Spermatorrhoea.—That special form of sexual neurosis, which has for its most common phenomenon the premature and involuntary ejaculation of seminal fluid, has been the great catch-all of fakirs and venders of popular sexual literature. Not a town of any size in any country is without an advertising spermatorrhoea doctor, who cries his vocation and writes up his fraudulent certificates of thousands of cases cured, and the great danger of millions more sinking into premature decay. Strange that laws are not made to prohibit this wholesale deception of a confiding and innocent class of young men. Spermatorrhoea does exist, but in proportion to the effects of masturbation and sexual debauch, grave injury is exceedingly uncommon. Not because spermatorrhoea is a commonly grave disease, do I insert this paragraph; but because of the unpopularity of the subject, the isolated cases that are really bad, and the still more isolated ones that fall into the hands of the legitimate physician.

The term, spermatorrhoea, has been too loosely applied to a class of cases which the author has chosen to describe under pseudo-spermatorrhoea, and also to a class of cases more properly called sexual neurasthenia; when the weakness of a nervous character is only noticeable in a minor degree, or in contradistinction to centric structural changes. But the term is useful to describe such losses as are involuntary, and of frequent occurrence; or, as it were, such as occur without intentional friction of the glans, or without undue nervous shock from accident or fear of injury. To such emissions should the term be confined. Healthy young men sometimes have emissions before or soon after the intromission of the penis, and such occurrences are not uncommon; but with the individual such an occurrence rarely happens: such should not be called spermatorrhoea—only a sexual weakness—neurasthenia. Again, after prolonged sexual excitement, when the organs are simply weak and the erotic energy intense, an emission is not sufficient to declare such a diagnosis.

When it is customary for a male to ejaculate immediately after intromission of the organ, he may have, and quite likely has, a spermatorrhoea; but this is not in itself diagnostic of anything further than mere weakness; and he must at other times than these lose semen, to constitute that real flow which is the true signification of the term. When a male commonly ejaculates before venereal friction of the glans has taken place, and in successive attempts at sexual congress has been baffled, he most certainly has spermatorrhoea, as well as partial impotence. Whenever an involuntary emission is followed by weakness, headache, wakefulness, heat of the skin, there is certainly great sexual neurasthenia; and, if such losses are continuous, the diagnosis of spermatorrhoea is without a doubt. It is necessary that these points should be duly understood, in order that our future study of the disease may not lead to confusion in the study of the conditions of the nervous system leading to such phenomena.

In common cases of the disease, the losses of semen are as often as two or three times a week; not uncommonly, every night, for a week or two; and then an interval of a week, when the nightly ejaculations occur with a dreamy, erotic pleasure, with the patient half sleeping. The young man wakes up and finds his linen soiled: he remembers his dream and is highly disgusted, and soon visits or writes to a traveling or standing venerealist, who sends him a circular containing the thousands of cases treated and cured, with a poetical description of the ten years hence, and perhaps a Marriage Guide, and the price required to cure such a case. He feels all the many things pictured in the book, and if the fee is within reach he is sure to send it, and only too soon finds how badly he is victimized. Not every case is troublesome enough to visit a specialist; or the young man is wise enough to first call upon the family doctor, or a friendly physician, when he is sent home with an opposite kind of discouragement; or he is treated by the latter M. D. (?), who has not booked himself on such matters, and the poor fellow is left to himself and the “specialists.”

It is a fact, that the common practitioner is so fastidious on this subject, that he has neglected to obtain the familiarity due his own patrons; and if he attempts to treat a case, he will be as likely to fail as to do good. This lack of familiarity is the great cause of such confusion, and in the application of the term so loosely to conditions.

That the subject may be better understood, I shall arrange my treatment of it, that view may be had from the several points necessary to perfect comprehension.

Causes.—The vice of masturbation is perhaps the most common cause. In youth, the sexual organs being in an undeveloped state, local weakness is very commonly produced, and that even before puberty, by the titilations taught the child by accident or by a designing nurse. The novel sensation, followed by the profuse flow of semen, commonly surprises the youth, and through curiosity and a desire to reproduce the new pleasurable sensation, he continues this very common cause, masturbation. Ignorant of the consequences that may follow, he pursues the practice with intense vigor, until the sad effects are wrought, and too late to repent, he learns the evil of his vice.

Boys of the effeminate type suffer first and most from this vice, for the reason that they practice the habit more persistently than phlegmatic children and, it is a fact, that they are willing victims and their nervous system is much more susceptible to impressions. Premature development predisposes a child to manipulate the genitals, as the curiosity is excited in finding such conditions which should only accompany a more advanced age. Any handling of the genitals may indirectly give to the child the knowledge of that sexual sensation, or excite precocity of the genitals.

Boys of a vigorous habit of body are not inclined to play with their genitals; on the contrary, are often markedly disgusted at an attempt of a schoolboy to instruct them in the vice. They are therefore not easily made victims of, and commonly grow up free from, this vice; but they are the most willing participants in prostitutional debauch, in a more natural way. With the irritated and excited condition of the tissues of the genitals at puberty, then passing the first sexual crisis, what an opportunity for local and general injury must necessarily be present! The nutrition, so essential to growth and development, constantly demanded to compensate for the vicarious and premature waste, great neglect in the natural developments of other portions must necessarily be a result, which is most likely general in character.

As the boy grows up, during the years from fourteen to twenty, the attention he pays to his virile member, and the frequency of his seminal emissions, would be astonishing to one not acquainted with the possibilities.

In the above we have the most common cause of spermatorrhoea. I venture to say that the disease is rare in subjects who never practiced the vice till after maturity or adult age; but it is nearly as rare to find an adult male who has not, at some period of his adolescence, practiced the vice of masturbation.

In addition to the vice of boyhood, the debauch of sexual congress in the natural way, indulged in to enormous excess, produces a state of weakness and loss of general health, with actual impairment of the grey matter of brain and spinal cord, which are reflected upon the genitals in the form of involuntary seminal losses.

