Sexual Neurasthenia.—Another and more general aspect of the results of the sexual mismanagement will be studied under the above heading. The general weakness, nervousness, general debility, general nervous exhaustion, proceeding from sexual excesses, will be considered from another stand-point than those, subsequently, which are considered and named, more from the more attractive phenomena, than from an understanding of their pathological anatomy. A generalization of signs, symptoms, and conditions of sexual weakness, covers a multitude of manifestations found under other names, but calculated more especially to assist in the study of a weakness not depending upon observable organic disease.

Sexual neurasthenia differs from neurasthenia of other origin, in that the former is always coupled with weakness of the genital organs, which is not necessarily the case in neurasthenia of mental origin. Again, the genital weakness is always traceable to sexual excesses or juvenile pollution.

The most troublesome form of neurasthenia is the sexual. There are but few symptoms in common with neurasthenia from any cause that do not appear in this variety.

The diagnosis, or line of demarkation between sexual neurasthenia and the variety of actual organic diseases, is not always well defined. It undoubtedly forms a stage beyond which is structural disease of sexual excess, or the cause is perpetuated. I cannot admit that true impotence and spermatorrhoea are concomitants of neurasthenia, as they are phenomena of structural changes; but a threatened condition may exist. In this, I believe, I am at variance with some modern writers high in authority.

For the most satisfactory description of this disease, and the application of the term, neurasthenia, the profession is indebted to Geo. M. Beard, who has given the subject a most thorough review in periodicals and in Beard and Rockwell’s Medical and Surgical Electricity. In 1869, Beard published an article in the Boston Medical and Surgical Journal, giving illustrations of thirty cases treated principally by electricity; and again, with a better understanding of the cerebral and spinal forms, he presented a paper before the New York Neurological Society, in 1877, which was published in the New York Medical Journal. Other papers, by the same author, have appeared, which evince a careful study of nervous weakness. Erb has given also a very excellent treatise in vol. XIII of Ziemssen’s “Cyclopoedia.” Authors have not, thus far, given due credit to the sexual organs as a cause of neurasthenia. Erb treats of the disease in a confused manner, in portions of his treatise, compared to his clearness on other subjects, evincing more book theories than facts from clinical observation. In generalizing he is clear, but in classifying, he is not particular enough in pointing out the different signs of neurasthenia originating from the brain, from that form belonging to the spinal cord.

The most common form of nervous manifestations is such as would lead one to think of exhaustion of the forces usually attributed to the structures of the cord: the nervous energies are very much depleted. They seem, at times, to be duly supplied, but the forces may as quickly depart and leave the system languid and depressed, without power to coordinate the muscles. This more especially applies to a certain class of cases which assimilate organic trouble in the nervous structure. No change observable takes place in the circulation, yet it must stand to reason that the replenishing power of the nerve-matter is deficient. This must be impaired nutrition, and a lower order of nerve-structure organized, not capable of evolving so perfect a function or force—nervous energy. This suspension of nervous energies is only transitory when a fair degree of activity is established. This would seem to be caused by depriving the nerve-tissues of elements demanded to supply natural waste; which is, in all probability, the true nature of this exhaustion.

We have neither spermatorrhoea nor impotency, in the strict sense of these terms. They perform the sexual function well, but lack power to repeat the act as often as healthy people are wont to do. Sometimes they cannot control their ejaculation during various conditions of excitement, fear, or fright. It is in this condition that a lack of confidence in the sexual ability is had at certain times when copulation would be the most desired. It is in such cases that a young man complains of chagrin and embarrassment. Many a time have young men described their afflictions in the language more forcible than elegant, describing such opportunities with voluptuous “sylphs,” saying, “he went back on me.” This is a weakness of the genital organ, having lost its innate power to become erect, in which all the powers of mind and will, concentrated upon the act, are required to establish the erect posture. Whenever any great mental effort is required to procure an erection, either there is local weakness, or there has been too often repeated sexual contact, which has not been followed by proper rest; or the female has not a fascinating influence over the male.

