Chapter XIV: Introduction (2)

The phenomena of puberty depend, in both sexes, upon the developement of the generative organs; for whenever this is prevented, or only imperfectly produced, a corresponding character is impressed upon the individual, as we see so well exemplified in the appearance of eunuchs[281]. In females, however, the uterus does not appear to be the essential organ which impresses the sex with its distinctive peculiarities: _Van Helmont_ has said “_Propter solum uterum mulier est, id quod est_”——but Dr. _Caillot_ has shewn in the second volume of the _Medical Society of Paris_ that a woman may grow up with all the external appearances and attributes of her sex, and yet have no uterus; numerous cases of a similar kind are upon record, to some of which we shall have occasion hereafter to allude: the same facts do not hold good in relation to the _Ovaria_; their developement, like that of the testicles in the male, seems to be absolutely essential to the perfection of the sex. A very interesting case,[282] in illustration of this truth, is afforded by Mr. _C. Pears_; in which account all the characters belonging to the female after puberty were absent; her breasts never enlarged, she never menstruated, no hair appeared on the pubes, and she died at the age of twenty-nine; when upon dissection the _Ovaries_ were found wanting; the _os tincæ_ and uterus had their usual form, but never increased beyond their size in the infant state.

JUVENTUS—_Youth_.—This succeeds to adolescence, and in its turn is replaced by manhood. If the law does not acknowledge this stage of life, it at least tacitly allows it, as being the one best adapted for the vigorous discharge of public duties; it is the age at which the greatest enterprizes have been achieved, and the most brilliant efforts of human genius fulfilled; the developement of the body having been accomplished, its powers are expanded in the production and support of intellectual energies. The action of the arterial system may be said to predominate over every other, and hence the diseases to which man is exposed in this stage of his existence are of an acute and inflammatory character. To the common observer his march of life would seem to be arrested, little material change, either of a moral or physical nature, is discernible from the age of twenty-five to thirty-five; and this period may therefore be said to occupy a part of the second great division of Aristotle to which we have alluded (the period of _Perennity_.)

ÆTAS VIRILIS—_Manhood_. Youth passes into manhood by such insensible shades of gradation, that it has been considered as only a continuation of the same stage of perennity; and yet we shall find that the change from one to the other is sufficiently striking to entitle them to distinct places in the scale. Hippocrates and Galen have compared youth to the summer, and manhood to the autumn, thus insinuating that if one be less fervent, it is yet more mature than the other; and this is certainly morally and physiologically true; for although the imagination loses much of its glowing fervour, its dominion is succeeded by that of a maturer judgment; the arterial system no longer predominates over every other, its energies have been reduced, and a juster equipoise established; the diseases, therefore, to which he is liable assume a different aspect,[283] and maladies of a chronic character prevail, and thus while in the apparent plenitude of his existence is he fast journeying to his destined goal;[284] man never stands still, he is either progressing to the zenith of his strength and vigour, or he is declining from it; in vain shall we attempt to cast our anchor in the stream of life, it will alike carry away those who struggle against it, and those who yield quietly to the force of the current; the panaceas and boasted elixirs, and the many other means which have been proposed to renovate the body, are as chimerical, says Buffon, as the fountain of youth is fabulous.

SENECTUS—_Old Age_. The system has now undergone a considerable change; its bony framework has acquired increased solidity and density; the vascular system is greatly abridged in the extent and subtlety of its ramifications; the muscles become less irritable, their fatty matter is absorbed, the cellular structure collapses, and the whole volume of the body diminishing.

“—The sixth age shifts
Into the lean and slippered pantaloon;”

The skin also wrinkles, particularly in the forehead and face; the hair turns grey, and afterwards white; all the senses lose their acuteness, the heart and arterial system are diminished in force; while the venous system is in a state of plethora; and hence this stage of life is exposed to diseases of a peculiar cast: the blood-vessels are also liable to ossific depositions, from which apoplexy, and various affections of the heart and other organs, arise; the faculty of reproducing the species ceases long before the natural termination of his existence, although the period at which his organs fail is more precarious and less definite than that at which they commenced their functions.

Woman, in relation to her powers of propagation, may be said to anticipate the male sex in her advancement to old age; at the period of forty-five or fifty, the menstrual discharge ceases, and a change is produced in the system, called the _turn of life_, which renders women at this age subject to many diseases to which a great number fall victims; but when this dangerous time has passed, their life is even more secure, and a probability exists of its being protracted beyond that of a man of equal age; and although the breasts become flaccid, the fleshy contour of the body diminishes, and the skin forms wrinkles, yet her mental powers retain their full vigour for a considerable period, and her decline into the vale of years is distinguished by a steady cheerfulness which contributes, in no small degree, to divest the path of its thorns, if not to prolong its duration.

DECREPITUDO—_Advanced Age_. At length the limbs fail under the burthen which for so many years they had sustained with ease; the exterior muscles gradually return to that state of debility in which they were during infancy, and being unable to sustain a continued state of contraction, relieve themselves by alternate intervals of relaxation, from which arise the tremors[285] so characteristic of old persons; upon the same principle is to be explained the _Vacillatio Senilis_, (see-saw) for by these motions the muscles which preserve the perpendicularity of the body, are alternately quiescent, and exerted; and are thus less liable to fatigue or exhaustion.[286] The teeth having successively dropped out of their sockets, the alveolar processes are absorbed, and the projection of the lower beyond the upper jaw, imparts a very peculiar physiognomy to the countenance.

