as crises. These may occur in the legs or arms or in the stomach or
sometimes in other organs. Occasionally they are the first symptoms of
the disease that are noticed, and they may continue for months or even
years before other symptoms manifest themselves. This sometimes makes
it difficult to recognise the disease for what it really is. The pains
are usually most excruciating, are tearing or boring in character, and
are sometimes described by the patient as being similar to the
sensation that would be felt if a red hot iron were forced into them,
or if a knife were inserted and then twisted round. Hence the
descriptive name which has been applied to them of "lightning pains"
which describes the suddenness of their onset and the intensity of
their character. {322} Most of the ordinary anodyne or pain-killing
medicines fall to influence them, and the patient is one of the most
pitiable of objects while they last.
It is now conceded on all sides that at least 75 per centum of the
cases of tabes are directly due to syphilis. Indeed this affection and
paresis are sometimes spoken of as parasyphilitic affections.
Unfortunately the ordinary treatment for syphilitic manifestations
does not affect them in the least. So far as we know at the present
time, there is nothing that will hinder the course or prevent the
progress or alleviate the symptoms or have any curative action on
either of these dreadful diseases. They are much more common in Europe
than they are in this country, but have been seen here with quite
sufficient frequency in recent years to make physicians, at least,
realise the necessity for having young men appreciate the dangers they
invite in thoughtlessly yielding to the temptations of great city
life.
There are other affections which can be traced directly to the social
diseases. One of the most important of these consists of certain brain
tumours which may even cause death if not properly treated. These
syphilitic brain tumours frequently cause paralysis and may lead to
permanent changes in the nervous system with consequent loss of motor
power. Whenever the symptoms of brain tumour occur, careful inquiry is
made as to the previous existence of syphilis in the case, in order to
determine, if possible, if this is the morbid agent at work. If there
is a history of syphilis it is usually said to be fortunate, for brain
tumours due to syphilis may be made to disappear by the proper use of
mercury and the iodides. If the treatment of the case is delayed,
however, alterations in the nerve substance take place which can not
be improved.
This disease affects especially the blood vessels and, as a
consequence of the thickening of the coats of the arteries, blood may
be shut off from certain portions of the brain entirely. This will, of
course, produce symptoms of paralysis. Indeed, whenever paralytic
symptoms manifest themselves under forty years of age, the physician's
first thought is sure to be that there is syphilis in the case. This
is not always {323} true, for by heredity and very hard work
occasionally arteries become so degenerate that they rupture before a
patient has reached many years beyond forty, but the case is always
suspicious. In this, as in the corresponding instance of brain tumour,
treatment, if applied sufficiently early, may not only give relief of
all the symptoms, but produce a complete cure. That is, at least the
symptoms are relieved for the time, though there may be relapses.
Usually these relapses are quite amenable to treatment, but sometimes
they get beyond the control of the physician and death ensues. It is
almost the rule where there have been serious nervous symptoms once,
that recurrences of them must be feared, and they will eventually
shorten the patient's life.
Syphilitic manifestations of serious character develop, however, not
only in the nervous system, but also in certain of the important
internal organs. The liver may become so much affected as to refuse to
do its work. Solid tumours may develop in the stomach, or along the
course of the intestines, resembling cancer so much that occasionally
operations are performed for their removal. As a rule, however, these
yield quite promptly to proper antisyphilitic treatment. Whenever an
obscure intraabdominal tumour is present, accordingly, it has become
the custom among physicians and surgeons not to make an absolute
diagnosis nor to perform any serious operation until antisyphilitic
treatment has been tried. The surprises of such treatment constitute a
very interesting chapter in obscure diseases in medicine.
As we said at the beginning, it is perfectly possible to have
contracted the disease innocently, and indeed, the first
manifestations may be so mild as to fail to attract the patient's
attention. In these cases there will be no history of syphilis, yet
the test of antisyphilitic treatment will demonstrate that the disease
has been present. Not a few physicians have died from these serious
manifestations of syphilis after having contracted the disease through
a cut on the finger or the prick of an infected needle in the ordinary
course of their professional work. Some of these cases in young men
prove to be especially malignant and fail to react to treatment, so
that a fatal issue takes place within a few years.
