-
I I 1 11ll1 11l1ll11ll 11lll 1 1 1 11lll
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SPERAMATORRH(EA:
ITS CAUSES,
SYMPTOMS, RESULTS,  AND TREATMENT.
BIY
ROBERTS  BARTHOLOW, A.M., M.D.,
Professor of Materia Medica and Therapeutics in the Medical College
of Ohio; Lecturer on Clinical Medicine, and Physician to the
Hospital of the Good Samaritan; Lecturer on Morbid
Anatomy, and Pathologist to the Cincinnati
Hospital, &c.
THIRD EDITION, REVISED.
NEW YORK:
WILLIAM WOOD & CO., 61 WALKER STREET.
1871.




Entered, according to Act of Congress, in the year 1871, by
WILLIAM WOOD & COMPANY,
in the office of the Librarian of Congress, at Washington.




TABLE OF CONTENTS.
PAGE
Preface to the Third Edition.................  iii
Preface to the First Edition..........................    iv
Preface to the Second Edition........................  vi
Introduction........................................           1
I.  TRUE SPERMATORRH(EA....................   5
Causes...................................           5
Physical..........................         5
Masturbation.................          6
Premature Puberty.............          6
Masturbation in Infancy......... 
Phymosis.....................   8
Influence of Example...........    10
Lesions of Urethra.............        11
Lallemand's Views.........          13
State of Nervous System....    24
Moral..............................    26
Symptoms...............................            28
Objective Symptoms of Masturbation.....         28
Subjective       " ".                           31
Objective        "      Spermatorrhoea.         32
Subjective " " 34
Genital Form.........................    36




iv                            CONTENTS.
PAGE
Cerebral Form......................                 42
Spinal,,......................., 48
Results.................................                 53
Weakness of Mind....................   53
Irregular Action of Heart............... 54
Impotence.................    56
Varicocele............................               55
Irritable Testis........................             58
II. SPERMATORRHCEA AS A. SYMPTOM.........   62
Tabes Dorsalis........................               63
Diseases of Brain and Cord...............            64
III. IMAGINARY SPERMATORRHCEA............   71
IV.  TREATMENT.......................               14
Local...................................
Porte Caustique........................               7
Injections............................               82
Circumcision..........................               85
Other Instrumental Means.........      87
Systemic Treatment...............  8.9
Remedies............................               90
Anaphrodisiacs.................    90
Aphrodisiacs...................     96
Treatment of the Causes................     99
Remedial Management..........              03
Marriage.............................    114
Formule................................    116




PREFACE TO THE FIRST EDITION.
A SHORT essay on the Pathology and Treatment of
Spermatorrhea, based upon a clinical lecture delivered at St. John's Hospital, and published in the
Cincinnati Journal of lMedicine, having met with a
very favorable reception from the profession, itchas
seemed desirable to give the subject fuller treatment
from the same point of view.
There have been but few special treatises on this
disease of a reputable character.  The work of
Lallemand, Des pertes sbeminales involontaires, Paris
et Montpelier, 1837-41, is the source from which
subsequent writers have drawn their information.
A portion of this work has been presented in an
English dress by two translators-Wood and McDougall. Additions to the translation of the last
named have been made by Maris Wilson, and in this
form it is the principal authority now in the hands
of American physicians. The subject is also discussed, necessarily in an incomplete manner, in various works on the practice of medicine and surgery.
Besides these authorities, Mr. Acton has lately addressed the general public in a work on the reproductive organs, in which he discourses more or less
fully on Spermatorrhcea.




vi                 PREFACE.
I think it is a reproach to our profession that this
subject has been permitted, in a measure by our own
indifference, to pass into the hands of the unscrupulous pretenders, whose suggestive publications are
amongst the crying evils of our time. Because the
subject is disagreeable, and to a certain degree disreputable, competent physicians are loath to be concerned with it. The same unnecessary fastidiousness
causes the treatment of this malady to be avoided
in private practice; and the unfortunate patients,
thus precluded from obtaining intelligent advice,
fall into the hands of advertising specialists, who
excite their worst apprehensions for a mercenary
purpose. For this reason, and to obviate the sad
consequences which result from spermatorrhcea, it is
our duty to exert our best efforts in behalf of those
afflicted with this malady. We should endeavor to
attain to correct views of its pathology, and apply
our knowledge to its cure-if for no other reason,
for the good of our species.
My little work will have done all that I can desire
for it, if it assist the practitioner in forming correct
views of the nature of spermatorrhzea, and enable
him to conduct cases of this disease to a more successful issue than he has hitherto been able to accomplish.




PREFACE TO THE SECOND EDITION.
A SECOND edition of this monograph having been
called for within less than a year after the publication of the first, is a gratifying evidence of the appreciation of my labor by the medical profession.
In the present edition, some typographical errors,
overlooked in the first, have been corrected; a table
of contents has been appended, and new matter has
been added at various places throughout the volume.
These improvements will, I trust, make the present
edition still more worthy of the favor so largely accorded to the first.








PREFACE TO THE THIRD EDITION.
I HAVE to express my acknowledgments to the
medical profession for the very great favor with
which the two previous editions of this work have
been received. As it now appears in this edition,
the material has been rearranged, and in large part
rewritten. Some illustrations have been introduced,
and an appendix of formulae added.  The value
of the book will, I trust, be considered to be enhanced
by these changes and additions.
More enlarged experience since the appearance of
the first edition, has not caused me to amend any of
my views of the nature and true mode of treating
spermatorrhcea. I am, indeed, more than ever confirmed in the view that it is a neurosis, and that the
treatment, to be successful, must be founded on this
pathological basis.
R. B.! 27 WEST 8THt STREET, CINaINNATI, OHIO.








NOTICES OF TIHE FIRST EDITION
OF THIS WORK.
From the New York 2medicacl JouealZ for October, 1866.
"Lallemand's erroneous teachings on the Pathology and Treatment of
Spermatorrhcea have been, for more than twenty years, the guide of the majority of practitioners, and we are glad, at length, to see the subject ably
and judiciously discussed in a special treatise, and the more correct views
of modern investigators fully set forth. Viewed in this respect alone, the
little work before us will accomplish a good purpose; but again it will be
productive of a double good, for an enlightened comprehension of the subject will lessen that aversion which too many practitioners entertain toward a subject at once disagreeable in itself, and to a certain extent disreputable, and thus many an unfortunate and truly pitiable subject of this distressing malady will be rescued from the hands of the ignorant and pretending charlatans to whose mercenary offers he is not unfrequently driven in
desperation to resort by the indifference of the regular practitioner. The book
supplies a want that has long been felt by the profession, and can be confidently recommended as a reliable guide to both student and practitioner, and as
embracing the more.recent and well-sustained advances that have been made,
both in the pathology and therapeutics of the malady in question."
From the Medical Record, November 1, 1866.
"This duodecimo, which is a philosophical revision of a by no means generally understood subject, clears away much of the rubbish that has heretofore encumbered its literature. The writer, who substitutes for many of the
vexed questions very tenable views of his own, makes no violent deductions,
but states objections with candor, and arrives at his conclusions by logical
sequences. We bespeak for the work a cordial reception on the part of the
profession, and for the author additional laurels to a growing reputation."
From the Twenty-fourth Annual Report of the Managers of the State
usnatic Asylum, Utica, N. Y., for the year 1866.
Report of Dr. Gray, Superintendent, p. 33:
"I would commend to the attention of the profession the admirable little
work of Dr. Roberts Bartholow on Spermatorrhcea, recently published be
Wm. Wood & Co., New York."




NOTICES.
Yromw tAe Boston Medical cand Surgical Journral, Nosember 8, 1866.
" This little book is a well-written and judicious essay on Spermatorrhcea
considered under the above divisions, which we can recommend to the perusal of our readers. The valuable and practical instruction on treatment
it contains will be found worthy of careful study by all who are consulted upon this neglected affection."
From the Philaclelphia Medical cand Surgical Reporter, Sept. 15,1866.
" Dr. Bartholow's treatise upon Spermatorrhcea seems to us to have been
judiciously conceived and well executed. Lallemand's ideas of the pathology:
and treatment of this affection have too long maintained the sway of routine.
Central in those ideas, as all know, is that of the constant importance, in the
production of Spermatorrhcea, of irritation or inflammation of the prostatic
portion of the urethra, and of the seminal ducts. Hence his use of the porte.
ccaustique.
k. Dr. Bartholow summarily disposes of all this, and asserts, we believe truly
that the affection in question should take its place among the euroses, as
essentially a functional derangement of the excito-motor spinal system. I-e
would limit the use of the porte-caustique to those conditions of inflammation
ulceration, and hypersesthesia of the prostatic portion of the urethra, really
proved to exist, and refractory to other less painful and dangerous methods;
or, for moral effect, to obstinate cases accompanied by severe hypochondria,
or continued masturbation. Moral treatment of a larger kind, with appropriate regimen, tonics, etc., will be of service in the greater number of cases.
('ircancision, it is well urged, should not be omitted in two classes of cases:
1. Those in which the habit of masturbation is due to the hyperaesthesia of
the glans, produced by an elongated prepuce, and the irritation of retained
sebaceous matter. 2. Those in which the same cause (a peripheral irritation)
induces the venereal orgasm and involuntary discharge.
" This treatise, however, goes very systematically over the whole subject.
It is extremely well worth reading by all practitioners, as a good exposition
of sound views. We will only mention, as particularly of interest, in addition to what has been said-the denial by Dr. Bartholow of the frequency of
ulceration or inflammation of the prostatic portion of the urethra in sperinatorrhcea, in this country, at least; his clear discrimination between the not
uncommon mucous discharges and true diurnal seminal pollutions; and his
testimony to the positively anaphrodisiac effects of bromide of potassium in
appropriate cases. This remedy, he states,' will be effectual in proportion
to the degree in which structural lesions are absent, or in other words, in proportion to the degree in which these morbid states are functional rather than
organic.' The failures of Dr. S. W. D. Williams and others, are accounted
for by the existence of organic causes."




SPERMATORRHCEA:
ITS CAUSES, SYMPTOMS, RESULTS, AND
TREATMENT.
INTR OD UCTION.
IT seems to be necessary to define, at the outset, what is meant by Spermatorrhcta. The sense
in which this term is used not always being the
same, confusion has arisen as to its real pathological import. By some, following in a literal
sense its etymological signification, this term is
restricted to that condition in which there is a
constant stillicidium of semen, without, of course,
1




2              SPERMATORRHCEA.
the preliminary phenomena of erection and ejaculation. If this definition be accepted, spermatorrhcea can be admitted to exist but rarely.
According to a more widely received view,
spermatorrhcea consists in the emission of semen
without copulation, or in involuntary seminal
losses of every kind. If the former definition be
defective by reason of too limited scope, the latter
is defective in a more injurious degree, because it
embraces a physiological as well as a pathological
state.
The term s~permatorrhca should be restricted
to that condition in which involuntary seminal
losses occur with sufficient frequency to produce
a definite morbid state.
It is very important to be accurate on this
point, for nothing is more common than mistaken
views in regard to the pathological importance of
occasional spermal losses. A physiological condition is frequently confounded with the results
of disease. The prevalence of this error is due
chiefly to the false statements so persistently put
forth by advertising specialists in regard to the
evil consequences of nocturnal pollutions. I cannot too strongly impress on my readers, that after




INTRODUCTION.              3
the period of puberty involuntary seminal losses
occur in the continent with more or less frequency,
according to the activity of their sexual organs.
The young man who, ignorant of its nature, happens to this accident for the first time, is much
concerned, especially if he have read the impure
publications on this topic now so widely distributed. In such a case the intelligent and humane
physician may render a lasting service by an
exact statement of the importance of these physiological emissions.
Although many cases of so-called spermatorrhcea are physiological in character, we should
not therefore assume that no morbid state is produced by frequent involuntary losses.
Spermatorrhoea is also a symptom of lesion of
some part of the central nervous system. It has,
then, but little importance as compared with
the serious disease of which it is but an indication.
It follows from the foregoing considerations, in
order to have a true comprehension of spermatorrhcea, it must be studied from several points of
view. I purpose, therefore, to treat of the subject according to the following scheme:




4              SPERMATORRHEA.
1. True Spermatorrhcea.
Its Causes.
Physical.
Moral.
Its Symptoms.
Its Results.
2. Spermatorrhcea as a Symptom.
3. False or Imaginary Spermatorrhcea.
4. Treatment.




CAUSES.                   5
TRUE SPERIA TORRHREA.
CAUSES.
Physical. —The vice of masturbation is undoubtedly the chief cause. The growth of the
sexual apparatus at the period of puberty is accompanied by abundant secretion of the seminal
fluid, which accumulates in the reservoirs.  The
sexual instinct, then fully developed, exerts a
powerful influence  over the mind, whilst the
reason is not in a sufficiently matured state to
correct the mirages of the imagination.  An
accidental friction of the erect organ in these
moments of delirium makes the unfortunate youth
acquainted with a new and voluptuous sensation.*  Ignorant of the dreadful consequences
which must ensue from the repeated perpetration
of this act, the youth perseveres in his secret
pleasures until arrested by realizing some of the
sad effects upon the mind and body which follow.
* Tissot. L'Onanisme. Dissertation sur les Maladies produites par la Masturbation. Also, Fourrnier et Begin, Dictionnaire des Sciences Midicales, vol. xxxi., pp. 100-134.




6             SPERMATORRHCEA.
Although the practice of this vice is not confined to boys of the nervous type, yet it finds in
them victims the most willing, and the least able
to resist the continually increasing demands of
the habit.  Boys of vigorous constitution, in
whom the digestive and muscular systems are
well developed, are less under the control of these
erotic impulses, and are more able to resist the
inroads of the habit when formed, because in
them the exercises of youth and the satisfaction
of the appetite occupy their minds.
A premature and unnatural development of
the genital apparatus may give origin to the vice
of masturbation. Mr. South has related an extraordinary case of premature puberty, in which
involuntary losses occurred:"When he was about four months old, the
hair on the pubes began to grow very thickly
and black, at which time the penis increased in
size, particularly the glans, so that it gradually
extended beyond the prepuce, till about fifteen
months, when it was entirely exposed; the pubes
were then completely covered with black, curling
hair....    Soon after this, she (his mother)
noticed that his linen was stained two or three




CAUSES.                 7
times in the week.            She also states
that since he has been in town (six weeks) the
emissions have been more frequent than for
some time previously."*  Mr. South gives the
following measurements of the penis of this extraordinary infant: length of penis when pendent
from the symphysis pubis, three inches; length
of penis when erect, six inches. This is probably
the "most rare and curious" case of premature
puberty on record; certainly it is the earliest
period at which spermatorrhcea has occurred.
Such an instance is wholly exceptional. Nevertheless, a premature development of the sexual
organs may constitute an occasional cause of selfpollution —the more especially if such development be not accompanied by corresponding
growth of the other organs and systems of the
body, and of the reason and moral control.
Independently, however, of a premature development of the sexual apparatus, the vice of
masturbation may be contracted at a very tender
age, a very instructive example of which has been
narrated by MIr. Heckford. "I believe it is not
* Medico-Chirurgical Transactions, vol. xii., p. 76.