“Last scene of all,
That ends this strange eventful history,
Is second childishness, and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.”

2. OF IMPOTENCE AND STERILITY.

1. _IMPOTENCE._

IMPOTENCE, or the incapacity of sexual intercourse, and STERILITY, or the inability of procreation, are subjects which frequently become questions in the Ecclesiastical Courts, as relating to the performance and dissolution of the marriage contract; and as medical evidence is generally required upon such occasions, the subjects necessarily present themselves for discussion in the present work.

IMPOTENCE may exist either in the male or female. STERILITY is confined to the female, for if the male be proved capable of accomplishing the act of coition, no farther question can arise as to his virility.

Impotence may be _Absolute_ or _Relative_, that is to say, the parties may be incapable of cohabiting with each other, and yet they may each accomplish the venereal congress, and enjoy a fruitful intercourse with others; it may also be _functional_ or _organic_, and depend either upon _physical_ or _moral_ causes; and hence in some cases it may be _temporary_, in others _permanent_, and upon this point the evidence of the medical practitioner will be always very essential. It is therefore important that we should proceed to investigate the subject in its various relations to those different causes.

1. _Organic Causes of Impotence._

IN MALES.

There was a period in the history of physiology, when the testicles were not considered essential to virility. Aristotle was led to such a conclusion from having observed that a bull was capable of impregnating the female after castration; a fact which depended upon the quantity of semen, retained in the _vesiculæ seminales_, conferring fertility upon a _coitus_ which took place immediately after the operation. The true theory of the functions of the testicles having been thus abandoned, it was necessary to substitute some other explanation of their use, and the Naturalist of Stagira has accordingly asserted, that they merely serve as weights to hinder the spermatic vessels from being folded up; an hypothesis which, absurd as it is, has found advocates in the later schools; and in its support we shall find many experiments and cases related by _Marchetti_ of Padua.[287] _Sabbatier_[288] observes, that subjects have been found who have only possessed one testicle, and what is more extraordinary, that there are others who although entirely destitute of these organs, have exhibited the other parts of generation in their natural state; in proof of which _Cabrolio_ mentions the case of a soldier addicted to sexual pleasures, in whose body no testicles were found, although the _vesiculæ seminales_ were distended with semen. _Scurigio_[289] and _Lieutaud_[290] refer to the same case; upon which _Portal_[291] very justly observes, that the soldier was doubtless furnished with testicles, but which, from their unnatural situation, probably escaped the notice of _Cabrolio_. The extraordinary situations in which the testicles may be found are fully detailed by _Rinlaender_;[292] their absence from the scrotum does not necessarily imply impotence; they are formed in the cavity of the abdomen, and until the sixth month, lie immediately below the kidneys on the fore part of the Psoæ muscles, after which period they gradually descend towards the abdominal ring, through which they generally pass into the scrotum before birth; but it occasionally happens that this descent, in regard to one or both testicles, does not take place until a late period, and in some instances they remain within the cavity of the abdomen during life;[293] in such a case, a question has arisen as to the virility or impotence of the individual so situated, and upon which medical opinion would seem to be still unsettled. _Foderé_ states that such persons have even been remarkable for their vigour; for these organs, says he, appear to derive greater power of secretion from the warm bath in which they lie, than when they have descended into their natural situation. Mr. _John Hunter_ has given a very different opinion, and one which appears to be more compatible with the sound doctrines of physiology; he believes that when both testicles remain through life in the belly, they are exceedingly imperfect, and incapable of performing the natural functions of these organs; and that it is such imperfection in structure which prevents the disposition for their descent taking place; an opinion in which _Zacchias_ and _Riolan_ entirely concur. Mr. _Wilson_[294] observes that he is acquainted with one case that confirms, and another that would to a certain degree refute this opinion; and this is probably the true state of the question; each case must rest upon its individual merits, and the practitioner, whose opinion is desired upon such an occasion, must carefully inquire into every moral and physical circumstance that can, collaterally, assist his judgment; such as the general appearance, _soprano_ voice, and effeminate physiognomy, of the individual, “_frustra enim ætas advenit, si testes defuerint; manebit enim etiam virili ætate fæminæ similis_.”[295] But the absence of the testicles in the scrotum may depend upon other and less equivocal circumstances, they may have been removed by excision (_Eunuchs_), in which case there will be no difficulty in ascertaining the fact by the appearance of the cicatrix: or they may have been actually absorbed by an operation of Nature, after considerable inflammatory action. Mr. John _Hunter_[296] has given an account of three cases in which such a result occurred.

It does not appear that _two_ testicles are essential to virility, although the Parliament of Paris in 1665 decreed that the matrimonial contract should not be deemed valid unless _two_ testicles were evident; it is now generally admitted that persons with only one (_Monorchides_) are fully capable of procreation.

It has occurred to Dr. _Baillie_,[297] and other anatomists, to observe the testicles exceedingly small, “I have known,” says this distinguished pathologist, “one case in a person of middle age, where each of them was not larger than the extremity of the finger of an adult; this, as appeared from its history, arose from a fault in the original formation, and was attended with a total want of the natural propensities.” Mr. _Wilson_,[298] on the other hand, relates a case that would induce us to pause before we pronounced judgment on such an occasion: “I was,” says he, “some years ago consulted by a gentleman, on the point of marriage, respecting the propriety of his entering that state, as his penis and testicles very little exceeded in size those of a youth of eight years of age. He was then six and twenty, but never had felt the desire for sexual intercourse until he became acquainted with his intended wife; since that period, he had experienced repeated erections, attended with nocturnal emissions; he married, became the father of a family, and these parts which at six and twenty years of age were so much smaller than usual, at twenty-eight had increased nearly to the usual size of those of an adult man.”

