VASECTOMY, OR STERILIZATION, BY STATE LAW
The State of Indiana in 1907 enacted a vasectomy law which obliges
the superintendents of some prisons and asylums to appoint two
surgeons whose office is to sterilize sexually criminals, idiots,
imbeciles, and similar persons, if these surgeons, in consultation
with the chief physician of the institution, deem the propagation
of children by such so-called degenerates detrimental to society.
The same law has been incorporated in the statutes by New York, New
Jersey, Washington, Iowa, Nevada, Wisconsin, Connecticut, California,
Utah, Kansas, Oregon, and Minnesota. The law has been proposed
several times in the Legislature of Pennsylvania, but it was vetoed
twice and held up once in the Assembly.
In New Jersey there was question of sterilizing an epileptic girl,
and the Supreme Court of that State[216] decided in 1913 that the
law is contrary to the State and Federal constitutions. In 1916
Probate Judge Lapeer of Michigan declared the law as passed in his
State in 1913 unconstitutional, but the State appealed against this
decision. The Supreme Court of Washington[217] decided in favor
of the law in a case where a man convicted of rape was sentenced
by the trial judge to life imprisonment and to vasectomy as a
punishment. The constitutionality of the Iowa law is on appeal to the
United States Supreme Court after a Federal judge had declared it
unconstitutional. The law in Indiana was put into effect in hundreds
of cases, but Governor Marshall set the law in abeyance. Two Federal
judges in Kansas said the law is unconstitutional and granted an
injunction against its application in a particular case. In 1808
the superintendent of a Kansan institution for the feeble-minded
castrated forty-eight boys. Up to April, 1916, about twenty-five
feeble-minded boys in the Wisconsin institution at Chippewa Falls
were sterilized, and the authorities then said they intended to
sterilize the girls. The law has been advocated by alienists in
Switzerland, and French and English physicians have advocated it.
[216] _Smith vs. Board of Examiners of the Feeble-minded, 88 alt.
R. 963._
[217] _State vs. Feilen, 126 Pac. R. 75._
The reason given by the advocates of this law is the alarming
prevalence of feeble-mindedness with its tendency to criminality; and
as, they say, heredity accounts for 65 per cent. of feeble-mindedness,
the feeble-minded should be prevented from propagating their kind.
Sweden, with 5,500,000 inhabitants, has 18,000 insane, 14,000 idiots,
20,000 imbeciles, and 7,000 epileptics. Much of this degeneracy is
due to the notorious alcoholism of the Swedes, which only lately
has been brought under some control. Pennsylvania had about 17,000
feeble-minded in 1913. In a single county almshouse in that State
were 105 women who had given birth to 101 defective children. One
feeble-minded couple in the same State had 19 defective children;
two other families had 9 imbeciles and 7 idiots. In New Jersey the
history of 480 individuals of the famous "Kallikak" family (a
pseudonym), descended from a feeble-minded woman who lived at the
time of the Revolutionary War, has been traced out, and of these
descendants only 40 were normal. New York State has 32,000 known
feeble-minded persons. One State school for the feeble-minded in
Indiana in 1908 had 1054 inmates. There are 6000 mentally defective
children in the schools of Chicago. An investigation made in Illinois
about 1907 brought out the conclusion that all the defectives and
delinquents in that State at the time could be traced to 150
families. Poehlmann of Bonn traced the descendants of one female
drunkard through six generations in 800 individuals, and of these
107 were illegitimate, 102 were beggars, 181 were prostitutes, 76
were criminals in a grave degree, 7 were murderers, and they had
cost the State $1,206,000. The Jukes sisters, two illegitimate
prostitutes in New York State, in five generations bred 709
criminals. Fifty-two per cent. of the women were prostitutes,
whereas the ordinary ratio of prostitutes to other women is 1.66
per cent. Alcoholics engender degenerates. In three generations
of 215 French alcoholic families, Legrand found that 60 per cent.
of the children were degenerates. Bourneville found that 62
per cent. of 1000 idiotic, epileptic, and feeble-minded children in
Paris had alcoholic parents.
Hereditary transmission is certainly a cause also of many diseases
of the nervous system. Friedrich's ataxia is hereditary. It is an
incurable progressive incoördination of the limbs, tongue, larynx,
and eyes, which attacks commonly between the tenth and the twentieth
year, and the patient dies from some intercurrent disease, usually
an infection. Progressive muscular dystrophy is also hereditary
and incurable. The legs and trunk atrophy, and death comes from
an intercurrent disease. Related to this malady are hereditary
progressive neurotic muscular atrophy, progressive spinal muscular
atrophy in infants, and progressive spinal amyotrophy in adults.
Amaurotic (_amaurosis_, blindness) family idiocy is hereditary,
and the child dies at about two years of age. Huntington's chorea
appears in every generation of an affected family. Its symptoms show
between the ages of thirty and forty years, and it progresses from
choreic and ataxic signs to dementia and death. The death is often
by suicide. In eastern Long Island, southwestern Connecticut, and
eastern Massachusetts 962 cases were all traced back to six persons,
three of whom were probably brothers, who came to America in the
seventeenth century. In the 3000 relatives of these choreics were
39 cases of epilepsy, 51 cases of cerebral inflammation, 41 cases
of hydrocephaly, 73 feeble-minded children, and other evidences of
neuroses. The heredity in this disease is apparently Mendelian.
Besides the diseases enumerated here, there are several pathologic
conditions of the eyes which are hereditary--presenile cataract,
stationary night blindness, and retinitis pigmentosa. If the persons
who have these diseases are sexually sterile, evidently the heredity
so far as they are concerned will be cut across; hence the advocates
of legal sterilization wish to have these patients sterilized to
protect society.
