Influence of Scrofula.—It is questionable whether this malady causes sterility as often as many authorities believe. I have not seen a single case, nor have other gynecologists. Nor does the literature of the subject show it to be the case. Probably the relationship is only an indirect one, the chronic malady lasting through childhood and puberty, and leading to deficient development of the entire body, the genitals included. It may well be doubted, however, whether milder cases can have any in fluence at all upon fertility.
liVluence of Tuberculosis. —The same may be said of tuberculosis as of scrofula as a cause of sterility. Grisolle has been its especial defender. We ourselves must, however, side with Lebert, and regard tuberculosis in all but its latest stages as without influence on fecundity. It is true that young women, in whom we suspect tuberculosis, often remain sterile, but they are as a rule " delicate " individuals, with doubtful apex catarrhs, in whom the diagnosis halts for a long time between chlorosis and tuber culosis. It is possible that in these cases a latent tuberculosis of the genitals may be present, but the rarity of the affection should prevent us from laying too great stress upon the possibility of its occurrence. It is important for us to recollect that it has recently been observed (see Weigert, Deutsche Natfirforscherversammlfing in Freiburg i. B., Sep tember, 1883), that phthisical patients often have the characteristic bacil lus present in the testicles, even when the genitals are apparently entirely normal. The presence of the specific morbific agent might well have a deleterious influence upon the generative elements. But the discovery is too recent and too little known for us to draw any conclusions from it as yet.
Influence of Alcoholiian.—The misuse of alcohol diminishes sexual potency in the male sex, and perhaps on that account some have claimed that it is a cause of sterility. My experience is opposed to its validity, though the English physicians, and especially Matthews Duncan, believe strongly in it. He holds that it induces sterility by causing a chronic in flammation of the ovaries.
Influence of Venereal Diseases.—No one can doubt that the gonor rhces1 affection is a potent cause of sterility. I shall return to its con sideration under the head of local causes. But I do not believe that the constitutional affection, syphilis, is a frequent cause. The special litera ture of the subject by no means proves that the malady has any unfavor able influence upon conception at all. It does happen that marriages in which one or both parties suffer from constitutional syphilis, are often childless. But they are not unfruitful, as witness the repeated early abortions which usually occur. It is possible that the changes caused by frequent abortions may eventually lead to sterility, even in non-syphilitic women. And the frequent combination of the constitutional disease with gonorrhcea, which may exert its evil influence even when latent, may ex plain the sterility in some cases.
Influence of other Chronic Diseases.—It is probable that other chronic diseases may lead to sterility, especially when they are constitutionally depressing in their action, whether they be local or general. It seems possible that the functions of the ovaries may thereby be greatly depressed or abrogated. Neither the pathologists nor the gynecologists say much upon this subject. But the severer maladies would certainly forbid co habitation, or intercourse would be affected in such a manner as to " pro tect the woman,:' and render conception impossible. Hence statistics upon this point would have but little value.
Influence of Acute Disease& —Acute maladies are not directly involved in the question of sterility, though we may inquire whether they may not cause such changes in the genitals as to lead eventually to stenlity. As is well known, Slavjansky has shown that acute diseases, such as typhus, cholera, ,septimemia, etc., lead to disappearance of the follicular part of the ovary, and Myschkin has proved the same as the result of poisoning from metallic substances. 'The chances are hence that here we may possess further causes of sterility.