, 1913 , Vol. VIII retained, as it should be in the contracted vagina. Fruitful normal women retain the semen while sterile women commonly lose it. Runge has shown that thirty-two hours after coitus there was spermatozoa in three-quarters of all fruitful women while only one-fifth of the sterile women had spermatozoa in the vagina. At the end of thirty-six hours, the proportion was two-thirds of the fruitful and only an occasional sterile woman had spermatozoa remaining. The infantilism is not unlike that atrophy of the uterus which sometimes comes during lactation. The best treatment for in tor; but they were the only ones I have ever seen in which endometritis influenced the condition. Chronic endometritis is a rare disease. Chronic endocervicitis, which is usually meant when endometritis is spoken of, is a common form of gonococcus infection. It occasionally causes sterility; but not often, as is proved by the report of maternity clinics. Gonococcus salpingitis is a more common cause of sterility although cases of pregnancy have been reported where there were pus tubes on both sides. These causes are by no means frequent, and I do not believe that the gonococcus is responsible for nearly as fantilism is pregnancy which increases the blood supply and development and wards off many of the evil symptoms of infantilism of the genitalia, known symptomatically as the premature menopause, neurasthenia gastroptosis, etc. It is for this reason that patients in this condition should be encouraged to undergo treatment for sterility. The majority of cases of sterility are caused by infantilism of the genitalia. Other causes as before mentioned are occasional; but this is constant. It is not believed that endometritis or alteration in the vaginal or uterine discharges play much part in the production of sterility. I have seen two cases in which membraneous endometritis seemed to be a fac Stem pessary. many cases of sterility in women as are commonly ascribed to it. But as has been said these causes are only incidental and the chief and constant factor in infantilism of the genitalia or mal-development or lack of function from genital mal-development or congenital hypoplasia of the genitalis or asthenia congenitalis, all of which mean the same thing. This condition does not improve without treatment. If the function is not exercised, it disappears. So the infantilism of the genitalia without pregnancy or treatment ends in various nervous manifestations associated with decrease in menstruation or the premature menopause. The prognosis of the condition must be based upon the local condition of the dis ease and upon the general evidences of infantilism. If the infantilism is slight in degree, the woman otherwise well developed and the evidences of function as judged by the menstruation good, the prog fat type. This last is itself probably an expression of the infantilism. The local conditions, the amount and regularity of the menstruation are the chief factors in the prognosis. If there is evi Fig. 3. Fenwick-Pozzi operation. nosis is good. The general condition of robustness, vital force and general health must enter into the prognosis. Infantile genitalia sometimes may exist in a marked degree in women who are of the athletic type or in women who are of the pudgily as dence of the premature menopause, shown by irregularity and lessening of the menstruation, this is not a good sign in the prognosis. The male semen should always be obtained in a condom or from the vagina, and , 1913 , Vol. VIII examined before any treatment is undertaken. It is best examined upon the dark ground illumination; it is probable that sterility exists in a considerable proportion of men-placed all the way from 10 to 50 is too high. Epididymitis is the chief cause; but it is probable that, of men having had specific urethritis, not more than six or seven percent have azoospermia from this cause. Of those who have had epididymi percent. Fig. 4. Fenwick-Pozzi operation. tis only ten percent are potent; but epididy mitis occurs only in about seven percent of cases of urethritis, according to In a previous exhaustive paper1 upon this subject, the percentage of probable male sterility was placed at 25 percent. It is believed, however, that this Finger's statistics. 'McDonald, Ellice. Sterility in Women. N. Y. Med. Jour., 1912. Dec. 23 and Dec. 30. Infection with Neisser's coccus in women is not a frequent cause of sterility. |