In regard to the anamnesis, it is not always very difficult to get the nee.essary information from the wife, in regard to her married life; on this delicate point a clumsy proceeding on the part of the physician is as undesirable as an investigation clothed in too flowery a style. It does not require much dexterity to put the question in a becoming form, and in proper words. In this way we can make it easy even for a bashful and backward woman to disclose the secrets of her marriage. Sometimes it is difficult for the woman to say at once what she wants—she begins to complain of disturbances of menstruation, etc. The experienced physician soon dise,overs the true object of the consultation; he can direct the con versation toward the proper theme by a single question properly put.
In taking the woman's anamnesis, we must go back to the time of Puberty. The diseases of this period, for instance, chlorosis, must be in quired into. We must let her describe to us accurately the disturbances of her menstruation, dysmenorrhcea, etc., if present. It is of no small im Portance to know whether a lencorrhcea appeared early or not. Then we must try to become familiar with the sexual relations at the beginning of the marriage, as to time and frequency of cohabitation, the manner of its execution, whether manual assistance was necessary, perfect or imperfect entrance of the penis into the vagina, sexual satisfaction, presence or ab sence of pain during coitus, discharge of spermatic fluid, etc., questioning, according to circumstances, more or lees thoroughly. Th9 women are also able to give information as to the strength and duration of the erec tions of the males. Should the wife hesitate to reply, either from bash fulness or from fear of exposing herself or her husband, we must make her answers easier by stating, as an excuse, that we put such questions only when necessary, and by pointing out the necessity of the informa tion. Generally we can get all the information that is necessary from the wife, when we have once gained her confidence. If sterility is acquired,
we must gather information as to the rapidity of the first e,onception, as to the occurrence of abortions, course of the delivery and puerperal period, disturbances of the latter (fever, inflammations), suckling of the child, menstruation, changes in the sexual congress, etc. With some bashful. women it is advisable not to ask about everything that may be necessary or desirable at once, but rather to supplement our data later.
It is still better, as we have already seen, to bear the husband also, in the absence of the wife. This is indispensable when there is suspicion of niale sterility, especially impotence. If tbe physician has the opportu nity to acquire the history from the husband himself, it is not always easy to get a clear account of his previous life. The men will vary among themselves just as much as the women. While some talk very openly about their past life, and do so in a cordial tone, others are very back ward, and in spite of all our efforts can not be made to tell us the truth. The information derived from the husband in regard to erections, their strength and duration, as well as in regard to ejaculation, is of course of much greater value than the statement of the wife; often we may also obtain statements in regard to the conduct of the latter during coitus. that modify the information given by her.
Only by the communications of both parties can we obtain a complete picture of the sexual life. Unfortunately we must too often content ourselves with the Esomewbat one-sided and insufficient statements of one party. It would, however, not at all be to the purpose to confine our aliamnesis to the sexual functions; the constitutional condition of both man and wife must be considered. Previous diseases must be thoroughly investigated; in case of the husband we must especially endeavor to learn about former sexual diseases. In view of the many constitutional affec tions and diseases of organs that lead to sterility, we must, in obscure cases, often make a rigid examination.