When the ends of a cut vas are released from cicatricial tissue, these ends may be sutured together; but as the lumen of the vas is extremely small, there is sometimes obliteration by occlusion at the juncture. Christian and Sanderson[222] described a method of preventing this obliteration. A piece of No. 0 twenty-day catgut is inserted three-eighths of an inch into each end of the vas, and these ends are brought together by two catgut sutures, leaving the inserted catgut in the canal. The ends heal together and the catgut in the canal is absorbed. This method has been used successfully to join the cut end of a Fallopian tube.
Gemelli[223] did vasectomy on eleven dogs and seven cats; about six months later he reunited the cut ends, and on dissection found restoration perfect, anatomically and functionally, in the eighteen animals. The vas deferens in these animals is smaller than in man; and therefore offers greater difficulty in the suturing. He used no inserted catgut, but told me he employed the method Carrel applies in joining cut arteries. In one case, where the dissection was broad, he successfully inserted a piece of a vas taken from another animal. Whether there is occlusion or not after end-to-end suturing depends largely on the skill of the surgeon.
Dr. Edward Martin of the Pennsylvania University[224] and Delbet[225] have removed sterility by effecting a patulous anastomosis between the vas and the epididymis, and this method is applicable after vasectomy by cutting, but it is not successful, as a rule. It has been done effectively where the vas had no stricture. McKenna,[226] in five attempts on men, succeeded once. Fürbringer[227] said that in his experience with a thousand cases of double epididymis, the condition is incurable in 80 per cent. of the gonorrheal infections.
Apart from the so-called vasectomy law, gynecologists quite frequently sterilize women who have chronic heart disease, tuberculosis, nephritis, diabetes, or hereditary mental taints. Some men, like Spinelli, Cramer, Polak, and others, would sterilize also in chronic anemia, persistent albuminuria, epilepsy, syphilis, contracted pelvis, diseases of metabolism, infections, and cirrhosis of the liver. There are several methods of sterilizing women—removal of the ovaries, ligation of the Fallopian tubes, resection of portions of the tubes, resection of the whole tube on each side, cutting the tubes and burying the cut end in the tissues by various methods, and destruction of the lining of the uterus by vaporization or the thermocautery. De Tarnowsky[228] describes the various methods. Some ligations and short resections have failed to sterilize. When the ovaries or uterus are removed, or the major part of the tubes are resected, or the lining of the uterus has been destroyed, the sterilization is permanent. Almost certainly function could be restored where the resection of the tubes is not too destructive. Apart from the matter of mutilation, the effects of double oöphorectomy are very grave,[229] and removal of the uterus or the ovaries merely for sterilization is not only immoral, but altogether unjustifiable scientifically.
A phase of this subject which is important and has occasioned much discussion is whether vasectomy causes sexual impotence or not. From a medical point of view, there is no question of impotence; physicians would say it causes sterility only. Most canonists, however, hold that the condition after vasectomy is technically impotence in the canonical sense. Ferreres of Tortosa, a leading Spanish canonist, in several articles in the Ecclesiastical Review, in Razon y Fe (xxviii, 376; xxxi, 496), and in his book De Vasectomia Duplici (Madrid, 1913), opposed my opinion published in 1912 and 1913, which then was that vasectomy does not cause canonical impotence. De Smet of Bruges[230] holds that it causes impotence. So do Ojetti,[231] René Michaud,[232] Wouters,[233] Eschbach,[234] Capello,[235] Stucchi,[236] De Becker, Vermeersch, De Villers, and Salsmans of the University of Louvain, and others. Gemelli of Milan[237] agreed with me. The weight of authority is certainly in favor of the notion of impotence, but the arguments are by no means convincing, as virtually every canonist who has discussed the question has made gross misstatements of the physical facts in the case.
If a man or woman is impotent, the disability is an impedimentum juris naturalis, and as such it would nullify any marriage, no matter what the dispensation. There are two opinions among moralists as to the essence of canonical impotence.
I. Some hold that any permanent obstruction to fecundation, no matter in what stage of the physiological process or in what part of the genital tract it occurs, constitutes impotence. They maintain that a woman whose ovaries or uterus have been removed is impotent. Roman Congregations have promulgated several decrees in peculiar cases permitting the marriage of spayed women; but, these moralists say, it is not clear that in those special cases the entire ovary on each side of the whole uterus was taken out; they hold there is doubt as to the fact. And, since there is disagreement of moralists, the Holy Office or other congregations would give the same decision because of the dubium juris.
April 2, 1909, the Congregation on the Discipline of the Sacraments decreed that the marriage of a Spanish woman, from whom, according to the physician in charge of the case, the uterus and both ovaries had certainly been removed, should not be prevented.
February 3, 1887, the Holy Office made the same decree in the case of a woman from whom the uterus and both ovaries had been removed.