8             SPERMATORRHCEA.
generally known," says Mr. Heckford, "that this
vice is practised not only by adults of both sexes,
but also by young children, and even infants in
the cradle. The following notes, kindly given
me by Dr. Hughlings Jackson, are a sufficient
guarantee as to the correctness of this assertion,
at least as regards one case...  The following is the narrative of Dr. Jackson:-A woman
came to the Hospital for Epilepsy and Paralysis,
on account of fits. She took the opportunity of
asking my advice about her child. The boy was
fifteen months old; he was delicate, and had
never been able to stand; but the special circumstance about which the mother wished to hear
my opinion was the peculiar position of his legs.
The right leg was almost always placed high up
over the other, and he kept it moving in a sawing
way towards the pelvis. The penis was in the
way of friction, and was quite stiff when I examined it. He was much annoyed at my interference with the movements of his leg, making
resistance and crying.... The boy had congenital phymosis, but he did not cry when he
made water. Mr. Hutchison was kind enough,
at my request, to circumcise him..   After




CAUSES.                 9
this the habit ceased, for a time at least, and the
child much improved in health." *
I have had lately under observation a case, a
boy four years of age, who had practised the
habit for two years. He exposed the penis to
friction between the thigh and abdomen. His
mother informed me that he was much excited
during the act, and at its termination passed into
a nervous state, preceded by a shudder. He had
frequent epileptic convulsions.  Circumcision,
although it interrupted, did not cure the habit,
for the boy resumed it again after the wound healed. Threats, punishment, and restraint were alike
unavailing to prevent the perpetration of the act.
A very influential cause in determining the
habit of onanism is a redundant prepuce. Around
the corona glandis, in the sulcus, are situated a
number of sebaceous glands, the secretion of
which, if allowed to accumulate, excites irritation
and itching. Erection and the venereal orgasm
follow the friction which is innocently used to
allay the itching. Moreover, when the glans is
habitually covered, it becomes morbidly excita* London Hospital Reports, vol. ii. p. 58.




10            SPERMATORRH(EA.
ble, and the least friction develops the special
sensibility of its nerves.
According to Simon* (de.fetz) various causes
besides the foregoing increase the excitement of
the genitals at puberty, among which he enumerates prolonged sitting, as at school, which fatigues the spinal column and causes an accumulation of blood in the inferior parts of the trunk.
" For the same reason," says Simon, " that clerks
and persons who ride much on horseback or in carriages are exposed to hemorrhoids, boys will experience excitement of the genitals in consequence
of engorgement of the testes and spermatic cord."
Patients frequently refer the origin of the habit
of masturbation to the influence and example of
older boys. In public institutions, where many
boys of the more depraved sort are collected together, this may sometimes occur; and even in
the better class of boarding-schools a bad boy,
given to this vice, may induce others to commence
it; but generally speaking, the remark of Quintilian is true: Non accipiunt e scholi8s maa ista,
sed in scholas aferunt.  The masturbator takes
* Traite d'Hygisne appligue- d l'Education de la Jeunesse.
Paris, 1827, p. 164.




CAUSES.                 11
into the school those organic tendencies which
lead to the perpetration of the vice. Possessing
the erotic temperament, slight causes will suffice,
at school or at home, to awaken the special sensibility of the sexual apparatus.
Under what circumstances soever the vice of
masturbation may be contracted, it is usually
continued, and with increasing frequency, until
weakness of the genital organs and various functional derangements are produced.  The habit is
discontinued, either because of some evident ill
consequence which alarms the patient, or he is
informed of the serious results which must finally
ensue from his violation of a natural law.  But
the unfortunate victim finds that the cessation or
diminution of the habit does not restore him to
the natural state. He cannot rid his imagination
of the erotic fancies which have so long possessed
it. During sleep lascivious dreams beset him,
accompanied by the venereal orgasm and the seminal loss. During the day erotic ideas constantly
invade his mind, and partial erections occur, followed by a tenacious discharge which slowly
escapes from the urethra.
It is probable, also, that spermatorrhcea may




12             SPERMATORRHCEA.
result from  excesses in natural coitus.  Cases
apparently originating in this way have fallen
under my observation. The history of these cases
is as follows: After very free indulgence symptoms have occurred indicating the necessity for
abstinence.  This sudden and forced continence
puts the mind of the individual and his genital
apparatus in the same condition as that which
occurs after the habit of masturbation ceases.
The relation which sper-matorrhcea bears to
certain structural alterations of the genito-urinary
organs requires to be carefully investigated. Very
contradictory opinions have been expressed on
this point.
By surgeons it is regarded as an affection-an
inflammation or an irritation-of a part of the
genito-urinary apparatus, and the surgical treatment is based upon this pathological doctrine.
One of the most recent and able of surgical authorities* treats of it under the heading of' functional disorders of the testicle."  The mrodern surgical writers in general adopt this view,
especially those  accessible  to  the  American
* Holmes's System of Surgery —Art., Diseases of the Male
Organs. Vol. iv., p. 539. London. 1864.




CAUSES.                     13
reader.* The work of Lallemand t is the principal source of these pathological views. It will
be proper, therefore, to present an outline of this
author's doctrines before presenting our own.
Views of ll. Lallemand. —This author regards
the following as playing an important r6le in the
production  of this disorder: Blenorrhagia and
stricture of the urethra, the former affecting the
prostatic part of the urethra and the orifices of
the seminal ducts, and the latter producing dilatation of the ducts by the efforts of micturition;
gouty and rheumatic affections occurring in these
parts; accumulation of sebaceous matter under
the prepuce, constituting a source of irritation;
venereal excesses and masturbation, which act
principally by provoking inflammation or irritation of the ducts; prolonged -erections excited
* Gross's System of Surgery, p. 831-2, vol. ii. Phila.:
1865. Erichsen's Surgery, p. 1224. A Practical Treatise on
the Disease of the Testis, etc., by Curling. Phila. Ed., p.
326, et. seq., etc., etc., etc.
t Des Pertes S&minales involontaires, op. cit. Also, Observations sur les Maladies des Organes Genito- Urinaires. Premicre Partie. p. 158 et seq., 1825, by the same author. The
influence of a "hobby" is well seen in the growth of M.
Lallemand's opinions and practices during the fifteen years'
interval between these works.




14             SPERMATORRHCEA.
by erotic ideas or lascivious publications; the
use of diuretics, of ergot, of cantharides, etc.;
the abuse of alcoholic drinks, of coffee, and of
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.
The organic peculiarities which predispose to
spermatorrhcea are, according to this authorexcessive length of the prepuce; hypospadias;
extraordinary size of the meatus urethrae; flaccidity of the corpora cavernosa; smallness, tardy
descent and  lack of firmness of the testes;
relaxation of the cord and of the scrotum; varicocele; congenital induration of the prostate,
and great development of the pelvis with feminine characters.
When the nocturnal pollutions are due to excesses, to abuse, to the presence of ascarides in
the rectum, they produce, according to Lallemand, grave disorders in a short time after their
appearance. After a little, all the phenomena
of excitation which precede or accompany the
orgasm  diminish, and finally completely disappear; the act of emission  occurring without




CAUSES.                 15
erection, pleasure, or any particular sensation.
The semen loses little by little its color, its odor,
and its spermatozoa, and comes to resemble,
more and more, either mucus or the prostatic
fluid. This progressive diminution in the excitation of the genital organs, and this increasing
alteration in the sperm, correspond with a remarkable' augmentation in the gravity of the
general symptoms and in the difficulties in the
treatment. At the same time the vesiculme seminales acquire the power of contracting under the
influence of a less energetic excitement. Then,
also, fulness of the bladder or rectum, a warm,
soft bed, lying on the back, warm drinks, excitants, etc., provoke emissions more or less easily.
The effects are much more serious when to the
nocturnal are added diurnal pollutions. Some
patients suffer only from nocturnal pollutions,
but such cases are rare.
The diurnal pollutions, according to Lallemand, are produced by all those causes which
increase constipation and favor the excitation
of the genital organs; such as prolonged sitting,
the jolting of a carriage, riding on horseback,
etc. In some subjects the pollution does not




16             SPERMATORRHIEA.
take place passively during the efforts of defecation, and by the simple effects of compression,
but by the proper action of the ejaculatory apparatus.  These cases are unusual.  In all the
others the semen is emitted without the sensible
phenomena of ejaculation.  The evil effects are
determined by the abundance of the loss; but
some persons support the losses better than
others.
The varieties of noctural and diurnal pollutions
manifest themselves successively or simultaneously. The specific character is the sudden expulsion of semen in notable quantities at variable intervals. A symptom which has close relation to spermatorrhcea, and which ordinarily accompanies it, is impotence. In all cases of nocturnal or diurnal pollutions, the first symptom
discovered is a notable diminution in the energy
and duration of the erections, and an increased
readiness of ejaculation.
MIM. Lallemand gives the following result of his
microscopic examinations of the excreted matters
in the different varieties of seminal loss: " When
the evacuations are rare and the semen has preserved its distinctive characters, the animalcules




CAUSES.                 17
present nothing remarkable either in respect to
numbers or dimensions. But when the spermatorrhcea has assumed sufficient importance to
influence the rest of the economy, the semen becomes more liquid, and the animalcules are less
developed and less vivacious, although their
number may not appear to be diminished. When
the erections commence to diminish, the semen is
more aqueous; the dimensions of the spermatozoa are sometimes one-fourth or one-third their
normal size, their caudal prolongation being distinguishable with difficulty, with a power of 300
diameters." *
The central idea of M. Lallemand's theory of
the pathology of spermatorrhcea, is the production, by various causes, of an irritation or inflammation of the prostatic portion of the urethra and
of the seminal ducts. This view is not supported
by anatomical eviden, c.  Although cadaveric
examinations, as is well said by  M. RaigeDelorme,t have resulted in the discovery of diverse alterations of the genital organs in cases in
which seminal losses were presumed to have ex* Op. cit., II. p. 404.
t Dictionncair de Medeine, vol. xxviii., p. 506.




1 8            SPERMATORRH(EA.
isted, these alterations were so connected with
important diseases of other parts of the genitourinary apparatus, that little reliance can be
placed in them as indicative of spermatorrhcea.
These alterations consisted in ulcerations of the
orifices of the ejaculatory ducts; injection and
ulceration of various parts of these canals; analogous alterations of the vesiculm seminales;
purulent depots in the vesicles, in the vasa deferentia, in the epididymis, in the body of Highmore, and in the testicle. It is impossible to associate these lesions with spermatorrhcea, since in
all the cases cited they were accompanied by
more or less grave alterations of the urinary passages. One cannot avoid the reflection in looking over Lallemand's cases, published in his work
on the genito-urinary organs in 1825, and in his
work on seminal losses in 1839, that his cases as
well as his theory were constructed to justify his
practice. There is no proof that the anatomical
lesions described by this author were causative of
spermatorrhcea, or that they were even accompanied by it. On the other hand, the observations are numerous enough in which these alterations occurred without the production of sper



CAUSES.                19
matorrlhea.  The truth is, undoubtedly, that
there is no specific anatomical element in all that
Lallemand has submitted, to be associated indissolubly with that disorder, and to which it may
be attributed. In support of our opinion, we
may cite the high authority of Mr. Thompson,*
who asserts that inordinate sexual indulgence
cannot have the effect to produce prostatitis unless gonorrhcea be already existing.
I may also refer, in opposition to -the views of
Lallemand, to my personal observations. As
pathologist to the Cincinnati Hospital, and during the time of my military experiences, I have
had numerous opportunities to ascertain-if it
exist-a causative relation between the lesions of
the generative apparatus and spermatorrhcea described by Lallemand, but hitherto have failed to
observe this connection. To place this question
beyond controversy I have lately made a most
careful dissection of the sexual apparatus of a
young man dead of a double pneumonia, who was
known to have practised masturbation in an extreme degree for many years. Besides a catarrhal
* On Enlarged Prostate: Its Pathology and Treatment.
London, 1858, p. 195.




20             SPERMATORRIRHEA.
condition of the mucous membrane of the seminal
and prostatic ducts, and of the vesiculce seminales,
there was literally no lesion of these organs. I
therefore reject this position of Lallemand as untenable, and as leading to improper methods of
treatment.
The views of Lallemand in regard to the alterations in the spermatozoids, and their destruction
in advanced cases of spermratorrhcea, are hardly
more tenable than his doctrine of the structural
alterations peculiar to this disease. Liegeois,
who has examined this question, remarks: "My
own observations (six cases) are not at all in accordance with the description given by Lallemand. Azoospermia, existed in only one of my
patients. The other five, though the involuntary emissions were frequent, and  the virile
faculties had materially diminished, though the
affection had lasted from two to ten years, I have
never found any change in the aspect, the consisteney, or the odor of the seminal fluid, not even in
the number or the configuration of the spermatoza.* " This accords with my own observation.
* The Seminal Secretion in Disease. Medical Times and
Gazette, Nov. 6, 1869.




CAUSES.                    21
Spermatorrhoea is, in the view of the author, a
neurosis. Although structural alterations may
be coincident, they are not causative. It is certainly true, however, that lesions of various parts
of the generative organs may increase that disorder of their nervous apparatus which finds expression in frequent involuntary seminal losses.
In order to a just comprehension of spermatorrhcea, our inquiry must start from the physiology of the normal coitus. The seminal ejaculation -is a reflex act.  The sensation excited by
friction of the erect and turgid male organ is
transmitted to the cord, and the impression is
reflected over the testes, vesiculke seminales, urethra, and appended muscular apparatus, producing the seminal ejaculation. The whole constitutes the venereal orgasm.*   It approximates
in many of its phenomena to epilepsy, and is
accompanied in some persons with an epileptiform seizure. This is more particularly exhibited
* Carpenter's Physiology, 5th ed. p. 794. Kirke's Physiology, p 411. On this point the reader may consult with
great advantage the elaborate work by Luys entitled Recherches sur le Systeme Nerveux CBrebro-Spinal, sa SBtructure
ses Fonctions et ses Maladies. Paris, 1865, pp. 296 and 339.




22             SPERMATORRHEA.
in the act of masturbation, in which the excitation of the genital organs is more intense, the
imagination more inflamed, and the orgasm more
profound. There is a great expenditure of nervous force in a single act of coitus-much more
so in the unlawful excitation-manifested by the
languor, weakness, and mental feebleness which
occur for some time afterwards. Of course, these
effects will be experienced in a much greater degree when the orgasm is frequently repeated.
The generative apparatus of the male and
female has a very intimate relation with the nervous system.  It is the impression which the
individuals of each sex make upon the organs of
sense that excites those desires which have coitus
for their object.  There is a corresponding influence of the genital organs upon the nervous
centres; for when semen accumulates in the reservoirs, the organs of generation transmit an influence to the cerebro-spinal centres, giving rise
to sexual desire.
"The glans penis," says Kobelt,* " is the principal point of reunion of the sensitive nerves of
* De'cppareil du sens gkeital. Strasbourg: 1851; quoted
by Luys.