The surgical operation by which the man is sterilized according to
the State laws mentioned above is an interruption of the continuity
of the vasa deferentia near the testicles. This interruption may be
a severing of each vas, a cutting out of a part of each vas, or a
ligation of the vasa. The term vasectomy is now used loosely to cover
all these methods. The vas deferens, or seminal duct, passes from the
testicle up along the groin on each side, in through the belly-wall
by the inguinal canal, down along the pelvis and under the bladder,
where it opens into the bottom of the urethra a short distance in
front of the bladder exit. Each vas is about two feet in length, and
it has a diameter of one-tenth of an inch throughout the greater part
of its length, but its lumen is extremely narrow.
There are two essential parts in the semen, the spermatozoa and
the carrying liquid. The spermatozoa, which fructify the ovum, are
formed in the testicle; the liquid, which is the essential vehicle
of the spermatozoa, and without which the spermatozoa are inert and
sterile, is secreted, except a few drops from the testicles, at the
distal end of the vasa deferentia under the base of the bladder, in
the seminal vesicles, the prostate gland, and Cowper's and Littré's
glands. The semen is made up of 90 per cent. water and 10 per cent.
solids, and in these solids is the nitrogenous base called spermin,
which is produced by the interstitial cells of the testicles and the
prostate gland. Ovarin, secreted from the ovaries, corresponds in the
woman to spermin in the man. The ductless glands, and some that have
ducts, produce secretions which sustain the tone of the blood-vessels
and neutralize the toxins from waste substances while these are in
the body before excretion. An excess of spermin or ovarin causes
congestion of the cerebrum and cerebellum and the nerve centres
there, with consequent sexual erethism. When there is a pathologic
sexual erethism from an excess of spermin or ovarin, vasectomy,
castration, spaying, or the menopause cuts off this excess and the
erethism disappears. Sometimes the waste product toxins excite the
patient when the spermin or ovarin has been eliminated, just as the
excess of spermin or ovarin excites, and the neurotic disturbance
or sexual erethism continues until compensation by other glands
neutralizes the irritating substance.
The testicles in man are by no means the sole organ of generation.
There are at least seventeen distinct organs in the male generative
system. The seminal vesicles with the prostate gland are as necessary
in generation as the testicles, as their removal sterilizes the
spermatozoa and prevents the formation of the liquid vehicle.
Castration effects an atrophy of several parts of the generative
tract, and an irremediable degeneration; vasectomy cuts off the
spermatozoa but causes no atrophy or degeneration, and the condition
is remediable. Dr. Edward Martin of Philadelphia found active living
spermatozoa in a testicle that had been ligated off for twenty years.
Running along the vasa deferentia, within the sheath of the two
spermatic cords, are the spermatic arteries, the pampiniform plexus
of veins, and the deferential arteries. These vessels, with the vas
deferens and the sheath enveloping the bundle, make up the spermatic
cord. In vasectomy, under local anesthesia, a slit is made through
the skin of the scrotum behind, the sheath of the spermatic cord
is opened, and the vas is isolated and tied or cut. The skin wound
is left to heal. This operation is repeated on the second vas. If
the blood-vessels in the cord are ligated or cut with the vas,
the testicle will atrophy; if the vas alone is operated upon, the
testicle is not injured. The person upon whom vasectomy has been done
is conscious of no change. The semen is discharged as before the
operation, but in a slightly less quantity, and it is, of course,
sterile from the lack of spermatozoa.
Dr. Carrington of Virginia reported, in 1910,[218] twelve cases of
vasectomy on convicts. He said ten of this dozen had been confirmed
masturbators, and all were cured by vasectomy. One masturbating
epileptic was cured of both conditions. Two dangerous homicides were
rendered harmless and peaceable. One of these two homicides was a
negro under a long sentence for murder. He grew insane in prison,
and while insane killed a second person. A confirmed masturbator and
sodomist, and a dangerous savage, he became lucid and relapsed into
insanity several times. A year after vasectomy he was "a sleek, fat,
docile, intelligent fellow, a trusty about the yard."
[218] _Virginia Medical Semi-monthly_, vols. xiv, xv.
Dr. Sharp of Indianapolis, after ten years' experience with the
operation, during which time he did 456 vasectomies, says:[219]
"There is no atrophy of the testicle, no cystic degeneration, no
disturbed mental or nervous condition following." He says, further,
that 176 men in the Indiana Reformatory asked him to perform the
operation on them. Vasectomy tends to check masturbation, and the
minds of the masturbators frequently improve after the operation.
[219] _Jour. Amer. Med. Assoc._, December 4, 1909.
If a man has been sterilized by vasectomy, restoration of function
and removal of the sterility seems practically always possible. If
a ligature has been used, releasing the ligature restores function.
Dr. William T. Belfield of Chicago[220] restored function fully by
removing the ligature eight weeks after it had been applied. In a
letter to me, Dr. Belfield said: "My observation accords with the
general experimental and clinical experience that the restoration of
the lumen after vasectomy or ligation, or both, is more certain than
the lasting occlusion of the vasa by these measures. The perseverance
of natural forces in restoring the lumen of the vas--and the success
achieved over such obstacles as silk ligatures--is surprising until
one reflects upon the natural factors favoring such restoration. In
one case I tied a waxed (to avoid cutting through) silk ligature
_tightly_ around the sheath of each vas; a specimen examined a month
later was devoid of sperms; one six months later contained plenty of
them. I cut down upon the ligatures, found them in place and neatly
encysted, and removed them. Evidently the pressure from behind had
squeezed a passage on at least one side. The gynecologists have
learned that ligatures around the Fallopian tubes are apt to cut
through, whereupon the tubal lumen is restored, though pressure
must be less than in the vas. Even when a piece of the vas has been
excised cases of spontaneous restoration have been observed in men
and dogs."[221]
[220] _Jour. Amer. Med. Assoc._, October 19, 1912.
