[ o C-J-^^' f' /L A PRACTICAL TREATISE ON THE CAUSES, SYMPTOMS AND TREATMENT SPERIATORRHCEA: BY M. LALLEMAND, FORMERLY PROFESSOR OF CLINICAL SURGERY AT THE UNIVERSITY OF MONTPELLIER, ETC. HBNEY J. McDOUGALL, MEMBER OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, ETC. ETC. FOURTH AMERICAN EDITION. TO WHICH IS ADDED, 0^ DISEASES OF THE YESICUL^ SEMINALES AND THEIR ASSOCIATED ORGANS: WITH SPECIAL REFERENCE TO THE MORBID SECRETIONS OF THE PROSTATIC AND URETHRAL MUCOUS MEMBRANE. HARRIS WILSON, M.D. PHILADELPHIA: BLANCHAED AND LEA. 1861. PHILADELPHIA : COLLIJfS, PEINTEK, 705 JAYNE STKEET. AMERICAN PUBLISHERS^ NOTICE A considerable period having elapsed since the publica- tion of the work of M. Lallemand, the publishers have thought that the value of the present edition might be en- hanced by the addition of the little treatise of Dr. Marris Wilson, which, since its recent appearance in London, has already acquired a high professional character. The reader will thus have the advantage of comparing the views ad- vanced by M. Lallemand, with the latest results of profes- sional experience, embodying the present state of the sub- ject investigated with the aid of modern pathology. Philadelphia, July, 1858. AUTHOR'S PEEFACE. During a period of fourteen years, I have collected more than one hundred and fifty cases in which involuntary seminal discharges ■were sufficiently serious to disorder the health of the patients con- siderably, and even sometimes to cause death. Most of these patients have been sent to me on account of sus- pected cerebral affections of more or less standing. Hence, by a singular chance, it has been in consequence of the publication of my '•'• Recherches Anatomico-PatJiologiques^ sur Vencepkale et ces depen- dances," that I have obtained the most remarkable cases of diurnal pollutions ; and I have correctly refused to acknowledge the presence of disease of the brain or its membranes in many cases where the existence of such disease had previously been considered indisputa- able. Many other of these patients were supposed to suffer from chronic gastritis, or gastro-enteritis ; from aneurisms near the heart, the early symptoms of phthisis, &c. &c. ; and in other cases from nerv- ous affections, and especially from hypochondriasis. These few words show how frequent, important, and difficult of detection, are involuntary seminal discharges, and to what deplorable errors of treatment they daily give rise : it may be foreseen, too, that their causes must be very varied, and their treatment present con- siderable difficulties. The Brochure of Wickmann and the commentaries on it by Sainte- Maria,' are the only writings we possess, on a disease that degrades man, poisons the happiness of his best days, and ravages society ! Of the researches of these conscientious observers, too, the profession are almost ignorant. They have, nevertheless, done all in their power to call the atten- ' Dissertation sur la pollutioa diurne involuntaire ; par Wickmann ; traduction de Sainte-Maria. — Lyons, 1817, yi PKEFACE. tion of practitioners to a subject of which they fully felt the impor- tance, and they have stated many valuable truths. Why is it, then, that a more lasting impression has not been made on the medical world ? Doubtless because they have not supported their statements by a sufficient number of well detailed cases, and especially because those related are vaguely and generally stated. Althouf^h "Wickmann and Sainto-Maria have stated facts which have not been appreciated, they have left numerous omissions to be supplied, and more than one serious error to be corrected. The materials I possess permit me to hope that I shall be more successful ; at all events, I consider it my duty to publish them. EDITOR^S PUEFACE. Ix la^'ing the following condensed edition of M. Lallernand's im- portant work on Involuntary Seminal Discharges before my pro- fessional brethren in an English dress, I have been actuated by the conviction that the disorder treated of is little understood by the profession generally in this country. The patients affected by it are always hypochondriacal — indeed, the symptoms of hypochondriasis and mental derangement are generally by far the most prominently marked in them — and after the usual remedies for digestive disorder and liver disease have been had recourse to without benefit, the prac- titioner becomes tired of attending a disease which is at best obscure and does not yield to the usual remedies, and either treats his patient as a malacle vnaginaire, or leaves him a prey to the wretched balsam- selling quacks, who are unfortunately permitted to pollute every pe- riodical publication with their disgusting advertisements. The subject of Spermatorrhoea is an uninviting one — especially to the fastidious — perhaps too fastidious English taste ; — hence, with very few exceptions, it has been generally avoided by regularly edu- cated practitioners in this country. An abstract of M. Lallemand's views was indeed published by my friend, Mr. Phillips, in the Medi- cal Gazette in the year 1843, and about the same time some papers appeared in the Lancet on the same subject by Drs. Ranking and Dangerfield, and Messrs. Ryan, Chatto, and Dudgeon. These pub- lications, however, from their transitory nature, were not calculated to remedy the want felt by the profession, of a systematic treatise on this important subject. Mr. Phillips, indeed, in the conclusion of his paper in the Medical Gazette, takes occasion to remark : " Since the publication of the first part of this paper, I have been painfully im- pressed with the conviction, that the evil is more widely spread than I had before conceived ; and that it will not be largely alleviated by the means I have adopted for advocating the relief of a particular remedy The pages of a strictly Medical Journal do not meet the eyes of the great mass of sufferers." In a notice also of M. Lallemand's work, in the British and Foreign Medical Review, the reviewer took an opportunity of pointing out the importance of the subject. Nevertheless, authors have always seemed to avoid the subject as dangerous ground, and with the exception of viii PEEFACE. an excellent chapter in Mr. Curling's work on Diseases of the Testis, aacl some observations published by Dr. Smyth in a work entitled " Miscellaneous Contributions to Pathology and Therapeutics," I