The structure of the testicle may be defective; Mr. _John Hunter_ has given a representation,[299] in his work on the Animal Œconomy, of a case in which the _Epididymis_, instead of passing to a _Vas deferens_, terminated in a cul-de-sac; with such a structure it is evident that the semen cannot be evacuated by the urethra, and that the individual must therefore be incurably impotent.

The structure of these organs may be so destroyed by a bruise, as to occasion impotence. This was formerly the mode adopted in the oriental courts for destroying masculine efficiency in the attendants of the Haram; and it is said that the Algerines, who are unwilling to castrate their horses, have recourse to this process, in order to render them incapable of procreation;[300] while it is well known that Park-keepers, who have the management of deer, annul the power of generating in bucks, by squeezing the testicles forcibly, and thus destroying their organization and secerning faculty.[301] Atrophy and wasting of the testicles may also result from local injury; Dr. _Pihorel_[302] relates an interesting case of this kind that occurred to an old soldier.

The body of the testicle is liable to many diseases, by which its structure becomes so changed, and its delicate organization so obliterated, that its secreting powers are entirely lost, such as schirrus, cancer, scrofula, &c. but we are to remember that such affections, if confined to one testicle, are not to be considered as affecting the virility of the party. M. _Larry_, Inspector General of the French Army, informs us that a disease which he calls _Atrophy of the Testicles_ seized many of the troops in their return from Egypt; by which these organs became soft to the touch, and gradually diminished in size, without any pain; and it is well known that persons who are afflicted with _Elephantiasis_ lose all sexual appetite, and that their genitals waste.

An organic fault similar to that which we have described, as relating to the _Epididymis_ of the testicle, sometimes occurs in the _Vesiculæ Seminales_, where instead of entering the urethra, they terminate, after being joined by the _Vasa Deferentia_, in imperforated pouches, or cul-de-sacs, producing incurable impotence. In some cases the spermatic chord becomes varicose, and is followed by loss of power.

The most common malformation connected with the penis is the unnatural situation of the orifice of the urethra; sometimes it opens in the perinæum, occasionally on the dorsum of the penis, and frequently underneath. Mr. _John Hunter_ was consulted by a person, who expressed great anxiety to have children, but whose urethra opened into the perineum, he therefore recommended him to inject by means of a syringe, previously warmed, the semen into the vagina, _post coitum_, and during the existence of the orgasmus venereus; the wife, it is said, became pregnant, and Sir E. _Home_ observes, that no doubt was entertained by Mr. _Hunter_, or the husband, that the impregnation was entirely the effect of the experiment. It would appear that _emissio seminis in vaginam_ is in some cases all that is required for impregnation, and therefore provided the orifice of the urethra be situated in a part of the penis that enters the vagina, any unusual deviation in its direction may not be material; nay farther, in some instances _emissio sine penetratione_ has appeared sufficient;[303] many cases are recorded in which the hymen was entire at the time of delivery;[304] and Dr. _Huxham_[305] relates an instance of pregnancy, where from the preternatural formation of the female genital organs, it was impossible that the act of copulation should ever have been completed. A contracted state of the Prepuce, or _Phymosis_, may so interfere with the discharge of the seminal liquor, as to constitute a cause of impotence, (_Dyspermatismus Præputialis_, Culleni) an operation, however, will always in such cases remove the impediment.[306] By some authors the undue dimensions of the penis have been classed under the causes of impotence, but upon this point we would observe that the case already cited from Mr. _Wilson_, p. 201, clearly shews that exception ought not to be taken against mere diminutiveness[307] of structure; extraordinary dimensions in length and thickness may certainly prove a cause of _relative_ impotence; there are besides certain enlargements in the neighbouring organs which may afford obstacles to the venereal congress, as remarkable obesity,[308] scrotal hernia, and hydrocele.

It has been a question to what extent the penis might be mutilated, without the extinction of virility: repeated instances have occurred where the _glans_ has been lost, and yet the individual has retained his faculty of procreation. _Piazzoni_[309] relates a case where both the _corpora cavernosa_ were destroyed, but as the canal of the urethra was preserved, the person could perform the act of coition without difficulty. _Franck_[310] also states an instance in which so considerable a portion of the penis had been carried away by a musket shot, that when the wound healed, the organ remained curved, and yet it proved adequate to the performance of its functions.

A Paralysis affecting the muscles of the penis is not a disease of very rare occurrence; it may depend upon various injuries of the nervous system, and while it remains, it is unnecessary to say that the penis is incapable of performing those sexual functions for which it is constructed, constituting the _Anaphrodisia Paralytica_ of Dr. _Cullen_. The continued erection of the penis (_priapism_) is sometimes the result of morbid irritation,[311] and occasions a temporary impotence, (the _Dyspermatismus Hypertonicus_ of _Cullen_) in consequence of the urethra being so closely shut up by the vigour of the erection, that the powers which throw the semen from the _vesiculæ seminales_ are unable to overcome it; gentle evacuations and a slender diet are the best remedies in such a case. Strictures in the urethra, or morbid affections of the prostate glands, may occasion a similar inconvenience, (_Dyspermatismus Urethralis_) and we perhaps ought to enumerate extreme costiveness under the same division of the subject.

