1057

were accidentally included in the material used for

insemination, or that abnormality of the plasma of theinfertile semen impaired the normal function of thespermatozoa. Complete removal of spermatozoa fromsemen by centrifugation is remarkably difficult. Centri-

fugation sufficient to produce a dense pellet of sperma-tozoa and other particulate bodies at the bottom of thetube may still leave actively motile spermatozoa suspendedfreely in the supernatant plasma. The presence of thesecells may go unsuspected, for the dilution of the

spermatozoa is so extreme that their detection under themicroscope requires patient examination. It is reason-able to suppose that the spermatozoa that remain

suspended in the plasma are there chiefly because theywere among the most actively motile cells in the samplepopulation. Centrifugation may therefore have selectedthe most vigorous and presumably potentially the mostfertile spermatozoa of the donor’s semen, and their

presence would constitute a very special hazard if theplasma were employed by RozN’s method. Abnormalityof the plasma of infertile semen might manifest itself asa deficiency of some normal component; but it is mostunlikely that lack of a normal constituent per se couldunderlie failure of spermatozoa to initiate conception,for pregnancy can be obtained by inseminating sperma-tozoa recovered from the epididymis and suspended inphysiological-saline solution.7 On the other hand,deleterious effects on spermatozoa may conceivablyresult from gross imbalance of plasma composition,from a normal plasma constituent in abnormally highconcentration, or from a foreign toxic substance in thesemen. These possibilities are largely hypothetical, andmuch work is still needed to establish their occurrenceand practical significance.Many observations have been made on conditions

affecting spermatozoa in vitro s ; and it is known that

they are, on the whole, more resistant than most bodycells to changes in physical and chemical environment.Motility is, of course, abolished if conditions departsufficiently from normal; and it is reduced by metabolicenzyme inhibitors. Usually spermatozoa recover theirmotility if removed from the medium containing theinhibitor before too long a time has passed and areplaced in a medium lacking inhibitory effect. Recoveryoccurs perfectly well in artificial media, and thereforedoes not depend on the presence of any constituent ofthe male accessory secretions. Broadly speaking,fertility is correlated with motility. 9 10 Generally, fertilityis lost before motility, and PARKES 11 and PARKES et al.l2have shown loss in this order to be especially constantfollowing the use of certain enzyme inhibitors, whichremove fertility without greatly affecting motility.WERTHESSEN et al.,13 in a study of seminal properties andfertility in stud stallions, exchanged the spermatozoaand the seminal plasma of. several animals and noted7. Hanley, H. G. Stud. Fertility, 1956, 8, 20.8. Mann, T. The Biochemistry of Semen. London, 1954.9. Bishop, M. W. H., Campbell, R. C., Hancock, J. L., Walton, A. J. agric.

Sci. 1954, 44, 227.10. Bishop, M. W. H. Stud. Fertility, 1955, 7, 48.11. Parkes, A. S. Lancet, 1953 ii 1285.12. Parkes, A.S., Rogers, H. J., Spensley, P. C. Stud. Fertility, 1954, 6, 65,13. Werthessen, N. T., Marden, W., Haag, F., Goldzieher, J. W. ibid. 1956.

8, 42.

that the plasma of different animals differed in its

capacity to maintain spermatozoon motility. Maintenanceof motility was inversely correlated with the concentra-tion in the plasma of non-protein sulphydryl com-pounds, which evidently exerted a deleterious influenceon the spermatozoa. Further investigations showed thatfertility also was inversely associated with the concen-tration of these compounds. Finally, the investigationswere extended to man, and here again the concentrationof non-protein sulphydryl compounds, though muchlower than in stallion semen, was inversely correlatedwith motility maintenance. WERTHESSEN et al. infer,therefore, that in man, too, the sulphydryl concentrationmay be inversely related to fertility.Thus in the human male infertility may sometimes

be due primarily to abnormality of the seminal plasma,and this abnormality may possibly take the form ofunusually high levels of non-protein sulphydryl corn-pounds. If this were proved to be so, remedial measureswould involve removal of the spermatozoa from theirnative plasma. Insemination would require resuspensionof the spermatozoa in another medium, but this need notnecessarily be seminal plasma unless the damagesuffered by the spermatozoa could be repaired only by aspecific factor in normal semen. Meanwhile muchfurther research is clearly needed.