believe the present to be the first attempt to render the profession familiar with this disorder, by any special work in the English lan- guage. Indeed, in Dr. Golding Bird's otherwise excellent book on urinary deposits, the author, although he admits that the spermatozoa are fre- quently discovered in the urine by microscopic examination, takes occasion to express his opinion, that the subject of spermatorrhoea is one by no means deserving the importance attached to it. He adds, " It certainly is not very consistent with our national character, to dilate so freely on a subject which, in the great majority of cases, can be treated of only as the eflFects of a most degrading vice." That any physician should relieve himself from the investigation of a most afflicting disease, because the subject treated of is an unpleasant one, appears to me unworthy the general character of our profession. Had similar opinions been held respecting syphilis — a subject quite as repugnant to English feelings as spermatorrhoea — what misery would have been entailed on the human race ? Lecturers on surgery, while entering fully on other diseases of the urethra, appear either not to have been aware of, or by common con- sent to have omitted, spermatorrhoea from their oral lectures and text- books of surgery. Professor Miller, of Edinburgh, having given a short notice of spermatorrhoea in his " Practical Surgery," published in 1846, is, as far as I am aware, the only exception to this rule. At an early part of my professional life my attention was much engaged by two cases, which to me presented peculiar features of interest. One, the case of a near relative since dead, proved par- ticularly unfortunate. The other, the case of a friend of about my own age — also studying medicine — recovered after several relapses ; and the patient is at present practising his profession in her Majesty's service. In both cases the best advice the West of England afforded was obtained without success, or, indeed, even slight improvement, and in neither case was the cause of the disorder, which particularly affected the brain and digestive organs, recognized. The interest I took in these cases led me to suspect, from certain hints thrown out by the patients, that their disorders were somehow connected with the genital organs. Further experience has con- vinced me that my suspicions were correct. A brief outline of these cases may not be uninteresting. E. H , ^t. thirty-nine, passed the early part of his life in the country, and was in the habit of taking much and violent exercise. About the age of sixteen, he entered a banking establishment in Lon- don, in which by great diligence and steadiness of conduct he rose, before he was twenty-five, to the post of cashier. The affairs of the house fell into disorder, and ultimately a bankruptcy occurred ; Mr. H , from the amount of confidence reposed in him by the PREFACE. ix partners of the firm, -was much harassed during these unfortunate pro- ceedings. Soon afterwards he became manager of a large mercan- tile establishment in the city, and about this time commenced some speculations in foreign bonds. From fluctuations in the share market he was a loser to a considerable extent ; his mind was much harassed, and he began to suspect those about him of dishonesty towards their employers. On investigation these suspicions were proved to be totally unfounded ; Mr. H gave way to great violence of con- duct, and resigned his situation. About this time his father died ; and Mr. H was much disappointed at finding that property, which he had incorrectly believed entailed, and consequently his, as eldest son, was left by will to be equally divided between himself and the rest of his family. His conduct at this period was of the strangest description. He dreaded to go out into the streets of the town where his family resided, refused to join in their meals, and ultimately ab- ruptly left their house to return to London. In 1837 his state had be- come such that in consequence of his repeated letters, members of his family visited London, and on their return took him with them into Devonshire. About this time his mental disorder put on a decided aspect ; and I had then, as well as later, ample opportunities of ob- serving his conduct; and frequently heard his complaints. Emissa- ries were constantly on the search for him to arrest him for unnatural crimes committed in London ; every one who met him in the street read in his countenance the crimes he had committed ; tailors made his coats with the sleeves the wrong way of the cloth, in order to brand him with infamy ; the sight of a policeman in the street alarmed him beyond measure ; and often, if a stranger happened to be walking for some little time in the same direction as himself, he would ex- claim that he was one of the emissaries sent to seize him. At other times he would lock himself in his room and weep by the hour. He never took his meals with the family, and never tasted food or drink without first preserving a portion for chemical analysis, as he was con- vinced his friends were in a conspiracy to poison him slowly, in order to wipe out the memory of his crimes. These ideas haunted him night and day. His digestion was much disordered ; his sleep broken and restless, and his bowels excessively constipated. His face was flushed, and periodical attacks of cerebral excitement occurred, during which he complained of vertigo, noise in the head, loss of sight, &c. He complained also of loss of memory, and frequently of bodily weak- ness and lassitude. The best medical advice the neighborhood afforded was obtained, unavailingly ; the opinions of the gentlemen consulted were, that Mr. H was laboring under aggravated hypochondriasis, complicated with monomania. Various causes were suggested as giving rise to the disorder, but no previous case of in- sanity was recollected in any branch of the family. Mr. H now began to talk of leaving England for America, in order to avoid his persecutors ; and to prevent this he was placed under the care of a private keeper ; while with this person he frequently and bitterly com- X PEEFACE. plained of constant pollutions while at stool, with darting pain, and a sense of weight between the rectum and bladder. He had also urethral irritati'on attended with discharge, pains in his loins, and in one groin, weakness of his