which a strong and healthy man was rendered incurably impotent after an attack of this disease. (Henke's 'Zeitschr.' 1842, vol. 2, p. 354: see also Curling, op. cit. p. 59.) On the withering of the testicles from disease, see a paper by Albers, Casper's Wochenschr.' Sept. 1851, pp. 568, 577. Inflammation of both testicles (double orchitis) is a rare, and according to some authorities, unknown sequela of mumps, though inflammation of one testicle is a common occurrence during the course of the disease. This is frequently followed by atrophy of the affected organ, but not by impotence. The editor is acquainted with the case of a married medical friend whose virility, he is assured, was rather increased than diminished by the wasting of one testicle after an attack of mumps.

Blows on the head or spine, by affecting the brain and spinal marrow, may produce impotency. Several cases of impotency from this cause are related by Curling (op. cit. p. 362.) It has been noticed that blows on the under and back part of the head, in the region of the cerebellum, have been followed by loss of sexual power on recovery. Sometimes this is temporary; but at other times, when there is wasting of the testicles, it is permanent and irremediable.

Of moral causes it is unnecessary to speak. The sexual desire, like other animal passions, is subject to great variation; and there are instances on record in which men, otherwise healthy-looking and healthily formed. have experienced no desires of this kind. They are in a state of natural impotency-a condition which the Canon Law designates as frigidity of constitution. This is not to be discovered by examination, but rather from their own admission. Under this head we may class hypochondriacal affections. [For a scientific summary of the causes and treatment of impotency, the reader is referred to the work of Curling, Diseases of the Testes.']

STERILITY.

CHAPTER 73.

STERILITY-CAUSES-PROCREATIVE POWER IN THE FEMALE-PUBERTY-EARLIEST AND LATEST AGES FOR CHILD-BEARING FEMALE PRECOCITY-AGE FOR CESSATION OF THE MENSES-LEGAL RELATIONS OF IMPOTENCY AND STERILITY— LEGITIMACY AND DIVORCE.

Definition. Sterility is usually defined to be the inability to procreate, or a want of aptitude in the female for impregnation.' It is not usual to speak of sterility in the male, although there may be procreative incapacity; because the defective condition in this sex, from whatever cause, is, in a legal view, included under the term 'impotency' (see p. 282, ante). In the strictness of language, a male who has been castrated is sterile; but it is commonly said that he is impotent (p. 283, ante). In reference to women, sterility implies that condition in which there is an inability to conceive." This appears to be the true meaning of the term, and the sense in which it is used not only by the best writers but in common phraseology.

Age at which menstruation commences. Procreative power in the female. -In the female, the procreative power is commonly supposed not to exist until after the commencement of menstruation, and to cease upon the cessation of this periodical secretion. The menstrual function is commonly established in females in this climate between the ages of fourteen and sixteen; but it may occur much earlier-indeed, in some rare instances,