The general weakness, so much the cause of alarm in young men, and yet not of the least danger, is the typical case of neurasthenia. The young man consults a doctor, with a long discourse of his symptoms: he has read a book on indiscretions of youth; feels badly; has had erotic dreams once a month; is “nervous,” feels languid, and apprehends danger.

Medical students, when listening to lectures graphically picturing disease of the genital organs from sexual debauch, all have each and every form, with the rare and peculiar sequelÆ. They consult the professor in whom they repose the most confidence, only to receive the assurance that nothing is the matter, only a little weakness which will soon of itself subside.

In treating of sexual neurasthenia I can but confine myself to that functional derangement caused, directly or indirectly, by the supposed lack of endurance of the genital organs and the coËxisting nervous weakness.

The fact that nearly all young men have at some period polluted, gives them a cause to fear that any nervous debility discovered may be caused by their early indiscretions. In this they are deceived, and only putting their minds at ease will dispel, often, the cause of this perpetuation. I am often consulted by literary men, who only need rest to be free from this languor. A zealous divine consulted me, with the impression that he was afflicted with some organic nervous disease or brain disease. After examining him closely, and assuring him that he had only a nervous weakness of a functional character, he thought best to confess all by saying that he had been “wild” in his youth, and he was laboring under great fear that he was beginning to feel its latent influence upon his brain. I again assured him that it was entirety impossible for him to become in any manner afflicted with a brain disease.

The transitory character of all neurasthenic symptoms is quite sufficient to distinguish this from organic disease. On one day the patient feels badly, with some signs of organic neurosis; but the next day he has forgotten that group of symptoms, and another is complained of; or he may be free and light, and in bright spirits; but whenever he feels weak and languid, the first thing he thinks of is his early indiscretion.

Neurasthenia Caused by Sexual Excess and Domestic Infelicity—Case.—Mrs. M., the mother of two children, passed through four abortions, came lately from Chicago to this city and, perchance, became my patient, when I learned her history. She had sustained a fracture of the left parietal bone and suffered some from compression. The specula was removed in Chicago. The injury was caused by a heavy glass, hurled by her husband in a fit of jealous rage. She is fleshy, weighing 135 pounds, and rather short; has some time been given to drink, to cover domestic infelicity; her face is florid, and on the least excitement becomes purple and ecchymosed in spots; she feels, sometimes, as if she would faint; often has vertigo, tingling in feet and hands, sickness at the stomach; she never cramps, but often cries, feels languid all the time, and lies in bed the most of the day; pulse normal, sometimes a little intermittent; tongue natural and bowels regular; no belt sensation; no tenderness in the cord; no bladder trouble.

Her husband compelled her to submit to his embraces three or four times on Sunday and every night during the week; and this had been practiced, with only menstrual intervals and when too sick to submit, for six years. She is peevish and fretful, and suffering from general exhaustion.

There are many manifestations of neurasthenia, when the cause has been from the sexual; prominent among which is irritability, exhaustion, and sleeplessness following sexual congress; nervous headache with black line under both eyes the next day; creeping sensation and itching of the skin, without any abnormal appearance to cause it; formication, numbness of the hands and feet, flushed face, tenderness and pains that are transitory: all without any detection of organic disease; not but what such symptoms exist in organic disease, but they are more permanent, when they do exist, and can be associated with some assurance. I have had my mind on the point of naming and searching for numerous organic and spinal and cerebral affections, when the patient would multiply antagonistic symptoms so rapidly that I have often concluded that my patient had a new and serious combination of lesions.

Organic disease generally has a set of signs and phenomena entirely in accordance with structures involved; but neurasthenic symptoms are most commonly such as are antagonistic to any two forms of neurosis.

A greater variety of symptoms exists in neurasthenia than any organic disease. Symptoms of one organic disease are common one day, and of another the next day; and though the two organic manifestations were wholly different, the patient on the third day will perceive them all combined and aggravated.

Not all cases of neurasthenia can be attributed to the genital organs. In my experience cases, arising from sexual irritation and other causes, are very evenly divided. I have often been convinced of genital irritation being caused from neurasthenia; but as I have intended the more to discuss sexual neurasthenia, in Neurasthenia from Genital Irritation, I shall be compelled to leave the subject with only having mentioned its bearing on sexual irritation as a cause.

