As the period of puberty is intimately connected with the subject of Marriage, and as the age of an individual has many other important relations with civil and criminal transactions, we shall take this occasion to consider the several physiological points which the subject necessarily comprehends.
The age of man is estimated, as it was in the days of David, at three score years and ten—not more, however, than one in eighty reaches the tottering confines of mortality, and it has been correctly stated, that one half who come into life, leave it again before the expiration of their eighth year; of a thousand children born in London, six hundred and fifty die before the age of ten. It has been computed by Herodotus, and acknowledged as correct by our ablest authors on political arithmetic, that three generations of men pass away in a century, and consequently the whole human species cannot be said to divide one with another more than thirty-four years of existence. The astonishing longevity of the Antediluvians[261] has given rise to much discussion, but neither the researches of the learned, nor the reasonings of the ingenious, have hitherto thrown any light upon the subject; nor is the question of any importance in relation to the objects of the present work; the medical jurist is alone interested in the existing laws of mortality, and in those exceptions which may occur in their general dispensation.
The several ages, or stages of man’s existence, have been differently determined, according to the particular views which have suggested the division, especially as they relate to legal or physiological objects; on the present occasion it is to the latter of these that we have more particularly to direct our attention. Aristotle marked three grand and obvious divisions in our existence, that of Growth—that during which we remain apparently Stationary—and that of Decline; each of which has been subdivided by subsequent authors,[262] so as to constitute seven ages: thus the stage of Growth includes Infancy, Second Infancy, or Boyhood (Pueritia) and Adolescence; the stage, during which we appear to remain stationary, consists of Youth (Juventus) and Manhood (Ætas Virilis). The last division—Decline, embraces Old Age, and Decrepitude. The philosophers and physicians of Greece were led to adopt several divisions corresponding with their superstitious reliance on the powers of certain numbers; Varro divided life into five portions; Solon into ten; but Hippocrates, Proclus, and the greater number of the ancient writers acknowledged Seven Ages, a division which has been very generally adopted by the poets and philosophers of later times; in proof of the opinion of the former, we may adduce the testimony of Hippocrates,[263] who says, εν ανθρωπου φυσει επτα εισιν ωραι, and in confirmation of the truth of our remark upon those of the latter, we may remind the reader of the celebrated passage in Shakspeare,[264] in which the progress of human life is so beautifully illustrated. The duration of each of these stages has moreover been considered as under the influence of the same mystical numbers, and will generally be found to be a multiple of seven, for the ancient physicians were persuaded that every period of seven years effected some material alteration in the human system; thus Solon, although he divided life into ten stages, considered each stage as a Septenary;[265] so with the Canonists there are six ages, but the duration of each is seven years, or some multiple of that number; thus, Infantia from one to seven; Pueritia from seven to fourteen;—Adolescentia from fourteen to twenty-eight;[266]—Juventus from twenty-eight to fifty; (Quere, Forty-nine?)—Ætas Senilis from fifty to seventy;—Senectus from Seventy.[267]—Before we quit the conceits of the Numerists, we may state that in their notions the number Nine was supposed to possess some mystic power in relation to our ages; and for this reason, superstition has attached considerable apprehension to the age of sixty-three, in as much as being the multiple of both the numbers so important to our existence, viz. 9 × 7[268]. This period of life has accordingly been anticipated with fear, and passed with exultation; a conceit, which has been perpetuated in our own times, under the imposing title of the Grand Climacteric of Life, while its antiquity is shewn by the memorable letter of Augustus to his nephew Caius, in which he encourages him to celebrate his nativity as he had escaped sixty-three.
We shall now proceed to consider the Seven Ages of man in detail.
Infancy—Infantia—(from Infari, not able to speak) commences at birth, and terminates at the seventh year. The signs by which the age of an infant may be computed, are derived from its moral as well as physical characters; and as circumstances connected with medico-judicial inquiries may render the problem of importance, we shall proceed to offer some data that may assist its solution. The feebleness and size of the infant; its epidermis yet reddish, and wrinkled; its face covered with down; its head soft, and the fontanelles greatly extended; the eye but little sensible to light, and lastly the appearance of the navel, are circumstances which will at once lead the medical practitioner to the conclusion of its not being many days old; while its smiles and tears, its upright posture in the nurses arms, the thickness and whiteness of the skin, the plumpness of its thighs and buttocks, the eagerness with which its eyes seek and follow brilliant objects, its agitation on the occurrence of noisy sounds, and its eager desire for the breast, are occurrences which will, according to the force and degree of each, announce the child’s progress towards the third, fourth, or fifth month. The pleasure which it testifies at the sight of its nurse, its jealousies, and other passions, the habit of carrying its fingers and different objects to its mouth, the facility and pleasure with which it chews bread, and the copious discharge of saliva, announce the approach of dentition, and assure us that the infant must be in its seventh month. The progress of dentition will at this period afford some farther data; towards the end of the seventh month the middle Incisor teeth of the inferior jaw perforate the texture of the gums; and soon afterwards the corresponding Incisors of the upper maxilla make their appearance; then the lateral Incisors of the inferior, and subsequently those of the superior jaw; about the twelfth or fourteenth month, sometimes sooner, the first of the Molares of the under, then the corresponding teeth of the upper jaw appear; the four Cuspidati are usually protruded through the gum the last; thus the Cuspidati and the second Molares will sometimes appear at the same time, and this is usually between the twentieth and twenty-fifth month; so that at, or soon after two years of age, the twenty temporary or milk teeth[269] are to be found in situ. It must however be remembered that the formation and appearance of the milk teeth are subject to considerable variety, and there are some examples on record, though very uncommon, of children born with two Incisors in the upper maxilla, but such teeth have been found to be imperfect in their structure, and without fangs, and they have consequently soon been detached; in other cases, children, although enjoying perfect health, have not cut a single tooth until the end of their second year. Nor are the other signs to which we have alluded, as affording indications of the age, to be considered as immutable; the infant may have been more or less retarded, or accelerated in its march of developement by its state of health and vigour, and it deserves remark, that scrophulous and rickety children very commonly present an aspect of intellectual precocity, by no means commensurate with their age; and hence the popular notion has arisen, that very intelligent children rarely continue to live. The fact of this premature expansion of the mind is too apparent to be doubted; but philosophers have endeavoured to explain it upon very different principles; the physiologist has sought the cause from some peculiarity in the organization of the body, while the moralist has attempted to account for it by supposing that in consequence of the inability of these subjects to partake of the sports and exercises suitable to their years, they necessarily enjoy more of the instructive society of their parents and preceptors.