Spermatorrhoea is only a symptom of a disease, and must be studied as a neurosis. This diseased condition is generally wrought by frequently repeated erotic crises and sexual orgasms, for a long period of time, in conjunction with habitual spermal losses, during the period of development. The frequent repetition of sexual orgasm so completely destroys the erotic sensorii, that the long practice of masturbation destroys the venereal orgasm, and an emission is produced without even a pleasurable sensation; and even the glans penis becomes so anÆsthetic in venereal sensibility that the mental effort only produces a venereal excitability enough to bring about an erection. In copulation, such persons do not enjoy a venereal thrill, only by fresh novelties and different females. The subsidence of the venereal thrill, and the loss of erotic sensibility and intensity of enjoyment at sexual crisis, or during sexual orgasm, is evidence that structural changes have occurred and that the disease has become located.

Not until structural changes are wrought in the nervous system, is it probable that involuntary seminal losses will continue, or should be corrected as a disease.

Sexual congress may, under favorable circumstances, when indulged in to great excess, become a cause of such organic changes in the nerve-centers as are followed by spermal losses. A few such cases have come under my observation, that were of an unmistakable character. The report of one case, which is a typical one, will suffice.

Case.—Chas. B., a rather gentlemanly fellow, consulted me for spermatorrhoea, with the following history: When he was a small boy, some twelve years of age, a servant girl was his room-mate, with other small children; his parents thinking him too small to interfere with the servant girl, and did not change his room until a year or more after she taught him the significance of his erect genital organ, by coaxing him to an attitude favorable to her own gratification. Thus she cultivated her new-found pleasure, as he grew up and developed. After his room was changed, he found no impediment to nightly visits to the servant’s bed. He was soon able to comply with all demands, and nightly they indulged in sexual congress to satiety, and grew up together. She, being much older than he and knowing all the probabilities, exercised her vigilance and precaution, and all went well until he was twenty-two years of age; when he found that, upon leaving home and undergoing a few weeks’ deprivation from sexual contact, an involuntary discharge of semen occurred two or three times per week, in his sleep, accompanied by a lascivious dream. The constant and profuse discharge of semen and prostatic fluid had passed from his glans penis, for which he had often sought advice in vain. These cases are not very uncommon, although many a young man has passed through similar experiences with unimpaired virile powers. I opine that, if a young man passes to the age of twenty without much sexual excitement, he will not be likely to suffer with any form of sexual weakness; but if he has the predisposition spoken of elsewhere, he will not be likely to pass to the age of eighteen without being fully aware of his sexual instinct, and the pleasure that may be derived from sexual indulgence or masturbation.

The great author, Lallemand, has given as causes a list of organic troubles, a great portion of which are, instead of causes, produced by the genital irritation and spermatorrhoea. He overlooks the general phenomena which point directly to neurine pathology. As causes, Lallemand gives, among various organic troubles, prolonged erections, excited by erotic ideas or lascivious publications; the use of diuretics, of ergot, of cantharides, etc.; the abuse of alcoholic drinks, coffee and tea; constipation; ascarides in the rectum; hemorrhoids, fissures of the anus; heating and irritation of the anal and perineal regions by habitual sitting, or prolonged horseback riding.

Notwithstanding the eminent authority, it must appear quite impossible for any of the above conditions to cause spermatorrhoea as a disease. The few seminal emissions that may occur from such causes are in isolated cases, and of short duration. Even when spermal losses have seemed to arise from such causes, I should think grave reasons present for the suspicion of self-pollution or sexual excess. The simple denial would not be reason to attribute so permanent a disease to such trivial causes.

It cannot be disputed with tangible evidence, that Lallemand’s causes may develop a morbid sexual instinct, by reflex excitation, and act as a predisposition by exciting sexual desire and self-pollution, and thereby spermatorrhoea; but the innate condition must be present also in every case.

While it is well known that various morbid anatomical changes are found in the genital organs, on careful dissection, yet scarce any can be said to act as a cause, but rather as a result of long debauch by pollution and venereal diseases; and as commonly, such changes have been found in the genito-urinary organs, when spermatorrhoea never had been suspected.

Roberts Bartholow, in opposition to the views of Lallemand as to causes, says:

I can but conclude the cause of spermatorrhoea with one definite remark: That the frequently repeated sexual orgasm, continued for a long time, causing to be evolved so rapidly the great amount of nerve-force which must each time be lost forever, must be the only direct cause of that obscure neurosis upon which spermatorrhoea invariably depends.

Moral Effect.—There is a moral effect wrought upon the mind of every person suffering from an inflamed imagination. The constant dwelling of the mind upon the sexual organs, or the imagination of a future cohabitation, must stimulate the free flow of seminal fluid to the overflowing of the vesiculÆ seminales. Old debauchÉs frequently feast upon the virgin countenances that pass street corners, and constantly stand in wait for an expected girl, to be secured by a procuress, that they may feast upon her ruin. The cultivation of such morbid imaginations is an effect, rather than a cause, of long-practiced sexual debauch, and grows out of a cultivated or congenital grossness of the sexual instinct.

Elsewhere, the effects of unrequited passion have been fully elucidated, as cause and effect of local neurasthenia.