CAUSES.                 23
the virile organ; no other part which it regulates can be compared with it in this respect.
In respect to richness in nerves, the glans penis
yields to no other part of the economy, not even
the organs of sense." According to Kobelt,'* the
division of the dorsal nerve of the penis, in the
most powerful and erotic stallion, deprives the
animal of sexual desire as completely as castration.
"Anatomically  regarded,"  says  Handfield
Jones, "it is very remarkable how closely the
different nervous centres, or parts of a nervous
centre, are connected by commissural fibres; and
from a pathological point of view, the same connection is very manifest. The general exhaustion induced by excess in venery; the production
of neuralgia in weakly persons by bodily exercise; the effect of muscular exertion in causing
drowsiness-are examples which show how excessive consumption of nerve-force in one part
weakens it also in others," etc.
Experience has abundantly shown that the
lesions resulting from  masturbation are those
due to expenditure of nervous force and derange* De l'appct1eil  duz sens g#nital. Op. cit., as quoted by
Luys.




24             SPERiMATOIRRH(EA.
ment of the intimate and harmonious relation
existing between the sexual system and cerebrospinal centres, and not to a mere loss of seminal
fluid; for under no other circumstances is so
small a discharge from the body accompanied by
such serious results. This conclusion is further
strengthened by the more important effects which
follow  masturbation  than  spermatorrheea, although the mere seminal loss in two cases may
be exactly equal.
A marked feebleness of the intellectual faculties is observed after abuse; other parts of the
nervous system also participate in the debility of
the encephalon. The organs of sense, especially
that of vision, lose their sensibility to their appropriate stimuli, and their functional activity is
lowered.
By masturbation, by excesses in venery, a
condition of hyperaesthesia of the glans and
urethra is induced, and the reflex act of ejaculation becomes abnormally excitable.  Under
these circumstances erotic ideas are readily experienced, and so promptly does the reflex function of the cord respond, that the seminal loss
nmay occur without a decided venereal orgasm.




CAUSES.                 25
This is the essential pathological condition in
spermatorrhcea.  By frequent involuntary losses
a habit is induced, and power diminishes.  This
idea has been well expressed  by HIandfield
Jones:
"It seems a well-established  fact that the
nervous tissue, both in the centres and in the
peripheral extensions, becomes more excitable
and mobile in proportion as its power becomes
weaker. The motor nerve is more readily thrown
into action, though the impulse it communicates
is weak, and cannot be long sustained." *
The physiological origin of spermatorrhcea
must not be overlooked.  As I have already indicated, adults in full health have emissions,
when continent, more or less frequently, according to their sexual peculiarities. This spontaneous evacuation is an effort of nature, under
these circumstances, to supply the lack of use of
a physiological function. That such occasional
loss is physiological rather than pathological,
seems confirmed by the good effects which ensue
from it upon the mental and physicaF constitution  of the individual.   The inquietude  of
* Functional Nervous Diseases, op. cit., p. 48.
2




26            SPERMATOIRRHEA.
mind, the headache, and the hebetude of body
which are experienced anterior to the evacuation become relieved thereby; the munscular
movements are then more easily executed; the
headache ceases, and the mental operations are
more rapid and clear. In some subjects, however, these evacuations may become so frequent
and excessive as to constitute a pathological state.
This occurs in clergymen, in studious persons of
sedentary habits, and in those whose nervous
apparatus has been deranged by dyspepsia. The
excessive use of such stimulants as coffee and
tobacco by continent persons who have weak
digestion, slight muscular development, and a
preponderating nervous system, powerfully contributes to the conversion of a physiological into
a pathological spermatorrhcea.
obral. —Foremost amongst the moral causes
must be placed the indulgence in lascivious
thoughts, which acts by maintaining a state of
turgescence of the sexual apparatus.
Duri~g this condition of excitement semen is
abundantly secreted, and accumulating in the
vesiculaw seminales, must find an outlet by the
nocturnal loss. Frequent repetition of this ex



CAUSES.                 27
citement induces that condition of irritability of
the sexual organs, the essential cause of spermatorrhmea. Similar to this in all respects is the
effect of that venereal excitement caused by
taking liberties with the opposite sex without
the gratification of desire. The intimate relation
which exists between parties "engaged to be
married,"'if long continued, frequently produces
the same condition of genital weakness.




28            SPERMATORRHICEA.
SYMXPTO[S.
The signs and symptoms of spermatorrheea
may be divided into the objective and sudjective;
the objective being those which are recognised
by the physician; the subjective those of which
the patient himself only is conscious. It is not
always possible to separate the symptoms due
to masturbation from those of spermatorrhcea.
There is a practical utility in placing them side
by side for the purpose of comparison. The two
conditions are so frequently united, and the connection between them of cause and effect so intimate, that the symptoms of both may be comprehended in the experience of the same individual.
It is to be remarked that the voluntary semninal
losses by unnatural means are much more active
in producing the various secondary phenomena
of this disorder, than the involuntary. The former are manifested, also, by more positive objective signs.
OBJECTIVE SYMPTOMS DUE TO MASTURBATION.
Objectively considered, the masturbator is recognised by a marked facial expression, by a charac



SYMPTOMS.                29
teristic mannerism, and by a peculiar mental
state.
The facial expression consists of a pale and
sallow tint of the skin; unusual development of
acne, especially on the forehead; a dark ciiecle
around the orbits;. dilated and- sluggish pupils;
lustreless eyes, and an oblique line extending
from the inner angle of' the lids transversely
across the cheek to the lower margin of the
malar bone. The face has a haggard, troubled,
furtive expression.  These signs of themselves
are by no means conclusive, for they may be produced by- other causes than masturbation. This
observation is especially true with respect to
acne. This eruption occurs at puberty, more or
less abundantly'in different temperaments; and
hence it would be very unjust to accuse young
men of practising onanism  in whom  no other
evidence of the fact' existed than the presence of
this eruption.
The manner of the masturbator is peculiar.
He is listless, shy, retiring, and easily confused;
he avoids society, preferring solitude; there is a
want of steadiness and decision in his locomotion; his inferior extremities seem, deficient in




30            SPERMATORRHIEEA.
power, and all his movements betray a mind ill
at ease.
His mental operations are confused; his speech
is embarrassed, awkward, and without directness; his memory is defective, and he is absentminded and given to reverie.. If the habit has
long existed, and been excessively frequent in
repetition, epilepsy may be produced; or serious
mental disorder, as delusional insanity, dementia,
etc., may occur.
The state of the genital organs varies with
the length of time the habit has been indulged.
In some young subjects, there will be observed
an extraordinary development of the organs,
owing to premature excitement; but the disproportion is not maintained. With the progress of
the habit the penis becomes relaxed, the erections feeble; the corpora cavernosa either atrophy
or their vessels lose their tonicity, whereby an
apparent diminution.in bulk takes place; the
corpus spongiosum and the glans also shrink, so
that the prepuce appears unnaturally elongated.
The testes may increase in size, become tender
and "irritable," or they may undergo a certain
degree of atrophy; the latter is the more usual




SYMPTOMS.                31
result. In addition to these signs; a strong and
sometimes overpowering spermatic odor is observed about these parts, and may diffuse itself
in the atmosphere around the patient.
SUBJECTIVE SYMPTOMS DUE TO MASTURBATION.Pains in the lumbar region, a sense of weight
and aching in the loins, around the anus, and in
the testes, are experienced. The appetite is capricious, the digestion feeble, and the bowels are
constipated,. or constipation alternates with diarrhcea.
The mind is deficient ill power of attention;
the imagination  is constantly pervaded.with
vague erotic dreams, the moral sense is.blunted,
and the perceptions are dull and confused.
Pains in the head, in the occipital and frontal
regions, and a sense of fulness, and in serious
cases alarming  vertigo; pains. in the course
of the principal nerves, and an extreme nervous
susceptibility are experienced. The organic nervous system  manifests a functional disturbance
in harmony with the disorder of the nervous systemn of animal life.  Gastralgia and abdominal




32             SPERMATORRH(EA.
pain and uneasiness are in some cases very distressing symptoms.
The distinctiveness of' the foregoing symptoms
will be determined by'the'extent and duration of
the habit, and by the constitutional peculiarities
of the patient. The more highly developed the
nervous system, and the more it preponderates
in activity over the muscular and digestive systems, the more serious the effects.
OBJECTIVE SYMPTOMS OF SPERMATORRIH:EA.These are in many respects similar to those due
to masturbation. The same cause, indeed, is in
operation, but is much less powerful.
The facial expression is not so marked. Acne
is not common. The discoloration of the eye-lids
is decided only in cases of very frequent seminal
loss. The face is usually pale, sallow, and thin,
anxious or sad in advanced cases. The manner
is more or less retiring, subdued, and melancholy.
Effeminacy, and sometimes extreme pusillanimity,
are observed. Society is distasteful, or is absolutely avoided. Memory and power of attention
are defective, and the patient is subject to fits of




SYMPTOMS.                33
depression and melancholy, and is absorbed in
the contemplation of his infirmity.  These mental
effects are frequently greatly disproportioned to the
real importance of the malady; they are increased
by popular workls on this subject, for the perusal
of which these patients have a prodigious penchant. They imagine themselves possessed of
every infirmity portrayed in these works, and are
not unfrequently driven to the verge of insanity
by their apprehensions. Hypochondria is a very
constant mental symptom; but true mental alienation is not, by any means, so frequently observed
as in masturbation.
The genital organs are relaxed, the scrotum
pendent, the veins of the spermatic cord varicose,
the erections deficient in power and duration, and
the seminal fluid is thin, watery; the spermatozoa
are deficient in size and activity, and are imperfect in development.'The urine is pale, of low
specific gravity, and loaded with urates. An
evident feebleness of the general system exists,
manifested by a quick, weak pulse, cold hands
and feet, hurried respiration, and loss of flesh and
muscular vigor.
2*




34            SPERMATORRHIEA.
SUBJECTIVE SYMPTOMS OF SPERMATORRHCEA.
Weakness in the back and pain extending upwards to the scapula; pain along the spermatic
cord, in the hips, around the anus, and pain in
micturition, are experienced by the patient. He
has a variable appetite, and suffers from dyspepsia, borborygmi, constipation, and diarrhzea. He
complains of weakness in the knees, with pain and
soreness of the calves, and loss of power in the inferior extremities. His sensations in these parts
may be perverted. He has also headache, or a sense
of fulness in the head; he can fix his mind on any
subject with difficulty; his attention wanders, and
he is given to day-dreams and to erotic visions.
The importance of the foregoing symptoms will
be governed by the frequency of the spermal
losses. They are felt in the greatest intensity on
the morning succeeding the nocturnal emissions.
The essential symptom in spermatorrhcea is the
occurrence of seminal losses. Lallemand, and
succeeding writers following him, divide these
into nocturnal and diucrnal pollutions. The nocturnal occur at night in an erotic dream, with a
more or less decided venereal orgasm; and their




SYMPTOMS.               35
importance, in a pathological point of view, will
be wholly determined by the frequency of their
occurrence, and the evident derangements of the
organism which precede or accompany them.
The diurnal pollutions, according to Lallemand,
occur principally in micturition and defecation;
passively in some subjects, owing to a superabundance of semen in the vesiculae seminales; in
others with a certain pleasure and a definite ejaculation; and in others, habitually, without sensation, with a feeble or scarcely perceptible ejaculatory effort. The first variety can hardly be regarded as pathological.
It is peculiarly unfortunate that these views
of M. Lallemand, with reference to diurnal pollutions, have obtained such general credence. The
minds of patients become so impressed with the
conviction that every mucous flow from the urethra
is seminal, that it is difficult to overcome it. They
parade this symptom and dwell upon it, believing
that it has the pathological significance which
Lallemand and his followers have ascribed to it.
The various symptoms of spermatorrhcea may
be comprehended in three groups: genital; cerebral; spinal.




36             SPERMATORRHCEA.
In the first, or genital form or phase, which is
the most common, there are excessive sensibility
of the sexual apparatus, and greatly increased
reflex excitability of the cord.
In the cerebral form there are associated with
the preceding condition certain disorders of the
mind-melancholia, delusional insanity, and mania.
In the spinal form the functional derangement
of the cord is either excessive and pronounced, or
has resulted in organic lesion.
I.-GENITAL FORM.
The sexual organs are relaxed; the testes tender, painful, and sometimes wasted; the erections
feeble and the seminal flow  watery.  Slight
causes —an erotic idea, gentle friction, a voluptuous dream-will produce a feeble erection followed by a quick emission with but little sensation. Whenever an erection and an emission occur, there is an evident orgasm, but not nearly
so pronounced as in the normal state. After
every erection without seminal loss, there is a
mucous flow from the urethra. A nmixture of
this mucus with the semen produces the so-called




SYMPTOMS.                37
watery semen. The same mucous discharge is
not unfrequently observed after urination and
defecation. It alarms the patient, because he has
been led to believe that it is seminal.  These are
the cases to which M. Lallemand' applies the term
" diurnal pollution."  If a proper examination of
this fluid be made, it will be found not to contain
spermatozoa. It is a thick, transparent, albuminous fluid, alkaline in reaction, and presents
under the microscope the cellular elements noted
in Fig. 1. We need hardly remnark that the presence of spermatozoa (Fig. 2.) is essential to prove
the existence of semen.' No other test is at all
applicable to the determination of this question,
than the microscopic. It cannot be denied that
spermatozoa may be found in the urine or mucous
secretion from the urethra, if a nocturnal emission, or an emission produced by natural or unnatural means, have recently occurred; but these
fluids should be examined, when this source of
error may be eliminated. We are glad to have
an opportunity of quoting in support of our
opinion so able an observer as Prof. Flint,* who
* Practice of Medicine: H. C. Lea. Phila., 1866.




38             SPE]EMATORRH(EA.
remarks on this subject-" In the most of these
cases the fluid is either the liquor prostaticus or
a secretion from  the vesiculhe seminales.  The
microscope affords the. only mode of determining
that the fluid is seminal. Were this mode of examination generally adopted, cases of spermatorrhcea would be extremely rare."   We  quote
further some excellent remarks on this subject
from IHassell:   "Care must be taken not to confound the discharge of urethral gleet with the
seminal fluid; the distinction is easy, since the
former is distinguished by the absence of infusoria, by the presence of scaly epithelium, and by
the escape being in general continuous. Sometimes the gleety discharge occurs only after sexual
excitement and lasts but for a short time, when,
of course, its character is more apt to be
mistaken.  The prostatic fluid might also be
mistaken for semen; in this the spermatozoa
would also be absent, and in addition, the microscope would reveal in it the presence of the prostatic cylinders, and perhaps, also, of the peculiar
lamellated concretions of phosphate of lime, which
* The Urine in Health and Disease. London: 1863.




