the motility of spermatozoa as a test of fertility

637

careful examination. The Society suggested thatcouncils should consider the question of insuringthemselves and their medical officers against liabilitiesresulting from mistaken diagnosis. This course theStoke Newington Committee decided to recommendto the council, after ascertaining that some otherborough councils had already accepted offers frominsurance companies to cover the risk for a premiumof jE15 per annum-the limit for any one claim being25000. Damages, it is believed, can only besubstantiated where negligence on the part of a

medical officer is actually proved. The policy isto cover the council, the medical officer of health,and any doctor authorised to act on his behalf inconnexion with the diagnosis of infectious diseases,against any claims in respect of erroneous diagnosesthe terms of such policy to be acceptable tothe chairman of the health committee. It mayseem to some of our readers that protection of thiskind is duplicating the machinery of existing medicaldefence societies, but it should be noted that thenew policies relate to both the council and its medicalofficer, and those with most experience are wellaware that responsibility in a case of mistakendiagnosis is often a very debatable point. Whilstthe medical officer may be fully protected againstany claim made against him on the ground of allegedpersonal negligence, it is possible that cases mightarisewBherel’he question of responsibility is debatable,and where the additional protection affordedby the policies which the borough councils are now

taking out would stand him in good stead. Moreover,action might conceivably be taken against thecouncil and its medical officer jointly. On the otherhand, no medical officer should rely for his safetyon these new policies, for their scope is limited.The protection afforded is only in respect oferroneous diagnosis and does not exceed 25000.

THE MOTILITY OF SPERMATOZOA AS A

TEST OF FERTILITY.

FOR years the motility of the male sex cells hasbeen regarded as the best criterion of male fertility.but Dr. Gerard L. Moench 1 thinks that the externalfactors which affect it are so numerous as to bemisleading. Under apparently identical conditionsspecimens .from the same person may show activityor inactivity, and it is only when absence of movementis consistently noted in repeated examination ofabsolutely fresh and uncontaminated semen thatsterility can be diagnosed. Moench could find norelation between activity of movement and fertility.Some specimens of semen from men with normalbreeding records contained actively motile spermswhich remained alive 12, 24, and even 30 hoursand more, whereas other samples from equallynormal men contained only sluggishly motile cells

Iwhich seemed to be nearly all dead after five or

six hours. In order to test the various ways in I

which motility is affected experiments were madein diluting the semen with distilled water, saltsolutions, and various dilutions of sodium bicar-bonate, dextrose, and human blood-serum. In everycase, with the exception of human blood-serumand 2-5 per cent. dextrose solution, motility wasreduced by the diluent. In 5 per cent. dextrosemotility of the sperms could be observed for morethan 54 hours after emission. Light and gravityhad no effect on motility, but changes of temperaturecaused much variation. Specimens which were

kept cold retained their motility longer than thoseleft at room temperature, probably because thesperms were more sluggish in the cold and used uptheir store of energy less rapidly. Moench foundno verification for the statement that the vitalityof sperms is lessened by age ; those from old rabbitsseem to have shown as much active movementas those taken from younger animals. Poor general

1 Jour. Amer. Med. Assoc., Feb. 15th, p. 478.

health, on the other hand, had a definite effect, andhe quotes a case in which an attack of influenr.;aabolished motility for six months. He doubts whetherit is true that spermatozoa with straight tails, evenalthough stationary, have been alive at the time ofejaculation, and those with curled tails dead. Hewas able to produce the curled variety by addingthree or four volumes of distilled water to a freshspecimen of semen, and therefore considers thecurling up of the tail to be the result of chemicalaction. The deduction Moench makes from hisexperiments is that great caution must be exercisedin drawing conclusions from slight changes observedin the motility of sperm cells.

It may be recalled 2 here that Prof. F. Unterbergerreports that addition of bicarbonate of soda to thevaginal contents during coitus results in the cureof many cases of sterility and in the birth of male

children. ---

AN INCLUSIVE FEE AT A SPECIAL HOSPITAL.

THE secretary of the Royal Westminster OphthalmicHospital thinks it may interest our readers to knowthat it has been found possible to offer a privateroom in the hospital with central heating, hot andcold running water, light, maintenance, generousfeeding (including tea supplied to patients’ friends).and full nursing services, for an inclusive fee of sixguineas a week. No extra charge is made for the

use of the theatre, or for drugs or dressings. Thebacteriologist’s fee is half a guinea ; that of a patholo-gist or radiologist, if required, is a guinea in eachcase. The surgeon’s fee is a matter of arrangementbetween surgeon and patient and although the averagefee is from ten to thirty-five guineas, according tothe operation required, a staff surgeon has been known,he says, to accept as little as five guineas. No

charge is made for the surgeon’s assistant, and forthe services of the hospital’s medical officer a chargeof only a guinea is made, even if the patient remainsunder treatment for a month. The rooms are fittedand furnished more in the style of a modern hotelthan of a nursing home, and there is a special sittingroom with wireless and other amusements, wherepatients who are up and about may meet each otherif they wish to do so. In an extension of this systemof private nursing, at moderate inclusive charges, infully equipped hospitals, the secretary of the hospitalsees the solution of a problem which lies heavy onthe middle classes.

PROBLEMS OF SYPHILIS.

THE minds of clinicians and pathologists have longbeen exercised about the diagnostic value of positivereactions (Wassermann and its various modifications.flocculation and opacity tests)’in the blood and spinalfluid of patients who have no clinical manifestationof syphilis. This was the subject of a symposiumrecently conducted by the Vie Médicale, Jan. 25th,1930, and although the inquiry did not evoke aunanimous reply, the opinions of the experts con-cerned-most of them French-are not withoutinterest. A somewhat similar problem, namely, thecausation and treatment of Wassermann-fast syphilis,was discussed recently by the Medical Society for theStudy of Venereal Diseases at a meeting reported inour issue of Feb. 8th (p. 298).

In the summary of the French symposium, Dr. P. E.Morhardt says that almost all are agreed that anisolated positive Wasseimann reaction, in the absenceof clinical signs, has scarcely any value, and thatbefore a diagnosis of syphilis is made and appropriatetreatment is given, several observations, all withundoubtedly positive results, are necessary. Onewriter, Clement Simon, is emphatic that no one shouldcarry out delicate biological tests, such as theWassermann without adequate training and withouthaving mastered all the details of technique involved.

2 See THE LANCET, March 1st, p. 475.