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a discharge resembling the menstrual has been known to occur in mere infants. The occasional appearance of the menstrual flux at an early age does not necessarily imply that in other respects the female attains the development of puberty, or with any undue precocity of the child as to sexual instincts. In other cases its appearance has been protracted to a much later period. According to Rüttel, the menstrual function appears in the smallest number of females at 12, 13, and 14, and in the largest number at 16, 17, and 18 years. In some it is only first established at from 19 to 21 years; and he states that at this age he has often found the womb small and quite undeveloped. According to Hogg (Med. Times and Gaz.' 1871, 2, p. 555), out of 2000 inquiries, personally made, the earliest age for the commencement of menstruation in one case only was 9, and the latest 22. Among this number there were at 12 years of age, 253; at 13, 437; at 14, 502; and at 15, 270. Other statistics show that among 2696 fruitful women menstruation commenced in the greatest number (560) at 14 years of age; in the smallest number (3) at 9 years, and in 2 at 26 years. From these cases it appeared most frequently at 14 years of age, then at 15, 16, 13, 17, 12, 18, 19, 11, 20, and 10. ('Obstet. Trans.' 1870, 11, 243.) The earliest and latest period in a large number of cases were respectively 9 and 23 years. (Lancet,' Nov. 30, 1844, p. 283.) Perhaps, in this country, the most frequent age for the commencement of menstruation may be taken at 15 years. It is liable to be accelerated in its appearance by certain moral and physical conditions under which a girl may be placed. In India women begin to menstruate after the twelfth or at the beginning of the thirteenth year, and the function continues until the fortieth or even the forty-fifth year. Menstruation at ten years is very uncommon, and probably does not occur in more than one or two instances out of a hundred females. It is equally rare that it should be delayed beyond the thirteenth year. (Med. Jurispr. for India,' 1856, p. 461.) The most common intervals for the appearance of this function are twenty-eight and twenty-one days. It is sometimes late in life before it appears. Camps found that it had not appeared in a married woman, æt. 30, who had borne no children. (Med. Gaz.' vol. 32, p. 409.) Another case is mentioned in the same volume where it appeared for the first time at the age of 47. So soon as this function commences, a woman may be considered to have acquired procreative power; but a female may conceive before the function has commenced, during the time of its occurrence, or after it has ceased. From facts elsewhere stated (ante, p. 243) there is some reason to believe that the period which immediately precedes or follows the discharge is favourable to conception: although the experience of most accoucheurs has proved that impregnation may take place at any time between one menstruation and another.

It is important to remember that these changes in the womb may produce remarkable effects by sympathy with the brain and nervous system. At or about the time of puberty, especially if any cause of obstruction exists, girls become irritable, easily excited, and they have been known to perpetrate, without apparent motive, crimes of great enormity. It has been remarked that acts of arson and murder have been frequently committed by girls at this period of life without any apparent motive or for the most trivial reasons, and the crime has spread by imitation. The case of Brixey, tried for the murder of an infant, and acquitted on the ground of insanity, will serve as an illustration of the morbid effect produced on the brain by disordered menstruation. (See post, INSANITY.) Other causes have been already referred to in this work in which crimes of the greatest magnitude have been traced to girls of this age, without any apparent reason for imputing actual insanity. The only suggestion that could be advanced

was the atrocity of the act, without any of the ordinary motives which actuate criminals, and the acts of murder were perpetrated on helpless children incapable of giving offence. In the case of Vamplew (vol. 1, p. 436), Lincoln Aut. Ass, 1862, it was proved that a girl under thirteen years of age, acting as nurse in a family, had destroyed with strychnine an infant entrusted to her care. It transpired that in two other families she had previously destroyed with poison infants placed under her charge. The case of Constance Kent, a girl between fifteen and sixteen years of age, furnishes another illustration. She was convicted on her own confession of the murder of her infant step-brother (vol. 1, p. 547) under circumstances showing great atrocity and cunning, and for which no motive could be suggested. Quite recently (1882) a young nurse girl was tried for the murder of several of her master's children by drowning them at successive intervals in a well. These acts seemed to be done without motive, and took place at long intervals, so as to simulate accidental death. Lastly, there is the case of the girl Norman (ante, p. 93), aged fifteen years, convicted of an attempt to murder, by suffocation, a child placed under her care as nurse. It came out that four other children to whom she had been nurse had died under her hands from suffocation. There was no evidence of intellectual insanity, in any of these cases, nor was there anything to show that the uterine sympathy, if it existed, was beyond the power of control. They were all convicted. At this period of life the state of the mind should be closely watched, and any causes of irritation or violent excitement removed. Irregularity, difficulty, or suppression of the menstrual secretion may give rise to temporary insanity, indicated by taciturnity, melancholia, capricious temper, and other symptoms. Puberty in the male may be attended with similar morbid propensities, but these are not so commonly witnessed as in the female sex.

