WHOIISAU DRUGGISTS 
 
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 Presented by 
 Maurice F. Decker, D. 0. 
 
 COLLEGE OF OSTEOPATHIC PHYSICIANS 
 AND SURGEONS LOS ANGELES, CALIFORNIA

 
 I'LATK ./. 
 
 T. -Sinclair 5 Chromo
 
 CAUSES AND CUKATIVE TREATMENT 
 
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 STERILITY, 
 
 PRELIMINARY STATEMENT 
 
 PHYSIOLOGY OF GENERATION 
 
 ttlj Colorcb ITitljograjjIjs anb ^umercus S&oob Cut Illustrations. 
 
 AUGUSTUS K. GARDNER, A.M., M.D., 
 
 PERMANENT MEMBER OF THE NATIONAL MEDICAL ASSOCIATION J FELLOW OF THE NEW YORK 
 
 ACADEMY OF MEDICINE ; MEMBER OF THE MASSACHUSETTS MEDICAL SOCIETY ; 
 
 MEMBER OF THE NEW YORK PATHOLOGICAL SOCIETY ; LATE INSTRUCTOR 
 
 OH DISEASES OF WOMEN AND CHILDREN IN THE NEW YORK 
 
 PREPARATORY SCHOOL OK MEDICINE ; 
 
 PHYSICIAN FOR DISEASES OF WOMEN, IN THB NEW YORK NORTHERN DISPENSABT } 
 
 AUTHOR OF MONOGRAPHS ON ERGOT, UTERINE HAEMORRHAGE, 
 
 RUPTURE OF THE PERINEUM, ETC., ETC. 
 
 NEW YORK: 
 DE WITT & DAVENPORT, PUBLISHERS, 
 
 160 & 162 NASSAU STREET.
 
 E.TTIEED according to Act of Congrcet, in the yew 1856, by 
 
 DE WITT & DAVENPORT, 
 In UM Clerk ' OCBce of the District Court of the U. S. for the Southern Dutrict of New York. 
 
 W. H. TiM80K, Stercotyper. GKOEQ* RcHxtL & Co., Printer*. G. W. Alexander, Binder.
 
 NOT TO THE INVENTOR OP THE 
 
 CLAMP SUTURE, 
 
 THE CROWNING SURGICAL APPLIANCE OF THE AGE; 
 NOR TO THE PHILANTHROPIC PROJECTOR OP THE 
 
 WOMAN'S HOSPITAL, 
 
 THE NOBLEST CHARITY OF THE NINETEENTH^ CENTURY ; 
 BUT TO THE MAN OF PRIVATE WORTH, TO 
 
 J. MARION SIMS, M.D., 
 
 THIS VOLUME IS DEDICATED, 
 
 AS A TOKEN OP THE PERSONAL FRIENDSHIP 
 
 AND PROFESSIONAL ESTEEM OF 
 
 THE AUTHOR.
 
 PREFACE. 
 
 
 FOK many years my attention has been almost undividedly 
 given to the treatment of the various diseases peculiar to 
 women, to parturition, and to its accompanying and succeeding 
 maladies. From the many thousand cases in hospital and 
 private practice, which have fallen under my observation, I 
 have gathered experience, and, insensibly to myself, I have 
 also formed opinions, which have grown, strengthened, and 
 been verified by every day's labors. The result, in relation to 
 one affection only, I propose to give in this treatise. 
 
 Impotency and Sterility are the names given to that condi- 
 tion of the sexes which makes a childless bed and matrimonial 
 discords, which have changed the fate of nations, and the 
 destiny of the world. Occasionally these conditions arise from 
 a defect in the provisions of nature, almost always, however, 
 are the consequences of disease. Sometimes the difficulties have 
 been suffered to continue unchecked, till organic changes are 
 effected, which can never be palliated. In the vast majority 
 of cases, not only can they be alleviated, but the disorders can 
 be entirely removed, and a most joyous result will not only 
 bring proof of the cure, but will be 
 
 " A baby in the house, a well-spring of pleasure."
 
 vi PREFACE. 
 
 Impotency is the affection of the male parent, and will not 
 be treated in this work. Sterility, or the barrenness of the 
 female, its almost universal local cause, the means and 
 certainty of its cure, will occupy the following pages. If the 
 undoubted facts of my own experience, and the gathered 
 wisdom of those of the past and present time, who have given 
 their attention to this subject, shall be stated with clearness 
 and force sufficient to convince the practitioners of medicine 
 in this country who are the depositaries of the secrets of so 
 many families and thus enable them to hold out a remedy for 
 this gnawing worm in the bud of happiness, the purpose of 
 this treatise will be effected. 
 
 NSW YORK, 141 EAST THIRTEENTH ST., 
 May lt., 185.
 
 CONTENTS. 
 
 INTRODUCTION. 
 
 PAQB 
 
 Harmony of nature in its anatomical formations Identity of the reproduc- 
 tive functions The greatness of the divine Creator manifested in all his 
 works What human energy has discovered How animal life is perpetu- 
 ated Reasons for entering upon the physiology of generation ... 10 
 
 I. 
 PHYSIOLOGY OP GENERATION. 
 
 In what reproduction consists Fecundation in plants and fish Natural and 
 artificial STATED TIMES OF IMPREGNATION in animals and women That the 
 woman who menstruates is capable of being fecundated Identity of 
 fecundation in all animal life Theory of producing sexes at will Propor- 
 tion of male to female births Description of the ovum Male life princi- 
 ple The female organs of reproduction Their functions Manner of 
 menstruation Character of the discharge THE HUMAN EGG Anatomy of 
 egg Secretions of female genital organs Epitome of the " cell theory" of 
 growth and reproduction Man in his first estate SEMEN Its composi- 
 tion Germinating and fertilizing vesicles Development of Spermatozoa 
 not animalcules Manner of union of the male and female life-giving 
 principle ACTION OF UTERCS IN CONGRESS Why women raped are rarely 
 fecundated Direct passage from the vagina to the ovaries BischofFs and 
 others' views Passage of ovum Distinctive duties of the divisions of the 
 germ vesicle Growth of development ceases and the growth of augmen- 
 tation commences ...14 
 
 n. 
 
 PATHOLOGY OF STERILITY. 
 
 Fecundation How ensured Circumstances preventing AFFECTIONS OF THE 
 VAGINA Novel cases in law Impotence of male from malformations, 
 disease, &c. Virility at advanced age Effects of various vaginal dis- 
 charges Various appearance of hymen Constriction of, and strictures in
 
 viii CONTENTS. 
 
 PAQl 
 
 the vagina Prolapsus, malpositions, flexions and versions of uterus 
 AFFECTIONS OF os AND CERVIX UTERI Polypi of uterus Ovulse nabothii 
 Value of the speculum in diagnosis Diseases of the os and cervix, the 
 analogue of various skin-diseases A scrofulous diathesis having a 
 marked tendency to uterine disease, also to fecundation Uterine disease 
 established, rarely disappearing spontaneously Impossibility of the aged 
 sense being taught Symptoms of uterine disease Leucorrhoea Char- 
 acter of vaginal discharges Cause of death of spermatozoa Falling of 
 the womb Raspberry os Leucorrhoea an evidence of a strumous 
 diathesis Fissures of os uteri Speculum os uteri Effects of inordinate 
 sexual intercourse DISEASES OF CAVITY OF THE UTERUS Uterus ossified 
 Metritis DISEASES OF THE FALLOPIAS TUBES Stricture Rupture 
 Obliteration DISEASE OF FIMBRIATED EXTREMITY Disease, deformity or 
 misplacement of Polypi DISEASE OF OVARY Tumors in and around 
 Hernia of, absence of, atrophy Inflammation acute and chronic Rheu- 
 matism and neuralgia of uterus and appendages INFLUENCE OF FATNESS AS 
 CAUSING STERILITY "Free-martins" The female of male and female twins, 
 barren Character of those malformed in the genital organs General attri- 
 butes Mental manifestations of the diseased Absence of sexual appetites 
 from over stimulation, venereal excesses, masturbation, &c. Effects of 
 
 constitutional syphilis, mercurialization, &c 58 
 
 ^ 
 
 III. 
 THERAPEUTICS OF STERILITY. 
 
 Treatment and cure sometimes synonymous Requisites for fecundation 
 Instance of precocity Operations on HYMEN STRICTURES OF VAGINA 
 treated Sensitiveness of vagina from urethral tumors, relieved by local 
 anaesthetics Removal of urethral tumors by knife, ligature, cautery 
 Eversion of the uterus treated by Simpson's uterine supporter Effects 
 of constipation POLYPI Various modes of treatment excision, torsion, 
 caustics, curette Little danger of haemorrhage from Removal by Chas- 
 eaignac's ecrasseur By galvanism Hydatids How removed New form 
 of speculum ULCERATIONS treated by local injections of cold water 
 Infusions of tannin Caustic applications alteratives SEXUAL INTER- 
 COURSE not necessarily interrupted Scarifications in hypertrophy Excis- 
 ions of os uteri Issues upon os uteri Leeches and their danger Stric- 
 ture of cervix, and fissures of os Lacerations of os and cervix Dysmen- 
 orrhoea Instrument for division of strictures Sponge Tents Difficulty 
 in using sounds Anatomical formation of the interior of the cervix 
 CATARRH OF THE WOMB Treatment by injections Dangers of Oblitera- 
 tion of the cavity of the uterus PROBING FALLOPIAN TUBE Treatment 
 for affections of the ovary excessive fat Torpor of uterine system 
 Application of electricity Syphilitic taint Sobriety of body and mind 
 recommended 114 
 
 AUTHORITIES CITED 1G5
 
 THE 
 
 CAUSES AND CURATIVE TREATMENT 
 
 OF 
 
 STERILITY. 
 
 INTRODUCTION. 
 
 i 
 
 THE economy and harmonious beauty of nature are 
 nowhere more manifest than in the arrangement and 
 operation of its reproductive organs. This is in 
 accordance with the same disposition respecting the 
 other organs. Take, for instance, the skeletons of the 
 various creatures in animated nature they have all 
 one general type, and it is easy to note the resemblance. 
 To create a bird, an animal, and man, nature did not 
 construct three distinct forms, but modified this general 
 type. The necks of the elephant, of the giraffe, of the 
 owl, the goose, the fish, of man, are but varieties of
 
 10 INTRODUCTION. 
 
 the same conformation, diverse as they may appear. 
 The arm of the man, the fin of the fish, and the wing 
 of the bird are formed upon the same model. In each 
 may be found the (scapula) shoulder-blade ; the (clavicle) 
 collar-bone ; the (humerus) single bone of the arm ; the 
 (radius and ulna) double bones of the fore-arm, with 
 the bones of the wrist and hand more or less fully 
 developed. Each, according to the duties required, is 
 magnified or diminished. The clavicle of the man 
 bears a very small proportion to that of the duck, and 
 the wing of the flying-fish is but an hypertrophy of the 
 fin of the ordinary fish, in itself a modification of the 
 human hand. 
 
 To the careless observer, the ponderous shoulder 
 and the short fore-leg of the patient, slow-moving 
 ox have little to remind him of the light, slender, 
 rapid-moving arm of the monkey. The student of 
 comparative anatomy, however, speedily discovers their 
 identity. 
 
 In the same manner, the organs concerned in the 
 reproductive functions are identical. In every living 
 thing there are the male and female structures, in a more 
 or less developed condition. In every genus and species 
 of sentient life, the new being is reproduced from an 
 egg, the creation of a former parent. 
 
 For several reasons we shall endeavor to make this 
 abstruse matter plain. First, because it adds another 
 cause of wonder at the greatness and power of the
 
 INTRODUCTION. 11 
 
 divine Architect of creation ; it shows, not how great is 
 God, but how small is man. Dr. Young once said 
 that " an undevout astronomer is mad ;" with greater 
 emphasis it might be proclaimed, that a doubting 
 anatomist was devoid of reason. It would seem as if 
 man could not look down upon man, either as a whole, 
 or in his apparently as wonderful integral portions, 
 without being overwhelmed with the stupendous 
 greatness of the Creator of all things. 
 
 Secondly The method by which growth is effected, 
 and still more, the manner in which a new creation is 
 formed, is one that interests every person of whatever 
 faculties or education. All men are curious by nature. 
 They love to look into the interiors of even man's feeble 
 constructions. The child seeks to discover the motive 
 power in the watch ; and man, but an older child, gazes 
 at the movements of the steam engine and the spinning- 
 jenny. A step higher, and the loftiest intellects of 
 earth have spent their lives in analyzing the material 
 body of man, in speculating upon his mental attributes, 
 and in developing the hidden mysteries of his double 
 nature. 
 
 Human energy has done something. It has discovered 
 how we breathe, and the office of respiration ; why we 
 inhale air ; why we expire it ; what effect is produced 
 thereby. It has discovered how the food is masti- 
 cated, comminuted, changed to chyle, taken up by the 
 absorbents, poured into the impure blood, purified in the
 
 12 INTRODUCTION. 
 
 lungs, and its subsequent office. The formation, cir- 
 culation, and intention of the blood are known. Science 
 has carried this subject through from the beginning 
 to the end. In other directions, science has made less ' 
 progress we know that the brain is the organ whence 
 thought, sensation, and character proceed, but we know 
 little of its methods of working. 
 
 The method whereby the various genera and species 
 of life are perpetuated, is another branch of human 
 inquiry, of which our knowledge is limited. Still, 
 upon this point we are not entirely ignorant ; but, 
 notwithstanding the almost irrepressible desire of the 
 human being to know somewhat on this topic, a false 
 sense of propriety has attempted to ignore this subject, 
 and the ardent investigator has been compelled to turn 
 to the fanciful statements of ignorant and credulous 
 pretenders to science, to satisfy his cravings for 
 knowledge. This subject is, therefore, here enlarged 
 upon, because there is no treatise in our language 
 upon this subject, which gives a correct statement 
 of the knowledge of this century, and of the present 
 decade. 
 
 Thirdly It is necessary, for the purposes laid out in 
 the design of this work, to state in what nature consists, 
 that the deviations from nature may be made clear and 
 palpable to the intelligent understanding, for without 
 both of these points being lucidly perceptible, the means 
 here proposed for the correction of these deviations will
 
 INTRODUCTION. 13 
 
 not be firmly impressed upon the mind. In other words, 
 unless the reader fully knows what is health, and what 
 disease, he cannot understandingly perceive what is the 
 remedy and why its potency.
 
 14 PHYSIOLOGY OF GENERATION. 
 
 I. 
 
 PHYSIOLOGY OF GENERATION. 
 
 FOLLOWING the same laws shown in the development 
 of the different forms of animated nature, the 
 reproduction of the species is effected in the same 
 manner throughout creation. Reproduction consists 
 in the growth of an ovum, egg, germ, seed, or embryo 
 in a living part, from which it is separated when 
 capable of independent existence. The females of 
 plants and animals supply the germ, while the male 
 affords a fructifying fluid. 
 
 In plants the existence of distinct sexes is well 
 known, and the method of their union and their 
 fecundation, by means of the pollen, has long been 
 observed, and horticulturists have availed themselves of 
 this knowledge to raise varieties of fruit at their option ; 
 all that is necessary being to shake a blooming branch 
 of the male over the flowers of the female. 
 
 The same thing is now being effected in this country 
 with the fish tribe, after the plan of Mons. Coste, the 
 distinguished embryologist of. the College of France, 
 Paris.
 
 ARTIFICIAL FECUNDATION. 15 
 
 The fecundation of the fish ovum is almost as free as 
 the seed of the plant. The female deposits her eggs, 
 and the male finding them, ejects the fructifying 
 principle, pertaining to his sex, upon them ; both 
 leaving them afterwards to chance. Mons. Coste 
 discovered that by taking the female, and by gently 
 pressing, he could cause the eggs to be discharged into 
 a vessel prepared for the purpose, and that by treating 
 the male in a similar manner, the seminal principle was 
 also discharged. Then by gently shaking them together, 
 placing them in proper situations, the egg was 
 fecundated, and innumerable fish were thus propagated. 
 
 In the higher types of animal life fecundation is not 
 so easily effected, but throughout all nature, the 
 essential principle is the same. The female furnishes 
 the germ, egg, embryo. 
 
 In the female of most, if not all animals, this 
 germ is afforded only at periods of greater or less 
 intermediate intervals. In the greater animals, the 
 horse, cow, deer, elephant, camel, many birds, this period 
 occurs but once a year ; with the cat and dog species, 
 twice or three times, and with the rabbit and domestic 
 fowl, it is much more frequent. This season is termed 
 time of heat, rutting period, &c. 
 
 With the human female, the general opinion has- 
 been that there was no particular period, which is 
 unquestionably an error. It is almost demonstrated 
 that the woman is never impregnated, except for a
 
 16 PHYSIOLOGY OF GENERATION. 
 
 short season immediately subsequent to her menstrual 
 discharge. That they are more apt to conceive at 
 this period, was noted so long ago as the life-time of 
 Pliny, who, in his Zoology, says: "Conception is 
 generally said to take place most readily either at the 
 beginning or the end of the menstrual discharge ;" and 
 we are informed by the French historians ' ' that their 
 king, Henry II., and his wife, Catherine, having 
 been childless eleven years, made a successful 
 experiment by the advice of their physician, Fernel ; 
 intercourse immediately after the cessation of the peri- 
 odical discharge, proving fruitful." Lemaire, vol. iii., 
 p. 83, also William Harvey in 1651, in his work 
 " On Birth and Conception" says : "Wherefore, their 
 terms being now at hand, or nearly over, whilst the 
 warmth and moisture of the part (which are the 
 necessary causes of generation) do remain, women are 
 most apt to conceive." 
 
 Says Pouchet (in his " Theorie Positive de 
 VOvulation Spontanee, Paris, 1847, p. 274, 275), "But 
 as we have recognized that the decidua always is 
 destroyed from the tenth to the twelfth day of men- 
 struation, it consequently results therefrom, that con- 
 ception cannot take place except during the ten days 
 subsequent to the appearance of menstruation, and that 
 it can never take place after this epoch." Bischoff, 
 Courty, and other eminent physiologists, recognize this 
 statement as correct. The occasional exceptions when
 
 TIME FOR CONCEPTION. 17 
 
 pregnancy occurs later, are accounted for in some other 
 satisfactory manner, which has been alluded to in 
 another place. Certain it is, however, that in the vast 
 majority of cases, conception takes place only after 
 menstruation, although the length of this period is vari- 
 ously prolonged. This season is in almost every respect 
 analogous to the heat of animals. The outward signs 
 are distinctly perceptible. The bitch in heat has the 
 genitals tumefied #ud reddened, and a bloody discharge. 
 The human female has nearly the same ; and although 
 she may possess sensual appetites at other periods, they 
 are notoriously heightened, somewhat anteriorly, and 
 very manifestly immediately subsequent to this epoch.. 
 Of this fact I am fully convinced from the testimony of 
 very many females who have replied to my questions, 
 asked of them in order to elicit the fkcts upon which I 
 have based the theory enunciated in this treatise. 
 
 A medical army officer, according to the Am. Med. 
 Monthly, says : " The Indians of Puget Sound have a 
 season of amorousness affecting both sexes from May 
 to October, most active in June corresponding with 
 the salmon-eating season. The remainder of the year 
 they are cold and without passion." 
 
 It is from a generally wide-spread error upon this 
 point that it is deemed necessary to insist with some 
 earnestness upon this particular. The tables compiled 
 by Churchill and others, in order to determine the time 
 of the duration of gestation, also prove this fact, which 
 
 2
 
 18 PHYSIOLOGY OF GENERATION. 
 
 will hereafter be more fully alluded to. The point to 
 be borne in mind is, that the human female is capable 
 of being impregnated only for a few days every four 
 weeks, subsequent to her usual menstrual periods. 
 
 One fact should be most particularly noted, that the 
 regular monthly bloody flow is always excited by the 
 ^discharge of an ovum that no other hemorrhage ever 
 occurs periodically and as a consequence, which admits 
 of no exception, every woman who regularly menstruates 
 .is capable of being fecundated under certain conditions. 
 
 The fecundation of the ovum in accordance with the 
 providence of nature, is the same with all animated 
 creation. It is simply the union of the male -vivify ing 
 principle with the ovum of the female, in a proper and 
 natural situation. 
 
 In the allusion already made to the procreation of 
 fish, all that was done was in accordance with this 
 statement. The ovum of the fish in water was mixed 
 with the seminal principle, of the male ; both being 
 in a sound physiological condition. All that was 
 unnatural was the manner in which the union was 
 effected, and this, as will be seen, is unimportant. 
 
 Dr. Silas Hibbard of New Hampshire, has recently 
 .advanced the theory in the Buffalo Medical Journal, 
 Sept. 1850, that males are conceived shortly before the
 
 SEXES AT WILL. 19 
 
 time of the courses, and females after. The theory is, 
 that there is generally a periodical development and 
 maturation of an ovum near the time of the courses, 
 and that said maturation usually bears the same relation 
 to the time of the courses in all women, and thus they 
 are ordinarily more susceptible of impregnation shortly 
 before and shortly after menstruation, and also that this 
 susceptibility is nearly equal at both these times. His 
 theory further is, that the same ovum, if fecundated 
 shortly before the courses, will generally grow to be a 
 male, while if fecundation is deferred till after the 
 courses, it will generally grow to be a female. 
 
 Apart from the very loose and vague manner in 
 which, unsubstantiated, this statement is made, it is 
 contrary to general opinion, which is worth something 
 when no argument is brought against it. 
 
 In regard to the production of sexes at will, many 
 unsupported theories are advanced one, that the right 
 ovary produces males, and the left females, a fact 
 frequently disproved, not only by the birth of twins 
 where the placenta and membranes show whether one 
 or both organs were concerned in the creation but 
 also by the numerous failures of those females, who, 
 following the propositions of the theory, assume a 
 position either upon the right or left side, immediately 
 subsequent to commerce. 
 
 Many curious investigations have been instigated in 
 regard to this point in the world of nature. It is a
 
 20 PHYSIOLOGY OF GENERATION. 
 
 matter of familiar knowledge that the male and female 
 characteristics of the higher species of the animal 
 creation are not produced in the same individual as 
 they are in the great majority of the higher species of 
 plants. The organs, as will be seen, from which the 
 two are evolved, are, however, so nearly related to 
 each other in intimate nature, that the one may be 
 readily mistaken for the other in the earliest period of 
 their formation. Physiologists now incline to the 
 opinion that the fertilizing vesicle is merely a 
 germ vesicle, in a somewhat more exalted stage of 
 development. Mr. Knight has shown that plants, like 
 the oak, that bear the male and female flowers on 
 separate individuals, may be made to produce either at 
 will, by regulating the supply of light and heat 
 according to the end in view. If the heat be excessive 
 as compared with the light, male flowers only appear ; 
 but if the light be in excess, female flowers are 
 produced. He also found that, whenever the eggs 
 of birds are not allowed to be fertilized until 
 immediately before they are laid, and therefore, their 
 own intrinsic development has been carried to the 
 highest possible pitch before renewed vivification of the 
 germ vesicle is effected, as many as six out of every 
 seven of the birds subsequently hatched proved to be 
 males. This view would seem to corroborate the 
 opinion entertained by Dr. Hibbard. 
 
 Quetelet believes that the relative ages of the male
 
 DESCRIPTION OF THE OVUM. 21 
 
 and female parent, influence the sex of the offspring 
 produced, to a very considerable extent. In support 
 of this theory M. Hofacker has shown that when the 
 father is considerably younger than the mother, the 
 proportion of female to male children is generally as 
 ten to nine ; but that when, on the contrary, the father 
 is nine years older than the mother, the proportion of 
 male offspring to female is as five to four, and when 
 eighteen years older, as two to one. 
 
 In a general way, more males of the human species 
 are born into the world than females. If all Europe 
 be included in the estimate, the proportion of male 
 to female births is about 106 to 100. Possibly, if 
 Quetelet's views be based on truth, this preponderance 
 on the side of the males may be due to the fact that in 
 civilized communities men, from prudential and other 
 motives, mostly marry women younger than themselves. 
 But there are other reasons why this preponderance 
 exists. Three male children are born dead to every 
 two female. 
 
 But before proceeding further we will describe 
 the ovum and the male virile life-giving principle 
 according to the opinions of the day, as proved by the 
 investigations of Bischoff, Coste, Donne", and other 
 distinguished physiologists and microscopical observers. 
 And first, to render this clear, a brief recapitulation 
 of the leading anatomical characteristics of the genera- 
 tive organs will be expedient.
 
 22 PHYSIOLOGY OF GENERATION. 
 
 FIG. 1. 
 
 A is the body of womb, B the cervix uteri, CO the vagina, D one of the ovaries, 
 EE the fimbriated extremities, F the fallopian tube, G the small ligament attaching 
 the fimbriated extremity to the ovary. 
 
 The uterus, or womb, is a pear-shaped organ, in its 
 unfecundated, healthy state, about two inches long and 
 one wide. Its normal position will be seen by reference 
 to Plate II. It has long been divided into two portions 
 in common parlance, but not until quite recently have 
 these two parts been recognized by the anatomist and 
 physiologist as two distinct divisions of the same organ 
 in its anatomical character, in the distribution of its 
 nerves, and in its functions. The knowledge of these 
 two distinct characters is most important to the 
 accoucheur and still more to any one engaged in the 
 treatment of all uterine diseases, and especially of 
 sterility. The consideration of the peculiar functions 
 of these will form a part of the practical portion of this 
 treatise ; all that is to be here noted is the duplex 
 character of the womb.
 
 ANATOMY OF THE UTERUS. 
 
 23 
 
 FIG. 2. 
 
 The uterus divided longitudinally, showing its interior cavity. A is the os 
 internum uteri, B the os externum uteri, CC the horns from whence spring the 
 Fallopian tubes, A to B the canal of the cervix. 
 