Symptoms.—The physiognomy of a spermatorrhoea patient is often very striking; especially one who has been an extensive masturbator, and has been led to think that any physician has but to behold his countenance to judge of his entire condition and its cause. He bears the aspect of one who has been convicted of a shameful vice. This is the picture of an advanced case, yet not beyond the threshold of reason. As he realizes his condition, he is embarrassed that he is compelled to converse on the subject and confess his shame. The face is commonly pallid: the eyes are sunken, with dark lines beneath: the lips are anÆmic: the corners of the mouth are drawn down, and haggard lines are deep-cut about the face. He looks much older than he is, and his beard is tardy, isolated and of a dirty color. The general aspect of hunger is marked upon his entire figure: he is often lean and wan. He trembles with slight exertion, and complains of fatigue: his muscles feel doughy, and an unpleasant odor is emitted from his body, strong, like a goat or a pig, and his voice is feeble. He speaks low, as if he desired to be very quiet and secret, even when his subject has nothing in it of a secret character. In common conversation, his voice is reduced almost to a whisper. He often has pustules on his face—acne. A young man may have spermatorrhoea with very few of these symptoms present; but when he has advanced far in the disease—in the nervous lesions—the above symptoms are only the common manifestations noted by close observation. Yet all these symptoms may exist from other causes, and the patient may be free from spermatorrhoea or pollution. Then, only by the history and physical signs connected with the general aspect, can we hope to effect an exclusive and conclusive diagnosis. He relates his history, which is only a confession of his vice and the story of his spermal losses nightly, with languor, bad digestion, pains and aches too numerous to mention. His tongue is coated, breath foetid, appetite poor, circulation feeble, and heart-sounds feeble and irregular. Often, a dull aching is located in his back-head, forehead and eyes, with asthenopia, anthropophobia, agoraphobia, astrophobia, monophobia, syphilophobia, nocturnal ephidrosis, palmar hyperidrosis, and neuralgia of different localities and of varied intensity.

Spinal Congestion.—This is one of the varieties of disease-pictures that call for a deviation in management, and is, perhaps, as common as any of the special types, and may be recognized by the following symptoms: pain in the back, as if from long stooping, not increased by pressure; also a dull, aching sensation, as after prolonged exercise. This pain is aggravated by the recumbent posture; hence the sleeplessness so common in many of these cases. Fainting sensations are produced by standing long upon the feet: a misstep, or a sudden jolt in a wagon or car, causes much suffering. Intense burning is often felt along the cord and base of the brain, which is not influenced by pressure; hyperÆsthesia of the skin of one or both legs and feet, and the scrotum; testes and penis are often too sensitive to touch; at times, neuralgic pains in the genitals, with herpes prÆputialis, periodically appearing; great tenderness of the anus, with herpetic eruptions ab margine ani. Again, anÆsthesia may take the place of exalted sensibility, with formication—or tingling, or sensation of “pins and needles”—of the feet and legs. Sometimes they complain of a sensation of fullness of tissue, as if they were swollen, with no signs of any puffy or oedemic condition present. I have often observed both anÆsthesia and hyperÆsthesia at the same time, in different localities, upon the same patient. Shooting, neuralgic, or knife-cutting pains often emanate from the spinal cord and pass into the limbs, testes or penis. Sometimes a tight belt is felt constricting the limbs, thorax or abdomen; again a choking sensation, as in globus hystericus, with a sensation of drawing in the spermatic cord and testes; pain in the heart, lungs, abdominal viscera and genitals, is of common occurrence. Irregularities in cardiac movements are not uncommon, with troublesome erections of the penis in the morning, even when erections were impossible at night. Such erections are commonly without erotic desire, and with the bladder empty. They are more troublesome after lying upon the back during the night, which seems to aggravate the engorged spinal cord. As these cases advance paralysis may intervene, more or less profound, generally in the form of paraplegia.

The above, under treatment, will be referred to as the congestive type of spinal cord disease, where the direct adaptation of agents to conditions will be pointed out, founded on the only principle that can lead to ultimate satisfaction—“specific medicine and specific diagnosis.”

Spinal AnÆmia.—That form of spinal anÆmia caused by the sexual differs from spinal irritation of other causes only in the more usual beginning at the lower portion of the spinal cord—sacral and lumbar regions. In this we have a group of symptoms of spermatorrhoea that is not by any means rare; not always diagnostic yet, coupled with the necessary history, they afford a condition to which too little attention has been given. Spinal tenderness is always present, increased by pressure, relieved by the incumbent position and aggravated by walking. Unless these symptoms be present, no case is to be considered anÆmia of the cord.

Where spermatorrhoea and spinal anÆmia are associated, and sexual debauch has evidently been the cause of the latter directly, it will be observed that sexual excesses have existed a long time before the latter, or before constitutional disturbance had in any way manifested itself. Spermatorrhoea, when associated with spinal anÆmia, appears only secondarily, as a phenomenon of the disease thus caused.

As spinal anÆmia advances and other tender points appear in the cord, the eccentric symptoms also change and the phenomena are various in accordance with the location and symptoms coincident with such phenomena when the causes have been other than sexual.

The lumbar tenderness is generally accompanied by neuralgic pains in the lower limbs, back, abdomen and rectum, cramps in the bladder, with difficulty in urinating; at other times incontinence.

In one case, which was under my care two years without any benefit, the whole spinal cord was tender to the touch, and the patient was epileptic and very feeble in mind.

When the dorsal region is involved and tender, as might be supposed, there will appear gastric troubles; acidity, pyrosis, nausea and vomiting, gastrodynia; again intercostal neuralgia and rheumatism, cough and dyspnoea, palpitation, fits of fainting and epileptiform convulsions.

Case.—Mrs. P., in addition to unmistakable symptoms of spinal anÆmia, with dorsal tenderness would, at the sudden closure of a door, complain of great pain in her abdomen, stomach and uterus. On several occasions she had had involuntary evacuation of foeces and urine during a thunderstorm. Her skin would be covered with cold sweat (hyperidrosis). Medicine had very little influence in this case; but electricity applied daily for three months—a mild current of Faradisation—effected a very satisfactory improvement. This was a case of sexual origin and a result of fifteen years’ sexual excess in her early life; after which she married well to enjoy the remainder of her life in wedlock under the care of a physician constantly.

The cervical region is not uncommonly affected and may be very tender, which may produce pain in the stomach and nausea, rejecting everything swallowed, at times. Sleep is nearly always deranged: sometimes sleeplessness, and again, in the same patient, profound coma of long duration is observed, and somnambulism is also likely to occur in such cases. Twitching of muscles, contraction of flexor tendons, hiccough, aphonia, vertigo, head-pain through the top, tinnitus aurium, disturbance of vision, asthenopia, and mental derangements, as the last stage of the disease, when the brain and entire nervous system are in a feeble condition: all follow, in rare occurrence, the sexual debauch, and are symptoms of the entailed conditions, viz., sexual neurosis, of which spermatorrhoea is only one of the numerous symptoms, yet perhaps the most attractive.

