ON THE TREATMENT OF STERILITY IN GENERAL.
The difficulties which we encounter have already been considered, but it will not be out of place to recapitulate them here.
The first of these is our imperfect knowledge of the etiology of the condition. In only a little more than half the cases can we decide with certainty upon the cause of the infecundity. In other cases again we are compelled to deal with probabilities. In a small number of cases we are confronted by suspicions only. Compelled to do something, we attack to-day this and to-morrow that abnormality which might entail sterility. Sometimes we hit upon the right thing, but we do not have that feeling of satisfaction at the result which flows from a certzlin diagnosis and an appropriate line of treatment Nevertheless, when we consider the not infrequent cases where for years treatment of the most varied kind is persisted in by different physicians without result, we cannot but feel a certain satisfaction.
Another obstacle to treatment is found in the fact that several causes of sterility may- be present in one and the same individual, and one of these may be the only really active cause of the unfruitfulness. If now at our examination the unimportant conditions assume undue prominence, we are liable to underestimate or neglect entirely the true cause of the in fecundity.
We are often also confronted with the difficulty that only one of the couple, usually the woman, is at our disposal for examination and treat ment. Now in the female sterility occurs in connection with a large number of genital affections, and frequently with such as do not give any other evidences of their existence. They are not necessarily the cause of sterility, nor do we know the conditions under which they become so. These naaladies are very common; it is not improbable that they are often diagnosticated and treated as the cause of the sterility, while in the male resides the true cause of the infecundity. Kehrer's experiences would show this to be quite common, and it is to be hoped that the public will soon lose this idea, which physicians have given them, of the entire in nocence of the male as a cause of sterility in marriage.
How then shall the physician, knowing the etiological, diagnostic and prognostic relations of sterility, and the difficulties of its therapy, con duct himself ? A few hints will not be out of place.
What shall we say when examination reveals an insuperable hindrance to conception? Here we must individualize. In cases where in spite of the desire for offspring the reasoning is stronger than the sentimental side of the Psyche, or where for years all imaginable cures have been uselessly tried, and hope is almost gone, here the whole truth had better be told. Monetary and other sacrifices are thus avoided, and the •long period of anxiety and desire is brought to a close. But when the couple are of nervous and impressionable temperament, and it would not be hunume for the physician to expose to them the true state of the case, he should advise against any local treatment, direct their attention to general treatment, and use, if it must be done, remedies for any indication which may be present But the patient's friends should be told the full truth.
As to the treatment of curable cases, it is easy to institute it when any abnormality is positively recognized a8 the obstacle to conception. But even when we only recognize a probable cause, it is proper to treat it without insisting upon an examination of the patient's partner.
It is different, however, when examination reveals only probable causes. Here the physician must insist upon a thorough examination of both parties.
The question arises as to whether the physician is to continue his ex amination when one of the couple will not submit to examination. I think he should, provided that the state of affairs has been mule quite clear to the patient that consults him, and an earnest effort has been made to obtain an examination of the other party.