 Through the centre of this oblong organ runs a 
 cavity. In the body of the organ this cavity is of a 
 triangular shape with the base resting upon the fundus 
 of the uterus, while from each corner the canal is 
 continued. Those at the base are the Fallopian tubes; 
 which end in the " fimbriated extremities," and are 
 usually floating loose in the cavity of the peritoneum. 
 The opening at the lower corner of the triangle is the
 
 24 
 
 PHYSIOLOGY OF GENERATION. 
 
 canal of the cervix, and when of natural size and 
 without disease, will not allow an ordinary Simpson's 
 uterine sound to pass through it without pain and a 
 very decided pressure, generally followed by a bloody 
 flow. 
 
 The shape of this canal is generally misunderstood. 
 By most it is supposed to be of the same size 
 throughout. Bennet first noticed the incorrectness of 
 this opinion, and half rectified the error, by stating that 
 the interior orifice, i. e., where it enters the body of the 
 uterus (A, Figure 2), was manifestly smaller than the 
 
 FIG. 8. 
 
 Fio. 4. 
 
 Fig. 3 represents the cavity of the uterus, according to Quain and the older 
 anatomists, the os internum not being recognized, and contrasting markedly with 
 Jigs. 2 and 4.
 
 FUNCTIONAL ANATOMY OF THE UTERUS. 25 
 
 general calibre of the canal.* So far he was correct. 
 It is equally true that the external orifice is, in virgins, 
 when no disease has existed, also smaller than the cavity 
 within, with difficulty admitting a small probe. 
 
 The anatomy of the canal of the cervix, therefore, 
 evinces that this passage is short, of about one and a 
 half inches in length, of an equal size throughout, 
 except at the external and internal orifices, and in its 
 healthy, virgin state, and when not menstruating, no 
 instrument of any size can be passed into the cavity of 
 the uterus without injury to the living membrane. A 
 large instrument cannot be passed without force, and a 
 small one will seriously lacerate and puncture the 
 mucous membrane. 
 
 I will here mention, what may perhaps be again 
 alluded to, that both of these organs dividing the 
 body and cervix into two organs are muscular, and 
 both susceptible of being irritated and provoked to 
 muscular contractions. This has always been recog- 
 nized of the body, but not so generally of the cervix. 
 But this may easily be noted by those treating uterine 
 disease. It was markedly perceptible in a case on the 
 morning of the day on which I write these words (May 
 30, '55), when attending a female for sterility, at the 
 
 * The opening of the os uteri is of considerable size, and is named the orificium 
 uteri externum ; the canal then becomes narrowed, and at the upper end of the 
 cervix is contracted into a smaller opening, the orificium internum. Anatomist's 
 Vade Meeum, by Erasmus Wilson, fifth edition, London, 1851.
 
 26 PHYSIOLOGY OF GENERATION. 
 
 Northern Dispensary; I invited my friend, Dr. E. B. 
 Warner, to witness the operation. I passed a loose 
 piece of nitrate of silver, about three quarters of an 
 inch in length, into the cavity of the cervix, by means 
 of a long pair of forceps, and as fast as it was intro- 
 duced and there left, it was immediately pushed out by 
 the contractions of the neck of the uterus, and with so 
 much force as to be thrown out of the vagina. This 
 demonstration of the foregoing statement was most 
 satisfactory. 
 
 Fio. 6. 
 
 Fig. 5 represents the cervix uteri, divided longitu- 
 dinally, and folded back upon itself, displaying the 
 peculiar structure of its internal living mucous mem- 
 brane, which, from the arrangement of its folds, is 
 denominated the arbor vitse. This formation, materially 
 modifying and affecting the treatment of difficulties in 
 this situation, will be more fully enlarged upon in suc- 
 ceeding chapters of this work. 
 
 Attached, on each -side of the uterus, on a level with
 
 RESULT OF BISCHOFF'S POST-MORTEMS. 27 
 
 the fundus, are the ovaries, the internal testicles, as 
 they were formerly considered, and are now popu- 
 larly called. 
 
 From the upper portion of the uterus, connecting 
 with the upper corners of the interior, the angular 
 cavity before alluded to, spring the fallopian tubes, 
 terminated by their fimbriated extremities, which are 
 sometimes attached to the ovary by a slight ligament. 
 
 THE FUNCTIONS OF THE FEMALE ORGANS OF GENERATION. 
 
 1 ' From the commencement of puberty up to the 
 period of involution, the ovaries are the seat of a 
 continual detachment of the ova by dehiscence of the 
 Graaffian vesicles, which, independently of sexual con- 
 gress, takes place in women and virgins, above all at 
 the menstrual period, although it may and does fre- 
 quently occur at other times, under conditions not yet 
 accurately determined." 
 
 The recent examinations by Prof. Bischoff, of the 
 organs of generation of thirteen women who had died 
 suddenly by violence while menstruating, throw some 
 light upon the subject. 
 
 Prof. B. remarks that these cases confirm the doctrine 
 that, in women, at every menstruation, a follicle 
 ripens, swells, and bursts, that the ovum escapes, and 
 that a corpus luteum is formed. The eleventh case
 
 28 PHYSIOLOGY OF GENERATION. 
 
 seems to prove that the full consequences of menstrua- 
 tion are not, in every instance, fully carried out, but 
 that a follicle may swell, and the ovum ripen, without 
 the bursting of the follicle, or the escape of the ovum. 
 Such a condition will cause sterility, notwithstanding 
 menstruation. Perhaps, also, the pain of the menstrual 
 period depends upon the incomplete development. 
 
 A woman may not menstruate, and yet she may 
 conceive ; for the essential condition, the ripening and 
 escape of an ovum, may proceed, and only the usual 
 outward symptoms of this event, the secretion of blood, 
 MlHenle's & Pfeufer's Zeitschrift, 1853. 
 
 At Jlie appropriate season the shad discharges her 
 upon the waters, trusting that they may be found 
 
 f and fecundated by the male ; the domestic hen, at 
 proper intervals, prepares a batch of eggs, which, when 
 sufficiently matured, she " lays," whether they are or 
 not fecundated by the cock. In like manner, the 
 ovaries of the human female, at her regular periods of 
 four weeks, take on action and discharge one or more 
 eggs, if a virgin not to be fecundated, if in the habit of 
 sexual intercourse, to be or not fecundated, as other 
 circumstances may affect. 
 
 The process of menstruation is the laying of a human 
 egg, differing little in its general characteristics on its 
 first appearance, from the egg of a cow, a dog, or a 
 bird. 
 
 The menstrual discharge is a mixture of blood and
 
 THE HUMAN EGG. 29 
 
 glandular albuminous secretion. The act of menstrua- 
 tion is one in which the whole genital apparatus sympa- 
 thizes, if not the entire constitution. The ovisacs, i. e., 
 the sacs containing the ova, usually called the Graafian 
 vesicles, are contained within the substance of the 
 ovary. These enlarge during the month, and in their 
 growth, approach the exterior of the ovary, till having 
 arrived at the period of maturity, the sac bursts, and 
 borne on by a flow of blood accompanying this break- 
 ing, the ovum is floated down the canal of the Fallopian 
 tube, the fimbriated extremity of which, concealing the 
 open mouth of the canal, has, warned by the general ute- 
 rine disturbance, been closely applied to the ovary, ready 
 for the coming ovum. The egg is speedily wafted through 
 this canal into the cavity of the uterus, which transit it 
 accomplishes, according to Pouchet, in from two to six 
 days. This organ also, forewarned of the coming of the 
 ovum, is in a high state of turgescence, and the numer- 
 ous follicular glands which stud its inner surface, and 
 are continued through its neck, throw out an abundant 
 supply of mucus, glandular, semi-albuminous discharge, 
 and sometimes blood exudes from the turgid vessels 
 lining its surface. When this exhalation is limited and 
 natural in its character and quantity, it forms a mem- 
 brane, lining the interior of the cavity of the uterus, 
 which is called the decidua, and in certain cases of 
 Dysmenorrhoea, or painful menstruation, a similar 
 membrane, or oftener membranous threads and strings,
 
 30 PHYSIOLOGY OF GENERATION. 
 
 are discharged, which are considered to be semi-organ- 
 ized fibrinous secretions, from the internal surface of 
 the uterus. 
 
 If from any diseased action or extraordinary conges- 
 tion of the parts, tne flow of blood and glandular 
 secretion is unusually profuse, then the ovum may be 
 washed away, and with the menstrual discharge, be 
 borne out and destroyed. But if the discharge be of 
 moderate quantity then in the cavity of the uterus, this 
 ovum, caught in some fold or cell, may remain until 
 its vitality is lost, and like all effete matter of the 
 system, it is voided. 
 
 Fio. 6. 
 
 This physiological action is easily traced in the ovary 
 of birds. In Figure 6 we have a representation of the
 
 COMPARATIVE PHYSIOLOGY. 31 
 
 ovary of a fowl, a a a are nearly mature ova contained 
 within their bags of investing membrane ; c c are 
 young ova in their earlier stages of development ; at 
 b b b ruptured bags are seen, from which mature ova 
 have escaped. In Fig. 7, the position of the several 
 parts of a matured ovum are represented in outline ; 
 p o is the thickness of the ovarian bag ; o v and r m are 
 
 the proper investing membranes of the ovum, and c is 
 the small germ vesicle lying on one side of the large 
 yolk mass, to which reference will hereafter be made. 
 
 The ovum quietly remains within the uterus, await- 
 ing the fecundating principle of the male. In some 
 insects, with the providence which lays up for a day of 
 need, the spermatic fluid received at some anterior 
 period, is retained in a place set apart for this purpose, 
 until the ovum be formed. In a certain degree, this 
 may also be the case with the human female. The
 
 32 PHYSIOLOGY OF GENERATION. 
 
 vivifying principle may lie awaiting the coming ovum, 
 for a day or two anterior to the period of menstruation, 
 and this opinion is sometimes apparently made proba- 
 ble by delivery occurring at a period corresponding to 
 the commencement, rather than the cessation of the 
 menstrual discharge. Bischoff says, that in all his 
 observations upon mammalia, he knows of no instance 
 where conception occurred after the egg had reached 
 the uterus, and that the inclusive time of possible 
 impregnation is that from the discharge of the egg 
 from the ovary until it reaches the uterus, and this is 
 considered by him to be but ten or twelve days. 
 
 These views are directly opposite to those in vogue 
 some twoscore years ago. The doctrine of those days 
 was, that the ovum was discharged at the time of 
 sexual intercourse, and at that time only that the 
 ovum was in fact the result of the female orgasm, in 
 the same manner as the seminal fluid was the result of 
 the male orgasm. Sir Everard Home, the great phy- 
 siologist of past days, even, stated that he saw the 
 human ovum four days after union, of which he con- 
 sidered it the direct result. 
 
 The secretions of the female genital organs, 
 except those of the ovarium, are, 1, a whitish mucus 
 in the uterus and vagina, which in the former is 
 derived chiefly from the uterine glands, the distinc- 
 tions of which are mentioned elsewhere ; 2, a 
 transparent viscous albuminous mucus in the cer-
 
 PHILOSOPHY OF GROWTH AND REPRODUCTION. 33 
 
 vix uteri ; 3, the clear, viscid secretion of the Bar- 
 tholinian glands, which is poured out in large quantity 
 in copulation ; and upon excitation, as was noticed by 
 Hugier and Scanzoni, it even frequently escapes in jets, 
 which may be ascribed to the muscles of the excretory 
 ducts ; 4, the secretions of the minute sebaceous and 
 mucous follicles of the external organs. (Kottiker.) 
 
 In order to more clearly demonstrate this subject, I 
 will here epitomize the present generally received 
 " cell theory " of growth and reproduction. 
 
 According to the researches of the celebrated com- 
 parative physiologists and microscopists of the present 
 day, into the philosophy of growth and reproduction, 
 it is demonstrated, as first pointed out by Schwann, 
 that at the bottom of all vitality is a microscopic atom, 
 which is alike found in every living thing, from that of 
 the highest to that of the lowest organization. It is 
 found in the sap and in the leaf, in the blood and in the 
 bone. So minute are they in their most attenuated 
 state, that twenty millions could be located on a five 
 cent piece. This omnipotent pigmy, this type of life, 
 assumes a great variety of appearances, but in all 
 possessing the same essential construction, and the 
 same general form. Its generic name has been Cella, 
 a cell, or little chamber a place provided for some 
 store. A more acceptable title, and one which is 
 destined to supplant the former, is vesicula, or vesicle. 
 
 3
 
 34 PHYSIOLOGY OF GENERATION. , 
 
 A cell is a hollow space ; a vesicle is a little bladder, 
 and such we find this essence of life to be. 
 
 The vesicle of organized structure consists of a filmy 
 layer of delicate membrane, rolled up into the form of 
 a bladder ; or, still more correctly, of a hollow ball, the 
 interior cavity being everywhere closed from external 
 space. This cavity always, however, contains some 
 kind or other of material substance. The matter 
 contained within the vesicle is introduced by transu- 
 dation through the apparently poreless membrane. 
 Dutrochet was one of the first observers of this curious 
 process of transudation through organic membranes, 
 now known by the term " osmose." This is the simple 
 type of all vitalized creation. 
 
 The increase of these vesicles is seen in the earliest 
 states of a simple plant, the liverwort or anthoceros. 
 The delicate film is so transparent as to allow the 
 substances contained in it to be easily perceived. This 
 substance is a thick liquid, in which a great number of 
 minute opaque globules float about, among which is one 
 larger body, Fig. 8, a, which first makes its appearance 
 
 as a speck, which soon assumes more importance by 
 attracting to itself portions of the surrounding mole-
 
 METAMORPHOSIS OF VESICLES. 35 
 
 cules, and attaching them to its own substance ; in short, 
 it grows until it becomes itself a hollow structure, like to 
 that in which it is held, save in size. It is then a vesicle 
 within a vesicle a kernel to the vesicular nut, and on 
 this account is called the nucleus. For a certain time, 
 both the larger and smaller vesicle increase together, 
 but at length this process of growth is arrested, and 
 streams of the finer granules begin to flow backwards 
 and forwards between the outer wall of the vesicle and 
 the imprisoned nucleus, and a very delicate filmy lining 
 is soon perceived to be separating itself within from the 
 wall of the vesicle, and to be extending a fold inwards 
 towards the kernel, in the form of a flattened ring. 
 This delicate lining appears to be a structure of great 
 importance, and is called by Mohl, the German physio- 
 logist, the " primordeal utricle," or the "original little 
 bag." This inward fold of this living membrane at last 
 constitutes itself a complete partition across the vesicle, 
 cutting the kernel also in half. Fresh cell film is then 
 produced by it within its own fold, and the first vesicle 
 is thus metamorphosed into two. These then both 
 grow in their turn, form new nuclei in their interiors, 
 develop partitions, and again divide, and thus in a 
 similar manner ad infinitum. 
 
 In Fig. 9 the condition of the cell drawn in Fig. 
 8, is shown, after four partitions have been developed, 
 and four distinct cells have been called into being (one 
 of them is on the farther side of the object, and invisi-
 
 36 PHYSIOLOGY OF GENERATION. 
 
 FIG. 9. 
 
 ble, in consequence of lying beyond the focal reach of 
 the microscope). 
 
 Vesicles which are thus multiplied by splitting into 
 pieces, are called fasiparous ; that is, producing by fis- 
 sure or division. 
 
 Vesicles are sometimes multiplied by the formation 
 of external buds, and are called gemmiparous. The 
 delicate lining of the parent vesicle, instead of growing 
 inward into its cavity as a partition, is pushed out- 
 ward, carrying a sort of pouch of the external cell- 
 wall before it ; and this pouch by degrees, gets nipped 
 by a narrow neck of communication, and at last falls 
 off completely, as a distinct offset or bud. The parent 
 vesicle is then not resolved into two new ones, as in 
 the cases described above, but forms a young one. 
 
 Fio. 10. 
 
 This process is seen in the yeast-cell, Fig. 10, magni- 
 fied many thousand times.
 
 PRIMEVAL APPEARANCE OF MAN. 37 
 
 Both plants and animals, in their most rudimentary 
 forms of living existence, agree in certain important 
 particulars. They are both isolated vesicles of mem- 
 brane, possessing the power of absorbing fluid nourish- 
 ment into their cavities, of growing to a certain extent 
 out of the material thus acquired, and of then forming 
 a brood of living vesicles, in all respects like to them- 
 selves. 
 
 Every animal, be it what it may, the colossal ele- 
 phant, the majestic lion, the lord of creation himself, 
 all commence their terrestrial career as simple monads ; 
 they are all unicellular creatures before they assume 
 their more dignified and complex conditions. Man 
 begins life as a small membranous vesicle, full of fluid ; 
 c, in Fig. 12, page 40, is a picture of his important 
 person in the primeval stage of its existence ! In a the 
 primary vesicle is shown, contained within the parent 
 cell ; and in which is also a quantity of food for the 
 early nourishment of the young creature ; in b, the 
 protecting case is broken, and the germ vesicle, with its 
 environing nutriment, has escaped from the ruptured 
 cavity. This vesicle absorbs through its walls the 
 nourishment that is furnished for its use, and then 
 begins to divide and subdivide, as already described 
 (Page 35), into generation after generation of other 
 vesicles, as may be seen in Fig. 11, a, b, c, d, e. 
 
 At first, the multiplying brood remains in communi- 
 cation with the body of the parent animal, and all the
 
 38 
 
 PHYSIOLOGY OF GENERATION. 
 
 ch 
 
 material that is required for the support of the multi- 
 plication is derived from the parent blood, but subse- 
 quently this connection is dissolved, and thenceforth 
 the developing individual has to cater for itself. A 
 digestive apparatus is brought into play, and nourish- 
 ment is prepared by it from various sorts of food, from 
 the substance of which the new broods of vesicles draw 
 their material. The various subdivided vesicles unite in 
 divers ways, to build up the organic body of the indi- 
 vidual. Some get encrusted with earthy matter, and 
 are piled together to form bones ; others ooze a gelatin- 
 ous product through their walls, multiply therein, and 
 then set themselves fast as cartilages ; others coalesce 
 into tubes ; others arrange themselves as the contractile
 
 THE FECUNDATING PRINCIPLE. 39 
 
 fibres of muscular flesh ; others assume the form of 
 nerve-threads and nerve-cells, &c., &c. In f of Fig. 
 11, the growing mass is represented as it appears after 
 its moulding into a definite organic shape has been com- 
 menced ; and the appearance of the new creature has 
 begun to be assumed cho, indicating the already com- 
 mencing chorion, with its shaggy tufts. These germ 
 vesicles of the animal frame are developed in a mass 
 of condensed vesicular structure, provided for their 
 structure, and termed, as before described, the ovary. 
 Large, distinct vesicles are formed here and there in this 
 mass ; and in each of these a true germ-vesicle slowly 
 makes its appearance, and gradually surrounds itself 
 with nutritious particles of an albuminous and oily 
 nature, attracted out of the neighboring blood-vessels ; 
 the whole then gets covered by an external membran- 
 ous investment, and becomes what has already been* 
 designated as an ovum or egg. The outer protecting 
 coat of the ovum is called the ovisac, or egg-bag. 
 When the ovum is quite mature, and the germ- vesicle 
 is prepared for fertilization, the wall of the developing 
 vesicle dissolves entirely, or is ruptured in some part, 
 and the ovum escapes into a channel provided to carry 
 it away. In Fig. 12, a is the representation of a 
 mature ovum, containing a germ-vesicle and nutritious 
 particles. At b the coats of the ovum are burst, and 
 the germ-vesicle is seen falling from the cavity. See in 
 this connection b, b, b, in the ovary of the fowl, Fig. 6.
 
 40 
 
 PHYSIOLOGY OF GENERATION. 
 
 FIG. 12. 
 
 The fecundating principle, the sperm, the spermatic 
 fluid, or, in scripture language, the seed, is a compo- 
 site substance. The greater portion consists of mucus, 
 the secretions, of the numerous glands which line the 
 urethra, the prostate gland, &c., and the secretion of 
 the testicles, which last is the true spermatic, life-giving 
 emanation. 
 
 Its composition, according to the analysis of Vauque- 
 lin, is 
 
 Water, 
 
 Animal mucilage, 
 
 Soda, 
 
 Phosphate of lime, 
 
 900. 
 60. 
 40. 
 80. 
 
 This true semen forms but a small portion of the 
 fluid ejected from the urethra during coition, and this 
 muco-glandular discharge ite necessary not only to give 
 sufficient bulk to be effectually ejaculated by the ducts, 
 but also is all-important to dilute the concentrated true
 
 MICROSCOPY OF THE SPERMATIC FLUID. 41 
 
 semen. " The true semen, of which we have given the 
 chemical analysis, as found in the vas deferens, is a 
 whitish, viscid, inodorous material, consisting almost 
 entirely of fertilizing vesicles, or spermatic filaments, 
 and containing between these bodies an extremely 
 minute quantity of connective fluid. ***** 
 In the pure semen, the filaments exhibit no movements, 
 or scarcely any, when it is too much concentrated. 
 The movements are first visible in the contents of the 
 vesiculse seminales, 'and in ejaculated semen, or when 
 pure semen is diluted." (Kolliker.} 
 
 FIG. 13. 
 
 The fertilizing vesicles, spermatic filaments, animal- 
 cules, fila-spermatica, spermatozoa, Fig. 13, were first 
 discovered by a German student, Louis Hamon, August, 
 1677, by whom they. were shown to Leeuwenhoeck, who 
 first made a study of them. They are perfectly homoge- 
 neous, soft corpuscules, in which are distinguished a 
 thicker portion the body or head and a filamentary 
 appendage the filament or tail. The former is flat- 
 tened, and viewed on the side, pyriform, with the acute
 
 42 PHYSIOLOGY OF GENERATION. 
 
 end in front ; on the surface, oval, or even rounded 
 anteriorly, and also, though more towards the anterior 
 part, slightly capped. 
 
 The development of the fertilizing vesicle of the ani- 
 mal is after the same manner as the germ-vesicle. Large 
 cells are especially set apart for the purpose, in which 
 are gradually formed several nuclei. These nuclear 
 cells then grow and mature, until they hecome complete 
 hollow vesicles. Fig. 14 is a representation of one of 
 the large developing cells of the fertilizing vesicles of 
 the sparrow, with its brood of young vesicles in the 
 interior. But when the interior vesicles have completed 
 
 FIG. 14 
 
 their growth, a change begins to take place in their 
 interior cavities also. An opaque granular matter, 
 which they contain, is moulded step by step until it 
 has assumed a very peculiar form. A small, egg- 
 shaped body, with a long coiled-up tail, is slowly shad- 
 owed forth from the cavity of the vesicle, and grows 
 more and more distinct. 
 
 In Fig. 15, this tailed body is seen at b, still snugly 
 lying in the midst of the formative granules ; and in
 
 LIFE OF THE SPERMATOZOA. 43 
 
 the right hand sketch, with its structure perfected, the 
 bed of granules being all consumed, and nothing being 
 
 Fio. 15. 
 
 left around it but the transparent walls of the prison. 
 At a the tail projects through the walls, which seems to 
 be a preparatory step to the complete emancipation of 
 the prisoner. These figures are taken from the devel- 
 oping cell of a quadruped. This peculiar little body, 
 with the egg-shaped body and curling tail, will be 
 recognized as the " spermatic filament," as shown in 
 Fig. 13. According to Dr. Burnett, our distinguished 
 countryman, lately deceased, the spermatic filaments 
 are not formed, as stated by Kolliker, by a deposit 
 from the contents of the sperm-cell or nucleus, but by 
 an elongation of the cell or nucleus itself. It will be 
 observed that its development is an affair of three gen- 
 erations successively. First, the developing cell is 
 made in the midst of a cellular mass. Then this cell 
 perfects its brood of secondary vesicles (Fig. 14) and 
 next, each of these vesicles produces (Fig. 13) the 
 final object of the process the true fertilizing agent, 
 the spermatic filament, or fertilizing vesicles.
 
 44 PHYSIOLOGY OF GENERATION. 
 
 ^ 
 
 The movement of these bodies is effected solely by 
 the alternate flexure and extension, or serpentine 
 motion of the filamentary portion, or tail, in which 
 way are produced such lively and various undulating, 
 rotatory, quivering changes of place during which the 
 head or body always precedes that these elements of 
 the semen were formerly regarded as animals. 
 
 The duration of these movements (i. e., the life of the 
 spermatozoa, or fertilizing vesicle), depends upon 
 various circumstances. In the dead body they are not 
 unfrequently perceptible, even twelve to twenty-four 
 hours after death (on one occasion Valentin noticed 
 faint motion at the end of eighty-four hours), and in the 
 female genital organs of the mammalia, they exhibit 
 motion even after seven or eight days (Leeuwenhoeck, 
 Prevost and Dumas). Water at first renders the 
 motions more lively, but they soon cease, and the 
 filaments are not unfrequently curved in a loop-like 
 form. Blood, milk, mucus, pus, syrup, and a dilute 
 saline solution, have usually no injurious effect ; but it 
 is otherwise with urine (Wagner) and bile, the former 
 
 PL 
 
 particularly, when it is strongly acid or much diluted. 
 All chemical reagents, acids, metallic salts, caustic alka- 
 lies, &c., cause the motion to cease, as do narcotics, 
 when they act chemically upon the filaments, or are too 
 much diluted ; especially uterine mucus, of a decided 
 alkaline character, is destructive to their vitality. 
 (Doniit).
 
 MANNER OF IMPREGNATION. 45 
 
 The formation of the spermatic filaments and of the 
 semen, it is true, usually ceases in old age, although 
 they are not unfrequently found in men of sixty, 
 seventy, or even eighty years of age, and even accom- 
 panied though this, it must be confessed, is an unusual 
 phenomenon with the procreative faculty. 
 
