The Fallopian tubes are two in number, attached to the upper angles of the uterus, and communicating therewith. Each is about five inches in length, and trumpet-shaped at its extremity, which floats free in the pelvic cavity.

Attached to the margin of this trumpet-shaped extremity, is a number of tentacle-like fringes, the function of which is to embrace the portion of the ovary, where an ovum has matured during or immediately after menstruation.

At all other times these tubes are practically unattached to the ovaries. Ova may and do mature on the surface of the ovaries, but do not always pass into the Fallopian tubes; being almost microscopic, they are disintegrated and reabsorbed. If they do pass into a tube they are lost or fertilized as the case may be.

It can be seen that the function and vitality of the ovaries are in no way affected by the tubes. The ovarian function goes on, whether the tubes perform their function of conveyance or not, and if this function can be destroyed, life-long sterility is assured. There is no abdominal operation more simple, rapid and safe, than simple ligature of the Fallopian tubes. It may be performed by way of the natural passage, or by the abdominal route, the choice depending on various circumstances. If the former route be taken, there may be nothing to indicate, in some cases not even to a medical man, that such an operation has been performed.

The Fallopian tubes have been ligatured by Kossman, Ruhl and Neuman for the sterilization of women with pelvic deformities; but all testify to the danger of subsequent abnormal or ectopic pregnancy, and several instances are given. Mr. Bland Sutton relates a case in an article on Conservative Hysterectomy in the British Medical Journal.

After numerous experiments on healthy tubes, I have found that simple ligature with even a moderate amount of force in tying will cut the tube through in almost any part of its length. The mucous lining is so thrown into folds that its thickness in relation to the peritoneal layer is considerable. Because of this, the tube when tied alone is brittle, and a ligature applied to it will very easily cut through, and either allow of reunion of the severed ends or leave a patent stump. In a recorded case in which pregnancy occurred after each tube was ligatured in two places, and then divided with a knife, a patent stump was no doubt left.

In order to obviate this danger the peritoneal layer must be opened, and the mucous membrane, which is quite brittle and easily removed, must be torn away for about one quarter of an inch. A simple cat-gut or silk ligature lightly tied would then be sufficient to insure complete and permanent occlusion.

Nature often performs this operation herself, with the inevitable and irrevocable result, lifelong sterility, with no tittle of positive evidence during life of its occurrence.

Here are a few examples:—A young married woman has a miscarriage; it is not severe, and she is indiscreet enough to be about at her duties in a day or two, but within a few days or so she finds she must return to bed, with feverishness and pelvic pain. Before a month is past she is up and quite herself again. But she never afterwards conceives. What has happened? To the most careful and critical examination nothing abnormal is detected. Her general health, her vitality, her emotional and sexual life, her youthful vigorous appearance, all are unimpaired. But she is barren, and why? A little inflammation occurred in the uterus and spread along the tubes. The sides of the tubes cohered, permanently united by adhesive inflammation, and complete and permanent occlusion resulted.

The operation of tubo-ligature is an artificial imitation of this inflamatory process.

Pelvic inflammation, sometimes very slight, following a birth, or the same process set up by uterine pessaries used for displacements, may induce adhesive inflammation in the tubes, and simple and permanent sterility is the incurable result. It is a well known fact that prostitutes are usually sterile, and this arises from the prevalence of venereal disease, which produces gonorrhoeal inflammation of the Fallopian tubes, resulting in complete and permanent occlusion.

This process could be best imitated, if cauterisation of the tubes were a safe and reliable procedure. An electric cautery passed along the tubes would result in a simple and speedy occlusion. But in the present state of our gynecological knowledge this appears impracticable.

We have therefore at our hand, a simple, safe, and certain method of stopping procreation by the sterilization of women by tubo-ligature.

This operation would entail no hardship on women. It is so easy, safe and painless, that thousands would readily submit to it to-morrow, to be relieved from the anxiety which a possible increase in their already too numerous families excites. Hundreds of women and men to-day are living unnatural lives, because of their refusal to bring children into the world with the hereditary taint they know courses in their own veins.

Many men are living loose and irregular lives, amongst the easy women of society, because the indiscretion of their youth has damned them for ever with a syphilitic taint, which they could not fail to transmit to their progeny.

Many virtuous men and women are living a life of abstinence from even each other's society, because their physician has taught them something of the law of heredity. Would not all these women readily submit to sterilization?

As it produces no mental nor moral, nor physical change, it violates no law, and outrages no sentiment. It is an outrage upon society, and a greater upon an innocent helpless victim to bring a defective into the world; it is a moral act to prevent it by this means.

And of all the methods yet suggested or devised, or practised, tubo-ligature is the simplest, most effective, and least opposed to sentiment and prejudice.