[221] _Belfield, loc. cit._
When the ends of a cut vas are released from cicatricial tissue,
these ends may be sutured together; but as the lumen of the vas is
extremely small, there is sometimes obliteration by occlusion at
the juncture. Christian and Sanderson[222] described a method of
preventing this obliteration. A piece of No. 0 twenty-day catgut is
inserted three-eighths of an inch into each end of the vas, and these
ends are brought together by two catgut sutures, leaving the inserted
catgut in the canal. The ends heal together and the catgut in the
canal is absorbed. This method has been used successfully to join the
cut end of a Fallopian tube.
[222] _Jour. Amer. Med. Assoc._, December 13, 1913.
Gemelli[223] did vasectomy on eleven dogs and seven cats; about
six months later he reunited the cut ends, and on dissection found
restoration perfect, anatomically and functionally, in the eighteen
animals. The vas deferens in these animals is smaller than in man;
and therefore offers greater difficulty in the suturing. He used no
inserted catgut, but told me he employed the method Carrel applies in
joining cut arteries. In one case, where the dissection was broad,
he successfully inserted a piece of a vas taken from another animal.
Whether there is occlusion or not after end-to-end suturing depends
largely on the skill of the surgeon.
[223] _La Scuola Cattolica_, November, 1911.
Dr. Edward Martin of the Pennsylvania University[224] and Delbet[225]
have removed sterility by effecting a patulous anastomosis between
the vas and the epididymis, and this method is applicable after
vasectomy by cutting, but it is not successful, as a rule. It has
been done effectively where the vas had no stricture. McKenna,[226]
in five attempts on men, succeeded once. Fürbringer[227] said that
in his experience with a thousand cases of double epididymis, the
condition is incurable in 80 per cent. of the gonorrheal infections.
[224] _University of Pennsylvania Medical Bulletin_, 1902, p.
388; 1903, xv, 2; _Therapeutic Gazette_, December 15, 1909.
[225] _Revue de Thérapeutique Médico-chirurgicale_, January 15,
1912.
[226] _Journal Amer. Med. Assoc._, January 26, 1915.
[227] _Deutsche med. Wochenschrift_, xxxix, 29.
Apart from the so-called vasectomy law, gynecologists quite
frequently sterilize women who have chronic heart disease,
tuberculosis, nephritis, diabetes, or hereditary mental taints.
Some men, like Spinelli, Cramer, Polak, and others, would sterilize
also in chronic anemia, persistent albuminuria, epilepsy, syphilis,
contracted pelvis, diseases of metabolism, infections, and
cirrhosis of the liver. There are several methods of sterilizing
women--removal of the ovaries, ligation of the Fallopian tubes,
resection of portions of the tubes, resection of the whole tube on
each side, cutting the tubes and burying the cut end in the tissues
by various methods, and destruction of the lining of the uterus by
vaporization or the thermocautery. De Tarnowsky[228] describes the
various methods. Some ligations and short resections have failed
to sterilize. When the ovaries or uterus are removed, or the major
part of the tubes are resected, or the lining of the uterus has
been destroyed, the sterilization is permanent. Almost certainly
function could be restored where the resection of the tubes is not
too destructive. Apart from the matter of mutilation, the effects of
double oöphorectomy are very grave,[229] and removal of the uterus
or the ovaries merely for sterilization is not only immoral, but
altogether unjustifiable scientifically.
[228] _Jour. Amer. Med. Assoc._, April 19, 1913.
[229] See the chapter on Gonorrhea.
A phase of this subject which is important and has occasioned much
discussion is whether vasectomy causes sexual impotence or not.
From a medical point of view, there is no question of impotence;
physicians would say it causes sterility only. Most canonists,
however, hold that the condition after vasectomy is technically
impotence in the canonical sense. Ferreres of Tortosa, a leading
Spanish canonist, in several articles in the _Ecclesiastical Review_,
in _Razon y Fe_ (xxviii, 376; xxxi, 496), and in his book _De
Vasectomia Duplici_ (Madrid, 1913), opposed my opinion published in
1912 and 1913, which then was that vasectomy does not cause canonical
impotence. De Smet of Bruges[230] holds that it causes impotence.
So do Ojetti,[231] René Michaud,[232] Wouters,[233] Eschbach,[234]
Capello,[235] Stucchi,[236] De Becker, Vermeersch, De Villers,
and Salsmans of the University of Louvain, and others. Gemelli of
Milan[237] agreed with me. The weight of authority is certainly
in favor of the notion of impotence, but the arguments are by no
means convincing, as virtually every canonist who has discussed the
question has made gross misstatements of the physical facts in the
case.
[230] _Ecclesiastical Review_, September, 1912.
[231] _Synopsis Rerum Moralium et Juris Pontificii_, 31st ed., n.
2425.
[232] _Nouvelle Revue Théologique._
[233] _Nederlandische Katholische Stemmen_, January 15, 1911.
[234] _Analecta Ecclesiastica_, September, 1911, and _La Scuola
Cattolica_, February, 1912.
[235] _La Scuola Cattolica_, February, 1912.
[236] _Ibid._, November, 1911.
[237] _Ibid._, November, 1911.
If a man or woman is impotent, the disability is an _impedimentum
juris naturalis_, and as such it would nullify any marriage, no
matter what the dispensation. There are two opinions among moralists
as to the essence of canonical impotence.