 " That the seminal filaments are not animalcules, but 
 elementary parts of the male organism, it is useless, at 
 the present time, to demonstrate (Leeuwenhoeck and 
 Spallanzani, insist that they are animalcules. Ehren- 
 burg considers them among the microzooaires suceurs, 
 while Czermak, placing them among the infusoria, 
 classes them among the vibriones and the cercaires. 
 Indeed, the former saw stomachs and intestines in 
 them, and Schwann and Henle made the important dis- 
 covery that they had mouths) although it is still as 
 much as ever unknown, and may not easily be soon 
 ascertained what is effected by their curious move- 
 ments, which are obviously intended to convey them to 
 the ovum from the uterus, which they probably reach 
 in fruitful congress. Nor, from the experiments of 
 Prevost, Dumas, Schwann and Leuckart, can the least 
 doubt be entertained that they are the true impregna- 
 ting agent, and for the purpose of impregnation must 
 necessarily come in contact with the ovum. The cir- 
 cumstance that motile spermatic filaments alone possess 
 the fertilizing property, and according to Newport 
 (Newport Phil. Trans., 1851, I), that the effect upon
 
 46 PHYSIOLOGY OF GENERATION. 
 
 the ovum takes place immediately upon the contact, 
 although a short duration of the contact of the sper- 
 matic filament with the ovum is necessary to render it 
 efficient, also shows, as it appears to me, that they do 
 not act by affording any material substance to the egg, 
 but in consequence of their exciting actions in it, as 
 bodies in a state of peculiar activity." (Kolliker). 
 
 According to Mr. Newport's researches, impregnation 
 is effected by the spermatic cilia alone, and not by the 
 agency of the liquor seminis. It was found that when 
 the seminal fluid was filtered, so as to separate the 
 spermatozoa almost entirely from the liquor seminis, 
 the impregnating power of the spermatozoa was 
 immense, while that of the liquor seminis was very 
 small, and commensurate only with the small number 
 of spermatozoa which had passed through the filter. 
 When the spermatozoa were entirely separated, the 
 liquor seminis was found quite incapable of impregnat- 
 ing ova. 
 
 ' 
 
 According, therefore, to this statement, the most 
 modern received opinion, the vivifying principle is a 
 spermatic filament or vesicle, which must come into 
 contact with the ovum of the female, when, by some 
 as yet undiscerned manner, a new life is the result, 
 possessing marked properties and characteristics, often 
 indicating the persons from whence each portion come.
 
 VITALITY OF THE SPERMATOZOA. 47 
 
 IN WHAT MANNER DO THESE ELEMENTS UNITE ? 
 
 In the act of copulation the virile organ, in ordinary 
 cases, penetrates into the vagina to the distance of from 
 three to four inches, and upwards, or to such a distance 
 that the corona glandis, or the extremity of the organ, 
 is in immediate approximation with the opening of the 
 uterine canal, the os uteri. Here the spermatic fluid is 
 discharged 
 
 According to most physiologists, the active labors of 
 the spermatozoa here commence, which accordingly, as ., *$] 
 if imbued with a knowledge of its duties, or pressed 
 forward by instinct, commences to make its way 
 through the patulous mouth of the uterus, into its 
 cavity, and not finding the ovum there, prolonging its 
 search through the length of the Fallopian tubes, even 
 to the ovary itself. Some microscopists have recently 
 asserted, that they had seen the ovum just emerging 
 from the ovary, already surrounded by the spermatozoa 
 rapidly moving around it, and embracing it ; others, 
 that they had noted the ovum transfixed by the sperma- 
 tozoa, the head being imperceptible, and the tail alone 
 noticeable, quivering with evident vitality. 
 
 A popular opinion, but which has attained currency 
 without foundation upon which to base it, that I am 
 aware of, declares that in the act of copulation, at the
 
 48 PHYSIOLOGY OF GENERATION. 
 
 time of the " crisis," or height of venereal sensation on 
 the part of the female, the mouth of the womb opens to 
 receive the Danaean shower, and the spermatic fluid is 
 ejected immediately into the cavity of the uterus. 
 
 So little is known of the os and cervix uteri in 
 its minute anatomy, and its physiological action and 
 sympathies, either in a healthy or a diseased state, that 
 there may be some truth in this opinion. 
 
 Kolliker states : " It is probable that movements 
 take place at the time of menstruation, and in the act 
 of congress, but the fact has not been ascertained. In 
 the latter case, an opening of the os uteri, and a dilata- 
 tion of the canal of the cervix are commonly supposed 
 to take place. If this is to be regarded as a spon- 
 taneous action of the cervix, it would be justifiable, 
 with Kiwisch, to refuse assent to the supposition, for 
 the radiating fibres described by Kaspar, which alone 
 could effect anything of the kind, do not exist ; the 
 fact, nevertheless is conceivable, if we assume a relax- 
 ation of the muscular element in the cervix and os, 
 together with a contraction, especially of the longitud^ 
 inal fibres, in the fundus and body." 
 
 It is further added, that in order to fecundation, it is 
 very important that the female should participate in 
 the excitement and pleasure of the act, for without 
 such participation the os uteri remains closed, and the 
 female childless. 
 
 To this impassionless performance of the act from
 
 WHY WOMEN ARE CHILDLESS. 49 
 
 personal repulsion to the male, is ascribed the fact, 
 that women raped, and virgins forcibly deflowered, are 
 rarely impregnated why women are childless with 
 their first husband, and fruitful with a succeeding one. 
 
 The fact that many women are passionless, and yet 
 have sometimes very large families, or that women 
 brutally forced are occasionally impregnated, seems 
 to controvert the general theory upon this subject. 
 (I am personally acquainted with a physician and his 
 wife, who have a large family, increasing rapidly by the 
 addition of one a year, where the female never has 
 experienced any sensual gratification, as the husband 
 states.) I shall have .occasion to refer to this view 
 when treating upon the cure of barrenness. 
 
 Some have argued that the spermatozoa possessed an 
 instinct which compelled it to seek for the ovum, from 
 the fact that it was not necessary for the seminal fluid 
 to be thrown into contact with the os uteri. The virile 
 member is occasionally so diminutive as not to extend 
 more than an inch and even less into the vagina ; from 
 the effect of stricture, the power of ejection is greatly 
 diminished, so that the semen is not thrown far into 
 the canal ; that from congenital malformation, hypos- 
 padias, or the consequence of accident, the opening of 
 the male urethra, is sometimes upon the lower surface 
 of the penis, and often so close to the body as scarcely 
 to enter the vagina in the act of copulation, and yet 
 fecundation follows the act. 
 
 4
 
 50 PHYSIOLOGY OF GENERATION. 
 
 The recent decision of microscopists, already quoted 
 from Kolliker, stating that the spermatozoa is not an 
 animalcule, will set this theory at rest. 
 
 We must, therefore, account for the arrival of the 
 ; ' spermatic filament " in the uterus in some other way 
 by its specific gravity, the fluids of the vagina flowing 
 back towards the uterus, while the female is in the 
 recumbent position, during and succeeding the act 
 that this may be worthily considered in this connection 
 is the popular theory, that procreation cannot be 
 effected in a standing position, and that violent dancing 
 immediately after sexual intercourse, will prevent 
 pregnancy by the semen being carried far up into the 
 vagina by the mechanical action during the season of 
 intercourse, a not improbable manner ; or by some 
 other method by which the vital principle of the semen 
 is transmitted to the ovaries, 
 
 This latter view demands a particular attention. A 
 physician, Dr. Brundige of this city, of decided anatom- 
 ical ability, states that he has discovered two passages 
 leading from the vagina direct to the ovaries. This 
 demonstration I have never seen, but it is thus verbally 
 described to me. 
 
 From near the external orifice of the vagina, upon 
 the superior verge of the vulva, and upon either side, 
 there may be often found a follicle sufficiently notice- 
 able. It is of small size, and by inserting a probe, a 
 pervious canal may be traced running posteriorly and
 
 DIRECT PASSAGE TO THE OVARIES. 51 
 
 laterally along the broad ligaments, until it reaches the 
 ovary. It is not always to be found in the human 
 female, and sometimes but one only can be discerned, 
 communicating with but one ovary. He states that 
 in other mammalia, these passages are found with more 
 constancy. 
 
 I am inclined to think, however, that the discovery 
 claimed by Dr. Brundige was only the re-statement of 
 an exploded view, made some time since by a Swedish 
 anatomist, where the supposed conduit, never after- 
 ward satisfactorily demonstrated to exist, is but the 
 remains of the Wolfian bodies. Still there is some 
 authority for this statement, for M. Baudelocque stated 
 (Acad. Roy ale de Med., 12th February, 1826) that he had 
 discovered a canal which proceeds from the right Fallo- 
 pian tube, passes into the parietes of the uterus, and 
 opens into the cavity of the cervix. 
 
 Its only occasional presence in the human female, as 
 alleged, would seem to indicate that it was merely a 
 correspondence of nature, and not in woman, generally 
 of any practical importance. Still it would seem that 
 perhaps, in a few cases, such a passage might exist, 
 through which the vital principle of the seminal fluid 
 might pass, and through which it did pass in the few 
 cases of pregnancy occurring where an imperforate 
 hymen, or any important malformation, or deficiency 
 of the male organ existed. 
 
 By whatever route the fecundating principle takes,
 
 52 PHYSIOLOGY OF GENERATION. 
 
 it ultimately arrives at the ovary. Without much 
 doubt, it is through the canal of the cervix, the uterus, 
 and the Fallopian tubes. The only argument against 
 this proposition is a theoretical one. It is stated, that 
 nature, in no other instance, has created a canal or 
 passage which serves two opposite purposes, i.e., which 
 serves at the same time both as an outlet and an inlet ; 
 that, therefore, if the Fallopian tube allows the fecun- 
 dated ovum to come down in its passage to be deposited 
 in the uterus, the spermatozoon must find some other 
 way up. As neither argument, corroborating, nor con- 
 tradictory hypothesis can settle this matter, and as it is 
 not important to my plan, I shall leave the question 
 with the mere statement of the two sides of the subject. 
 
 How the fecundation is effected is still as much a 
 matter of doubt as ever. The astronomer in vain 
 enlarges his telescopes, the instrument of double power 
 but divides the supposed single star, leaving each as 
 undetermined as the original and the laborious embry- 
 ologist in vain traces the spermatozoon in its path, and 
 even when the microscope reveals him at his final 
 entrance into the ovum how the new creation is 
 effected, is still a mystery above the ken of ordinary 
 mortals. 
 
 All that is necessary to effect the renewed fertiliza- 
 tion of the germ vesicle of an animal, is the bringing 
 of a fertilizing vesicle into contact with the membrane 
 of the ovum in which it is contained. An interming-
 
 UNION OF MALE AND FEMALE VESICLES. 53 
 
 ling of the contents of the two vesicles then takes place, 
 osmometric transudation occurring through the inter- 
 vening membranes. Most physiologists now believe 
 that the contents of both vesicles play their own parts 
 in the production of the germ that is to develop a new 
 creature, and that it is on this account the offspring 
 ultimately presents some of the characteristics of each 
 parent. Wagner conceives that the germ vesicle bursts 
 and mingles itself with the albuminous and oily matters 
 that surround it in the ovum, and that the contents of 
 the fertilizing vesicle then pass into the ovum too, the 
 entire ovum becoming the fertile germ vesicle. Dr. 
 Martin Barry believes that fertilization never takes 
 place unless the fertilizing vesicles pass bodily through 
 the membranes of the ovisac, and get amidst the oily 
 and albuminous matter within, as stated more fully in 
 the following paragraph. Mr. Newport stated that this 
 was by no means necessary, and that the mere contact 
 of the fertilizing vesicle with the outer covering of the 
 ovum for four or five seconds is sufficient to ensure the 
 fertilization of the germ vesicle, although a merely 
 instantaneous contact is not sufficient for the purpose. 
 
 Drs. Barry and Nelson have since re-affirmed, and 
 published their observations of the entrance of the 
 spermatozoon into the ovulum ; but their statements 
 were not regarded as completely satisfactory, but sup- 
 posed to be disproved by Newport, till Keber, following 
 the path which they had pointed out, and examining
 
 54 PHYSIOLOGY OF GENERATION. 
 
 the fresh water muscle, unio, in which this portion of 
 conception is peculiarly evident, made out and described 
 the different stages of this wonderful function. Bis- 
 choff, who at first denied most strenuously, now fully 
 corroborates this statement. 
 
 " In the fresh water muscle (unid), at the time of 
 conception, the ovulum, although still small, projects at 
 one part a minute process which springs from the mem- 
 brane of the abdomen, and perforates the cortical 
 membrane. This process dehisces, lets escape a little 
 albumen, and admits one of the spermatozoa which 
 surround it. This done, the mycropyle, as it is called, 
 again closes by constriction or obliteration. 
 
 " Afterwards (and sometimes earlier), there is formed 
 near the mycropyle an adhesion between the membranes 
 of the albumen and of the yelk, then the yelk-bag 
 dehisces, receives the spermatozoon into its interior, and 
 again is closed. 
 
 ' ' The spermatozoon afterwards sinks deep into the 
 yelk, swells, and becomes rounded ; after some time a 
 nucleus appears in it, while its outer membrane thins, 
 and at length disappears. 
 
 " The nucleus of the spermatozoon splits up into 
 several irregular divisions, which at first lie near one 
 another, and then become diffused through the yelk, so 
 that before the dissolution of the germinal vesicle, the 
 yelk is filled with small particles from the male." 
 Ed. Med. $ Surg. Jour.
 
 PASSAGE OF THE OVUM. 55 
 
 Da Costa has doubted the correctness of this assertion 
 of Keber, but the recent endorsement by BischofF would 
 seem to settle the matter. 
 
 The passage of the ovum after its escape from the 
 ovary, is a matter of some interest. In the fowl we 
 have seen it in Fig. 6 and 7. It falls from the ovary 
 into a tube with a funnel-shaped end, through which it 
 rolls along, with a slight twisting movement, enveloping 
 itself in a quantity of viscid liquid albumen, secreted 
 by the tube as represented by the Fig. 16, where we 
 
 FIG. 16. 
 
 see the ovum enclosed in albumen slightly coagulated, 
 to show the spiral way in which the mass is arranged 
 in consequence of the twisting of the ovum. At the 
 further end of the tube, the secretion changes, and a
 
 56 PHYSIOLOGY OF GENERATION. 
 
 deposit of membrane and lime is made over the albumen, 
 and we have the shell, the membrane, the white of the 
 egg, the yelk, and the true germ vesicle floating within. 
 The ovum is kept in its central place within the 
 investing albumen, by the instrumentality of a couple 
 of twisted ropes of albumen, one at either end X X 
 in the figure. 
 
 The egg of the fowl is many hundred times larger 
 than the egg of any mammalia, and it is for this reason 
 that the former is soon separated from the parent, while 
 the latter is longer cherished ; the germ vesicle of the 
 former is to be nourished by the yelk, and its albumin- 
 ous subordinate, but that of the latter is supplied 
 direct from the parental blood. 
 
 The human egg in a similar manner falls from the 
 ovary into the Fallopian tube, and arrives in the cavity 
 of the uterus. The nutritious matter surrounding it, 
 is sufficient but for a few days. "We have already 
 shown how the cells in the yolk may divide and sub- 
 divide, Fig. 11, and finally where the ovum throws 
 out little rootlets from the chorion interlacing with the 
 maternal portion, and from thence 1 drawing its nutri- 
 ment as in Fig. 11, f. 
 
 The further tracing the growth of the human egg, as 
 it is more and more fully 'developed, is unimportant for 
 the purposes of this treatise, and I leave it here 
 unfinished. Curious and miraculous indeed is its won- 
 drous growth. Within three or four weeks of the first
 
 GROWTH OF DEVELOPMENT. 57 
 
 division of the germ vesicle, the foundations of the 
 eyes, limbs, and the spinal cord are laid. In two 
 more weeks traces of forming bone are observed, a face 
 is sketched out, and fingers may be traced. In another 
 two, a forehead, lungs, and ribs have been added. In 
 another month a rudimentary brain, and a two-sided 
 heart. In two months additional the nails and teeth 
 bud, and in four beyond this, every organ in the 
 scheme that is necessary for the accomplishment of 
 human life. Then this growth of development ceases ; 
 thenceforward all growth is that of augmentation.
 
 58 PATHOLOGY OF STERILITY. 
 
 II. 
 
 PATHOLOGY OF STERILITY. 
 
 c 
 
 FROM what has already been said in the previous 
 chapter, after copulation, fecundation is ensured upon 
 certain conditions. 
 
 First, on the part of the male that the semen be 
 emitted in loco; that it contain the vital principle ; 
 that it be unmingled with syphilitic taint, or other 
 morbific poisons. 
 
 It will be seen that this modern view entirely 
 discountenances the speculations of Spallanzani in 
 behalf of the sympathetic theory. 
 
 These circumstances may not occur, as before alluded 
 to, first, from the abnormal size of the male organ, 
 either from its diminutiveness rendering it insufficient, 
 or from its excessive magnitude, preventing its entrance. 
 Albinus has recorded a case of divorce granted by the 
 Dutch courts, propter magnitudinem ipsius penis. A 
 suit for divorce was commenced within a few years in 
 this city, quashed by the death of the female before 
 trial came on, where divorce was sought for upon this 
 ground ; the evidence being that the virile member of
 
 DEFICIENCIES OF THE MALE. 59 
 
 i 
 
 the husband was eleven inches in length in its unexcite 
 condition. Also, from its unnatural direction, or mal- 
 formation of the fraenum, from stricture of the 
 urethra, which may retain the semen from flowing out ; 
 hypospadias, or a fistulous opening into the urethra may 
 allow the semen to escape externally ; an elongated 
 prepuce tightly closed over the gland may act as a 
 purse or bag, retaining the semen within its cavity, to 
 be discharged only after the organ is withdrawn from 
 the vagina, and the erect condition passing off, allows 
 it to flow forth freely. 
 
 Secondly, the spermatic fluid may be devoid of 
 spermatozoa ; from disease of the testis ; from the 
 effect of poisonous drugs ; from mercurialization ; 
 from mere old age. * 
 
 Thirdly, constitutional syphilis, acute blennorrhagic 
 discharge, 'or chronic gleet may destroy, by its admix- 
 ture, the vitality of the seminal emission. 
 
 The consideration of the deficiencies of the male 
 parent belongs to a treatise., on impotence, or the dis- 
 orders of the male genital apparatus, and they are here 
 but briefly alluded to en passant. 
 
 Secondly, on the part of the female, the semen of 
 
 * Rare examples are on record of virility in men of very advanced age ; thus, 
 Massinassa, king of Numidia, begat Methynate after 86 years. Wadilas, king of 
 Poland, had two children at 90, and Thomas Parr possessed all his powers, as 
 is well known, at 100 years. I knew a child of the Hon. Jeremiah Smith of New 
 Hampshire, begotten at considerably over 80, who possessed the form and 
 features of the Judge in a marked degree.
 
 60 PATHOLOGY OF STERILITY. 
 
 the male may fail to enter into the vagina, or the 
 uterus, or its vital principle to come in contact with 
 the ovum, which is consequently left unfecundated ; its 
 vitality may be destroyed by acrid, vitiated, syphilitic, 
 blennorrhagic, or cancerous discharges ; or it -may, 
 without any change, be washed away by the immense 
 flow of the leucorrhoeal exhalations. 
 
 The semen of the male may fail to enter into the 
 vagina, or the uterus, or its vital principle to come into 
 contact with the ovum. 
 
 It may fail to enter into the vagina, from malforma- 
 tion of the vagina itself. It is proper to allude in this 
 connection to the rare cases of adhesion of the labia 
 from inflammation,* and to the still more uncommon 
 cases where no vagina existed, as in the case reported 
 by Fode"re", as occurring in 1722, and again another, by 
 Amussat, to the French Institute in 1835. 
 
 Not an uncommon form of this difficulty arises from 
 an unusual growth of the hymen, closing up entirely all 
 
 * The most common cause of this abnormal condition is its intentional production 
 by the surgeon to alleviate worse evils. Thus my esteemed friend, Dr. H. Weeks 
 Brown of this city, during the last year, united the labia-majora, the only opera- 
 tion possible, to relieve the dire effects of a complete prolapsus uteri. This serious 
 and bold operation was entirely successful. Within a few months, I assisted my 
 friend, Dr. Sims, in his operation the operation of this century for vesico 
 vaginal fistula. The base of the bladder was entirely destroyed, and the only 
 possible operation was to destroy the vagina. This unique and hazardous, yet 
 successful operation, was effected by passing sutures of silver wire, fastened by 
 clamps, from the rectum posteriorly, through the labia majora anteriorly.
 
 VARIATIONS IN THE FORM OF THE HYMEN. 61 
 
 entrance to the vagina. " This organ assumes a great 
 variety of appearances ; it may be a membranous 
 fringe, with a round opening in the centre, or a semi- 
 lunar fold, leaving an opening in front ; or a transverse 
 septum, leaving an opening both in front and behind ; 
 or a vertical band, with an opening at either side." 
 Tolberg, in his Medical Jurisprudence, I think, enumer- 
 ates thirty different varieties. 
 
 When this organ is imperforate, the menstrual fluids 
 are not apparent, and are, when secreted, retained within 
 the vagina, and the uterine cavity the uterus gradu- 
 ally expanding to receive the monthly accession until 
 the protuberance of the abdomen and other symptoms 
 plainly evince the retained fluids. 
 
 The quantity thus retained is sometimes immense. 
 In a case operated upon at the London Hospital it 
 amounted to two gallons. Cases of death are on record 
 from the filling up of the Fallopian tubes after the 
 uterus is overflowed, and its escape into the cavity 
 through the fimbriated extrejnity, produces peritonitis. 
 
 More frequently the orifice is small, and sufficient to 
 allow, sometimes with accompanying pain, the discharge 
 of the menses. 
 
 In rare instances, the hymen, which is usually a thin 
 and easily dilated, or lacerated membrane, proving but 
 a feeble barrier to sexual congress, is made of sterner 
 stuff, and resists all the force which can be brought 
 against it by the male organ, or the finger of the 
 examiner.
 
 62 PATHOLOGY OF STERILITY. 
 
 A lady who recently came under my notice, had been 
 married some ten years, and with whom, for this reason 
 only, sexual intercourse had never been consummated, 
 false modesty being overcome, she applied to her phy- 
 sician, who consulted me in respect to the case, when, 
 after appropriate means were used, congress was not 
 only facile, but I believe fruitful in its results. 
 
 Another form of mechanical impediment arises from 
 the contractions of the vagina. These may be the 
 effect of disease, or the cicatrices of wounds. I might 
 say that it was possibly sometimes congenital, but 
 that I think it scarcely probable, and rather that this 
 condition is the result of inflammation, which at an 
 early age not unfrequently occurs in poor and ill-cared 
 for, neglected children of every class. 
 
 Dirt, primary and inherited constitutional syphilis, 
 not only frequently are followed by adhesive inflamma- 
 tion and contraction of the vagina, but gonorrhoea, 
 leucorrhoea,~and others of the profluvia, by their acrid 
 nature, inflame and irritate these textures, and the 
 resulting scar of the acute inflammatory affection is the 
 cicatrized or contracted vagina. 
 
 External wounds from injuries, falls upon sharp 
 stones, fences, tools, or other objects, have, during the 
 recuperative process, resulting in the cure of the wound, 
 so contracted the vagina as to entirely preclude the 
 entrance of the male organ. 
 
 Instances of which I have known, have arisen from a 
 fall upon any sharp instrument. Several are recorded
 
 INJURY FROM IMPALEMENT. 
 
 63 
 
 in various medical journals, where the patient was 
 impaled by falling upon the upright handle of a 
 pitchfork, &c. (Am. Jour, of Med. Sciences), Oct. 1853, 
 pp. 355-399. 
 
 FIG. 17. 
 
 In Fig. 17, we have a representation from Prof. Meigs, 
 of an unusual form of stricture of the vagina, which
 
 64 PATHOLOGY OF STERILITY. 
 
 was the cause of an almost fatal error in diagnosis. 
 Similar strictures are occasionally seen, which it is 
 necessary to remember and to recognize. In the case 
 above displayed, the stricture in the vagina #, was 
 supposed to be the open os uteri, which, as may be 
 noted, b, is an inch or two higher. 
 
 Wounds during previous tardy labors have often 
 resulted in sloughing, general disorganization, contrac- 
 tions, and cicatrizations. Dr. Joel Foster consulted me 
 in the case of a lady where such a result occurred, the 
 inflammation being so extensive and so intense as to be 
 followed by entire union of the sides of the vagina, 
 and a perfect obliteration of the cavity of the vagina. 
 
 Sometimes, from malposition of the uterus itself, as 
 in falling of the womb. This complaint is very gener- 
 ally but a symptom of uterine congestion, hypertrophy 
 of the os uteri, &c., but occasionally it is simply a 
 falling of the womb. Where this condition exists to 
 any great extent, pregnancy is rarely found. The irri- 
 tation causes so great a leucorrhoeal flow as entirely to 
 carry away any semen deposited. Still I have seen a 
 case of falling of the womb so complete that the vagina 
 was completely everted and the os uteri was exposed to 
 view, yet the woman was impregnated, la verge de 
 Vhomme ttant introduite dans Vos uteri m&me. 
 (Reported in Am. Jour, of Med. Sciences, Oct., 1846.) 
 
 Chopart reports a. similar case, and Dr. Gruhn of 
 Reppen, a like case of prolapsus, which accident how-
 
 PLATK III. 
 
 1 
 
 T Sinclair's Chromo Iith PhoJ a
 
 MALFORMATIONS OF THE VAGINA. 65 
 
 ever did not occur till the fourth month of pregnancy. 
 The vagina is also contracted in its length, being a mere 
 fent or chink between the labia in its circumference 
 amounting almost to obliteration. In one instance 
 recorded, this contraction was such as to simulate the 
 os uteri, and the attending physician, examining per 
 vaginam, supposed that he had arrived at the external 
 os uteri low down in the pelvis, and the case was sup- 
 posed to be a falling of the womb. 
 
 I need not add that the presence of tumors or other 
 adventitious growths in the vagina, the rectum, the 
 bladder, or in the adjacent cellular substance, may so 
 block up the passage as to render it impossible, or 
 nearly so, for the semen to fairly enter into the vagina. 
 In one case, where there was chronic constipation of the 
 bowels, the rectum was so completely filled, as to 
 materially diminish the calibre of the vagina, so that 
 with the extra sensitiveness of the parts, full coition 
 was not effected, if possible. 
 