{324}
On the other hand, in general it may be said that the disease is
eminently curable, though it may require great care on the part of the
patient and the avoidance of all excesses either of work or indulgence
for the rest of life. It has often been noted that people who live in
the midst of serious emotional strain are most likely to suffer from
manifestations of syphilis in their nervous system. Hence it is that
paresis and locomotor ataxia are comparatively quite common among
actors, brokers, and financiers. They are also quite common among sea
captains and military men who are exposed to severe hardships and have
to assume weighty responsibilities. In such men the previous attack of
syphilis has so weakened the nervous system that it degenerates under
the strain placed upon it by the subsequent responsibilities. These
diseases are very uncommon among clergymen and are less common in
Ireland than in any other country in the world, which would serve to
confirm the opinion that the venereal disease is a prominent factor in
their causation.
We would not have the idea be assumed that syphilis is an incurable
disease and is bound to be followed in all cases by the awful
manifestations that we have described. There are many thousands of
cases of syphilis that never have any of these serious manifestations
at all. It is evident that some cases are completely cured and that no
deleterious influence remains. On the other hand, it must not be
forgotten that the presence of this disease in the tissues of either
parent during the first five years of its course are almost sure to
affect offspring born at this time. The children may suffer from the
skin lesions of syphilis in their early life, may suffer from serious
eye diseases a little later, and then eventually succumb to nervous
and mental diseases resembling paresis and locomotor ataxia in early
adult life. In fact it is this transmission of the disease that
constitutes one of its saddest pictures, and the sins of the parents
are indeed visited on the children.
Besides this severer type of social disease, there is what has been
called sometimes a milder form. It consists only of a discharge with
some fever, which is considered to last not more than a few weeks. As
a matter of fact, however, the disease may continue to exist, though
the symptoms become latent {325} and the patient may infect others
when he least suspects it. This form of disease gives rise to many sad
complications in family life. Practically all the severe eye diseases
of newly born children, the ophthalmia from which so many eyes are
lost, is due to this disease. Special medical care is now taken of
these cases, and the serious consequences are not so often seen as
used to be the case. Within a score of years, however, about one-half
of the inmates of blind asylums owed their loss of sight to this
disease. At the present time there still remains a very notable
proportion of persons blind from early childhood whose infirmity must
be attributed to the sad consequences of the social disease.
Most of the sterility in families is due to the same cause. There is
an unfortunate impression that usually the woman is responsible in
these cases, and not a little sympathy is wasted on the man, because
of the absence of children in the family. Almost invariably, however,
the real cause of the family misfortune is to be traced to an
infectious disease in the man contracted perhaps many years before, of
whose presence he may be more or less unconscious, the symptoms have
become so slight, but this has proved sufficient to infect the wife
and bring about serious changes that preclude all possibility of the
procreation of children.
These statements may seem exaggerated. On the contrary, they are
rather understatements of actualities. No one who knows the real state
of the case will fail to realise this. Physicians themselves have only
come properly to appreciate the true state of affairs in the last
twenty years. We need a coordination of all the forces that make for
social amelioration in modern life to correct present false
impressions.
JAMES J. WALSH.
{326}
XXX
DE IMPEDIMENTO MATRIMONII DIRIMENTE IMPOTENTIA
Hoc argumentum praecipue ad juris consultos ecclesiasticos et civiles
pertinet; et quamvis differentia sit inter jurisdictionem judicis
civilis et ecclesiastici tamen judicium utriusque quatenus necessario
pendet ab existentia conditionum physicalium in medici consilio situm
est. Obscuritas doctrinae et quidem gravis de hoc impedimento, libris
moralistarum, medicorum et juris consultorum perlectis, invenitur; et
quamvis, elapsis perpaucis annis, fere omnis liber tractans de
scientia medicinali parva fide dignus, tamen multa ex editis
physiologorum veterum tanquam vera a moralistis praesertim
promulgantur. Hae difficultates per ignorantiam anatomiae et
physiologiae genitalium non minuuntur. Ut auxilium, si quid sit, ad
difficultates solvendas feram, species et gradus Impotentiae hie
collegi tanquam medicus, eo modo ut conditio physica clarius
cognoscatur.