SYMPTOMS.                  39
are found in the prostate in such numbers.  Like
the mnucus from  ordinary gleet, that from  the
prostate may also be continuous, but more friequently it appears only after violent efforts at defecation, when a small quantity of matter may be
expressed, forming only a drop or two, of a thick,
stringy, and transparent fitlid, which appears at
the orifice of the urethra."  Dr. Chambers, in
a lecture delivered at St. Mary's Hospital, expressed his conviction that this mucous flow
from the urethi'a has no more pathological significance than the leucorrhcea of woman. He further
asseits that true spermatorrhcea is a rare, almost
unknown disease, but he evidently here refers
to that constant stillicidium of semen to which
Lallemand gave the name diurnal pollutions, and
which many writers consider, but erroneously,
the  true  spermatorrhcea.  Again, Dunglison t
says, " the presence of such a fluid in these circumstances, by no means shows that it is sperm.
* Lecture on Gonorrhcea and Imaginary Spermatorrhcea.
delivered at St. Mary's Hospital, June 14, 1861. Lancet,
1861.
f Cyclopaodia of Practical Medicine. Aim. Ed., Vol. II.
p. 212.




40             SPERMATORRHEA.
Indeed, it probably rarely is so, and is nothing
more than the mucous fluid from the prostate or
Cowper's glands."  It seems a labor of supererogation to multiply authorities on this point.
There can be no question that this mucous fluid is
derived from the prostate, vesiculoe seminales, Cowper's glands, and from the follicles of the urethra.
The frequent excitement accompanied by increased blood supply, to which these parts are
subjected, must induce a greater secretory activity in their glandular appendages. Hence we
should expect to find blennorrhagia in cases of
masturbation or spermatorrhoea.  The urethra is
red, injected, and exceedingly sensitive, and considerable irritation is referred to the region of the
neck of the bladder and prostate gland. No other
anatomical lesions can, with propriety, be attributed to spermatorrhcea. If any other be present, they are merely accidental or accessory and
not essential. In this category may be placed
those lesions described by Lallemand: thickening and stricture of the urethra, ulceration of the
seminal ducts, suppuration in the prostate, etc.




SYMPTOMS.                41
The phenomena of the genital form will be
better exhibited by an illustrative case.
CAsE I.-This was a patient, aged 32, who had
practised masturbation with great frequency as a.youth, but on learning the evil consequences had
resolutely abandoned the habit. He afterwards
suffered from frequent nocturnal emissions, and
had, finally, such sensitiveness of the genital
organs, that the slightest excitement produced a
feeble erection and ejaculation. After micturition and defecation he had a thick, tenacious discharge, which gave him great concern. He had,
also, considerable irritation of the bladder, pain
and aching about the anus, in the back and loins.
He was pale and thin; his appetite was capricious,
and he suffered much from constipation, pain in
the abdomen, borborygmi, and flatulence. His
pulse was quick; hands and feet cool and damp.
HIis special senses were unimpaired; he had no
mental aberration in any form; he was despondent and brooded over his sexual condition, fearing impotence. Although more easily fatigued
thanusual, he was still capable of very considerable exertion. His sexual desire was not materially lessened, for he had contracted a marriage




42            SPERMATORRH(EA.
engagement with which he feared to comply. His
fears had been aroused by advertisements in the
newspapers and. popular works on his malady,
for the reading of which he had the usual propensity. His organs were not materially damaged.
The prepuce was long and the penis lax; the
left testis was somewhat atrophied, owing, probably, to a varicose condition of the veins of the
cord on that side.
The cases of the genital form of spermatorrhlea
vary very much in importance. They occupy all
possible intermediate gradations between the pale
and emaciated subject who suffers from nightly
pollutions and severe gastric and cardiac symptoms, and the plethoric subject whose weekly
nocturnal loss is an expression of a necessity of
his sexual nature.
II.-CEREBRAJ, FORM.
The most serious mental effects are produced
by masturbation. This vice, commenced at the
period of puberty, interferes seriously with the
development of the brain and the evolution of
the mental faculties. We have already seen that
this sad habit is contracted by those in whom the




SYMPTOMS.                43
nervous apparatus predominates in activity over
the muscular and digestive, and in whom the
imaginative faculties are more highly cultivated
than the reason and judgment. The mental
effects of spermatorrhcea are also marked in those
cases which we have denominated the cerebral.
It is to be remarked that the mental phenomena
of spermatorrhcea are not always in proportion to
the seminal losses. In the cerebral form, in addition to those lesions of the sexual spinal system,
of the digestive apparatus, and of the circulation,
described under the genital form, there are certain
disorders of the mind. That spermatorrhcea will
produce in one class of cases mental disorders,
and not in another, indicates either that some
predisposition to these disorders existed, or that
the habit of self-pollution was merely an expression of mental alienation. The lascivious images
which pervade the minds of boys possessed of the
highly developed nervous organization of masturbators are those of delusional insanity. In one
case the spermatorrhcea is a symptom of mental
disorder; in the other, the spermatorrhcea is an exciting cause-the predisposition already existing.
There is, however, a cerebral phase of sperma



44            SPERMATORRIHgA.
torrhcea which may be separated from the two
preceding classes. It is characterized by indis-'
tinctness of vision, dilatation of the pupil, amblyopia, diplopia; diminution in the sensitiveness
of the auditory apparatus; feebleness of voice;
mental preoccupation, hebetude of mind, confusion of ideas, and a profound melancholy.  "Patients who have been laboring under spermatorrhcea for a series of years are much more liable
td hypochondriasis and cerebral affection than'
to tabes dorsalis," says Romlberg.*  Not only do
long-continued and excessive seminal losses produce these cerebral symptoms, but they may
occur in those unhappy individuals who have
acquired very false and highly-colored views of
their condition from popular works on the subject. The termination of such cases is in suicidal
monomania, delusional insanity, etc.
In that variety of the cerebral form in which a
decided predisposition must be admitted to exist,
to disorder of the intellectual faculties, there are
found various forms of mental alienation. The
chronic -form is the most common, which cor* Vol. II., p. 400.




SYMPTOMS.                45
responds to the mnelancholia of Pinel, or the lypemzania of Esquirol, terminating  in dementia.
Several of the most characteristic cases which
have happened under my observation correspond
to the delusional insanity of Bucknill and Tuke. *
Many writers are disposed to underrate the importance of this tendency in spermatorrhcea. To
the influence of quack advertisements and popular works, which, of course, greatly exaggerate
the evils of this disease, is ascribed the melancholy, the hypochondriasis, and other mental
disorders which occur in the course of it. The
statistics of any of our large insane asylums will
illustrate the influence of masturbation in the
production of mental alienation.  We have already given the opinion of Rornberg on this
point. Mr. Holmes Coote, in a discussion which
followed Dr. Drysdale's paper on the "Medical
Aspects of Prostitution," read before the Harveian
Society of London, remarked that A" he still entertained the opinion that there were worse evils
appertaining to human weakness than prostitUtion.  Hte had opportunities of witnessing the
fact that among the young there was no cause
* Manual of Psychological Medicine. Phila. Ed., p. 103.




46             SPERMATORRHCEA.
of insanity more common than indulging  in
habits which he would not further particularize,
but -which were known to result in the most complete bodily and mental prostration." * Dr. John
P. Gray, the distinguished Superintendent of
the State Asylum  at Utica, New York, thus
speaks t of the influence of masturbation in the
production of insanity:-" The records of this
institution show five hundred and twenty-one
cases admitted directly attributable to this vice,
and I aml well convinced that the number is
greatly understated." We might add confirmatory testimony from a variety of sources, but the
foregoing is sufficient for our purpose.
The cerebral form is exhibited in'the following
typical cases:
CASE ii.-Was a young man admitted to St.
John's Hospital as a private patient; met. 30;
five feet five inches high; leuco-phlegmatic temperament; beard scanty; hair thin. At the time
of admission he could not give a rational account
* British Medical Journal, Feb. 17, 1866.
t Twenty-fourth Annual Report. 1867.




SYMPTOMS.              47
of himself. His eye was wild; pupil very much
dilated; face pale, thin, and haggard. He walked
unsteadily because of disturbance of cerebral circulation; he was "dizzy."  At night he was
given up to various hallucinations; he did not
sleep, but spent the night in talking in a wild
and incoherent mariner, in wandering about his
room, and beating upon the walls. During the
day he was quiet, but his conversation was disconnected, his ideas wandering, and his speech
confused. His appetite was capricious, his bowels
constipated, and he had suffered greatly from borborygmi and abdominal pain. From his brother
it was ascertained that he had been greatly
addicted to natural and unnatural venereal excitement, and had suffered lately from frequent
involuntary losses.  The state of his genital
organs confirmed this.
CASE IIi.-W- as similar to the preceding-a
young man who had passed several years in the
military service, during which time he had indulged very freely in the vice of masturbation.
He was led to St. John's Hospital by a comrade;
he could not walk without support, in conse



48              SPERMATORRH(EA.
quence, he said, of " lightness of his head."  He
had neither delirium nor hallucinations, but ]le
was reduced to a state of mental feebleness bor-'dering on dementia.  He was pale, thin, and had
little appetite; his vision was indistinct; his pupils were dilated, and his hearing was dull and
indistinct.  All of his senses, indeed, were in a
state of torpor.  He admitted a degree of selfabuse, extending over several years, too revolting
to be narrated, and had lately, after discontinuing it, suffered from a pitiable degree of seminal
weakness.*
III.-SPINAL FORM.
Impairment of locomotion and spinal paralysis
have long been associated with venereal excesses.
The progressive spinal paralysis, the tabes dorsalis
of the Germans, and the ataxie locornotrice proqressive of Duchenne, was formerly confounded
with the effects of masturbation and excesses in
venery. The differential diagnosis will be a subject for future consideration.
* Both of these cases formed the subject of a Clinical Lecture at St. John's Hospital, before the class of the Medical
College of Ohio. Session of 1865-1866.




SYMPTOMS.                49
In the spinal form of spermatorrhcea there are
weakness of inferior extremities, altered-diininished or perverted-and referred sensations, incontinence of urine and fieces, and sometimes
paraplegia. These symptoms are additional to
those described as pertaining to the genital form;
they may also be superadded to the cerebral. In
the following typical case, it will be seen that the
spinal symptoms were distinctive.
CASE IV.-A travelling showman, met. 35, came
under my care, suffering from weakness, with
perverted sensations of both inferior extremities.
He had an ill-conditioned ulcer on the right leg;
slight pressure, as of riding on horseback, induced
intractable ulcerations of buttocks and thighs.
He had also, to a limited extent, incontinence
both of urine and freces. The sensibility of the
skin, as to touch, pain, pressure, and the electric
current, was diminished.  He had a sense of
formication in his legs and tingling in his feet.
The tendo-achillis of each side was a little shortened. He volunteered the information that earlier in life he had been much addicted to onanism,
and that since the habit was discontinued lie had
suffered from firequent nocturnal emissions. His
3




5 0           SPERM.ATORRHCEA.
mental powers were unimpaired.  He had the
unavoidable depression and anxiety arising from
his very miserable physical condition, and nothing
more.
In what does the spinal lesion consist in these
cases? We have stated that the important pathological condition in the genital form of spermatorrhca- is a morbid excitability of the reflex
faculty, with congestion, probably- of the cord.
In the spinal form there is probably some structural lesion inappreciable by our ordinary means
of investigation, a, molecular change, possibly, or
the nervous phenomena are of the reflex character. We have, however, no anatomical facts on
which to base the former opinion-our knowledge
of these cases being entirely clinical; but the
symptoms and the results of treatment seem to
confirm  our view of the pathology.  Schroeder
van der Kolk,* also, has made some observations
which tend to establish the same view.  Says this
able observer: "Onanism  is commonly considered, and often correctly, to be a cause of epilepsy; but onanism and excitement of the sexual
* On the Minute Structure and Functions of the Spinal
Cord and Medulla Oblongata. Syd. Soc. Translation, p. 268.




SYMPTOMS.                51
organs are, to a greater degree than is usually
supposed, the result of irritation and congestion
of the medulla oblongata. The opinion formerly
advanced by Gall as to the localization of the
sexual impulse in the cerebellum, has been sufficiently refuted, and the close relation between
the medulla oblongata and the action of the genital organs, is generally received by physiologists.
Let it suffice to call to mind the occurrence of
erection and emission in persons hanged, how the
sexual action is exalted in idiopathic mania with
irritation of the brain and medulla oblongata;
how frequently, after injuries of the part, erection
and emission, or perhaps impotence is observed.
* * * * In the case of epilepsy I have just
recorded this influence was very evident; the
emissions disappeared for a time, when the sensibility and over irritation of the medulla oblongata
had again discharged themselves in a fit. *- *
It is but a short time since a similar case occurred
to me, of a young man who was unable to continue his studies regularly on account of epilepsy,
apparently originating in onanism. A few days
ago I received a report, that for the last three
months, after an issue had been by my advice




52             SPERMATORRI(EA.
established in the neck, neither the involuntary
pollutions, which in this case also were very frequent, nor the epileptic attacks, which commonly
returned every two or three weeks, had again
appeared, while the patient's head had become
much clearer, and he was able to continue his
studies."
On the other hand Gull relates* a case of complete paraplegia, produced by sexual excess, in
which no structural alteration of the cord could
be detected, even by the most careful microscopic
examination.  This case is justly regarded as exceptional.
* Guy's Hospital Reports, 1858, p. 174.




RESULTS.                53
RES ULTS.
I have already sufficiently shown that various
forms of mental derangement may accompany
frequent involuntary losses. I need not waste
space by recapitulating the observations on this
topic.
An ordinary result of spermatorrhcea is weakness of mind. The brain acts slowly and imperfectly because a large part of the produced nerveforce is consumed in the frequently repeated venereal orgasm. These patients are dull and listless. To accomplish a given amount of intellectual labor, they find that an unusual effort is
necessary.  They are given to reverie, and to
vague and shadowy dreams in which erotic phantasms play. They take little interest in business
and in the affairs of life, and to this cause is to
be attributed, in many instances, unexpected failure in business and professional pursuits.  They
are men of dreams instead of men of ideas and
action. This condition of the mental and moral
forces is a more frequent result of sperma



C54            SPERMATORRHE A.
torrhcea than mental derangement, properly
speaking.
I have not observed any disorder of the special
senses beyond the diminished sensibility due to
increased consumption of nerve force in the
sexual system.
The respiration becomes more or less irregular.
Frequient deep inspirations, sighing, and a dry
cough are often observed. Dryness of the fauces, especially of the posterior wall of the pharynx, and huskiness of voice also occur. I cannot say that I have observed phthisis to be produced by spermatorrhoea, neither do I believe
that such result is probable; but, on the other
hand, it is certainly true that if a tend ency exist,
hereditary or acquired, to this disease, frequent
involuntary losses may promote its development,
as indeed any cause may, which lowers the vital
forces.
Irregular action of the heart is most common.
Pains are felt in the praecordial region, the
rhythm of the heart's movement is altered, and a
subjective sense of fluttering is felt. These phenomena are frequently accompanied by a sense
of constriction of the throat-a globus hysteri



RESULTS.                55
cus-a tendency to shed tears, and the emission
of a plentiful quantity of pale urine.
The most serious results of spermatorrhcea are
those produced in the generative organs themselves. Amongst these are impotence, " irritable
testis," varicocele, and a -state of hyperoesthesia
of the spermatic plexus.  Impotence should not
be confounded with loss of procreating power.
A man is said to be impotent when he is unable.
to perform the act of coitus. Capacity for sexual
intercourse may exist without the power of procreation. The practice of masturbation, or spermatorrhcea, more usually results in impotence
than in a mere loss of procreating power.
Long-continued excitation of the generative
organs, whether by natural or unnatural means,
so inflames the imagination and exalts the reflex
faculty that emission occurs before intromission
of the male organ can take place, or after very
imperfect coitus.  The latter is the more usual
condition for which the physician is consulted.
Patients are peculiarly fearful and sensitive on
this point.  The morbid  apprehension under
which they labor, greatly increases their incompetence. In some instances, without being at all




56            SPERMATORRIHEA.
seriously damaged in their sexual function, they
are rendered temporarily impotent by the mere
dread of failure. The London quack, Dr. Graham, understood the influence of the imagination upon the sexual congress. "Amongst the
furniture of the'Temple of Itealth' was a celestial bed, provided with costly draperies, and
standing on glass legs.  Married couples who
slept on this couch were sure of being blessed
with a beautiful progeny. For its use, one hundred pounds per night were demanded, and numnerous persons of rank were foolish enough to
comply with the terms." *
The impotence of spermatorrhcea is not a permanent condition, unless serious cerebral or spinal complications have occurred.  Ordinarily,
the capacity for coitus returns with the cessation
of the seminal losses-the evidence of a healthy
functional state of the spinal cord. The loss of
procreating power is not a frequent accompaniment of seminal weakness; the difficulty is in
the intromission of the organ. Every practical
physician is cognizant of instances of men whose
*A Book about Doctors. Jeaffreson, p. 338.