 The semen of the male may fail to . enter into the 
 uterus. In a few rare cases recorded, the vagina, from 
 congenital malformation, has opened into the rectum, 
 and sometimes it ends in a cul-de-sac, leaving the uterus 
 to open either into the cavity of the bladder or the 
 rectum. Dr. Steger, (Nashville Journal of Medicine 
 and Surgery, August, 1855), records a curious mal- 
 formation, where there ' ' was no development whatever 
 
 5
 
 66 PATHOLOGY OF STERILITY. 
 
 of the labia externa observable, nor even the slightest 
 trace, or indication by which we should infer that they 
 ever existed ; about two inches above the symphisis 
 pubis, on the linea alba, there is an opening from the 
 uterus not more than an inch and a quarter in length, 
 presenting rather the appearance of a smooth incision, 
 than the misplaced pudendum, and immediately above 
 which there is a hirsute growth and a merely observa- 
 ble development of a mons veneris. From the external 
 opening of this orifice to the os tincse, about two and 
 a half or three inches, is the vagina covered by a smooth 
 surface of mucous membrane, the urethra perforating it 
 immediately under the deep-seated fascia." This woman, 
 a negro slave, was however, pregnant, and delivered 
 by a sort of cesarian operation, which was the enlarging 
 this peculiarly situated vagina, by a longitudinal incision. 
 
 But having surmounted the obstacles in the vagina, 
 peculiar difficulties sometimes occur impeding fecunda- 
 tion from disorganizations in the womb itself in the os 
 externum, the cavity of the cervix, the os internum, in 
 the cavity of the body of the womb, in the Fallopian 
 tubes, in its fimbriated extremity, in the ovary. 
 
 In investigating these various difficulties, I shall have 
 occasion but to merely enumerate the occasional con- 
 genital absence of the uterus itself, or the os and cervix 
 only, leaving the body remaining healthy (such doubtful
 
 DOUBLING OF THE WOMB. 67 
 
 cases having been reported), or the general diseases of 
 its various tissues, or its appendages, where those 
 diseases do not affect the interior portion with which 
 the seed of the man comes in contact, in its passage to 
 unite with the ovum. Such, for instance, are numerous 
 forms of tumor, and of- local or other manifestations of 
 constitutional syphilis, which according to its location, 
 may or not form a- barrier to fecundation. Their 
 general effect, as disturbing the constitution, will be 
 referred to in a distinct paragraph. 
 
 The semen may fail to enter the cavity of the womb 
 from an imperforate os uteri, or the alteration in the 
 passage, or its closure, by the doubling of the womb 
 
 FIG. 18. 
 
 a 
 
 upon itself, as in the forms of disease, or rather of 
 debility, of late recognized as much more frequent than
 
 68 PATHOLOGY OF STERILITY. 
 
 was generally supposed, variously called (by refinement;. 
 of nomenclature more exact than the appearances they 
 are supposed to represent,) retro and ante-flexion or 
 version. 
 
 In Fig. 18 we have representations of various obli- 
 quities of the uterus ; a, c, and e, are of the class called 
 flexions, while b, and d, are denominated versions. As 
 may be supposed, there are endless varieties and shades 
 of deviation from both of these classes, and I have 
 therefore used these terms synonymously. 
 
 By reference to Plates II. and III., the position of the 
 uterus will be perceived in situ, and in reference to the 
 other organs, Plate II. representing the womb in the 
 normal position, and Plate IY., indicating it in a posi- 
 tion, resembling d in Fig. 18. 
 
 This obliquity, it will be perceived, not only affects 
 the functions of the uterus, but it also seriously militates 
 with the healthy action of the rectum and bladder, as 
 it presses upon one or the other. 
 
 By this accident the womb is forced into an abnormal 
 condition, as if doubled together, and it may readily be 
 perjeiyed, that the interior canal must not only.be 
 sensibly diminished in its calibre, but the opening of 
 the os must be more or less drawn aside and occluded. 
 In these cases the menstrual fluid being secreted within, 
 is discharged with more or less pain, often with very 
 great accompanying suffering, by means of the muscular 
 uterine force. No such force is exerted, or can be, to
 
 POLYPI OF THE UTERUS. 69 
 
 force in the seminal fluid, which consequently rarely 
 reaches within the uterus. I am convinced that this 
 obliquity is the present cause not only of sterility, but 
 also of dysmenorrhoea in very many cases, from the 
 number of such instances which have within a short 
 time fallen under my observation, both in private prac- 
 tice and public charities : and I am equally persuaded 
 that I have passed by unnoticed, many other similar 
 cases, because my attention had not then been directed 
 to them. 
 
 Fig. 19. 
 
 Another form of mechanical obstruction is the pres- 
 ence of tumors, filling up the orifice or some portion 
 of the passage. They are of various characters, and 
 those of the fibrous nature, often growing to an immense 
 size the largest pedunculated on record, as reported 
 by Dr. J. W. Francis, weighed one hundred and one 
 pounds. Polypi, either vesicular, mucous, or cellular, 
 in various localities affect this end. They are very
 
 70 PATHOLOGY OF STERILITY. 
 
 often not suspected, for the menstrual flow is, perhaps, 
 more than ordinarily free, certainly as much and as 
 frequent as usual. The polypus hangs by a pedicle 
 from the os, from within the neck, within the cavity of 
 
 Fig. 20. 
 
 the uterus ; projecting into the passage more or less, 
 and acting as a valve, preventing all ingress, but not 
 interfering with egress. (Plate III, & Figs. 19, 20, 21 
 22.) The vesicular polypi are often most insignifi- 
 cant in appearance, not larger, frequently, than a half- 
 pea, (Plate III, Fig. 1.) often unnoticed by the patient, 
 even passed over by quite shrewd medical men, whose 
 attention has not been directed to them unfelt by the 
 touch, and unobserved by the speculum. 
 
 Often, however, they are not perceptible by any 
 sense, until the os externum being dilated with an 
 instrument, discloses the little parasite concealed within 
 the cavity, a sure sentinel, permitting not even the 
 proper occupants of the locality to enter and pass in. 
 Blood constantly exudes from these tumors for many
 
 POLYPI OF THE UTERUS. 71 
 
 months, until the patient's strength is quite exhausted 
 by this slow and continuous hemorrhage. Their vascu- 
 larity may be seen by reference to the figures on Plate 
 No. Ill, taken from Professor Meigs' excellent Essay 
 on the Acute and Chronic Diseases of the Neck of the 
 Uterus, in the Transactions of the National Medical 
 Association, Vol. vi. 
 
 Other tumors may exist within the substance of the 
 os uteri, which may so press upon the canal as to close 
 it against any entrance. 
 
 FIG. 21. 
 
 Some six months since, I saw a lady about twenty- 
 six years of age, a patient of Dr. Cyrus Weeks, who 
 had never menstruated, although every four weeks she 
 was compelled by excessive pains in the back and abdo- 
 men, to keep her bed for several days. She had been 
 married about two years, but without experiencing any 
 change, neither had she been impregnated. On examin- 
 ation, the finger discovered nothing abnormal, and when
 
 72 
 
 PATHOLOGY OF STERILITY. 
 
 passed into the rectum, the uterus appeared to be about 
 three times its natural size. The uterine sound could 
 not be passed through the internal os uteri. It was con- 
 cluded that a fibrous tumor filled the interior of the 
 uterus, which originated in the substance of the uterus 
 and entirely occluded the passage. 
 
 The presence of hydatids can scarcely be called a 
 cause of sterility, since, in the opinion of the ablest 
 pathologists, as Desormeaux, Yelpeau, Orfila, Milne 
 Edwards, Pouchet, Meigs, and others, hydatids are 
 commonly nothing- more than a pathological degener- 
 ation of the product of conception. Still their presence 
 actually preventing subsequent impregnation, I have 
 mentioned them in connection with the other causes of 
 sterility. 
 
 Fig. 22. 
 
 One form of disease which may sometimes be con- 
 sidered as polypi, especially as polypi of the diminu- 
 tive character above referred to, are the ovula nabothi 
 a name originating from the early supposition that
 
 OVULA NABOTHI. 73 
 
 they were abortive ovules which had attached them- 
 selves to the os and cervix uteri. Subsequent writers 
 have spoken of them as obstructed follicles of the 
 mucous membrane. Dr. Whitehead considers them to 
 be glandular bodies, and states that he has ' ' strong 
 reasons for believing that their function is intimately, if 
 not solely concerned in the phenomenon of the venereal 
 orgasm." He also says, " I have been led to regard 
 the nabothean bodies as consisting anatomically of an 
 erectile tissue, inclosing a number of cells and tubes, 
 which probably have a peculiar arrangement, and are 
 highly organized. After the escape of their contents, 
 the accumulation and emission of which appear to be 
 but a momentary act, they immediately collapse and 
 
 Fig. 23. 
 
 disappear from view." Dr. Tyler Smith, satisfactorily 
 disapproves this opinion, alleging that the difficulty of 
 finding them in the healthy state, is one of the -best 
 proofs of their non-existence, except as a diseased con- 
 dition. He considers them the origin of the vesicular 
 polypi above noted. They are in themselves little cysts,
 
 74 PATHOLOGY OF STERILITY. 
 
 rarely seen except in diseased states of the os and 
 cervix uteri. They may be noted in Fig. 23, where the 
 os and cervix uteri, partially inverted, show the cervical 
 rugae. Two nabothean ovules are visible, and the 
 surface of the os is eroded in patches. 
 
 For full dissertations on the pathology of these 
 tumors, see Huguier's Memoire sur les Kystes Follicu- 
 laires du Vagin ; M. Robin's Memoire pour servir a 
 VHistoire Anatomique et Pathologique de la membrane 
 muqueux Uterine, de son Mucus, de la caduque et des 
 O3ufs ou mieux glands de Naboth, or the able resume, 
 by Tyler Smith, from whose work on Leucorrhcea, I 
 have borrowed Fig. 23. 
 
 By far the commonest cause of Sterility, as it has 
 appeared to me, is from disease of the os externum, 
 and particularly that form mentioned by Bennett, and 
 deduced from the teaching of Recamier, Lisfranc, and 
 other French magnates of modern days. 
 
 The treatment of all diseases of females, has been 
 immensely simplified by the discovery of the speculum 
 by Recamier, and both French and English have written 
 much upon its value and the results gathered from its 
 use. Still they have not laid stress upon its peculiar 
 value, as an adjuvant for the cure of sterility. 
 
 Most barren women believe themselves in perfect 
 health ; at least very many of them do not dream of 
 any local disease, which is the cause of this condition. 
 They are content with the idea of personal idiosyncrasy.
 
 INTERNAL CORRESPONDENCE OF EXTERNAL DISEASE. 75 
 
 In a large proportion of these females, a speculum 
 examination evinces a greater or less degree of chronic 
 inflammatory disease of the os and cervix uteri, and, 
 the cause and continued persistence of it is easily 
 accounted for in many instances. 
 
 'The trouble commences sometimes before marriage, 
 sometimes during the "honey-moon," sometimes, and 
 very often succeeding an abortion, or after a " bad 
 getting up " at childbirth. 
 
 The cause of the various forms of uterine disease is 
 certainly not entirely known, but my own investiga- 
 tions have shown some facts not generally recognized. 
 
 First. There are often originally internal manifesta- 
 tions corresponding to external cutaneous affections. 
 Were not these facts demonstrated, we might reasonably 
 infer their existence from the marked similarity which 
 exists between the mucous membrane of this locality 
 and the skin ; this resemblance being much more evi- 
 dent than between the mucous membranes of other situ- 
 ations, and the cutaneous structure. The facility with 
 which, in cases of prolapsus, the exposed mucous 
 membrane of the everted vagina takes the character and 
 functions of the skin is another corroborating proof. 
 
 Secondly. There are forms of disease accidentally 
 excited, developed and modified by the locality, of 
 general constitutional taint. 
 
 First. Every medical man knows that small-pox 
 and varioloid not only form their pustules on the
 
 76 PATHOLOGY OF STERILITY. 
 
 external skin, but also on the internal mucous mem- 
 branes, and that they and their subsequent cicatrices 
 are noted on the eye-ball, the tongue, the fauces, tonsils 
 &c., and even on the internal viscera. So also they may 
 be observed upon the os uteri. Rubeola is noticed on 
 the throat and vagina. Scarletina exfoliates the epider- 
 mis, but the mucous membranes of the throat, ear, eye, 
 vulva, uterus, secrete pus. Psoriasis exzema, and lichen, 
 have corresponding types upon the vagina and cervix 
 uteri. Hence have originated as I have noted, many of 
 the uterine difficulties. This view I need not develope 
 further, its probability will render it scarcely question- 
 able, and observation will endorse the bill of credit. 
 
 Secondly. Local scrofulous disease is often ob- 
 served in the same manner that we recognize local 
 cancerous developments. A tuberculous diathesis 
 is manifested not only by tubercular lungs, tubercles 
 in the brain, kidneys, but also, less recognizable as 
 the same disease, by tubercles in the bones. Still more 
 remotely of the same type, by long eye-lashes; extreme 
 purity of skin ; peculiar growth of the nails ; a . ten- 
 dency to slow glandular inflammation, an 1 subsequent 
 suppuration ; and likewise, according to my own obser- 
 vations, by a tendency to uterine excitability, and con- 
 sequently of disease, 
 
 That tuberculosis or a phthisical disposition is mani- 
 fested in uterine excitability, it is useless to reason upon, 
 but the marked tendency to fecundation evinced by
 
 NECESSITY OF EARLY EDUCATION. 7.7 
 
 the consumptive woman is universally conceded. The 
 prolific disposition of those of a cachetic family, 
 although as yet manifesting no form of this disease, 
 needs only to be looked for to be plainly perceived. 
 
 Be it when it may, with very rare exceptions,* this 
 condition of things is never corrected, and the disease 
 never disappears, unless by proper treatment, or by the 
 effect of some overwhelming disease, diverting the 
 powers of nature, until after the cessation of the 
 menses, when every hope of offspring has ceased. 
 
 The speculum plainly discovers the lesions, or the 
 educated touch educated by the conjoined use of the 
 speculum may often distinguish the local difficulties. 
 
 Scarcely twenty years has attention been paid to 
 these local diseases, and it is only the younger men 
 of the profession, taught to observe these manifestations, 
 of disease, that fully understand and recognize them: 
 The knowledge of first principles, can, as a general 
 thing, be properly and easily attained but in comparative 
 youth. The old physician is slow to adopt new ideas, 
 and even were his mind ready to entertain them, the 
 senses unpracticed when in the vigor of youth are dull 
 for the required perception. The elderly man can never 
 bring his ear to detect the nice distinctions of sound in 
 pulmonic and cardiac complaints, or the evidences of 
 foetal and placental circulation in pregnant women. 
 The ear of the old physician can never be 'but imper- 
 fectly educated.
 
 78 PATHOLOGY OF STERILITY. 
 
 The eye is the same, and the sense of touch is equally 
 imperfect. With the speculum, the aged vision may 
 indeed behold immense disorganizations, and large 
 fungous growths ; the feeble finger may discover a 
 gaping os, or the ravages of cancer, but to the true 
 eye, and the tactus eruditus of younger years, what 
 appear but trifles to the former, or remain unnoticed 
 until pointed out, are easily discernible. 
 
 It is these " trifles " not unfrequently, I may say 
 almost invariably, in apparently healthy females, in 
 which consists the disease of sterility. 
 
 The os and cervix uteri, in one or all of its surfaces, 
 exterior and interior, is the seat of inflammatory 
 diseases, both acute and chronic. It is the latter form 
 that immediately interests us. 
 
 The symptoms of the disease are dragging pains in 
 the back, in the loins, in the thighs, a sinking feeling 
 in the stomach, irregularity of the bowels and of the 
 menses, sympathetic irritation of the stomach, frequent 
 micturition, loss of appetite, sometimes vomiting, occa- 
 sionally morning sickness simulating pregnancy, head- 
 aches, great nervous susceptibility, fainting, spasms, 
 great fatigue upon slight exertion. These symptoms in 
 numerous degrees, and variously modified in different 
 cases, are accompanied very generally by a more or 
 less profuse vaginal discharge, known as leucorrhoea, 
 whites, " a weakness," &c. 
 
 Leucorrhoea has been always considered to be a
 
 CHARACTER OF LEUCORRHOEA. 79 
 
 disease of doubtful pathology, but I apprehend that 
 before a very long time, in a work on Diseases of 
 Females, that name will be recognized only as the 
 name of a symptom of numerous fully recognized 
 disorders. Some advance towards this result is already 
 attained, and it still retains its place as the designation 
 of an affection, solely because the advance of science 
 has not yet recognized in one or two classes of cases 
 only, the particular lesion upon which this flow is 
 dependent. 
 
 In some forms of these complaints, although occa- 
 sionally of considerable apparent magnitude, no dis- 
 charge is perceptible. Sometimes there is no discharge 
 worthy of note. Occasionally the speculum evinces 
 that this exhalation is very considerable, but as it does 
 not escape from the vulva, we can account for its disap- 
 pearance in the lower portions of the vagina, only by 
 its being absorbed in its progress outward. 
 
 The character of this discharge is pathognomonic, 
 of the locality from whence it springs. Dr. Tyler 
 Smith, of London, in his memoir before the Royal 
 Medical and Chirurgical Society, April 1852, and sub- 
 sequently gathered into a volume under the title of 
 " The Pathology and Treatment of Leucorrhoea," and 
 Dr. Brigel, of La Charite", Berlin, have made full micros- 
 copic and chemical investigations of this secretion, and 
 have thrown much light upon this subject. 
 
 According to the latter, the secretion of the uterus 
 is always alkaline, that of the vagina and urethra, acid,
 
 80 PATHOLOGY OF STERILITY. 
 
 and that of Duverney's glands neutral. If the secretion 
 is found sometimes acid, and sometimes alkaline, this 
 depends upon whether the uterus or the vagina fur- 
 nishes the largest share. The discharge is, however, 
 almost always, sour, as the acid reaction of the vaginal 
 secretion is too considerable to be neutralized by the 
 alkaline fluid, &c. 2, great viscidity (Zahtgkeit), of 
 the secretion indicates that it is uterine. 3, milk-white 
 secretion, that is not viscid or filiform, denotes simple 
 vaginal catarrh. 4, a puriform condition results from 
 acute or chronic gonorrhoea, but may also depend upon 
 other conditions. In the first case, the urethra, and 
 Duverney's glands are especially affected, but not so in 
 the others. 5, the microscope enables us to distinguish 
 whether the discharge proceeds especially from the 
 uterus or the vagina, and also whether it consists 
 merely in an increased separation of epithelial cells 
 (simple catarrh), or is accompanied by the formation of 
 pus cells (blenorrhcea.) 6, the author has carefully 
 sought for, without ever finding the trichonas vaginalis, 
 which Donne* states to be characteristic of infecting 
 fluor albus ; but the changed epithelial cells, enclosed 
 in tough mucus, bear a great resemblance to the 
 figures he has given. 
 
 Mons. Donne* found that in the healthy secretions of 
 the vagina and uterine canal the spermatozoa lives 
 for a considerable period, but that in certain morbid 
 conditions they are speedily destroyed. Dr. Tyler 
 Smith has elicited many important facts, and his
 
 PHYSICAL EXAMINATION IMPERATIVE. 81 
 
 chemical examinations of the secretions from the 
 various portions of the utero-vaginal canal, have 
 plainly shown that excessive acidity of the vaginal 
 mucus, or increased alkalinity of the "cervical mucus, 
 are alike destructive to the spermatozoa. Dr. White- 
 head also notes the same general facts. 
 
 The great point pertinent to this investigation, is, 
 if this discharge be or not albuminous. If albuminous, 
 or even partially so, then it may be set down as positive, 
 independent of further observation, that the lesion is 
 within the os externum uteri ; for the glands of the 
 vagina do none of them secrete albumen ; they are 
 muciparous glands, and their exhalations are mucus, or 
 if diseased, mucus combined with pus. 
 
 On the contrary, the intra cervical glandular appa- 
 ratus secretes albumen, with or without pus combined, 
 according to their- health or diseased condition. 
 
 Finding a profuse discharge combined with albumen, 
 or great general diseased action without external 
 discharge, duty must overcome delicacy, and a physical 
 examination is imperative, and he who neglects this, 
 neglects his duty, disregards the obligations which he 
 voluntarily assumed on entering the profession, to do 
 all in his power to assuage the ills incident to humanity. 
 Ignorance is no excuse in the eyes of the law, on the 
 part of the physician it is unpardonable. 
 
 The finger passes into the vagina, and reaching the os 
 
 6
 
 82 PATHOLOGY OF STERILITY. 
 
 v 
 
 uteri, may find it in various localities and conditions- 
 low down and anterior, high up and posterior, indicating 
 either the ante or retro-flexions before referred to, or 
 prolapsed by its own weight, and the lax condition of 
 the vaginal walls resulting from its diseased condition. 
 In size it will vary from a slight enlargement to an 
 immense hypertrophy, being not unfrequently many 
 times its original size and weight. It is this increased 
 ponderosity that gives it the phase of " falling of the 
 womb," till recently the only recognized symptom. In 
 the vast majority of cases, " falling of the womb ?? 
 depends wholly and only upon this increased weight, 
 and this increase is owing merely to causes which we 
 shall proceed to enumerate. One affection so induces 
 another, which itself excites a third, and this reacting 
 upon the first, and so through the chain, that it has 
 been difficult to determine the great first cause. 
 Patient investigation however, has. at last found the 
 root of the matter, and the finger of the explorer ar- 
 rives at it, when, upon the surface of the hypertrophied 
 os uteri, he feels a soft, unctuous, velvety spot. This is 
 generally felt at and around the os externum, occasion- 
 ally limited in extent, generally confined to the 
 anterior or posterior lip, but in severe cases embracing 
 and entirely covering the os and cervix uteri. 
 
 When limited in extent, the portions of the os 
 surrounding this described spot, are often hardened in 
 their character, giving a firm, unyielding impression to
 
 OBSERVATIONS BY THE TOUCH. 
 
 83 
 
 the touch, and the edges, the point of union between 
 the healthy and diseased surfaces, seem in some cases 
 thickened and defined. 
 
 The os externum is found, not as in the healthy state, 
 with difficulty admitting an intra-uterine sound, but the 
 finger passes into the cavity to some distance, and often 
 seems capable of being introduced up to the fundus of 
 
 FIG. 24. 
 
 the uterus itself: The character of the walls of the 
 neck of the uterus seem materially changed ; they are
 
 84 PATHOLOGY OF STERILITY. 
 
 flaccid and easily dilatable, so that with ease a second 
 finger may often be introduced by the side of the 
 former. 
 
 Upon withdrawing the finger, it will be found covered 
 with a muco-purulent discharge, often mixed with 
 freshly exuded blood. 
 
 To the touch nothing more is capable of being 
 elicited, but the speculum throws a flood of light upon 
 the matter. By its use we perceive that what was to 
 the finger soft, velvety, is an ulceration, and the unc- 
 tuous softness comes from the granulations of newly 
 forming substance, or the denuded papillae. We find 
 that invariably this ulceration starts from the cavity of 
 the os, or at any rate that the os internum is always 
 involved in the ulcerated portion. 
 
 From the exterior of this ulcerated surface proceeds 
 the pus, the yellow ingredient of the leucorrhceal 
 discharge ; while flowing from the os, a limpid, tena- 
 cious fluid, may be observed adhering with so great 
 tenacity that it .cannot be wiped away. 
 
 The ulcer bleeds, often from the mere touch of the 
 instrument, or the soft sponge or lint used to wipe 
 away the secretions. 
 
 In color the ulceration varies, according to the 
 character and intensity of the inflammatory action 
 going on, and the condition of the surface. A peculiar 
 form is the " raspberry os" (see Plates I. and V.), so 
 called from its general resemblance to that berry, and
 
 RASPBERRY OS. 
 
 85 
 
 which in its surface is nodulated from the exaggeration 
 of the villi, till recently supposed to be mucous follicles, 
 like the inflamed papillae of the tongue in glossitis, or 
 particularly in scarletina. 
 
 FIG. 25. 
 
 I have called this morbid lesion an ulceration, not- 
 withstanding that Lee and some others deny that it is 
 such. They state that there is no lesion except of 
 epithelium, and that abrasion would be a better term to 
 apply to it. According to the teachings of my youth, 
 an ulcer is but " a solution of continuity attended with 
 a secretion of pus ;" and the condition of things answers
 
 86 
 
 PATHOLOGY OF STERILITY. 
 
 to this statement. In the heat of unworthy party 
 and unprofessional controversy, the London physicians 
 have left the main issue of facts, and have disputed 
 merely about names. The condition of things is how- 
 ever, as I have stated, call it by such names as you 
 will. 
 
 FIG. 26. 
 
 Fig. 24 is a circumscribed ulcer of the os uteri, 
 magnified twenty diameters, showing the removal of 
 the epithelium and erosion of the villi. The ulcer is 
 surrounded by a fringe of enlarged villi. Figs. 25 and 
 26 represent respectively these villi, of the os uteri mag- 
 nified two hundred and twenty diameters, and of the 
 cervix uteri of one hundred diameters, covered with
 
 ULCERATIONS OF OS AND CERVIX. 
 
 87 
 
 epithelium. These, till recently, were considered to 
 be the enlarged mucous follicles, on the authority of 
 Huschke, who stated that these follicles which are 
 numerous at the ostium vaginae became more frequent- 
 as the mucous membrane approached the cervix uteri. 
 Paul Dubois states that M. Giraldes, the able anatomist 
 was unable to discover any in the upper part of the 
 vagina. 
 
 FIG. 27. 
 
 On examination of these villi, which may often be 
 seen with the naked eye, like the papillae of the
 
 88 PATHOLOGY OF STERILITY. 
 
 tongue, they are found to consist each of a looped 
 blood-vessel, which may be seen passing to the end of 
 the villus and returning to its base (Figs. 25 and 26), 
 where it inosculates with the neighboring villi. Seen 
 in profile (Fig. 27), they evidently project above the 
 surface, forming an irregular fringe upon the edge, and 
 as a whole, are not unlike the " pile " of velvet. 
 