As these foregoing types or conditions advance, they become complicated and even change in essential features; but if not remedied, the result must be toward paralysis, insanity, tabes dorsalis, epilepsy and imbecility; all of which can best be studied as special diseases in numerous volumes on diseases of the nervous system.

Cerebral Sexual Neurosis.—That form of neurosis, brought on by masturbation in adolescence and sexual excesses, does not exist independently of other portions of the nervous system, and only as the spinal cord becomes impaired by excessive sexual shocks and evolution of nerve-force, which is expended in orgasms during sexual excitement, does the brain become involved, and its tissues fail, by feeble perpetuative force, to evolve healthy intellect. When the formative forces fail to construct as perfect a brain-structure as has existed, renewal is required more and more often, which cannot be brought about by the impaired nerve-forces, and softening must, necessarily, follow or, at least, a mal-renewal and mal-construction of cells and neuroglia, too unnatural to evolve the elements of healthy mind.

That there is a connecting link between the intellectual and the sexual there can be no doubt, and that for the sexual to be appreciated, without the assistance of the intellectual, would be only animal and should not be considered advisable for human beings, but that the intellectual should not only predominate, but preside over, all sexual conditions.

Thomas would have us believe that the cerebellum is the seat of amative desire, and that that organ presides over the sexual function. Again, an opposite claim has attempted to overthrow such doctrines, by experiments to prove that the cerebellum presides over coÔrdination of muscular movements.

I am not prepared to accept the doctrine of either as true, but only can see evidence that both may be disturbed or lost for a time by pressure upon, or section of, a part of the cerebellum, and that this organ perhaps tends to effect an equilibrium of the nervous forces between the cerebrum and cord, and also as a generator of nerve-force. We do know that coÔrdination of muscular movements is interfered with by any structural changes in this organ; but it would seem that, if the sexual was so much depending upon the cerebellum for force, or there was such an intimate relation between these organs, muscular movement would be oftener impaired or disturbed by reflex irritation, owing to the frequency of impotence and other genital diseases, through the close relations supposed to exist between the genitalia and cerebellum. The coÔrdination of muscles is seldom interfered with by sexual diseases directly, but only as a secondary issue, by first producing chronic impairment of the nutritive forces, and thereby effecting the changes in nerve-cells.

The sensitive nervous organizations are of themselves predisposed to morbid changes, from too often repeated shocks of pleasure or grief; such persons are first to suffer mentally through shame, from having indulged in such vices, and secondly, from actual structural changes that have occurred.

The vice, commenced at puberty or before, interferes greatly with the development of the brain, and only a feeble intellect is possible as a product of such feeble brain-structure. The mental powers often yield, as it were, when the genital organs possess the power to copulate ad libitum. This is not an uncommon occurrence. Lunatics frequently possess such genital vigor, when their lunacy has been produced by masturbation and other sexual debauch.

Roberts Bartholow has, in his monograph, recorded a paragraph worthy of mention:

The general anÆmia that so often occurs in spermatorrhoea, caused by impaired digestion and spermal losses, is secondarily the cause of the cerebral anÆmia, and tertiarily of softening. The digestive powers, so much impaired by frequent draughts on the vegetative centers, must be a cause for a great disturbance in the nutritive supply of the brain. The vicarious expenditure of nerve-force upon the exaggerated secretory power of the testicles must be a source of great waste, as well as the actual loss of elements, necessary to the structures of a body losing annually by decay. The tendency of local spasm is of no little importance as a cause of local anÆmias. Centric irritations, such as influence the vaso-motor centers, without a doubt, cause local spasms of the vasa vasorum, capillaries and supplying arterial trunks of organs; and the vessels of the brain are the most likely to be influenced in such a manner, and the tissues of the brain the most likely, of all tissues, to suffer from such a condition.

The brain-symptoms do not end with feeble intellection or insanity, but impairment of the special senses and motility is not unfrequently present, as a phenomenon evolved from structural changes in the brain. Asthenopia amblyopia, diplopia, dilatation of the pupil and hyperÆsthesia alternated with anÆsthesia of the visionary apparatus, aphonia, perversion of the sense of taste, with loss of smell and deafness, are rare yet occasional complications.

The usual catalogue of symptoms bears closely to one of two forms, the hyperÆmic or anÆmic, local or general, of the cerebral substance.

The profound impressions wrought upon the minds of these patients by popular sexual literature must greatly exaggerate the structural changes, but are not sufficient of themselves, as a rule, to produce anything but morbid emotions until after enfeeblement has first been organized.

The records of the State Asylum, at Utica, N. Y., show five hundred and twenty-one cases admitted directly attributable to this vice; and Dr. Jno. P. Gray, the able superintendent, thinks this greatly understated.

Sexual excesses, pollution, and other mismanagements of the sexual functions have received too little attention, and are too seldom mentioned in the etiology of nervous and brain lesions. Too little effort has been put forth to ascertain the proportion of mental diseases caused by the sexual and reproductive organs. A greater number of brain-lesions occurs, in which the sexual function has been a remote cause, than any author, as yet, has ventured to affirm. Statistics of any degree of accuracy are impossible to obtain; but supposition, imagination, and guess-work only can be found to assist in making up a statement of the most important of all causes of disease.

Clinical Illustrations—Case.—Mr. X. came from the South with his brother to consult a physician in St. Louis. I found the patient, who was aged 24 years, feeble and wan. He wore a thin, scraggy beard, about an inch long, over his chin and under his maxilla, but the side of his face contained only a little furze. When I entered the room it was not necessary to inquire which one of the young men had come to consult me, as his general aspect told me that he was a sick man. He was cadaverous in looks, staggering in gait, anÆmic and haggard. He had been a masturbator, and practiced it as long as he could obtain erection, which had been until within a year; although I learned that for five years previous his erections had been only occasional and feeble. His semen was wasting nocturnally and his genitals flabby, cold and damp: his scrotum especially was relaxed and pendant. The spinal cord was very tender to the touch, giving great pain upon examination, over the lumbar, dorsal and cervical vertebrÆ. He complained of a sensation of constriction (girdle) around the body, painful digestion, constipation of the bowels, and talked incoherently. His mind wandered: he had no wishes to go home, or to stay, or to live, and became quite passive. He failed fast, and I soon lost sight of him, as he was placed in an insane asylum. All treatment failed to benefit him.

