EXAMINATION OF THE MALE.
Not only are the organs much more acces sible, but the maladies causing sterility are much less numerous, and, when not of nervous origin, cause much more palpable local disturbances. On the other hand, male unfruitfulness is much more commonly due to diseases of distant organs or of the general system; and our examination must be consequently more extensive. With honest patients, however, the history will help us far more than it will in females. But the most important help in diagnosis comes from the fact that the male principle of conception, the sperms, can be directly examined.
We can best explore the genitals by taking them in order; testicle, epididymis, cord and penis. We can thus decide whether any congenital defect or disease which might cause sterility is present. The condition of the prostate, the seminal vesicles, and the parts in their neighborhood must be found out by rectal examination, and the existence of cryptor chidism may sometimes be decided in the asme way. The penis must be inspected and palpated. If stricture is suspected, the catheter must be used, and in some cases the deeper portions of the urethral canal must be inspected by endoscopy after Griinfeld's method. • If the history points to disease of other organs, or of the system at large, we will be confronted by the difficulty that the malady causing the sterility is often in its earliest stages, and marked symptoms may not be present to enlighten us as to the diagnosis.
If the facts elicited point to former abuse of the genital function, we must obt,ain information as to the nature, duration, and extent of the sex ual excesses, as also as to the present state of the sexual functions (erec tion and ejaculation). It is important to fizid out whether spermatorrhma exists with the genital weakness.
It is different if the history shows that we probably have a temporary or psychic impotence or sterility to contend with. If we believe this to be the case, we may postpone examination of the genitals.
But if the genitals appear normal, and cohabitation also, we must sus pect some fault in the spermatic fluid itself. The conclusions reached as
to the activity of the zoosperms in the female genital canal vary, and the results of experimentation upon animals cannot be confidently applied to men, and it is, therefore, advisable to examine the contents of the vagina as soon as possible post coitum. Any examination made more than twelve hours after intercourse is useless. All gynecological treatment and vagi nal injections must be suspended for several days before intercourse, and thereafter; since we know that apparently harmless things will influence the sperms. All instruments used to remove the semen from the vagina must of come be very clean and quite dry. The secretion of the cervical cavity can be rernoved by means of a fine syringe, or by Simon's smallest spoon curette, or with a camel's hair brush, and then examined under the microscope—remembering that while the cervical mucus contains far less spermatozoa than does the vaginal, they remain alive much longer in it.
The vaginal mucus may be removed with the dry forefinger, or the speculum inay be introduced, and enough will be found adherent to its apex when withdrawn to suffice for all practie,a1 purposes. The secretion should be at once examined under the microscope.
The result may vary much. If we have taken vaginal secretion, the entire field may be so filled up with spermatozoa that other objects pre sent, epithelium, crystals, granules, may be quite invisible. In other cases zoosperms may be nearly or quite absent. If the result is negative, repeated examinations should be made; for even a short time after coitus the aemen may lie in one coherent mass in the vagina, and we may fail to get any of it in the mucus we collect. Nor must we forget that the zoo sperms soon scatter in the vaginal fluids, and that a small number of them in a ipecimen collected late by no means necessarily implies a deficient amount of semen. And besides, the semen flows away out of the vagina after copulation. Both vaginal and cervical mucus should be examined before it is decided that the zoosperms are absent.