In unoquoque Statuum Foederatorum Americae Septentrionalis impotentia
ratio sufficiens divortium obtenendi est, in plurimis autem
matrimonium irritum ab initio non reddit. Impotentia vel temporanea
causa divortii esse potest si impotens intra spatium temporis
rationabile remedium medicinale recuset. Sub lege civili Americana
contrahens qui tempore matrimonii ineundi certior erat de impotentia
consortis jus divortii petendi propter abnormalitatem istam amittit.
Procrastinatio longa et inexplicabilis divortii petendi, et etiam
inscitia culpabilis impotentiae consortis divortium impossibile coram
judice civili reddunt.
Conditio haec etiam impedimentum dirimens matrimonii sub lege canonica
Ecclesiae est. Si impotentia contractum matrimonii anteat et perpetua
sit, matrimonii contractus {327} solvitur ipso facto, quandocumque
detegitur. Procrastinatio aut ignorantia culpabilis non excusant.
Jurgia oriuntur ex eo quod impotentia cum sterilitate saepius
confunditur. Juris consulti civiles infrequenter hoc modo offendunt,
medici autem et moralistae crebro in errore isto versantur. Juris
consulti Americani et medici de impotentia doctrinam accipiunt
librorum praesertim _On Domestic Relations_, auctore Irving Browne
(Boston. 1890), _A System of Legal Medicine_, auctore Allen MacLean
Hamilton (Neo-Eboraci, 1897), et _A Manual of Medical Jurisprudence_,
auctore A. S. Taylor (Neo-Eboraci, 1897). Irving Browne (op. cit.)
ait: "Ubi Impotentia adsit nullum habetur matrimonium validum.
Impotentia autem incapacitatem prae se fert physiciam, non meram
frigitatem, declinationem seu repugnantiam, neque etiam recusationem
absolutam coitus sexualis. Neque sterilitas nec malformatio quae
copulam non impediant, neque infirmatio quaecumque sanabilis
incapacitatem gignunt. Impotentiam tempore ineundi matrimonii
exstitisse necesse est." Eadem est doctrina Schouleri et Baldwinii.
White et Martin, medici, (_Genito-Urinary and Venereal Diseases_.
Philadelphiae. 1897.) impotentiam ita definiunt: "Inabilitas actus
sexualis perficiendi. Non necessario cum sterilitate consociatur,
neque necesse est quod sterilis impotens sit." Et ita alii omnes.
Significatio vocis Impotentiae sub lege canonica deducitur, (1), ex
dijudicationibus Pontificum Romanorum, aut (2), ex judiciis
Congregationis Sancti Officii, tribunalis ad sententias hujus generis
pronuntiandas instituti, aut, (3), ex legis interpretatione a
moralistis scientia praeditis.
Sixtus V, Pontifex Romanus, (Const. _Cum frequenter_, anno 1587)
decrevit eunuchos impotentes esse sensu legis canonicae de Impotentia,
nullum autem judicium papale totam questionem conficit. Congregatio
etiam Sancti Officii in perpaucis casibus particularibus dijudicavit
sed legem nullomodo distincte definiebat. Norma igitur a nobis
sequenda ex interpretatione moralistarum est depromenda.