I might enumerate scores of similar cases, in which it is impossible to see any cause but abuse of the sexual function, in which spermatorrhoea and impotence blend in a very obscure manner, but combined with other phenomena prove, beyond a doubt, the existence of a sexual neurosis, peculiar to itself, which needs study as to pathological anatomy; when it will be discovered that more than mere cause for general neurosis is found in the sexual abuse so lightly spoken of by authors in treatises on diseases of the nervous system. It will not require an accurate observer to discover signs of myelitis and softening in the above case; but his symptoms had been, long before, markedly those of anÆmia, as related to me by his brother. Many cases selected for this section are in the advanced stage that I may the better show the termination of some of these cases. The majority of the cases that I have observed have been wanting in these distinctly organic features, only for the reason that they were not so far advanced, and their indulgences had been limited to a more careful habit of pollution and sexual congress.

The usual course of lesions appears in the following order after sexual excesses and pollution: Nervous weakness (neurasthenia), anÆmia or congestion, myelitis, and softening. These may point either to the brain or spinal cord, or both associated, in any given case, in accordance with compatibility of lesions and conditions.

A most striking condition of sexual neurosis is not uncommonly observed, that is not confined strictly to a locality, but shows a general breaking down of the conductors of nerve-force, both motor and sensory, as well as the nerve-cells, with a tendency to softening of both brain and spinal cord.

Case.—A marked case of impaired conductivity is now under my observation. The patient is a masturbator, and I have thus far failed to disrupt the vice.

In addition to many symptoms, not of general interest, is the impaired condition of the sensory conductors. When he is touched, it is a second before he feels. He sees the finger placed upon his hand or foot, but does not feel it for one or two seconds: sometimes it is quicker than at other times. When he is spoken to, he does not receive the idea for ten or fifteen seconds after he has heard the sound. He comprehends that such is the condition. He says he does not desire to practice self-pollution, but simply performs the act because he can’t help it. He is sensible and strong-minded on some things, and very feeble on others. He is agoraphobic, but has no pathophobia. He is not anthropophobic, but even foolish after female society, and still has no inclination to copulate. He prefers to masturbate, rather than to accept of coition when accessible.

The motor nerves and centers are rarely, but sometimes, involved directly. When paralysis does occur, it is from advanced complications and need not be mentioned here; but sometimes an unnatural class of movements is produced by this variety of neurosis, generally of a spasmodic character and located in the involuntary sphere. I wish only to record, in this place, the fact that such is a lesion of sexual neurosis, and take it up elsewhere with greater precision.

Tabes dorsalis has not been uncommonly caused by sexual abuse, in proportion to the frequency of the disease. Loss of sensibility is also exceedingly rare, but impairment is not uncommon. The loss of venereal sensation is a very common consequence and will be spoken of elsewhere.

Paralysis of some of the muscles of the genitals and bladder is of frequent occurrence, especially those connected with urination; the bladder is often paretic and micturition is frequent, and the quantity very small: often the natural warning as to time is wanting. The mental symptoms are often very prominent: loss of memory; conversation difficult; language incoherent and ideation very imperfect; insanity, idiocy, imbecility and epilepsy.

Hitzig says, under Etiology of Paralysis of the Insane, “Probably the combination of excessive labor with excesses in Baccho et Venere is the most common cause. The influence of sexual excesses can be recognized in females also.”

Case.—An epileptic gentleman, Æt. 24, consulted me for his fits. He had practiced masturbation from childhood to twenty years of age; was losing semen nightly; often without erection; had been epileptic four years. At first the fits were as frequent as every four months, but now they are weekly. His face was of a venous color, as if a venous stasis was the constant condition. His eyes and hair were black. His face was expressionless and covered with acne; memory very poor. He was a fine penman, and had been a book-keeper. He had felt no aura, and always had his fits during the day-time. All treatment failed in this case to produce any impression upon the fits. The bromides at first could not be used, as dangerous symptoms followed three successive attempts. Electricity, if any thing, aggravated his general condition. I cast lots for general treatment, in an empirical manner, but very little benefit followed: his general condition was downward, and the epilepsy continued to grow more frequent. Large doses of bromides benefited him and increased the interim, but finally four drachms a day failed to control or to modify them. Galvanization and Faradisation, both singly and conjointly, were tried in vain. Ergot also was tried, and many agents of lesser prospects, as he staid with me three years, growing feebler in body and mind constantly, until he is now nearly imbecile. Four cases so nearly alike have come under my observation, that the one will answer as a typical case of them all; not a single one recovering: two have ended up in the insane asylum: the other two I have lost sight of, but not until they had passed into a state of dementia.

Case.—Jno. W. My attention was called to this patient by Dr. M., who was the attending physician. The patient was in bed, very much emaciated and feeble; form originally tall, bony and muscular; dark hair and eyes. The Doctor informed me that he had passed through the hands of a number of physicians, without relief. His pulse was feeble and averaging 100: his venous circulation was feeble; a livid appearance of the skin: the redness would disappear upon pressure and return very slowly. There was profuse nocturnal hyperidrosis, with great morning prostration and general coldness. He was exceedingly irritable and profane; appetite poor, and what little was eaten was digested with pain; bowels constipated; urine high-colored and of high specific gravity, containing blood and pus. The spinal cord was so tender, during its whole extent, that the slightest pressure produced intense pain. His rectum was indurated and very tender to the touch. The urethra was diminished in calibre to a No. 8 catheter, and that was passed with great pain. The prostate gland was enlarged and hyperÆsthetic. He complained much of the girdle sensation, which placed the diagnosis beyond a doubt as chronic myelitis of the posterior columns. There were no lesions of motility, but lesions of sensibility were present throughout the body and lower limbs; anÆsthesia of the skin and hyperÆsthesia of the mucous membranes of the rectum, urethra and bladder. All treatment proved futile, and he died after a year of most distressed suffering.