Neurasthenia does not differ, when of a genital origin, from the same disease of other origin; only that the genital irritation antedates the neurasthenia.

It has been said that neurasthenia usually confines itself to the nervous diathesis. If we only had a definite condition, known as the nervous diathesis, that could be relied on, much would be gained. Some of the most troublesome cases of neurasthenia have appeared in persons whom no one would point out as possessing a nervous diathesis. Beard says, “Among the chief signs of a nervous diathesis are fine, soft skin, fine hair, delicately cut features and tapering extremities.”

These are often marked features in nervous women, but neurasthenia has existed in persons coarse, dark, thick-skinned, clump-fingered, and very uncomely in shape; often large and fleshy.

In attempting to show the relation of neurasthenia to the genitals in both male and female, it will lend information to relate a few cases:

Case.—Jno. B. wishes to know what makes him so “fidgety and good-for-nothing.” He says he has visited his intended, to whom he is “engaged to be married,” twice a week for nearly two years. “We are very intimate and kiss and embrace: I think too much of her to do anything wrong. My penis is up all the time I am with her; and when I go home my testicles are sore, and I lie awake all night.” This is typical, as a cause from continuance; and if the female is as amorous as the male, she will also become nervous and irritable. The restlessness, following the protracted turgescence of the genitals, is a fruitful cause of neurasthenia. Yet all will gradually pass away after marriage, which should be advised speedily. With nymphomania, there commonly exists a neurasthenia that long remains after all signs of any organic disease have disappeared.

Mrs. M., aged 26; the mother of one healthy child; rather adipose; short and firm of organization; flushed face; weight, 140 pounds; apparently a very vigorous woman. She cannot endure any muscular effort of any kind, as she becomes exhausted; dizziness, formication, sickness at the stomach, one day; coldness of feet and hands, with paresis of first one side then the other, tingling of the tongue; no hysterical manifestations, cramping or fainting, at any time. Uterus is normal; no tenderness along the spine. Sometimes a local hyperÆmia of the brain exists, but only lasts a short time. Her heart-sounds are normal, and pulse regular; bowels perfectly regular at all times, and menses regular. Within a period of two years’ time, she produced four abortions upon herself. Each time at third month, and each time did so well that no physician was called. She informed me that she became more and more nervous after each abortion. I have not benefitted this case by any manner of treatment, as yet, and still there is no manifestation of any organic disease.

If ever a physician is perplexed, it is when he is called on to advise a patient whom he calls “nervous.” This is more commonly the case with the general practitioner, as he is looking for something to be the matter, and finds nothing but phenomena which he illy comprehends.

These cases are of vast interest to the neurologist, as he is in an expansive field for study, and he feels a pleasure with his work; not as to the rapidity with which he expects to see these manifestations pass away, but in the assurance that these most troublesome phenomena are harmless.

Treatment.—In the management of these peculiar nervous appearances, many agents may become necessary; but to obtain rest is the all-important consideration. To aid nutrition is the next in importance, and thereby build up the structure of the nervous system, improving tone by assimilation. All causes, of course, must be removed. The medical treatment will consist of agents that stimulate evolution of nerve-forces. Tinct. pulsatilla, bromide ammonia, dil. phos. acid, are agents which act excellently, given one after the other, changed in a manner to perpetuate their influence. With determination of blood to the face and head, small doses of gelseminum or bromide potassium, for temporary relief, and ergotine continued in grain doses.

When the hands and feet are inclined to become cold, the hypophosphites should be given.

As a tonic in these conditions, and especially when the patient is not often seen, formula No. 1 will act in a majority of cases very kindly.

Electricity must be resorted to for the permanent relief of nearly all cases. General Faradisation will be the most generally useful, used often and by short sittings.

The general bathing, resorted to in bath-houses, is often very injurious; as no selection of cases as to the peculiar necessities, and no adaptation, is made; but proper douching is a most excellent remedial measure, and must be conducted with special care and judgment, as regards the adaptation of kinds to each and every condition and temperament.