BARRENNESS.
Sterility proceeds from either a temporary or permanent incapability of conceiving or retaining the embryo, till it acquires a form. The causes producing this incapability, may consist in some malformation or deficiency of the womb, or its appendages, which cannot always be discovered during life, or in merely a weakness in the action of the womb. This last is by far the most frequent cause, and it is occasioned by local weakness of the womb, or general affections of the whole system; and is marked usually by an obstruction, deficiency, or redundancy of the menstrual evacuation, or by the complaint termed female weakness.
It may be considered as highly probable, that the absence of the capacity to be impregnated, will sometimes depend upon the imperfect condition of either the uterus itself or of the ovaries. If the former, it may consist in some derangement of the secreting surface of this organ; for, though there may be a regular discharge of a colored fluid, and this so nearly resembling the perfect secretion as to deceive the senses, it may yet want an essential condition or quality, and thus entail barrenness—hence, all women are not fruitful who may have a regular catamenial discharge; though, as far as can be determined by appearances, this discharge is every way healthy, and at the same time, the ovaries free from fault.
If it depend upon an imperfection of the ovaria, it may not, perhaps, admit of relief. The diseases of the ovaria may consist, 1st, in their imperfect development; 2dly, in derangement of structure; 3dly, in a want of a healthy organization of the ova themselves. Now, either of these conditions of the ovaria may be so complete as to altogether destroy their influence upon the secreting surface of the uterus; the catamenial discharge may, therefore, continue, with all due regularity, and yet the woman may be barren; and, hence, this discharge cannot be considered, rigidly, as a constant sign of fertility.
Yet it may be safely admitted, as a general rule, that women who menstruate regularly without pain, or the expulsion of coagula, or false membrane, are fecund; and that the reverse of these conditions is almost sure to be attended with sterility. It may also be observed, that we cannot attach much consequence to the quantity evacuated; for the woman who may evacuate double the quantity of another, is not for this reason more certainly prolific. I have known a number of instances of repeated impregnations, where, as far as could be ascertained, not more than two ounces were habitually evacuated; and this not occupying more than a day and a half, or two days, for its elimination: while, on the contrary, I have known women who were barren, discharge three or four times this quantity; and the fluid bear all the sensible marks of a healthy secretion. From this it would appear, that mere regularity in returns, the elimination of a proper quantity of fluid, and this fluid apparently of a healthy character, do not always declare the woman to be fecund. Yet, when the woman has never menstruated, or when this discharge has altogether ceased, agreeably to the ordinary arrangement of nature, or from disease, she either never becomes impregnated, or ceases to become so, if she ever have been.
We proceed on the principle of rectifying the constitution, where it is injured or weak, and of restoring the menstrual evacuation, to its due and healthy state. The means for effecting these purposes, must depend on the situation of the individual.
Causes.
There are chiefly two states of the constitution productive of those deviations in the action of the womb, which cause barrenness. The first is a state of fulness, and a disposition to obesity.
The person gradually becomes fat and inactive, the menstrual evacuation continues regular for some time; but at last diminishes, and becomes obstructed, or goes to the opposite extreme, and becomes frequent or profuse. The patient is either barren or subject to false conceptions. This state is to be rectified by spare or vegetable diet, total abstinence from malt liquor, regular and constant exercise, especially early in the mornings and on horseback, the prudent use of laxatives, and after some time the cold bath. These means will, if persisted in prudently, effect the desired changes; but if pushed to an undue degree, and especially if repeated purgatives, and much vinegar, or great abstinence be resorted to, the health may be completely ruined.
The second state is that of relaxation; the habit is spare, instead of corpulent; the mind lively, and, perhaps, even irritable; the menstrual evacuation either profuse, or it recurs too frequently, and at times clots and shreds are discharged.
This requires a different treatment: the diet, if not unusually nutritive, is at least not to be sparing, the exercise must not be carried the length of fatigue, the cold bath is useful, and strengthening medicines are required.
Such remedies as have been pointed out for the removal of irregularities of the menstrual evacuations, or of the fluor albus, must be employed when necessary.
There are also certain diseases of the female genital organs, which, when they exist, are found to cause sterility. Polypus in utero is very generally considered to belong to this class; but although the opinion is generally correct, it is not universally true, for it has happened that conception took place notwithstanding the presence of a very large tumor in the uterus. Of this the late Dr. Beatty (Trans. of the Association of Coll. of Phys. in Ireland, vol. 4) has described a very remarkable instance, which occurred in Dublin in the year 1820. The patient was a lady twenty-five years old, who, in consequence of the indisposition of her husband, had left his bed in May, 1819, to which she did not return until August, 1820. In the previous May she first perceived what she termed a “lump in her womb,” attended with external swelling and soreness on pressure at the lower part of the abdomen. This swelling was not permanent, but was observed to disappear during the menstrual period. Finding an increase in her unpleasant symptoms, she applied to Dr. Beatty in September, and on the 28th of that month he made an examination per vaginam. The os uteri was found dilated to the size of a dollar, and in its opening was a large dense substance with a regular smooth surface. On the 10th of November, while out in her carriage, she had a moderate discharge of blood from the vagina, and upon examination the parts were found as they were a month before. At two o’clock the following morning she miscarried, the embryo was entire, the membranes not being ruptured: the contained fœtus was about three months old—a period corresponding with the time at which the connubial intercourse had been resumed, and at which she had last menstruated; and just three months after she first experienced uterine uneasiness. The tumor was expelled in six days afterwards by pains resembling labor, the uterus was inverted by its descent, but on separation of the slight attachment between it and the tumor it was easily reduced. The weight of the tumor was found to be nearly four pounds. This lady was delivered of a healthy boy on the 10th of February, 1822. This was an instance of pregnancy during the existence of a tumor of considerable magnitude in the uterus; but we believe it to be an exception to what usually takes place.