{328}
Lex non est decretum mere disciplinare: e natura ipsa contractus
matrimonialis desumitur. Ballerini (_Theol. Mor._, vol. 6, p. 658)
scribit matrimonium consistere "in mutua traditione potestatis ad
copulam conjugalem." S. Thomas (_Supplem. Sum, Theol._, q. 58, a. 3)
ait: "In matrimonio est contractus quidam, quo unus alteri obligatur
ad debitum carnale solvendum: unde sicut in aliis contractibus non est
conveniens obligatio si aliquis se obliget ad hoc quod non potest dare
vel facere, ita non est conveniens matrimonii contractus, si fiat ab
aliquo qui debitum carnale solvere non possit; et hoc impedimentum
vocatur _impotentia coeundi._"
Antequam explicationem a moralistis pleniorem vocum "Impotentia
coeundi" dabamus, attendendum accurate est ad definitionem matrimonii
finum a S. Alphonso Liguorio (_Theol. Mor._, lib. vi., n. 882) datam.
"_Fines_," inquit, "intrinseci essentiales [sc. matrimonii] sunt duo:
traditio mutua cum obligatione reddendi debitum, et vinculum
indissolubile. _Fines intrinseci accidentales_ pariter sunt duo:
procreatio prolis et remedium concupiscentiae. _Fines_ autem
_accidentales extrinseci_ plurimi esse possunt, ut pax concilianda,
voluptas captanda, etc. His positis, certum est quod si quis
excluderet duos fines intrinsecos accidentales, non solum valide, sed
etiam licite posset quandoque contrahere; prout si esset senex et
nuberet sine spe procreandi prolem, nec intenderet remedium
concupiscentiae; sufficit enim ut salventur fines substantiales, ut
supra."
Haec sententia S. Alphonsi magni momenti est, et in ea solutio
multarum difficultatum inveniri potest. Dicit hic (1) fines
intrinsecos essentiales matrimonii esse traditionem mutuam cum
obligatione reddendi debitum, et vinculum indissolubile, atque illis
demptis nullum matrimonium; (2) procreationem autem prolis et remedium
concupiscentiae abesse posse, et tamen matrimonium esse validum si duo
fines essentiales adsint.
Sanctus hoc loco infert, ut patet e contextu alibi (_e. g._, lib. vi.,
n. 1095, res. 2), traditionem mutuam potestatis ad copulam carnalem
necessario potentiam coeundi supponere, potentiam autem generandi non
esse necessariam nec remedium concupiscentiae. In libro vi., n. 1096,
ait: "Impotentia est illa propter quam conjuges non possunt copulam
habere per se aptam ad generationem; unde sicut validum est
matrimonium {329} inter eos qui possunt copulari, esto per accidens
nequeunt generare, puta quia steriles aut senes, vel quia femina semen
non retinet, ita nullum est matrimonium inter eos qui nequeunt
consummare eo actu, quo ex se esset possibilis generatio."
Distinctio haec inter potentiam coeundi et potentiam generandi a
moralistis omnibus datur; illa autem data, plurimi distinctionem
obliviscuntur et sterilitatem simplicem cum impotentia confundunt.
A. Konings, C.SS.R., (_Theol. Mor._, ed. 7, vol. 2, p. 276) haec
habet: Impotentia est "incapacitas ad copulam carnalem, per se aptam
ad generationem." In n. 1619, Sec. 5, ait: "Non est confundenda
impotentia coeundi cum impotentia generandi. Hinc steriles et senes
qui matrimonium consummare valent, valide contrahunt, item mulieres
quae possunt semen excipere, etsi illud non retineant." Hanc doctrinam
S. Alphonso refert (_Theol. Mor._, lib. 4, n. 1095, ed. Mech. 1845),
et paragraphum hoc modo complet: "Non tamen carentes utero vel
vagina." Hoc est, tenet mulierem utero et vagina carentem impotentem
esse. Unusquisque carentiam vaginae impotentiam esse admittit; mulier
autem sine utero semen excipiendi capax est, concupiscentiam quoque
maris satiare potest. Sterilis tantum est. Potentiam etiam habet
coeundi, semen excipere potest et retinere, concupiscentiam quoque
satiare potest, etiamsi uterus, ovaria et tubi Fallopiani absint.