legs, thick urine, piles, and obstinate cos- tiveness. He kept a diary at this time, which is at present in mj hands. Not a day is passed in this diary without mention of the dis- tressing seminal discharges from which he suffered. These were treated as of no importance by his medical attendants, although he never ceased to complain of them, and solicited aid so long as he con- tinued in confinement in England. When led away from his dis- order' into any discussion on public matters, he was, however, a most amusing and instructive companion ; as a man of business he was equally acute, and to a stranger, as long as nothing was done to offend him, he was, to all appearance, a man of observation and experience in life. For about two years and a half he was under the care of various gentlemen, devoted to the insane, and at length he was dis- charged from an establishment near Bath, by the visiting magistrates, as a person confined without due cause. His first act was to com- mence legal proceedings against his friends for his detention, and having gained his action, he immediately proceeded to London, and waylaid and violently assaulted a gentleman of high commercial standing in the city. After this offence he was confined for a con- siderable period in default of bail, and immediately on his liberation it is believed that he proceeded to America. From this time nothing was heard of him until September, 1843, when a letter was received b}^ a gentleman who formerly attended him, in which he stated that the same course of persecution was pursued towards him in America as had been followed in England. He complained of not being able to obtain efficient medical treatment, although he had applied to the most eminent practitioners in Cincinnati, and afterwards at Philadel- phia and New York. After this, nothing more was heard of Mr. H until the year 1845, when an American newspaper was for- warded to his friends by an unknown hand, containing an account of his death, and of an inquest held on him, headed, "Death of a Hermit in West Jersey." It was stated that he lived on a small farm, entirely alone, with the exception of a dog, and that he had shunned all intercourse with his neighbors. He was taken suddenly ill, applied to a neighboring farmer for assistance, but died in the course of the following day. From information subsequently ob- tained by his friends, it is believed that he died of apoplexy, or per- haps, in one of the attacks of congestion of the brain, from which he frequently suffered before he left his native country. The symptoms of this unfortunate case strongly resemble those of tlie thirty-second and fifty-sixth cases related by M. Lallemand. It was more aggravated, however, and presented the somewhat uncommon feature of the patient's discovering the fre,quent pollutions, and con- stantly complaining of them : these, unfortunately, were treated as matters of no importance. Mr. H 's insanity, at first, constantly PREFACE, XI bail reference to his liaviu^: either committed or been accusetl of com- mitting unnatural crimes, and this ideanever entirely left him, although during the latter part of his life, his more prominent hallucinations had reference to imaginary persecutors constantly watching him, and endeavoring to ruin him by spreading false reports, and to poison him by adulterating his food, and infusing noxious gases into the air. There can be little doubt, on taking into consideration his complaints of weight between the rectum and bladder, with darting pains, &c,, in the same region, that the pollutions arose from irritation in the neighborhood of the prostate, and I think, that if at an early period of his disease this had been relieved, there would have been con- siderable hope of his recovery from the hallucinations he manifested. The other case to which I have alluded as particularly attracting ray attention, and which came under my notice about the same time, was that of a young man of high intellectual power and general talents, studying medicine. This gentleman was one of ray most constant Companions, when almost suddenly a serious change came over him — he shunned society, especially that of females, was morose, taciturn, and frequently shed tears ; he sat sometimes for hours in a kind of abstraction, and on being aroused from it, he could give no explana- tion of his thoughts and feelings ; he constantly expressed to rae his conviction that he should never succeed in his profession, and fre- quently exclaimed that he was ruined both here and hereafter — body and soul — and by his own folly. About twelve months previous to this depression of spirits, he had a very severe attack of blennorrhagia, with orchitis and phimosis. This left a degree of irritability in the bladder which required him to pass urine frequently. His digestion became so disordered that the simplest food would not remain on his stomach, and he had frequent eructations of fluid which blazed like oil if spit out into the fire. This gentleman's father was a physician, and being naturally anxious for his son, obtained for him the advice of many of the most eminent of the faculty. No improvement took place, however. After he had been six months in this state, I had an opportunity of spending three weeks by the sea side, and my friend accompanied me. We slept in the same room, and he was scarcely ever out of my sight. Before our return his health was almost re- established, and his spirits had returned to their natural condition. Twelve months later, however, he again fell into the same state of despondency, and this time his condition was much worse than on the former occasion. He frequently remained in bed three parts of the day, and no threats or entreaties on the part of his father could induce him to get up. His intellectual faculties were totally pros- trated, and a vacant stare which took the place of his natural lively expression, induced considerable fears of his ultimately becoming idiotic. I was the only person who possessed any influence over him, which may perhaps be attributed to his feeling that I was aware of the cause of his disorder. This state continued between three and four months, during which time I was with him as much as my other ^\[ PREFACE. duties would permit, and frequently showed him the folly of the course he pursued. At the expiration of this time he gradually re- covered. He has