Sterility and Abortion.

1030 in the light of the newly won experiAt present Dr. HEAD has not indicated any the whole may stand and the world be in of the lesions producing his four ence, and he modestly states that his results possession of a new, illuminating conception. For varieties, " 2000 years philosophers have reasoned about are of no direct practical value to the physician "; the phenomena of thought and speech ; analysis but it has long been clear that our theories, based and introspection yielded various explanations of upon hypothetical "centres" for memories of the relationship between mind and body. Then images have been inadequate to explain the actual came the period of the experimental method ; on symptomatology of any patient, and destructhe one hand the phenomena of mind were studied tive criticism based upon experimental evidence by the psychologists, and on the other the in conjunction with a new classification, running anatomists and physiologists began building up a across the lines of the older theories, consure knowledge of the organ of mind. Medical men stitutes an important step. It means that we are amount to of what enabled to study our patients from a new angle. observers being necessarily destructive experimental lesions carried out by If experience of his methods in other hands leads to confirmation of his results, and still more if he Nature, it is natural that bridge-builders should found working in their ranks. discovers to us a localisation corresponding to the Dr. HENRY HEAD, in his recent papers,’ has new varieties of aphasia, Dr. HEAD will have placed reopened the whole question of aphasia. He a valuable diagnostic weapon in our hands. Until traces the modern development of our knowledge then we must rely upon the older methods which, from GALL, with his six varieties of memory although possibly based upon an incorrect psycholocated in the frontal lobes, to the schematic logical foundation, have nevertheless many clinical explanations of CHARLTON BASTIAN and WERNICKE successes to their credit. and the attempt to make theory fit facts more closely, which was made by MARIE. Dr. HEAD has devised a new method of examination and Abortion. of the aphasic, based upon the principle that IN his Sir John Struthers lectureProfessor the patient’s power of response must be tested ARTHUR ROBINSON offers a serious challenge to the of in a series which the observations by belief that sterility and prenatal death, and same task occurs on two or more occasions. He resulting therefrom, are due to disease or claims that the observations made indicate that environment of either parent. Defining abnormal disorders in the use of language cannot be classed death as the death of ripe extruded ova, prenatal under the category of isolated affections of of the formed by the union of such ova ! or zygotes ing, reading, or writing, nor can they be explainedwith before the termination of the spermatozoa as due to the destruction of visual, auditory, or motor images. What is affected is essentially the normal period of gestation, he proceeds to offer evidence that this is a frequent and regular ability to grasp the significance of symbols of all occurrence in certain groups of healthy mammals kinds, the power of " symbolic thinking and under " In order to prove conditions. ordinary expression," so that even in motor " aphasia, not whether the defect to death is germinal or leading external but certain of only speech, aspects in any species, the ovum extruinternal speech are affected. As a result of parental in origin and the actual birth-rate must first be sion-rate lesions in different parts of the brain this in a satisfactory number of cases ; the ascertained power becomes dissociated in a manner analogous to the effect produced on sensation by lesions period, before or after fertilisation, at which preof the cerebral cortex; and Dr. HEAD dis- natal death occurs-and if the latter, whether before or after the attachment of the zygote to the uterine tinguishes four main varieties of dissociation mucosa-is also important. Professor ROBINSON’S in and verbal, nominal, syntactical, resulting In verbal and syntactical investigations on horses and ferrets, two very semantic aphasia. different groups of mammals, provide much, though aphasia it is the idea of the structure of the word not all, the data. which principally suffers both in external and i, The records of the matings of 390 Clydesdale internal speech ; there is a defective conception of the structure and the rhythmic balance of the stallions with 28,241 mares, and of 43 thoroughbred stallions with 3640 were placed at his disposal. symbol. In nominal and semantic aphasia the The mare ovulatesmares at heat period, whether every full ultimate significance, the range of association, inseminated or not. Since none of the mares died of the word is impaired or lost, so that the word cannot be used perfectly as a language or were killed, the ovaries and genital canals could not be examined, and in these respects the history symbol. He maintains that we have been led is incomplete. The average prenatal mortality of BASTIAN and who based their others, astray by the Clydesdales during a period of six years worked work upon the theory that we think in words, out at 48 per cent.; the thoroughbreds during five while his results substantiate the teaching of HUGHLINGS JACKSON that it is the power to form years gave a prenatal mortality of 58 per cent. Of the ferrets, 165 only were available, but since propositions which is affected, and the more nearly the ovum production-rate, as calculated by the a symbolic action approximates to a proposition number of lutea present in the ovaries. A the greater the difficulty it presents. priori amounted tocorpora 9’95 per animal at each breeding " motor " or as such terms, sensory aphasia, these could be regarded as representing "alexia," and agraphia do not correspond period, over 1600 ova. Ferrets ovulate only after inseminato any actual discoverable functional categories; and, according to Professor ROBINSON, not till they should be abandoned, as should be all tion, after spermatozoa have entered the caudal third attempts to find any localisation for them in the of thetheoviduct. Other anatomical characteristics brain. of the ferret, as well as the conveniently small size of its ovary for purposes of serial section, make it 1 Disorders of Symbolic Thinking and Expression, British Journal

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of Psychology ( (General Section), vol. xi., Part II. Aphasia and Kindred Disorders of Speech, Brain, vol. xliii., Part II. Aphasia: An Historical Review, Brain, vol.xliii., Part IV.

