The Fertility of the Unfit Part 13

Such a claim arises out of insufficient knowledge of the physiology of s.e.x, and the pathology of crime. Emasculation would have little influence in preventing a recurrence of this crime, for the operation does not render its subjects immediately impotent, nor does it change their s.e.xual nature any more than it beautifies their character.

The instinct remains, and the power to gratify it remains at least for some years. With the less knowledge of surgery of earlier times, a social condition in which such a practice might be rationally considered, is conceivable, but with the present state of our profession, such measures would be unthinkable.

CHAPTER XI.

TUBO-LIGATURE.

_The fertility of the criminal a greater danger to society than his depradations._--_Artificial sterility of women._--_The menopause artificially induced._--_Untoward results._--_The physiology of the Fallopian tubes._--_Their ligature procures permanent sterility._--_No other results immediate or remote._--_Some instances due to disease._--_Defective women and the wives of defective men would welcome protection from unhealthy offspring._

There is a growing feeling that society must be protected, not so much against the criminal as against the fertility of the criminal, and no rational, practicable, acceptable method has as yet been devised.

The operations on men to induce sterility have been discussed and dismissed as unsatisfactory.

But a.n.a.logous operations may be performed on women. And if women can be sterilized by surgical interference, whence comes the necessity of sterilizing both?

Ooph.o.r.ectomy, or removal of the ovaries is a.n.a.logous to castration. It is an equally safe, though a slightly more severe and complicated operation.

It can be safely and painlessly performed, the mortality in uncomplicated cases being practically nil.

The changes physical and mental are not so grave as in the a.n.a.logous operation on the opposite s.e.x, and they vary considerably at different ages and in different cases. The later in life the operation is performed the less the effect produced. At or after the menopause (about the 45th year) little or no change is noticeable.

In many, and especially in younger women however, grave mental and physical changes are induced. The menstrual function is destroyed, the appearance often becomes masculine, the face becomes coa.r.s.e and heavy, and hair may appear on the lips and chin. Lethargy and increase of weight are often noticed, and not a few, especially in congenitally neurotic cases, have an attack of insanity precipitated.

On the same principle on which the radical operation on men was condemned, Ooph.o.r.ectomy must also be condemned. It is a serious operation, often attended with grave mental and physical disturbances, not the least of which is the partial uns.e.xing of those subjected to it.

While these are delicate they are also pressing questions, questions which, like the mythical riddle of the Sphynx, not to answer means to be destroyed, yet the sentimental difficulties, are accentuated by modern progress, for the public conscience becomes more sensitive as problems become more grave. But as science has prepared the bridge over which society may safely march, so, with rules easily provided by an enlightened community all remedial measures formerly proposed--wise in their times, probably, may now be waived aside.

With our present knowlege, the simple process of tubo-ligature renders uns.e.xing absolutely unnecessary in order to effect complete and permanent sterility. As the lesser operation vasectomy, is effectual in men, so is a lesser operation, tubo-ligature effectual in women. And it has this paramount advantage that, whereas vasectomy being an occlusion of a secretory duct, leads to complete atrophy and destruction of the testis, ligature of the Fallopian tube, which is only a uterine appendage and not a secretory duct of the ovary, has absolutely no effect whatever on that organ.

A simple ligature of each Fallopian tube would effectually and permanently sterilise, without in any way whatever altering or changing the organs concerned, or the emotions, habits, disposition, or life of the person operated on.

The Fallopian tubes are two in number, attached to the upper angles of the uterus, and communicating therewith. Each is about five inches in length, and trumpet-shaped at its extremity, which floats free in the pelvic cavity.

Attached to the margin of this trumpet-shaped extremity, is a number of tentacle-like fringes, the function of which is to embrace the portion of the ovary, where an ovum has matured during or immediately after menstruation.

At all other times these tubes are practically unattached to the ovaries. Ova may and do mature on the surface of the ovaries, but do not always pa.s.s into the Fallopian tubes; being almost microscopic, they are disintegrated and reabsorbed. If they do pa.s.s into a tube they are lost or fertilized as the case may be.

It can be seen that the function and vitality of the ovaries are in no way affected by the tubes. The ovarian function goes on, whether the tubes perform their function of conveyance or not, and if this function can be destroyed, life-long sterility is a.s.sured. There is no abdominal operation more simple, rapid and safe, than simple ligature of the Fallopian tubes. It may be performed by way of the natural pa.s.sage, or by the abdominal route, the choice depending on various circ.u.mstances.

If the former route be taken, there may be nothing to indicate, in some cases not even to a medical man, that such an operation has been performed.

The Fallopian tubes have been ligatured by Kossman, Ruhl and Neuman for the sterilization of women with pelvic deformities; but all testify to the danger of subsequent abnormal or ectopic pregnancy, and several instances are given. Mr. Bland Sutton relates a case in an article on Conservative Hysterectomy in the British Medical Journal.

After numerous experiments on healthy tubes, I have found that simple ligature with even a moderate amount of force in tying will cut the tube through in almost any part of its length. The mucous lining is so thrown into folds that its thickness in relation to the peritoneal layer is considerable. Because of this, the tube when tied alone is brittle, and a ligature applied to it will very easily cut through, and either allow of reunion of the severed ends or leave a patent stump. In a recorded case in which pregnancy occurred after each tube was ligatured in two places, and then divided with a knife, a patent stump was no doubt left.

In order to obviate this danger the peritoneal layer must be opened, and the mucous membrane, which is quite brittle and easily removed, must be torn away for about one quarter of an inch. A simple cat-gut or silk ligature lightly tied would then be sufficient to insure complete and permanent occlusion.