Pregnancy before menstruation.—The occurrence of menstruation is not indispensable to pregnancy: many cases are on record in which women who had never menstruated have conceived and borne children. One case is reported in which a woman, aged 25, became pregnant and bore a child, and menstruation was only regularly established afterwards. ('Lancet,' Feb. 1842.) Murphy mentions another instance of pregnancy previous to menstruation'in a woman aged 23. ('Obstet. Rep.' 1844, p. 7.) Numerous cases of conception without previous menstruation are quoted by Capuron ('Méd. Lég. des Accouch.' p. 96); and no fewer than nine instances of pregnancy before menstruation have been collected by Whitehead. The women were all in excellent health during the whole time, and one did not menstruate until more than two years after the marriage had been consummated. (On Abortion,' p. 223; see also Orfila, Méd. Lég.' 1848, 1, 257.) Another case is reported (Med. Gaz.' vol. 44, p. 969). A girl, aged 13, bore a child before menstruation had appeared. (Med. Times and Gaz.' March 12, 1853, p. 277; see also, for remarks on this subject, Edin. Month. Jour.' July, 1850, p. 73.) Reid stated that a patient of his bore a child at the age of 17, without having previously menstruated; and he collected from various authorities a number of cases of pregnancy occurring in women who had not menstruated. (Lancet,' Sept. 3, 1853, p. 296.) Pridie met with the case of a girl, æt. 15, who was then for the first time confined and had never menstruated. In some cases it has been noticed that menstruation has ceased after marriage or taken place only at rare intervals without interfering with impregnation. Young has added to the number of these cases. (Amer. Jour. Med. Sc.' Oct. 1870, p. 568.) 1. A woman, married on Sept. 10th, 1859, menstruated in October thereafter, but not again until June, 1870, and she had had in the interval six healthy living children. 2. A woman married in Jan. 1856, and only menstruated

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297

three times up to June, 1870. She was the mother of nine children, seven of whom lived. In these cases the women had menstruated regularly until they were married.

According to Bischoff, the uterine discharge of blood in menstruation is only a symptomatic although a usual appearance. But it may be absent, while the ovarian changes go on in the usual way: hence a non-menstruating woman may conceive. At the menstrual period the uterus undergoes certain changes; the mucous membrane is swollen, and the uterine glands are strongly developed: hence the expelled ovum finds a ready spot of attachment when impregnated, and an absence of this swollen condition of the mucous membrane at other times may be one cause of sterility. From an inspection of the generative organs in the human female, in thirteen cases, during or shortly after menstruation, he inferred that the change in the uterine mucous membrane was synchronous with the commencement of menstruation: this condition was observed to remain for so long a period as eighteen days after the function had ceased. The true function of menstruation appears to be the ripening and separation of the ovum. Times and Gaz.' Ap. 8, 1854, p. 354.)

('Med. Premature puberty.-Instances of premature puberty in the female are numerous, and are far more common than in the male sex. Whitmore met with the case of a female child who, from a few days after her birth, menstruated regularly, at periods of three weeks and two or three days, until she had attained the age of 4 years, when she died. On inspection after death she appeared like a much older girl. The breasts were unusually large, and the female organs and lower limbs were considerably developed. (North. Jour. of Med.' July, 1845, p. 70.) Another case of a child aged 3 years is reported. (Lancet,' Jan. 29, 1848, p. 137.) The breasts were as healthily developed as in an adult of 20 years, and the sexual organs were also as much developed as in a girl at the age of puberty. It was observed that this child, who had been regularly menstruating for twelve months, had the appearance of a little old woman. (For other cases of menstruation at 5 years, see 'Med. Gaz.' vol. 25, p. 548; at 3 years, vol. 47, p. 244; and at 3 years, Med. Times and Gaz.' July 24, 1858.) Flugel reports the case of a female child who died at the age of five years and six months, and who had attained the height of five feet and a proportionate development of the body throughout. When six months old she had cut all the incisor teeth, and when nine months, all the molars. When she had reached the eighteenth month the menses first made their appearance, and from that time occurred with great regularity. The hair of the head was long, the breasts prominent, the external genitals well-developed but without hair. The pelvis was capacious. The intellectual powers were not more advanced that usual. (Amer. Jour. Med. Sc.' July, 1872, p. 245.) In most of these instances there is reason to believe that procreative powers are early, developed; but it is not common to hear of such young females becoming impregnated. A case is mentioned by Beck, of a girl menstruating at one year; she became pregnant, and was delivered of a child when little more than ten years old. Walker met with a case in which the menstrual function was established at the age of 11 years, and the patient was delivered of a living child when only 12 years and 8 months old. (Amer. Jour. Med. Sc.' Oct. 1846, p. 547.) In another, observed by Rüttel, a female of the age of fourteen became pregnant by a boy of the same age. He also quotes three other cases, where one girl of the age of nine, and two of the age of thirteen, became pregnant (loc. cit.). The first of these three cases represents the earliest age for pregnancy yet assigned by any author. The editor has met with two cases of menstruation at 11 years of age, without unusual precocity.