I. Some hold that any permanent obstruction to fecundation, no matter
in what stage of the physiological process or in what part of the
genital tract it occurs, constitutes impotence. They maintain that a
woman whose ovaries or uterus have been removed is impotent. Roman
Congregations have promulgated several decrees in peculiar cases
permitting the marriage of spayed women; but, these moralists say,
it is not clear that in those special cases the entire ovary on each
side of the whole uterus was taken out; they hold there is doubt as
to the fact. And, since there is disagreement of moralists, the Holy
Office or other congregations would give the same decision because of
the _dubium juris_.
April 2, 1909, the Congregation on the Discipline of the Sacraments
decreed that the marriage of a Spanish woman, from whom, according to
the physician in charge of the case, the uterus and both ovaries had
certainly been removed, should not be prevented.
February 3, 1887, the Holy Office made the same decree in the case of
a woman from whom the uterus and both ovaries had been removed.
July 23, 1890, the Holy Office made the like decree under the same
conditions.
July 31, 1895, the Holy Office permitted the marriage of a woman from
whom both ovaries had been removed.
Another case, in 1902, in which the physician was not certain that
the whole ovary on each side had been removed, was decided in the
same manner.
There have been, then, four decisions so far permitting the marriage
of women who lacked both ovaries, and three of these women lacked the
uterus also. The Congregation of the Council has made four decisions
in recent time forbidding the marriage of women because of impotence;
March 21, 1863, a case in which there was neither vagina nor uterus;
January 24, 1871, a case in which the vagina was only two inches in
depth; September 7, 1895, a case in which the vagina was obliterated
in greater part; December 16, 1899, a case in which the vagina was
only five centimetres in depth.
That a woman who certainly lacks both ovaries is canonically impotent
is the opinion of Antonelli,[238] Lehmkuhl,[239] Rosset,[240]
Alberti,[241] Bucceroni,[242] and others. These men meet the
decisions of the congregations concerning the spayed women by saying
it is not certain the whole ovarian tissue or the entire uterus
was removed, although as a matter of fact the physician in one
case testified explicitly that both ovaries and the whole uterus
were undoubtedly removed. That a woman lacking both ovaries is not
impotent is the opinion of Gasparri, D'Annibale, Génicot, Berardi,
Aertnys, Tanquerey, Ojetti, De Smet, and others.[243]
[238] _Medicina Pastoralis_, vol. ii, n. 43.
[239] _Theologia Moralis_, 8th ed., ii, n. 744.
[240] _De Matrimonio._
[241] _Theologia Pastoralis_, p. iv, n. 88.
[242] _Theologia Moralis_, ii, n. 994.
[243] See Ferreres, _De Vasectomia Duplici necnon de Matrimonio
Mulieris Excisae_, p. 110. Madrid, 1913.
II. The second opinion on impotence is that this condition is caused
exclusively by those permanent disabilities which exist in the copula
itself. If the sexual act contains in itself all that is essential
to generation, if the copula is _de se apta ad generationem_,
prescinding from all antecedent and subsequent, temporary or
permanent, obstructions to generation, there is no impotence. In
this opinion the woman without ovaries is not impotent, but the
vasectomized man is; in the first opinion both the _mulier excisa_
and the vasectomized man are impotent. The second group says the
vasectomized man is incapable of performing an act _de se apta ad
generationem_ because his semen lacks the essential spermatozoa. If
one objects that the spayed woman, who is not impotent according to
some moralists that so interpret the decisions of the congregations,
lacks the essential ovum, so that she cannot perform an act _de se
apta ad generationem_ because she has nothing to generate with,
they answer that her copula is _per se apta_, that there happens in
it everything which takes place in a copula from which generation
actually follows. The vasectomized man cannot go through the form
of the act with all the elements which, _so far as the act is
concerned_, are required and sufficient for generation because he
lacks the spermatozoa, but the _mulier excisa_ can. His inability is
intrinsic to the act, it vitiates the very substance of the act; her
inability to present ova is not intrinsic to the act, they say. All
that is necessary in her case is that she be capable of receiving the
semen.
Marriage was instituted to beget children; that is the proper end of
the contract, its basic justification. Whenever the debitum is used
it must be with the intention of generating children. Even the use
of marriage as a remedy of concupiscence is so secondary an end that
it alone is not enough to legitimize marriage. Because a woman does
not always have ova present in the tubes,--and there is no means
of knowing just when the ova are present,--it is justifiable to
repeat the conjugal act until the woman is impregnated; secondarily
and dependently, the repetition may be a remedy of concupiscence.
The sexual act does not form either the spermatozoa or the ova;
these pre-exist. The spermatozoa are always released in a normal
sexual act; the ova are not always present when the spermatozoa are
released. A copula which is perfectly _de se apta ad generationem_
supposes not at the time the presence of both sperm and ovum, but
it does suppose the possibility of the ovum, otherwise generation
is utterly impossible; and every copula becomes justifiable solely
because there is a hope that it may be present. It is a mere
quibble to say that an act is _de se apta ad generationem_ if by
no possibility generation ever can take place; nevertheless the
congregations in four cases have apparently judged to the contrary.
In these special decisions, however, Rosset, Antonelli, Bucceroni,
and Palmieri hold there was a doubt in the minds of the members of
the congregation as to the complete removal of the ovaries or uterus.
Bucceroni expressly states[244] that the Cardinal Secretary of the
Holy Office told him personally the members of the congregation
supposed in the particular cases that generation could follow.
Therefore these decisions do not say that the _mulier excisa_ in
general is not impotent or potent; they merely gave the women of
these cases the benefit of the doubt. Tho question is entirely open
so far as these decisions are concerned.