since had a slight relapse once only ; he has pur- sued his professional studies with success, and is at present a medical officer in her Majesty's service. On this case, I need only remark that the symptoms did not arise from involuntary seminal discharges, but from excessive dis- charges caused by abuse. The various treatment recommended by the distinguished practitioners consulted, proved unsuccessful, be- cause the origin of the disorder was unrecognized, and the remedies consequently useless, while the habit of abuse was continued. Such were the two cases which first attracted my attention to the influence of the generative organs over the system generally, and the brain especially; and my suspicions once awakened, further observa- tions soon convinced me of their correctness, as well as of the fre- quent occurrence of such cases. I was soon convinced, too, that the profession generally, either were not aware of the immense import- ance of these discharges, or that, by a kind of common consent, they neglected to recognize a subject certainly repugnant to delicacy. As a consequence, sufferers finding themselves neglected by their ordinary medical attendants, rush to find relief wherever there seems to them the slightest chance of its being obtained ; and the ignorant and rapacious advertising quacks have a rapid and profitable sale for their injurious nostrums. Several cases of gross imposition by these charlatans have come under my notice, which it is my intention, at some future period, to lay before the profession in one of our medi- cal periodicals. Their introduction here would swell these prefa- tory observations to an inconvenient length. It now remains for me to make a few remarks on one or two points of my own experience respecting the symptoms and treatment of spermatorrhoea. One symptom which I have three times met with as the result of masturbation, is little more than alluded to by M. Lalle- mand — I mean epilepsy. Masturbation is admitted by most medical men to be a frequent cause of epilepsy ; and I am surprised to find that M. Lallemand has related no cases in which epilepsy occurred. Two of the three cases to which I have alluded were simple uncom- plicated cases of epilepsy brought on by masturbation. In these, after the masturbation had been arrested the effect ceased. The third case, however, was by no means so successful; it occurred in a hid of weak intellect aged sixteen. The attacks of epilepsy frequently took place as often as twice in the day. He admitted that he was in the constant habit of practising masturbation, and even seemed aware of the influence the practice had in producing his fits. I have reason to believe that this lad corrected himself; but from the weakness of his intellect, much dependence could not be placed on his statements. As long as he continued to attend the dispensary at which I saw him, little improvement took place in his general health, and the epileptic paroxysms continued very frequent. I regret that I took no notes of PREFACE. xiii this case, and still more that I lost sight of the patient, as I am in- clined to believe that the epileptic paroxysms might have been kept up by involuntary seminal discharges, after having been once ex- cited by masturbation. This is a point which I earnestly recommend to the attention of the profession. Another very frequent symptom in cases of spermatorrhoea, is the occurrence of urethral discharge from very slight excitement. Several cases of this kind have come under my notice, the patients having consulted me on account of the discharge. These cases often give rise to distressing suspicions, and much family unhappiness, espe- cially as they often occur in married men. The symptoms are often almost as severe as those of a virulent clap, and the discharge is at- tended with great irritation in the neighborhood of the prostate, and frequent desire of micturition. The discharge came on in one case of a married man who consulted me, after taking a single tumbler of whiskey and water at night — this gentleman not having been in the habit of taking spirits for several years, on account of continued ill health. The discharge in these cases is thicker than that of or- dinary clap, and sticks in patches on the linen. These patches may be scaled off, after which there is little mark left, and the discharge seldom penetrates through calico, so that on the opposite side of the shirt there is little or no appearance of stain. On wetting the linen, the discharge feels slippery, and it is washed off with difficulty. I am inclined to believe that these discharges are not contagious ; but notwithstanding this, sexual intercourse should be avoided on account of the injury that may result to the patient himself. In most cases, indeed, connection is impossible during the first stages of the dis- charge, on account of the painful chordee to which excitement gives rise. I have generally, on questioning these patients, found that such discharges were connected more or less with deficiency of generative power. In the case I have above alluded to. impotence was almost complete ; and in another similar case occurring in the person of a married surgeon, the powers had greatly declined. Both these pa- tients were in the prime of life, and both had, in their youth, led very irregular lives. The irritation in these cases, I am inclined to believe, is situated in the posterior part of the urethra. Indeed, the surgeon whose case I have just alluded to, believed himself affected by enlarged prostate — many of the symptoms of which generally accompany the discharge I have described, especially frequent desire to pass w^ater, and a feeling as though the bladder were never completely emptied, or as though two or three drops of urine were retained in the pos- terior part of the urethra. In the treatment of these cases, I have found the application of the solid nitrate of silver most effectual. The condition of the mucous membrane is immediately modified by it ; within twelve hours the xiv PEEFACE. patient experiences a degree of comfort to which, very frequently, he has loner been a stranger. The condition of the membrane, too, seems permanently altered by this treatment ; and the discharge has never, as far as my experience goes, returned after subsequent excitement — a circumstance which is very apt to occur when the discharge has been