2. STERILITY.
Sterility occurs more frequently in the female, than impotence does in the male sex.
Its causes may be distinguished into those that arise from imperfect structure, and into those that entirely depend upon a morbid performance of certain functions.
1. Organic Causes.
Absence of the uterus. We have before alluded to this occasional defect; it has sometimes occurred, where the vagina has been wholly impervious.[[330]] Columbus dissected a woman who had always complained of great pain in coitu, in whom he found the vagina very short, and no uterus at its termination. In Hufeland’s German Journal[[331]] for May 1819, a case is related of a total deficiency of the uterus, which was discovered by Professor Stein during an operation undertaken to remedy a supposed contraction; in this paper the author quotes several analogous cases from the writings of Engel, Schmuker, and Theden.
Imperforated uterus. The os uteri, says Dr. Baillie, has been found to be so contracted as to have its passage in a great measure obliterated; and it has even been known to be closed up by the growth of an adventitious membrane. The os tincæ may be also shut up, either originally, or by cicatrix, in consequence of suppuration, laceration, ulceration, or the like, when the case may be considered as incurable, unless the menstrual discharge force a passage by its pressure, or the introduction of a trochar is able to afford an opening[[332]]. Original conformations of this kind seldom admit of any cure, for besides the impervious state of the os tincæ it not unfrequently occurs that the uterus itself appears as a solid body, without any cavity in its centre.[[333]] Morgagni states that he was consulted by a barren woman, whose vagina was only a third part of the usual length, and that its termination felt firm and fleshy, in which case he advised a dissolution of the marriage. Marchetti, on the contrary, has given a case where the vagina ran downwards beyond the internal orifice of the uterus, and terminated in a kind of cul de sac.
Polypus in utero. This may be sometimes removed by exsection; a valuable paper upon this subject by M. Deguise is to be found in the Nouveau Journal de Medicine, entitled “Observations des Polypes Uterines,” in which the author relates many successful cases, and controverts the common opinion, that after the operation for an uterine polypus, the organ is incapable of being impregnated.
Ovaria, absence of, or diseased condition of. There is a specimen in Dr. Hunter’s museum, in which one ovarium is wanting; other instances have been recorded in which no vestige of an ovarium could be observed on either side.[[334]]. The case of this kind published by Mr. Pears in the Philosophical Transactions for 1805, we have before described: to this may be added another instance from the writings of Morgagni. Instances of diseased ovaria are very common, and may arise from a variety of causes: the Fallopian tubes may also, in consequence of peritoneal inflammation, become obliterated, and lose the power of conveying the ovum from the ovarium to the uterus; they may besides be originally defective in structure; Dr. Baillie has seen them, without any aperture, or fimbriated extremity, terminate in a cul-de-sac. Morgagni noticed these tubes in some courtesans having been entirely obliterated by the thickening of their parietes; an evident consequence of the habitual orgasm in which they had been kept by too frequent excitement. Richerand on dissecting a subject at La Charité that had been sterile, found the fringed margins, or expanded extremities of the tubes, adhering to the lateral and superior parts of the pelvis, so that it had been impossible for them to perform the motions necessary for fecundation.
2. Functional Causes.
These are constitutional debility, leucorrhœa, or an excess, or deficiency of the menstrual discharge. Observation has fully established the fact, that women who do not menstruate cannot conceive; this discharge appears to be essentially necessary for the due and healthy state of the uterus, and Dr. Denman[[335]] has also observed that in cases of painful menstruation, a membranous substance is often discharged, and that no woman, in the habit of forming such a membrane has been known to conceive, although, he adds, that as it is not uninterruptedly formed at each period of menstruation, the capability of conceiving may exist at any interval of freedom from its formation.