Pueritia—Second Infancy—Boy-hood. At about the age of Seven years, Detentition, or the shedding of the temporary or milk teeth commonly commences, in order to make room for the adult set; and this event is considered as marking the arrival of the second epoch, and which, in its turn, is terminated at fourteen or fifteen in boys, and at twelve or thirteen in girls, by that peculiar change which the constitution undergoes, and which we have hereafter to consider under the head of Puberty. Persons of this second age are called Pueri, or Impuberes, not being considered as yet in possession of the complete powers of reason, although they may be allowed to possess some faint ideas with regard to the customs and habits of society; their memory is also most clear and comprehensive, but it soon becomes governed by the imagination.
Adolescence or Puberty.—This important and tumultuous epoch of our existence commences at about fourteen in males, and at twelve in females, and ends at twenty-one, or later according to constitution, habit, and climate. The body having nearly completed its stature, its powers of growth are directed into other channels; and in the male, the beard begins to sprout; the voice becomes fuller, deeper, and more sonorous;[270] the parts of generation acquire the magnitude which they afterwards preserve, and become shaded with hair; the whole volume of the body augments, and at the same time assumes a character so decidedly masculine, as at once to proclaim the sex of the individual in whom it appears; in addition to these general changes, the secretion of the seminal liquor by the testicles commences, and the individual thus irritated by new desires, soon distinguishes the means of gratifying them, and the life of the species may be said to commence its existence. Nor are the moral changes which take place less remarkable, or less characteristic of the period of puberty than those which appertain to his physical condition; his mind acquires increased tone, and his manners and habits assume a more manly character; these changes however do not immediately succeed, and we are much inclined to admit with Zacchias[271] the existence of three gradations in Adolescence, Incipient Puberty (at about fourteen), Puberty (from seventeen to twenty), and Perfect Puberty (from twenty to twenty-five). These distinctions are undoubtedly founded in nature, and are admissible both in relation to sexual and intellectual maturity. Important changes likewise occur at this critical age, with respect to the extinction or kindling of disease; in cases of hereditary predisposition, the particular malady will frequently remain dormant until the age of puberty; this is particularly evinced in maniacal affections,[272] in consumption, and other scrophulous diseases. The phenomena which attend the accession of puberty in females are not less remarkable than those which we have described as occurring in males; and although there is neither the change of voice, nor the production of hair on the face, so remarkable in the other sex, yet the body enlarges in volume, the breasts swell with exuberance, and the excess of vitality no longer required for general growth, invests her limbs with those rounded and graceful forms, which have so universally constituted the theme of the poet, and the admiration and study of the artist: but the most remarkable change which the female system undergoes at this period is indicated by the commencement of a periodical sanguineous discharge[273] from the vessels of the uterus, and which from the monthly interval that it observes has received the name of Menses. The period of life at which this change takes place is under the control of various moral and physical circumstances, as climate, temperament of the individual, habits of living,[274] &c. In tropical climates puberty takes place at an earlier period than in northern latitudes; in Greece, the Corea, Indostan, and Java, girls begin to menstruate at eight, nine, or ten; in Spain, Sicily, and the Southern part of Europe, at twelve; but advancing to the northern climes, there is a gradual protraction of the time until we come to Lapland, where women do not menstruate till they arrive at a maturer age, and then in small quantities, at long intervals, and sometimes only in summer.[275] This difference in the time of life at which puberty takes place, has been ingeniously assigned by David Hume as the reason why women in hot climates are almost universally treated as slaves; and why, on the contrary, their influence is so powerful and extensive in colder regions; for in the former, woman may be said to be in the zenith of her beauty while she is yet a child in understanding, and long before her intellect is matured she ceases to be an object of love; but in temperate countries her personal charms and intellectual endowments are simultaneous in their progress to perfection; the united force of her beauty and mental qualities is irresistible, and man voluntarily pays to her the homage which her powers are so well calculated to command[276].
There are, moreover, many cases on record[277], in which both males and females have prematurely arrived at the stage of puberty; a most remarkable instance of this precocity is recorded[278] by Mr. Anthony White, in the history of Philip Howorth, and the author of the present work can bear testimony to the correctness of the statement, for he had frequent opportunities of seeing him, and of tracing from time to time the constitutional changes which so rapidly succeeded each other in the first two years of his existence. Dr. Wall has presented us with a similar instance of precocity in a female infant, in whom the menstrual flux appeared at the age of nine months[279].
Various methods have, at different times, been adopted for determining the age of puberty. One sect of ancient Roman lawyers, called Cassiani, fixed it by the state of the body, which Justinian and others after him suppose to have been done by a personal examination, at least in the male sex; for as to the female it is pretended that the twelfth year was the only guide; though others allege that the eruption of the menses served instead of it. The Proculiari, on the contrary determined the puberty of males by the expiration of the fourteenth year. Javolenus pursued a middle course, and made use of both methods.[280].
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 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.
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.
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.
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.
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.
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.
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.
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.
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.