arrested by other means. The involuntary seminal discharges often present in these cases, and to which the diminution of virile power is generally due, are also at the same time arrested, and the patient experiences a return of vigor wholly unexpected. This peculiar form of urethral discharge has hitherto for the most port, I believe, been confounded with contagious clap ; indeed, many members of our profession are in the habit of setting down all dis- charges from the urethra indiscriminately as the result of impure con- nection, however positive the patient may be that such has not taken place. In all the cases I have hitherto met with, however, the pa- tients have admitted that they had previously been affected with con- taf^ious clap — frequently on more than one occasion. The discharges I have described are, I am inclined to believe, from the number of cases I have met with since my attention was first attracted by the subject, by no means uncommon, and certainly deserving the careful attention of the profession. The diagnosis of spermatorrhoea, in aggravated and long-standing cases, is by no means easy. When frequent diurnal pollutions have deteriorated the patient's health — discharge of watery semen taking place almost every time the patient makes water — the spermatozoa are often only distinguishable under the microscope after a long-con- tinued and patient manipulation; and perhaps for no researches con- nected with medical science is it more important to possess one of the best microscopes. When I first commenced the study of this subject, I was more than once tempted to give it up in despair, in consequence of my not possessing a perfect microscope. At present I use one of Powell's instruments, which I prefer to those constructed by Ross, on account of the greater convenience of the motions of the stage — a matter which will be found of much importance in all researches re- quiring delicate manipulation. The eighth of an inch object glass will be found almost indispensable in the study of these cases, al- though the spermatozoa in healthy semen can be perfectly well exa- mined with an object glass of a quarter of an inch focal length. M. Lallemand has described the operation of cauterization as a very painful one, and its after effects as very severe. This by no means accords with my experience. In no case in which I have performed the operation has the pain been severe, or the subsequent inflammation violent ; indeed, I have several times had difficulty in persuading the patients to remain twenty-four hours in bed after the operation — a precaution which I have thought advisable in all cases. At first I feared that sufficient inflammation had not been excited, and that the operation would require to be repeated — this has only hap- PREFACE. XV pened in my practice once, however, and in that case I am inclined to think that the caustic was not properly applied to the surface of the prostate on the first occasion. The instrument commonly sold for the purpose of cauterizing the prostate, by instrument makers in this country, is, in my opinion, exceedingly defective. From its being made nearly straight, it is by no means easily introduced while the patient is lying down — and in no other position ought the operation to be attempted — the irrita- bility of the canal, too, increases the difficulty of introduction, and consequently every possible facility should be given to the operator, by having the instrument constructed of a convenient form. It is difficult, also, to measure the length of the passage exactly by apply- ing a curved catheter to a nearly straight porte-caustique. I have, therefore, had an instrument constructed of precisely the same curve as the catheters I generally use. This instrument is rather larger than those generally sold, being about the size of a number 6 cathe- ter, and its bulbous extremity is two sizes larger, or as large as a No. 8 catheter ; with this instrument many of the difficulties of cauteri- zation are avoided. It can be easily introduced like an ordinary catheter while the patient is lying on his back ; the moment when the bulb enters the neck of the bladder is clearly distinguishable by the sensation communicated ; and the caustic, on account of the greater size of the curvette, is more fairly applied to the whole of the infe- rior surface of the urethra, which is to a certain extent distended by its presence. With regard to the other precautions to be used, I quite agree with M. Lallemand. In translating the following pages, I have endeavored more to render the sense of the author in as few words as possible, than to give a full and literal translation. I must beg my readers to bear in mind, that M. Lallemand's treatise consists of three thick octavo volumes — these having been written at different periods, there are of course many repetitions, which I have, as much as possible, en- deavored to avoid. The total number of cases related by M. Lalle- mand is one hundred and fifteen. Of these I have selected sixty- two, which, after mature consideration, appear to me to illustrate the subject sufficiently. The same reason which induced me to omit so many of M. Lallemand's cases, has prevented me from inserting cases from my own experience. As I have endeavored to render this entirely a practical work — I have omitted M. Lallemand's inter- esting researches on the spermatozoa, except as far as they refer to the diagnosis of spermatorrhoea, as well as several digressions made by M. L. to topics of no practical interest in this country ; of these a disquisition on the character of J. J. Rousseau is one of the most remarkable. In speaking of spermatorrhcea arising from contagious urethritis, I have avoided the word gonorrhoea as being a misnomer, substi- tuting for it blennorrJiagia, which is certainly more correct in its derivation, although also liable to some objections. ■^y{ PEEFACE. I conclusion, I must beg to express my thanks to M. Lallemand for the kind and complimentary manner in which he was pleased to erant me permission to undertake my task, as well as for the aid he has more than once afforded me in performing it. If through the medium of the following pages the profession becomes more fully acquainted with, and consequently better able to relieve, one of the most distressing disorders that affect mankind, I shall feel perfectly satisfied in the conviction, that the time I have appropriated to the subject has not been entirely misspent. 