Inflammation, suppuration, calculous depositions, cancer, cauliflower excrescence, corroding ulcer, the irritable uterus of Dr. Gooch, and any disease in which the texture of the uterus is much engaged, or with which the constitution sympathizes strongly, are so many obstacles to impregnation, as are diseases of the ovaria, in which the natural structure of these organs is obliterated, and both of them engaged. Leucorrhœa, when profuse, is very often also attended by barrenness; but this is by no means a constant effect, as we have known instances in which this disease existed to a great extent without preventing impregnation.
A question has arisen whether menstruation is necessary in order that a woman shall be prolific; and it is generally stated that women who do not menstruate cannot conceive. (Paris and Fonblanque, Med. Jur. vol. i., p. 214.) This is true when applied to those who have never menstruated, but is not in cases that have had even a single monthly discharge. Foderé (Méd. Légale, vol. i., p. 397, ed. 2me) states that, in the first edition of his work, he had maintained that females who do not menstruate are sterile: but he afterwards was obliged to change his opinion, from having observed some patients under his own care enjoying good health without this evacuation, and bearing many children. One of them was a woman thirty-five years old, the mother of five children, the last of which she was suckling. She was in good robust health, and had never menstruated but once at the age of seventeen years. It would appear that a single occurrence of this periodical evacuation is a sufficient indication of generative power; and although irregularity in subsequent years is frequently attended by sterility, it is not to be taken as an absolute cause of it. There is a form of dysmenorrhœa described by Dr. Denman (Denman’s Midwifery, 6th edit., p. 90), and Dr. Dewees (Dewees’ Midwifery, p. 154) of Philadelphia, which both these authors state to be productive of barrenness. The striking peculiarity in this disease is the formation of an adventitious membrane in the uterus, which is expelled after severe and protracted suffering at each menstrual period. This membrane is sometimes thrown off in pieces, and at others entire, at which time it bears the strongest resemblance to the decidua, so much so that, when it occurs in unmarried females, it may and sometimes does give rise to most painful suspicions. There is a preparation in the museum of the College of Surgeons, Dublin, of an entire membrane of this kind, which might deceive the most experienced eye. Morgagni relates a very remarkable instance in which pregnancy occurred during the existence of the habit just described, but it is probable that there was a suspension of the disease for a time in that case, when the capability of conceiving might exist.
It is well known that instances have happened in which persons have lived for years in unfruitful matrimony, and being after divorce remarried, have both had children. This is a fact which in the present state of our knowledge we are not able satisfactorily to explain, and we will not delay the reader by offering any speculative opinion upon it.
Treatment.
The treatment of impotence and sterility must be influenced by the causes from which they spring, some of which are incurable, whilst others may be removed by appropriate remedies. Those cases which depend upon congenital deficiency of the penis, testicles, vagina, uterus, Fallopian tubes, or ovaria, belong to the former; but we have seen that some of those arising from malformation and disease of these parts are susceptible of cure. Such are phimosis, adhesion of the prepuce to the glands with diminution of the orifice of the urethra, priapism, partial paralysis, strictures in the urethra, diseases of the neighbouring parts, contracted vagina, occlusion of the mouth of this canal by adhesion of the labia, or by a dense hymen, prolapsus and procidentia uteri, polypus in utero, leucorrhœa, dysmenorrhœa: all these are more or less capable of removal either by operation or general treatment.
By persisting carefully in a proper plan, sterility may at length be frequently removed. There are many instances of women bearing children, after having been several years barren.
Various remedies have been recommended for the cure of barrenness, among which tincture of cantharides is the most prominent, but its effects being evanescent, are invariably succeeded by lassitude and debility, and therefore can be attended with no good results. The various preparations of sassafras and sarsaparilla are useless and not in the least calculated to reach the nature of the case. The specific known as the most successful in curing sterility or barrenness—and it has certainly performed wonderful cures—is the celebrated Morand’s preparation, called “Morand’s Elixir,” which appears to be specially adapted to give tone and healthiness to the generative functions, for the discovery of which, he received a handsome donation from the French government, as also frequently rewarded by the liberality of private individuals, who have realized their fond wishes by his discovery.
