The Analytic Method in Psychotherapeutics; Illustrative Cases

1906 Boston Medical and Surgical Journal  
I. The anatomical results are shown by the following photomicrographs : Figs. 1, 2, 3 (diagrammatic), show technique of suture. Note, ligature of vas at its junction with epididymis, and that the sutures are so placed in the vas that when tension is made on them the slitlike opening is changed to a more circular form. 2. To demonstrate functional patency of the anastomosis the seminal vesicles were emptied by stimulation of the hypogastrics (as above outlined) at the time of the original
more » ... the original operation. At a subsequent date, varying from ten to twentyseven days,13 the abdomen was again aseptically opened, ejaculation caused, and the semen examined under the microscope. Four animals were thus examined with the following results: Pig No. Ejaculation, Motile sperm, by Days post. op. microscope. 2 10 Abs. 4 11 Près. 5 I? j Près. 12) 7 20} Près. 27) The ease with which these anastomoses can be done on man was also demonstrated by the writer on an autopsy subject. Here the use of such fine needles make it unnecessary to penetrate the lumen of the vas. The above work, added to the evidence obtained from the writings of Martin and others,14 make it undoubted that such a vaso-epididymal suture with proper technique is a perfectly definite surgical possibility. There remains to be discussed its application to the clinical condition of sterility. Applied to the human being the diagnosis of permanent azoöspermia due to obliterating epididymitis having been established, this operation has as advocates for its employment three main facts. The first is, that, carefully and intelligently done, the condition after operation cannot possibly be worse than that existing before, even though the patency be not restored. " You can't spoil a bad egg." Secondly, since the restoration of patency on one side only is sufficient to permit ability to impregnate, this therefore means that the patient has a double chance of cure. The third fact is that this operation, offering, as it does, practically, the only rational treatment for such a sort of sterility, has been proved feasible both in animal and man. In the performance of the operation we must of course consider carefully the seat of stenosis in relation to the anatomy of the parts, and in each instance make the union at a place which will as surely as possible create an efficient short circuit. The determination of such a spot on the epididymis can best be made by the hypodermatic syringe. Withdrawal of a drop or two of fluid and demonstration of motile spermatozoa by microscope will show clearly where to make the anastomosis.15 This point having been settled, the rest of the operation will be found of easy execution. In summing up, the following points may be emphasized: 1. In all cases of sterility both husband and wife should be carefully examined. 2. Sterility in a certain number of instances is due to the stenosing effects of a bilateral epididymitis. 3. When so caused it may be relieved by an anastomosis between the vas and epididymis below the point of occlusion, as has been demonstrated on guinea pigs (author) and on dogs and man (Martin). 4. Such an operation offers practically no risk to life. 5. Its performance is not difficult, needing only familiarity with the anatomy and pathology, proper suture material and gentleness in manipulation. I wish to acknowledge the courtesy of the Department of Physiology of the Harvard Medical School, in whose laboratory the above experimental observations were made. 13 Massazza (cit. by Furbringer) has found that spermatozoa disappear by the ninth day following castration. This was shown on various animals.
doi:10.1056/nejm190611081551904 fatcat:njuoicuvkvcnzaqc3ohlzf6tpq