1 Edinburgh Medical Journal, xxvi., April, 1921.

Nos. 3 and 4, March and

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The cause of sexual incompatibility. He goes still excellent subject for this investigation. 165 killed of at further. To him his material animals, suggests that a large genital apparatus after insemination varying from 18 hours to 42 days, amount of the prenatal death which occurs in the usual period of gestation, yielded a considerable mammals is normal, that it is not dependent amount of material for detailed microscopical upon disease of the parents, detrimental environexamination, the results of which have been ment, insufficient nutrition, or disease of the tabulated by Professor ROBINSON. gametes, but is in a sense a side issue of the The prenatal death-rate of the extruded ova process which gives rise to the variations which works out at 24’16 per cent., but since the animals appear so universally in all mammals and probably in all living beings. were killed at various periods of gestation, and not at Again, if prenatal death is the end, the figure is not comparable with the horse admitted to be constant and normal, Professor figures. Professor ROBINSON suggests that some of ROBINSON points out the obvious corollary that in the ova and zygotes which appeared normal in the some animals abortion also must be normal. In first week or two of gestation would doubtless mammals which produce multiple young at birth, have shown signs of degeneration had the killing any dead zygotes are removed by absorption in all of the mothers been delayed. These and other con- but the very latest stage, for obvious reasons. In siderations lead Professor ROBINSON to place the animals which produce only one young after a normal prenatal death-rate at not more than long gestation period abortion immediately follow39 per cent. ; but, as he says, the exact percentage ing death of the zygote, is an economical and is unimportant. His main point is that in ferrets, necessary arrangement, as the uterine mucosa as in horses, the prenatal death-rate in healthy quickly regains a condition favourable to a new animals in a normal environment is high and gestation. Thus the changes in the decidua usually variable. In general support of the contention that regarded as degenerative, and as the possible cause this is probably true for other animals he adduces of the death of the zygote may be the result the observations of J. P. HILL on marsupials, thereof, and should in this case be regarded as of J. HAMMOND on swine, and of C. R. STOCKARD regressive changes adapted to bring about as and G. N. PAPANICOLAOU on guinea-pigs, though he soon as possible a normal pro oestral condition of the uterine mucosa. If Professor ROBINSON is right admits that the evidence is not conclusive. Professor ROBINSON makes other interesting that a considerable number of abortions are not deductions, positive and negative, from his material. only normal but necessary, and adapted to prevent From breeding experiments alone, unless carried diminution of the birth-rate, his further contention out on a very extensive scale, he considers that it that the condition of the uterine mucosa associated would not be possible to say that any stallion, or with them is not degenerative or diseased and that probably any other male animal, was impotent. treatment directed thereto is unnecessary, if not One thoroughbred stallion was infertile with 51 detrimental, is justified. The discussion on out of 52 mares with which he was mated, a second sterility, its causation and treatment, reported with 93 out of 103 mares, and one Clydesdale in our present issue, would certainly appear stallion with 96 out of 104 mares. The horse data to show that the practical clinical experience give no help as to where, when, and how death of obstetricians at least does not conflict with takes place, but the evidence offered by the ferrets his experimental findings. appears again to be confirmed by the work of HAMMOND on swine and rabbits, G. W. CORNER on swine, HILL on marsupials, and A. W. MEYER on THE PROBLEM OF SLUM AREAS. intra-uterine absorption of which show ova, THE slum area of Brady-street, Bethnal Green, was that the cause of prenatal death cannot in the subject of a recent question in the House of some cases be attributed to uterine disease. Commons. The Minister of Health was asked whether Professor ROBINSON finds that in ferrets extruded the London County Council had presented to his the peritoneal cavity, into which Department a plan for dealing with the area, whether ova die in they have escaped; in the periovarial sac, the plan had been approved or rejected, and when the from which they have failed to escape into the Council had been informed of the decision. Sir ALFRED oviduct; in the oviducts; and in the uterine MOND replied to the effect that a local inquiry was held June, 1920, into the scheme proposed by the London cornua. They die when still ova, either lost in the in it was then found that adoption of the County peritoneal cavity or because they fail to unite with scheme Council; involved a number of legal and administrative the spermatozoa present. As zygotes they die in questions, of which settlement was necessary before the morula and in the blastula stage, after attach- a decision could be given upon the case in quesment to the decidua and after differentiation into tion. Action upon the scheme would in any case embryo and appendages. The majority of the have to be deferred until further progress was made extruded ova become zygotes, and of these the with provision of new houses. The numerous complicaunder existing conditions, upon any majority which die in the prenatal period die tions attendant, after they have become attached to the decidua. conveyancing of densely-populated property must How they die is more difficult to decide, but it inevitably tend to hamper the advancement of health in this country; and it is made plain in is always apparently by an alteration of their public the answer of the Minister of Health that even when structure, ending in disintegration. " The death is slums have been acquired by local authorities for not due to inflammation or to micro-organismal purposes of destruction, shortage of new houses still attack, but apparently simply to an incapability to bars the way to demolition of property unfit for live and develop properly under conditions which habitation. It may be true, as some would have us are quite favourable to immediately adjacent believe, that the slum-bred tenant speedily reduces

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any house he occupies to the level of his own personal squalor; but if any progress is to occur After discussing and dismissing other possible this fact constitutes no argument against the making Professor that the ROBINSON concludes factors, of a steady effort to supply dwellings built and cause of prenatal death is the constitution of the drained and lighted in such a way that the slum gametes and zygotes, and further, that it is a tenant may have at least the opportunity to prove structural peculiarity of the gametes which is the the statement false.

zygotes."