He was a debauchÉ, given to extreme sexual indulgence and wine; was a victim of early indiscretions, and to a great excess: spermatorrhoea was present up to six months of his death; but was only impotent after he took his bed from general exhaustion. He was thirty-three years of age when he died.

Gull’s case of paralysis reported must be quite exceptional, as paralysis generally found, which has been caused from a sexual neurosis, has not differed in any manner from the same paralysis from other causes; and I can only see the sexual neurosis as a cause of paralysis, and not as a special variety. The same may be said of an anÆsthesia of the skin, or a hyperÆsthesia; that the sensory nerve-roots are influenced by either anÆmia or turgescence, and the phenomena are manifested at the periphera. The phenomena do not differ, when these conditions are caused by the sexual, from phenomena when conditions are wrought by other causes; and conditions causing identical phenomena are in themselves identical, but not as to their cause; hence so many forms of sexual neurosis, and so many conditions.

Local Structural Changes.—Structural changes in the genital organs, in a chronic case of spermatorrhoea, are not a little interesting to the student of pathology. The scrotum is pendant, baggy and relaxed. The penis is flabby, cold and pallid. The veins are dilated and tortuous, and the organs are in a condition of anÆsthesia or hyperÆsthesia; and as irritability often exists, causing unnatural attention of the patient, and he finds much difficulty in dressing to suit his genitals. The spermatic cord is hypertrophied, and the epididymis enlarged and baggy. If the examination can be obtained when there is an erection, tenderness will be observed, along the entire course of the urethra. The urethral mucous membrane is thickened, and the canal is strictured throughout its length. The prostate gland is changed and tender to touch, congested, and its ducts relaxed. (See Prostatorrhoea.) The anus is sore to manipulate, and at stool, when scybala pass over the prostate gland, a sensation of pain is felt, and fluid is forced out of the ducts into the canal and drips from the end of the penis. The veins of the spermatic cord are varicose, the erections are deficient in power (see Impotence), and seminal fluid is thin and watery. The spermatozoa are deficient in size, shape, and amoeboid movements. The urine is of a low specific gravity and contains a superabundance of urates. The orgasms are feeble and often imperceptible, and the proportion of spermatozoa to fluid is not great.

Spermal Changes.—The only known detection of spermzoons is by the microscope, which only can detect the seminal from the prostatic fluid in this stage of disease. The reason that spermatozoa have not been detected oftener in the urine of spermatorrhoea patients, is simply from the fact that the urine was not examined more than once, perhaps twice. When I have watched for ten days, making daily observations, before discovering spermatozoa, I have then found them daily for as many days. The first object to be determined is, is the patient strictured, or has he a general narrowing of the calibre of his urethra? If so, then this is a good reason to suppose there may be spermatozoa in his urine, providing that he is losing semen; as the fluid is thin, and the walls of the canal are clumsy in performing those wave movements which are so essential in ejaculating semen or expelling the last drops of urine; therefore regurgitation may take place, and semen be found in the next discharge of urine. When nocturnal losses occur, a large portion may be expected in the urine at the next micturition. This is commonly the case in aspermatism, and may act as a cause of sterility.

The married, as well as the unmarried, have involuntary discharges of semen when every possible opportunity is present for an emission to take place in the natural way. The newly married, after the novelty period has subsided may, from excessive indulgence, have an involuntary emission, which occurred during a lascivious dream, when no desire for cohabitation preceded his going to sleep. When the cause producing these involuntary emissions is not transitory, the young man must have indulged extensively in his boyhood. Such a discharge, if followed by the usual depressing effects, is invariably pathological; yet with proper rest, self-recovery is probable when the cause is transitory.

SequelÆ.—The common results of spermatorrhoea and sexual excesses become noticeable, either shortly before or soon after marriage. The young man well knows his defects, and he consults a physician to ascertain the magnitude of what may occur to him on account of his indiscretions. He informs us that sexual orgasm occurs very soon after intromission, on account of which he is grieved, and fears that his buxom, voluptuous bride will not be satisfied with such tantalizing as he may be able to afford. A few months’ tonic treatment encourages him, and he makes a trial of his condition before entering wedlock, that he may be sure not to disappoint his fresh, true and virtuous maiden. Again, the matrimonial rites have been consummated, and the young man fails to reach the expected goal of marital adaptation and aptitude: the wife is of course unsophisticated, and thinks there is nothing wrong; but the husband is well satisfied that he is not what will be expected, or what is necessary to promote marital felicity; and he consults his physician. Perhaps he was not a little disgusted, upon the first attempt at intromission, at ejaculating his semen either upon her linen, thighs, or vulva; she of course being innocent and not knowing the why such was not the natural procedure, he could excuse himself and thereby palliate his embarrassment.

Others, less sensitive in organic construction, do not understand these shortcomings, and are not quantum sufficit for a healthy female, as ejaculation follows a moment’s rapid copulative movement, leaving the female aflamed with erotic passion, and physiological turgescence of the sexual apparatus. These are only the sequelÆ of seminal weakness, such as pertain to the neurotic origin and character of this disease. The grave and less common results are, as the symptomatology illustrates, spinal anÆmia and congestion, cerebral anÆmia and hyperÆmia, insanity, epilepsy, tabes dorsalis (progressive locomotor ataxia), paralysis, impotence and structural disease of the heart and blood-vessels.

Treatment.—The treatment of spermatorrhoea, with its associate phenomena, demands careful investigation of the lesions and conditions of every case. The results and character of lesions are so varied that often a diagnosis as to condition is not an easy task. To know that spermatorrhoea exists is but a small part of the diagnosis necessary to arrange a treatment that may rationally result in benefit. As has been shown, seminal losses may exist when opposite conditions are present; and only can benefit be rationally expected from equally opposite methods of treatment. Any physician of experience has, and always will have, much difficulty in treating and controlling these cases, as they are hard to manage when even doing well, and only an intelligent and positive course can succeed in managing them during any great length of time.