IN FEMALES.

Adhesion of the Labia may take place in adult women from inflammation; in consequence of which the due secretion of mucus with which these parts are naturally clothed on their internal surface is prevented; or it may arise from the neglect of accidental excoriation. In children the labia frequently cohere in such a manner as to leave no vestige of a passage into the vagina, except at the anterior part for the discharge of urine; the disease, whenever it may occur, is easily and safely removed by the knife.[312] In some cases hard labour has given rise to preternatural union of the labia.[313]

In cases of ulceration, where due care has not been taken to prevent the surfaces from remaining in contact with each other, the opposite sides have adhered so as to obliterate the passage; Schirrous and steatomatous tumours,[314] and polypi may also occupy the cavity of the vagina: in certain cases these may be removed with safety,[315] in others some hazard[316] will attend the operation. There is sometimes a faulty organization of the vagina itself, it may be too short, and too narrow,[317] (_Arctitudo_.) Inversion or Prolapsus is perhaps one of its most common diseases;[318] in some rare instances the passage has been obliterated by the _Clitoris_, elongated and enlarged in such a manner as to equal the size of the penis, when it constitutes one of those many peculiarities which have been mistaken for an Hermaphrodite.

The membrane called the _Hymen_ has been found of so strong and ligamentous a texture, that it cannot be ruptured, and consequently prevents venereal congress. Ambrose _Paré_ relates the case of a young woman, whose hymen was as strong as parchment, which he was obliged to cut with the scissars, before coition could be effected; a more recent case is recorded in which the density of the membrane was so considerable as to require the application of a trocar.[319]

With respect to the incompatible locality of the vagina, a malformation which occasionally occurs, it is only necessary to allude;[320] the medical judgment upon it must be directed by the circumstances of each particular case.

Where irritability of the sexual organs exists to such a degree as to occasion insufferable pain at the moment of coition, it must be regarded as a source of impotence.[321] It may depend upon various causes; Dr. _Cockburn_[322] relates a case of this kind which depended upon internal piles, and which was cured by their removal. Mr. Anthony _White_[323] has published three very interesting cases, in which the pain which accompanied the attempt at coitus was so acute, that the women rarely escaped fainting; upon examination he discovered in each of them a small fistulous opening, leading into a sinus of at least two inches and a half in length; the disease was attributed in each instance to a local injury having some years previously occasioned an abscess in those parts; the painful state of the vagina was entirely and permanently cured by dividing the sinus.

2. _Functional Causes of Impotence._

Repeated intoxication, and vicious indulgences, may so debilitate the constitution in general, and the organs of generation in particular, as to render the debauchee wholly incapable of venereal congress; such impotence however is not to be regarded as permanent; bark, steel, the cold-bath, and above all, a change of habits may restore the patient to the full possession of his powers. There is a peculiar species arising from debility which deserves some notice in this place; it depends upon a want of consent between the immediate and secondary organs of generation; thus the penis acts without the testicles, and becomes erected when there is no semen to be evacuated; while the testicles secrete too quickly, and an evacuation takes place without any erection of the penis. Under the consideration of constitutional causes, we must not omit to enumerate the occurrence of Epilepsy: there can be little doubt, but that in certain cases, the venereal orgasm has excited an attack of this disease, and prevented the consummation of the act; we are therefore bound to recognise it as an occasional cause of impotence, and Dr. _Cullen_ has accordingly considered it as forming a distinct species, under the title of DYSPERMATISMUS _Epilepticus_.

The operation of certain powerful narcotics may be likewise regarded as capable of producing impotence, and cases are recorded where impotence, so occasioned, has become permanent;[324] much credulity, however, has existed upon this subject; the anaphrodisiac powers of Camphor were long believed, and is one of the vulgar errors noticed by Sir Thomas _Brown_;[325] and Amurath the IVth published an edict which made smoking tobacco a capital offence: a measure which was founded on an opinion that it rendered the people infertile;[326] equally gratuitous are the different opinions which have been advanced respecting the aphrodisiac virtues of particular substances; one of which, from the extent to which it is believed, and the authority by which it is countenanced, deserves to be noticed on this occasion; we allude to the popular notion that a fish diet contributes to increase fecundity; and we are not a little surprised to see it sanctioned by such a writer as _Montesquieu_, who observes, that “the regimen of certain monks seems to be wholly repugnant to the intention of their founders.” The same belief is very generally entertained in fishing towns, in consequence of the great population of such places, but surely the fact admits of easy explanation upon that general principle in political economy, which no one will attempt to deny, that the number of marriages will be in proportion to the facility with which children can be supported.

A blow on the head may also deprive a man of his virility; a case of this kind is related by _Hennen_, in his Military Surgery, where a soldier became so affected in consequence of a fracture of the occipital bone, by the fragment of a shell.