 From the anatomy of this morbid condition of the 
 parts, we do not wonder at the readiness with which 
 these surfaces bleed upon the slightest touch, or even 
 from the friction caused by the gentlest exercise. 
 
 More particularly, it is to be noted that in that form 
 of ulceration or epithelial abrasion already alluded to, 
 as called the " raspberry os," os framboisee, sterility is 
 its constant accompaniment, and this is the result of 
 the observed fact that the disease seems to originate 
 within the cavity of the os, and spreads outward upon 
 the external surface of the os and cervix. 
 
 This is one of the most ordinary forms of uterine 
 disease in females of leisure, those who have time to be 
 sick, and in those of the laborious class, whose employ- 
 ment is of a sedentary character. It is therefore very 
 common in private practice, and comparatively rarely 
 seen in our cliniques, dispensaries, and other public 
 institutions, and then principally confined to seam- 
 stresses and the like. I account for this from the fact 
 that the poor washerwoman is obliged by her necessities, 
 to be active, and this slight form of disease, neglected
 
 PHTHISIS PRODUCED UPON LEUCORRHOEA. 89 
 
 in its origin, is, by the friction against the vaginal walls, 
 increased, till a more serious form of difficulty ensues, 
 which alone brings her to the public charities. 
 While recently attending the obstetric clinique of my 
 esteemed friend, the erudite Professor of Obstetrics in 
 the New York Medical College, Dr. B. Fordyce Barker, 
 I was happy to hear these views confirmed, and there 
 first publicly stated. So important have I deemed 
 them in connection with this subject, that I have 
 thought it proper to enlarge upon this form of papillary 
 hypertrophy, looking like morbid granulations, and 
 to exemplify it more fully by the cuts borrowed 
 from Tyler Smith's " Pathology and Treatment of 
 Leucorrhasa." 
 
 Were this the proper place, I would present my 
 views supported by facts relative to the development 
 of phthisis, superinduced or developed by the wasting 
 effects of the discharges consequent upon this form of 
 uterine trouble. 
 
 It is well known that females of a strumous habit 
 are particularly subject to leucorrhoeal discharges, and 
 consequently to uterine disorganization. In my attend- 
 ance at the Northern Dispensary, it has not unfre- 
 quently occurred that a patient was under the care of 
 Dr. Cammann for cough and disease of the lungs, and 
 at the same time I was topically treating the uterine
 
 90 PATHOLOGY OF STERILITY. 
 
 difficulty. Sir Charles Clarke noted that women in 
 whom the glandular system is more active than usual, 
 are affected with leucorrhoea. Dr. Tyler Smith says 
 that leucorrhoea is common in consumptive patients, 
 but not sterility. Dr. J. W. Francis has noted an 
 hereditary tendency from constitutional debility. Mr. 
 Anderson, in the Association Journal, places leucor- 
 rhoea as a symptom of phthisis. 
 
 A state of general anaemia probably, by interfering 
 with the maturation of the ovules in the ovaria, is 
 always unfavorable to fecundation, and when this 
 condition advances to amenorrhcea, and chlorosis, the 
 function of ovulation is always suspended. Fecund- 
 ation is not incompatible with ulceration of the os 
 externum. We often find immense hypertrophy of 
 this portion covered with extensive ulcerations, 
 bathed with pus, where conception has occurred time 
 after time. Occasionally, too, pregnancy with such 
 local condition will run its full course in safety, 
 but, far more generally, abortion or premature delivery 
 is the result. Particularly is abortion apt to ensue 
 where there is accompanying fissure of the os (See 
 Plate Y., Fig. 1). This form of abortion, which is not, 
 although pertinent, within the scope of this treatise, I 
 have described in a paper, entitled " Uterine Haemor- 
 rhage" in the " American Medical Monthly" June, 1855. 
 
 But while fecundation is possible, although improba- 
 ble, in the great number of instances where such ulcer-
 
 ALBUMINOUS PLUG OF THE OS UTERI. 91 
 
 ative disorganization exists, it is, I imagine, if not 
 utterly impossible, at least nearly so, where there is 
 this thick, glairy, albuminous discharge blocking up the 
 os externum. 
 
 To this point I am anxious to draw especial attention, 
 because it has been heretofore, generally, if not univer- 
 sally, overlooked by practitioners. The only recogniz- 
 able morbid appearance in many cases of confirmed 
 sterility, is this exudation from the os externum ; this 
 thick, tenacious, firmly-adhering collection of albumen, 
 which we cannot wipe away with a piece of lint, 
 nor draw away .with a forceps, unless coagulated and 
 solidified by chemical change, effected in its character 
 by local application. It would seem from its tenacity, 
 impossible for the most vigorous spermatozoa, to pass 
 through this substance, and as we shall show, equally 
 difficult to pass between it and the internal surface of 
 the os. 
 
 Dr. Tyler Smith, op. cit., and Professor Meigs, in his 
 "Acute and Chronic Diseases of the Neck of the Uterus," 
 recognize this appearance ; but the former, without 
 connecting with it its most invariable concomitant of 
 barrenness, and the latter passing it by so casually as 
 to deprive his observations and remarks of much of 
 their proper force. 
 
 He says : " But in cases where a thick and highly 
 viscid string of mucus is constantly exuding from the 
 os uteri, we can easily understand that the ascent of
 
 92 PATHOLOGY OF STERILITY. 
 
 the spermatic particles thrbugh the cervical neck may 
 be impeded mechanically." 
 
 Bennett in his invaluable work, says: "It is diffi- 
 cult to determine precisely, in what way inflammation 
 and ulceration of the neck of the uterus occasion 
 sterility, although careful and lengthened observation 
 enables me to assert most confidently the fact. * * 
 The cause of sterility may be removed by curing the 
 inflammatory disease to which it owes its origin." 
 
 Besides the external visible ulcerations of the cer- 
 vix, we often find instances where the os externum 
 is of natural size and appearance, except a slightly 
 increased redness, and accompanied by this plug of 
 albumen ; and in other cases, finding the os enlarged, 
 admitting the finger to the first joint. In these latter, 
 however, the disease is so great that it is easily recog- 
 nizable, but the discharge so profuse, that the peculiar 
 albuminous plug is rarely seen blocking up the passage. 
 
 Ocular examination of the cavity of the os uteri is 
 easily made. In the cases where the local disease is 
 great, without the further aid of any instrument, the 
 gaping lips of the os will plainly show the inflammatory 
 action within (See Plates I. and V.). In other cases it 
 may be necessary to separate the lips, by lifting the 
 upper border with the uterine sound, or more forcibly 
 expanding the passage by means of the blades of long 
 uterine forceps or the speculum of the os uteri. 
 
 A very ingenious instrument for this purpose is
 
 EXAMINATION OF THE OS UTERI. 93 
 
 made by Mr. Tiemann, the well-known surgical instru- 
 ment maker, Chatham St., N. Y., which well answers this 
 purpose, separating the lips of the os uteri, and effectu- 
 ally displaying its interior (Yide Fig. 28). 
 
 Fig. 28. 
 
 In most instances it will be found difficult to observe 
 the internal disorganization, but without being seen, 
 the presence of the albuminous plug will be patho- 
 gnomic of the existing disease. In the forms where the 
 vision can plainly observe the morbid action, one 
 manifestation of disease is always recognizable, viz. 
 the same inflammatory affection observed on the 
 external surface of the os, modified only by the 
 different structure affected. 
 
 The true mucous membrane which begins at the 
 cervix uteri and covers the os uteri in its vaginal por- 
 tion is continued through the canal of the cervix, and is 
 reflected over the internal surface of the womb but 
 below it, in the cervical canal, lie numerous albumen- 
 secreting glands, whose office is apparent in the 
 abundant exhalations attending labor. At the men-
 
 94 PATHOLOGY OF STERILITY. 
 
 strual period and at seasons of sexual intercourse, these 
 glands are also active, and a profuse emission of fluid 
 appears to take place. Under certain circumstances, 
 from too frequent and inordinate sexual congress, as 
 seen especially in prostitutes ; from the local injury of 
 the parts, as often visible as the consequence of the 
 too forcible entrance of the male organ with the new- 
 married ; from the effect of prolonged and fatiguing 
 exercise ; dancing ; of weighty dress ; of severe cold, 
 arresting the secretions suddenly, at a menstrual 
 period ; from prolonged irritation from the friction of 
 the cervix against the rectum torpid and overloaded ; 
 . from a similar state of things caused by the retained 
 contents of the bladder in extra delicate ladies, a more 
 or less severe and extensive inflammatory action takes 
 place, and the result not unfrequently observed as a 
 sequela, is the chronic irritation, if you please so to 
 denominate it, or inflammation of the local glandular 
 apparatus, the glandulse nabothii. Where the disease 
 is slight, the increased discharge, its viscidity, its ten- 
 acity are the most manifest indications, as I have stated. 
 They are not accompanied by any symptoms sufficient 
 to draw the attention of the sufferer to the part. 
 There may be no pain in the back, loins, thighs, no 
 debility ; but there is enough disease to prevent con- 
 ception, and simply from the mechanical cause before 
 mentioned. 
 
 This is a general relaxation marked by the flaccid con-
 
 PROPORTION OF CURABLE CASES. 
 
 95 
 
 dition of the uterus, a patulous " feel " to the os, the 
 mouth being more or less enlarged, and the cavity of 
 the canal open, resembling the appearance seen in Fig. 
 24. Contrasting this with Fig. 4, the abnormal condi- 
 
 Fig. 29. 
 
 tion is palpable. Such a condition of the os and cervix 
 will be manifested by little general symptoms other 
 than debility, albuminous leucorrhoea, and profuse 
 menstrual discharges, and consequent sterility. 
 
 The great majority of the women who say that " they 
 are in perfect health, and that they do not know why 
 they have no children," are in exactly this situation ; 
 which, as I shall show hereafter, is curable in more than 
 ninety-nine cases in a hundred, where no complications 
 exist, or where no organic changes have resulted during
 
 96 PATHOLOGY OF STERILITY. 
 
 the many years which may have elapsed since the 
 trouble commenced. 
 
 In certain cases, the interior of the cervix uteri 
 shows more than this local irritation ; there is marked 
 ulceration, or this has passed still further, the ulcera- 
 tion has heen cured, leaving in its cicatrization a 
 diminution of the calibre of the canal, a local stricture 
 of its whole course, or simply of the os externum, or 
 the os internum. 
 
 A very generally present symptom of this condition 
 of things is dysmenorrhoea. Pain in menstruation 
 may occur from several causes ; from ante-version, 
 retro-flexion, &c., as already stated ; but in far the 
 greater majority of cases, it will be found to arise from 
 the less serious difficulty because more easily and 
 surely curable of local stricture. 
 
 Among the married, lacerations of the os and cervix 
 in a first confinement are not unfrequently followed by 
 subsequent barrenness. The accompanying symptoms 
 being those of dysmenorrhoea, and the severest forms of 
 uterine disease, profuse leucorrhoea, &c. Examination 
 shows immense hypertrophy (in some cases the enlarged 
 os becoming too voluminous to be entirely displayed at 
 one view by a four-bladed speculum) ; the fissures, often 
 two or three in number, extending an inch or two 
 through the neck towards the body of the uterus, their 
 edges uncicatrized, the whole observable organ highly 
 injected, and the entire apparatus bathed in a profuse
 
 MEMBRANE OF DYSMENORRHOEA. 97 
 
 and often fetid muco-purulent discharge. In the year 
 1852, I divided a cartilaginous cervix in order to effect 
 delivery at the full time . ( Vide American Journal of Med- 
 ical Sciences, July, 1852.) The woman has never since 
 been pregnant, and as she complains of these symptoms 
 I do not doubt that a physical examination would 
 evince the disorganizations above enumerated. I 
 regret not being able to present a drawing of this con- 
 dition, although it would doubtless appear exaggerated 
 to any one not having noted its actual existence in 
 nature. 
 
 Passing beyond this point, the cavity of the uterus 
 proper has divers ills and affections, many of which 
 are not yet fully, if at all, known. 
 
 I have noted, in the preceding chapter, that at the 
 time of menstruation, the interior mucous membrane 
 of the uterus undergoes a peculiar development, 
 whether impregnation occurs or not, in order to fit it 
 for the reception of the ovum. 
 
 In some forms of disease this action becomes a 
 diseased one, and the consequence is, the so-called false 
 membrane of dysmenorrhcea. On the contrary, this 
 uterine development may be deficient from various 
 causes, such as sickness, general weakness, local cir- 
 cumstances, &c. The defective or absent formation of 
 this uterine mucous membrane is most probably a 
 
 7
 
 98 PATHOLOGY OF STERILITY. 
 
 frequent cause of sterility, especially if all the ordi- 
 narily observable conditions of menstruation be present. 
 An egg is discharged normally, and may even be as 
 regularly impregnated, but it meets no proper nidus in 
 the uterus. 
 
 There are other internal difficulties which are 
 swallowed up under the generic title of catarrh of the 
 womb. This is of the same character as the affections 
 of which we have been speaking, consisting of a slow 
 inflammatory action, with the development of spots 
 of profuse granulations, accompanied by the ex- 
 cretion of a muco-purulent fluid, or of blood, by 
 excessive haemorrhages at the menstrual period, at 
 intermediate occasions of unusual fatigue, sexual 
 excitement, &c. Acute local congestion, as in metritis, 
 &c., is not unfrequently followed by chronic disease of 
 this nature. 
 
 A more full development of these granulations, and 
 their subsequent more or less perfect organization con- 
 stitutes tumors and polypi of the uterus affections 
 already alluded to, but which in their full consideration 
 do not enter into the plan of this work. 
 
 Inflammation of the womb, either total or partial, is 
 sometimes though rarely followed by a partial or entire 
 obliteration of the cavity of the uterus, from the adher- 
 ence of the inner mucous membrane, lining it. 
 
 The womb is occasionally ossified. In the valuable 
 collection made by Dr. John W. Francis, of New York,
 
 DISEASES OF THE FALLOPIAN TUBE. 99 
 
 was the ossified uterus of a woman who was never 
 impregnated, four inches long, by about two-and-a-half 
 in thickness. Ossifications of this organ in virgins are 
 very rare, and we think no other case than this is 
 known, although I have seen several uteri with their 
 contents, a foetus, &c., apparently near its full time, 
 forming an immense ossified mass in the pelvis where it 
 had remained for many years. 
 
 In rare instances there are found rupture, obliter- 
 ation, strictures, and more or less severe inflammatory 
 action in the Fallopian tubes. These diseases are 
 more generally found at the two extremities of the 
 tubes, because inflammatory action, the origin of all 
 these difficulties, rarely "arises from the middle of the 
 tube, unless in consequence of some external violence 
 and consequent injury, but, either from the uterus, or 
 from the less passive portion, the fimbriated extremity. 
 
 Tyler Smith, in noting that the glandulse nabothae 
 were present in the cavity of the cervix, the muscular 
 walls of the uterus, and the broad ligaments, says : "I 
 have repeatedly observed that in cases where the 
 nabothean bodies are met with, small cysts are found 
 in the course of the Fallopian tube, or at its fimbriated 
 extremity." 
 
 Stricture of the uterine end of the Fallopian tube is 
 supposed to be left as a solitary evidence of previous 
 disease, and as thus isolated, we have had it described 
 by some celebrated Europeans ; but while we are ready
 
 100 PATHOLOGY OF STERILITY. 
 
 to recognize the fact that such local affection does exist, 
 and the occasional occurrence of a foetus being devel- 
 oped in the tube, authenticates it, we feel that except 
 when some unusual dilatation or organic change in the 
 os uteri co-exists, no method of exploration, can with 
 any definite approximation at certainty, demonstrate 
 its presence. Of this we shall speak more fully under 
 the head of Treatment. 
 
 Disease, deformity, and misplacement of the fimbri- 
 ated extremity may and do, not very unfrequently, 
 present a fatal bar to fecundity. 
 
 Inflammatory action, as an acute affection originating 
 in the extremity, is perhaps somewhat rare. Still, in 
 common with the entire tube, and the entire genital 
 apparatus, it is at regular monthly intervals subject to 
 a turgescence and excitation which in consequence of 
 certain untoward influences may take on irritative and 
 inflammatory action, followed by occlusion of the 
 patulous mouth ; first, by the extremities closing upon 
 themselves ; secondly, by the extremities being agglu- 
 tinated to the ovary ; thirdly, by the extremities f being 
 permanently fastened to some portion of the abdominal 
 cavity at a distance from the ovary. 
 
 If the mouth of the Fallopian tube be permanently 
 closed by the deposition of coagulable lymph, or the 
 adhesion of its sides, nothing can by any possibility 
 pass through it. Menstruation ci dit may occur, but 
 the discharge will consist simply of the excretions from
 
 DISORDERS OF THE FIMBRIATED EXTREMITY. 101 
 
 that portion of the tube below, from the cavity of the 
 womb, os uteri, vagina, &c. No ovum can, by any 
 possibility, pass through any of these cavities. 
 
 If the extremity of the Fallopian tube, in its natural 
 prehensile situation of clasping the ovary, be immova- 
 bly attached, by inflammatory action either within itself 
 or of the body of the ovary, a fortunate accident might 
 cause a Graafian vesicle to be so located that it might 
 in breaking, discharge its ovum directly into the ever 
 ready mouth of the tube ; but if the ovum be dis- 
 charged either to one side or the other, it falls void 
 into the oavity of the abdomen, where in most cases it 
 perishes, is absorbed, and disappears. 
 
 Inflammatory action at some other than the men- 
 strual period, may attack the fimbriated extremity, or 
 a local inflammation from peritonitis, hernia, or ex- 
 ternal injury, may exist in the vicinity, and may not 
 only withdraw the extremity from its propinquity to 
 the ovary, but it may fill up the intervening space, or 
 permanently fasten the extremity to some portion of 
 the interior of the abdominal cavity remote from the 
 ovary. 
 
 Small polypi may possibly exist in the course of the 
 canal, as in all other mucous passages, although I do 
 not know that any have ever been demonstrated as 
 having been noticed, and small tumors, filling up the 
 passage. 
 
 But a more formidable source of sterility, is the
 
 102 PATHOLOGY OF STERILITY. 
 
 forcible withdrawing of the fimbriated extremity from 
 the ovary. Tumors may be developed and exist in the 
 tube, or in the adjacent broad ligaments. These often 
 grow to a large size, and the more or less accompanying 
 inflammation may not only effect the disorganizations 
 before alluded to, but also, merely mechanically in their 
 growth, they may lift up and draw away the extremity 
 from the possibility left in a healthy state of uniting 
 with the ovary in its connected duties. Hernia of the 
 ovaries may also isolate them from the reach of the 
 fimbriated extremity. 
 
 These are not theoretical conditions, even if the 
 ascribed results be fanciful, for I have seen, and doubt- 
 less many others are conversant with, such morbid 
 appearance. A notable case was lately at the Woman's 
 Hospital of this city, under the care of my highly 
 esteemed friend Dr. Sims, where the tumor in its 
 growth drew up the uterus, so that its fundus was 
 distinctly felt, little, if any, above the natural size, 
 midway between the os pubis, and the umbilicus, and 
 springing from it, the ovary was distinctly recognizable 
 through the abdominal parietes. Vaginal examination 
 detected, as far off as could be reached, the os uteri, 
 made doubly evident by the other hand being simul- 
 taneously placed on the fundus. In order that this 
 state of things should exist, the neck of the uterus 
 must have been necessarily materially elongated. If 
 the fimbriated extremity remained in its normal situa-
 
 DISEASES OP THE OVARIES. 103 
 
 tion, it seems scarcely possible that it could come into 
 contact with the ovary at menstruation. 
 
 Finally, to finish the causes why sterility occurs ; the 
 semen of the male or its vital principle may fail to 
 meet the ovum of the female, from degeneration of the 
 ovaries proper. In some instances, this organ is 
 entirely wanting from congenital malformation, or it 
 may be present, but so atrophied as to be powerless, or 
 so disorganized, that the ovum itself is unformed. 
 Previous inflammatory action, either acute or chronic, 
 may have forever destroyed all efficient action on the 
 part of the ovary. Henceforth it is an useless organ, 
 and having no service to perform, it withers, becomes 
 atrophied, and often but a trace remains. ' This con- 
 dition is marked with the healthy aged less so, but 
 still sufficiently perceptible, with the diseased young. 
 
 I attended a young girl in the last stages of an acute 
 inflammation of the ovaries, where they had gone on 
 to suppuration. One ruptured into the cavity of the 
 peritoneum. A post-mortem showed that it was of 
 immense size ; the abscess in the other was unbroken, 
 and contained a quart of pus. This state of things was 
 not necessarily fatal. Had she recovered, it would 
 have been difficult for one to imagine a possibility,, 
 after such thorough disorganization, of subsequent 
 impregnation.
 
 104 PATHOLOGY OF STERILITY. 
 
 Ovarian tumors of various characters, benign and 
 malignant, dropsies, &c., often occur, which not only 
 destroy the nature and powers of the ovary, but as in 
 the case of tumors exterior to, and without the organ, 
 draw away and alienate the ovary, so that the fimbri- 
 ated extremity may not meet it, as above stated. 
 
 Even if there by chance remains a portion of the 
 ovary uncontaminated by the disease, sufficient to 
 eliminate a healthy ovum, the locale of the discharge 
 may be incorrect, and the Graafian vesicle may per- 
 chance break into the sack containing the dropsical 
 fluid, and thus be lost. 
 
 Chronic ovaritis is a form of disease much spoken of 
 by certain writers, but one which I am inclined to 
 consider of rare occurrence. I think that in most cases 
 where such an affection is considered to exist before 
 death, the difficulties are of a different nature, and 
 when apparently discovered in autopsies, it is rather 
 the disorganizations produced by, and subsequent to 
 acute inflammation which are mistaken for the evidences 
 of a chronic inflammatory state. 
 
 So, too, we hear of neuralgia (Giberi), and rheuma- 
 tisms of the uterus and appendages, which likewise 
 seem to be but long names given to obscure diseases, 
 heretofore little known, to hide the real ignorance 
 respecting their pathology.
 
 INFLUENCE OF PINGUIDITY. 105 
 
 And here, while speaking of the physical changes 
 which are the cause of sterility, I will allude to one 
 condition which is vaguely enough considered, both 
 popularly and by the profession, to be alike the cause 
 and consequence of barrenness. "Ah! she's getting 
 too fat to have children," is a frequent remark ; but 
 that pinguidity should be opposed to fecundation is not 
 yet proved, or why this condition should interfere with 
 conception, has never been stated. 
 
 We know that when a woman has passed her grand 
 climacteric, if spare before, she is quite apt to become 
 fleshy subsequently ; and this change has sometimes 
 been supposed to result from the transformation into 
 fat of the blood and fluids discharged monthly. True, 
 we do not know how great a tax upon the animal 
 economy it may be, to create that most subtle human 
 extract the ovum ; but further than that we do 
 know, that the quantity of blood, &c., lost at such 
 periods, is entirely insufficient to form the fat or 
 account for the great increase in flesh, when this flow 
 is arrested. 
 
 More than this, the menstrual flow is not arrested 
 in these cases, and is often increased with the increase 
 in robustness, and some more efficient and probable 
 evidence of its being a consequence of sterility, is 
 wanted to make this view appear probable. 
 
 In many instances where fatness is present, the 
 woman has had one or two children, and then the
 
 106 PATHOLOGY OF STERILITY. 
 
 sudden increase in size and weight ensues, and with it, 
 subsequent barrenness ! 
 
 I offer as a plausible reason, and leave it for those 
 who are enabled to make autopsies, to verify the truth 
 of the statement, that the deposition of fat in the 
 abdomen around the intestines, genital apparatus, in 
 the omentum, has an effect similar to that just men- 
 tioned, caused by tumors in that neighborhood. We 
 all recognize the fact that the actions of the heart are 
 manifestly impeded, and sometimes entirely arrested, 
 by the deposition of the fat in and around it. I con- 
 sider that the unusual deposit of fat around the uterus 
 and ovary, not unfrequently bends down the Fallopian 
 tubes, envelopes and obscures the ovaries, and offers an 
 effectual barrier to the union of the ovum and the male 
 fertilizing principle. 
 
 In some cases of extreme pinguidity, the deposit in 
 the abdomen has had the effect of adding a great 
 weight to the uterus, and to press this organ down into 
 the pelvic strait, sometimes producing e version, or so 
 that the os uteri pressed upon the sacrum where, by 
 mere friction, its surface became abraded, and profuse 
 leucorrhoea ensued. Cases of this character I have seen 
 not unfrequently. It is, however, among this class that 
 the instances of incurable sterility come, and the reason 
 given is to me a perfectly satisfactory one. 
 
 In certain of these cases it is evident that the sterility 
 can proceed from none of these causes, because after
 
 TWIN BIRTHS STERILE. 107 
 
 the administration of internal medicines intended to 
 act as local excitants, conception has followed. The 
 effect of these remedies could have been neither the 
 unlocking of the fetters which bound down the Fallo- 
 pian tubes, or by removing any of the interposed fat, 
 but was limited in its action, to that of a local stim- 
 ulus. 
 
 
 
 The only method of accounting for these cases is to 
 suppose a loss of vitality in the organs, and conse- 
 quently a failure in the evolution of the Graafian 
 vesicle in the ovary. 
 
 We are aware that we have merely substituted hard 
 words as a description of some unknown disease ; but 
 the plain fact is, that without any perceptible reason, 
 no ovum is formed in, or escapes from, the ovary into 
 the uterus and to no other condition of things can be 
 ascribed this actual untoward result. This form of 
 sterility will be again referred to, under the corres- 
 ponding head in the chapter on Treatment. 
 
