TREATMENT OF FEMALE STERILITY.
Among the constitutional causes of sterility excessive youth has been mentioned; and here the physician can do but little, sine,e he will hardly be able to enforce continence upon the married couple. But he can help prophylaxis by opposing too early marriage, especially with poorly-devel oped, chlorotic individuals. It will most often be his task to treat dis turbances in the genital sphere caused by premature sexual activity, and thus render conception possible.
Not infrequently the gynecologist is consulted on account of deficient sexual sensation.
Most often the husband appeals to him, sometimes the wife's rela tions, and occasionally the wife herself, when sterility is present at the same time. Can anything be done pharmaceutically to remedy the de ficiency? It has no influence upon the sterility, nor will its relief in any way affect it If the abnormality is due to congenital absence of the ovaries or of the central organs of sexual activity, medicines will hardly cause any improvement. It is a question whether in this way we can recall sexual sensations which once were active. If we consider the great extent of the therapeutic armamentarium of the earlier gynecolo gists for the increasing of sexual passion, and remember that no one of their many remedies has maintained its place, we may well doubt, in the female as in the male, whether any drugs at all are to be relied upon. I have not been able to investigate the subject. and there are no experi ments by others available.
Nervous influences also, especially dysmenorrlicea, whieh are regarded by many as the essential cause of sterility, do not need consideration therapeutically here, since they cannot alone hinder conception. Dys menorrhcea is to be reg-arded as a symptom only, and not as an idiopa thic malady, and its causes, if they hinder conception, are to be attacked. We have spoken above of the influence of nutrition upon fecundity, and of the connection between obesity and sterility. Rap:d and excessive increase of fat, especially when menstruation becomes scanty or disap pears, and when it comes on soon after a confinement, lessens the pros pects of pregnancy. A few striking cases there are in which by treat
ment of this condition the sterility has been relieved, but they are a minority, and we must not look forward too confidently for results. Never theless we should not neglect it. An appropriate regimen, with courses of mineral waters, among which those of Marienbad are most reliable, are the essential points of treatment,. When obesity is accompanied by scanty menstruation, it might be proper to attempt to restore the func tion to its entirety by means of local irritants. The conditions permit ting it are the same as those in chlorosis, but the contra-indications are rarer than in that malady.
No special mention need be made of the various measures to be em ployed in chlorosis; a roborant diet, residence among the hills, iron and steel, are to be used. To some of these latter is ascribed a specific in fluence favoring conception. With nervous individuals prolonged sexual continence is advisable. It is questionable whether it is wise, when scanty menstruation or amenorrhcea is present, to use local measures to relieve these, and to attempt t,o cause ripening and dehiscence of the fol licles by the genital congestion which ensues. Such treatment is locally irritating and may increase the general malady, and especially the ner vous symptoms, or it may excite or exa,cerbate some local malady. On the other hand it must not be forgotten that several practitioners have succeeded in relieving amenorrlicea and curing sterility by means of warm water injections, the application of leeches to the cervix, the introduction of sounds, etc. Some (especially E. J. Tilt) regard irritation of the mammary gland as a powerful excitant of the genital system. But in spite of all this we should be careful, and reserve such treatment for cases where general therapy has been persistently carried out for years without effect, and the condition of the genitals affords no direct contra-indication to the measures which we are about to employ.