[244] _Theologia Moralis_, 5th ed., vol. ii, p. 391, n. 994.
Those who hold that vasectomy causes canonical impotence say also
the constitution of Sixtus V. forbidding the marriage of eunuchs is
applicable necessarily to the vasectomized man, because the semen
from the vasectomized man, inasmuch as it lacks spermatozoa, is not
genuine semen, and Sixtus V. said eunuchs cannot produce true semen.
The relevant passage in the constitution is: "Cum frequenter in istis
regionibus eunuchi et spadones, qui utroque teste carent, et ideo
certum ac manifestum est eos verum semen emittere non posse; quia
impura carnis tentigine atque immundis complexibus cum mulieribus
se comiscent, et humorem forsan quemdam similem semini, licet ad
generationem et ad matrimonii causam minime aptam, effundunt,
matrimonium ... contrahere praesumant ... mandamus ut conjugia per
dictos et alios quoscumque eunuchos ... contrahi prohibeas."
Sixtus V. says here: (1) that eunuchs "who lack both testicles
certainly and evidently cannot emit true semen"; (2) that "although
eunuchs may perhaps produce a kind of liquid resembling semen,
this is by no means fit for generation or marriage"; (3) therefore
eunuchs are forbidden to marry. The effects of castration in the
eunuch are: (_a_) that all spermatozoa are absent; (_b_) that, as a
consequence of the absence of the testicles, the power of penetration
is lost; (_c_) that, as another consequence, the _liquor seminis_,
which normally is formed in the seminal vesicles, the prostate and
other glands, is no longer secreted. The eunuch, then, is completely
impotent, in the full sense of the term. Ferreres is of the opinion,
erroneously, that eunuchs, as a rule, have the power of penetration
and of emitting a _humor semini similis_, and that amputation of the
penis is requisite to cause impotence in eunuchs. There are only five
authentic cases of temporary apparent potence in eunuchs in modern
medical records, and these are explicable as cases of erethism from
waste-product intoxication.
The canonists who hold that the vasectomized man is impotent
interpret the words of Sixtus V. to fit their opinion, although the
vasectomized man has all the sexual potency of the normal man except
that his spermatozoa are occluded. The _potestas coeundi_ is not
lost in any degree; neither he nor the woman is conscious of any
change whatever. Only the microscope can tell that the spermatozoa
are absent if the fact that he has been vasectomized is not told.
Moreover, if vasectomy has been done by mere cutting without
considerable resection, and especially if the vasa have been shut by
ligation alone, no one can be certain that the occlusion is either
certain or permanent. There is always doubt that the spermatozoa
are present if the microscope is not used, and these canonists
all disclaim the use of the microscope in such circumstances. The
argument Ferreres uses, to the effect that the absence of spermatozoa
is seriously injurious to the woman, is a supposition of his own
arising from an erroneous notion of potency in the vasectomized. This
absence is not injurious to her, but it is probably injurious to the
vasectomized man because of the partial ejaculation. Onanism, which
is different, is decidedly injurious to both the man and the woman.
Onanism, _coitus interruptus_, or withdrawal before ejaculation,
which takes place _extra vas_, is intended to prevent impregnation.
In the normal sexual act the male genital tract suddenly becomes
congested with blood through nervous action of centres in the
lumbar cord and the cerebrum. Cowper's and Littré's glands secret
an alkaline fluid which neutralizes the acid urine in the urethra
and thus prevents killing of the spermatozoa. Muscular peristaltic
action presses out the spermatozoa and the secretions of the seminal
vesicles and the prostate. When the act is normal there is a complete
emptying of the tract of semen and of the blood engorgement; in
_coitus interruptus_ there is incomplete ejaculation and only
partial deplethorization. The seminal vesicles remain distended,
and this distention, with the congestion of the prostate, causes
continual excitation of the sexual centres without relief. There is
irritability and exhaustion of the centres, and this state brings on
premature ejaculation and final _impotentia coeundi_. Other common
effects are tenesmus of the urinary bladder, incontinence of urine,
nocturnal pollutions, sexual neurasthenia, pain in the legs, over the
eyes, and in almost any part of the body, general weakness, headache,
vertigo, cardiac palpitation, neurotic dyspepsia, and a train of
psychic symptoms which not seldom end in suicide.
In the woman there is the like blood engorgement and a pouring
out of the secretions of Bartholin's and the other glands, but
deplethorization takes place later in the woman than in the man, and
for this reason the woman suffers more from _coitus interruptus_ than
the man does. In onanism, as in masturbation, after the diseased
conditions have been established it is extremely difficult to induce
the patient to resist the almost overwhelming irritation.
The canonists have interpreted the text of Sixtus V. to the effect
that the eunuch is impotent precisely and solely because he cannot
produce semen "_elaboratum in testibus_." No man produces semen
_elaboratum in testibus_--more than 93 per cent. of the semen is
produced entirely outside the testicle; nothing but the spermatozoa
and two or three drops of a lubricating fluid are produced in the
testicles. The eunuch really is impotent because the removal of the
testicles and their nervous system so breaks the genital circuit,
which consists of at least seventeen distinct parts, that erection is
prevented, the formation of spermatozoa is impossible, the secretion
of the essential vehicle of the sperm and of the fluids which render
it fertile is cut off. The eunuch cannot penetrate and he cannot form
any semen; he is impotent; the vasectomized man can penetrate, and he
forms a semen which is sterile.
I think now the vasectomized man is really impotent for the reason
that I think the _mulier excisa_ is impotent, but he is not impotent
because of the constitution of Sixtus V., which is not relevant at
all to his case.