 There is a popular belief among a certain class, 
 that where a male and female are born at a twin birth, 
 the female will be henceforward sterile. It is probable 
 that this belief originated with the graziers, for it is 
 stated as a fact that where a heifer and bull twins 
 occur, the heifer will not conceive. Among cattle 
 raisers, this heifer is called a " free-martin," and so
 
 108 PATHOLOGY OF STERILITY. 
 
 undoubted is the belief, that this free-martin is either 
 killed as a calf, or if raised, is regularly broken to the 
 yoke and worked like any ox. Many men of intelli- 
 gence have made this statement to me, and it may be 
 found in agricultural journals. 
 
 Among cattle such may be the fact, although I very 
 much doubt it, but after a careful examination, I am 
 convinced that such is not the fact in respect to the 
 human race ; as I have known of numerous instances to 
 the contrary, and do not now remember ever hearing 
 one statement in corroboration of this opinion. 
 
 Prof. Simpson of Edinburgh, who has made con- 
 siderable research upon this subject, acknowledges 
 " the infecundity of free-martin cows to be a very 
 general fact, but by no means an universal one." He 
 has also collected the facts relative to the married 
 history of 123 females born co-twin with males, 112 
 of whom had offspring, and 11 none, although married 
 several years. " In other words, the marriages of the 
 females born under these circumstances were unproduc- 
 tive in the proportion of one to ten." 
 
 Sterility may be divided into two classes, the mar- 
 ried female who has never had children, and she who 
 has had one or more, but yet who has been barren for 
 many years. 
 
 Congenital malformation or imperfection, of course
 
 PECULIARITIES OF THE STERILE. 109 
 
 pertains exclusively to the first of these divisions. It 
 is of very rare occurrence, for in general it, in both 
 classes, arises from some of the diseases above enumer- 
 ated ; but occasionally natural physical imperfection is 
 the origin. When this is the case, there is usually 
 certain physical peculiarities and mental manifestations 
 and idiosyncracies which will lead one to suspect the 
 physical deficiency. 
 
 I have met with several cases of this character, 
 where there was an absence of the uterus, or where 
 there was evidently an uterus, but where there never 
 was any menstrual secretion. One where I made a post- 
 mortem of a lady nearly a century old, who had never 
 menstruated or borne children, and where atrophy of 
 the ovaries and obliteration of half the cavity of the 
 uterus existed, and all had marked peculiarities of 
 temper, feelings, and tastes. The maid who had never 
 menstruated had suffered from various maladies, and 
 was fickle and changeable in taste and manners. Both 
 the others manifested no fondness for men's society ; 
 one married for a home ; the other " went to parties to 
 hear the music and to get a good supper ;" both were 
 excellent housekeepers ; both were severe in their 
 judgments of their friends, and had no compassion for 
 "lovely woman stooped to folly." Neither of these 
 two was squeamish in her actions, and possessed little 
 delicacy or the soft attributes of woman. A recent 
 case is reported by Dr. Baskette (Southern Medical and
 
 110 PATHOLOGY OF STERILITY. 
 
 Physical Journal, May and June 1855.) I merely hint 
 at these peculiarities, to draw attention to them, and 
 not with the design of giving any description of the 
 cases ; they having been reported in the New York Mcd. 
 Times, and other journals some years since. 
 
 Tyler Smith says: "In general, the hair of the 
 mons veneris is short and curled ; but in sterile women 
 I have sometimes observed it to be straight, and longer 
 or shorter than usual this condition being indicative 
 of a feeble development of the internal organs of gener- 
 ation." 
 
 The woman barren from local disease, whether she 
 has ever borne children or not, is characterized by 
 other symptoms, which are clearly to be ascribed to 
 some disease, viz., nervous excitement and depression, 
 gastric irritations, with more or less desire for food, for 
 unusual articles, even for indigestible and often dis- 
 gusting things, hysterical urine, constipated bowels, 
 irregular menstruation, often protracted and profuse, 
 (occasionally very scanty), leucorrhoea, pain in back, 
 &c., &c. The phases of the symptomatic manifesta- 
 tions of this condition of things are equalled only by 
 the permutations of the ten cardinal numbers. 
 
 With these physical and mental manifestations of a 
 local, plainly evident disease the patient in her 
 frequent paroxysms of nervous excitement, insisting 
 ever and anon that she shall die or is dying and the 
 weary friends almost wishing, in their desire for a
 
 ABSENCE OF SEXUAL APPETITES. Ill 
 
 moment's quiet and forge tfulness, that she would ; the 
 sufferer lingers out year after year, till some crisis, 
 with its sure floodings, either reducing the sufferer by 
 exhaustion to an early grave, or longer delayed, 
 malignant disease, may seize the debilitated organ, and 
 after a life of torture unutterable, loathsome and com- 
 fortless to herself and her friends, inevitable death 
 made more cruel by delay, seizes its willing victim, 
 rejoiced to be once free from anguish. 
 
 According to my own views, the reasons given for 
 the want of fertility in the previous remarks, embrace 
 all the causes that exist, but there are a train of causes 
 alleged by other writers, and especially insisted upon 
 by Roubaud in his recent work, Traite de V Impuissance 
 et de la Sterilite, Paris, 1855, and which I will there- 
 fore mention. They are classed under the head of 
 " Impuissance par Frigidite." Frigidity or want of 
 sympathy in the sexual embrace, and an entire absence 
 of sexual appetites and pleasures, from age, constitu- 
 tion, temperament, diseases (the effects of over feeding 
 or drinking, masturbation, local disease, venereal 
 excesses, &c., &c.). 
 
 I am convinced that but one question only is to be 
 asked, viz. if healthy spermatozoa are brought into 
 contact with healthy ova, to decide this question. Frig- 
 idity may or may not accompany the act ; the result is as
 
 112 PATHOLOGY OF STERILITY. 
 
 independent of sensation, as if it were a chemical 
 transformation that is going on. 
 
 Before leaving this branch of my subject, I will 
 allude to two constitutional causes of sterility, the one 
 is mercurialization, the other, constitutional syphilis. It 
 is alleged that many persons who have been profusely 
 salivated, and whose constitution still retains mercurial 
 poison, are incapable of either generating or being 
 fecundated. I cannot here discuss the question, but I 
 doubt the fact of a person's retaining mercury in his 
 system for any long period of time. I have seen many 
 persons who had taken mercurials for various diseases, 
 and who complained of its effects, and in my experi- 
 ence, these effects were attributable solely to the 
 original disease not being entirely eradicated, and that 
 a little more of the poisonous medicine so loudly 
 blamed, entirely removed its supposed effects. 
 
 Constitutional syphilis is also supposed to be a cause 
 of infertility, and with some show of reason, for it 
 unquestionably does, in a degree, impair and paralyze 
 the male semen ; but in my opinion, in respect to 
 females, it is more often a cause of early abortion, from 
 an imperfect development of the ovum, than a cause of 
 sterility, as it is difficult to decide whether the woman 
 is ever impregnated or not. The menses are retained 
 a few days over the usual period, there is finally a
 
 ABORTION MISTAKEN FOR BARRENNESS. 113 
 
 some\rhat profuse discharge, accompanied by more pain 
 than usual, and the passage of what are considered 
 clots, but in them lies concealed the semi-developed 
 ovum a condition of things like to that observable in 
 those professional females who, by excessive intercourse 
 so irritate the uterus, that it throws off its contents. 
 These females not noticing any sign of pregnancy, 
 imagine themselves barren, when they are on the 
 contrary, subject only to repeated abortions. 
 
 S
 
 114 THERAPEUTICS OF STERILITY. 
 
 III. 
 
 THERAPEUTICS OF STERILITY. 
 
 THE previous chapters having been devoted to the 
 Physiology of Generation, and to a description of those 
 abnormal conditions and diseases, which in a greater or 
 less degree retard or entirely interfere with this pro- 
 vision of nature for the continuance of our species, I 
 come naturally to the third portion of my work, viz. 
 the Treatment. 
 
 SUCCESSFUL TREATMENT AND CURE are sometimes 
 synonymous. They are so where the surgeon coaptates 
 the ends of a broken bone, and restores the patient to 
 pristine strength and vigor ; it is not so where he is 
 compelled to amputate a diseased portion, and thus 
 leaves the sufferer well in health, but mutilated and 
 inefficient in power. 
 
 In the class of difficulties which we are now con- 
 sidering, in by far the greater proportion, the terms 
 are synonymous. The actual disease bears small rela- 
 tion to the misery it entails, and in the vast majority 
 of females it may be predicated that entire relief can 
 be afforded. But two requisites may then be required
 
 PERIOD OF POSSIBLE PREGNANCY. 115 
 
 in order to subsequent fecundation, under proper 
 influences. 1st. That the female shall have attained 
 a sufficient maturity, and yet may not have passed that 
 term, after which conception is unattainable. 
 
 (This period can scarcely be measured by any parti- 
 cular number of years, inasmuch as its limit is the 
 period during which menstruation occurs (sometimes, 
 as before noted, unmarked by any external manifesta- 
 tions. In different climates this period varies. Proba- 
 bly 14 is the average age of first menstruation in this 
 country, .and 39 that of its complete cessation. There 
 are strange exceptions however. A few years since I 
 had a patient aged 21, the mother of five children at 
 single full-timed births. I know another, married at 
 131 years of age, to a boy 17, and a mother at 14 
 and a few months, and that too, with no previous 
 signs of menstruation, except the blood of the nuptial 
 night. 
 
 A more remarkable instance was the precocity of a 
 little girl, Phoabe Ann Baker, exhibited at Barnum's 
 first baby-show. I saw her at my office, July 27th, 
 1855, and took the following notes. " Phcebe Ann 
 Baker was born at Sing Sing, New York, January 19th 
 1851. Her mother has one other child, a boy of 7 
 years. Parents both American. At birth she weighed 
 14 pounds, and has always since been large. Dr. Hoff- 
 man being the attending physician. When 10 months 
 old, a bloody flow was noticed from the puden-
 
 116 THERAPEUTICS OF STERILITY. 
 
 dum, and this has continued periodically ever since, 
 until the present date, without at any time going longer 
 than six weeks (and when thus protracted showing 
 signs of physical disturbance) without its appearing. 
 About the time this flow commenced, a marked enlarge- 
 ment of her breasts was noticed, and they very soon 
 attained to their present size, being now equal to 
 those of most girls of 16 years, of perfect shape, 
 having a well-formed, but not very protuberant 
 nipple, and an areola of a light brown color. She 
 weighs 64 pounds, and is of remarkable size for her 
 age, fully developed in form, and of a maturity of 
 appearance most noticeable. The hips are full, the 
 limbs rounded, and her form would indicate that she 
 had attained maturity and puberty." When I saw her 
 as above described, this flow had been retarded for 
 some two weeks longer than usual, and the mother 
 seriously supposed her pregnant, as she had discovered 
 a man (for which sex she evinced great fondness), in an 
 improper situation respecting her, and she had arrested 
 him, and he lay several days in prison on this charge. 
 The flow, however, soon reappeared.) 
 
 2nd. That no disorganizations have been effected in 
 the progress or cure of the disease, which may preclude 
 the possibility of a fruitful intercourse. 
 
 In expressing the results of my experience in the
 
 REMOVAL OF THE HYMEN. 117 
 
 treatment and cure of Sterility, I shall pursue the same 
 plan adopted in the chapter on the Pathology of the 
 disease, and commencing with the external vaginal 
 opening, shall in turn take up each portion of the 
 genital apparatus implicated, and follow it out, until 
 the investigation shall ultimate in the ovary ; and even 
 farther, where no recognized pathological condition is 
 present, to offer an answer to the query, why concep- 
 tion does not take place. 
 
 I have said that the semen of the male, or its fructi- 
 fying principle, the spermatic filament or vesicle, may 
 fail to enter into the vagina, or the uterus, or to come 
 into contact with the uterus. 
 
 First. From malformation of the vagina ; and an 
 imperforate hymen is among the most common causes, 
 and is easily recognized. Theoretically, the most 
 approved manner of treatment would be to divide it 
 by a quadrangular incision, but practically, an opening 
 made with a bistoury, an ordinary scalpel, or a lancet, 
 in any direction, of sufficient size to admit the finger, 
 will answer the purpose. 
 
 Brown says that the crucial or stellate incision 
 ordinarily used, may be used upon the very young. 
 This leaves the divided portion of the hymen to 
 retract, and remain on each side of the vaginal orifice, 
 and will create no irritation of consequence; but when 
 the woman has passed her 25th or 30th year, the 
 divided portions do not then shrivel or pucker up, and
 
 118 THERAPEUTICS OF STERILITY. 
 
 vaginitis is apt to occur from the friction of these 
 surfaces together, which may spread even to the peri- 
 toneum He therefore recommends that the hymen be 
 removed entire by a circular incision at the point of 
 junction with the labia. 
 
 If the organ be imperforate, the discharge of retained 
 menses will be sufficient evidence that the work has 
 been accomplished properly, and the incision has been 
 made in a right direction. Should an opening exist in 
 a firm and unyielding membrane, so strong as to have 
 resisted the marital impulses, a probe-pointed bistoury 
 will be the most available instrument to effect this 
 purpose. Little topical treatment will be found 
 necessary, unless the divided portions have a tendency 
 to fall together, and there be danger of reunion, then 
 a small piece of lint being placed within, cicatrization 
 of the Cut edges will soon take place, and it will be 
 found that little impediment will exist to congress. 
 .Even then, gentleness and inunctions with some bland 
 oil will be desirable, and ought not to be overlooked 
 for its simplicity. 
 
 The cutting of this membrane is so entirely free 
 from pain, bleeding, or any similar cause of fear, that 
 any attempts at dilatation will be scarcely worth the 
 delay consequent upon this method of relief. If, how- 
 ever, the idea of the knife is insurmountable, dilatation 
 may easily be effected in the manner I shall shortly 
 recount in cases of stricture of the vagina, or as
 
 STRICTURE OF THE VAGINA. 119 
 
 usually adopted in similar strictures of the urethra, 
 rectum, &c. 
 
 The mechanical impediment of a contraction of the 
 vagina, impeding and often preventing the perfect 
 entrance of the male organ sufficiently to enable the 
 semen to be ejected up to the os uteri is to be over- 
 come by purely mechanical means. If the passage be 
 a simple contraction without cicatrix or loss of sub- 
 stance, a bougie may be passed through the opening, 
 and the passage may be thus gradually dilated, by 
 increasing the size of the instruments, until it be suffi- 
 ciently enlarged to admit of a piece of prepared 
 sponge. Cones of this sponge should then be daily 
 introduced, increasing their size as rapidly as possible, 
 until the stricture be sufficiently overcome. 
 
 The most economical and convenient material for 
 making the graduated bougies above referred to, is 
 gutta percha, which, softened in hot water, will take 
 any shape that may be desired, and may be changed as 
 often as necessary. 
 
 Strictures which are the result of injuries, are more 
 formidable, but still will admit of relief. Local 
 injuries from sharp instruments, from falls upon stakes, 
 producing lacerations and bruises, are often followed by 
 great inflammatory action, resulting in sloughs, adhe- 
 sions, &c. These separate cases, having peculiar causes
 
 120 THERAPEUTICS OF STERILITY. 
 
 and conditions, can come under no general description. 
 Each case must be treated according to its character, 
 by dilatation with bougies, sponge tents, and by dividing 
 the contracted cicatrices with the knife. In this class, 
 which are the direct result of local injury, the astute 
 practitioner will have little difficulty in applying the 
 proper operation to the case, and effecting ultimately a 
 beneficial result. 
 
 I have seen one instance where the entrance of the 
 penis was prevented by a contracting of the passage, 
 produced by a rachitic condition of the pelvic bones, 
 so diminishing the passage, or rather rendering it so 
 tortuous, that the erect penis could not follow its 
 windings. 
 
 Pregnancy in such a case could only terminate with 
 the greatest hazard to the mother, and it is fortunate 
 that conception was thus rendered difficult, if not 
 impossible. As the difficulty arose from a distortion 
 of the ostia, and not from a bony tumor, any beneficial 
 interference would have been impossible. 
 
 Extreme sensitiveness of the vagina not unfrequently 
 produces so great suffering, that the female rarely 
 admits the embraces of her husband, and then with 
 such shrinking, as scarcely to allow the penis to enter 
 into the vagina. Such a condition is generally tem- 
 porary, and is the effect of a slight inflammatory action 
 either of a benign or of a gonorrhceal character. 
 When chronic, it is generally a consequence of the
 
 LOCAL ANAESTHETICS. 
 
 121 
 
 acrid discharges connected with disease of .the os uteri, 
 to be hereafter spoken of. 
 
 Occasionally it has been recognized as proceeding 
 from small tumors, exquisitely sensitive, which are 
 located within or around the mouth of the urethra. It 
 is sometimes necessary to divide the urethra, and to 
 carefully dissect these tumors away from their sites, 
 the most powerful caustics failing to give any relief. 
 In other instances, where there is no local cause per- 
 ceptible, relief has been found by the application of 
 narcotics, very effectual among which is the aconite 
 tincture. Marked benefit is also to be perceived from 
 the local application of the vapor of chloroform. 
 
 I will here allude to the very marked benefit some- 
 times observed from the injection of the vapor of 
 
 Fio. 30. 
 
 chloroform in various uterine affections productive of 
 pain, as dysmenorrhoea, rheumatic, neuralgic and other
 
 122 THERAPEUTICS OF STERILITY. 
 
 troubles. Mr. Tiemann has constructed an instrument 
 (Fig 30), peculiarly adapted for this purpose. 
 
 It consists of a tube in which is placed a sponge 
 saturated with cnloroform. An india rubber hollow 
 ball at one extremity, upon pressure, draws air through 
 a valved opening, and forces it, saturated with chloro- 
 form vapor, through the pointed extremity upon any 
 desired locality. By placing one end of an elastic tube 
 upon the valved opening, and the other being con- 
 nected with a vessel containing chloroform, pure vapor 
 may be injected. 
 
 Lately carbonic acid gas has been recommended by 
 Prof. Simpson as a local anaesthetic, and which seems, 
 from an imperfect experience, to be useful in some 
 cases. 
 
 Ligatures are useless in the treatment of these rare 
 affections, as they cannot be made to embrace the 
 whole diseased portion, and in dissecting them away 
 with the knife or sharp scissors, the mucous membrane 
 to which they are attached, should also be removed, and 
 .the spot should afterwards be seared by nitric acid, 
 applied upon a pointed stick, the circumjacent parts 
 being surrounded by a piece of lint soaked in a strong 
 solution of nitrate of potash. Mr. Brigham of the 
 Lock Hospital, Manchester, advises the actual cautery. 
 
 Tumors in the vagina, in the recto-vaginal septum, 
 the vesico-vaginal space, calculi, and various diseases 
 affecting the bladder and rectum, may all render coition
 
 VERSIONS OF THE UTERUS. 123 
 
 impracticable : their consideration does not demand 
 attention in this connection. 
 
 The difficulties which prevent the semen from enter- 
 ing the uterine cavity, as already enumerated, are 
 numerous. 
 
 Where there is chronic eversion of the uterus, preg- 
 nancy is impossible, for even if the uterus be restored 
 to its natural situation, the character of the parts is 
 so changed, that all hopes of future child-birth must be 
 precluded. 
 
 Ante and retro-versions are among the most trouble- 
 some forms of uterine disease, and, too, are far more 
 common than has been supposed. When not of severe 
 character, and when unaccompanied by other uterine 
 disease, pregnancy, although of rare occurrence, is not 
 impossible. I have witnessed three cases, in which 
 abortion took place, in consequence of slight extra 
 exertion, about the third month. 
 
 When recent, the displacement may be easily cor- 
 rected ; mere recumbency upon the back will tempor- 
 arily restore many cases of ante-version, which will 
 return again after any considerable exercise. 
 
 The uterine sound passed into the os uteri, with 
 pressure upon the fundus uteri by the finger through 
 the rectum, will often restore a recent case of retro- ver- 
 sion. When this displacement is chronic, the cure is 
 also chronic, frequent introduction of the sound into 
 the neck of the os uteri, allowing it to remain for a
 
 124 
 
 THERAPEUTICS OF STERILITY. 
 
 considerable period daily in the cavity, until the 
 internal surface has became accustomed to a foreign 
 body, and then introducing Simpson's internal uterine 
 supporter (Fig. 31), for an hour at first; gradually 
 
 FIG. 31. 
 
 increasing the time, until it can be borne constantly, I 
 have known followed by great benefit, and finally 
 effecting a radical cure. Great caution should be used, 
 or inflammation will be excited, which will sometimes
 
 SIMPSON'S PESSARY. 125 
 
 proceed to a dangerous extent. So warm and diverse 
 have been the statements made respecting this instru- 
 ment, that I consider it my duty to speak commenda- 
 torily of it in certain conditions, and in certain subjects. 
 I assuredly, however, should not venture to apply it in 
 cases where there was great uterine sensibility, at least 
 until, by a course of training, the organ had been 
 rendered less sensitive and impressionable. 
 
 One of the great objections urged against this instru- 
 ment, is its rigidity, that it remains in a fixed position, 
 irrespective of any change in the position of the body ; 
 that therefore it is frequently painful from pressure ; 
 that it is liable to effect immense injury to the wearer, 
 should any accident or shock happen to her. To 
 obviate these objections, Mr. Tiemann has modified the 
 instrument by placing a spiral, gutta-percha covered 
 spring at the union of the parts marked b and c, in 
 Fig. 31, so that free motion is permitted to b, the atem, 
 which is to enter the os. Another beneficial result is 
 that, while the tendency of this spring is to keep b 
 perpendicular, and thus to raise the uterus to its 
 normal position, yet this is not forcibly and entirely 
 accomplished immediately upon its introduction, but 
 is, if the resistance be great, to be gradually effected 
 by the constant action of the spring. The probability 
 of injury from accident is also much lessened. This 
 improvement is shown in Fig. 32. 
 
 Ante-version has occurred, and is often continued
 
 126 
 
 THERAPEUTICS OF STERILITY. 
 
 from irregularities of the bowels, the rectum being 
 allowed to remain filled with an immense accumulation. 
 
 Fio. 32. 
 
 In many cases, merely attending to this organ alone, 
 is sufficient to restore the uterus to its natural condi- 
 tion. Certainly, no other treatment would be justifi- 
 able, until the regularity and effectiveness of the 
 uterine discharges are fully established. 
 
 "An intestinal canal loaded with large fsecal accu- 
 mulations, not only obstructs the returning circulation 
 from the pelvic viscera, as is so commonly seen by its 
 effects in producing an hcemorrhoidal habit, but by 
 pushing down the uterus into the pelvis lower than 
 is natural, for its venous circulation becomes also 
 impeded, and considerable engorgement of the organ is 
 produced."
 
 TREATMENT OF VERSIONS. 127 
 
 "Until this deposit is removed, we can scarcely be 
 said to have ascertained the real extent of the local 
 affection." Dr. E. Rigby. 
 
 Retro-version has been caused by active exercise, or 
 merely passive exercise in riding or the like, with the 
 bladder over-distended with fluid. Such an occurrence, 
 however, may be a cause, but the cause is not persis- 
 tent, and its continuance is owing to other reasons. 
 
 Curious enough, the very producers of flexions and 
 versions of the womb which I have described, have been 
 recommended as curative agents. M. Hugier advises, 
 in cases of ante-version, that the urine be retained as 
 long as possible, and rarely, if ever, to be entirely 
 evacuated, that by the bulk of the distended bladder, 
 the obliquity of the uterus may be rectified. In the 
 same manner, also, he advises the feecal matter to be 
 retained in the rectum, to restore the retroverted 
 womb to its natural situation. I have no experience in 
 this method of cure. 
 
 Tumors forming mechanical obstructions to concep- 
 tion, are principally polypi. When lying within, and 
 low down in the vagina, they are usually of some size, 
 and it is from their irritation and the acrid character 
 of their discharges, that they can have much influence 
 upon the generative functions. Their treatment must 
 depend upon their variety. If possessing a distinctive
 
 128 THERAPEUTICS OF STERILITY. 
 
 neck, and small in diameter, it can be easily surrounded 
 by a ligature, and strangulated ; if larger, a doubly- 
 armed needle may be passed through the centre, and 
 by tying each half separately, the circulation will be 
 more effectually cut off, and the tumor thus destroyed. 
 
 According to my observation, the best form of liga- 
 ture is wire of pure silver, which may easily be passed 
 around and through the tumor, and twisted. It 
 requires no knot, remaining firm and fast ; it may be 
 tightened more or less, as desired, and ac often as 
 desired, with little difficulty ; is strong, cleanly and 
 efficient. In most cases it will require no instruments, 
 adjuncts, or accessories. When wire is not used, on 
 the contrary, if high up, or wherever the tumor be 
 situated, if it be requisite to tighten the ligature on 
 succeding days, a canula will be absolutely necessary. 
 
 One of the easiest means of removing these intra- 
 vaginal, or intra-uterine polypi, is by means of a little 
 polypus forceps (Fig. 33), invented by M. Luer of 
 Paris ; the first of which I saw, was presented to me by 
 the inventor and maker. The museau de tanche ter- 
 mination enables one not only to seize the tumor by a 
 broad surface, but its interior grooved bite prevents 
 any slipping. It will be found very effective in 
 drawing down the tumor, when any operation is to 
 be performed upon it. The rachet upon the handle 
 will hold the instrument at any fixed point. 
 
 In many cases where it might be found difficult to
 
 PLAT/; r. 
 
 T Sinclair's Chroma. I t
 
 UNNOTICED POLYPI. 
 
 129 
 
 pass a ligature around the pedicle of the tumor, the 
 pedicle itself may be seized by these forceps, and 
 
 FIG. 33. 
 
 ' - 
 
 compressed, and there retained by means of the rachet, 
 and if desirable, they may be left hanging loosely, or 
 supported by an attachment to a girdle, and worn 
 until the tumor thus strangulated, falls off, a result 
 easily obtained by the facility of increasing the pressure 
 by the r ache t-han die. These instruments are made of 
 various sizes, and can thus be adapted to tumors of 
 diverse magnitudes. 
 
