IMPOTENCY.-CAUSES.-PROCREATIVE POWER IN THE MALE.-PUBERTY.-AGE FOR VIRILITY. —VIRILITY OF CRYPSORCHIDES AND MONORCHIDES.-STERILITY.-PROCREATIVE POWER IN THE FEMALE.-EARLIEST AND LATEST PERIODS FOR CHILDBEARING.-LEGAL RELATIONS. Definition. Impotency is defind to be a [permanent] incapacity for sexual intercourse. It may depend, first, upon physical, second, upon moral, causes. With regard to the moral causes of impotency they do not concern a medical jurist. Such causes are not recognized by law, and he has no duty to perform beyond the application of the principles of medicine to the purposes of the law. Causes. Impotency may arise from age; from certain physical causes, e. g. disease; or from congenital malformation or defect. With regard to physical causes a distinction must be made between those which are remediable and those which are not. The presence of a disease of the testicle, such as atrophy or tumor, may give rise to incapacity; but this incapacity may be sometimes removed by an operation or by medical treatment, and therefore the physical cause may be removed-in other words, it is remediable. To such cases as these the law does not extend; but it is always expected in alleged incapacity that the practitioner examined on the subject should be able to say whether there is or is not a prospect of cure. In forming a judgment upon this point a good knowledge of his profession can alone assist him; no rules can be laid down for his guidance, for there may not be two cases that will precisely resemble each other in their features; hence it will be necessary in this place to point out the chief causes of impotency which are of an irremediable nature or those in which the incapacity is absolute and permanent-a point upon which medical opinion is chiefly required. In strictness of language, the definition of impotency as above given may be applied to a female as well as a male; and, undoubtedly, a physi cal incapacity for sexual intercourse may exist in either sex. As an instance of this incapacity in the female may be mentioned occlusion of the vagina-a condition not necessarily indicative of sterility. The mere occlusion of the vagina may be a remediable form of the malady; but its entire obliteration would be an absolute and irremediable defect. This latter condition, however, is the only instance of complete impotency in a female. A protrusion of the womb or of the bladder into the vagina is mentioned by some writers as a cause of physical incapacity for intercourse; but these forms of disease may commonly be remedied by art, and therefore require no further notice in this place. The editor was once consulted by a gentleman who alleged that anchylosis of the hip-joint of his wife-the broken limb being flexed across the entrance to the vaginawas a bar to sexual intercourse. It is unlikely that intercourse was abso 630 PROCREATIVE POWER IN THE MALE. lutely impossible under the circumstances; and it is known that even double anchylosis of the hip-joints is not an insuperable bar to coitus. In professional language the term "impotency" has been hitherto applied exclusively to a defect in the male sex; and the term "sterility" is usually confined to all those conditions in the female which not only render intercourse impossible, but which render it unfruitful. A male may, however, be sterile without being impotent-a condition observed in some crypsorchides; or he may be impotent without being sterile, as where proper intercourse is prevented by reason of physical defect in the virile member, although the testicles may be in a normal condition. (See on this subject, Curling, On Sterility in Man.) This author points out that sterility in the male apart from impotency may depend on three causes: first, malposition of the testicles; second, obstructions in the excretory ducts; and third, impediments to the escape of the seminal fluid. A man may not be impotent, i. e. incapable of intercourse, but by reason of one of the conditions above mentioned, such intercourse would be unfruitful. In reference to the male, the English law does not appear to go beyond the establishment of impotency from some clear and demonstrable cause, and unless the alleged sterility were accompanied by impotency it would take no cognizance of that condition. Further, sterility from such causes could hardly be demonstrated during the life of a person, and it would rest chiefly on presumption or probability. [A better definition of sterility applied to either sex would be, inability to conceive in the female and to procreate their kind in the male.] Procreative Power in the Male. Puberty.-Until the period of puberty the testicles are small and they increase very little in size in proportion to other parts. Curling found that the size of the seminal tubes differed but little at the ages of 18 months and 8 years. The sexual function in the male depends entirely on the development of the testicles; but the age at which it appears differs in different persons. The age of puberty in a healthy male in this country varies from 14 to 17 years; its appearance is, however, affected by climate, constitution, and the moral circumstances under which the individual is placed in some cases it is not fully devel oped until the age of 21. The access of puberty in the male is indirectly connected with the subject of rape. A boy under the age of fourteen years is presumed in law to be incapable of committing a rape. (1 Hale, p. 631; and Matthew's Digest, p. 57.) The statute law merely requires proof of penetration, so that rape might be physically perpetrated by a boy at or even under 14 years of age. In several cases, boys at 14 have been convicted of rape. In a case elsewhere related (see Rape), a boy, aged 19, communicated syphilis to a girl of 6 years of age. It appears that in India puberty shows itself much earlier in the male. Chevers, quoting from the Nizamut Adawlut Reports, states that a boy 13 or 14 years of age was found guilty of rape. A lad of 14 was convicted of rape on a girl of the same age; and in another case a boy only ten years old was convicted of rape on a girl 3 years of age. (Med. Jurispr. for