If the vasectomized man is impotent, the following cases are also
impotent:
1. A man whose germ-cells have been destroyed by the action of
the X-ray.
2. A man with double permanent occluding epididymitis.
3. A man whose vasa deferentia open into the ureters and not
into the urethra.
4. A man whose vasa are shut by surgical operations for stone,
or cysts of the prostate, or seminal vesicles.
5. A man whose seminal vesicles are shut by concretions, cysts,
or tumors.
6. A man with bilateral cryptorchidism.
7. A man with a tuberculous condition of the testicles.
8. A man with absolute neurotic aspermia.
9. A man with congenital lack of development of the testicles or
vasa.
Sterility in the male would exist only in advanced diabetes, general
tuberculosis, senility, or in cases of absent or diseased prostate
gland or seminal vesicles.
Here it is worth noting that since the copula must be natural, fit
for generation in the natural manner, artificial impregnation by the
use of instruments is immoral, and forbidden by a decree of the Holy
Office, promulgated March 24, 1897. Artificial impregnation does not
effect a copula which is by its nature proper to generation, but is
an act contrary to nature, one from which generation does not follow
in a natural manner, _secundum communem speciem actus_. It supposes
deliberate pollution and semination outside the vagina, both of which
actions are intrinsically evil.
In discussing the morality of vasectomy the following points must be
considered:
1. In what degree of mutilation is vasectomy?
2. Vasectomy may be done either at the request or by the permission
of the vasectomized person; or by order of the State.
(_a_) If done by the request or permission of the vasectomized
person, it may be either (1) as a means to use the debitum
without the inconvenience of having children; or (2) as a
therapeutic measure to cure some malady.
(_b_) If done by order of the State, it may be (1) a punishment;
or (2) a prophylactic measure to avert physical or moral evil
in society.
If vasectomy causes canonical impotence, that fact adds a special
moral quality. The weight of authority is on the side that it does
cause canonical impotence, as has already been mentioned.
A slight mutilation, in the sense of the term as commonly used, can
be any permanent effect of a wound, bruise, or similar cause, from a
mere scar to an amputation or other injury whereby any member of the
body is rendered unfit for normal action. That the causal wound or
injury is trivial in itself, apart from its effect, as in vasectomy,
has little or no direct bearing on the morality of the mutilation.
It is possible to have a very gross mutilation without extensive
wounding. We can blind a man permanently by putting the point of a
fine cambric needle one-twentieth of an inch within the pupil.
Vasectomy is a grave mutilation because (1) it removes from the
man the power of generation; (2) it inhibits the function of the
testicle, which is an important organ of the body. Although they
are not the entire organ of generation, the testicles are together
a complete organ in themselves, the function of which is to produce
the spermatozoa essential to the procreation of the human species.
If by a wound one inhibits the function of the testicles, he gravely
mutilates the human body, for a grave mutilation is nothing but an
inhibition of the function of a distinct organ through a wound.
A mutilation of this kind, since it frustrates the production and
action of the human generative semen and prevents generation, is
what is technically called a mortal sin against nature, unless
there is sufficient cause to necessitate the frustration, such as
to save life, to restore as a sole means the health of the whole
body, to protect society, or a similar reason. What is said here of
vasectomy is true for fallectomy or other methods of sterilizing the
woman. Fallectomy, however, is in itself a dangerous operation, and
oöphorectomy is never justifiable as a mere method of sterilization
because of its very injurious effects on the whole body and mind of
the woman.
Among the decretals of Gregory in _Corpus Juris_ (lib. v, tit.
xii, c. 5) is the following canon: "If any one, for the sake of
indulging lust, or through revenge, does anything to a man or woman,
or gives them anything to drink, whereby they cannot generate, or
conceive, or bear children, he is to be treated as a homicide." Any
one who sterilizes a man by vasectomy or a woman by fallectomy or
oöphorectomy, for an improper motive, _ipso facto_ falls under this
decree, and is before the canon law classed in the same category as
a murderer; that is, the agent is deemed guilty of a grave crime
against nature.
If a man has vasectomy done upon himself, his intention may be (1) to
use the debitum without the inconvenience of having children; or (2)
to avert from a wife with a narrow pelvis the dangers of the cesarean
section or other obstetrical operation to herself and the child; or
(3) to avoid the transmission to possible offspring of a hereditary
disease like Huntington's chorea or one of the others mentioned at
the beginning of this chapter; or (4) to cure himself of some malady.
1. If vasectomy is done merely to be able to use the debitum without
the inconvenience of having children, it is evidently illicit. It is
in that condition the same as onanism; it is contrary to the basic
justification of marriage; it is a frustration of nature; and so on.
2. If it is done to safeguard a wife with a narrow pelvis it is
a means, evil in itself, used directly to effect a good end; and
a good end, or any end or effect, never justifies a direct evil
means or cause. There is in reality no such thing as a good effect
from an evil means or cause; the evil means or cause essentially
and substantially vitiates the effect. There is no question here of
a double effect, one good and one evil, wherein the good effect is
intended and the evil permitted, both coming with equal directness
from the single causal act. On the contrary, from the vasectomy
here there is the single direct effect that the man is sterilized,
and then directly from this sterility comes the desired effect, the
protection of the wife. For exactly the same reason, vasectomy done
to prevent the transmission of a hereditary disease is illicit; it is
an evil means used directly to effect an end intended. In artificial
abortion when the fetus is inviable the act done is to empty the
uterus, and this act itself kills the fetus, which is not an unjust
aggressor, and is murder. This murder may save the mother's life,
but the end does not justify the means. The vasectomy to protect the
mother's life or to avert an evil heredity is a parallel case.[245]
[245] See the chapter on General Principles concerning Mutilation
for an explanation of the act with a double effect.
