..klthough it is perhaps possible to establish in a satisfactory manner the perception of sterility, it is not infrequently very difficult to deter mine the exact condition in single cases. It is seldom possible to declare with absolute certainty that a marriage is sterile; it is only when we find a positive cause of sterility in one or both of the married pair, or when the woman has passed the climacteric period, that we can make such a positive assertion. Much more uncertain are we in our decision when we find in one of the married pair one or more causes of relative sterility, for, in such cases, conception is not impossible, but is only made more difficult. It del-Aids then upon the greatness of the hindrance as to whether we can declare, immediately or only after the lapse of a long time, that the marriage is sterile. Still more difficult is the differentia tion when we find only unimportant hindrances, or when, in fa,ct, the causes of sterility are not to be found. We must not deny the procrea tive capabilities too quickly. The shorter the duration of the marriage, the sooner should we think that we are not dealing with any pathological hindrance, but only with the above-described unavailing attempts at co habitation. But the longer the duration of this period the more proba ble is the supposition that we ale dealing with actual sterility. To fix a definite number of years, after the lapse of which we may declare a mar iage as sterile, seems to be an arbitrary proceeding, since we know that often after the lapse of many years, and without anything having been done, conception does occur. And still the fixing of such a time has a certain justification, which is based upon reliable statistics. M. Duncan and Ansell have investig,ated this subject in a great number (over 9000) of marriages, and have arrived at the following results. At the end of the second year of marriage, of all the women had already borne children, while in the third, and still more in the fourth year, the numbers de creased markedly; but after tbe fourth year of marriage only 31D of all the women bore children. Of course these numbers have only a relative value, since the statistics include only those women who had borne one child, and did not extend to sterile women. They do not show us how
znany women remain sterile after a certain length of time. Still they do show how slight are the chances for descendants after the fourth year of maniage, and why we are justified in regarding a marriage as sterile after this time. For the acquired sterility, according to my idea, we have no limit of time based upon trustworthy figures. Howitz declares a woman to be sterile who, in the course of fiva years after a delivery or abortion, does not again conceive.
The difficulty in making a positive differentiation in single cases has as a consequenoe many disadvantages. M.any statistical calculations, so far as they are based upon small numbers, and the experiences of single cases, are robbed of their value thereby. An opinion as to the sterility of a marriage should really not be given until after the dissolution of the same, but these cases are presented to physicians, as we well know, at a relatively early period of the sexually mature age. According to the complaints and wishes of those seeking aid, these cases are looked upon and accepted as sterile; that in this way doubt as to the etiology and therapeutics enters is self-evident. Great care must, therefore, be exer cised in differentiation. But not only does scientific work, but also medical activity suffer, for instance forensic medicine, in that positiveness is lost in the estimate of single cases, which the reviewer so unwillingly misses. In diseases of the genitals also, where the occurrence of concep tion is not desired, because it may produce complications dangerous to life, an over-estimation of the hindrance to conception might be fatal. Different cases have shown me what severe blame that physician suffers, who, in the belief of the impossibility of conception, has allowed cohabita tion without any qualifie.ation. In the great majority of cases, the physi cian does not indeed have to answer the question whether sterility exists or not. The interested married parties themselves, if, after the lapse of a certain time no descendants are produced, consider their union sterile, and, therefore, they seek meslical advice and aid.