3. _Moral Causes of Impotence._

A temporary impotence from certain emotions of the mind is by no means so rare an occurrence as may be supposed; and in times of superstition was generally attributed to the influence of some magical incantation; an opinion which was even maintained by _Zacchias_, _Teichmeyer_, and _Schurigio_, but which it is hardly necessary to add, has been reprobated by _Vogel_, _Cullen_, and all modern authorities. Where this occurs it is often productive of the greatest distress of mind, and has not unfrequently led the unfortunate sufferer to the commission of suicide. Mr. _Hunter_[327] has treated this subject with his accustomed sagacity, and relates a successful mode of treatment; he prevailed on a person in this situation to promise on his honour to pass six nights in bed with a young woman without attempting to have any connection with her, whatever might be his power or inclination; he afterwards assured _Mr. Hunter_ that his resolution had produced such a total alteration in the state of his mind, that the power of connection soon recurred, for instead of going to bed with the fear of inability, he went with fears that he should be possessed with so much desire, and so much power, as to become uneasy to him, which really happened; and having once broken the spell, his mind and powers went on together, and they never relapsed into their former state of imbecillity.

Disgust is also a frequent cause of temporary impotence “Morositas, Contemptus, Iræ, Tristitia, Corporis immundities ac fætor, venerem primario supprimunt.”[328] The imagination[329] is sometimes the cause of temporary impotence, with regard to particular females, as exemplified in the famous case of the _Earl of Essex_ and _Lady Frances Howard_, in 1613, in which the marriage was declared void, because the Earl, on his own confession, was impotent with regard to his lady, (_erga hanc_) although he had no defect or impediment, and was able to copulate with other women.

We have thus related the principal causes of Impotence in the sexes; it would be as idle to dwell upon the absurdity of the opinions which attach any weight to astral influence, as it would to refute the idea, that suggested the custom so universally observed by the Scythians, and which is even followed at this day by the natives of some of the South sea islands, of cutting the veins behind the ears, in order to render the males impotent, and the females sterile.

2. _STERILITY._

Sterility occurs more frequently in the female, than impotence does in the male sex.

Its causes may be distinguished into those that arise from imperfect structure, and into those that entirely depend upon a morbid performance of certain functions.

1. _Organic Causes._

_Absence of the uterus._ We have before alluded to this occasional defect; it has sometimes occurred, where the vagina has been wholly impervious.[330] _Columbus_ dissected a woman who had always complained of great pain _in coitu_, in whom he found the vagina very short, and no uterus at its termination. In _Hufeland’s_ German Journal[331] for May 1819, a case is related of a total deficiency of the uterus, which was discovered by Professor _Stein_ during an operation undertaken to remedy a supposed contraction; in this paper the author quotes several analogous cases from the writings of _Engel_, _Schmuker_, and _Theden_.

_Imperforated uterus._ The os uteri, says Dr. Baillie, has been found to be so contracted as to have its passage in a great measure obliterated; and it has even been known to be closed up by the growth of an adventitious membrane. The _os tincæ_ may be also shut up, either originally, or by cicatrix, in consequence of suppuration, laceration, ulceration, or the like, when the case may be considered as incurable, unless the menstrual discharge force a passage by its pressure, or the introduction of a trochar is able to afford an opening[332]. Original conformations of this kind seldom admit of any cure, for besides the impervious state of the _os tincæ_ it not unfrequently occurs that the uterus itself appears as a solid body, without any cavity in its centre.[333] _Morgagni_ states that he was consulted by a barren woman, whose vagina was only a third part of the usual length, and that its termination felt firm and fleshy, in which case he advised a dissolution of the marriage. _Marchetti_, on the contrary, has given a case where the vagina ran downwards beyond the internal orifice of the uterus, and terminated in a kind of cul de sac.

_Polypus in utero._ This may be sometimes removed by exsection; a valuable paper upon this subject by _M. Deguise_ is to be found in the _Nouveau Journal de Medicine_, entitled “Observations des Polypes Uterines,” in which the author relates many successful cases, and controverts the common opinion, that after the operation for an uterine polypus, the organ is incapable of being impregnated.

_Ovaria, absence of, or diseased condition of._ There is a specimen in Dr. Hunter’s museum, in which one ovarium is wanting; other instances have been recorded in which no vestige of an ovarium could be observed on either side.[334]. The case of this kind published by Mr. _Pears_ in the Philosophical Transactions for 1805, we have before described: to this may be added another instance from the writings of _Morgagni_. Instances of diseased ovaria are very common, and may arise from a variety of causes: the _Fallopian tubes_ may also, in consequence of peritoneal inflammation, become obliterated, and lose the power of conveying the ovum from the ovarium to the uterus; they may besides be originally defective in structure; Dr. _Baillie_ has seen them, without any aperture, or _fimbriated_ extremity, terminate in a cul-de-sac. _Morgagni_ noticed these tubes in some courtesans having been entirely obliterated by the thickening of their parietes; an evident consequence of the habitual orgasm in which they had been kept by too frequent excitement. _Richerand_ on dissecting a subject at La Charité that had been sterile, found the fringed margins, or expanded extremities of the tubes, adhering to the lateral and superior parts of the pelvis, so that it had been impossible for them to perform the motions necessary for fecundation.

2. _Functional Causes._

These are constitutional debility, leucorrhœa, or an excess, or deficiency of the menstrual discharge. Observation has fully established the fact, that women who do not menstruate cannot conceive; this discharge appears to be essentially necessary for the due and healthy state of the uterus, and Dr. _Denman_[335] has also observed that in cases of painful menstruation, a membranous substance is often discharged, and that no woman, in the habit of forming such a membrane has been known to conceive, although, he adds, that as it is not uninterruptedly formed at each period of menstruation, the capability of conceiving may exist at any interval of freedom from its formation.