Wilson met with an instance in which a girl at the age of 13 years and 6 months gave birth to a full-grown child; conception must have taken place when she was 12 years and 9 months old. (Edin. Med. Jour.' Oct. 1861. See also Casper's 'Vierteljahrsschr.' Jan. 1863, p. 180.) Robertson mentions the case of a factory-girl who became pregnant in the eleventh year of her age. A case came before a magistrate in 1871, in which a girl under 13 was found to be pregnant. It appeared from the evidence that impregnation must have taken place when the girl was 12 years and three months old.

When

A man, æt. 45, was prosecuted (Coventry Sum. Ass. 1848, Reg. v. Chattaway) for a misdemeanor in having had carnal knowledge of a girl named Sprason, then between the ages of ten and twelve years. intercourse was first had, the girl was eleven years and eight months old; it was repeated several times subsequently; and when the prosecutrix gave her evidence in Court, it appeared from the statement of the mother that she was in the last month of her pregnancy: she was then not quite twelve years and six months old. Menstruation had commenced in this girl at the age of ten years and two months, and had continued regularly up to Dec. 1847, which was about the time when she had first had intercourse with the prisoner. It appeared that she was a factory-girl; and to the heat, confinement, and association with males, to which girls are subjected in this employment, may be referred the early commencement of puberty. When menstruation has thus commenced, conception may always be the result of sexual intercourse. The prisoner was convicted. ('Med. Gaz.' vol. 42, p. 751.)

Age at which menstruation ceases. Menstrual climacteric.—The average age at which this function ceases in women is usually from 40 to 50 years: but as it may commence early, so it may continue late in life. In one case it has been known to cease at the age of 23, and in other instances it has continued to the age of 66 and even of 75 years. (Whitehead, op. cit. p. 145 et seq.) Out of many cases collected by Hogg, the earliest age at which menstruation ceased was 23, the initial period having been 16 years. In one woman it ceased at 34 and in two at 53, but in the greatest number (nine) it ceased at 47 years. ('Med. Times and Gaz.' 1871, 2, p. 555.) Royle describes three cases, in two of which menstruation continued up to the age of 67. (Med. Times and Gaz.' Nov. 1860.) Thomas met with a case in which a woman had ceased to menstruate at the age of 45, but the discharge suddenly reappeared after an attack of illness when she had reached the age of 69. The discharge appeared several times, but not with monthly periodicity. It seems that her mother and sister had also menstruated at the ages of 69 and 60 years. (Med. Times and Gaz.' Aug. 7, 1852, p. 148.) In a case which occurred to Capuron, it continued beyond the age of 60 (op. cit. p. 98); but a more remarkable case, both of late menstruation and late pregnancy, is quoted by Orfila from Bernstein. A woman, in whom the function appeared at 20, menstruated until her ninety-ninth year. Her first child was born when she was 47, and her seventh and last when she was 60 years old. (Méd. Lég.' 4ème éd. 1848, 1, 257; see also Briand, 'Man. de Méd. Lég.' 1846, p. 137.) Other cases are recorded on good authority. Whitehead communicated to the 'Lancet,' 1866, the following facts. He was called to a lady, æt. 77, suffering from uterine hæmorrhage. Upon inquiry, he found that she had menstruated monthly up to the time at which he saw her. The discharge lasted from four to five days, and had then left her; but on this occasion it had been very profuse. She was restored by the usual remedies. Other cases are reported (Amer. Jour. of Med. Sc.' Jan. 1845, p. 107). In one of these, a nun, the menses ceased at 52: at the age of 62 they reappeared, and so continued regularly, until