Unfortunately the surgeon will frequently be compelled to treat doubt ful hindrances to conception in the female, and he must beware of be stowing too much attention on one anomaly, and should always keep in view the other, even if apparently less important, obstacles. Nor should advice as to other matters, even when resting upon theoretical grounds, be neglected. There are many such. I need only mention the coitus more bestiaritm in retroversio uteri and the vaginal injection of chemical substances to neutralize the evil influence of certain genital secretions upon the sperma. They are justifiable when other rational means have been exhausted, and when they are not opposed to common sense. We daily use means of just as doubtful efficacy in other branches of medi cine, without any scruple as to their scientific legitimacy. And it must be remembered that sterile women, to whom we hold out no hope, fall an easy prey to charlatans. Many sterile women persist in treatment for years, and if there is any chalice for them at all, we should treat them as if some real and tangible malady were present. The treatment of these cases is not one of the pleasantest tasks in medical practice. As Billroth ssys, this also must be borne with "Anstande." So much for the relief of sterility in general. As far as individual
cases go, their treatment will in a general way be that of the abnormality which forms the obstacle to conception, and the reader will find in the various text-books on internal medicine, surgery and gynecology, full directions concerning the treatment of the diseases of the male and fe male genitals, or of the general system, which lie at the bottom of the condition.
In other cases the cause of the sterility cannot be remedied, or its cure is too troublesome and would take too long; it may then be possible to relieve certain secondary conditions which form the special hindrance to conception. This relief need not even be permanent; it is only neces eary to remove the obstacle at the time when zoosperm and ovum are to unite. This is the case not only with the temporary removal of mechani cal hindrances, such as the dilation of stenosed parts, but also with the removal of complications or the improvement of the malady at the root of the trouble, as, for instance, the curetting of tho uterine cavity in chronic metritis. In these cases we may, therefore, undertake a special and specific treatment of the sterility, and this will form the chief part of the succeeding chapter.