Nature often performs this operation herself, with the inevitable and irrevocable result, lifelong sterility, with no t.i.ttle of positive evidence during life of its occurrence.

Here are a few examples:--A young married woman has a miscarriage; it is not severe, and she is indiscreet enough to be about at her duties in a day or two, but within a few days or so she finds she must return to bed, with feverishness and pelvic pain. Before a month is past she is up and quite herself again. But she never afterwards conceives. What has happened? To the most careful and critical examination nothing abnormal is detected. Her general health, her vitality, her emotional and s.e.xual life, her youthful vigorous appearance, all are unimpaired. But she is barren, and why? A little inflammation occurred in the uterus and spread along the tubes. The sides of the tubes cohered, permanently united by adhesive inflammation, and complete and permanent occlusion resulted.

The operation of tubo-ligature is an artificial imitation of this inflamatory process.

Pelvic inflammation, sometimes very slight, following a birth, or the same process set up by uterine pessaries used for displacements, may induce adhesive inflammation in the tubes, and simple and permanent sterility is the incurable result. It is a well known fact that prost.i.tutes are usually sterile, and this arises from the prevalence of venereal disease, which produces gonorrhoeal inflammation of the Fallopian tubes, resulting in complete and permanent occlusion.

This process could be best imitated, if cauterisation of the tubes were a safe and reliable procedure. An electric cautery pa.s.sed along the tubes would result in a simple and speedy occlusion. But in the present state of our gynecological knowledge this appears impracticable.

We have therefore at our hand, a simple, safe, and certain method of stopping procreation by the sterilization of women by tubo-ligature.

This operation would entail no hards.h.i.+p on women. It is so easy, safe and painless, that thousands would readily submit to it to-morrow, to be relieved from the anxiety which a possible increase in their already too numerous families excites. Hundreds of women and men to-day are living unnatural lives, because of their refusal to bring children into the world with the hereditary taint they know courses in their own veins.

Many men are living loose and irregular lives, amongst the easy women of society, because the indiscretion of their youth has d.a.m.ned them for ever with a syphilitic taint, which they could not fail to transmit to their progeny.

Many virtuous men and women are living a life of abstinence from even each other's society, because their physician has taught them something of the law of heredity. Would not all these women readily submit to sterilization?

As it produces no mental nor moral, nor physical change, it violates no law, and outrages no sentiment. It is an outrage upon society, and a greater upon an innocent helpless victim to bring a defective into the world; it is a moral act to prevent it by this means.

And of all the methods yet suggested or devised, or practised, tubo-ligature is the simplest, most effective, and least opposed to sentiment and prejudice.

It will of course be asked:--What about criminals and defective men? Let their wives be sterilized. The wife of any criminal would deem it a boon to be protected from the offspring of such a man, so would society.

If he is not married, then society must take the risk, and it is not very great. The women who will be his companions will be either sterilized by disease or by tubo-ligature, because they are defectives.

This protection from the progeny of defective men, though not absolute, is complete enough for all practical purposes.

If all defective women and the wives of all defective men are sterilized, a greater improvement will take place in the race in the next 50 years, than has been accomplished by all the sanitation of the Victorian era.

CHAPTER XII.

SUGGESTIONS AS TO APPLICATION.

_The State's humanitarian zeal protects the lives and fosters the fertility of the degenerate._--_A confirmed or hereditary criminal defined._--_Law on the subject of sterilization could at first be permissive._--_It should apply, to begin with, to criminals and the insane._--_Marriage certificates of health should be required._--_Women's readiness to submit to surgical treatment for minor as well as major pelvic diseases._--_Surgically induced sterility of healthy women a greater crime than abortion._--_This danger not remote._

The fertility of the unfit goes on unrestrained by any other check, save vice and misery. The great moral checks have not, and cannot have any place with them. But the State is, by its humanitarian zeal, limiting the scope and diminis.h.i.+ng the force of these natural checks amongst all cla.s.ses of the community, but especially amongst the unfit, so that its policy now fosters the fertility of this cla.s.s, while it fails to arrest the declining nativity of our best citizens. The greater the fertility of the unfit, the greater the burden the fit have to bear, and the less their fertility.

The State's present policy therefore, fosters the fertility of the unfit, and discourages the fertility of the fit. This disastrous policy must be changed without delay. The State can arrest the gradual degradation of its people, by sterilizing all defective women and the wives of defective men falling into the hands of the law. Mr. Henry M.

Boies in "Prisoners and Paupers" suggests life-long isolation. He says:--"It is time however that society should interpose in this propagation of criminals. It is irrational and absurd to occupy our attention and exhaust our liberality with the care of his constantly growing cla.s.s, without any attempt to restrict its reproduction. This is possible too, without violating any humanitarian instinct, by imprisonment for life; and this seems to be the most practicable solution of the problem in America. As soon as an individual can be identified as an hereditary or chronic criminal, society shall confine him or her in a penitentiary at self-supporting labour for life.

Every State should have an inst.i.tution, adapted to the safe and secure separation of such from society, where they can be employed at productive labour, without expense to the public, during their natural life. When this is ended with them, the cla.s.s will become extinct, and not before. Then each generation would only have to take care of its own moral cripples and defectives, without the burden of the constantly increasing inheritance of the past. When upon a third conviction the judicial authorities determine the prisoner to belong to the criminal cla.s.s, the law should imperatively require the sentence to be the penitentiary for life, whatever the particular crime committed."

M. Boies defines a criminal as one in whom two successive punishments, according to law, have failed to prevent a third offence.