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( Originally Published Early 1900's )

STERILITY is the inability to procreate, for whatever reason. The condition may be either temporary or permanent, depending upon the cause.

Sterility is confused with impotence in the minds of many persons, but there is a great difference in the meaning of the two terms. A man may be sterile without being impotent. That is to say, he may be deficient in the seminal secretion, or no spermatozoa may be present therein, although he may be perfectly potent and normal in other respects. On the other hand, there may be a normal formation of semen, with healthy spermatozoa, while practical sterility may result from impotence, for mechanical reasons. Of course it is true that in a great many instances the same devitalizing conditions which have made a man impotent are also likely to make him sterile. Sometimes the spermatozoa may not be entirely lacking, and yet because they are weak and wanting in vitality, fertilization will not take place. When the testicles are healthy in every way sterility may be produced through obstruction of the ducts.

Gonorrhea is without doubt the most frequent cause of sterility in men, sometimes through its destructive effect upon the testicles themselves, but more often through the closing up of the epididymis—the delicate convoluted structure which forms the beginning of the spermatic duct following the inflammation produced by this infection. Of course when the disease does not penetrate so far, sterility does not result. Stricture of the urethra, also usually due to gonorrhea, may cause sterility in rare cases by interfering with the passage of the seminal fluid, which, under these conditions, is forced backward into the bladder.

Sterility is occasionally caused by mumps, when this infection has been carried to the testicles, producing a destructive inflammation. The child so affected recovers from the disease, regaining apparently perfect health, but finds, years afterwards, that his marriage is not productive of children. In this case, as when it results from gonorrhea, the condition is incurable. Typhoid fever or the poisons of other infectious diseases may in rare cases cause sterility, and constitutional disorders like diabetes or obesity may have a great deal to do with the condition in some instances.

The Roentgen rays, or X-rays, will produce temporary sterility through their effect upon the spermatozoa. During the first few years after these rays were discovered, when little was known of their physiological effects, a considerable number of men. were rendered sterile for a time. X-ray operators may protect themselves, however, by wearing metal aprons through which the rays cannot pass. Fertility is regained by these men after a few months during which there is no further exposure of the glands to these rays. Radium rays are said to have a similar effect.

What may be called functional sterility is fairly common, being usually the result of a lack of vitality. A debilitated condition of the system from any cause, or the weakening effect of sexual abuses, may be responsible in such cases. Alcohol, strong medicines, drug habits, lead poisoning, nervous exhaustion, overwork, shock, grief, exhausting fevers and various other devitalizing influences are all capable of producing this result. In such cases the spermatozoa may be present in the seminal fluid but are so few in number and so feeble that fertilization is impossible. Or the semen may be practically absent alltogether. In nearly all such cases a cure is readily accomplished by building up the general health and thus restoring the functional strength of the testicles. The treatment is the same as for impotence. The general methods of virility building are advised, together with great care to avoid marital excesses. A complete sexual rest for some months is to be recommended.

Masturbation is not likely to result in sterility except in those cases in which it has been carried so far as to cause atrophy of the testicles, together with impotence. As a rule, if a man is still potent after having discontinued masturbation for some years, and has built up robust health and a vigorous body, he may depend upon having normal children. The question is one that depends upon one's present condition rather than upon one's past. If a man has recovered virility, and is not sterile, he will make a satisfactory parent.

As I have said, sterility of gonorrheal origin is almost invariably incurable, but it may sometimes be worth while to try persistent treatment by means of hot sitz-baths and gentle massage of the testicles. In such cases there is usually a hardened or lumpy condition of the epididymis, and if this can be overcome and the adhesions loosened so that an opening is re-established, through which the seminal secretion may pass, fertility may be recovered. I must admit that the chances are not very good, for it is only in extraordinary cases that this can be brought about. ,The chance is worth taking, however, even if it is only one in a million. There are cases in which, following venereal disease, disturbed functioning of the prostate gland and the seminal vesicles may be responsible for sterility, for the secretions of these organs mixing with the semen have much to do with the health and activity of the spermatozoa. An inflammatory or purulent condition of these parts would tend to destroy them, or lessen their vitality. Treatment for the prostate gland would effect a cure in such cases.

Childlessness sometimes seems to be the result of a peculiar temperamental or constitutional in-compatibility. It occasionally happens that both the husband and the wife may be individually normal and fertile, but do not possess the mysterious and peculiar chemical qualities that will combine through the process of fertilization to produce a new life. The man might have children by a second marriage, and the wife might have children by a second husband, but with each other they are unfruitful. This cannot be explained, but it is a well-attested fact. It probably happens mostly where there is a lack of sexual harmony.

When there has appeared to be no good reason for childlessness, and when it seems probable that the vaginal secretion has the effect of destroying or weakening the spermatozoa before fertilization could be accomplished, artificial impregnation has frequently been tried, and often with success. Artificial impregnation consists simply in introducing into the womb a few drops of the seminal fluid. It should never be attempted, however, except. by a skilled physician, under strictly aseptic conditions and with a sterilized syringe, and not even the physician should experiment without a thorough knowledge of the technique required. The failures always greatly exceed the successes.

When it is undesirable for eugenic or other legitimate reasons for a man to have children, sterility may be produced by a simple operation called "vasectomy," which consists merely in cutting out a part of the vas deferens, or spermatic duct, on each side, so that there will be no outlet for the secretions of the testicles. Sterility is thus produced mechanically. This treatment has been much recommended and in some States has even been employed to some extent in connection with criminals, insane persons, idiots and others deemed unfit for parenthood. It has also sometimes been submitted to voluntarily. It does not affect one's fitness for marriage, since the sex instinct and power are unimpaired, but only prevents parenthood. The seminal secretion in such a case is reabsorbed. In some instances a marked improvement in health has been reported, as a result of such operations, apparently because the frequent loss of the rich seminal fluid has been stopped.

It was once thought that childlessness was nearly always due to some defect in the generative organs of the wife. It is now known, how-ever, that it is the result, in a fairly large percentage of instances, of the husband. Therefore, when children are desired in the home and do not make their appearance, it is well to investigate the condition of both the husband and the wife, so as to ascertain just where the trouble lies and to see if it cannot be remedied.

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