kehrer, Lier and Ascrer, and Knorr-estimates that one third to one quarter of the cases of sterility of married life are due to the men. And certainly the largest part of these are due to disease of the vas. Atrophy of the testes and nonproduction of a spermatozoa seem to be irremediable; and whether obstruction of the vas is to remain equally incurable remains to be seen. Recently operative attempts have been made to overcome this obstruction, and Dr. Martin reports one case53 where a man whose semen had been devoid of spermatozoa for three years, by microscopical examination, became a father 297 days after the operation, having resumed marital relations sixteen days after the operation, and whose semen, eleven days after operation, contained a number of active spermatozoa. 169. Impotence. In addition to these conditions of sterility in the man, there are a number of conditions which may make him impotent, though he may not be sterile. Hammond54 classifies these causes of impotence as due to: 1. Absence of desire, which may be either congenital, in very rare cases, or acquired through mental preoccupation, masturbation, or sexual pervasion. 2. Absence of erections, from youthful excesses before puberty, obesity, extreme emaciation of disease, constitutional disease, such as nephritis, diabetes, cerebellar injury or tumor, and spinal cord disease. Also excessive horseback riding, morphinism, and chronic alcoholism, and the use of certain drugs, such as potassium nitrate and carbon bisulphid. The conditions mentioned in this class merely indicate possible or probable causes of impotency. The increase of the sexual desire in consumption is well known, even in the last stages. Hofmann cites the case of a man who had coitus the night before his death from tuberculosis; another case of coitus the night before death in the case of a man with syphilis of the liver and marked ascites; and another, on the fifth day of an acute lobar pneumonia. Caspar cites the case of a man seventy-two years old, married to a woman of thirty. For four years of married life they had no children. For the last six weeks before the husband's death he was severely ill. Three hundred and seventeen days after the death of the husband a child was born, and recognized as legitimate. In diabetes Furbin "N. Y. Med. Journ. and Phil. Med. Journ. 1903, Vol. LXXVIII., p. 697. Compare Goselin's remarks, note 52, supra. "Hammond, Sexual Impotence, 1887. ger55 cites the case of a man who had coitus twice daily until near the time of his death. In locomotor ataxia the general rule, certainly, is for the man to be impotent; but Roose56 says that he knew one case where the man had daily intercourse. And Furbinger cites the case of a man with paralysis of both legs who had two children after the paralysis. 3. Inability to copulate from special deformity of the penis or genitals, in elephantiasis of the scrotum, large scrotal hernia, scars in the penis, making erection incomplete, adhesions of the penis to the scrotum or to the abdominal wall, new growths of the penis, etc. But in this connection should be noted the fact that the stump of a penis, remaining after amputation, is sufficient for copulation; and hypospadias is no bar to intercourse or even to impregnation. Labalbary reports the case of a man with hypospadias such that he had to sit down to urinate, who had two sons with the same deformity; and further, Traubers and others have reported cases of pseudohermaphrodites of the hypospadias type, who have been educated as girls, and have impregnated their girl companions. In Trauber's case the infant had the same deformity as the father. 4. Absence of the feeling of the orgasm and therefore unsatisfac tory intercourse. Among the causes of impotence of the male should be included, also, those psychical elements which are scarcely explicable. Cases are on record in which, notwithstanding the existence of proper sexual feelings, and conformation on the part of the husband, he has been unable to complete the intercourse. Devergie59 and Streckerso have reported such cases. In both, the husbands had the sensation and the knowledge of emission with other women. In one of these cases this circumstance was attributable to indifference on the part of the woman. Excessive sexual desire will sometimes defeat its own end; and, on the other hand, too great timidity or aversion may prove a cause of impotence. We need hardly add that such are often but temporary in their nature. CHAPTER III. RAPE. I. IN GENERAL. 170. Definition. II. MEDICAL EVIDENCE OF RAPE. 171. In general. 172. Evidence of violence. 173. Possibility of rape on adult female. 174. Evidence of sexual intercourse, in general. 176. Hymen may not be destroyed. 177. Intact hymen as evidence of virginity. 178. Hymen ruptured otherwise than by coitus. 180. Seminal stains. 181. Venereal disease. 182. Conclusions. III. CLINICAL ASPECT of bape. 183. Rape upon children, in general. 184. Evidence of rape upon children; dilatation. 186. Marks of violence. 187. Venereal disease. 187a. Simple vulvo-vaginitis. 187b. Gonorrheal vulvo-vaginitis. 187c. Hereditary syphilis. 187d. Herpes of the vulva. 187e. Gangrenous vulvitis. 188. Rape on adult women. 189. Rape on old women. 190. Rape on the weak-mindea. 191. Rape during unconsciousness; under the influence of drugs. 192. Under the influence of anesthetics. 193. Possibility of anesthetizing during sleep. 194. Testimony of person under anesthetic. 195. During hypnotic sleep. 196. During normal sleep. 197. Unjust charges of rape. 198. Rape by women. I. IN GENERAL. 170. Definition.- From the medical point of view rape may be considered as sexual intercourse of one person with another of the opposite sex, without her or his intelligent consent. In the majority of the cases the woman is the passive agent, and the indictment is brought against the man; but in rare instances the female is charged with the assault. The degree to which penetration must be carried, or whether it is necessary for the completion of the act to have taken place in order that the crime may be considered rape, varies according to the law of the state or country, and is considered in the sections on the legal aspect of the question. Similarly, the conditions which limit the value of the consent given or the absence of consent as in the case where the woman is under the influence of drugs, also are questions for legal decision, and are treated in the latter sections. However, they need a few medical comments. II. MEDICAL EVIDENCE OF RAPE. 171. In general.-The medical evidence of rape consists in the evidence of the sexual intercourse, and also the evidence of violence necessary to overcome the resistance which the woman must make where she does not consent. Resistance less than the maximum which the woman is capable of offering is not consistent with dissent in the eyes of the law. 172. Evidence of violence.-The evidence that the intercourse has been attended with violence lies, to a large extent, in other than medical lines: in the previous history of the two persons concerned, the circumstances surrounding the case, etc. With these facts may be associated the evidence of injuries done to the man by the woman in her resistance, and the general injuries to the woman, inflicted by the man in overcoming her resistance. There is nothing characteristic of such bruises or wounds to mark them as distinctively different from any other bruises; the most that the medical man can say is that they have been inflicted at about the same time as that at which the plaintiff claims to have been ravished. The majority of writers on medical jurisprudence, among them Tidy, Taylor, Roose, Tardieu, Casper, Brouardel, Vibert and Hofmann, maintain that when there is no disproportion between the age and strength of the two persons concerned, and the woman is awake, well, and conscious, rape cannot be accomplished unless through threats against the woman's life. It must be remembered, however, that there are a few circumstances in which a woman can be placed, where, from confusion, surprise, and terror, she may be deprived of the command of her will and the power of resistance. |