The zoosperms may all or in part be in active motion, but even if they are not, it does not prove that they are dead. A weak alkaline solution (kal. caust. I :1000) may be added, which will perhaps restore motion to them when quiescent.
Our conclusions will vary in accordance with the results obtained. The presence of numerous zoosperms in active motion will of course ex clude all doubt as to potency, but their absence or immobility does not justify us in adopting the opposite conclusion, and this for the reasons above stated. The time which has elapsed after cohabitation has been too great, and another and more prompt examination is necessary, or the semen is that voided at the last of several rapidly succeeding cohabi tations, when it should be that of a single one after more or less prolonged abstinence. In elderly or weakly individuals the examinations should take place after. lengthy periods of continence, before we decide as to the amount of spermatozoa present.
Motionless spermatozoa may have been ejaculated in that condition, or they may have become so from causes resident in the female organs alone. If the woman is alone accessible to examination, a search immediately after cohabitation will be too prompt to permit the vaginal secretions to act upon the mass of zoosperms and kill them. If this does not succeed, we must endeavor to neutralize the acid vaginal secretion immediately before coitus, by washing out the organ with a dilute alkaline lotion. To decide whether the zoosperms are inactive merely or dead, the pro cedure recommended above may be employed.
Hausmann has shown that the spermatozoa have all disappeared from the vaginal fluids thirty-six hours post coitum. They may still persist in the cervical mucus. But even if we decide that they are entirely absent, we should not do so till after repeated examinations, since azoospermatism itself may be only a temporary phenomenon.
Sometimes it is impossible to obt,ain the genital secretion in the fresh state, and we are compelled to rely upon dry preparations. The secre tion that flows out of the vagin9, after intercourse may be collected upon clean fine linen, and permitted to dry there. These semen spotsare then
to be moistened with a very small amount of distilled water, scraped, and placed under the microscope. Or, if the spots are moistened with an ammoniacal ca,rmine solution, the spermatozoa will appear more char acteristically. It will not be superfluous to remind the reader that fibres of tissue may easily be mistaken for spermatozoa that have lost their heads.
In this manner the existence of zoosperms, though not their motility, may be proven. But the absence of the zoosperms in semen stains is less certain as a proof of male sterility than their absence in the vaginal secretions, since the stains may possibly consist simply of the secretions of the external genitals.
If the above-mentioned methods of obtaining the semen are not suffi cient, we must endeavor to get it directly from the man himself. He may wipe his glans and express the contents of the urethra upon clean linen immediately post collum, or, better still, may practise intercourse with a condom, and bring the semen thus obtained for examination. But the examination may be best of all conducted by t,aking the semen directly from the male, though this is sometimes quite impossible. Immediately after coitus, or at all events before the first urination, the remnants of the semen are to be expressed from the urethra, and examined directly. If we find on repeated examination made in this way that no zoosperms are present, the man is undoubtedly sterile.
If we find spermatozoa, but always motionless, they have died during their pump through the seminal canals, and probably from disease of these latter. According to A. Schlemmer, the other organized eompo nents of the semen increase as the zoosperms decrease. If the zoosperms are in active motion, the cause of the stezility must be sought in the female.
If aspermatism is present, there will be no fluid in the urethra to be examined. It must not be forgotten, however, that certain obstacles may cause the semen to flow backwards into the bladder, and in these cases the urine at the next micturition should be examined for sperma tozoa.