Praeterea, _illi duo fines intrinseci essentiales matrimonii
existunt_.
Augustinus Lehmkuhl, S.J., (_Theol. Mor._), alius illustris discipulus
S. Alphonsi est Impotentiam definit: "Defectus propter quern conjuges
non possunt copulam habere per se aptam ad generationem." Alibi
(_American Ecclesiastical Review_, vol. 28, n. 3), de impotentia
excisioneque ovariorum scribens, ait: "Puto, questionem propositam,
utrum excisio ovariorum vel uteri constituat impedimentum dirimens
necne, _theoretice_ nondum esse plane solutam." Existimat autem
questionem _practice_ solutam esse judiciis Congregationis S. Officii,
d. 3 Februarii, 1887, et d. 30 Julii, 1890, editis, matrimonium
mulieris ovariis carentis et mulieris utero et ovariis carentis,
permittentibus. Etiamsi haec judicia non edarentur tanquam leges
formaliter generales, Lehmkuhl opinatur in {330} casibus ejusdem
generis aptari posse. Re quidem vera illa doctrina sequi potest
practice et theoretice; nulla enim est quaestio seria de impotentia in
muliere carente ovariis.
Joseph Antonelli tamen (_De Conceptu Impotentiae et Sterilitatis
relate ad Matrimonium_, Romae, 1900) tenet carentiam ovariorum esse
impotentiam sub lege; et Casacca (_Amer. Eccl. Rev._, vol. xxvii, n.
6, et alibi) eamdem opinionem sequitur. E contra, Marc (_Inst. Mor.
Alphon._) docet carentiam ovariorum uterique non esse impotentiam.
Joseph Hild (_Amer. Ecc. Rev._ vol. xxviii., n. 6) optime vindicat
opinionem, nempe, carentiam ovariorum non esse impotentiam, et in
corpore tractatus citat definitiones impotentiae a moralistis egregiis
prolatas.
Schmalzgrueber (_Theol. Mor._, lib. iv., tit 15, n. 31) dicit: "Sola
impotentia ad copulam dirimit matrimonium, non vero impotentia ad
generationem."
Coninck (_De Sacr._, vol. ii., d. 31, dub. 7, n. 86) ita habet:
"Steriles ... si aliter potentes sint ad usum matrimonii, valide
contrahunt; quia nec generatio nec potestas generandi est de essentia
matrimonii."
Mastrius (_Dis. de Matr._, q. v., n. 114) ait: "Impotentia est
inhabilitas perpetua ad consummandum matrimonium . . . non est ex eo
praecise quod alteruter conjugum aut uterque sint steriles, quia
impotentia ad generandum seu ad prolificandum, dummodo adsit potentia
ad copulam carnalem et seminationem, non est impedimentum dirimens, ut
omnes passim concedunt cum Scoto . . . et ubi est certa impossibilitas
ad bonum prolis, tunc matrimonium est ibi in remedium, non in
officium."
Vincentius de Justis (_De Dispens. Matr._ lib. ii, c. 17, nn. 1, 2, 3)
scribit: "Impotentia ad matrimonium est duplex. Prima, quae
_sterilitas_ dicitur, efficit ut proles generari non possit, ex se
tamen matrimonium nec impedit nec dirimit, ut docent Sanchez, Guttier,
Coninck. . . . Ratio est, quia nec generatio, nec generandi potestas
sunt de essentia matrimonii."
S. Thomas (_Supplem_, q. 58, a. 1) in articulo de Impotentia, quam
_Frigiditatem_ et _Impotentiam Coeundi_ nuncupat, nihil de sterilitate
scribit, nec de impotentia generandi tanquam quid impotentiae coeundi
oppositum.
