INTER-ALLIED TYPHUS COMMIS

SION IN POLAND

The Inter-Allied Medical Mission sent by the International League of Red Cross Societies to study the typhus situation in Poland has begun its investigations Warsaw. the first

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which was organized to coordinate all Red Cross activities.

The Mission has had inspection trips, conferences with the Ministers of Public Health, Army Medical Officers, the American Red Cross Commissioner, and with municipal health officers. It took a week's trip to the southwestern front to study conditions in military regions. The commission is composed of Col. Hugh S. Cumming, Chairman, Assistant Surgeon General United States Public Health Service; Lieut. Col. Aldo Castellani of the Royal Italian Navy Medical Service; Lieut. Col. George S. Buchanan, Medical Officer of Health of the Ministry of Health of Great Britain, and Lieut. Col. Visbecq of the French Army Medical Service.

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Vol. XXXIV.

No. 12

In discussing sterility, two important factors present themselves for consideration. First, according to authorities as Reynolds, of Boston, and Max Huhner of New York, from twentyfive to fifty per cent of sterile marriages are due to sterility of the husband. Second, the principle factor in outlining the treatment of sterility of women is the determination of the exact cause of the sterility, rather than the haphazard currettage or round ligament operation now so frequently performed without any scientific indication. No woman should be treated much less be operated upon, for sterility unless the husband has first had a complete physical examination. Men who are really desirous of having children are willing and anxious to be thus examined; hesitancy on the part of the man is a sure indication that his previous history will not bear very close inspection.

Sterility in the male may be either absolute or relative. Absolute sterility is found in cases of congenital absence of the testes; in atrophy of the testes following infections; in permanent oc

clusion of the vasa; or to glandular changes preventing the formation of spermatazoa. These cases are hopeless for any known method of treatment.

In the class of cases designated as relative sterility, we have first the deformities, such as epispadias, hypospadias or malformations due to severe injuries with subsequent cicatrices. Surgery will correct the majority of such cases. Second, we have changes in the motility or the number of spermatazoa due to inflammatory changes caused by gonorrhea, tuberculosis or the orchitis following mumps. Third, we find a class of cases in which we have purely a functional derangement, causing impotence, premature ejaculation.

There is no longer any doubt but that gonorrhea plays an important role as an etiological factor in producing sterility in the male, just as important as it is in producing sterility in the female. The only reason why more women become sterile after gonorrheal infection than men, is because men as a rule recognize the infection and have early and thorough treatment. The majority of women, on the other

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hand, usually have a specific infection for months before it is recognized, giving the gonococci plenty of opportunity to invade the uterus and tubes. If the cases in the male were neglected as often as those in the female, we would find the same proportion of involvement in the adjacent structures. This is partially proven when we remember that the sterile cases are those in which we find frequently recurring acute exacerbations of an old infection, or in those cases giving a history of several, or many, distinct, separate acute infections leaving the individual with a chronic, almost incurable gleet, analagous to the chronic tubal infection in women.

Impotence and premature ejaculation are the result of excessive coitus, libido or masturbation, or follow the practice of coitus interrupticus. These practices produce a chronic passive congestion of the posterior urethra, prostate and epidydimis, with inter ference of the normal functioning of these organs, producing relative sterility.

A complete physical examination will disclose all gross pathology, but the microscopic examination alone will determine whether a man is sterile or not. The semen should be examined immediately after ejaculation, preferably after normal coitus. Where this is refused, the secretion may be brought to the office in a condome, great care being taken to keep the specimen at body temperature. A drop is placed on a warm stage, and with the high power the field is searched for spermatazoa. The sperm cells should cover the field and should grow great motility; this motility, although gradually diminishing, should continue for from six to twelve hours. In cases of absolute sterility no sperm cells, or only dead cells are found. The relatively sterile semen shows either a greatly diminished number of cells, or else the spermatazoa show a marked

decrease in motility, which may cease entirely in from a few minutes to an hour.

The treatment of relatively sterile cases is divided into the local and general. Local treatment consists of treating an old gonorrhea if present, and in relieving the congestion of the urethra and prostate in cases following sexual excesses of all kinds. The general treatment, briefly outlined, is as follows: Sexual rest for from three to six months. Not only is coitus prohibited, but the patient must avoid all other forms of sex stimulation. A vegetarian diet and cold baths are beneficial. The use of tobacco in any form must be stopped, since its use has a marked tendency to decrease virility. Tonics containing iron, phosphorus, strychnia or arsenic are excellent. The intravenous injection of sodium cacodylate, in three grain doses, once or twice a week, gives good results.

If this condition is found in the husband of a normal woman, the intrauterine injection of the semen is recommended. The patient assumes the knee-chest position. A speculum is introduced, and the cervix is sponged dry. A tenaculum is placed to grasp the anterior lip of the cervix. The special syringe, carefully sterilized, is filled with the semen, which is drawn from a condome. The long tip is then introduced into the cervix and pushed just beyond the internal os. Its contents are injected, and the syringe held in place for about five minutes. A rubbercapped pessary is then placed around the cervix, in an effort to hold the excess semen in close relation to the external os. The injection is most ef fective when given immediately before or after the expected period of menstruation.

In determining the cause of sterility in the woman, a complete physical examination should first be made in order to determine the presence of any constitutional reasons which might pre