Relative sterility is not amenable to medical treatment. The most common cause of infecundity of this character is the want of adaptation or fitness of the genital organs of the conjugal pair to each other. This want of adaptation is a very frequent cause of sterility, and should receive proper attention by the medical man to whom is intrusted the rectification of an unproductive union. Of itself, inadaptation may not be the cause of the atociac condition, but when associated with an atomic condition of the uterus, procreation rarely, if ever, ensues. It will not be necessary for me to detail the various forms of inadaptation, as the consideration of such causes of sterility more immediately concerns the medical attendant, but it is quite appropriate to make allusion to such causes, as the childless very properly desire information relative to all possible conditions hindering fructification. Self-treatment is not to be thought of; but a proper knowledge of all the physiological or anatomical causes of sterility should be possessed by all in conjugal association, especially by those who have not as yet attained the full measure of matrimonial enjoyment, by reason of an exceptional provision of fate by which their union is left without the graces and endearments of childhood.

One of the most common causes of barrenness is unquestionably what has been already alluded to, atony of the womb or appendages; in fact some pathological condition of the reproductive organs of the female is, in the large majority of cases, the sole cause. Uterine atony, or intonicity of the womb, may be of every degree of intensity -- ranging from a slight feebleness to complete exhaustion -- the latter condition being known as paralysis of the womb. This atonic state is owing not to any structural or organic disease of the womb itself, but is merely a secondary pathological condition, the actual seat of the disorder being in the sacral plexus, or that nervous net-work situated near the sacrum, from which the genital organs receive their nervous supply.  A paralyzed condition of the womb is aptly illustrated by a paralyzed arm or leg; the loss of natural power, motion, or functions resulting from a diseased condition of some cerebral or spinal nerve-centre, and not from any morbid condition of the part affected. In all cases, therefore, where the cause of sterility has been ascertained to be uterine paralysis, the proper treatment is to restore the tonic powers of the sacral plexus. This is best accomplished by the intelligent application of the electric or galvanic current, or by the employment of the appropriate cerebro-spinal tonics and other medicinal agents. The treatment is, however, to be intrusted to careful, able, and experienced physicians.

The physiological function of the womb, favoring the transmission of the male formative material from the os uteri to the ovarium, is a certain suction power or intro-staltic motion. This is accompllished by short and wave-like contractions upward of the uterine muscles. In a paralyzed condition of the womb, which is usually of a chronic character, there is a complete absence of this uterine motion, and consequently the respective formative materials necessary for procreation never come in contact.

Membranous menstruation has already been stated as one of the causes of sterility. This painful affection is characterized by either partial or complete denudation of the uterine cavity of its mucous covering at each menstrual period, leaving the uterine walls in an abraded condition, entirely unfitted for the purposes of gestation. Conception may, however, take place in these cases, but at the arrival of the first period for the occurrence of the menstrual exacerbation, the placenta and membranes are dislodged with the mucous membrane.

The childless wife will note that a pathological or abnormal condition of her pelvic organs is relatively the most frequent cause of sterility, all of the affections being characterized by more or less gravity and requiring the most appropriate and energetic treatment in order to restore the organs to health, and at the same time establish functional integrity and maternal capacity. As most of these uterine affections result from a wilful disregard of the laws of health, slavish obedience to the behests of fashion, and bad habits in general, the author hopes that all females, married or unmarried, who properly appreciate the grandeur of womanhood and motherhood will not wilfully violate physiological law, but strenuously endeavor to preserve uterine health and integrity of the maternal capacity.

Congenital phymosis is a condition of the male organ depriving him of procreative power in nearly every instance. The intervention of the prepuce in this case arrests the ejaculatory force of the seminal expenditure, preventing impulsion into the womb. This deformity is easily obliterated by a surgical operation, which is very frequently performed in my office. It causes but little pain, no inconvenience, and heals rapidly. Circumcision among the Jews is a custom having for its object the removal of this frequent obstacle to multiplication, as existing in the male. Infecundity, especially in the earlier years of marriage, is often a consequence of exhaustion, induced by improper excesses. Intemperate indulgence often renders both husband and wife, sterile. The semen must, in order to have procreative perfection, necessarily remain in the seminal vesicles for a certain time, where its procreatiave qualities are fully developed. After its escape from the vesicles, it further receives the intermixture of prostatic fluid, liquefying it to the proper consistence for easy propulsion into the uterine cavity. Marital excess is therefore preventive of full procreative quality of the semen. Excessive indulgence on the part of the wife causes a feebleness of peristaltic motion of the uterine muscles, or, as it may be otherwise termed, the suction power of the womb. Feebleness of the upward propelling forces of the womb and Fallopian tubes is caused by the excesses alluded to, and hence, if even the semen is introduced within the uterine embrace, the absence of retentive power allows its escape through the mouth of the womb. Sterility from such cause can only be overcome by the observance of moderation by the conjugal pair, and in most cases restorative medical treatment becomes also a necessity.

The most susceptible period for the occurrence of conception is immediately after the complete cessation of the menstrual flow. This susceptibility continues for eight or ten days, but is necessarily greatest at an early period after the menstrual discharge. The menstrual flow in its discharge carries away all obstructions that exist in the mouth of the womb, thus facilitating intro-propulsion of the semen, and the womb at that period has also its greatest tonic power. It is, however, not to be supposed that conception will not take place at the period just preceding the menstrual flow; on the contrary, it may occur at any period between the cessation and onset of the catamenial discharge.

It will thus be seen that many causes, both absolute and relative, tend to sterility. In but few cases, however, is sterility a fixed fact, or an irremediable condition. The greatest triumphs achieved by the medical profession were in the study of the causes of sterility, and the best means for their removal. No physician, alive to the importance and exalted character of his calling, should neglect the study of the subject; on the contrary, he should be conversant with all the pathological features sterility presents, and be able to intelligently ascertain the causes. An important trust is confided to his professional care; the intensest longing capable of the human  heart depends upon his skill, either to be appeased or unrequited. Professional acumen is in no respect more essential than in this, and the medical counsellor, unworthy of the trust by reason of imperfect knowledge of the subject, does a grievous wrong by attempting treatment, or venturing decisive advice. The childless pair should at all times seek the most intelligent counsel and most competent treatment, and not allow themselves to become victims of despondency before they have made such a definite attempt.

The author has devoted much time and study upon this subject, feeling that no greater field of usefulness is presented to the physician for the exercise of his skill and professional attainments. The success attained in this sphere of professional activity has only been gained at the expense of laborious study and by the advantages conferred by extensive practice. Competence can only gained by study and experience in every subject of intelligence -- proficiency being only the reward of intellectual labor and opportunity for exercise of the secured knowledge.

The author will gladly give advice to those to whom this chapter refers, being justified by previous success and long professional experience to give proper and definite advice and appropriate treatment. Those desiring to avail themselves of such an opportunity are referred to page 390 for guidance as to the proper information to submit for my consideration.