A positive code of government, rigidly followed, is indispensable; as well as perfect confidence in the managing physician.

The nasty drugs of our old-fashioned materia medica will not cure these cases The bringing about so-called tonicity, by tonics and nervines, only needs to be tested for a short period to convince any practical physician how useless is such a procedure, and how soon his patient will find another attendant. Drugs are often useful but bad ones, selected for a tonic principle only, will as often do harm. Only with a definite object in view, should we expect to accomplish such changes as can result in positive relief. The list of nasty tonics for indefinite purposes, or such as “have been used in such cases,” the author has resolved not to, in any manner, refer to, and at no time will he direct an agent or combination of drugs on so-called “general principles,” but with definite expectations only.

Spinal Congestion.—The group of manifestations pointing to spinal congestion will first receive attention. The remedies are bromide potassium, bromide ammonium, ergot and belladonna, with electricity.

These are selected also with reference to conditions only; yet the reader can evidently see that their ultimate effects are aimed at, as all of this list of agents affect the calibres of capillary blood-vessels; therefore, the engorged spinal vessels are unloaded by contraction, perhaps, of capillary parietes.

By this effect of drugs we aim at relief of the long compression of the cord, and liberation of nervous energies and forces supplying the organs of nutrition and assimilation.

It is pre-supposed that all sexual excesses and vices are under control; otherwise, all treatment will be useless.

Numerous are the contrivances to control or prevent seminal emissions. They have all failed, and nothing is lost; as only the effect is looked upon in their construction, and not the true nature of the disease; therefore, to prevent spermal losses is not the first object to accomplish, but to relieve the nerve-centers, which preside over the manufacture of semen, of these abnormal structural changes; and the loss of semen will abate. No instrument will then be required; and if this centric improvement cannot be effected, the patient is beyond help. No mechanical contrivance will relieve the centric lesions; therefore, such appliances are useless. The loss of semen is not a disease, only a manifestation or a phenomenon of centric lesions; and as we have said heretofore that spermatorrhoea is not even a cause of such lesions; but sexual shocks, often repeated for a long time, are the cause of the neurosis through which we have spermal losses—true spermatorrhoea. This reiteration is made that no mistake may be made in interpreting the means of relief, which are all aimed at the lesions instead of their phenomena.

When the patient is not too much debilitated, chloral may be administered to produce sleep; but very commonly the ergot or ergotine will allay all nervous irritation and bring on perfect rest. Large doses are demanded, as much as two grains of Beaujon’s extract three times per day, or one drachm of Squibb’s fld. ext. or an ext. of equal strength should be used. Belladonna should be used by commencing with small doses and gradually increasing until asthenopia is produced, when small doses should again be used: by this means the extent of tolerance may be ascertained, and that dose should be continued which does not affect the eye. When the bladder is involved and urine is voided with a lack of expulsive energy, or the urine dribbles away, ergot and belladonna are the remedies. Where there is extensive hyperÆsthesia the bromides are better agents, and also to overcome any reflex irritations.

Hot applications to the spine are often followed by very excellent effects, as the relief of pain and other troublesome symptoms.

Cold water to the hands, feet and genitals is often followed by surprising results, and should be used night and morning for a long period of time—many months. Tonics do great injury in this class of cases. Quinia, strychnia, phosphorus and iron should never be used in any form.

Electricity.—The downward, constant current, alternated with Faradisation, is indispensable to satisfactory results in the majority of the cases of the congestive type; using the galvanic one day, and the induced the next day, with general Faradisation, if it be followed by pleasant effects and relief of unpleasant nervous symptoms.

Stimulating food, as well as alcoholic and malt liquors, should be proscribed; yet a generous diet is at all times indispensable. Opiates should not be administered, even for the relief of pain.

The AnÆmic Form.—When this type of spermatorrhoea is satisfactorily diagnosed, the treatment is plain and the agents quite positive in their course of action, when the case is not so far gone that relief could not reasonably be expected. But if there be a doubt as to diagnosis, on account of mixed symptoms—and such is not unfrequently the case—if we are not well satisfied whether there is anÆmia or congestion of the cord, the administration of 1/60 of a grain of sulph. strychnia will decide the matter, which will produce some of its physiological effects if there be congestion; but if anÆmia exist, there will be no noticeable change, at least no unpleasant effects. With this point clear, we then direct a treatment which is intended to stimulate a free circulation of blood in the cord—spinal stimulants. Strychnia, phosphide zinc, cantharides, pulsatilla, phosphoric acid and collinsonia, are such agents.

Cold spinal and genital douche, with hot foot and hand bathing morning and night, are highly important agents, with strychnia 1/60 gr., three times a day. The author has for many years almost entirely depended upon formula No. 1, not on “general principles,” but as a combination that applies directly to the anÆmic condition of the cord and its consequence; and knowing its effects, as he has, so long, could not well do without it in the treatment of these complicated cases. If there be general anÆmia, as well as local, chalybeates may be of service, but not until the patient is eating and digesting moderately well: then we prefer the citrate in port wine. Stimulants in moderate quantity are admissible, especially wine and malt liquors. Opium may be administered to allay pain, but chloral is better.

Any agents, used for their stimulating effect upon the cord, must not be expected to act too rapidly. Patience is the all-important motto after the diagnosis is well made.

Counter-irritation will always be of great service, and the cantharidal plaster is the most desirable form. The seaton has in a few instances been of service, but we prefer the emplastrum canth.

Electricity is indispensable, and should be applied daily. The anode should be applied to the tender spots in the cord, and the cathode to the genitals, in the form of a large sponge placed in contact with the perineum, scrotum and penis. Faradisation may be alternated with the constant current daily. General Faradisation may be applied best by a large foot-plate covered with a wetted sponge, and the operator, holding the anode, may place his other hand on the patient’s head, back of his neck and along his spine: the hair of the patient will of course be moistened as the dry hair is a non-conductor of electricity.