The fourth case supposes that the vasectomy was done to cure the man
of some malady. If there were a malady that endangered the patient's
life, or destroyed the health of the body and it could be cured by
vasectomy, the operation would of course be licit for the reasons
given in the chapter on General Principles concerning Mutilation.
Dr. Carrington tells us[246] that he did vasectomy on an epileptic
convict and cured him. Such a cure is doubtful as to permanence. He
describes two dangerous insane negro homicides who were rendered
harmless by vasectomy. In cases like those of the homicides any
one responsible for them would probably be justified in having the
operation done, although these two cases are the only direct ones on
record. Epileptics sometimes show a homicidal tendency, but it is
doubtful that vasectomy would help them. The operation of vasectomy
as a cure for bodily ill has a very limited field. There are very
many conditions in women where it is necessary to remove the ovaries
or the tubes to save life, or to cure chronic invalidism of an
unbearable nature. These conditions are discussed in the chapter on
Gonorrhea. There is no objection to the removal of a tube or an ovary
when such removal is absolutely necessary, but the necessity must be
clearly evident. There is a tendency in some surgeons to mutilate
women in this manner without sufficient reason or to follow out a
therapeutic theory.
[246] _Virginia Medical Semi-monthly_, vols, xiv, xv.
Men, like Sharp, who have done hundreds of vasectomies, say the
operation commonly removes the inclination to masturbation.
Masturbation is, as a rule, a moral condition, but it can, like
alcoholism, come to have a large physical element. Idiots almost
unexceptionally have this vice, and in them there is no morality
possible. If by vasectomy they can be cured of this vice, which
injures their health and is a social indecency and a source of sin
in observers, the operation would be licit in their case. When the
patient is morally responsible vasectomy would not be licit, as there
is no adequation between a physical evil like sterilization and a
moral vice. There are cases of pathological sexual erethism which
are so violent that the patients must be put into strait-jackets to
prevent constant masturbation. The semen of such patients is usually
devoid of spermatozoa. If the patient is confined in a strait-jacket
he will die, and vasectomy, according to Sharp, will quiet such a
man. Vasectomy would be permissible in these circumstances.
The question has arisen in the case of a sane masturbator who is
neurotic, weak-willed, and a confirmed addict to his vice, whether
or not his vasa might be tied off by ligatures, temporarily, with
the intention of removing the ligature later and restoring function.
I think not. Even temporary sterilization is sterilization, a grave
mutilation, while it lasts, and the condition is really moral
fundamentally, and therefore not a fitting object for physical
remedies.
When vasectomy is done by the State, it is done either as a penal
or as a prophylactic measure. As a general statement we can say
the State in certain conditions has the right to kill or mutilate
a criminal in defence of the social order; but even then any
punishment, to be justifiable, must be effective and necessary,
and it has to be either reformative, exemplary, or reparative in
regard to the crime for which it is inflicted. Capital punishment
and mutilation are effective usually, and are necessary for the
preservation of society. The natural law permits the State to
preserve itself against the unjust encroachments of individuals by
curtailing their rights in so far as that curtailment is effective
and necessary: since the natural law requires the existence of civil
society, it must allow what is necessary for the preservation of that
society. There is no question here of a good end justifying evil
means; the means which otherwise would be evil in these conditions
become good. Homicide and mutilation are not mere killing or mere
maiming, but unjust killing or unjust maiming. Killing or maiming is
not intrinsically wrong under all circumstances, as lying, blasphemy,
and some other crimes are; nevertheless, as a punishment by maiming,
vasectomy is ordinarily wrong, and therefore a law making it an
ordinary mode of punishment for certain whole classes of criminals,
or all criminals, is unjust.
It is wrong because as a punishment it is neither effective nor
necessary nor reformatory nor exemplary nor reparative--it lacks
every quality of a justifiable punishment. In Dr. Sharp's list
of vasectomies done in Indiana prisons, 176 operations were done
on men who voluntarily asked for vasectomy. There is no pain, no
inconvenience caused by the operation, no sexual change perceptible,
but a fitting of the criminal to indulge his lust without the various
inconveniences of impregnation. Instead of being reformatory,
it is conducive to crime. I find only one man who objected to
vasectomy.[247] In this man vasectomy was added to life imprisonment
as a punishment for rape.
[247] _State of Washington vs. Feilen, 126 Pac. R. 75._
The legislators in the States which have passed the vasectomy law
all seem to have been influenced by the pseudoscientific notion that
criminality is a hereditary condition, a physical disease, and not
a matter of volition. This Lombrosan absurdity is now held by no
physical scientist, and from an ethical point of view it is nonsense.
Moreover, if the State vasectomized all the criminals in the jails,
this method would not appreciably affect the supply of criminals, nor
reach an appreciable minority of the criminal class, as the most
dangerous criminals are not in jails.
The operation is not a punishment to the men upon whom it is done,
but it is an unnecessary deprivation of an essential right of these
men, an excessive, ill-ordered attack on a primary right of man,
and an act of violence against human nature and its Author without
adequate reason. The law is against the natural order because it
directly deprives a man, and that against his will, of functions
which are at times a moral necessity to him, and puts him into the
occasion of sin. Vasectomy does not remove his venereal desires, but
gives opportunity to lust; it turns the conjugal relation into mere
onanism and degrades marriage into a crime. Other conditions, like
military service, in which necessity obliges the State to place its
citizens and thus prevent the conjugal relation, cause an indirect
temporary prevention, reluctantly permitted, not directly intended.
Vasectomy is an evil directly intended.