Women who are very corpulent are often barren, for their corpulence either exists as a mark of weakness of the system, or it depends upon a want of activity in the ovaria; thus spayed, or castrated animals generally become fat.

A state of exhaustion of the uterine system, occasioned by frequent and promiscuous intercourse with the other sex, is also a very common cause of barrenness in women, and hence few prostitutes conceive.

In some cases the uterine system is capable of being acted on by the semen of one individual, but not by that of another, for many instances are on record where persons have lived in wedlock without offspring, and being, after divorce, re-married, have each had families.

3. OF THE LEGITIMACY OF CHILDREN.

The validity of Marriage considered on medical grounds being established, the next point to be considered in the same light is the legitimacy and illegitimacy of children, as it may legally affect their rights to succession and property[336]. On this point the laws of England are most indulgently favourable to the child, for provided “it be born though not begotten in lawful wedlock,” (1 _Bl. Com._ 454.) the law will presume its legitimacy, (5 _Rep._ 98.) (_præsumitur pro legitimatione_). But this presumption may be rebutted by evidence. “As if the husband be out of the kingdom of England (or as the law somewhat loosely phrases it, _extra quatuor maria_[337]) for above _nine_ months, so that no access to his wife can be presumed, her issue during that period shall be bastards.” (1 _Bl. Com._ 454. 457. _Co. Litt._ 244.) but it was held that if the husband was in England during any part of the time between the conception and the birth (without any reference to the physiological impossibility of the fact) the child would be deemed legitimate (_Rex v. Alberton._ 1 _Raym._ 395.) If the husband be proved castrate the issue are bastards (1 _Ba. Ab._ 310. _Rolle Ab. tit. Bastard_, 356.) But though the husband were divorced from his first wife _causa frigiditatis_, yet his issue by his second were adjudged legitimate, (5 _Rep._ 98.) and this is reasonable, for there may be an _impotentia erga hanc_, from various causes; (_vide post._) If a man marries a woman who is pregnant, he is generally to be supposed cognisant of the fact, and that he is the father of the child; and the law which regards the time of birth, and not of conception, pronounces it legitimate. But the husband may have been imposed upon, and utterly ignorant[338] of his wife’s state. A man returning from abroad (to put the case of non access more strongly) marries immediately on his arrival; within four or five months his wife is delivered of a perfect child which lives, shall such child inherit? on the one hand _Præsumitur pro patre quem nuptiæ demonstrant_, on the other, the ordinary course of nature prohibits the supposition that the child can be the offspring of the husband. But see _Rolle Ab. tit. Bastard_, p. 358, where the woman was _grossement enseint_ the issue was held _un mulier_, and contrary decisions cited there: see also _Foxcroft’s Case, Rolle_, 359, & _sec._ 45. So also a man may purposely marry a pregnant woman to disappoint his supposed heir at law; on the other hand a woman may for some purpose of malignity bastardize her offspring, as was the case of _Savage_ the poet.[339]. But none can be legitimate who are born out of wedlock; in which our law differs materially from the Roman or Canon law, and it is somewhat singular that the celebrated[340] “_quod nolunt Leges Angliæ mutare_” of the Barons, at the Parliament of Merton, in the 20th of _Henry_ the 3d, should have been induced by an attempt on the part of the bishops, (_omnes episcopi magnates_) to introduce this novelty,—that children born before marriage should be legitimised by the subsequent performance of the ceremony between their reputed parents. There may indeed be a few instances where illegitimate children have been legitimised by Act of Parliament[341], but though such legislative interference might in some cases of extreme doubt and hardship be deemed not only excusable, but desirable, the present feeling appears to be so strong against such Acts, that the rule of Law may be considered as among the most fixed; yet there are some points which may yet receive considerable elucidation from the studies of the physiologist, and these will resolve themselves into several questions, (_vide post._)

For the legal authorities on this subject we cannot do better than refer the reader to the very learned note of Mr. _Hargrave_ in his valuable edition of _Coke Littleton_, and to the same subject in his _Jurisconsult Exercitations_, vol. 3. p. 411; but as these may not be of easy access to our medical readers we have added a full extract of them in the _Appendix_, p. 209.

SUPPOSITITIOUS CHILDREN.

But there is yet another question which may, and in truth frequently does occur; where either a pretended pregnancy is followed by the grosser fraud of imposing a strange child upon the husband, either for the purpose of fixing his affection, or securing his estate; or where a living and healthy child is substituted for one either dead, or too sickly to give reasonable hope of prolonged existence. To this crime our laws assign no specific punishment; the parties can only be indicted for a conspiracy as they might have been for any ordinary misdemeanor; the real punishment falls on the unconscious instrument of the wrong,[342] the child, who having been educated in every indulgence that affection and affluence could bestow, finds itself on the exposure of a vindictive menial, without name, hope, or fortune; abandoned by its assumed, it may be unable to trace its real parents, yet the authors of this irreparable wrong have generally escaped even the inadequate punishment to which their crime had subjected them. Those who are curious to inform themselves of the doubts and difficulties with which such questions are entangled, will do well to consult the proceedings in the celebrated Douglas case,[343] than which few have ever excited so much difference of opinion on the bench, or so much intensity of interest in the public mind. The Anglesea case also, with the several trials connected with it,[344] is well worthy of perusal by those whom interest or curiosity may lead to this species of investigation.

