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 analogous operations may be performed on women. And if women can be
sterilized by surgical interference, whence comes the necessity of
sterilizing both?
Oophorectomy, or removal of the ovaries is analogous 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 analogous
operation on the opposite sex, 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 coarse 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, Oophorectomy 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 unsexing 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
unsexing 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 pass into the Fallopian tubes; being almost microscopic, they are
disintegrated and reabsorbed. If they do pass 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 assured. 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 passage, or
by the abdominal route, the choice depending on various circumstances.
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 tittle 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 sexual
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
prostitutes 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 passed 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 hardship 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 damned 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.