 The minute polypi which spring from the cervix 
 uteri, seem originally to have been but profuse granu- 
 lations, which have become semi-organized. Bathed in 
 a muoo-purulent secretion, often enveloped in a clot of 
 blood, they are very apt to be unnoticed. In all cases 
 where a speculum examination is made, I am in the 
 habit of carefully and thoroughly wiping the os uteri 
 with cotton or lint, which will invariably expose the 
 polypus, if without the cervix. But even when plainly 
 before the eye, it will often be unnoticed by the care- 
 
 9
 
 130 THERAPEUTICS OF STERILITY. 
 
 less examiner, from its diminutive size, and its resem- 
 blance in color and general appearance to the diseased 
 surface around, with which it is in immediate contact. 
 
 The most effectual and best means for their removal 
 is at the same time the speediest. They should be 
 seized with the forceps, twisted and thus torn off. But 
 little haemorrhage results, and no pain is perceptible. 
 The abraded surface around and the site of the pedicle 
 should then be touched with a stick of pure Nitras 
 Argenti, which will effectually restrain any further 
 bleeding. This application should be continued weekly, 
 till all disease is entirely healed. 
 
 Occasionally there is a large fungous growth within 
 the cervix which may be the ovulae nabothii in large 
 quantities, or a profusion of vesicular polypi. Recamier 
 invented a curette or scoop, with which he scraped out 
 the os uteri, thus forcibly and roughly removing them. 
 At present, this plan has few followers, and either the 
 lunar caustic, or the acid nitrate of mercury is pre- 
 ferred to be applied, and thus more effectually to 
 destroy them. In such a diseased condition of the 
 cavity, the irritation from Simpson's intra-uterine 
 pessary, is sometimes found to be serviceable. 
 
 When polypi are felt within a patulous os uteri, or 
 when their presence is suspected from the haemorrhagic 
 discharges, the flaccid lips of the os uteri may be 
 gently pressed asunder by means of the speculum os 
 uteri (Fig. 28)-, or which is nearly as useful, by passing
 
 TORSION OF POLYPI. 131 
 
 the closed points of the vaginal forceps within the os, 
 and then separating the handles, thus parting the lips, 
 so that the eye may explore the cavity to some half- 
 inch, or inch and a half. 
 
 If a polypus is thus discovered, the treatment should 
 not differ from that already prescribed. More care, 
 however, should be used when in this locality from 
 the difficulty of controlling any haemorrhage that may 
 arise that no forcible traction or direct severance of 
 the attachments of the polypus be made, but that 
 gentle and careful torsion may remove it, and thereby 
 the more surely prevent any bleeding. 
 
 Occasionally these polypi originate from the interior 
 of the uterus, with the pedicle attached either to the 
 fundus or lower down upon its interior surface. . Often 
 growing to an immense size, and productive of great 
 danger when co-existing with a foetus and subsequent 
 labor, they are not only extremely prejudicial to 
 health, but fortunately are usually preventives of 
 pregnancy. 
 
 Great care is necessary in the treatment of these 
 cases, the manner of which is greatly modified by 
 the circumstances of the case, the condition of the 
 patient, the hsemorrhagic or malignant character of the 
 tumor, &c. Numerous interesting cases of this de- 
 scription are found in the medical journals and sur- 
 gical treatises, and especially several remarkable 
 cases reported, but not yet published, as treated by
 
 132 THERAPEUTICS OF STERILITY. 
 
 Professor B. Fordyce Barker, and "Sixteen Cases of 
 Infra-Uterine Polypi," by Dr. Walter Channing, of 
 Boston, are 1 worthy the attention of the student of 
 these peculiar affections. Dr. Montgomery's mono- 
 graph in the Dublin Journal of Medicine, August 1846, 
 is full upon this subject. 
 
 The only essential difference in the treatment of this 
 form of the affection, arises solely from its location 
 being out of easy access. This is to be obviated by 
 dilating the os uteri, so that manipulation may be 
 effected within the cavity, or by the administration of 
 ergot, until the uterine contractions shall so far expel 
 the tumor from its cavity, that it may be seized and 
 operated upon as deemed expedient. 
 
 Of late, less fears seem to be expressed respecting the 
 bleeding from polypi. Dupuytren is reported to have 
 had haemorrhage in two cases only, in two hundred 
 operations. In view of this fact, and in conjunction 
 with the well-known injurious effects of allowing the 
 putrescent mass to remain in the vagina, it is urged 
 with much seeming force, that excision is proper in 
 all cases ; some advising that the ligature should be 
 first applied, and the mass dissevered below; and others 
 recommending amputation, and the actual cautery to 
 be applied to the surface of the wound. An ingenious 
 method of performing this operation is to surround the 
 neck of the polypus with the two insulated wires of a 
 galvanic battery, which, on setting up the action of the 

 
 ECRASEUR. 
 
 133 
 
 Fia. 34.
 
 134 THERAPEUTICS OF STERILITY. 
 
 voltaic current, become red hot, cut through and sear 
 at the same time. (Middetdorpf, Boston Med. Surg. 
 Journal.) 
 
 This method sears the edges of the wound, and the 
 haemorrhage usually accompanying the removal of 
 these tumors is thus prevented. In hospital practice 
 this plan may be feasible, but setting aside the trouble 
 of transporting the large battery required for pro- 
 ducing the white heat in the wires, the formidable 
 appearance of so extensive an apparatus would form 
 a serious objection among private patients of nervous 
 susceptibilities. 
 
 M. Chassaignac, the distinguished surgeon of the 
 Hdpital la Ribosiere, Paris, has recently invented an 
 instrument peculiarly appropriate for effecting the 
 removal of these polypi of large size. The ecraseur is 
 the name given to this invention, shown in Fig. 34, 
 because it breaks the parts, instead of cutting them 
 asunder. The principle upon which the operation is 
 performed is the well-known effect of torsion in 
 restraining haemorrhage, as exemplified in all crushed 
 wounds. K is a blunt-edged chain, or metallic liga- 
 ture, which passes through C, a canula, GG- are the 
 handles, by moving which, the chain is tightened. 
 BB are two rachets, holding the chain as tightened. 
 
 In Figs 35 and 36 we have representations of 
 enlarged polypi of the uterus, and both in process of 
 operation for their removal. In Fig. 35, the polypus, 
 D, is of small size. A, represents the rectum ; C, the
 
 REMOVAL OF POLYPUS. 135 
 
 uterus ; B, the bladder ; F, shows a curved instrument 
 in E, the vagina, with the chain around the pedicle of 
 
 Fio. 85. 
 
 the polypus, just where it emerges from the os uteri, 
 and in its natural position. 
 
 In Fig. 36, the polypus, A, is of larger size, so as to 
 prevent successful operation within the cavity of the 
 vagina. By means of forceps it is drawn and exposed to 
 view, the Scraseur, D, is applied, and almost instantane- 
 ously, it is separated from its attachment, the uterus 
 returns to its normal situation, and no haemorrhage 
 accompanies or follows the crushing. 
 
 It is proper here to state that internal or constitu-
 
 136 
 
 THERAPEUTICS OF STERILITY. 
 
 tional treatment is rarely, if ever, of any advantage in 
 these forms of polypi ; the connection with the system 
 
 being of such a nature, that mercurials, iodine, or 
 arsenical preparations, exert no apparent influence 
 upon the tumor, while their administration adds a 
 depraved and cachetic condition to the already worn 
 and debilitated general system. The physical exhaus-
 
 HYDATIDS AND ULCERATIONS. 137 
 
 tion should not, on the other hand, be neglected, but by 
 the proper use of chalybeates, tonics, and nourishing 
 food, the drain upon the system should be met, and 
 the physical energies supported. Astringent and anti- 
 putrescent lotions should counteract the local irritations. 
 Should hydatids be recognized as present, the dis- 
 eased mass should be broken up by the use of the 
 sound, the uterus excited to action by the administra- 
 tion of ergot, by dilating the os uteri with the finger, 
 or in such other manner as may be necessary to cause 
 it to expel these unnatural contents. 
 
 Ulcerations are a very general, and most frequently 
 unperceived, or even if discovered, unrecognized cause 
 of sterility. In a previous chapter, this fact has been 
 already stated, with sufficient minuteness. The appar- 
 ent slightness of the cause is scarcely surpassed by the 
 simplicity of its treatment. 
 
 With the speculum the diseased portion is plainly 
 seen, as already described. This should be carefully 
 wiped with a pledget of lint or cotton wool, that the 
 whole surface be plainly exposed. In those who have 
 never been impregnated, i.e., where no injury could 
 have been done to the os or cervix during any abor- 
 tion, miscarriage, or labor at the full time, rarely is 
 any fissure discovered, but a more or less extensive 
 abrasion, or ulceration.
 
 138 THERAPEUTICS OF STERILITY. 
 
 There is frequently much difficulty found in exposing 
 the os to view, owing to various causes. One most 
 annoying, is slight ante-version of the uterus, which 
 brings the cervix into the cavity of the sacrum and 
 the os, entirely out of the reach of the eye, and often 
 almost of the finger. A new speculum, of French 
 origin, is now manufactured by Mr. Tiemann (Fig. 37), 
 the end of which is so shaped, as to catch the os in its 
 
 Fia. 87. 
 
 raised edge, and by slightly withdrawing the instru- 
 ment, to bring the retained neck into view. The 
 utility of this modification will be generally conceded 
 by those engaged in treating uterine difficulties. 
 
 In the majority of cases, all that will be necessary 
 to effect a perfect cure, is to touch this diseased surface 
 with Nitras Argenti Purum. As the disease almost 
 invariably, where of sufficient magnitude as to be the 
 cause of sterility, is not confined to the visible portion, 
 but is continued up the canal of the cervix, the caustic 
 should be passed freely into this passage, to the extent 
 of an inch or thereabouts and this treatment should 
 be repeated as often as the destroyed portion is cast
 
 LOCAL TREATMENT OF ULCERATIONS. 139 
 
 off, viz., in from five to seven days. During the 
 interim, the vagina should be carefully bathed by a 
 profuse injection of water, of such a cool temperature 
 as shall be most agreeable. After the vagina is thus 
 thoroughly cleansed, I am in the habit of prescribing a 
 wash of a decoction of the Corticis Querci Albae, 5 i, in a 
 quart of water, to which, when strained, is added suffi- 
 cient alum to saturate it. This has the double purpose 
 of slightly stimulating the diseased portion, and by its 
 astringency, contracting the lax parietes of the vagina, 
 so that it may the more easily hold up the hyper- 
 trophied, and unusually heavy uterus. If there be any 
 vaginal leucorrhoea accompanying, I have found most 
 marked benefit, as well as in cases of simple vaginal 
 flux, from the following : 
 
 9 . Ferrocyanuret, Potass, 3 iv. 
 Aquae Cinnamon! ii. 
 
 M. terendo. 
 Sume gtts. xxx. ter in die. 
 
 Other and more powerful caustics, such as the Acid 
 Nitricum Purum ; Hydrarg. Acid. Nit. ; Potassae cum 
 Calce ; Potassae Fusae, &c., I have found to be far 
 more unmanageable, more dangerous, often productive 
 of unpleasant results, and never having any superiority 
 over the simple Nit. Argentum. The heroic treatment 
 by the actual cautery, is, I think, called for by no con- 
 dition of things. It is as unscientific as it is revolting.
 
 140 THERAPEUTICS OF STERILITY. 
 
 In using these astringent internal injections, care 
 should be taken in the time of their application, for the 
 remarks made in previous portions of this volume will 
 show, that the chemical character of these local appli- 
 cations will destroy the spermatozoa ; or even if simply 
 mucilaginous or pure water injections be used, these 
 will destroy in very many instances, the hope of 
 offspring, by the mechanical washing away of the 
 spermatic fluid. The time of using all injections, if of 
 a chemical character, should not too closely precede 
 copulation, neither if composed merely of pure water, 
 should it soon follow the marital act. 
 
 In some cases I have found benefit after a longer or 
 shorter continuance of the Nit. Argentum, in alter- 
 nating with the Tinct, lodini, and Tinct. lodini Com- 
 positum. 
 
 In certain instances where the local sensibility was 
 unusually great, I have applied the Acidum Tannicum 
 dry ; to the abraded surface, and in a few instances, 
 when used as a lotion, by means of a syringe, a satu- 
 rated solution of Pulv. Boracis, benefit has resulted 
 where the cases seemed previously almost stationary 
 under other treatment. 
 
 In few instances I have used the Sub. Nitrat. 
 Bismuth, applying it dry to the diseased portion, but 
 usually with benefit. As in the use of Acidum Tan- 
 nicum, I have applied it by dipping a pledget of lint 
 into the dry powder, and thus conveying as much as
 
 SEXUAL INTERCOURSE NOT INJURIOUS. 141 
 
 possible to the desired locality. The Bismuth has 
 seemed to act by some mechanical irritation, in the 
 same manner, and perhaps as effectually as when given 
 by the mouth for dyspeptic symptoms or slight 
 gastritis, but its effects being transient and evanescent, 
 it is requisite that it be applied much oftener than the 
 caustic, generally every day or two. 
 
 Frequently it will be found useful as a lotion applied 
 with a syringe, the proportion being as follows. 
 
 . Sub. Nit. Bismuth, grs. x. 
 
 Aq. Rosse i. 
 
 Aq. Purae v. 
 M. 
 
 Under these methods of treatment, the external 
 ulceration is easily healed, but that of the cavity is not 
 so speedily relieved. There is often every trace of 
 inflammatory action, the redness, congestion, &c., 
 removed, and yet a tenacious, transparent fluid 
 pure albumen exudes from the orifice, which cannot 
 be easily removed, and until it disappears, your patient 
 is not well. The glands of the canal are preter- 
 naturally excited, and this flow, although of a normal 
 character, save its too great viscidity, and profuse 
 quantity, is the result of the over stimulation. 
 
 Sexual intercourse I do not find necessary to arrest, 
 as its temporary natural stimulus seems, when not too 
 frequent or excessive, to unload the congested glands
 
 142 THERAPEUTICS OF STERILITY. 
 
 and to leave them in a condition more favorable to 
 complete and speedy recovery. 
 
 Benign hypertrophy of the os uteri is invariably 
 found to be but an accompanying symptom of internal 
 cervical disease, and this phase will be relieved by the 
 treatment above enumerated, one which will be found 
 far preferable, and fully as effectual as Lisfranc's heroic 
 treatment, excision of the neck. 
 
 I have not found it necessary or advisable to adopt 
 the method proposed by Bennet, of making an issue by 
 caustics upon the hypertrophied cervix, as, theoretically, 
 I considered by so doing, I was treating symptoms, or 
 at the best, secondary results, rather than the first 
 prime cause. I have rather directed my attention 
 directly to ihefons et origo, the disease of the interior 
 cervix, and have not found the objectionable issue even 
 to facilitate the cure. 
 
 FIG. 38. 
 
 Scarifications of the hypertrophied cervix with a 
 long knife are frequently of marked benefit. For this 
 purpose an instrument (Fig. 38), with the blade sliding 
 through a shield, is manufactured by Tiemann, which 
 by means of a screw, enables one to set the knife at any 
 required length, and thus to make the incisions to any 
 depth.
 
 LEECHES TO OS UTERI. 143 
 
 When there is local acute congestion, or painful and 
 scanty menstruation, relief is not unfrequently found 
 by the application of two or three leeches .to the 
 cervix, through the speculum, care being taken not to 
 allow them to escape from the leech-tube, as they 
 sometimes crawl into the cavity of the os, producing 
 great uterine disturbance, pain, &c. ; one instance of 
 which is recorded by Dr. I. E. Taylor of this city. 
 
 In the same manner that after a chronic gleet, we 
 find urethral stricture, so, after the subsidence of 
 chronic leucorrhcea, the pathology of which we have 
 endeavored to elucidate, we have stricture of the canal 
 of the cervix. This stricture is, as already stated, 
 located generally at either the os internum or the os 
 externum. That at the external opening where its 
 character is more observable, is sometimes apparently 
 formed by the effusion and subsequent organization of 
 coagulable lymph. This new matter does not take on 
 the character of the tissue upon which it is located, 
 but remains firm and inelastic. Dilatation is effected not 
 by any stretching of the part but by its complete dis- 
 ruption. This is sometimes accomplished in the par- 
 oxysms of dysmenorrhcea and thus we account for the 
 occasional instances of fissures of the os uteri observed 
 in those who have never been impregnated, but which 
 in a former work ( Treatise on Uterine Hemorrhage in
 
 144 THERAPEUTICS OF STERILITY. 
 
 all its Forms, with some views respecting Fissures of the 
 Os Uteri, as a frequent cause of Abortion, with their 
 Curative Treatment), I have considered to arise from an 
 abortion, and to be afterward the efficient cause of the 
 frequently repeated premature deliveries, abortions and 
 miscarriages, with which some females are afflicted. 
 
 Lacerations of the os and cervix during labor, are 
 not unfrequently the cause of subsequent barrenness, 
 from causes already enumerated. The ulceration aris- 
 ing from the fissures is accompanied by immense 
 hypertrophy of the os, and great leucorrhoeal discharge. 
 In one instance, an Englishwoman, who had been 
 treated for ten or more years in England, having made 
 many trips to Bath and Harrowgate and other springs, 
 without relief, I found the os hypertrophied to a size 
 more than three inches in diameter, and barely to be 
 compassed by the fully distended four-valved speculum, 
 with three extensive rents in its periphery, and all 
 ulcerated and discharging pus. The haemorrhage at 
 the menstrual period was frightful. Similar cases I 
 have spoken of on page 96. 
 
 The semi-transparent whitish lining of the os uteri 
 plainly shows its fibrinous deposit, and the treatment 
 here imperatively called for is incision. 
 
 Simpson recognizes this condition as a cause of 
 dysmenorrhoea, and has presented an instrument with 
 which to make the incision. I have preferred one of a 
 simpler construction and of a more efficient character.
 
 UTERINE SOUNDS. 145 
 
 It is a probe-pointed knife with a short cutting edge 
 (Fig. 39), which will be found to easily divide the 
 projecting, hard-edged stricture, leaving the other 
 portion unscathed. 
 
 i 
 
 FIG. 39. 
 
 When this thin band is divided in two or more 
 places, a probe may then be easily passed into the 
 orifice, and if there be no superior disease, may be 
 passed into the cavity of the uterus. A few topical 
 pencillings with lunar caustic, and an occasional 
 passage of a sound through the opening, and the cure 
 is effected. 
 
 When, however, there is no fibrinous deposit, the 
 stricture is dependent solely upon the contraction of 
 the internal membrane, by the process of cicatrization. 
 Perhaps the original disease may have been a syphilitic 
 chancre. In any case, all that is present is a contrac- 
 tion without the addition, and probably without the 
 subtraction, of any substance. Dilatation is the remedy. 
 A probe of sufficient size should be passed within the 
 small canal (Fig. 40), an ordinary male bougie, and 
 often of the smallest size is all that can be made to 
 enter primarily. This is to be followed up by larger 
 ones. Simpson's Uterine Sounds, carefully graduated, 
 
 10
 
 146 
 
 THERAPEUTICS OF STERILITY. 
 
 may sometimes be effectually used. Similar sounds 
 may be made of gutta percha of such sizes as are 
 
 FIG. 40. 
 
 wanted, by heating the gum in boiling water, and will 
 be found an economical substitute. These should be 
 passed every two or three days, and allowed to remain 
 when entered, for an hour or two, or until their 
 presence becomes painful. 
 
 More effectual in my hands have been the prepared 
 sponges. These are made by taking strips of fine 
 sponge, about three inches in length, and an inch more 
 or less in thickness, according to the size required, 
 These are moistened in water, in which Gum Acacise 
 has been dissolved. They are then wound closely and 
 as firmly as possible with a cord, allowed to dry, when- 

 
 SPONGE TENTS. 
 
 147 
 
 the cord being removed, they retain the shape into 
 which they have been pressed, and after being trimmed 
 smooth, are ready for use. 
 
 Fio. 41. 
 
 Fig. 41 represents a tent, to which a cord is attached, 
 into which a firm wire (Fig. 42), is thrust, with which 
 to insert it, by the side is a representation of the tent 
 divided in its centre, and showing the cavity into which 
 the wire is passed, to effect its entrance into the os. 
 
 Preparing the sponge of the size and length appro- 
 priate to the case, attaching a piece of silk to it, in 
 order to favor its extraction, and the surface being 
 carefully oiled, and either with the wire (Fig. 42), 
 or seizing it with a pair of long forceps, it should be 
 forced into the cervical canal as far as desired, if possi- 
 ble, and there left for twenty-four hours, or even 
 longer, if it be not convenient to insert another imme- 
 diately : during which time the sponge will, moistened 
 by the secretions, expand to its natural size, and thus
 
 148 THERAPEUTICS OF STERILITY. 
 
 dilate the canal. If left longer, a more profuse and 
 fetid discharge is excited. Should there be any pain 
 
 \ 
 
 Fia. 42. 
 
 so as to render it necessary, it must be removed sooner. 
 Its presence is not incompatible with prolonged and 
 even severe exercise. Indeed I have repeatedly had 
 patients ride fifty miles in the cars, and return on the 
 fourth day subsequently without any displacement of 
 the sponge. The sponge should be enlarged in its 
 diameter as fast as it can be, and until the canal be 
 pervious during its entire extent, and of sufficient size. 
 When once properly dilated, I have never known the 
 os to again contract. 
 
 Recently, a proposition of doubtful feasibility has 
 been made in the French Journals, to dilate the os 
 uteri, by passing into it a long hollow tube of india- 
 rubber, connected by a tube of the same to a bellows ; 
 by this it is to be blown up, and then stopped tight. 
 From some experience with similar instruments in 
 other situations, I doubt much its utility. 
 
 Dr. H. R. Storer has proposed in the Boston Medical 
 and Surgical Journal, that tents made of Elm Bark, 
 be substituted for those of sponge, stating that they
 
 UTERINE SOUNDS. 149 
 
 swell less rapidly than sponge, and thus do not make 
 such sudden, and, as he thinks, injuriously rapid dila- 
 tation of the os and cervical canal, and also from their 
 freedom from offensive smell, even when the discharge 
 around is putrid. 
 
 During the continuance of this method of treatment, 
 such vaginal lotions as may be required should be used, 
 irrespective of this treatment, and if none are neces- 
 sary, a simple bathing in pure water will be all that 
 will be required. 
 
 When the stricture is midway, or affecting the entire 
 length of the canal, or the os internum, the treatment 
 does not materially differ, except that it is proportion- 
 ally longer, the farther it is from the external orifice. 
 
 The anatomy of the interior membrane lining the os 
 and cervix uteri, should be remembered, and the 
 manner in which it is folded upon itself, constituting 
 the arbor- vitae appearance, should not be forgotten. 
 
 The passing of sounds through the cavity of the 
 cervix, is often a matter of considerable difficulty, and 
 this not from the direct effect of the stricture, so much 
 as the cervical rugae which line the interior surface. 
 The anatomy of the interior of a virgin cervix uteri, 
 (Fig. 5), of the natural size, will be sufficiently demon- 
 strated to elucidate this practical remark, by the 
 accompanying cuts from Tyler Smith's Leucorrhoea. 
 Figs. 43 and 44, show the longitudinal and transverse 
 rugse from the virgin cervix, magnified respectively
 
 150 
 
 THERAPEUTICS OF STERILITY. 
 
 9 and 18 diameters. These reduplications of the 
 mucous membrane lying in corrugated folds, are 
 
 FIG. 43. 
 
 created to effect the dilatation of the cervix uteri 
 during labor, without laceration.
 
 DIFFICULTY IN PASSING SOUNDS. 
 
 151 
 
 The end 'of the sound is not unfrequently caught in 
 these rugae, and in the mucous crypts and sulci, and 
 
 Fro. 44. 
 
 the operator may perhaps imagine that the stricture 
 causes the resistance, which may be overcome by 
 increased pressure, in doing which he will run great, 
 danger of lacerating the lining membrane, and of 
 forming a false passage, thereby causing great subse- 
 quent inflammatory difficulty.
 
 152 
 
 THERAPEUTICS OF STERILITY. 
 
 The probability of such an accident occurring may be 
 seen by observing Fig. 45, which is a side view of one 
 
 FTG. 45. 
 
 of the columns of rugae and fossae, magnified but six 
 diameters. 
 
 Where there is a possibility of introducing an instru- 
 ment through a firm stricture, dilatation may some- 
 times be forcibly made, by gradually separating the 
 extremities of an instrument (Fig. 46), by means of a 
 screw in the handle, and in certain cases this treatment 
 will be found serviceable. 
 
 When the internal os is the seat of the disease, it 
 is sometimes quite difficult to pass any instrument 
 through it, or even to know if it is passed through,
 
 CATARRH OF THE WOMB. 153 
 
 and has entered into the cavity of the uterus. In one 
 case, where a lady from the interior of New Jersey 
 came to me weekly only, I was exceedingly troubled. 
 The affection was easily recognized the sound would 
 
 FIG. 46. 
 
 not pass in more than a half-inch. A smaller, and 
 very fine pointed flexible bougie without a stylet passed 
 in, however, but no such success could be attained 
 when the stylet was introduced, or a large bougie 
 attempted. Imagine my chagrin when, after several 
 attempts, and with perhaps a trifle more force, I found 
 that the end of the bougie was visible, and that it was 
 but doubled upon itself, and had not probably passed 
 any farther than the sound. In this case it was 
 necessary to dilate the lower portion of the os, until it 
 would easily admit the first joint of the index finger 
 before it had any effect upon the internal stricture. 
 
 Dr. Sims of New York recommends in those cases 
 of stricture, accompanied by diseased secretions, that a 
 metal bougie be fastened within the cervix, and 
 retained therein as long as it remains painless, to 
 allow the diseased portion to cicatrize around it. The 
 principle does not differ from the probe pessary of 
 
 i
 
 154 THERAPEUTICS OF STERILITY. 
 
 Simpson, so ridiculed as the "impaler," from which, 
 I have already stated, I have known marked benefits to 
 arise. 
 