29, Berners Street. CONTENTS. Page Author's Preface ...'... xiii Editor's Preface . . . . . . xv CHAPTER I. Lntroduction ... . . . . 33' CHAPTER II. INFLAMMATION OF THE SPERMATIC ORGANS. Pathological Anatomy . . . . .36 Case I. — Blennorrhagia — Diurnal Pollutions — Hypochondriasis — Chro- nic affection of the Brain and its Membranes — Death. Autopsy — Right Kidney in a state of Suppui-ation — Prostate nearly de- stroyed. Ejaculatory Ducts ulcerated — Seminal Vesicles altered — Nothing remarkable in the other organs . . .37 Case II. — Blennorrhagia — Spermatorrhoea — Hypochondriasis — Fre- quent attacks of Cerebral Congestion — Death. Autopsy — Suppu- ration in the Seminal Vesicles — Ossific deposit in the Vasa Defer- entia — Cystitis — Phlebitis — Old adhesions of the Arachnoid and Pleurte — Abscesses in the muscles of the Neck and Shoulders . 42 Case III. — Blennorrhagia — Retention of Urine, &c. — Apoplexy — Death. Autopsy — Effusion of Blood into the left Ventricle of the Brain — Hypertrophy of the Heart — Gastro-enteritis — Abscess and Tuber- cles in the Kidney and Prostate — Stricture, &c. . . .46 Case IV. — Mental Derf^ngement — Belief in a change of Sex — Death — Autopsy — Thickening of the Arachnoid — Great alteration of the Prostate — Atrophy and obliteration of the ejaculatory Ducts . 49 Summary of the preceding Observations. — Symptoms . 49 Lesions in the Prostate . . . . .51 In the Spermatic Organs . . . .63 In the Orifices of the Ejaculatory Ducts . . 54 2 XVlll CONTENTS. In the Ejaculatory Ducts In the Seminal Vesicles . In the Qualities of the Semen In the Vasa Deferentia . In the Testicles . In the Urinary Organs . Comparison of the two Sets of Organs Resumd * . 54 55 55 55 57 57 53 61 CHAPTER III. CAUSES OF SPERMATORRH(EA. Blennorrhagia . . . . . .62 Case V. — Lymphatic Temperament — Blennorrhagia — Orchitis — Nephri- tis — Nocturnal and Diurnal Pollutions — Abuse of Mercurials — Injurious effects of Cold and Tonics — Cure by means of Leeches, the use of Flannel and Milk Diet — Fresh attack of Blennorrhagia — Same Treatment with the same Result . . . .62 Case VL — Masturbation — Blennorrhagia — Diurnal Pollutions — Failure of the ordinary modes of Treatment — Cauterization of the Pros- tatic Portion of the Urethra — Rapid Recovery . . .66 Case VII. — Abuse of Spirituous Liquors — Blennorrhagia — Nocturnal Pollutions — Impotency — Frequent discharge of Urine — Cauteri- zation — Cure . . . . . • . • 69 Case VIII. — Masturbation — Blennorrhagia, repeated anti-venereal Treatment — Diurnal Pollutions — Increasing Weakness, especially of the Mental Faculties — Extreme Emaciation — Cauterization, and Cure after Sixteen Years — Venereal Excess, Relapse — Cau- terization again performed with success . . . .71 Case IX. — Blennorrhagia followed by Excoriations of the Glans Penis — Spermatorrhoea — Cauterization unsuccessful — Artificial Sul- phur Baths — Cure ...... 74 Consideration of the Causes . . . . .75 Mode of Action . . . . . .77 Treatment of Spermatorrhoea following Blennorrhagia . 79 Symptoms of Spermatorrhoea arising from Blennorrhagia . 80 CHAPTER IV. CAUSES OF SPERMATORRH(EA — CONTINUED. Cutaneous Affections . . . . .81 Case X.— Itch during Ten Months, at about the age of Fourteen— Pain in the Epigastrium — Tumor of the Testicle — Chronic Inflam- mation of the Bladder— Diurnal Spermatic Discharges — Hypo- chondriasis. Cure by Cauterization at the age of Twenty-eight . 81 CONTENTS. Xix Case XI. — Cutaneous affections — Repeated Attacks of Urethritis — Appli- cation of the Nitrate of Silver — Cure . . .83 Case XII. — Pruriginous Eruption around the Genital Organs — Two at- tacks of Blennorrhagia — Nocturnal and Diurnal Pollutions — Cure by means of Sulphuretted Baths . . .85 Case XIII. — Herpes Prteputialis, alternating in a remarkable manner with Irritation in the Prostatic Portion of the Urethra — Noctur- nal and afterwards Diurnal Pollutions — Occasional Impotence — Ile-egtablishment by Cauterization — Relapse — Cure by the Baths of Vernet ... .... 86 Case XIV. — Lymphatic Temperament — Various Cutaneous Eruptions alternating with other Affections — Habitual bad Health — Hypo- chondriasis — Spermatorrhoea undiscovered during Twenty-five Years — Cure by Sulphuretted Baths . . . .88 Consideration of Causes . . . . .90 Mode of Action . . . . . .91 Irritation of the Rectum . . . . ,92 Treatment of these Cases . . . . . 92 CHAPTER V. CAUSES OF SPERMATORRIKEA— CONTINUED. Influence of the Rectum . . . . .93 Case XV. — Spermatorrhoea from a Mechanical Obstacle to Defecation — Division of the Stricture — Rapid and Complete Cure . . 93 Case XVI. — Spermatorrhoea induced by Chronic Diarrhoea, and kept up by a Mechanical Obstacle to defecation — Removal of a Scirrhous Tumor from the anus — Rapid and Perfect Cure . . 94 Case XVII. — Hemorrhoids from the age of Puberty — Difficulty in evac- uating the Rectum at the age of Twenty-eight — Spermatorrhoea —Cure ....... 67 Case XVIII. — Blennorrhagia, Constipation — Fissure of the Anus — Dis- charge of Semen at Stool — Profound Hypochondriasis — Desire of committing Suicide — Diarrhoea — Cure of the Fissure of the Anus — Disappearance of the other Symptoms . . .93 Case XIX. — Horse Exercise — Constipation — Spermatorrhoea — Impo- tence — Frequent and violent Attacks of Cerebral Congestion — Ascending Douches — Cauterization — Sulphur Baths — Hot and Cold Douches on the Loins and Perineum — Cure . . 100 Case XX. — Lengthened exposure to severe Cold — Incomplete Paralysis of the Rectum — Seminal Discharges during Defecation — Cure by the application of Galvanism .... 105 Case XXI. — Intemperance — Lengthened exposure to Cold — Chronic In- flammation of the Bladder — Involuntary Seminal Discharges, &c. — Cauterization — Cure — Relapse — Same Treatment with the same Result — Remarkable influence of the Bladder on the Rectum . 108 Case XXII. — Unsuspected Spermatorrhoea — Attacks of Cerebral Con- gestion — Disorder of the General Health — Ascarides expelled from the Rectum, with immediate Recovery . . . Ill XX CONTENTS. Case XXIII.— Masturbation at Nine Years of Age— Constant Nocturnal Emissions— Ascarides— Cure in Eight Days . . 