RESULTS.                57
semen  had  fertilizing  power, but who were
almost incapacitated for the sexual congress, by
reason of a great excitability of the reflex faculty.
The same condition may exist as a result of
long continence in ardent temperaments. But
these cases only require a little time and familiarity with the object of desire.
Excluding from consideration those organic
deficiencies which may produce impotence, as
foreign to the purpose of this work, it will suffice
to allude to varicocele, and so-called "irritable
testes," when thev are due to sexual abuses.
It is exceedingly doubtful whether varicocele
confined to the left testis ever results in impotence. Some instances have occurred under my
observation in which this disease produced atrophy of this testis, accompanied by a painful state
of the right organ, and eventually resulting in
almost complete extinction of sexual desire. In
those exceptional and rare cases, where the varicocele is double, and atrophy results, impotence
necessarily occurs.
To the increased activity of the testes in secreting semen, has been attributed the varicose condition of the spermatic veins in spermatorrhoea.
3*




58             SPERM[ATORRHIEA.
This view  is hardly tenable.  As the varicocele
occurs on the left side almost invariably, in consequence of an anatomical peculiarity, and as it
is not a constant nor even a frequent complication, we may consider its presence, in general, as
accidental. Opposed to this view, we should not
omit mention of dir. Hutchison's * opinion, that
varicocele is of spinal origin.  Dr. Hughlings
Jacksont has reported a case which seems to
confirm this opinion of Mr. Hutchison.
The relation of "irritable testis " to impotence
is much more immediate. By this term, Sir
Astley Cooper,: to whom  we are indebted for
the most of our information on this subject, intended to express a state of hyperesthesia of the
spermatic plexus.  One or both testes are painful, sometimes exquisitely so, tender to the touch,
and occasionally swollen. The epididymis and
spermatic cord also become so painful that the
weight of the testes gives intolerable pain; and
pain is experienced in the back and loins. lNot* London Hospital Reports, vol. i., p. 77.
f Lancet, March 31, 1866.: Observations on the Structure and Diseases of the Testis.-Chapter iv. London: 1830.




RESULTS.                59
withstanding these symptoms, the testes are not
hot and inflared; the swelling is paroxysmal,
and is not accompanied by fever.  The general
health is much impaired, partly in consequence
of the suffering endured, and partly by reason of
the disturbance of the nervous and digestive systems.  The patient has a poolr appetite; he suffers from indigestion; he is hysterical and despondent, and is unable to sleep.  Impotence
is a usual attendant on this state. Venereal excesses, masturbation, and spermatorrhcea, are the
causes. At least we have frequently observed
it to accompany spermnatorrhcea, and in this case
it proved  the  most troublesome and distressing symptom.  The following case very well
illustrates the signs and symptoms of this malady occurring in connection with seminal trouble.
CASE v.-An Israelite, set. 25, was admitted to
St. John's I-Iospital, under the following circumstances: He had  been  married a week, but
proved unable to cousummate the sexual act, in
consequence of which he was placed by his
fiiends in a hospital to undergo treatment. I-e
presented these symptoms: Ile was pale and




60             SPERMATORRHI(EA.
sallow; his tongue coated; his appetite was
poor; he had much abdominal pain, especially
about the umbilicus, and he was constipated.
The testes were very tender, constantly painful,
especially when pendent, and the cord was also
painful. The testes were subject to periodical
attacks of enlargement, which lasted a few days
and then subsided, there being, however, no redness nor increased heat, but only increased tenderness. He experienced various nervous symnptorns; among others he had a well marked globus hystericu8, and he shed tears on the least
provocation. He admitted to very great sexual
indulgences for several years, which were followed by spermatorrhcea. Since the occurrence
of irritability of the testes, he had been entirely
without sexual desire. He admitted that he had
not been able to effect the sexual congress since
his marriage.*
Even when it does not result in impotence,
hyperoasthesia of the spermatic plexus produces
* This patient left the hospital after a stay of four weeks
He visited me recently, to assure me that he was restored to
sexual soundness.




RESULTS.                 61
distressing nervous symptoms of a hysterical
character.  The various pelvic pains, occurring
in spermatorrhcea, and referred to the prostate,
neck of the bladder, rectum, perineum, and
testes, are probably due to the same cause.




62              SPERMATORRHIEA.
II.
SPERMATOPRRHMA AS A SYMPTOM.
VARIOUS disorders of the nervous system, accompanied by frequent spermal losses, were, formerly, confounded with the results of seminal
weakness.  This was especially the case with the
disease known as tabes dorsalis, which in the time
of Hippocrates was assumed to be caused by venereal excesses.  In the work lDe Morbis * occurs
the following passage:
~Tabes dorsalis a sypinaci  medullca oritzr, maximze vero recentes Sponsos et libidinosos coirripit.
Febris sunt expertes, bene comedwnt, et colliquantur.  Quod si ita affectzon perconteris, dicet, sibi
videri ex superioribus partibtus a capite velut
formicas in spinacm descencdere; quumque urintzan
anut sterceus reddit, ipse semen yenitale copiosutn
et liquidum _prodit; necque genitura intus con* Dr. Adams, the learned author of the Sydenham Society's edition of the works of Hippocrates, thinks the book
De Morbis emanated from the Cnidian school.




SPERMIATORRII(EA AS A SYMPTOM.         63
cipitur et &nter dorm'iendum curm  uxore dorrmiat,
nec ne semen prof  nldat, etc.  (Lib. ii., cap. 19;)
Celsus also alludes to similar effects produced
by nimir profusio  seminis which tabe kominem
Under the same designation similar effects have,
since the time of Hippocrates, been ascribed to
masturbation and venereal excesses by various
German, French, and English writers. By Rtomberg,t however, the term  " tabes dorsalis" is
restricted to a nervous disease, identical with the
progressive locomotor ataxia of Duchenne. On
the other hand, so recent an authority as Dr.
i/leryon T adheres to the ancient idea of tabes dorsalis, defining it as a " tractable form of paralysis, not unfrequently seen in youth  and early
manhood, which may be traced to the vicious and
enervating habit of masturbation."
In progressive locomotor ataxia there occurs a
peculiar degeneration of the posterior columns of
a De Medicina, lib. iv., p. 187. Edit. Milligan, Edinburgh:
1831.
t A Manual of the Nervous Diseases of Man. Edition of
Syd. Society, translated by Sieveking, vol. ii., p. 395.
t Practical and Pathological Researches on the Various
Forms of Paralysis, p. 44. London: 1864.




64             SPERMATORRIHEA.
the cord: a gelatiniform degeneration of the nerve
fibres and a hyperplasia of the intervening connective tissue. " Progressive abolition of co-ordination of movements and apparent paralysis,
contrasting with integrity of the muscular force,
are the fundamental characteristics," says Duchenne, * of this disease. According to this author, it is divisible as respects its symptomatology into three periods:
" 1. Characterized by three symptoms-pains,
ocular troubles, and anaphrodisia; 2d, by disorders of motility and of sensibility in the inferior
extremities; 3d, the extension of the same symptoms to the upper extremities." Before anaphrodisia, and the disorders of volnntary movement,
symptoms referable to the generative organs are
present.  These symptoms are satyriasis and
spermatorrhcea.  In five cases of progressive locomotor ataxia, of which I have preserved full
notes, more or less decided increase of the sexual
appetite occurred in the inception of the disorder.
Involuntary seminal losses are observed at the
same time, and they attract the attention of the
* De l'Electrisation Localisee, etc. Deux. Md. Paris:
1861, p. 547.




SPERMATORRIICEA AS A SYMPTOM.          65
patient more than any other symptom then present. It is in consequence of this fact that progressive locomotor ataxia was so long confounded
with the results of excesses in venery. Trousseau* has especially called attention to these sexual symptoms which attend upon the first stage
of this singular affection.
In some observations on this topic, Topinard t
thus speaks of the symptoms in progressive locomotor ataxia, belonging to the generative organs:
"Four symptoms present themselves: spermatorrhcea, satyriasis, anaphrodisia, and impotence.
The first occurs amongst the most renlote antecedents of the first period, throughout which it
continues. The nocturnal pollutions, at first accompanied by erections and a sensation of pleasure, at last become passive.  After the spermatorrhtca, or without having been preceded by
it, there occur after some months or years, progressive diminution of desire, difficulty in pro* Clinique Medicale de 1'Hotel Dieu de Paris. Tome
Deux., p. 534, et seq.
f De l'Ataxie Locomotrice et en particulier de la Maladie
appelee Ataxie Locomotrice Progressive. Paris, 1864, p.
171.




6 6           SPERMATORRHCEA.
curing satisfaction, and at last absolute impotence."
Eisenmann reports a case (Topinard) in which
priapismn existed thirty years. " During thirty
years of his life, priapism  had tormented this
patient, and was only calmed by continually increasing and enormous doses of opium."
In order to exhibit the relation of the genital
symptoms to the other phenomena in cases of
progressive locomotor ataxia, I subjoin an analysis of the symptoms of the first period in the five
cases of which I have preserved notes:
The disease commenced in No. 1, at 35. He
is 5 feet 6 in. in height; has a light complexion,
light auburn hair, blue eyes, and the lymphatic
temperament. The first symptoms manifested
themselves in No. 2, at 40 years of age; he is
now 65. I-e- is 5 feet 8 in. in height, of nervous
temperament; has blue eyes, and his hair, now
gray, was originally auburn. No. 3 experienced
the first symptoms at 43; he is now 46. He
has also a fair complexion, blue eyes, and light
auburn hair. [No. 4 was 42 years of age when
he began to experience the pains; lie is now 45.
He is 5 feet 10 in. in height, and has a dark




SPERMATORRHICEA     A SYMPTOM.   67
complexion, dark eyes and black hair.  No. 5
experienced his first symptoms at 37, ten years
ago. He has reddish hair and beard, blue eyes,
and a strongly marked nervous temperament.
No. 1 had satyriasis, spermatorrhcea, tingling
and numbness of the feet and legs, and ainaurosis
and double vision. The satyriasis was soon succeeded by anaphrodisia and impotence.  The
dimness of vision and the double vision suddenly
disappeared at the commencement of the second
period. He did not experience those peculiar
pains so commonly present in this disease. The
whole duration of the first period, commencing
with the satyriasis, was only three months. The
symptoms of the first period in No. 2 were similar in character, but extended over a much
longer period. The state of the sexual appetite
in the beginning could not be accurately ascertained, but anaphrodisia soon occurred, and absolute impotence was the final result.  Violent
pains, supposed to be rheumatic, preceded the
other symptoms. These pains are localized in
the inferior extremities, and especially in the left
hip, so that disease of this articulation was suspected. No derangement of vision occurred at




638           SPERMATORRtEMA.
any period. No. 3 experienced, for more than a
year, sharp pains in the extremities, and also
deep-seated pains in the trunk, before the ataxia
manifested itself. These pains, being sudden in
onset, fugitive in character, and irregular in their
recurrence, were supposed to be neuralgic. A
decided decrease in sexual desire, and imperfect
sexual congress were observed, but complete anaphrodisia did not occur. Dimness of sight, but
no other ocular trouble, has thus far been present
in this case. In No. 4, two years of neuralgic
pains preceded the other symptoms. The pains
had the two characters so frequently noticed in
this disease: the first, deep-seated, dull, and
heavy, pretty nearly constant; the second, sharp
and sudden, temporary.  The dull and heavy
pains experienced in the lumbar region, in the
thighs, and in certain parts of the trunk, preceded the others, which attacked the legs and
thighs. No ocular derangement occurred in this
case. Spermatorrhcea, anaphrodisia, and impotence, however, were experienced early. No. 5
began to have pains in the lumbar region in
1857, and soon after severe attacks of neuralgia
along the course of the sciatic. These were suc



SPERMATORRH(EA AS A SYMPTOM.      69
ceeded by sharp, sudden, and fugitive pains in
both inferior extremities.
The patient compares these pains to electric
shocks. Anaphrodisia and spermatorrheea did
not occur until two years after the pains had
been experienced. He admits that at the present time he is completely impotent. Derangements of vision manifested themselves in two
years after the commencement of his malady.
These consisted in amblyopia and double vision.
They disappeared suddenly —in a night, he saysafter continuing for several months.
After the first period has passed there can be
no difficulty in coming to a conclusion as to the
relation of the spermatorrhiea to the other phenomena.
Various other affections of the nervous system
are accompanied by involuntary seminal losses.
Diseases of the medulla, cerebellum and pons, of
the spinal cord, epilepsy, chronic mania, may
have this as a more or less pronounced symptom.
In the early stage of diabetes, before impotence
results, spernmatorrhcea is sometimes present.
In all cases in which the involuntary loss is a
symptom merely, it is of little consequence from




70            SPERMATORRHCEA.
the therapeutical point of view; the centric
lesion, of which it is a sign, is the point of
importance to which our attention should be
directed.