India, p. 463.) The seminal secretion in the male is not considered to be prolific until it contains those peculiar filiform bodies which are known under the name of spermatozoa, or zoosperms. All agree that they are normal and essential constituents of the healthy and prolific seminal fluid. They are peculiar to the spermatic secretion, and in healthy males are always present in it after the age of puberty. They disappear in certain states of disease and sometimes in advanced age: they have not been found in the undeveloped testicles of crypsorchides. In cases in which they are absent, from what IMPOTENCY FROM AGE. 631 ever cause, it is a fair inference that the person is impotent, or that he has lost the power of procreation. (See on this subject, Curling, On Sterility in Man.) In this pamphlet, one case is related in which a man, æt. 42, who was married and whose wife had borne a son then eight years of age, had died after four days' illness from strangulated hernia. The testicles, from the fact of their being found in the inguinal canal, were examined separately by Gosselin and Goddard and no spermatozoa were discovered in the fluid contained in either of them; but these may have been merely absent at the time of examination, as the child begotten was then eight years of age. During this long interval, the secretion may have undergone a change and have become unprolific. Impotency from Age.-It may be fairly assumed that a male is incapable of procreation until spermatozoa have appeared in the seminal secretion and that he loses this power when they disappear. The age at which they are formed varies with all the causes that affect puberty. In one instance they were found by Casper in the seminal fluid of a crypsorchid boy only 14 years old, and Curling found them in the secretion of a boy aged 18. This observer found spermatozoa in the liquid taken from the testicles of a man upwards of 70 years of age, and on one occasion in the testicles of a person aged 87. Wagner states that they are to be found in the secretions of men between 70 and 80 years of age. Rayer found them in the secretion of a man aged 82 years. (Gaz. Méd., June 2, 1849.) Other cases of a similar kind are recorded by Debrou. (Gaz. Hebd., 1861, p. 6.) Dien examined the bodies of 106 men between the ages of 64 and 97. In 64 cases out of the 106 there were no spermatozoa, i. e. in 61 per cent. of the cases. Four of Dien's observations were on nonogenarians: of these none had spermatozoa. (Med.-Chir. Rev., 1868, p. 279.) Facts tend to render it highly probable that a fecundating power may be retained by the male up to the age of 100. According to Duplay, the seminal fluid of old men contains spermatozoa even when they are beyond the age of feeundation; but he does not state the circumstances which enabled him to arrive at this conclusion (Med. Times and Gaz., 1853, i. p. 581). Sexual propensities are often strongly developed in children and thus they may be prolific at an early age. Rüttel met with a case in which a female, at the age of 14, became pregnant by a boy of the same age. (Henke's Zeitschrift der S. A., 1844, p. 249.) This is the earliest age at which, so far as we can ascertain, the procreative power has appeared in the male. Hartshorne refers to an instance of extraordinary development of the male sexual organs in a child 4 years old. (Amer. Jour. Med. Sci., Oct. 1852, p 561.) In a case of contested legitimacy or affiliation, this question regarding the age at which a procreative power appears in the male may have an important bearing on the issue. Thus the person may be so young as to render it impossible that he should be the father of a child imputed to him. Cases involving questions of legitimacy on this ground are not heard of in the present day. The following case in reference to the affiliation of children occurred in 1840. A woman wished to affiliate a child on a youth who was in his sixteenth year. The boy denied that he was the father of the child; and there was reason to suspect that the imputation had been wrongly thrown upon him in order to divert suspicion from the real offender. There was some difficulty in this case; but the rule for a medical man to follow on these occasions is this: not to regard the mere age of the youth, whether he is above or below the average age of puberty, but to observe whether the sexual organs are fully developed and whether there are about him any of the marks of precocious virility, indicated by muscular develop 632 IMPOTENCY FROM DISEASE OR ACCIDENT. ment, the growth of a beard, and a manly voice. If these signs are present, whatever may be his age, there is strong reason to suppose that the sexual functions are developed. We occasionally hear of instances of extraordinary precocity, but the development of sexual power is generally accompanied by other well-marked changes in the person. Sometimes these changes do not make their appearance until after the age of twenty one. On the other hand, it may be a question at what time the procreative power disappears in a male. That impotency is one of the natural consequences of advanced age is undoubted, but this, as we know, forms no legal impediment to the marriage of parties, however old. The legal presumption is that the generative faculty does not disappear through age; and if this be alleged, and legitimacy disputed on this ground, it must be satisfactorily proved by those who would benefit by the allegation. This amounts almost to an impossibility, because it is well known that there is no fixed age at which the sexual functions cease either in the male or female; and individuals at least of the male sex, who have passed the ages of 60, 70, and even 80 years, have been known to be capable of fruitful intercourse. Duplay believes, from his anatomical observations on the bodies of aged persons, that the causes of impotency (sterility) in advanced age are to be found rather in the excretory than in the secretory apparatus. Thus he has met with obliterations in the canal of the epididymis, the vas deferens, and the vesiculæ, the effect of which is to prevent the accumulation and passage