A highly nutritious diet should be always advised, and plenty of open-air exercise, even to fatigue; as the mind is thereby employed, and not so much time is found to brood over these physical conditions. The very common and exceedingly troublesome constipation may be overcome by rhamnus purshiana, in teaspoonful doses of the fluid extract, morning and night.

When extreme sleeplessness prevails, grain doses of svapnia have acted excellently; also ten-grain doses of chloral hydrate.

I do not prescribe for seminal losses under any consideration: I simply ignore them during the whole course of treatment. Where the general health improves, and with that the nerve-symptoms, the seminal losses become less frequent and finally cease. As the involuntary discharges diminish, we may conclude the central lesions are improving.

Cerebral Sexual Neurosis—Treatment.—The most prominent feature of the cerebral manifestation is mental asthenia, or feeble-mindedness, from real exhaustion of all the forces; a general lack of power.

To impart vigor to the general nervous system must be the first indication. For this purpose dil. phos. acid may be administered. If the extremities are cold the hypophosphites are of positive benefit, and must be continued for a month or more. Tinct. nux vomica imparts tone to the nerve-centres. When active symptoms are present the bromides act very kindly, and may be combined with ergot, or the latter may be used separately with most excellent results. But the physician must be certain that he has a case of hyperÆmia, before such agents are resorted to, and then they should be given in large doses.

Electricity, in the form of general Faradisation, seems to be of the most service, and must be applied daily for several months. Only a feeble current should be used.

The structural changes that have occurred in the genitals always demand attention.

Chronic turgescence of the prostate gland will best be treated by the internal use of tinct. staphisagria, large doses of bromide of potassium, and the introduction of catheters increasing in size until the urethra is fully dilated.

Electricity should be used as recommended under Prostatorrhoea. The organic stricture, which is so commonly present, should be treated by dilatation with suitable bougies or catheters. The bougie must be used as often as twice a week, until the full size and elasticity of the urethra are obtained.

Injections are sometimes useful. A solution of nitrate of silver, ten grains to the ounce of water, used only once, and followed by a solution of brown sugar (sacch. communis), morphine and rose-water, will answer a most excellent purpose. After the acute inflammation has subsided the bougies must always be resorted to, and used persistently until the object for which they are used is accomplished. Any ulceration may be relieved by injections of permanganate of pot., not stronger than one-half grain to the ounce.

The glans and prepuce should be closely scrutinized from time to time, and if the prepuce be of undue proportions, or if the patient is filthy, permitting accumulations to form beneath the folds and creating a local irritation, circumcision should be performed without hesitation.

Reflex irritations have often prevented recovery, and even produced grave manifestations. Cases of epilepsy have been reported from such peripheral causes, and cured by relieving the cause, or circumcision. The division of the sensitive nerves, which occurs in the operation of circumcision, often prevents involuntary spermal losses, and even permits such patients to perform normal copulation as had even ejaculated previous to intromission. Such little causes must not be overlooked. It is often in attending to little things that great results are accomplished; and in this we have no exception to the rule.

There is no room for a doubt in my mind that the Jewish rite was first established from hygienic motives only; and as “cleanliness is,” and always has been, “next to godliness,” circumcision would seem a very natural sacred rite for any religious sect to adopt.

We have no history of anything more ancient than the operation of circumcision. The Egyptian priests were practicing circumcision nearly 5,000 years ago. A translation of Herodotus informs us that such hygienic measures were in existence amongst the Egyptians in the most ancient of periods; and it is quite reasonable to suppose that the Jews obtained this rite from the Egyptians.

Dilatation of the Anus—Anal Plug.—A very troublesome complication of the genital structural changes occurring in spermatorrhoea is induration of the mucous membrane and sub-mucous tissues. Where such a condition is present, little benefit should be expected until relief is obtained from the local difficulty.

The dilatation should be accomplished by suitable means; such as by bougies, or a bi-valve rectal speculum. An anal plug may be constructed that is self-sustaining, polypoid in shape, which will be of more service than compression of the anal surfaces. The troublesome pruritus, and hemorrhoidal tumors, and indurated anal tumors, will gradually subside under such management. Suppositories of iodoform are also of invaluable service in reducing indurated conditions of the anus and rectum, as well as enlargement of the prostate gland. The old-fashioned stretching of the sphincter ani for spermatorrhoea, so highly recommended by Trousseau in his clinic on this subject, from indiscriminate use, is neglected, when it is really a most important means, deviating the reflex current from the genitals as well as relieving actual structural change in the anus. Roberts Bartholow has dwelt upon this subject without pointing out definitely such cases as it has actually relieved, leaving the reader to guess or find out for himself. The failures from its use have been so numerous, and the cases in which benefit has followed so few, that it is no wonder that it is not in better repute as a remedial means.

Whenever this dilating process is restricted to thickening and induration of the mucous membranes of the anus and rectum, much benefit will follow its use.

Many peculiar means have been recommended and are resorted to, many of which only need a condemnatory mention, which seems the more necessary that they are in almost general use. The most prominent is the porte caustique, which was probably introduced by Ambrose ParÉ, and improved and so highly recommended by Lallemand. Other prominent supporters of this manner of medicating the urethra and prostate gland were Wiseman, Hunter, Amussat, and Everard Home. The supporters of this manner of cauterizing the openings of the vesiculÆ seminales were under the impression that spermal losses constituted the essential cause of the disease, instead of the habit the testicles had taken on by a hyper-supply or vicarious evolution of nerve-force.

We do not hesitate to say that this method is seldom followed by beneficial effects, and often by irreparable injury.

Bartholow advises its use in exceptional cases; “those in which,” he says, “the moral effect of the application is desirable.” From this I must dissent; as any superabundance of attention demanded may be bestowed by cauterizing or vesicating the perineum, obtaining an excellent moral effect and even accomplishing, by way of counter-irritation, physical improvement.

We might suppose that these harsh means of treatment, owing to the elevated character of their supporters, were in good repute; and that a work on this subject would be incomplete without a full detail of them; but a better success without than with them has led me to discontinue their use, and conscientiously speaking of the treatment, I can but manifest my disapprobation of all caustic applications to the urethra or prostatic ducts.