Annotations

A NEW AUSTRALIAN MEDICAL SCHOOLIT is exciting to contemplate the long-overdue rebuild-

ing of some of the medical schools in this country-=forexample, at Liverpool, as we report on p. 1066. But howmuch more exciting to welcome a completely newschool! Men and women of Western Australia wishing tostudy medicine have had to leave their home State,usually for Adelaide, for the preclinical and clinical years,and in 1955 the Government decided to establish a

medical school at Perth-provided that the universitycould show that public opinion was in favour by thestringent test of raising E400,000 by appeal (the populationof the State is less than 700,000). The result of the appealwas unequivocal, for more than E500,000 was subscribed,and plans for a new school were begun ; and on April 10Sir Charles Gairdner, the Governor, formally opened it.The faculty of medicine is the ninth in the university.

Teaching began with the academic year in 1957, when afirst-year class of 85 students was enrolled, and 16 WesternAustralian students who had been studying at Adelaidebegan their sixth-year work at Perth. The departments ofanatomy, physiology, and biochemistry began teaching inMarch.The school buildings are not yet complete ; but more

interesting than the prospects of new buildings are theprospects for teaching and research. In designing its

teaching programme the new school is doubly free, fornot only has it no traditional curriculum but also it beginswork at a time when the General Medical Council hasrelaxed its detailed control and permits experiments.Until i957 the Council had been precise and detailed,and while its influence had certainly maintained an

adequate standard of education in English and Australian

1058

medical schools, it had tended to stifle individual enter-prise in the framing of new forms of teaching or newapproaches to the medical curriculum." Today the staffhave an opportunity for boldness. For research there is

ample money available, since, besides several bequestsmade in the years before the appeal and a gift to establisha research foundation (primarily for investigation of cardio-vascular disease), E250.000 of the appeal moneys hasbeen set aside for research and special projects, and thebalance, beyond the sum needed to establish the school,has been used to form a permanent endowment fund.We send our greetings and good wishes to all concernedin the new school.

1. See Lancet, 1956, ii, 562; ibid, Jan. 25, 1958, p. 201.2. Scott, H. W., Jr., Bahnson, H. T. Surgery, 1951, 30, 206.3. DeCamp, P. T., Birchall, R. ibid. 1958, 43, 134.4. Poutasse, E. F., Dustan, H. P. J. Amer. med. Ass. 1957, 165, 1521; see

Lancet, Jan. 25, 1958, p. 201.

HYPERTENSION DUE TO RENAL-ARTERYSTENOSIS

ANY lesion which significantly narrows a renal arterymay induce hypertension. This type of hypertension isimportant particularly because it may be relieved byrestoring an unobstructed blood-flow to the kidney, orby nephrectomy if the disease is unilateral.1 It has longbeen recognised that such conditions as unilateral atrophicpyelonephritis may be associated with reversible hyper-tension ; but that stenosis of the main renal artery can causeincrease of blood-pressure has become apparent only in thepast few years. A renal humoral mechanism, similar tothat demonstrated by Scott and Bahnson,2 in thoraciccoarctation of the aorta, is thought to be responsible.Hypertension due to unilateral renal arterial stenosis

differs, however, from that due to coarctation in that thecontralateral kidney is exposed to the full effects of thedisease.