113 Case XXIV. — Hypochondriasis — Impotence — Attacks of Cerebral Con- gestion — Ascarides— Cure within Eight Days . .114 Case XXV. — Nocturnal Pollutions resisting all modes of Treatment during Six Years — Great Physical and Moral Depression — Ex- pulsion of Ascarides with complete Relief . . .114 Case XXVI. — The habit of Masturbation contracted spontaneously at the atre of Fifteen, and continued until the age of Twenty — Nocturnal and Diurnal Pollutions — Increasing Disorder of the Health until the age of Twenty-nine — Frequent and prolonged Erections — Pain at the Margin of the Anus, &c. — Cauterization performed without Benefit — The expulsion of Ascarides followed by rapid Recovery 117 Case XXVII. — Masturbation at the age of Fifteen — Serious disorder — The application of a Blister followed by Involuntary Nocturnal Emissions — Cauterization, Douches, &c., unsuccessful — Expulsion of Ascarides followed by a rapid Recovery . . .119 Remarkable case of Urethral Discharge kept up by Ascarides — Editor's note to page .... 121 Case XXVIII. — Masturbation at the age of Ten — Seminal Emissions produced by Horse Exercise — Nocturnal, and afterwards Diurnal Pollutions — Constant Erections — Stools Relaxed, and containing abundance of Mucus — Burning at the Anus — Cauterization, with slight benefit — Expulsion^ of Ascarides followed by rapid and complete Recovery ...... 123 Resume ....... 125 CHAPTER VI. CAUSES OF SPERMATORRHCEA — CONTINUED. Abuse 126 Case XXIX. — Masturbation — Nocturnal Pollutions — Palpitation and Dyspnoea simulating Cardiac Disease — Repeated Venesection fol- lowed by increased Disorder — Sulphuretted Baths and rapid Re- covery ....... 126 Case XXX. — Masturbation at the age of Eight Years — At Twelve, very frequent Emissions of Urine— At Sixteen, Coitus Impossible — Nocturnal and afterwards Diurnal Pollutions — Cauterization at the age of Twenty-eight, followed by rapid Recovery . . 127 Case XXXI. — Masturbation at the age of Seventeen, carried so far as to cause emission of Blood, but soon afterwards abandoned — In- creasing Debility during Four Years — Symptoms of Phthisis Laryngea and Chronic Gastritis — Extreme Prostration — Cauteri- zation followed by rapid re-establishment . . . 130 Case XXXII. — Masturbation from Twelve to Twenty-one Years of age — Melancholy — Inclination to Suicide — Serious alteration of the Health — Monomania — Unperceived Diurnal Pollutions — Cauteri- •zation followed by perfect Recovery . . . .131 CONTENTS. XXI Case XXXIII. — Abuse caused by sleeping on the Belly — Efifects of reading Erotic Works — Power of Habit — Alteration of the intel- lectual and moral Faculties — Impotence — Chronic Irritation of the Bladder — Nocturnal and Diurnal Pollutions — Cauterization followed by prompt Recovery ..... Case XXXIV. — Sexual ideas at the age of Eight — Abuse at thirteen — Various diseases in consequence, until the age of Thirty-two — Nocturnal and Diurnal Pollutions — Cauterization — Slow, but pro- gressive improvement ...... Case XXXV. — Masturbation at Sixteen Years of Age — At Twenty-one, compression of the Uretha during Ejaculation, followed by a sen- sation of tearing, and acute pain — Urethral Discharge recurring frequently — Discharges of Semen during Defecation and the emis- sion of Urine — Reciprocal Influence of the D gestive Organs — Chronic Catarrh of the Bladder Recovery after several relapses Causes of Abuse Internal or Predisposing Causes External or Exciting Causes . Varieties of Abuse Effects of Abuse Effects on Children and on Females Effects of Temperament, Idiosyncrasy, &c. Urethral Discharges following Abuse Prostatitis .... Cystitis .... Emissions of Blood . Orchitis .... scharges on the Di- Cauterization — 135 137 139 142 143 143 148 153 155 158 158 159 159 159 159 CHAPTER VII. CAUSES OF SPERMATORRHCEA — CONTINUED. Venereal Excesses ...... 161 Case XXXVI. — Nervous Temperament — Excessive Intercourse at the age of Twenty-one, continued during Eighteen jMonths — Increas- ing Derangement of Health — Symptoms of Gastritis, and of disease of the Heart — Repeated Abstraction of Blood — Nocturnal and afterwards. Diurnal Pollutions ; Milk Diet, &c. — Acupuncture followed by perfect Recovery ..... 161 Case XXXVII. — Robust Constitution — Venereal Excesses continued till the age of Twenty-four — Chronic Inflammation of the Bladder — Nocturnal and Diurnal Pollutions — Cauterization followed by per- fect Recovery ....... 105 Case XXXVIII. — Three attacks of Blennorrhagia — Hypochondriasis — Danger of Suicide — Recovery — Marriage a few months after — Change in the moral Faculties — Disordered Digestion — Consti- XXll CONTENTS. pation Agitation — Insomnia — Fits of Passion —Symptoms of Mental Derangement — Impotence — Nocturnal and Diurnal Pol- lutions Cauterization followed by rapid Recovery — Excesses Re- peated — Relapse ....... Case XXXIX. — Strong Constitution — Masturbation at the age of Seven- teen Serious disorder of the Health until Twenty-six — Marriage Rapid Improvement — Gradual Relapse after Three Years, not- withstanding the cessation of Coitus — Seminal Discharge during Defecation and the emission of Urine — Hypochondriasis — Inflam- mation of the Genito-urinary Organs — Cauterization — Rapid and complete Cure ....... Case XL. — Sanguineous Temperament — Masturbation from Fourteen to Eighteen Years of age — Marriage at Nineteen — Immediate im- provemeut in the Health — Afterwards disorder of the System — Hypochondriasis — Inclination to Suicide — Symptoms of Chronic Gastritis treated for Six Years with Leeches, Blisters, &c. — Noc- turnal and Diurnal Pollutions — Frequent Discharge of Urine — Cauterization followed by a rapid and complete Cure Case XLI. — Nervous Temperament — Delicate Health — Masturbation be- fore Puberty — Urethral discharge after Sexual Intercourse — Or- chitis — Nocturnal Pollutions — Absolute Impotence — Injection with Solution of Nitrate of Silver unsuccessful — Cauterization followed by rapid Cure ...... Case XLII. — Masturbation — Venereal Excesses — Prolonged Horse Ex- ercise — Blennorrhagia — Nocturnal and Diurnal Pollutions — Two Cauterizations — Recovery — Premature Excesses — Relapse — Cure by another Cauterization ...... Case XLIII. — Lymphatic Temperament — Early and Long continued Masturbation — Horse Exercise — Infrequent Coitus — Urethritis — Repeated attacks of Inflammation in the Testicles — Frequent dis- charge of Urine — Pollutions during Defecation — Imperfect Ejacu- lation — Two Cauterizations followed by perfect Recovery Case XLIV. — Lymphatico-Sanguineous Temperament — Coitus when nearly intoxicated, at the age of Twenty-two — Blennorrhagia — Pollutions during Defecation — Disturbance during Ejaculation — Band in the membranous portion of the Urethra — Cauterization — Cure by means of Antiphlogistics and Rest Case XLV. — Coitus in a state approaching Inebriety — Gleet increased by a Journey — Diurnal Pollutions — Cauterization with rapid Im- provement — Relapse from premature fatigue of the Organs — Cure lay means of Antiphlogistics and Rest Resume Characteristics of Venereal Excesses Age . Temperament Genital Instinct Diflferences of Genital Development Influence of Encephalic Organs Accidental Influences General Effects of Venereal Excesses Special Eff"ects of Venereal Excesses 166 170 172 173 175 180 182 183 184 187 188 188 188 188 191 192 192 CONTENTS. XXlll CHAPTER VIII. CAUSES OF SPERMATORRHGEA — CONTINUED. Action of certain Medicines ..... 