We should not have alluded to personal resemblance[345] between parents and children, as a mode of proof in these cases, first, as we have doubted whether such proof can be satisfactory, and secondly, as it may not be considered a point of medical evidence; but as to our first doubt, we find that so high an authority as Lord _Mansfield_ thought that a family likeness was a material proof that a child was the genuine offspring of the parents through whom he claimed. His lordship in delivering his judgment in the House of Lords on the Douglas cause, is reported to have said, “I have always considered likeness as an argument of a child’s being the son of a parent; and the rather, as the distinction between individuals in the human species is more discernible than other animals[346]: a man may survey ten thousand people before he sees two faces perfectly alike; and in an army of a hundred thousand men every one may be known from another. If there should be a likeness of feature, there may be a discriminancy of voice, a difference in the gesture, the smile, and various other characters; whereas a family likeness runs generally through all these, for in every thing there is a resemblance, as of features, size, attitude, and action. And here it is a question, whether the appellant most resembled his father Sir _John_, or the younger _Sholto_ resembled his mother Lady _Jane_? Many witnesses have sworn to Mr. _Douglas_ being of the same form and make of body as his father; he has been known to be the son of Colonel _Stewart_, by persons who had never seen him before; and is so like his elder brother, the present Sir _John Stewart_, that except by their age, it would be hard to distinguish the one from the other.”

“If Sir _John Stewart_, the most artless of mankind, was actor in the _enlevement_ of _Mignon_ and _Saury’s_ children, he did in a few days what the acutest genius could not accomplish for years; he found two children, the one the finished model of himself, and the other the exact picture in miniature of Lady _Jane_[347]. It seems nature had implanted in the children what is not in the parents; for it appears in proof that in size, complexion, stature, attitude, colour of the hair, and eyes, nay in every other thing, _Mignon_ and his wife, and _Saury_ and his spouse were, _toto cœlo_, different from and unlike to Sir _John Stewart_ and Lady _Jane Douglas_.” 2 _Collec. Jurid. p._ 402.

A painter or a sculptor would be more competent to decide a question of this nature than a physician or surgeon, but in their absence there is none on whose testimony we can more safely rely than on the medical witness, whose habits of observing the formation, changes, and peculiarities of the human body, naturally prepare him for such examination.

It has been supposed that an experienced surgeon or midwife might be able to determine whether a newly born infant was the child of a particular woman, both being submitted to their examination; but this mode of proof, fallacious as it must always be, can be of no possible value, unless the investigation take place within a very few days of the supposed delivery; and even then it goes no further than to determine that the birth and delivery have been nearly cotemporaneous, a result not inconsistent with the supposition that the infant is the child of some other woman, and substituted for one dead, unhealthy, or of the sex incapable of succession.

In ordinary cases this early inspection is not likely to take place, as in the lifetime of both parents the heir presumptive seldom has a summons to view proceedings; but in the case of a pregnant widow, and especially where there has been a question _de ventre inspiciendo_, it is otherwise, and it then becomes a point of duty in all parties, to obtain the most satisfactory evidence.

A yet more important occasion occurs at the birth of princes; whose entrances and exits are equally subject to question, whenever a disputed succession or an impatient heir give rise to speculation. In England and elsewhere precautions are taken which are as offensive to female delicacy as they are ineffective to the demonstration of truth. The chamber of a pregnant princess, at the moment when quiet is most necessary, is crowded with officers of state and lords of the household; yet we need not remind the reader of all the questions which have, however foolishly, been raised on the supposititious births of princes; for the evidence on the birth of Prince _Charles Edward_, see 12 _Howel. St. Tri._ 123. We need only observe that imposition is best practised by skilful jugglers in a crowd, and without disrespect to those learned and reverend personages, we may doubt whether the Archbishop of Canterbury, or the Lord High Chancellor, can be as effective at an _Accouchement_, as the President of the College of Physicians, or the Master of the College of Surgeons.

TENANT TO THE COURTESEY.

Whether a child, born under certain circumstances, was or was not born alive, is a frequent and important question on the right of the father to the tenant of the courtesey; and as it is naturally connected with the doctrine of gestation, will be partly considered here, though the external signs of incipient and independent vitality will be more fully treated of under the head of Infanticide.

[348]“Tenant by the courtesie of England is where a man taketh a wife seized in fee simple or in fee taile general, or seized as heir in taile especial, and hath issue by the same wife, male or female, born alive (_oyes ou vife_), albeit the issue after dieth or liveth, yet if the wife dies the husband shall hold the land during his life by the law of England, and he is called tenant by the courtesie of England, because is this used in no other realme but in England onely.[349] And some have said that he shall not be tenant to the courtesie unless the childe which he hath by his wife be heard crie[350]; for by the crie it proved[351] that the child was borne alive. Therefore Quære.”[352] _Co. Litt._ 29. 30.—Here therefore is another occasion[353] where Medical Evidence may be useful or necessary, and it cannot be too often forced on the attention of practitioners, who at the expiration of many years may be called upon to give testimony, very frequently affecting property of considerable magnitude, that they should on all occasions make sufficient notes of the births which they attend, the circumstances which they have observed, and the number and descriptions of the persons present, who may at a future period be called to corroborate their testimony. We have known an instance where the books of a surgeon attending a then obscure individual, became necessary evidence before the highest tribunal of the land towards determining the right of peerage.

