Infertility

“ The signs of delivery that are well marked at the full period, the general symptoms then obtaining, the size of the uterus, ascertained by the hand and sound, lacerations of the perineum and cervix, the lochia, the state of the breasts, abdomen, vagina, and vulva, all of little value except in conjunction with each other, are proportionately less defined as we go back, until near the commencement of pregnancy it becomes impossible to distinguish the abortion from severe hemorrhage or from menorrhagia, unless by detecting the impregnated ovum. ”

“ The comparative growth of the fœtus infinitely surpasses that of its whole future existence. But the exact age of uterine embryos, and of abortives, is, in some degree, conjectural. Before the seventeenth day after conception, its rudiments are not even visible to the naked eye: the glary ovum has then slidden down from the ovarium, through one of the lateral tubes into the womb. The size of an abortion, comprehending the fœtus, its membranes, waters, and placenta, at the end of six weeks, does not exceed in size that of a pigeon’s or hen’s, and in three months, a goose’s egg. ”

“ Not only do women become sterile in consequence of a miscarriage, and then, longing for offspring, find themselves permanently incapacitated for conception, but, in other cases, impregnation, or rather the attachment of the ovum to the uterus, being but imperfectly effected, or the mother's system being so insidiously undermined, the children that are subsequently brought forth are unhealthy, deformed, or diseased. ”

“ Chronic inflammation of the vagina also gives rise to acrid secretions, which destroy the vitality of the spermatozoa. Suppression of the menses, or any disorder of the uterine functions, may disqualify the female for reproduction. Flexions of the uterus, displacements, congestions, and local debility, may likewise prevent fertility. Sterility may result from impaired ovarian innervation or undue excitement of the nerves, either of which deranges the process of ovulation. Even too frequent indulgence in marital pleasures sometimes defeats conception. ”

“ Normal Course.—We have already delineated the normal course of abortion at this period. The death of the embryo has usually preceded, often for weeks, and is characterized by the feeling of pelvic congestion, gastric and vesical irritation, weariness, weakness, and increase of uterine and vaginal secretion; the membranes have developed more or less; expulsion is inaugurated by hemorrhage. If the cause be more violent, the flow of blood is free. Usually there is but a slight oozing, which ceases at times, but gradually increases; the suffering which accompanies uterine contraction is present. ”

“ I’m a physician, practicing obstetrician and gynecologist, and I think I’ve had a passing experience in matters of abortion. Now, when I was a medical student, in 1949, we had no such science as fetology. We were taught that the unborn child—the fetus—was something in the uterus, but it was really an article of faith as to whether or not it was a human being, and whether or not that human being had any unique, personal qualities. ”

“ But then, again, there are some rare cases who have menstruated throughout their pregnancy, and also cases where menstruation was never established and pregnancy occurred. Nevertheless, the non-appearance of the period, with other signs, may be taken as presumptive evidence.
5. "ARTIFICIAL IMPREGNATION".—It may not be generally known that union is not essential to impregnation; it is possible for conception to occur without congress. All that is necessary is that seminal animalcules enter the womb and unite there with the egg or ovum. ”

“ In these cases the fœtus is found outside of the Womb, in the Tube, or the Ovary, or even in the Abdomen, among the intestines. Such an occurrence seems to render it almost certain that the ovum must have been fecundated in the Ovary, because we cannot well conceive, if it were not so, how it could reach the outside of the Womb. This difficulty is not, however, regarded as insuperable, by the advocates of the opposite theory. Possibly conception may occur in both ways.
There are many causes which prevent conception, or, in other words, which produce barrenness and [56] sterility. ”

“ Here it may be met by the male life element, and if so, it becomes fertilized and remains in the uterus to grow into a baby. This is called fertilization, fecundation, impregnation or conception. But if the egg is not fertilized, [Pg 12] it passes from the uterus through the vagina and out of the body. The ovaries take turns in developing the ovum.
Every twenty-eight days or so a woman, from the time she is about thirteen or fourteen till she is about fifty, has a slight flow of blood from the uterus, which is called menstruation. ”