IMAGINARY SPERMATORRHEA.         71
III.
IMA GINARY SPEtRIA TOBIRHtEOA.
IT is important to bear in mind that involuntary seminal losses, to constitute a disease, should
occur with sufficient frequency to produce definite
symptoms. Many patients who come to a physician for advice and treatment for this affection,
are not really suffering from the'seminal losses,
but from an imaginary ailment.  Experiencing
an occasional seminal loss, and ignorant in regard
to the physiological condition, they imagine themselves the subjects of spermatorrhcea. Brooding
over their presumed " weakness,' they fall into a
hypochondriacal state, and soon experience the
whole train of wretched symptoms depicted in
popular works on the subject. Every subjective
sensation, lio matter what its origin, is referred
to the debilitating effects of the spermal losses.
As an evidence of the attention which these aptients give to their sensations, and of their mental
and moral peculiarities, I subjoin a written state



72            SPERMATORRHCEA.
ment handed to me by one of them, on presenting
himself at my consultation-rooms:
"Ringing in my ears occasionally.
"Fulness and weight in stomach at all times.
" Considerable wind in the stomach.
" Want of strength in thighs and groins.
"Dull, heavy feeling in back of head at night
and after dinner.
" Drowsiness after supper, so that I cannot read.
" Great want of clearness and want of strength
of vision.
" Weakness of voice, and sometimes thickness
of speech.
"Very sensitive to the least rudeness, and very
apt to become nervous and low-spirited from
being harassed or worried in any way.
" Heart palpitates somewhat violently at times.
"Digestion is very imperfect.
"Dryness of the scalp.
"Have been very subject to having boils on
my legs, which always were of a dry nature.
"' Apt to have pimples on forehead and neck."
All of these symptoms he referred to seminal
emissions, occurring at intervals of three weeks.
His health was robust, and he was actively en



IMAGINARY SPERMATORRHCEA.         73
gaged in business; but the corners of his mouth
were depressed, and his countenance had an air
of deep dejection.
Cases of this kind are very numerous, and
difficult to manage. No explanation or demonstration satisfies them.  One apprehension allayed, they quickly take up another, returning at
last to the sexual disorder. They exhibit a real
pleasure in dwelling upon this infirmity, and in
talking with endless iteration over all the disgusting details connected with it.
Certain masturbators, struggling to free themselves from the trammels of the vice, but too
weak of will to resist it wholly, please themselves
with the delusion that the act is involuntary,
because it is indulged in during the dreamy consciousness of the half-waking state. They consult the physician under the guise of having
involuntary evacuations.
4




74             SPERM ATORRH(EA.
IV.
TREATMENT.
A  CORRECT view  of the pathology of spermatorrhcea is necessary to its successful curative
treatment.
If spermatorrhcea be a purely local disease-an
inflammation and ulceration of the prostatic portion of the urethra-local treatment only will be
required.  If, however, the essential condition
consists of an increased reflex excitability of the
spinal cord, due to frequent peripheral irritation seated in the urethra, then the local must be
regarded as accessory to the general treatment.
The relative importance of these two views as to
the causation of the disease, should be definitely
ascertained. A particular plan of treatment is
followed by the adherents of each view. A wise
therapeutist will not reject whatever is beneficial
in either plan.
THE LOCAL TREATMENT consists in the application of the porte caustique to the prostatic portion
of the urethra; the use of injections of the nitrate
of silver, sulphate of copper, acetate of lead, etc.;




TREATMENT.                75
certain mechanical expedients; the internal administration of copaiba, cubebs, and other remedies of this class; cold hip-bathing, and injections of cold water into the rectum, etc. The
most important of these measures is the use of
the porte caustique. This instrument has been
largely employed since its introduction for this
purpose. Few practical surgeons at the present
day will assent to the dictum of Lallemand, that
"two-thirds of the cases of spermatorrhcea would
be beyond the reach of medical assistance, if it
were not for the good effects produced, by the application of the nitrate of silver to the prostatic
portion of the urethra."
It is very desirable, however, to ascertain its
real importance and the limits of its application.
The Porte Ccwastique. —This instrument, which
is so closely associated with the name of Lallemnand, had an existence long anterior to his employment of it. Ambrose Pare devised an instrument for cauterizing the urethra, which is the
progenitor of' the modern instruments for this
purpose. It consisted of a silver canula and a
stylet of the same metal, having at its' extremity
a tampon of linen which was dusted with pow



'76             SPERMATORRIHEA.
dered caustic.  Loizeau is said to have cured
King Henry IV. of France of an induration of
the urethra (organic structure) with a similar instrument. Wiseman, of England, and afterwards Hunter, employed the nitrate of silver in
a porte caustique, but the latter substituted a
caustique  holder for the linen tampon.   Sir
Everard Home * was a warm  advocate for the
proceeding of Hunter.  The instrument of Ducamp was the more immediate progenitor of Lallemand's.  It was a porte caastique composed of
a gunm elastic canula, the stylet being an ordinary
bougie, and of a. caustic holder of platinum which
was attached to the bougle. Amussatf  in 1824
also invented a porte caustique, the canula being
of silver, and the stylet, of the same metal, contained at its extremity a platinum point for lodging the caustic. About the same time Lallemand
proposed his instrument, and a discussion.arose
* Practical Observations on the Treatment of Strictures
of -the Urethra and Esophagus. Second Edition. Londoii:
1797. P. 116 et seq.
t LeFons due Amussat, sur les retentions d'urine, etc. Paris:
1831, p. 115 et seq., from which many of these particulars
have been obtained.




TREATMENT.                 77
as to the value of each instrument respectively.
Differing in merely mechanical arrangements,
the object to be attained in the use of them was
essentially the same.  The application of the
caustic was employed in cases of thickening of
the canal, ulceration and stricture due to chronic
inflammation.  We find in Lallemand's treatise
on the disease of the gonito-urinary organs,  the
germ of those ideas put forth in full maturity
fifteen years later in his work Des pertes serinales involontaires.  After a discussion of the
changes produced by blennorrhagia, he proceeds
as follows:
" It may be easily conceived that irritation of
the mucous membrane of the prostatic portion
may extend -itself to the ejaculatory canals, the
vesicula  seminales, etc.; and the proof is, the
engorgement of the testicle which so frequently
accompanies stricture. The results of this irritation of the seminal reservoirs and ejaculatory
ducts are, that the act of coitus is promptly followed by the ejaculation; that the patients have
* Observations sur kes M2cacadies des Organes Genito-urinaires,
Premiere Partie. Paris: 1825, p. 158.




78             SPERMATORRH(EA.
frequent nocturnal pollutions, and that in some
cases the voluptuous sensation is accompanied by
a more or less acute pain.  Still further, the irritation augmenting, the seminal emission takes
place with an incomplete erection, or is expelled
with the last drops of urine.
Governed by analogy and by direct experiences,
I have not hesitated to apply to these parts the
~nitrate of'silver; the mucous membrane takes
on a new action; a benign inflammation supplants the chronic inflammation; tone is restored
to the tissues, and the mucous secretion progressively diminishes." The original idea of Lallemand, following Pare, Hunter, Ducamp, and
others, was the treatment of these chronic inflammatory affectionstof the urethra resulting in stric~ture, ulceration, and abscess. The extension of
the method of cauterization to the treatment of
spermatorrhcea was an after-thought.  Very diverse views have obtained since as to the utility
of the porte caustique. It has not, in general,
produced that favorable impression upon these
cases claimed for'it by its advocates. Not only
does it often fail to cure the patient, but the application of the caustic is frequently followed by




TREATMENT.                 79
most serious consequences.*  In all cases it produces great irritation, frequently strangury and
bloody urine, and sometimes severe urethritis and
cystitis.  Too long contact of the caustic may
induce induration and organic stricture, a very
serious complication of the case. Notwithstanding these sometimes unfortunate results, some
surgeons adhere to it, and a few claim  all that
IDucamp, or Amussat, or Hunter, or Home, did
in former times.  Mr. Acton, for instance, is a
zealous partisan of the porte caustique, contending [p. 225] that, as far as his own experience is
concerned, it "fully bears out " the statement
of Lallemand as to the infrequency of any ill
consequences arising from  its use. We should
not, therefore, reject this practice of cauterization
entirely.  Under what circumstances may we resort to it? There appear to be two classes of
cases in which it is indicated:
1st. Those in  which  chronic  inflammatory
changes exist as a complication of spermatorrhoa.
* Thompson, On Enlarged Prostate: Its Pathology and
Treatment, etc. Op. cit.




80             SPERMATORRHIEA.
2d. Those in which the moral effect of the
application is desirable.
We have already, we think, conclusively established that the lesions of the prostatic portion of
the urethra, described by Lallemand as constant
to spermatorrhcea, are only accidental. They.are
produced by inflammation arising in the course
of gonorrhcea, as appears evident enough indeed,
on the perusal of the cases given by Lallemand in
his treatise on diseases of the urinary organs. At
all events, it is not at all common to find such
changes in the urethra of patients suffering from
seminal weakness in this country. A hyperoesthetic state of the canal, especially of the prostatic part, is, on the other hand, a most usual
condition.
Romberg* has very well indicated the cases of
the second class to which the use of the porte
caustiqute is adapted: "Spermatorrhlea, to.which
not unfrequently hypochondriasis is to be attributed, requires special attention, arid if all other
remedies fail, we must have recourse to cauterization of the urethra, which has a moral as well
* Manual of the Nervous Diseases of Man. Op. cit. Vol.
i., p. 188.




TREATMENT.               81
as a physical effect, by withdrawing the patient's
attention from his malady."  It is not improbable
that to this "moral effect" is to be attributed
much of whatever good is accomplished by the
use of the porte caustique.
We would limit the application of caustic,
then, to those conditions of inflammation, ulceration, and hypermesthesia of the p'rostatic portion
of the urethra, which proved'refractory to other
less painful and dangerous methods. For the
moral effect, we would limit it to those obstinate
cases accompanied with severe hypochondria, in
which the fancy of the patient referred all the
suffering to the region of the prostate, and to the
cases of youths who persevered in the vice of
masturbation.
The use of the porte caustique is not attended
with difficulty. Certain precautions, however,
are requisite to avoid injury to the parts. In the
first place, it is necessary to ascertain the length
of the canal, which may be done by introducing
the catheter and observing the moment it enters
the bladder. The length of the urethra from the
meatus to the bladder is then marked on the
canula. The curette is now charged with melted
4*




82            SPERMATORRI(EA.
nitrate of silver and placed in the canula, which
is oiled and introduced the desired length. The
operator, however, will perceive when he enters
the sphincter of the bladder by the sensation of
the passage of the enlarged extremity of the instrurnent. Now when this enlarged extremlity is
withdrawn through the sphincter the sensation
will be quite distinct, and the operator will know
that he is in the prostatic part. It is only necessary to withdraw the outer canula half an inch
and rotate rapidly the curette, withdrawing it
quickly into the canula. Before the operation
is performed the patient should empty the bladder, and he should not make water for some hours
afterwards. The recunmbent position should be
enjoined, diluents and alkalies prescribed, and a
moderate diet directed. Should there be much
pain, opiates, morphia, or chlorodyne may be pre:
scribed, or an anodyne suppository, or an enema
of starcli and laudanum may be introduced. For
several days afterwards considerable irritation is
experienced, even when most care has been exercised.
Injections. —If cauterization be desirable, it
may be accomplished by injection. This is cer



TREATMENT.                83
tainly as effectual and much safer than the preceding operation. A special instrument, such as
AMr. Acton's glass syringe, may be employed, or
the universal syringe (Fig. 3),' which may be
fitted to a silver catheter, will suffice for the
purpose. The catheter must be introduced into
the bladder, and then withdrawn into the prostatic portion of the urethra.  The solution of nitrate of silver, of sulphate of copper, of acetate of
lead, or, preferably, of tanno-glycerine ( 3 j.-   j.),
may now be injected and allowed to apply itself
thoroughly to the mucous surface.  Not more
than 3 j of the solution should be used at a time,
and too great force should be avoided lest the
fluid be thrown into the bladder. The strength
of the nitrate of silver solution should not exceed
gr. x.- E j. Before the injection is made the patient should be required to empty the bladder,
and should avoid emission of urine after as long
as possible. Injections by an  ordinary penis
syringe are sometimes recommended, but they
are entirely futile. It is difficult, if not impossible, to make efficient application in. this way to
the prostatic part of the urethra.




84                SPERMATORRHIEA.
(FIG. 3-)         (FIG. 4.)
The instruments and appliances referred to in the text
may be obtained from Mr. Wm. Autenreith, No. 71, West
Sixth street, Cincinnati, Ohio.




TREATMENT.               85
A great many instruments have been devised
for making application to the prostatic part of
the urethra. It would be a waste of space to
mention them all.  The universal syringe and
catheter answer most purposes. I have had constructed, in imitation of many that have been
devised, a syringe which is very useful for this
purpose. It consists of an ordinary hard-rubber
syringe having a nozzle the diameter of a No. 6
catheter, and seven inches in length. The nozzle
terminates by an olive-shaped blind extremity,
behind which are a number of orifices for the
escape of fluid. (Fig. 4.) The injected fluid
flows from within outward, and is prevented by
the bulb in front from escaping into the bladder.
Catheterism is beneficial in that state of hyperesthesia of the prostatic part of the urethra:which is so commonly present in cases of spermatorrhcea. The mere stretching of the canal
by a full-sized bougie or catheter has the effect
to diminish the excessive sensibility of the parts,
and the moral effect of the introduction of the
instrument is not inconsiderable.
Circuznmcision.-When the prepuce is long the
glans penis is kept moist and the epithelial layer




86             SPERMATORRHCEA.
becomes exceedingly delicate and susceptible.
The abundant'sensitive nerves of the glans are
thus placed in the most favorable condition for
the reception of imnpressions; an irritation experienced there is promptly, and with heightened
impulse, conveyed to the cord, and hence, in the
act of coitus, the emission takes place too quickly.
So too,- in sleep, the venereal impulse takes its
origin, frequently, in these nerves thus endowed
with an exaggerated sensibility.  For these reasonls, the operation of circumcision is frequently
necessary in the treatment of spermatorrhcea. It
-would, probably, be well for society if the Jewish
rite were made universal. It is a well-known
fact, that, although the Jews suffer from gonoirhoea, they are rarely affected with syphilis.
My observation justifies me in asserting that it is
uncommon to meet a Jew afflicted with " seminal
weakness." The freedom with which they expose
themselves to contagion,- and their great sexual
activity, would, certainly, favor the occurrence of
these disorders, if circumcision did not prove a
protection. A knoWledg.e of this hygienic fact,
probably, existed at a very remote period of anti



TREATMENT.                 87
quity, for, according to Herodotus,* the Egyptian
priests "practised circumcision for cleanliness,
considering it better to be cleanly than comely."
The editor of Herodotus in a foot-note expresses the
belief that " this institution reaches to the most
remote antiquity; we find it existing more than
2,400 years before our era, and there is no reason
to doubt that it dated still earlier."  At first confined to the priests, it afterwards extended through
all ranks of society, as the benefits of the practice
became known. In all probability the Jews
obtained it from the Egyptians.
Other instrzumental methods.- We may classify
under this head various mechanical appliances to
prevent involuntary seminal discharges. A useful expedient of this kind is a leather ring armed
with metallic points large enough to be worn
without discomfort until erection occurs, when
the pricking will arouse the patient. This instrument may be employed by those who have
decided erections and the emission with a distinct
orgasm. Trousseau t recommends the introducV* ol. ii., chap. 37, p. 53.
1 Clinique Medicale de l'llotel Dieu, etc., op. cit., vol. ii.,
p. 646-8.