Foreign jurists have doubted whether a child extricated by the Cæsarian operation[354] is capable of succession. “Illud autem valde controversum est inter jurisconsultos, an is qui editus est execto matris ventre reputetur partus naturalis et legitimus et successionis capax.” (_Caranza de partu naturali et legitimo._ _p._ 427). And though the question is now decided in the affirmative, some nice points may yet arise,[355] if not for the instruction of the jurist at least for the amusement of the casuist.

OF MONSTERS AND HERMAPHRODITES, LEGALLY CONSIDERED.

It will be seen by the note from _Co Litt_, quoted under the preceding head, that by the law of England a monster cannot inherit; but the question as to what constitutes a monster is left vague and undetermined. It can seldom have been necessary to agitate this point, since few well attested instances are recorded of any monster, which has materially deviated from the human form,[356] having long survived its birth. Some curious instances, however, have occurred of twins who, having become united in the womb by an obvious operation of nature,[357] have lived for several years.[358] Whether each body should possess separate legal rights would probably be determined by the question whether each possessed the vital organs necessary for a separate existence, if, bating the danger of the operation, they could be corporeally severed. Is it necessary to inform the midwife that he is not authorised to destroy any production however monstrous![359]

The case of Hermaphrodites, or rather of those who may have been deemed such, stands on different grounds; in the physiological illustrations of this subject, the circumstances will be investigated which have led to erroneous conclusions upon this point. In a legal view, it is only necessary to caution the medical attendants to be more careful in the investigation of such cases of doubt, especially where succession to property may depend on the sex of the child. The case of the celebrated _Chevalier D’Eon_, may long serve as a warning to those who would judge of the doubtful sex of a party by any ordinary and external distinctions;[360] while that related in the _causes celèbres_ of a female[361] who, on account of a _prolapsus uteri_, was pronounced by the sagacious physician at the Hotel Dieu to be an hermaphrodite, is sufficient to shew the futility of any personal examination, unless conducted by a skilful anatomist.

PHYSIOLOGICAL ILLUSTRATIONS CONNECTED WITH THE FOREGOING SUBJECTS.

The investigation of the preceding subjects necessarily comprehends within its range a series of physiological questions of great importance, the solution of which is essential to the establishment of just and satisfactory conclusions; we therefore now proceed to the consideration of _Conception_: a subject which in relation to Legitimacy, and the various legal questions dependant on it, may be considered as the basis upon which the superstructure rests, or the trunk from which the various ramifications of inquiry must proceed.

OF CONCEPTION AND UTERO-GESTATION.

The different theories which the ingenuity of the physiologist has invented for the elucidation of this mysterious and wonderful process, have been supported with so much zeal and argument by the disciples of one school, and disputed with so much warmth and plausibility by those of another,[362] that to recite the merits and defects of each system would be a task as laborious in its execution, as it must be unsatisfactory and unprofitable in its results; we shall therefore not attempt to ascend into the scale of causes, but rest on the phenomenon of conception, as an ultimate fact, and confine our researches to the history of its œconomy. The series of changes which constitute the phenomena of conception and gestation are clearly proved by the experiments of _De Graaf_ to originate in the ovaries, and not in the uterus, as former physiologists had supposed. One or more of the vesicles, or _ova_, contained in the former of these organs, no sooner receive the vivifying impression communicated by the _coitus_ than they are loosened from their connection, and grasped by the fimbriæ of the Fallopian tube, by whose peristaltic contractions they are, in due time, conveyed into the uterus; the spot in the ovarium from which the ovum has been thus separated, when examined after death, exhibits a slightly lacerated appearance, as if the germ had been detached from a vesicle at the moment of conception, by the rupture of its parietes; to this structure, which from the colour that it assumes has been called by physiologists _corpus luteum_, we shall have frequent occasion to allude during the course of the present inquiry. While these actions are proceeding, the uterus passes through several contemporary changes, in order to prepare it for the reception of the _ovum_; its blood-vessels are increased in size, as seen in slight cases of inflammation; the texture of its internal surface becomes softer, and more spongy, and a white mucus is secreted, which, from the extreme delicacy of its arrangement, has been compared by _Harvey_[363] to the web of the spider; it soon, however, assumes a more solid form, becomes vascular, and adheres so as to form a lining to the whole cavity of the uterus, except at the orifices which lead to the Fallopian tubes, and the os uteri. _Dr. William Hunter_ considered it as the inner lamina of the uterus cast off, like the _exuviæ_ of some animals, after every conception, and he accordingly called it the _Decidua_, and from the manner of its passing over the ovum, the Decidua _Reflexa_.[364] It is not known what exact interval is required for the fœtal primordia to pass through the Fallopian tube, and descend into the cavity of the uterus. _Valisnieri_ and _Haller_ have never been able to find it distinctly in the latter viscus before the seventeenth day. As the mouth of the pregnant uterus is sealed up with gelatinous matter from the moment of conception, it is, under ordinary circumstances, incapable of allowing any passage for the Catamenia, although exceptions to this law are frequently mentioned by men of science,[365] which have probably arisen from the observation of an occasional sanguineous discharge from the vessels of the vagina; and which, says _Burns_,[366] are neither regular as to the monthly period, nor of the same quality as that of the menses, and he concludes by remarking, that he has never known any instance where menstruation was perfect and regular during the whole of pregnancy. _Dr. Denman_[367], whose authority upon such a question must carry with it very considerable weight, says, “a suppression of the _Menses_ is one of the never-failing consequences of conception, at least I have not met with a single instance to the contrary.”