It will of course be asked:—What about criminals and defective men? Let their wives be sterilized. The wife of any criminal would deem it a boon to be protected from the offspring of such a man, so would society.

If he is not married, then society must take the risk, and it is not very great. The women who will be his companions will be either sterilized by disease or by tubo-ligature, because they are defectives. This protection from the progeny of defective men, though not absolute, is complete enough for all practical purposes.

If all defective women and the wives of all defective men are sterilized, a greater improvement will take place in the race in the next 50 years, than has been accomplished by all the sanitation of the Victorian era.



CHAPTER XII.

SUGGESTIONS AS TO APPLICATION.

The State's humanitarian zeal protects the lives and fosters the fertility of the degenerate.—A confirmed or hereditary criminal defined.—Law on the subject of sterilization could at first be permissive.—It should apply, to begin with, to criminals and the insane.—Marriage certificates of health should be required.—Women's readiness to submit to surgical treatment for minor as well as major pelvic diseases.—Surgically induced sterility of healthy women a greater crime than abortion.—This danger not remote.

The fertility of the unfit goes on unrestrained by any other check, save vice and misery. The great moral checks have not, and cannot have any place with them. But the State is, by its humanitarian zeal, limiting the scope and diminishing the force of these natural checks amongst all classes of the community, but especially amongst the unfit, so that its policy now fosters the fertility of this class, while it fails to arrest the declining nativity of our best citizens. The greater the fertility of the unfit, the greater the burden the fit have to bear, and the less their fertility.

The State's present policy therefore, fosters the fertility of the unfit, and discourages the fertility of the fit. This disastrous policy must be changed without delay. The State can arrest the gradual degradation of its people, by sterilizing all defective women and the wives of defective men falling into the hands of the law. Mr. Henry M. Boies in "Prisoners and Paupers" suggests life-long isolation. He says:—"It is time however that society should interpose in this propagation of criminals. It is irrational and absurd to occupy our attention and exhaust our liberality with the care of his constantly growing class, without any attempt to restrict its reproduction. This is possible too, without violating any humanitarian instinct, by imprisonment for life; and this seems to be the most practicable solution of the problem in America. As soon as an individual can be identified as an hereditary or chronic criminal, society shall confine him or her in a penitentiary at self-supporting labour for life.

Every State should have an institution, adapted to the safe and secure separation of such from society, where they can be employed at productive labour, without expense to the public, during their natural life. When this is ended with them, the class will become extinct, and not before. Then each generation would only have to take care of its own moral cripples and defectives, without the burden of the constantly increasing inheritance of the past. When upon a third conviction the judicial authorities determine the prisoner to belong to the criminal class, the law should imperatively require the sentence to be the penitentiary for life, whatever the particular crime committed."

M. Boies defines a criminal as one in whom two successive punishments, according to law, have failed to prevent a third offence.

If such a criminal is a woman, she should be offered the alternative of surgical sterility or incarceration during the child bearing period of her life; if a man, his wife should be offered this remedy against the procreation of criminals in exchange for her husband, on the expiry of his sentence, or the protection of divorce.

No woman in the child-bearing period of life should be released from an Asylum, until this operation has been performed. If a man is committed, his wife should have the option of divorce or be sterilized before his release.

A central Board should issue marriage certificates, after consideration of confidential medical reports upon the health, physical condition, and family history of the parties to a proposed marriage contract.

Medical officers should be appointed in the various centres of population by the central Board, and fees on reports should be paid after the manner of Life Insurance fees.

In fact the Life Insurance system would serve as a good model, for the establishment of a system of marriage control, and if questions involving a more detailed family history were added to a typical Life Insurance report form, it could hardly be improved upon, for the purpose of marriage health reports.

If upon consideration of the medical report of the contracting parties, in accordance with the law upon the subject, a certificate of marriage were refused, a certificate of sterilization by tubo-ligature, forwarded to the Board by a Surgeon, should entitle to the marriage certificate.

No law should attempt to step in between two lovers, who have become attached to each other by the bonds of a strong affection, lest a greater evil befall both themselves and society.

A marriage certificate of health should state the complete family history as well as the physical condition of the parties to a proposed marriage, and such certificates should be issued only by the Central Board of Experts, who would receive the medical reports of its own medical officers.

When the principle of artificial sterilization is accepted by the State, the organization necessary to ensure that only the fit shall procreate, will only be a matter of arrangement by experts.

One danger looms ahead however if the operative means of producing artificial sterility are popularised.

Every surgeon of experience knows how readily large numbers of married women encourage surgical treatment for ovarian and even uterine complaints, if they become aware that such treatment is followed by sterility. It is not at all an uncommon thing for women in all ranks of life, to encourage, and even seek removal of the ovaries in order to escape an increase in the family.