It is to the interest of the State to prevent the transmission of
hereditary disease, and in doing so it may to a certain degree
curtail the natural liberty of its citizens. When the peril is great,
as in a plague, the State may isolate infected individuals, and thus
indirectly, but temporarily, prevent a natural right--namely, the
conjugal relation. It may even perpetually isolate, as in leprosy.
Vasectomy, however, is a direct prevention without reason, and it is
done as a direct evil means to effect a so-called end which it never
attains.
A man with Huntington's chorea, if married and if he has children,
will surely transmit the disease to some of these children, and they
to their children. Vasectomy on him will prevent a propagation of
his kind but will cure no disease. Moreover, he is not a criminal
and not amenable to punishment. The bad effect, sterilization, must
be perpetual in his case or it is foolish, but the sterilization is
not a punishment, nor a means of saving the health of the patient.
Whatever good comes of the act comes out of an evil cause. If such a
man persists in marrying, his marriage might be prevented, but that
is different from mutilating him.
The State has no _direct dominion_ over the lives or members of its
citizens, nor are citizens naturally mere instruments for the good of
the government; on the contrary, the government exists solely for the
good and utility of the citizen. The State may not take the life of
an innocent person, nor mutilate him, unless these acts are necessary
either (1) to protect the life or rights of individuals; or (2) to
preserve the social life of the commonwealth. Now, neither of these
two requisites is present when there is question of vasectomizing a
man.
The right or life of no individual is at stake. The rights of the
possible children, yet unborn, are not injured, because, as these
children are not in existence, they have no rights. Should they come
into being, it is always better to be, even though diseased, than not
to be. The methods of cattle-breeders in dealing with human beings is
not a virtue in the State, but an outrage and a degradation of human
nature.
The rights of the wife are not injured, because she personally
receives no injury; and if her possible children have chorea, for
example, she either voluntarily took that risk when she married, or
if she did not, through ignorance, there are other means to avoid
the trouble than the evil of sterilization, which in itself would
render the use of marriage onanistic. If the husband has syphilis,
gonorrhea, leprosy, tuberculosis, or any other infectious disease,
vasectomy is no protection for the wife.
May a physician employed by the State in a prison, an institution
for the feeble-minded, or a like place, do vasectomy at the command
of the law? Certainly he may not, except in those rare cases where
vasectomy is permissible as described above.
The advocates of freakish legislation harp on the assertion that
insanity and imbecility are increasing alarmingly, and as a
consequence the entire nation is degenerating. To cure this evil we
are to mutilate certain criminals and the mentally defective. It is
not true that insanity and mental imbecility are increasing in a very
marked degree in the United States. The number of inhabitants in this
country is increasing rapidly, and as there are more people here than
there were a few years ago, the number of the insane and the mentally
defective has increased _pari passu_, but the percentage does
not increase to any degree that calls for immoral and ineffective
legislation. Only of late years have the State governments begun to
classify, diagnose, and gather up the insane and the imbecile, whom
we always have had with us, and these processes have brought the
defectives into the light.
Our late immigrants are not equal in race, in mental and moral
strength, to the old northern European immigrants. In Philadelphia
the foreign-born population is 24.7 per cent. of the whole, but
that foreign-born population gives us 44 per cent. of the indigent
insane. In New York State 27 per cent. of the registered insane are
not American citizens. What we need here is not sterilization, but a
better control of the immigrant, a keeping out of the unfit. Again,
our insanity percentage is increased avoidably by the undoubted
increase of insanity among negroes. We are accountable for this
because we do not care for our helpless negroes. These people are
prevented by trades-unions from learning and working at elevating
trades, and they are thus forced unjustly into a poverty and
degradation which lead to vice and mental deterioration. The cure is
not a jail surgeon's scalpel, evidently.
A system of education that ignores the will, upon which morality
and virtue are based, and substitutes a sham intellectuality as
elaborated by ignorant boards of education and administered by
emotional, half-educated women, together with a lack of genuine
religion, is a prolific source of mental and moral deterioration and
consequent degeneracy in the physical and moral orders. Our American
public-school system is such, and its deity is the unwashed and
crassly depraved god Demos, whose bible is the evening newspaper.
If we could civilize our schools, we should have no mention of
legislation by vagary.
BIBLIOGRAPHY
Ecclesiastical Review, vols, xlii, xliii, xliv, xlvi, xlvii,
xlviii, _passim_. Philadelphia.
Gemelli. La Scuola Cattolica, November, 1911. Milan.
Stucchi. _Ibid._
Eschbach. _Ibid._, February, 1912; Analecta Ecclesiastica,
September and October, 1911.
Capello. La Scuola Cattolica, February, 1912.
Michaud. Nouvelle Revue Théologique. Paris, 1914.
Schmidt. Zeitschrift für katholische Theologie, nn. 1 and 4,
1911.
Ferreres. De Vasectomia Duplici necnon de Matrimonio Mulieris
Excisae. Madrid, 1913.
De Smet. Collationes Brugenses, December, 1910.
Wouters. Nederlandische kathol. Stemmen, January 15, 1911.
Waffelaert. De Virtutibus Cardinalibus, vol. ii. Bruges, 1889.
Sharp. Journal of the American Medical Association, December 4,
1909. This is the article which started the entire vasectomy
controversy.
Barker. Maryland Medical Journal, April, 1910.
Bell. Hereditary Criminality. Medico-Legal Journal, vol. xvii.
New York.
Desfosses. Presse Méd., vol. xviii.
Rentoul. St. Thomas Hospital Gazette, vol. xx. London.
Swift. Maine Medical Association Journal, December, 1914.
Lydston. Medical Record, November 8, 1913. New York.