 After the treatment of the stricture is finished, the 
 enlarged condition of the os and its patulous condition, 
 the discharges, &c., speedily cease, the os resumes its 
 natural appearance, menstruation is effected without 
 pain, and the patient feels nothing which can remind 
 her of the part affected. 
 
 Catarrh of the womb is, in other words, a chronic 
 inflammation of its lining membrane, and generally 
 accompanied by a greater or less co-incident uterine 
 congestion. Its curative treatment is prolix and more 
 uncertain than any other form of uterine disease. 
 Quiet the absence of sexual excitements the use, 
 sometimes, of a mild, alterative treatment, and injec- 
 tions into the cavity of the uterus of solutions of Nitras 
 Argenti of various strengths, gradually increased in 
 potency, have been the means usually found effectual in 
 my practice. Often the monthly uterine congestion has, 
 at its close, left the patient apparently no better than 
 she was after the whole intervening month's treatment. 
 
 Occasionally excessive pain follows the injection, 
 which I have relieved in some cases, by throwing 
 in a similar quantity of olive-oil. Metritis is said to 
 sometimes occur from this treatment. I have never
 
 DILATATION OF THE FALLOPIAN TUBE. 155 
 
 found actual inflammation, although I have sometimes 
 feared it. 
 
 I have heard of cases where ovaritis followed its 
 administration, and the reason supposed, was that the 
 injection had been in such quantity and propelled with 
 such force, as to pass through the length of the Fallo- 
 pian tube. 
 
 A convenient instrument for this injection is a silver 
 syringe (Fig. 47), which will not corrode, and is in 
 every respect efficient. 
 
 Fro. 47. 
 
 In these catarrhs of the womb, the Ferrocyanuretum 
 Potassii, as before formularized, I have found of much 
 benefit, the dose often being beneficially increased to 
 double or quadruple its quantity. 
 
 Obliteration of the cavity of the womb, either 
 general or partial, is with difficulty diagnosticated, if 
 ever discovered, and even if its presence was really 
 certain, it could not be successfully treated. I have
 
 156 
 
 THERAPEUTICS OF STERILITY. 
 
 seen but one case only, and that of partial obliteration, 
 of a barren lady who died at 94, already referred 
 to, for her mental as well as physical idiosyncracies. 
 
 Disease and stricture of the Fallopian tube, and 
 especially of the uterine end, to which reference has 
 already been made : theoretically there is little doubt 
 of its existence, but practically, there is immense 
 doubt of the possibility of recognizing it, save, perhaps, 
 in some exceedingly rare instances. The recommend- 
 ation of some recent English writers, Tyler Smith the 
 originator, of passing a bougie into the os, and through 
 
 Fio. 48. 
 
 the cervix, and thence into the Fallopian tube, and by 
 a series of graduated instruments removing this stric- 
 ture, in the same manner that we have just recom- 
 mended for the os and cervix uteri, is itself so seem-
 
 OVARIAN DISEASE. 
 
 157 
 
 ingly impossible, that it has scarcely been considered 
 worthy of a thought by the profession, and the professor 
 himself no longer urges it as a means of cure. 
 
 Fig. 49 represents another form of instrument, more 
 resembling a catheter ; through the opening in the 
 extremity of which a small probe may be protruded. 
 These cuts (Figs. 48 and 49), serve to show the many 
 difficulties which prevent the successful issue of this 
 attempted operation. The impediments to the insertion 
 of a curved instrument like that represented, through 
 the os uteri externum and internum will be perceived 
 by observation of them, and by reference to the diffi- 
 culties of the passage of uterine sounds stated on 
 page 151. 
 
 FIG. 49. 
 
 In the other diseases of the tube and fimbriated
 
 158 THERAPEUTICS OF STERILITY. 
 
 extremity, enumerated in the pathology of the disease, 
 the diagnosis, if possible, is obscure, and the treatment 
 must be of the most vague and unsatisfactory character. 
 We may hope that nature may effect some desired 
 change, but from medicines or other forms of treatment 
 we may not expect any beneficial result. 
 
 The affections of the ovary bearing upon sterility, 
 are chronic congestion or inflammation, tumors from 
 and of the organ, and a peculiar adynamic condition 
 unmarked by any perceptible alteration, in its patho- 
 logical character. The first of these diseases has a 
 pathology, but with slight and obscure symptoms 
 evincing it ; the second is evident both before and after 
 death ; the third has abundant symptoms, but no 
 pathological alteration in its tissues. 
 
 Chronic congestion is a sequela of acute inflamma- 
 tory action, and is superinduced by numerous causes 
 not necessary here to enumerate. It is often the result 
 of interrupted menstruation, and is to be met by local 
 antiphlogistic treatment ; leeches to the abdominal 
 region adjoining, sometimes, and particularly if any 
 sympathy exist, to the os uteri ; and a very mild altera- 
 tive course. Especially is a loose condition of the 
 bowels important, and an aloetic daily pill will be found
 
 LOCAL STIMULATION. 159 
 
 an important adjunct to such other treatment as may 
 be necessary. 
 
 If the theory enunciated as to the manner in which 
 a superabundance of fat prevents conception, be true, 
 then the only method of accomplishing the desired end, 
 is to reduce the plethora. If, however, the fat is but 
 a result of the cessation of the functions of the ovary, 
 from a failure in the evolution of the G-raafian vesicle, 
 topical stimulants are to be resorted to, and by no 
 medicines have such beneficial results been attained, as 
 by the internal administration of the Cantharis. This 
 may be given in pill, powder, or tincture, beginning 
 with small doses, and gradually increasing until its 
 specific effects upon the mucous passages are plainly 
 perceptible. The following formula may sometimes be 
 found serviceable, where general stimulation is con- 
 sidered advisable : 
 
 9 Pulv. Capsici | es. 
 
 " Zinziberis iss. 
 
 " Cantharidis 3 iiss. 
 
 Croci 3 iss. 
 
 Pulv. Caryophili ss. 
 
 Alcohol. Oiiiss. 
 
 M. 
 Dose 3 ss to 3 iii- 
 
 The administration of Cantharides is indeed empirical, 
 for it is given without a due knowledge of the existing
 
 160 THERAPEUTICS OF STERILITY. 
 
 condition, and also without an adequate idea of its 
 method of action. It is presumed, however, that it 
 stimulates, and even produces inflammatory action in 
 the mucous passages of the kidneys, the uterus, the 
 bladder, urethra, and the intestinal tract to some 
 degree, and that the uterus and its appendages sympa- 
 thize in this excitation, and the sluggish ovaries are 
 provoked to new and vigorous action. Certain it is, 
 however, that in many cases where no local or general 
 disease is manifest, and yet where sterility is present, 
 the administration of this medicine, is not unfrequently 
 followed by pregnancy. 
 
 Dr. Mackenzie before the Med. Society of London, 
 recently recommended Amorphous Phosphorus in cer- 
 tain affections of the uterine organs, attended with 
 weakness and irritability of the nervous system to be 
 given in doses from 10 to 30 grains diffused in water. 
 It appears to act as a direct tonic or stimulant to the 
 uterine system. He had known pregnancy to super- 
 vene upon its employment, after a lengthened period 
 of sterility, subsequent to marriage. 
 
 Raisers of stock have noted that high-conditioned 
 mares and fat cattle do not readily breed, and they are 
 in the habit of reducing the animal by copious bleedings 
 and purges, before the male is admitted, and, thus pre- 
 viously treated, the desired end is obtained. In several 

 
 ELECTRICITY AND GALVANISM. 161 
 
 instances where, acting upon this hint from the stables, 
 a copious bleeding and, free purgation followed the 
 menstrual period, accompanied by a season of dietetic 
 attention, conception has resulted, which had failed to 
 be effected during many previous years of married 
 life. 
 
 The application of electricity is sometimes of benefit 
 in arousing the reproductive organs to their natural 
 action. M. Roubaud in his recent work, states that he 
 has had a greater success than most in the treatment 
 of cases that I am now describing, where no disease is 
 apparent. Indeed, he claims that in 6 out of 10 cases, 
 particularly in those whose sterility proceeds from 
 sexual abuse in prostitution, this treatment is followed 
 by childbirth. The application is made once or twice a 
 week for several months, during which time coition is 
 suspended, and great simplicity and regularity in all 
 the details of life are to be rigorously exacted. 
 
 In those cases where there is reason to suspect that 
 the female may be tainted by syphilis, it will be found 
 necessary to premise all other treatment by a constitu- 
 tional course, and almost without exception, a cautious 
 and protracted administration of mercurials will" be 
 
 11
 
 162 THERAPEUTICS OF STERILITY. 
 
 found advisable. Those mixed with Iodine in minute 
 doses, I have found most serviceable. Particularly 
 have I been pleased with the following preparation : 
 
 9- Chloridi Auri grs. v. 
 
 Hydrarg. Chlor. Corrosiv. grs. i. 
 
 Amyli. 3 ii. 
 
 Gum Acaciae Pulv. 3 ss. 
 
 M. 
 Et div in pil. DO. LX. 
 
 Una ter iu die. 
 
 Finally, infrequent coitus, and especially at seasons 
 following soon after the disappearance of the menses, 
 will be found important. 
 
 Conception is prevented and pregnancy interrupted 
 by excessive intercourse with the married as with the 
 courtezan, and if not so generally, at least, with suffi- 
 cient frequency as to be noted and guarded against. 
 The uterus, when too much excited, becomes irritable, 
 and expels its contents. In animals it is noticed, and 
 graziers are in the habit of throwing cold water over 
 their brood mares and kine who are generally sterile, 
 with beneficial results. 
 
 Pure air, quietude of mind, temperance in food, 
 drink, and sleep whatever conduces to general health 
 and regularity of life, will be found advantageous, in 
 conjunction with all medicines, and every variety of 
 treatment. The cultivation of correct habits of mind 
 and body can do no harm. They may not have the
 
 BENEFICIAL RESULTS. 163 
 
 desired result which is the object of these pages, but 
 they will assist in cultivating a frame of mind and 
 temper of spirit that will render the inevitable and 
 incurable ill easier to be borne, and perhaps less 
 regretted. 
 
 THE END.
 
 AUTHORITIES 
 
 REFERRED TO AND QUOTED IN THIS BOOK. 
 
 Manual of Human Microscopical Anatomy, by A. Ktflliker, Prof, of 
 Anat. and Phys., Wiirsburg, Edited by J. Da Costa, M. D. 
 
 Practical Treatise on Inflammation of the Uterus, its Cervix and 
 Appendages, by James H. Bennet, M. D. 
 
 The Cause and Treatment of Abortion and Sterility, by James 
 Whitehead, M. D. 
 
 An Inquiry into the Pathological Importance of Ulceration of the Os 
 Uteri, by Charles West, M. D. 
 
 The Pathology and Treatment of Leucorrhrea, W. Tyler Smith, M. D. 
 
 Traite de 1'Impuissance et de la Sterilite chez I'Homme, et chez la 
 Femme, par le Docteur Felix Roubaud, Paris, 1855. 
 
 The Philosophy of Marriage, by Michael Ryan, M. D. 
 
 Clinical Reports of Ovarian and Uterine Diseases, by Robert 
 Lee, M. D., London, 1853. 
 
 The Writings of Hippocrates and Galen, by John Redman 
 Coxe, M. D. 
 
 A Practical Treatise on Diseases of the Uterus and its Appendages, 
 by Mme. Veuve Boivin. 
 
 The Philosophy of Reproduction, by R. J. Mann, M. D., London, 1856. 
 
 On some Diseases of Women, admitting of Surgical Treatment, by 
 Isaac Baker Brown, F. R. C. S., London, 1856. 
 
 Report on the Acute and Chronic Diseases of the Neck of the 
 Uterus, by Charles D. Meigs, M.D., of Philadelphia, to the Am. Med. 
 
 165
 
 166 AUTHORITIES. 
 
 Association. (From which, by the kind permission of its distinguished 
 author, I have borrowed Plate III., and Fig. 1 of Plate V.) 
 
 The Cell, its Physiology, Pathology, and Philosophy, by Waldo J. 
 Burnett, M. D., prize Essay of the Am. Med. Association. 
 
 Obstetric Memoirs and Contributions of James N. Simpson,' M. D., 
 F. R. S. E. Edited by W. Priestly, M. D., H. R. Storer, M. D., vol. 1. 
 
 Traite Complet de 1'Art des Accouchements, par M. Paul Antoine 
 Dubois. Tome premier. Paris, 1849. 
 
 Maladies de 1'Uterus, d'apres les Ie9ons Cliniques de M. Lisfranc, 
 faites a 1'Hopital de la Pitie, par M. Pauley, Paris, 1856. 
 
 Mondat on Sterility. 
 
 Memoire sur les Ulcerations du Col de la Matrice &c., Revue Medi- 
 cale, 1857, 1855, par Camille Melchior Gibert. 
 
 Traite de 1'Ecrasement Lineaire, &c., par M. E. Chassaignac, Paris, 
 1856. 
 
 Die Galvanocaustik ein Beitrag zur Operativen Medicin, von Dr. 
 A. T. Middeldorpf, Breslau, 1854, and On Cauterization by Galvanism, 
 by Algernon Coolidge, M. D., Boston Med. and Surg. Jour, Nov. 1855.
 
 INDEX. 
 
 Abortion, 112. 
 Acid, nitric, use of, 122. 
 " Hydrarg. nit., use of, 139. 
 " Tannic, use of, 140. 
 Age of those capable of fecundation, 115. 
 " cause of sterility and impotence, 59. 
 Albumen from cavity of the os, 90. 
 Anaesthesia, local, 121. 
 Anatomy, comparative, 9. 
 " of the egg, 31. 
 " " canal of the uterus, 24. 
 
 " " uterus, 23. 
 
 Amorousness, periodical, 17. 
 
 B. 
 
 Births, proportion of male to female, 21. 
 Bismuth, 140. 
 Bleedings, 160. 
 Borax, 140. 
 
 C. 
 
 Cantharides, 158. 
 
 Carbonic acid gas, 122. 
 
 Caustics, their variety and relative value, 
 139. 
 
 Cautery, actual, 132. 
 
 Cell, theory of growth and reproduc- 
 tion, 33. 
 " in yeast, 36 
 
 Cervix, cartilaginous, 97. 
 
 Chloroform, use of, 121. 
 
 Conception, time of, in woman, 16-32. 
 
 " tendency to, in the phthisi- 
 cal, 77. 
 
 D. 
 
 Decidua, 29. 
 
 " when destroyed, 16. 
 Diagnosis, niost certain in the young, 77. 
 Dysmenorrhoea, 29-96. 
 
 E. 
 
 Economy of nature, 0. 
 Ecrasseur, 132. 
 Egg of birds, 28-31. 
 " fish, 14. 
 
 " " woman, 28. 
 
 " anatomy of, 31. 
 
 " passage of, 29. 
 Electricity, 160. 
 Ergot, 132. 
 Examination, physical, when necessary, 
 
 81. 
 Exzema of os uteri, 76. 
 
 F. 
 
 Fallopian tube, 22-52-99. 
 
 " inflammation of, 99. 
 " obliteration of, 99. 
 " polypi in, 101. 
 " stricture of, 99. 
 " " " treatment, 156. 
 
 False membrane, 97. 
 Fatness, influence of, 105. 
 
 " theory concerning, 106. 
 " treatment of, 158. 
 Fecundation in plants, 14. 
 " fish, 15. 
 how ensured, 58. 
 
 " not incompatible with ulcor- 
 
 ations, 89.
 
 
 1G8 
 
 INDEX. 
 
 Fecundation, tendency to in the scrofu- 
 lous, 76. 
 
 Fimbriated extremity, inflammation of, 
 100. 
 
 " deformity of, 100. 
 
 " " misplacement, luO. 
 
 Forceps polypus, 128. 
 
 Frigidity, 48-111. 
 
 Free-martins, 107. 
 
 is. 
 
 Galvanism, 134. 
 
 Genitals, secretions from female, 32. 
 Gleet a cause of sterility, 59. 
 Gonorrhoea a cause of sterility, 59. 
 
 Hydatids, uterine, 72. 
 
 " " removal of, 137. 
 
 Hymen, varieties of, 60. 
 imperforate, 61. 
 treatment of, 117. 
 small orifice in, 61. 
 
 " " " division of, 117. 
 unusually strong, 61. 
 removal of, 118. 
 Hypertrophy of uterus, 96. 
 " " os uteri, 96. 
 
 " " " treatment of, 
 
 142-144. 
 
 I. 
 
 Impotence, 69. 
 
 Impregnation, seasons of in animals, 15. 
 " " " women, 16. 
 
 Inflammation of os and cervix, 75. 
 Iodine, 140. 
 
 Labia, adhesions of, 60. 
 Leeches to os uteri, 143-158. 
 
 " " " danger from, 143. 
 Leucorrhoea, 79. 
 
 " its hereditary tendency, 89. 
 
 " character of os in, 95. 
 
 Leucorrhceal discharges, 60. 
 Lichen of os uteri, 76. 
 Ligatures, varieties, 122. 
 
 " of silver wire, 128. 
 Lotions, 140. 
 
 M. 
 
 Man in his first estate, 37. 
 Masturbation, 111. 
 Menstruation in animals, 17. 
 
 " character of, 27. 
 
 " without external evidence, 
 
 28. 
 Mercurialization, its effects, 59-112. 
 
 N. 
 
 Neuralgia of the uterus, 104. 
 
 " " " treated by chloro- 
 
 form, &c., 120. 
 
 0. 
 
 Os uteri, abrasions of, 85. 
 ' anatomy of, 23. 
 
 ' excisions of, 142. 
 
 ' fissures of, 90-143. 
 
 ' issues upon, 142. 
 
 ' strictures of, 143. 
 
 Ovary, 30-103. 
 
 ' acute inflammation of, 103. 
 ' chronic inflammation of, 104. 
 ' atrophy of, 103. 
 ' malformations, 103. 
 ' passage to and from vagina, 50. 
 Ovisacs, 29-39. 
 Ovula? nabothii, 72. 
 Ovum, its character, 21. 
 
 " passage through Fallopian tubes, 
 56. 
 
 P. 
 
 Passion, venereal, absent, 49. 
 
 " " excessive, 111. 
 
 Peculiarities, mental, 109. 
 Penis, its magnitude a cause of barren- 
 ness, 58. 
 
 " " " a cause of divorce, 58. 
 
 Phosphorous, 160. 
 Phthisis, developed by uterine dis 
 
 ease, 89. 
 Pinguidity, U>5. 
 Polypi of uterus, 69. 
 
 " vesicular, 70. 
 
 " of Fallopian tube, 101. 
 
 " removed by ligature, 128. 
 
 " " forceps, 128. 
 
 . " " caustics, 130.
 
 INDEX. 
 
 I 
 
 169 
 
 Polypi removed by curette, 130. 
 " ' " excision, 132. 
 
 " " galvanism, 134. 
 " " ecrasseur, 124. 
 " little haemorrhage from excision 
 
 of, 132. 
 Potassa fusa, 139. 
 
 " cum calce, 139. 
 " ferrocyanuretum, 139. 
 Precocity of development, 115. 
 Pregnancy period, if possible, 115. 
 
 Raspberry os, 84-88. 
 
 Rectum, tumors in, 65. 
 
 Reproduction, in what it consists, 14. 
 
 Rickets, 120. 
 
 Rheumatism of uterus, 104. 
 
 S. 
 
 Scarifications of os, 142. 
 Scrofula, evidenced by uterine suscepti- 
 bilities, 77. 
 
 Secretions of female genital organs, 32. 
 Sexes, distinct in all nature, 14. 
 " produced at will, 19. 
 " proportion of the, 21. 
 Sexual intercourse, inordinate, 94. 
 " appetites, absence of, 49. 
 " intercourse not contraindicated, 
 141. 
 
 " excessive, 111. 
 
 Skin, diseases of, analogued on cervix 
 
 uteri, 75. 
 Sounds, uterine, 145. 
 
 " difficulty in using, 151-158. 
 Speculum, new form, 138. 
 
 " treatment with, 138. 
 
 value of, 74. 
 " of os uteri, 92. 
 Sperm, 40. 
 Speimatozoa, 41. 
 
 top of, 44. 
 
 possessing instinct, 49. 
 activity commences, 47. 
 entering ovum, 47-53. 
 how destroyed, 81. 
 Spermatic filament, 43. 
 
 " fluid, composition, 40. 
 
 " without spermatozoa, 95. 
 Sponge Tents, 146. 
 Sterile, peculiarities of the, 109. 
 " proportion of, 21. 
 
 Stricture of Fallopian tubes, 99. 
 
 treatment, 155. 
 ' " os uteri, 96. 
 
 " " treatment, 145. 
 " vagina, 64. 
 
 " treatment, 120. 
 Supporter, uterine, 124. 
 Syphilis, its effects, 59. 
 Syphilization, 111. 
 
 treatment, 161. 
 Syringe, uterine, 156. 
 
 T. 
 
 Tumors in Fallopian tubes, 102. 
 " " abdomen, 102. 
 
 " urethra, 121. 
 
 " removed by ligature, 122. 
 " by knife, 122. 
 " by caustic, 122. 
 Twin birth, female sterile, 107. 
 
 Ulcerations of os and cervix, 83. 
 
 " treated, 137. 
 
 Uterus, anatomy of, 23. 
 
 absence of, 109. 
 
 " canal, 24. 
 
 muscular character of neck, 26. 
 
 malposition of, 64. 
 
 ulceration of cervix, 88. 
 
 laceration " " 96. 
 
 prolapsus, 64. 
 
 flexions and versions, 67. 
 
 hypertrophy of, 64. 
 
 falling of, 64, 82. 
 
 ossified, 98. 
 
 obliteration of cavity, 155. 
 
 catarrh of, 154. 
 
 injections into cavity, 154. 
 
 pain relieved by anaesthetics, 121. 
 
 secretions from, 80. 
 
 disease of, 78. 
 
 " symptoms, 78. 
 
 stricture of os, 96. 
 
 mouth of, opens at congress, 48. 
 " " menstruation, 48. 
 Utricle, primordial, 35. 
 
 V. 
 
 Vagina, passage from, to ovary, 50. 
 " secretions of. 80. 
 
 secretions of, 80.
 
 170 
 
 INDEX. 
 
 Vagina, malformation of, 66. 
 
 ' inflammation of, 120. 
 
 ' absence of, 60. 
 
 ' obliteration of, 59. 
 
 ' contractions of, 62. 
 
 ' stricture from wounds, 63. 
 
 * " " labor, 64. 
 
 1 " treatment, 120. 
 
 ' sensitiveness of, 120. 
 Versions, character of, 67. 
 
 " treatment of, 123. 
 Vesicles, 33. 
 
 " a type of vitality, 34. 
 
 " fissiparous, 36. 
 
 " gemmiparous, 36. 
 
 Vesicles, germinating, 34. 
 
 " fertilizing, 41. 
 
 " subdivided, 38. 
 
 " union of germinating and fer- 
 tilizing, 53. 
 
 " duties of, 57. 
 Villi, enlarged, 87. 
 Virility at advanced age, 59. 
 
 W. 
 
 Wolfian bodies, 51. 
 Womb. See Uterus. 

 
 DE Wrrr & DAVENPORT with pleasure aimouuce that they have in 
 press and will issue as soou as possible a work by the author of STERI- 
 LITY, entitled : 
 
 ABORTION AND MISCARRIAGE. 
 
 THEIR CAUSES, EFFECTS UPON THE CONSTITUTION, AND METHODS OF 
 ARRESTING, 
 
 With Wood-cuts and Colored Lithographs. 
 
 This work will be issued, in paper, typography and illustration in 
 all respects equal to the present work. The author having devoted 
 much time and thought to this subject one of great importance and 
 heretofore but imperfectly treated upon in American medical literature 
 it is confidently expected that a large edition will be required. Orders 
 from physicians and others, for single copies, remitting the retail price 
 (for which see future announcements), will be early supplied through 
 the mail, postage paid. 
 
 THE PUBLISHERS have also to announce the speedy publication of 
 W. TYLER SMITH'S NEW WORK 
 ON OBSTETRICS, 
 
 now in course of publication in London. The work will be issued as 
 soon as possible after its completion, and will, in mechanical execution, 
 compare most favorably with the English edition. It will constitute 
 a volume of about 400 pages with two hundred Wood-cut Illustrations, 
 forming the most valuable and most fully illustrated work upon this 
 subject ever published in any language. The completed portion evinces 
 a niceness of description and an accuracy in detail that will commend 
 it to every educated physician. Not only is it a clear and logical 
 work for the student, but its originality, its able resume of the most 
 modern views upon every branch of practical obstetricy, such as the use 
 of anaesthetics, the treatment of placenta praevia, of puerperal convul- 
 sions ; together with the collateral branches of the microscopical appear- 
 ance in the growth of the fetus, in the changes in the uterus, the pla- 
 centa, the mamma &c. (comprising the accepted views of Lee, Simp- 
 son, Murphy, Dubois, Cazeaux, Chailly, Coste, Channing, Meigs, 
 Francis), will render it the most comprehensive work extant and one 
 eminently worthy of the attention of old practitioners of medicine, and 
 indeed of all who wish to be " up " to the most modern views of the day. 
 In order to render the work still more complete, the Publishers 
 have engaged Dr. A. K. Gardner to undertake the editorial supervision 
 of the volume, who will enrich it with notes, emendations, and additional 
 illustrations, both wood-cut and colored lithographs, drawn from his 
 extensive personal experience.
 
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 JO !K3HiV3>!i 3AUVWO QNV S3SMO 
 NOUI03 '311U 
 
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 WP570 
 
 G226c 
 
 1856 
 Gardner, Augustus K 
 
 Causes and curative treatment 
 of sterility. 
 
 WP570 
 G226c 
 1856 
 
 Gardner, Augustus K 
 
 Causes and curative treatment of 
 
 sterility. 
 
 MEDICAL SCIENCES LIBRARY 
 
 UNIVERSITY OF CALIFORNIA, IRVINE 
 
 IRVINE, CALIFORNIA 92664
 
 ii