{331}
In omnibus hisce definitionibus verba _de se, ex se, per se,_ et alia
similia, adhibentur de copula carnali _qua copula_. Amort (_De Matr_,
q. 101) de his verbis loquens ait: "Impotentia est inhabilitas
corporalis ad copulam carnalem _de se_ ad generationem prolis
idoneam.--Dicitur: _de se;_ potest enim contingere _per accidens_, v.
g., ob debilitatem spirituum seminalium in viro aut femina, vel ob
_indispositionem matricis_ in muliere, quod copula carnalis, etiam
perfecta, hoc est, _per effusionem seminis in vagina_ mulieris
completa, non sit idonea ad generationem prolis." Loquuntur
moralistae, ut dixi, de copula carnali quatenus copula est sine
respectu ad possibilitatem generandi.
Hisce omnibus positis, rogamus:
(1), Quid sit impotentia sub lege in muliere?
(2), Estne mulier carens ovariis, utero vel tubis Fallopianis
impotens?
(3), Quid sit impotentia sub hac lege in viro?
(4), Estne vir aspermatosus impotens, et quid de viris semen sterile
habentibus?
I. _Impotentia Mulieris._ Mulieres steriles frequentius quam viris,
viri autem impotentes frequentius quam mulieres sunt. Impotentia
absoluta et perpetua raro in mulieribus, in viris crebro invenitur.
In fundo pelvis femineae septum est a latere in latus, rectum inter et
vesicam urinariam, et in medio hujus partitionis uterus, qui
piroformis est, quasi ad perpendiculum jacet et cervix sua in vaginam
intrat.
A cornibus uteri, i.e., ab angulis superioribus, tubi Fallopiani
procedunt ad libellam, et apud terminos tuborum ovarium est in utroque
latere. Tubi aperti sunt prope ovaria, et non substantiae ovariorum
continui. Si unum ovarium et tubus oppositi lateris demantur, vel si
tubus iste occludatur, ovum ex ovario manente migrare per partem
exteriorem uteri et foecundari potest.
Genitalia externa mulieris e labiis majoribus praecipue constant;
intra et inter haec labia minora seu nymphae sunt. Intra labia minora
ad summum versus clitoris est; infra hanc est meatus urinarius; infra
meatum, orificium vaginae. Per imam partem orificii in virginibus
extenditur pellicula tenuis quae hymen vocatur. Haec communiter in
coitu primo rumpitur.
{332}
Tempore mensium praesertim ova egrediuntur ex ovariis in tubos
Fallopianos et inde in uterum. Si ova non foecundentur per vaginam
amittuntur. Foecundatio in tube Fallopiano fit.
In muliere impotentia temporanea aut perpetua oriri potest e causis
sequentibus:
(1), propter hymenem imperforabilem aut cribriformem, aut septatum aut
annularem;
(2), propter vaginam duplicem;
(3), propter vaginismum aut dolorem;
(4), propter uterum prolapsum aut productionem cervicis uteri;
(5), propter atresiam vaginae aut labia adhaerentia;
(6), propter orificium vaginae in loco abnormali;
(7), propter arctationem vaginae;
(8), propter tumores aut incrementum morbidum intra vel circa
genitalia;
(9), propter Sadismum;
(10), propter Masochismum;
(11), propter Sodomiam gradus secundi seu defeminationem; Sodomiam
gradus tertii; Sodomiam cum horrore; Urningismum; Androgyniam.
1. Aliquando vice hymenis normalis invenitur membrana densa seu
cartilaginosa, aut membrana continua, aut cribro similis, aut tanquam
septum, aut annularis, quae impediat intromissionem. Operatione
simplici chirurgica conditio removetur.
2. Raro septum adest quod vaginam in duas partes dividit et
impotentiae causa est. Chirurgus septum removere potest.
3. Vaginismus contractio spasmodica musculorum ad orificium vaginae
est, et haec vaginam claudit. Frequenter inter neuroses ideopathicas
includitur, scrutinium autem diligens locum inflammationis detegit qui
origo est spasmi reflexi. Insolenter conditio ex hyperaesthesia
murorum vaginalium inducitur.