myself have done it twice for marked anteflexion, and under very favora ble external circumstances, but without success. Only in one of these cases, however, had the semen been microscopic,ally examined beforehand. Of course the non-success is due in a number of c,ases to errors of diag nosis as to the cause of the sterility; the genital tract perhaps was absent above the internal os, or the fault lay in the semen itself. In one case of Fritsch's the injected mass turned out to be gonorrhceal secretion.
Very probably the want of success is due to faulty manipulation. Perhaps the semen is exposed to an improper temperature, and the syringe is not kept at blood heat, or mechanical injury is done to the delicate spermatozoa. It is possible that the genital secretions are sucked into the syringe with the semen, and exercise a deleterious influence upon it. Or the preliminary vaginal cleansing may have caused sufficient fluid to be left behind to kill the zoosperms before they have been transferred. Possibly the sperms may only retain its vitality in animal cavities, like the blood in the vessels, thougb the lengthy vitality of the zoosperms outside the body speaks against this hypothesis.
The possible evils are exactly the same as those liable to follow the in troduction of medic,aments into the uterine cavity, and have helped to discredit the operation. Perhaps the large mass of injected fluid, and the absence of the necessary antiseptic precautions, may be to blame. Fritsch's case, above-mentioned, may give us a clue to the cause of the evil results in the worst cases.
The following rules should be observed in doing the operation. The semen of earlier ejaculations must be carefully examined (see diagnosis of male sterility). Absence or paucity of zoosperms, or the presence of many dead and deformed ones, and especially the presence of pus cells, contra-indicate the operation. The vagina and cervix must be carefully cleansed, and the cleansing agent then washed away by a solution con taining some substance favorable to the life of the spermatozoa (see post, treatment of vaginal obstacles to conception). Then cohabitation should speedily ensue, since the obnoxious secretions are rapidly reproduced. The operation should take place as soon as possible post cnititm. The
syringe must be new, and thoroughly disinfected, and before use it should be filled with the fluid used for the last vaginal washing. The ordinary Brann's uterine syringe will suffice. It must be brought exactly to the temperature of the body, and for this purpose Sims recommends that it be placed in the vagina some time before it is needed. The semen is ob tained either by suction directly from the vaginal vault, or a speculum may be introduced, and the semen which collects in its gutter be em ployed. Courty recommends the use of a condom, so that the semen is not exposed at all to the influence of the vaginal secretions. The suc tion should be done very slowly, and the canula then passed immediately up to the fundus uteri. A very few drops of semen will suffice, but if antiseptic precautions have been observed even larger masses will certainly do no harm. After injection the woman should lie quiet for a time.
The operation is best done immediately after a menstrual period, or a few days before one sets in.
It is desirable for various reasons that artificial impregnation be oce,a sionally done in suitable cases. Sterility of the male, and disease of the female genital canal above the internal os uteri, must, however, be ex cluded. It should be our last resort in hopeless cases.
Experiments in artificial impregnation should also be done upon mam malia, and the cause of failure in man ascertained.
Much more simple is the treatment of pure, uncomplie,ated versions. Here the difficulty is that the vaginal portion is not in the pelvic axis, and the external os has been displaced through the tension of the vagi nal vault. We must endeavor to effect reposition, and then maintain the organ in its place, but only too often, in spite of our pessaries, it partially returns to its faulty position. But the external os is rendered freer by the support, and the access of the semen is facilitated.
Pajot recommends a more natural method. For some time ante coi tum the fieces aro to be retained in retroversions, and the urine in ante versions; and in latero-versions the woman is to lie upon the side towards which the vaginal portion tends, thus straightening out the uterus as far as possible.