This delay in the prompt occurrence of conception after cohabitation cannot be regarded as sterility, since the fact that delayed occurrence of conception appears to be the rule forbids it being considered as patho logical. We see that in the majority of marriages, after a shorter or longer time, the occurrence of conception terminates this period of fruit less coliabitations.
But what then do we understand by sterility? It is not an easy task to furnish a generally satisfactory definition of this abnormal condition.
Fertility is directly opposed to sterility. In a fruitful marriage, the relations should be such that immediately after marriage the epochs of conception, pregnancy and delivery should occur in a normal manner, and that these should be repeated without any lengthy interruptions throughout the whole period of generative capability of the wife, so that the unconscioua purpose of the marriage is arrived at by a numerous progeny. In ordinary walks of life, we do not make such high demands on the marriage state. We satisfy ourselves with a few of the above mentioned epochs of the ideal sexual capability—indeed, we speak of a fruitful marriage, if the procreative capability of the married pair is sub stantiated by a single delivery. It is unfruitful if this result is not achieved, and no descendants ara produced. We could, indeed, speak of a sterility of the married state when fruit are born but are not viable; the marriage is then, as we may perhaps better express it, childless; the sexual union, so far as its design is concenied, has remained without re sult. The expressions " sterility " or " unfruitfulness," are, as a rule, not used in this wide sense of the word in medicine, but we understand by them that condition where, in the course of the whole married life, or at least during a great part of it, conception does not occur, or if it does occur, the impregnated ovum is not developed in the female organ ism. In this way, those women who suffer from habitual abortions, and who, in that wider, popular sense are said to be unfruitful, from a medi cal point of view cannot be classified as sterile. In this treatise, sterility will be spoken of in its narrower sense.
Sterility is not the same in all marriages, but presents itself in differ ent forms, which are given particular designations. If marriage is pri marily sterile, when conception does not occur from some ante-nuptial fault of the woman, as, for example, absence of the uterus—or when, at least, conception is rendered impossible by the occurrence of some disease at the commencement of married life—as, for instance, peritonitis as a re sult of gonorrhcea acquired at the first cohabitation; secondary or ac quired, when in a hitherto frultful marriage an intercurrent disease pre vents the occurrence of conception. This may occur as a result of a not
altogether normal puerperium. We speak of a temporary sterility when bodily or mental conditions prevent temporarily the occurrence of preg nancy. Sterility is absolute when in either one of the married pair there is a hindrance to conception, which cannot be done away with either by natural or artificial MCl/118. Relative sterility is spoken of when conception is not absolutely prevented, but is made more or less difficult, —as, for instance, by flexions of the uterus.
The term " relative sterility" is indeed used in an altogether differ ent sense. Usually, we understand by it that condition where both of the parties have lived together in an unfruitful state, while both, either before or after this marriage, were capable of begetting children with other individuals. By others, a lesser degree of fertility is designated, relative sterility, for instance, marriages with only one child, or marriages where births occur at greatly prolonged intervals. Others designate ac quired sterility as relative sterility. It would be advisable to employ the term " relative sterility'' only in the above positive sense, tile more so, as it shows a condition opposed to absolute sterility. We might speak of a sexual discord, or sexual disunion, when the married pair, separately regarded, are fertile, but with each other are not in a condition to beget children; and we may speak of " diminished fertility '' when referring to those marriages with few children.
The unfruitfulness of marriage is occasioned by the sterility of one or both of the married pair. Here also the defect may be of different kinds, so that we may have to use different designations, which are in part iden tical with those above mentioned. In this way we speak of the temporary sterility of the male or the acquired sterility of the female, etc.