Essays In Pastoral Medicine Part 28

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 const.i.tute 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 p.r.i.c.k 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.

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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 a.s.sume 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 a.s.sumed 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 succ.u.mb to nervous and mental diseases resembling paresis and locomotor ataxia in early adult life. In fact it is this transmission of the disease that const.i.tutes 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.

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x.x.x

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 amitt.i.t.

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, quandoc.u.mque detegitur. Procrastinatio aut ignorantia culpabilis non excusant.

Jurgia oriuntur ex eo quod impotentia c.u.m 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 s.e.xualis. Neque sterilitas nec malformatio quae copulam non impediant, neque infirmatio quaec.u.mque sanabilis incapacitatem gignunt. Impotentiam tempore ineundi matrimonii exst.i.tisse necesse est." Eadem est doctrina Schouleri et Baldwinii.

White et Martin, medici, (_Genito-Urinary and Venereal Diseases_.

Philadelphiae. 1897.) impotentiam ita definiunt: "Inabilitas actus s.e.xualis perficiendi. Non necessario c.u.m sterilitate consociatur, neque necesse est quod sterilis impotens sit." Et ita alii omnes.

Significatio vocis Impotentiae sub lege canonica deducitur, (1), ex dijudicationibus Pontific.u.m Romanorum, aut (2), ex judiciis Congregationis Sancti Officii, tribunalis ad sententias hujus generis p.r.o.nuntiandas inst.i.tuti, aut, (3), ex legis interpretatione a moralistis scientia praeditis.

Sixtus V, Pontifex Roma.n.u.s, (Const. _c.u.m 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 n.o.bis sequenda ex interpretatione moralistarum est depromenda.

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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 voc.u.m "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 c.u.m 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 c.u.m 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 s.e.m.e.n 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 oblivisc.u.n.tur et sterilitatem simplicem c.u.m 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, -- 5, ait: "Non est confundenda impotentia coeundi c.u.m impotentia generandi. Hinc steriles et senes qui matrimonium consummare valent, valide contrahunt, item mulieres quae possunt s.e.m.e.n 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 v.a.g.i.n.a." Hoc est, tenet mulierem utero et v.a.g.i.n.a carentem impotentem esse. Unusquisque carentiam v.a.g.i.n.ae impotentiam esse admitt.i.t; mulier autem sine utero s.e.m.e.n excipiendi capax est, concupiscentiam quoque maris satiare potest. Sterilis tantum est. Potentiam etiam habet coeundi, s.e.m.e.n 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 ill.u.s.tris 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 const.i.tuat 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., t.i.t 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 pa.s.sim concedunt c.u.m 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.

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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 v.a.g.i.n.a_ 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 s.e.m.e.n 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, r.e.c.t.u.m inter et vesicam urinariam, et in medio hujus part.i.tionis uterus, qui piroformis est, quasi ad perpendiculum jacet et cervix sua in v.a.g.i.n.am 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.