TETE DIAGNOSIS OF STERILITY IN GENERAL.
Male sterility indeed is certainly less frequent, but still the percentage is so high that really in deciding upon the cause of sterility the condition of both parties should be equally inquired into. Only where the deficiency of one party is very striking should examination of the other be omitted. Thus, for instance, if the history shows that through years of married life the husband has been unable to have any erection, the wife need not be examined; and on the other hand, if an examination of the wife reveals a high degree of cicatricial stenosis of the external genitals, an examination of the husband may be desisted from. But in a great many cases the condition is a different one: if the party first seen should show but slight obstacles to conception, we should insist upon an examination of the other party, such examination of course being absolutely necessary when there cannot be detected any anatomical or physiological defect in the party first seen. Practically, however, this rule cannot often be put into execution; circumstances often compel us to depart from it.
If a marriage remains sterile, it is generally the wife who. first seeks medical aid; the husband generally either remains away altogether or at least remains reserved in the matter. The cause of this is not far to see. Medical opinions are gradually absorbed by the laity, who retain them even long after the medical profession have found them to be false. Thus the people still hold the opinion that sterility is almost always duo to defects in the wife, and but very rarely in the itusband—an opinion which even now it is difficult for us physicians to abandon. We will have _ to struggle for a long time against this opinion, which prompts the hus band to adopt his passive conduct; it will for a long time yet be difficult to make him consent to undergo an examination. Another cause for the wife's initiative is the much greater interest which she takes in her pro geny, while the husband regards childlessness as a much less sad affair, and bears it witb more resignation. The depressing feeling of having
failed iu her. duty, the fear of displeasing her husband by her sterility or of even causing him to dislike her, brings the woman early to the physi cian. The painful sensation of having to renounce the pride of a mother sometimos even causes her to seek aid, although the fault is not in her self, and though she may have reason to doubt her husband's potency. But even when the negative result of the examination of the wife calls for an examination of the husband. it is not always easy to persuade the latter to submit to it. IIis pride sometimes considers it an insult that his ability should be doubted; frequently if he is able to fulfil his sexual duties, he will share the opinion so general among the laity, that the ability to have connection necessarily presupposes ability to beget, and he will consider an examination to be an unnecessary proceeding. In still other cases a certain fear keeps the husband away from the physician, because his conscience is heavy with the sins of his youth. A gonorrhwal affection is indeed rarely concealed from the physician, but it is very difficult for him to confess self-abuse or syphilis.
I can not entirely subscribe to the opinion that it is always the fault of the physician if, after a protracted treatment of the wife, it is found that the cause lies in the husband, for sometimes it is only this ill success in treatment that will persuade the husband to subject himself to an examination. Even if the belief is expressed with certainty, that. the sterility is not to be sought in the wife, but in the husband, this is often not sufficient to cause the latter to come. Whatever be the case, in the' beginning the wife is often the only subject of an examination; she is also the only source from which the physician can get data, for the anam nesis of the case.