THE CONSTITUTIONAL CAUSES OF FEMALE STERILITY.
They most generally cause local disturbances in the sexual sphere, though the exact mode in which they do so is often by no means clear. The simplest way would be by nervous influence, but it has not yet been satisfactorily proven. On the other hand experience teaches us that general diseases cause disturbances in nutrition and function of the sexual organs. A case recently reported by M. IIofmeier is important here. A strong girl twenty years of age, who had formerly menstruated quite regularly, ceased to do so entirely, and became affected with pruritus of the external genitals. A e,areful examination revealed diabetes mellitus as the cause of the genital affection, and atrophy of the ovaries was found. Evidently, ovarian atrophy fol lowed the general disease, and amenorrhcea and sterility then set in.
In other cases the sexual organs, and especially the ovaries, take part in the general constitutional disease, but are masked by its other pheno mena. The results of C. Jani's observations in pulmonary tuberculosis favor this view. Though there were no external changes apparent in the testicles of patients of this kind, characteristic tubercle bacilli were found there. It is true we have as yet no positive information as to the occur rence of bacillary invasion of the ovaries, but the researches of J. Strauss, and Ch. Chamberlain would render it probable that that organ does not enjoy any special immunity. It does not seem improbable that the pre sence of parasitic organisms may cause disturbances of function.
It is certainly possible to have the function of the sexual apparatus interfered with without an actual lesion in other diseases. Thus I have been able to prove that the ovaries were entirely normal in sterile chlorotic women, and excessively fat women suffering from amenorrhcea, the gen eral disease preventing local congestion and rupture of the follicle, and menstruation returning when this general condition was improved.
But sterility may be dependent upon the general condition in other ways. As we shall see below, it is very probable that morphological changes in the spermatozoa play a part in the development of male sper matorrhcea, possibly in connection with changes in that organism as yet invisible to us. Might not the female generative element,. the ovum, be
subject to the same changes? We have lately learned that many chronic as well as acute diseases are dependent upon the life activity of various micro-organisms, which might easily penetrate the tissues of the ovum, and injure it. This will be difficult to prove, since the ovum cannot, like the semen, be obtained from the living woman, but further microscopic examination of the ovaries after operations and autopsies may enlighten us upon the subject. NVe may assume it to be possible for ovulation to be perfectly normal, and yet the ovum be affected by structural changes Aufficiently to render it useless for reproductive purposes.
Influence of Age.—lt seems to be the fact that extreme youth or age on the part of the woman at the time of marriage does have an unfavor able influence upon her fertility. The statistical tables which M. Duncan has compiled from the reports of Edinburgh and Glasgow plainly show that many more women, relatively, that marry between the ages of fifteen awl twenty, are sterile, than is the case with those who marry between the twentieth and twenty-fifth years. Not only the number of cases of sterility, but also the length of time ensuing between marriage and con ception show this plainly. Whitehead calculated that while among 541 women who married in their twenty-second year, childbirth occurred on the average at eleven and a half months, it was much retarded in the case of those who married earlier. Again, in his second class (marrying between twenty to twenty-five years) among 1835 cases 1661 gave birth to a child within the first two years of married life, while in the first class (marrying between fifteen to twenty years) only 306 out of 7C/0 women hail borne a child in the like time. Pfankuch found that women who marry before their twentieth year bear their tirst child on the average half a year later than do those who marry after that time, the average time being twenty-six and twenty months. This is a considerable differ. ence, and demands an anatomical explanation.