Although few instances of hypertension associated withrenal-artery stenosis have been reported, a surprisingvariety of lesions has been noted: in young people con-genital stenosis and other anomalies of the renal-artery,aneurysm of the renal artery, and coarctation of theabdominal aorta; in older patients atherosclerosis,trauma, compression, thrombo-angiitis, and embolism ofthe renal artery.The symptoms and signs of this type of hypertension

are unfortunately no different from those of other types:the diastolic level is high and stable, and signs and

symptoms progress rapidly. Diagnosis is therefore not

easy and depends essentially on arteriography. It would

obviously be unwise and unnecessary to subject everyhypertensive patient to renal arteriography, and muchjudgment is needed to select patients for this elaborateinvestigation. DeCamp and Birchall 3 advise arterio-

graphy in all patients whose hypertension develops (inthe absence of primary renal disease) before the age of 25,and in all in whom persistent severe diastolic hypertensioncomes on after the age of 50-similar recommendationsto those of Poutasse and Dustan.4 In the intervening age-groups they undertake aortography if there is somethingin the history which does not conform to the normalpattern of essential hypertension. It is important to

exclude as far as possible a phasochromocytoma beforeaortography, as the injection may provoke a fatal hyper-tensive attack. In the adult aortography is performed bytranslumbar puncture of the aorta just above the mouths ofthe renal arteries: if placed too high the dye escapes intothe other major aortic branches and the renal vessels are

not plainly seen. In children the dye may be put in retro-gradely by catheterisation of the femoral arteries.Adequate renal circulation may be restored by excising

the strictured area and reconstructing the artery byend-to-end suturing, by endarterectomy, or by using thesplenic artery as an end-to-side anastomosis. DeCampand Birchall believe that, with arteries of the size of therenal, free grafts (homografts or synthetic) are bestavoided. Freeman followed three cases in which therenal artery was occluded during endarterectomy foraortic thrombosis, the grumous material being accident-ally forced into the orifice of a renal artery. In one of the

patients severe hypertension developed but subsided afternephrectomy.

Aortography during investigation of high blood-

pressure would be advised more commonly if the tech-nique was free of complications. Huger et al. have

attempted to minimise the risk of renal parenchymaldamage, during the flooding of the kidney with dye, bygiving an intra-aortic injection of procaine before the dye.There is evidence that in dogs this gives some protection;but in man this is less clear, and two other factors aremuch more important-the site of injection and the doseof contrast medium. The constant factor in reportedcases of severe bilateral renal damage has been the largedose of concentrated organic iodide used. Renal arterio-

graphy should be done with 30 ml. or less of one of theless toxic dyes, such as sodium diatrizoate (’ Hypaque ’);with such a quantity the risk of parenchymatous damageis very slight.

5. Freeman, N. E., Leeds, F. H., Elliott, W. G., Roland, S. I. J. Amer.med. Ass. 1954, 156, 1077.

6. Huger, W. E., Jr., Margolis, G., Grimson, K. S. Surgery, 1958, 43, 52.7. Bergmann, M., Fiance, I. J., Blumenthal, H. T. New Engl. J. Med. 1958,

258, 471.

THESAUROSIS

ANOTHER foreign body is being added to our reticulo-endothelial system’s treasure chest. Bergmann et al.7

report the case of a 27-year-old receptionist who hadmild malaise and increasing fatigue for two or three monthsand was admitted to hospital with a chest radiographwhich showed bilateral fuzzy hilar enlargement andreticulated infiltration of all parts of both lungs. A

general examination six years before had included a

chest radiograph, which had been entirely normal.

Physical examination and many tests all yielded normalresults except for the chest picture. Resection of the

right scalene fat pad produced three moderately firmlymph-glands, one of which yielded no organisms ona wide variety of cultures. Histological examination of theother two showed pronounced hyperplasia of large epi-thelioid cells with occasional giant cells. Again noorganisms could be found, nor was there any fat in thecells of the granulation tissue. There were, however,round granules in the epithelioid cells and interstitialtissue. The only foreign body which could be incrimin-ated was a hair-spray which the patient had used fortwo years, during the last six months of which her hairhad been sprayed twice daily. After the use of the spraywas stopped, radiographs of the chest showed partialclearing of the infiltration and lymphadenopathy intwo months and a normal picture after four months.Shortly before this, a 22-year-old married woman hadbeen seen as an outpatient because of an abnormal chestradiograph found on routine examination: there wasextensive bilateral reticulated infiltration of both lungfields and enlarged lymph-nodes in both hilar regions, but