They become acquainted with persons who have submitted to this operation for ovarian disease, and noting nothing but improvement in their health, attended by sterility, their intense anxiety to enjoy immunity from child-bearing makes them eager to submit to operation.

It would be distinctly immoral to sterilize healthy women, who become possessed with the old Roman passion for a childless life, or who simply wish to limit their families for any selfish or personal reason.

Any law which recognizes the induction of artificial sterility should make operative interference with those fit to procreate a healthy stock an offence.

Induced sterility should rank with induced abortion, and be a criminal offence, except in certain cases which could be defined.

There is much evidence to suggest that artificial sterilization may become as a great vice, as great a danger to the State as criminal abortion.

Artificial abortion, as commonly performed, is a much more dangerous operation than tubo-ligature. Of the two operations, any experienced surgeon would readily declare that the latter is the simpler and the safer; the one less likely to lead to unfavourable complications, and the one, moreover, that would leave the subject of it with the better "expectancy of life."

Anaesthetics and antiseptics have made this comparison possible and true.

Any surgeon who performs tubo-ligature should be liable to prosecution, unless he can justify his action according to the law relating to the artificial sterility of the unfit.

While the law would eventually require to be obligatory, with regard to the absolutely unfit, it would require to be permissive in all other cases.

Many voluntarily abstain from marriage, because of a strong hereditary tendency to certain diseases such as cancer and tubercle.

There must of necessity be many on the border-land between the fit and the unfit, and clauses permitting sterilization under some circumstances would be required.



CONCLUSION.

In conclusion let us briefly review the whole position taken up in this imperfect study of a great question.

1. The birth-rate is rapidly and persistently declining.

2. The food-rate is persistently increasing.

3. The declining fertility is not uniform through all classes.

4. The fertility of the best is rapidly declining.

5. The fertility of the worst is undisturbed.

6. The policy of the State is inimical to the fertility of its best, and fosters the fertility of its worst citizens.

7. The infertility of the best stock is due to voluntary curtailment of the family, through sexual self-restraint.

8. No such-factor does or can obtain as a check to the fertility of the unfit.

9. The proportion of the unfit to the fit is in consequence annually increasing.

10. The future of society demands that compulsory sterilization of the unfit should be adopted.

11. No method ever tried or suggested offers the advantages of simplicity, safety, effectiveness, and popularity, promised by tubo-ligature.

12. The State must protect itself against the collateral danger of artificial sterilization of its best stock.

The highest interest of Society and of the individual urgently requires that the size of families be controlled.

The moral restraint of Malthus (delayed marriage) and post-nuptial intermittent restraint are the only safe and rational methods, that our civilization can possibly encourage, or physiology endorse.

These methods must of necessity be peculiar to the best class of people. For the worst class of people, induced sterility, or prohibited fertility, is an absolute necessity, if Society and civilization must endure.

Now what are likely to be the results of, first, the moral methods, and, second, the surgical method of our curtailment.

"It does not appear to me," says Dr. Billings (Forum, June, 1893), "that this lessening of the birth-rate is in itself an evil, or that it will be worth while to attempt to increase the birth-rate merely for the sake of maintaining a constant increase in the population, because to neither this nor the next generation will such increase be specially beneficial."

To Aristotle, the great advantage of an abundant population was, that the State was secured against invasion by numerous defenders.

If we can find no stronger justification for a teeming population than this to-day, we will be forced to agree with Dr. Billings, that neither to this nor the next generation, is a great increase especially beneficial.

But the moral effect of judicial limitation is very great. If men and women can marry young, one great incentive to vice is removed. If married people can bear their children when they can best support them, they will marry when their bodies are matured, and bear their families when their finances are matured.

For children well provided for, and educated, and born after full physical and mental maturity in their parents, turn out the best men and women.

If the conditions of life are made easy, if ease and comfort are tolerably secured to all, if the strain and stress of life are reduced, if hardship, poverty, and want are reduced to a minimum, the sexual instinct and parental love in human nature, so far unimpaired by any known force, are powerful enough to keep the race alive, and insure a progressive development.

The greater the proportion and the fertility of the defective, the less hope for the future. If the fertility of the unfit be reduced to a minimum, not only will many dreadful hereditary diseases be eradicated, but the fertility of the fit will receive a powerful stimulus, because of the great diminution there will necessarily be in the burdens they will have to bear.

The advantages of sterility to the unfit themselves will, on the whole, be incalculable. They are self-evident, and need not be dwelt on here.

The whole sum of human happiness would in this way be most assuredly increased, and the aim and object of all social reform be to some extent at least, realized.

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