Its effects, it is said, are so wonderful upon the general health, and particularly upon the generative functions, that a medical writer of some note says that he has recommended its use in several instances, and, with one single exception (a case of malformation), with invariable success. He says:
“I was acquainted with a very worthy married couple whose life was, if not embittered, at least unhappy, because of their having no offspring. They were of respectable and influential standing, possessed of property, surrounded by friends and relatives, were then married nearly ten years, and desirous only of having children to make them happy. Physicians were consulted without success, because physicians mostly look upon sterility as incurable.
“About this time I visited a patient who had been married about seven years without having children, who was affected with fluor albus (whites), and was using ‘Morand’s Elixir,’ by my recommendation, to eradicate this weakening complaint from the system. This lady having been married seven years, as I before observed, without offspring, had nearly resigned herself to a conviction that she was destined to have none. In recommending ‘Morand’s Elixir,’ I had the fullest confidence that it would accomplish a thorough cure of her complaint, because I had often used it in my practice, and with invariable success, but I had neither hope nor expectation of its ability to remove what I then considered confirmed sterility, or barrenness, as I then gave no credence to the various marvellous properties it was alleged to possess, classing it merely among the impositions of the day. The lady continued its use, and I found her health evidently and perceptibly improve. The fluor albus entirely disappeared and her health was restored. Under pretence that she derived great benefit from it she still continued its use, however, and to my utter surprise, as well as the great joy of her husband, four months after she commenced its use, she became pregnant, and in due time was delivered of a fine, fat, healthy daughter, and had two more children in close succession after.[[49]]
“The lady being of the most pure and irreproachable character, it may well be supposed that it gave me the greatest confidence in recommending this truly wonderful ‘Elixir,’ in like cases. When, therefore, I was consulted by the husband of the lady first mentioned, I did not hesitate to recommend ‘Morand’s Elixir,’ and informing him of its effect in the case described. My advice was followed. In due course of time this worthy couple had their fondest wishes realized. Since which time they also have had several children. Their gratitude to me for recommending its use, was unbounded. My confidence in the virtues of ‘Morand’s Elixir,’ was confirmed, and I have heard of its success in other instances. Indeed, I am convinced, that if the case is curable, ‘Morand’s Elixir’ is infallible.”
It has attained a pre-eminent celebrity in France, Germany, on the continent of Europe generally, as well as in England, for its unexampled success in removing general debility, weakness, physical imbecility and supposed barrenness (for judging from the astonishing results of ‘Morand’s Elixir,’ it is denied that it really exists). The truly wonderful effect of the “Morand’s Elixir,” has now established the fact that most, if not all, supposed natural incurable defects, are only artificial ones, within the powers of the skill and scientific combination of the virtues and essences of the most nourishing, strengthening and invigorating fruits and plants of Italy to remove. Its action is not sudden and ephemeral, leaving the system but the more debilitated by reason of the previous unnatural excitement, but is gentle and gradual, by degrees displacing the latent causes affecting the body, strengthening and invigorating the generative functions, cheering the mind, enlivening the spirits, engendering a free, full and healthy circulation, and thus arousing the sexual feelings.
Great and surprising as are the results of the skilful and scientific combination in the composition of “Morand’s Elixir,” it is not idly pretended that without any reference to the circumstances of each individual case of supposed barrenness, it will, unaided and unassisted, in a few weeks, remove deep seated and obstinate cases of unfruitfulness—causes which had been growing, strengthening and fastening for years. Far from it. The absurdity of such pretence is manifest on the face of it. Assistants, in many instances, must be resorted to for successful treatment, in respect to diet, clothing, occupation, &c. Instant and immediate relief is neither to be expected nor practicable; and even if practicable would lead to the most injurious results, aggravating instead of relieving. A remedy, therefore, to be permanent, must be gradual to an almost imperceptible degree, slowly but surely removing the stagnant humors and impure secretions, by the searching and penetrating virtues of the “Elixir,” systematically purging the system of those dormant and inactive particles, which frustrate the action of the generative functions, and thus dislodging the cause of unfruitfulness. It may take some time ere this is accomplished; but, by a proper perseverance in the course marked out, success, sooner or later, is inevitable. Thousands who had imagined themselves irretrievably doomed to descend to the grave unpitied and unmourned by interesting and affectionate children have, by the use of “Morand’s Elixir,” been blessed with offspring to love and adore in infancy and youth, and to look to for comfort and solace in old age.
In all cases of incontinence of urine, fluor albus, gleet, painful and difficult menstruation, incipient stages of consumption, languor, debility, night sweats and wakefulness, it is surprisingly efficient and certain. Its chief and great celebrity, however, in eradicating every symptom of that state of the functions superinducing barrenness or sterility, is too well established to require comment. Indeed, such has been its success, as to make it doubtful that what is usually termed barrenness in fact exists, since by the use of this wonderful remedy, properly persevered in, a cure has in all cases been effected, and what had been supposed incurable natural defects proved to be only some deranged state of the functions.
As there are many who pine and grieve for children—who feel desolate and lonely without the enlivening and cheering influence of children around the domestic hearth, the author does not deem it inappropriate or out of place to present this celebrated specific for the consideration of those to whom it might prove a great blessing. He has taken its Agency for the United States, at his Office, 129 Liberty street. Letters must be postpaid and addressed to Box “1224,” New York City.