88            SPERMATORRHaEA.
tion of a pear-shaped. cylinder of wood into the
rectum to compress the prostate and seminal
ducts. This barbarous contrivance, as it seems to
me, cannot prevent venereal excitement and erection, although it may prevent emission, or force
the semen backward into the bladder. Trousseau,
however, speaks warmly in its praise, and adduces
evidences of the good effects of the practice..Any
theoretical objection which we may entertain
must yield to the demonstrations of clinical observation.  Accordingly, I will, when a suitable
case presents itself, give this method of treatment
a fair trial. Meanwhile, having no experience of
its use to narrate, we propose to put our readers
in possession of the experience of M. Trousseau.
He observes that this apparatus has been of real
service, and that more than one case, rebellious
under all methods of treatment, yielded completely and promptly to this means. lie alludes
especially to the rapid return of the virile power
in the cases treated in this way.
In the same category may be classed the
method of acupuncture.. This consists in passing
long needles into the prostate, vesicule seminales,
and sometimes into the testes and vasa deferentia.




TREATMENT.               89
Lallemand thinks it unfortunate that acupuncture
has fallen into disuse! We can hardly join in
his regrets. A general objection may be urged
against all of those mechanical appliances, that
they fix the attention of the patient upon his
infirmity, thereby retarding recovery.
Another remedy, proposed in Trousseau's clinical lecture on spermatorrhcea, is forced dilatation of the anus. This practice was recommended
to him by Dr. Adolphe Richard, who operated
on a case in Trousseau's presence, with a most
fortunate result. Four months afterwards Dr.
Richard received a letter from. the young man,
announcing that the good effects continued. The
frequent passage of rectal bougies, increased to
the utmost capacity of the anus, is, sometimes,
very beneficial.
The internal mecdicines intended to act locally,
are chiefly copaiba and cubebs. They need only
be mentioned to be condemned, for the irritation
which they produce in the mucous membrane of
the stomach and kidney will more than counterbalance any possible good which they can accomplish in the urethra. Enemas of cold water and
other medicaments and suppositories are capabie




90             SPERMATORRHEt A.
of much more useful results. We have found
urethral suppositories, especially, of great utility
in those cases of so-called "' diurnal pollutions,'
which  consist essentially  of urethral leucorrhoea.
THE MEDICAL TREATMENT has consisted in the
main in efforts to improve the general health by
appropriate tonics, as iron, quinine, strychnia,
sea-bathing, douches, etc.; by suitable dietetics;
by improved hygiene, etc. Conjoined with these
measures.anaphrodisiacs are employed as th]ey
seem to be indicated.
REMEDIES EMPLOYED IN THE TREATMENT OF
SPERMATORRHCEA.- It will be convenient to discuss under this head the actions and uses of the
most approved remedies.
Anapchrodisiacs. One of the oldest of these
remedies is camphor. Camyphoraper nares castrat
odore mares, was an aphorism of the school of
Salernurn. It is not, however, a very valuable
remedy. To produce the desired anaphrodisiac
effect large doses are necessary; it frequently fails,
and its action upon the stomach is unpleasant,




TREATMENT.                91
giving rise to a sense of heat and burning, and
followed by disagreeable eructations.
Lupulin is much employed by many distinguished therapeutists.  Thus it is a favorite
remedy with Lebert,* who gives it in combination with camphor. It has considerable efficacy
as an anaphrodisiae, but, like camphor, it is uncertain. Belladonna, or better its alkaloid, atropia, is much more efficient than camphor. Our
indigenous remedy, gelselmium, is still more
powerful in its action on the sexual organs. The
fluid extract of either of these agents may be combined with other anaphrodisiacs, or they may be
given alone. The tincture of belladonna and the
tincture of gelsemrium may be prescribed with
advantage together.
The most important agent of this class, the most
efficient and certain, and the least distressing in its
immediate and remote effects, when freely administered, is the bromide of potassium. The anaplhrodisiac property of this drug is now almost
universally acknowledged, but the conditions of
its success and failure have not been as definitely
determined as is desirable. There are yet some
* Op. cit., vol. ii. p. 587.




92            SPERMATORRH(EA.
sceptics who disbelieve in this property of the
bromide of potassium. One of the most recent
and pretentious of them is Dr. S. W. Duckworth
Williams.*  The cases submitted by him  in
proof of his views serve very well to illustrate the
conditions under which the bromide of potassium
fails to produce its characteristic effects. We
accordingly reproduce them in Dr. Williams's
words, as they are very suitable to our purpose.
"Dr. Crichton Browne, in a pamphlet on' The
Action of the Bromide of Potassium upon the
Nervous System,' published since I commenced
writing these remarks, is very much inclined to
allow it strong anaphrodisiac properties, although
I cannot quite perceive on what data. He owns
that he had had no opportunity of trying the
bromide of potassium in simple nymphomania,
although he used it without effect in one patient
who was in a state of mania, following upon
melancholia, and in whom there was presumed to
be excitement of the sexual feelings, on account
of the extraordinary obscenity of language which
* On the Efficacy of the Bromide of Potassium in Epilepsy
and certain Psychical Affections. Churchill, London, 1865.
(Pamphlet.)




TREATMENT.               93
she used. Now, I have tried it in every variety
of uterine affection that has come within my reach,
including nymphomania, satyriasis, menorrhagia,
amenorrhcea, dysmenorrhiea, etc., etc., but without
perceiving the least benefit accrue.
I had under treatment at one time two cases that
seemed especially well adapted for favoring the
anaphrodisiac properties of this medicine. They
were both strong, healthy girls, the one a lady, the
other a domestic servant. Both were admitted
into the asylum at Northampton, suffering from
simple mania without any positive delusion.
They were lively, excitable, restless, and extremely volatile, often able to command their
faculties sufficiently to  converse calmly and
rationally for a few minutes on any ordinary subject, but liable at any moment to burst out laughing or into a fit of tears without any visible cause,
or to begin to rave and scream, or swear; both
were'fine, handsome, fully developed young
women; both were most indecent in language,
voice, and gesture, and both openly practised selfpollution. The bromide of potassium was given
to them in doses of gr. v. bis die in a little pure
water, and increased up to gr. xx., and although




94            SPERMATORRHIEA.
both were much affected by its use, and both
became pale and thin, and reduced, and their circulation powerfully controlled (indeed, in one
case the pulsations were reduced from 90 to 60
beats in a minute), nevertheless they persisted in
their bad habits, and their sensuality became, if
possible, more confirmed. The administration of
the medicine was persisted in for nearly twelve
months in both cases.' Another case in which I tried it was that of
a married lady, nearly 40 years of age, in a state
of chronic mania, and at the same time I made
some observations as to the influence of the bromide on the heart's action. This lady was extremely amative, fell in love with every person
of the opposite sex she encountered, and was in
the habit of writing the most obscene letters to
all her male acquaintances.  Her pulse was
habitually about 90-tolerably strong and full.
Being of a strong constitution, I commenced by
giving gr. xv. his die. About an hour after the
third dose her pulse was 76; two hours from
that time it had almost regained its accustomed
frequency, but in an hour's time from the fourth
dose it was reduced to 70, and on one occasion




TREATMENT.                95
during the first week it was nearly as low as 60.
Combined with this decrease in the circulation
there, was, as might be expected, marked languor
and ennui almost amounting to debility, and she
seemed inclined to maintain the recumbent position constantly; but I cannot say that her lascivious wishes or ideas were in the least disturbed, or that her advances were marked by more
delicacy; aut contraire, I am not quite sure that
she was not worse."
The experience of Dr. Williams, which seems
so entirely opposed to that of other observers, is
easily interpreted by a knowledge of the conditions which retard or altogether prevent the action
of the bromide of potassium. In some investigations, published recently,* I attempted to define
these conditions.  My conclusions were embodied
in the following:
" Its physiological effects are not very decided,
and are readily modified by any local disturbance.
" Its therapeutical action is still more decidedly
influenced by local morbid processes.
* Experimental Investigations into the Actions and Uses
of the Bromide of Potassium. Cincinnati Lancet and Observer, 1865.




96             SPERMATORRIIXEA.
" It is indicated where a sedative to the nervous
system is required, e. g.-in insomnia; too great
reflex excitability; nervous and spasmodic affections of the larynx and bronchi; sexual excitement, and in an irritable state of the sexual
organs.
" It will be efectual in the foregoing conditions,
in proportion to the degree -in which structural
lesions are absent, or in other words, in proportion to the degree in which these morbid states are
functional rather than organic."'
These conclusions, the result of observation and
experiment, afford us a satisfactory solution of the
cause of failure in the use of the bromide of potassium in cases such as those described by Dr. Williams. The cases of sexual excitement in mania
are due, as is shown by Schroeder van der-Kolk,
to structural alteration in the medulla oblongata,
the centre, according to this author, of the sexual
impulse. The bromide of pdtassium can have
no influence over these structural alterations, and
hence cannot control the manifestations of sexual
excitement which depend upon them.
Aphrodisiacs.-These are indicated under certain circumstances.  The tincture of cantharides




TREATMENT.                97
is sometimes beneficial in cases of great atony and
relaxation —those characterized by profuse mucous
discharge, so-called diurnal pollutions, very feeble
power of erection, and absence of sexual desire.
It is contra-indicated where much hypersesthesia
of the prostatic portion of the urethra exists. To
prevent its irritant effects, or at least to reduce
them to the minimum, opium, or cannabis indica,
or chlorodyne, may be advantageously combined
with it. The red or amorphous phosphorus, or
phosphide of zinc, may be given in the same class
of cases as suggested for the tincture of cantharides.
Nux vomica is adapted to those cases in which it
is desired to restore the functional activity of the
sexual organs, after the state of quiescence induced
by the prolonged administration of anaphrodisiacs.
Cimicifuga (actea racemosa) has seemed to me to
possess considerable aphrodisiac power, and has
proved useful in cases of long-standing spermatorrhcea accompanied by nervousness and anxiety,
and diminished sexual desire.
Galvanism, especially the induction current,
and static electricity, are often decidedly aphrodisiac, and are probably applicable to more
numerous cases than any other remedy of the class.
5




98             SPERMATORRHIEA.
Duchenne * (de Boulogne) operates in the following manner: One rheophore properly insulated
is introduced into the rectum, and placed in contact with the basfond of the bladder; the other
is passed to the prostatic part of the urethra.
In this way a current can be made to traverse
the vesictdlce seminales and ejaculatory apparatus.
Benedikt t applies " the copper pole to the lumbar vertebrae, and passes the zinc pole along the
spermatic cords, over the different zones, transversely, of the penis, and along the perineal region
antero-posteriorly... Beside this, usually three
times in two weeks, the copper pole is applied
by means of a catheter-shaped rheophore to the
orifices of the ejaculatory ducts, and the zinc
pole is passed along the spermatic cords."
Ergot has been much extolled in those cases in
which emission takes place quickly with feeble
erections.
Tonics.-Iron, quinine, the vegetable bitters,
the mineral acids, are indicated in anemic cases.
The hygienica, air, exercise, bathing, travel, etc.,
are valuable adjuncts to the remedial measures.
* De rl'lectrization Localisee. Paris, 1861, p. 97.
f Elektrotherapie. Wien, 1868, p. 446.




TPEATMENT.               99
THE THIERAPEUTICAL MANAGEMIENT OF SPERMATORRHEA comprehendsFirst, the treatment of the causes.
Second, the treatment of the malady.
The Treatment of the Cacses. —We have already expressed the opinion that venereal excesses, and especially masturbation, are the causes
of spermatorrheea, in a vast majority of cases as
they occur in this country. Hence it is important to recognize this vice at an early period, to
prevent the immediate and remote consequences
of its continued perpetration.
We have already seen that this vice is contracted chiefly by boys in whom the nervous preponderates over the muscular and digestive systems, and that certain moral and social circumstances, and organic peculiarities, increase the
tendency to it. These influences must, as far as
possible, be repressed. Of course, it is not within the power of the physician to alter those inherent mental and physical defects which exercise such a baneful influence; but much may be
done to diminish the activity of the nervous system, and to restore the balance between it and




100           SPERMATORRI(ECA.
the other systems. Therefore, to the physical
culture of boys possessing these inherited peculiarities too great importance cannot be attached.
The development of the muscular and digestive
systems should be promoted by every agency.
Open air exercise, constant physical employment,
avoidance of confinement and idleness, cold bathing, etc., are the means necessary for this purpose. Lebert * places chief reliance upon these
hygienic means in all cases of masturbation and
spermatorrhcea.  The principal organic peculiarity promotive of this vice, is phymosis. Where
this condition exists, the operation of circumcision is proper. A long and contracted prepuce
hinders the development of the penis, and by
retaining the moisture and secretions of the part,
increases the sensibility of the glans.
Ignorance of the character and tendency of
the habit favors the perpetration of masturbation.
Parents and public teachers have a sad duty to
perform in this connection which they naturally
shrink from. In a large majority of cases, the
habit would be discontinued, if the dreadful consequences of it were plainly set forth to the
* Op. cit., p. 784, vol. ii.




TREATMENT.               101
unfortunate victims. This becomes especially
necessary in boarding schools and in other public
institutions where numbers of boys are congregated.
It is also very important to prevent suggestive
novels, and books of every description having a
tendency to excite erotic ideas, falling into the
hands of these youths.
As a general rule it is sufficient in cases of
masturbation to set forth clearly the dangers of
the practice; to institute a thorough system of
physical culture; to reduce the mental work; to
keep the body occupied; to correct, if possible,
any organic imperfection which may be remedied
(phymosis), in order to effect a cure. In some
inveterate cases this may not be sufficient. The
habit may be so confirmed, the instincts so low,
and the moral obliquity so great, that no means
other than physical restraint will prevent the
perpetration of the act. The mechanical appliances may be assisted by anaphrodisiacs.
Mr. Heckford* has recently published a paper
showing the great -value of;"circumcision as a
* London Hospital Reports, 1865, vol. ii., p. 62. Already
quoted.