of the seminal fluid. (Med. Times and Gaz., 1856, i. p. 650.) Lord Erskine, in the Bambury Peerage claim, quoted the case of Sir Stephen Fox, who was married at 77, and had had four children, the last when he was 81. Schneider met with a case in which a man of 71 had a child by his wife, who was only 17. (Henke's Zeitschrift, 1842, Bd. 2, p. 165.) Rüttel mentions the case of a man who, at the age of 92 years, married and had two children by his wife. When the procreative power even appears to be lost at advanced age, the stimulus for intercourse is often very great. The same authority mentions cases in which these erotic feelings were remarked by him in reference to men between 75 and 86 years of age. (Henke's Zeitschrift, 1844, p. 252.) In all cases of prolonged virility, it is observed that the bodily and mental powers are also retained in an extraordinary degree, showing the close relation which exists between the sexual functions and corporeal and mental development, even to the latest period of life. Romilly remarked, in reference to the retention of procreative power in advanced age, that the liberality of the English law on this subject was excessive; for there was no age, from seven upwards, at which a man had been denied the power of procreating children. (See in reference to this subject, Henke's Zeitschrift der S. A., 1842, p. 332.) Males at the age of 14, and females at the age of 12, are legally competent to contract marriage. [In the American States this is regulated by the statutes of each State.] Impotency from Local Disease or Accident.-The loss or destruction of the penis or testicles, either by disease, accident, or from necessary operations, would be sufficient to render a man irremediably impotent. The loss of one or both testicles, from any of these causes, would be indicated by the presence of distinct cicatrices in the scrotum. When both have been removed by operation, the person is incurably impotent; but if the organs are healthy, a sufficiency of the spermatic fluid to confer procreative powers may remain in the ducts for two or three weeks after the operation. Thus it is that animals have been known to be prolific for some time after castration; and one case is on record, in which a man, IMPOTENCY FROM DISEASE OR ACCIDENT. 633 both of whose testicles had been carried off by a gunshot, is said to have retained the power of impregnating his wife after the healing of the wound. (See a paper by Krügelstein, Henke's Zeitschrift, 1842, i, pp. 348 and 352.) The loss of one testicle only, by accident or operation, does not render a man impotent. Monorchides, as they are called, have been known to be prolific. Cases of this kind must not be confounded with those in which one or both testicles have not descended into the scrotum. In some rare instances the testicles do not descend into the scrotum at the usual period; but one or both may remain either in the abdomen or in the inguinal canals, and only descend some time after birth; or one may be found in the scrotum, and the other remain during life in the abdomen. In some cases of partial descent the organs have been mistaken for and treated as ruptures by the application of a truss. (Henke's Zeitschrift der S. A., 1844, 1, p. 249; Curling, On Disease of the Testis, 2d ed., p. 31.) In one instance, the attempt to reduce the tumor, mistaken for hernia, and the application of a truss, caused the death of the person. (Med. Times and Gaz., 1861, i. p. 240.) When one testicle only has descended, there is no ground, cæteris paribus, to impute impotency; the descended organ has been found healthy and to contain spermatozoa. Curling has collected six cases in which the retained testicle and its ducts did not contain spermatozoa; four of these fell under his own observation. (On Sterility in Man, 1864, p. 6; and Med. Times and Gaz., 1861. i. p. 213.) When neither testicle has descended, the scrotum will be found empty, without any scar indicative of a removal by operation, but the other marks of virility may still be present. These persons have been called Crypsorchides. It has been stated that in such cases the testicles are to be regarded as congenitally defective, and further, that the individual, although capable of sexual intercourse, is incurably sterile. The non-descent of the testicles is a state rarely seen. Marshall met with only one case of non-descent of one testicle in 1000 recruits, and with one case of non-descent of both testicles in 10,000 recruits. There are three preparations, showing the non-descent of these organs in the Museum of Guy's Hospital; one of them was taken from a man who shot himself from despondency at his supposed defective condition. Hunter thought that the undescended testicles were always imperfect, both in their structure and functions, and that crypsorchides were invariably impotent (sterile). Other observations have tended to support the views of Hunter. In 1860, Partridge communicated to the Pathological Society the case of a man, æt. 25, in whom both testicles were found in the abdomen. Several specimens of the secretion from these organs were examined, and no spermatozoa were detected. Another case was examined with a like result (Lancet, 1860, i. p. 66), and a third by Curling (Med. Times and Gaz., 1861, i. p. 213). The conclusion to which these observations have led is that, although in cases of non-descent there may be a capacity of sexual intercourse, it will not be prolific-the person will be sterile. According to this view, malposition of the organs must be taken as synonymous with defective condition; as a result of this malposition, they are not capable of secreting prolific spermatic fluid, and the person is as sterile as if he had no testicles. The cases of monorchides reported by Curling to Some extent support this theory, since spermatozoa were found only in the fluid of that testicle which occupied its usual position in the scrotum. He has also collected from various sources seven cases of crypsorchides, in which both testicles were either in the abdomen or in the inguinal canals: the fluid contained in them was destitute of spermatozoa, and, |