“ Look at the figure of the fœtus in this Ovum, see how its growth has been checked!—In size it represents an embryo scarcely five weeks old—yet 20the Ovum came away at four months and a half from a patient whom I was engaged to attend in her confinement. Examine the cord; it is like the amnionic vessels, distended with florid blood.
REMARKS. In the knowledge of the doctrine of abortion and the treatment of it, a preparation like the present is of infinite value. ”

“ There is some uncertainty respecting the exact length of the period of gestation, which grows out of the difficulty of determining, in many cases, the exact time when conception takes place.
Uterine Life.—The uterine life of the new individual begins with the impregnation of the ovum, which occurs the instant it is brought in contact with the zoösperms of the male. While in the uterus, the young life is supported wholly by the mother. She is obliged to provide not only for her own sustenance, but for the maintenance of her child. ”

“ In one point of view, more especially, is the present diseased Ovum particularly interesting to me; for it exhibits the most distinct proof that what I call the cortex of the Ovum, and which others have, without direct evidence, considered as a membrane of the uterus, is, in good truth, a natural covering of the Ovum. It is this very natural covering of the Ovum which is liable, from disease, to become fleshy, opaque, vascular, and lastly coriaceous, thereby cutting short the supply, or accretion of substance to the fœtus, and thus destroying its life and producing abortion. ”

“ That the embryo probably lives in utero in virtue of its own life-principle, even through the entire period of gestation, (51, 56, and 58,) is rendered probable by many facts related by unimpeached authorities, which go to prove that when the whole intact Ovum has been expelled at an advanced period of gestation, or at the natural termination of that period, the fœtus has continued to live, and the circulation of the blood has not ceased for an instant during a space of time of from nine minutes to a quarter of an hour. ”

“ The pain becomes so great and the reflex symptoms are so aggravated that finally the woman resorts to the only relief,—an operation for the removal of the tubes.
When we consider that the ovule, the human egg, must travel through these tubes to reach the uterus and, if they are destroyed, has no other way of reaching the womb and, if it cannot reach the womb and be impregnated, cannot develop into the babe, then we realize how this disease is dooming women to childless lives,—women whose natural instincts and desires cry out for motherhood. ”

“ In the normal course of nature the living embryo carries on its work of self-evolution within the maternal womb, deriving its nourishment from the placenta through the vital cord, till, on reaching maturity, it is by the contraction of the uterus issued to lead its separate life. Abortion is a fatal termination of this process. ”

“ Any thing that enfeebles the functional powers of the system is liable to disqualify the female for reproduction.
Treatment. An extensive observation and experience in the treatment of sterility, convinces us that, in the majority of cases, barrenness is due to some form of disease which can be easily remedied. If the passages through the neck of the uterus be closed or contracted, and this is the most frequent cause of sterility, a very delicate surgical operation, which causes little if any pain or inconvenience to the patient, will remove the impediment to fertility. ”

“ The stimulus of the sperm so pent up causes that ovary to mature a germ, although it may do so slowly, and after two or three months it is perfected, fertilized, and a second conception occurs within the uterus. If each embryo observe a regular period of growth and each be born at maturity, there must be an interval of two or three months between their births. But it is far more common for the parturition of the first, displaying signs of full maturity, to coincide with the birth of a second which is immature and which cannot sustain respiratory life. ”

“ The danger to the mother is from hemorrhage before the expulsion of the embryo, and from retention of membranes after the fetus is born. These decaying in the uterus, the poison is absorbed into the system and septicæmia is the result.
The causes of abortion, both remote and exciting, [Pg 244] are numerous. Any diseases of the womb that take away its vitality or prevent its enlargement will result in death of the fetus. Any general disease or condition of the system that results in weakness or feebleness may make the continuance of life in the embryo impossible. ”