102            SPERMATORRHEA.
remedial measure in certain forms of epilepsy,
chorea, etc." In the very instructive cases given
by Mr. Hleckford, the convulsive affections depended upon masturbation.
As the operation of circumcision is easily performed, and is without danger to life, it should not
be omitted from the treatment in two classes of
cases: i. Those in which the habit of masturbation
is due to the hyperoesthesia of the glans produced
by an elongated prepuce and the irritation of the
retained sebaceous matter; and 2. In those cases
in which the same cause (a peripheral irritation)
induces the venereal orgasm and involuntary
discharge.
Although we do not deny the possibility of it,
we regard it as rather improbable that a mere
peripheral irritation, such as an irritable or inflamed state of the prostatic portion of the urethra,
or a balanitis, will of itself produce the reflex
phenomena of spermatorrhcea. Such irritation,
however, will undoubtedly increase the morbid
excitability of the reflex faculty, if it have already
been aroused by such causes as masturbation and
venereal excesses.
Ceasing an ill habit may suffice in many cases




TREATMENT.               103
to cure these local irritations. The operation of
circumcision should be performed when the prepuce is long, the glans moist, and epithelium very
sensitive. The frequent application of cold water
to the glans, when in this condition, is of great
service. The tanno-glycerine ( 3 i.- S i.) may also
be applied daily to the glans with advantage.
Similar measures may be adopted for an irritation
ill the prostatic part of the urethra: daily injections of cold water; the injection through a silver
catheter in the manner already recommended, of
the tanno-glycerine, or of a solution of nitrate of
silver. But the irritable state of the prostatic
portion is more properly an effect rather than a
cause of spermatorrhcea; accordingly we postpone the further consideration of it until we
come to treat of the therapeutic measures proper
to the malady itself.
IRemedia[l 2Jfanagernenzt.-Remled ies should be
employed with reference to the pathological states
of the several phases of spermiatorrhcea.
In the genital form there are associated with the
peripheral irritation increased reflex excitability
and derangement of the primary assimilation.
There may be a condition of plethora, or more or




104            SPERMATORRHCEA.
less emaciation; much more usually, the latter:
the therapeutical methods are indicated in this
brief pathological summary.  In those rather exceptional cases, in which the spermatorrhcea is the
result of plethora and forced continence, it may
only be necessary to impart to the patient correct
views of the importance of the losses, which, influenced by current publications, he will be very apt
to exaggerate. If his vessels are full, his bowels
are' constipated, aud his digestion active, he will
be benefited, if somewhat reduced by saline cathartics, by liu20or potassce, by a less liberal diet, by
abundant exercise, and by diminishing the number of hours devoted to sleep. Many cases of socalled idiopathic spermatorrhcea occur in studious
persons of sedentary habits, whose nervous system
has been rendered unduly excitable by prolonged
mental work with enfeebled digestive powers.
These are relieved by mental rest, by some physical employment, and by attention to the state of
the digestive organs.
Activity of the sexual system may be associated
with this excitable state of the nervous system in
studious persons; when, of course, the anaphrodisiac remedies will be required. It has happened




TREATMENT.              105
to me to meet cases of this character in clergymen
who led a life of celibacy. A judicious employment of the hygienic means together with the
medical, and especially a candid statement of the
real importance of the infirmity, will be followed
by most satisfactory results.
A vast majority of the patients who present
themselves for treatment do not belong to either
of the foregoing classes. They are those in whom
seminal weakness has been induced by masturbation, or by prolonged excesses in venery.  They
have frequent nocturnal emissions.  The reflex
excitability of the cord is so much increased, that
the feeblest irritation procures a prompt emission
with little of the venereal orgasm, and the frequent
discharges of nervous force affect the supply to
all the organs-whence come palpitation, indigestion, constipation, irritable bladder, pain in the
back, mental feebleness, and debility. The peripheral irritation and the reflex excitability must
be diminished.  These important objects may be
accomplished by means partly hygienical and
partly medicinal.
The patient should cease his excesses, whatever
they may have been, and avoid all sources of ex5*




106            SPERMATORRHCEA.
citement, whether the reading improper publications, suggestive novels or works upon his own
nalady, or the society of women of easy virtue.
The liberties between the sexes permitted by custom in many places and in certain circles of society
without extending so far as the gratification of desire, are so very injurious to young men with
" seminal weakness," that they should be absolutely interdicted. The mind of the patient should be
freed, as far as possible, from any association with
his disagreeable infirmity.  Hence constant and
agreeable employment, physical rather than mental, or an association of the two, is especially desirable. The bromide of potassium will powerfully
contribute to the success of these measures. Forty
to sixty grains may be given every night until
sexual desire is entirely suspended. This remedy
has a decided power to allay urethral irritation, as
we have found, not only in the cases for wlich it
is now recommended, but in gonorrhea after the
acute stage has subsided, and in gleet. We observe that Mr. Hutchison * has committed himself
to the same opinion. In that very distressing corn* London Hospital Reports, vol. ii., p. 340.




TREATMENT.              107
plication of spermatorrhcea-.hyperesthlesia of the
spermatic plexus-the bromide of potassium is,
also, very effective. If decided ancemia exist in
these cases of the genital form, iron and quinia
may be given during the day, conjoined with lnpulin, should it be desirable to increase tile anaphrodisia.
We have seen that dilatation of the inter-rachidian vessels probably exists in advanced cases.
This view seems confirmed by the fact that the involuntary emissions occur much more certainly
when the patient is lying on his back-a position
favoring congestion of the cord. Hence management of tle position in bed is not to be neglected.
The patient should lie upon his side, and if
unable to continue in this position when asleep,
should adopt some mechanical appliances to compel it. Tying the hand to the bed-post so that the
position of the back cannot readily be assumed
may suffice in some instances. Or, Lallemand's
contrivance may be adopted: this consists of a
thin sheet of lead to which a piece of wood is fastened, attached by a girdle to the loins. Or, Mr.
Acton's expedient, which is nothing more than
a towel tied about the waist with a large knot be



108            SPERMATORR CEA.
hind. Or, lastly, the leather ring armed with metallic points, which will arouse the patient when
erection occurs.
The principal remedial agent for inducing contraction of the inter-rachidian vessels is ergot.
The drug should be fresh, or carefully prepared
ergotin or fluid extract should be used. Gelsemium  may be used for the same purpose. It is
probably more effective even than ergot. Cold
to the spine, not too prolonged, or alternate hot
and cold douches, may be usefully conjoined with
the ergot.  It should be remembered, however, that cold to the spine is a powerful
aphrodisiac.
If the patient experience the tenacious discharge from the urethra, consisting of the secretion from the prostate, Cowper's glands, and follicles of the mucous membrane, he will undoubtedly
believe himself to have " diurnal pollutions," and
will be correspondingly alarmed. If the discharge
do not cease during the course of treatment just
recommended, it will be necessary to adopt some
special means to arrest it. These special means consist in the local application in the manner already
indicated of tanno-glycerine, of solutions of nitrate




TREATMENT.               109
of silver, or the use of the porte caustique. We
should not forget, however, that caustic applications are considered by HIenry Thompson * as a
cause of prostatitis.
Our duty is not ended in a case of spermatorrhcea, with the production of a state of anaphrodisia and the curing of irritation in the
urethra.  We must restore the patient to the
proper performance of his sexual functions, and
this must be accomplished in such a way that he
will not lapse into his former infirmity.  The
bromide of potassium  and the ergot must be suspended, and tonics and special excitants -must
be employed. Extract of nux vomnica or str-ychnia
with iron, is a useful combination under these
circumstances.  Cimicifuga and gelsemnium  are
also indicated, if there be any decided nervous
phenomena present as a complication.  Galvanism  should not be neglected.  In these cases,
Duchenne's method should be practised: i.e., one
rheophore in the rectum; the other passed into
the prostatic part of the urethra.'Benedikt reports great success by his mode of applying the
* On Enlarged Prostate: Its Pathology and Treatment.
London, 1858, p. 195, op. cit.




110            SPERMATORHCE A.
currents.  Sometimes static electricity is of great
service. The patient is placed on an insulated
stool, in communication with  the prime conductor, and sparks are drawn from the genitals.
During the whole period occupied by this treatment certain accessories must not be disregarded.
Simple but nutritious food must be taken; the
supper should be light., and eaten four or five
hours before retiring, and alcoholic stimulants
should be avoided. The habitual use of tea, coffee, and tobacco should be discouraged.  Fluids
and articles of food having a diuretic action should
be sparingly used, since erections occur when the
bladder becomes full. Laxatives are indicated if
constipation exist, but not otherwise.
In that phase of spertnatorrhiea which we
have denominated the cerebral, in addition to the
derangement of the sexual-spinal system there exists sotne formn of cerebral disorder. If the sexual
troubles are mere symptoms of mental derangement, the treatment of them is merged into that
for insanity. If, on the other hand, the mental
derangement is the result of seminal losses or
abuse, the treatment of it becomes associated
necessarily with that for the cause. The cases




TREATMENT.              111
given in the extract from Dr. Williams's pamphlet
belong to the first class; the typical cases presented under the head of the cerebral form are
instances of the second. The first are not amenable to the action of anaphrodisiacs, whilst the
second are. Usually the mental derangement has
proceeded no further than hypochondria, melancholia, or trembling delirium (delusional insanity)
corresponding to delirium tremens of alcoholismus. In all of the psychical affections of spermatorrhcea, the bromide of potassium  is very efficacious. Ergot shonld be administered in conjunction with it, and counter-irritants (firing,
setons, blisters) should be applied to the nape of
the neck, on Schroeder Van Der Kolk's plan, and
also as recommended by Romberg.
The early recognition of mental disorders arising
from abuse is very important. With the anaphrodisiacs-bromide of potassium, lupulin, and camphor-and moral agencies, should be conjoined
the operation of circumcision.  Physical constraint may also be resorted to, but this is a
temporary expedient which more usually fails
than succeeds.  Division of the vasa deferentia
in inveterate cases has been recommended, and we




112            SPERMATORRHCEA.
have seen it performed in an inveterate case.
Nothing but a failure in the means already proposed will justify the performance of this operations, as in its practical results it is equivalent to
castration. The operation is readily enough performed. The duct can be easily felt and separated
from the rest of the spermatic cord, when it may
be divided by the subcutaneous section.
In the spinal form of spermatorrhcea the treatment will be influenced by the condition of the
cord. If the loss of power, the altered and referred sensations, the paraplegia, be merely functional derangements, or due to a " dynamic
alteration," strychnia, cimicifuga, faradization,
douches, hot and cold, to the spinal column, will
be indicated. Bromide of potassium is hurtful in
the paraplegia of sexual excess.  It is, however, especially applicable to the treatment of
the epilepsy and chorea of spermatorrhzea. The
striking results obtained by Mr. Heckford, and my
own observations, warrant, me in strongly urging
the operation of circumcision, in those convulsive
disorders dne to masturbation. In the typical cases
of the spinal form narrated under that head, I found
the extract of belladonna of signal advantage.




TREATMENT.              113
Treatment of Inpotence.-The temporary impotence of spermatorrhcea requires time and iamiliarity with the object. of desire.  If it consist of
nothing more than such a degree of excitability
of the reflex faculty, that intromission cannot be
accomplished, or that the seminal discharge takes
place after very imperfect coitus, then the treatment recommended for the genital form of spermatorrhoea may be pursued.
In the impotence dependent upon spermatorrhcea of long standing, hot and cold douches to
the spine, galvanism or static electricity, and a
properly conducted system of physical training
and exercise, are the most appropriate measures.
Special excitants may be employed in conjunction with these means: strychnia, phosphide of
zinc, cannabis indica, cantharides, etc.; but these
remedies will not be successful unless the general
health has been restored by proper hygiene and
suitable hbematinics. When the impotence depends upon " irritable testis," a judicious course
of bromide of potassium should precede the use
of the other measures. Some of these cases may
be very quickly cured by an induction current
passed through an insulated metallic sound in



114            SPERMATORRHIIA.
trodueed into the bladder. The occasional passage of a full-sized catheter, I have found in
not a few instances, to produce energetic erections.
The question of the propriety of marriage
often involves considerations of great delicacy.
Many cases are undoubtedly curable in this way.
Marriage will always have a fortunate result in
the cases of spermatorrhcea of physiological origin. In true spermatorrhcea, marriage mnay be
enjoined when the genital apparatus is not so
impaired in function as to prevent intromission.
Regular intercourse, not too fiequently repeated,
will prove of signal advantage in these cases.
At first sexual contact may be unsatisfactory in
consequence of the greatly increased reflex excitability of the ejaculatory apparatus; but power
increases by judicious use of the organs.
Singular as the opinion may appear, I cannot refrain from  stating that marriage has resulted unhappily more frequently in cases of
imaginary  spermatorrhcea than in  the other
forms described. When the supposed existence
of this trouble becomes a predominant idea, and
moral and medicinal treatment cannot destroy or




TREATMENT.              115
weaken it, marriage will only confirm the delusion, for the first attempts proving failures, the
patient will give himself up to the most absolute conviction of incompetence.




SPERMATORRH(EA.
FORiMU~LUzK.
INJECTIONS.
Argenti Nitrat., gr. x.
Aqum Distil.,:  j.
Solve.
Zinc. Sulphat., gr. xij.
Morphike Sulphat., gr. iv.
Atropike Sulphat., gr. ss.
Aquoe Distil., ~ j.
lM.
Acidi Tannici, 3j.
Glycerini, Ej.
M.
Acid. Tannici, 3 j.
Tinct. Iodinii, 3 ss.
Glycerini, S j.
M.




FROMULE.                  117
Anaphrod;isiacs.
Lupulin., gr. vj.
Pulv. Camphorse, gr. iij.
Ext. Belladonne, gr. j.
ft. pil. No. vi.
S. One 3 times a day.
JI.
Atropike Sulphat., gr. ss.
Aquse Distil., S ss.
M.
S. 3 to 5 drops 3 times a day.
1f.
Tinct. Gelsemii, 3j.
Tinct. Belladonnse, 3 ij.
M.
S. 15 drops 3 times a day.
Tinct. Gelsemii, 3j.
Tinct. Cimicifugme, 3 vij.
S. 30 drops to a teaspoonful 3 times
a day.




SPERMATORRH(EA.
Potassii Bromidi, S j.
ft. pulv. No. viii.
S. One dissolved in water every
night.
Potassii Bromidi, S j.
Ext. Gelsemii Fl. 3 ij,
Syrp. Simpl. ~ i.
Aquae Cinnamomi, ~ iij.
M.
S. A teaspoonful 3 times a day.
l. Potassii Bromidi, ~ j.
Ext. Belladonnam  Fl.
Ext. Gelsemii Fl. dd 3 ij.
Syrp. Simpl., S iss.
Aquase Menth. P., ~ ij.
M.
S. A teaspoonful 3 times a day.
Aphrodisiacs.
Tinct. Cantharidis, 3 j.
Tinct. Cannabis Ind.




FORMULaE.                119
Sol. Morphike Bi-mec., sa 3 ij.
S. 15 drops 3 times a day.
Zinci Phosphidi, gr. iij.
Conserv. Rosae, 3 ss.
ft. pil. no. xxx.
S. One night and morning.
Tinct. Nucis Vom., 3j.
Tinct. Actere Rac., 3 iij.
MI.
S. 20 drops 3 times a day.
Syrp. Ferri, Quiniae, et Strychnike
Phos., S ij.
S. A teaspoonful 3 times a day.
Auri Terchloridi, gr. j.
Ext. Nucis Vorn., gr. v.
ft. pil. No. xx.
S. One 3 times a day.




120             SPERMATORRHaAX.
Urethral Suppositories.
Iodoformi,
Acid. Tannici, fi, gr. vj.
01. Theobrom., q. s.
ft. supposit. ureth. no. vi.
I@.
Acid. Tannici, gr. vj.
Ex. Belladonnoe, gr. j.
01. Theobrom., q. s.
ft. supposit. ureth. no. vi.
IW.
Plumbi Acetat., gr. xij.
Morphime Acetat., gr. j.
01. Theobrom., q. s.
ft. supposit. ureth. no. vi.
IW.
Morphiae Sulph., gr. iij.
Zinci Sulph., gr. vj.
01. Theobrom., q. s.
ft. supposit. lureth. no. vi.
THE END.