1
637 careful examination. The Society suggested that councils should consider the question of insuring themselves and their medical officers against liabilities resulting from mistaken diagnosis. This course the Stoke Newington Committee decided to recommend to the council, after ascertaining that some other borough councils had already accepted offers from insurance companies to cover the risk for a premium of jE15 per annum-the limit for any one claim being 25000. Damages, it is believed, can only be substantiated where negligence on the part of a medical officer is actually proved. The policy is to cover the council, the medical officer of health, and any doctor authorised to act on his behalf in connexion with the diagnosis of infectious diseases, against any claims in respect of erroneous diagnoses the terms of such policy to be acceptable to the chairman of the health committee. It may seem to some of our readers that protection of this kind is duplicating the machinery of existing medical defence societies, but it should be noted that the new policies relate to both the council and its medical officer, and those with most experience are well aware that responsibility in a case of mistaken diagnosis is often a very debatable point. Whilst the medical officer may be fully protected against any claim made against him on the ground of alleged personal negligence, it is possible that cases might arisewBherel’he question of responsibility is debatable, and where the additional protection afforded by the policies which the borough councils are now taking out would stand him in good stead. Moreover, action might conceivably be taken against the council and its medical officer jointly. On the other hand, no medical officer should rely for his safety on these new policies, for their scope is limited. The protection afforded is only in respect of erroneous diagnosis and does not exceed 25000. THE MOTILITY OF SPERMATOZOA AS A TEST OF FERTILITY. FOR years the motility of the male sex cells has been regarded as the best criterion of male fertility. but Dr. Gerard L. Moench 1 thinks that the external factors which affect it are so numerous as to be misleading. Under apparently identical conditions specimens .from the same person may show activity or inactivity, and it is only when absence of movement is consistently noted in repeated examination of absolutely fresh and uncontaminated semen that sterility can be diagnosed. Moench could find no relation between activity of movement and fertility. Some specimens of semen from men with normal breeding records contained actively motile sperms which remained alive 12, 24, and even 30 hours and more, whereas other samples from equally normal men contained only sluggishly motile cells I which 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 made in diluting the semen with distilled water, salt solutions, and various dilutions of sodium bicar- bonate, dextrose, and human blood-serum. In every case, with the exception of human blood-serum and 2-5 per cent. dextrose solution, motility was reduced by the diluent. In 5 per cent. dextrose motility of the sperms could be observed for more than 54 hours after emission. Light and gravity had no effect on motility, but changes of temperature caused much variation. Specimens which were kept cold retained their motility longer than those left at room temperature, probably because the sperms were more sluggish in the cold and used up their store of energy less rapidly. Moench found no verification for the statement that the vitality of sperms is lessened by age ; those from old rabbits seem to have shown as much active movement as 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, and he quotes a case in which an attack of influenr.;a abolished motility for six months. He doubts whether it is true that spermatozoa with straight tails, even although stationary, have been alive at the time of ejaculation, and those with curled tails dead. He was able to produce the curled variety by adding three or four volumes of distilled water to a fresh specimen of semen, and therefore considers the curling up of the tail to be the result of chemical action. The deduction Moench makes from his experiments is that great caution must be exercised in drawing conclusions from slight changes observed in the motility of sperm cells. It may be recalled 2 here that Prof. F. Unterberger reports that addition of bicarbonate of soda to the vaginal contents during coitus results in the cure of many cases of sterility and in the birth of male children. --- AN INCLUSIVE FEE AT A SPECIAL HOSPITAL. THE secretary of the Royal Westminster Ophthalmic Hospital thinks it may interest our readers to know that it has been found possible to offer a private room in the hospital with central heating, hot and cold running water, light, maintenance, generous feeding (including tea supplied to patients’ friends). and full nursing services, for an inclusive fee of six guineas a week. No extra charge is made for the use of the theatre, or for drugs or dressings. The bacteriologist’s fee is half a guinea ; that of a patholo- gist or radiologist, if required, is a guinea in each case. The surgeon’s fee is a matter of arrangement between surgeon and patient and although the average fee is from ten to thirty-five guineas, according to the 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 for the services of the hospital’s medical officer a charge of only a guinea is made, even if the patient remains under treatment for a month. The rooms are fitted and furnished more in the style of a modern hotel than of a nursing home, and there is a special sitting room with wireless and other amusements, where patients who are up and about may meet each other if they wish to do so. In an extension of this system of private nursing, at moderate inclusive charges, in fully equipped hospitals, the secretary of the hospital sees the solution of a problem which lies heavy on the middle classes. PROBLEMS OF SYPHILIS. THE minds of clinicians and pathologists have long been exercised about the diagnostic value of positive reactions (Wassermann and its various modifications. flocculation and opacity tests)’in the blood and spinal fluid of patients who have no clinical manifestation of syphilis. This was the subject of a symposium recently conducted by the Vie Médicale, Jan. 25th, 1930, and although the inquiry did not evoke a unanimous reply, the opinions of the experts con- cerned-most of them French-are not without interest. A somewhat similar problem, namely, the causation and treatment of Wassermann-fast syphilis, was discussed recently by the Medical Society for the Study of Venereal Diseases at a meeting reported in our issue of Feb. 8th (p. 298). In the summary of the French symposium, Dr. P. E. Morhardt says that almost all are agreed that an isolated positive Wasseimann reaction, in the absence of clinical signs, has scarcely any value, and that before a diagnosis of syphilis is made and appropriate treatment is given, several observations, all with undoubtedly positive results, are necessary. One writer, Clement Simon, is emphatic that no one should carry out delicate biological tests, such as the Wassermann without adequate training and without having mastered all the details of technique involved. 2 See THE LANCET, March 1st, p. 475.

THE MOTILITY OF SPERMATOZOA AS A TEST OF FERTILITY

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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.