The Fertility of the Unfit

by W. A. Chapple

The Fallopian tubes have been ligatured by Kossman, Ruhl and Neuman for the sterilization of women with pelvic deformities; but all testify to the danger of subsequent abnormal or ectopic pregnancy, and several instances are given. Mr. Bland Sutton relates a case in an article on Conservative Hysterectomy in the British Medical Journal.

After numerous experiments on healthy tubes, I have found that simple ligature with even a moderate amount of force in tying will cut the tube through in almost any part of its length. The mucous lining is so thrown into folds that its thickness in relation to the peritoneal layer is considerable. Because of this, the tube when tied alone is brittle, and a ligature applied to it will very easily cut through, and either allow of reunion of the severed ends or leave a patent stump. In a recorded case in which pregnancy occurred after each tube was ligatured in two places, and then divided with a knife, a patent stump was no doubt left.

In order to obviate this danger the peritoneal layer must be opened, and the mucous membrane, which is quite brittle and easily removed, must be torn away for about one quarter of an inch. A simple cat-gut or silk ligature lightly tied would then be sufficient to insure complete and permanent occlusion.

Nature often performs this operation herself, with the inevitable and irrevocable result, lifelong sterility, with no tittle of positive evidence during life of its occurrence.

Here are a few examples:—A young married woman has a miscarriage; it is not severe, and she is indiscreet enough to be about at her duties in a day or two, but within a few days or so she finds she must return to bed, with feverishness and pelvic pain. Before a month is past she is up and quite herself again. But she never afterwards conceives. What has happened? To the most careful and critical examination nothing abnormal is detected. Her general health, her vitality, her emotional and sexual life, her youthful vigorous appearance, all are unimpaired. But she is barren, and why? A little inflammation occurred in the uterus and spread along the tubes. The sides of the tubes cohered, permanently united by adhesive inflammation, and complete and permanent occlusion resulted.

The operation of tubo-ligature is an artificial imitation of this inflamatory process.

Pelvic inflammation, sometimes very slight, following a birth, or the same process set up by uterine pessaries used for displacements, may induce adhesive inflammation in the tubes, and simple and permanent sterility is the incurable result. It is a well known fact that prostitutes are usually sterile, and this arises from the prevalence of venereal disease, which produces gonorrhœal inflammation of the Fallopian tubes, resulting in complete and permanent occlusion.

This process could be best imitated, if cauterisation of the tubes were a safe and reliable procedure. An electric cautery passed along the tubes would result in a simple and speedy occlusion. But in the present state of our gynecological knowledge this appears impracticable.

We have therefore at our hand, a simple, safe, and certain method of stopping procreation by the sterilization of women by tubo-ligature.

This operation would entail no hardship on women. It is so easy, safe and painless, that thousands would readily submit to it to-morrow, to be relieved from the anxiety which a possible increase in their already too numerous families excites. Hundreds of women and men to-day are living unnatural lives, because of their refusal to bring children into the world with the hereditary taint they know courses in their own veins.