“ The fact, therefore, is now scientifically established that the embryo from the first moment of conception or fecundation is a human being, having a human immortal soul.
II. Now we come to the direct study of abortion. Abortion, or miscarriage, strictly means the expulsion of the fœtus before it is viable, i.e., before it is sufficiently developed to continue its life outside of the maternal womb. The period of arrival at viability is usually after the twenty-eighth week of gestation. ”

“ The Ovum.—Pathological changes of the ovum itself, of the embryo, of the surrounding membranes are less frequent as primary causes of abortion, and they are of less importance to the practitioner as being in no way amenable to treatment. When they do occur they usually lead to expulsion in the earlier months.
Those conditions liable to lead to abortion are especially diseases of the [p. 490] chorion, placenta, and umbilical cord, rarely of the amnion, the embryo itself, or the amniotic fluid. ”

“ Impotence and sterility may arise from organic or from functional causes, and may be curable or incurable. Impotence (q.v.) is taken cognisance of by the law courts as a ground of divorce, and might, of course, be urged as a defence in a case of rape. Sterility is not a ground of divorce, but might be a question of importance in cases of legitimacy.
6. Pregnancy.—This subject presents one of the widest fields for medico-legal evidence. The limits of age between which it is possible, the limits of utero-gestation, and the signs of pregnancy may all in turn be the subjects of investigation. ”

“ Conception Soon After a Preceding Pregnancy.—Conception sometimes follows birth (or abortion) with astonishing rapidity, and some women seem for a period of their lives either always pregnant or with infants at their breasts. This prolificity is often alluded to, and is not confined to the lower classes, as often stated, but is common even among the nobility. Illustrative of this, we have examples in some of the reigning families in Europe to-day. A peculiar instance is given by Sparkman in which a woman conceived just forty hours after abortion. ”

“ After all that has been said, our opinion in a case of supposed impregnation must, in the earlier stages, be formed from a review of all the circumstances appertaining to the condition of the uterus, ovaria, and fallopian tubes; and should these present such appearances as they usually assume in pregnancy, and 72the condition of the mammæ should at the same time agree with them, the proof is strongly presumptive; although it must fall short of the demonstration which the actual inspection of the ovum in utero can alone afford. ”

“ To understand the physical effects of abortion we must know something of the causes, which are in the main the same as the causes of miscarriage and premature delivery. Abortion may be due to pathological changes in the ovum, the uterus, or its adnexa—one or both ”

“ I support the affirmative by appealing to all those of the profession who have had occasion to be consulted in cases of abortion and the expulsion of those singular productions of the uterine cavity, which seem connected with menstruation or faulty conception. Let them say whether a work, in which the principal of the infinitely varied aborted human ova, and of the uterine productions alluded to, are faithfully represented, be not likely to be useful ”

“ TERMINATION.—Dangers of Abortion.—Though fatal results are rare and, when occurring, due to sepsis rather than to hemorrhage, much of female suffering is traceable to this accident, the pathological interruption of pregnancy. Uterine and pelvic disease, especially subinvolution and consequent displacement, diseases of the endometrium and cervical tissue, result from abortion; sterility as well—all diseases which leave their traces indelibly marked upon the system of woman. ”

“ In the next place, I mention that one abortion paves the way for another, because, setting other circumstances aside, it gives the uterus a tendency to stop its action of gestation at an early period after conception, and therefore it is difficult to make a woman go to the full time, after she has miscarried frequently. ”

“ When conception occurs, still more extensive changes ensue, the fertilized ovum becoming imbedded in the uterine mucous membrane, and the pregnant uterus, in shape and structure and in the respective relations of the body and neck of the organ, in the increasing distension of its veins and the increasing size of its nerves, becoming adapted to the important functions it has now to fulfil. When these have been fulfilled, and, parturition having taken place, the uterus is empty once more, the organ again adapts itself to altered circumstances by the process of involution. ”