196 Astringents ....... 196 Case XLVI. — Intermittent Fever — Large Dose of Bark — Obstinate Con- stipation — Diurnal Pollutions — Symptoms of Chronic Gastritis, and of Disease of the Heart — The use of Douches followed by rapid Improvement ..... 196 Purgatives ....... 197 Narcotics ....... 198 Case XLVII. — Frequently repeated Narcotism at the age of Sixteen from the Vapor of Tobacco — Dilatation of the Pupils — Vomiting — Constant Headache — Constipation — Nocturnal and Diurnal Pol- lutions — Impotence — Cauterization at the age of Nineteen — Rapid Recovery ..... . 198 Case XLVIII. — Nervous Temperament— Repeated Narcotism from Smok- ing betvreen the ages of Twenty and Twenty-two — Impotence, &c. 200 Cantharides ....... 201 Camphor . . . . . . .202 Nitrate of Potass . . . . . .202 Ergot of Rye . . . . . .203 Coffee . . . . . . .203 Case XLIX. — Excessive use of Coffee — Frequent and profuse Discharge of Urine — Nocturnal and afterwards Diurnal Pollutions — Impo- tence, &c. — Cauterization — Sulphuretted Baths — Recovery . 204 Tea . 205 CHAPTER IX. CAUSES OF SPERMATORRHEA — CONTINUED. Action of the Cerebro-spinal System .... 206 Case L. — Masturbation — Extreme weakness of the Limbs and Senses — Erections exited by Percussion of the Occiput — Catheters left in the Urethra — Rapid Recovery .... 207 Case LI. — Sickly Childhood — Nervous Temperament — Masturbation Rare — Coitus still more so — Symptoms of Aneurism and Gastritis — Nocturnal Pollutions — Predominance of Erotic Ideas — Tension at the Nucha — The application of cold Lotions to this Region fol- lowed by considerable Improvement .... 208 Action of the Spinal Cord ..... 211 xxiv CONTENTS. CHAPTER X. CAUSES OF SPERMATORRHEA— CONTINUED. Congenital Predisposition ..... 21_ Sebaceous Matter ...••• 213 Case LII.— Natural Phimosis— Frequent Nocturnal Pollutions from the age of Puberty— Abundant and Fetid sebaceous Secretion be- tween the Glans and Prepuce— Circumcision at the age of Twenty- three followed by immediate Relief .... 213 Natural Phimosis ...... 214 Case LIII.— Natural Phimosis- Erections at the age of Eight— At- tempts at Coitus at Nine— Vesical Catarrh— Diurnal Pollutions — Paraplegia, &c. .... • • -1^ Case LIV.— Very long Prepuce— Badly developed Genital Organs- Childhood Delicate — Incontinence of Urine — Sebaceous Discharge from the Orifice of the Prepuce at the age of Ten — Nocturnal Pollutions increasing in frequency — Hypochondriasis — Loss of Memory and failure of Intellect — Constipation — Diurnal Pollu- tions — Constant application of Lotions attended by Relief— Cir- cumcision at the age of Twenty-eight, followed by Cure . . 217 Case LV.— Very long Prepuce — Badly developed erectile Tissues — Abundant Secretion of Sebaceous Matter — Seminal emissions induced by Horse Exercise, and afterward, by incomplete Inter- course — Marriage unconsummated during Five Years — Diurnal Pollutions — Circumcision followed by rapid Cure . . 219 Exuberant Prepuce ...... 220 Abundant and vitiated secretion of Sebaceous Matter . 221 Congenital Debility ...... 224 Ca?e LVI. — Relaxed Genital Organs — Spermatic Cords Varicose — Few but debilitating Nocturnal Pollutions — ^Opposite effects of Coitus — Unsuspected Diurnal Pollutions — Constant Headache — Dis- ordered Senses — Intellectual Debility — Hallucination — Tonic treatment at the age of Twenty-one, followed by Recovery . 224 Varicocele ....... 227 ooc Case LVII. — Hypospadias — Impotence — Frequent Seminal Discharge . Case LVIII. — Atrophy of one Testicle at the age of Eight — Nocturnal and afterwards Diurnal Pollutions — Frequent desires of Micturi- tion, &c. . . . . . . . 230 Case LIX. — Lymphatic Temperament — Incontinence of Urine — Neither Masturbation nor Sexual Intercourse — More and more frequent Nocturnal Pollutions — Relaxation of the Sphincters of the Anus and Neck of the Bladder— Treatment unsuccessful . . 231 Case LX.— Sickly Childhood— Extraordinary Nocturnal Pollutions at Sixteen — Some time after. Pollutions during Defecation — Ejacu- lation impossible— Slow discharges of Semen after the subsidence of Erection— Urethra very slightly Sensitive— Prostatic Surface Hard and Cartilaginous ..... 232 CONTENTS. XXV Symptoms of Debility of the Genital Organs . . 233 Symptoms affecting the Urinary Organs during Childhood . 237 Incontinence of Urine ..... 237 Retention of Urine ...... 239 Hereditary Transmission ..... 240 Case LXI. — Blennorrhagia at the age of Twenty-one — Pains in the Testi- cles — Pollutions during Four Years — Serious Gastric and Cerebral Symptoms occurring in Paroxysms — Hereditary Predisposition — ■ Iced Milk — Cauterization — Acupuncture — Sulphuretted Baths — Recovery ...... . 240 Case LXII. — Nocturnal and Diurnal Pollutions occurring in Three Bro- thers . . . . . . .244 Congenital increased Nervous Susceptibility . . . 2-15 Long-continued Continence ..... 246 General Review of the causes of Spermatorrhoea . . 249 CHAPTER XL SYMPTOMS OF SPERMATORRHCEA. Local Symptoms ...... 251 Nocturnal Pollutions ...... 251 Diurnal Pollutions ...... 254 During Defecation ..... 255 During the Emission of Urine .... 256 Appearance of Spermatic Urine .... 256 Other Diurnal Pollutions ..... 258 Impotence ....... 259 Diagnosis of Spermatic Urine .... 259 Chemical Analysis ...... 260 Microscopic Examination ..... 260 Spermatozoa ....... 262 Appearances on Making Water in a Bath . . . 264 Simplest mode of Detecting the presence of Spermatozoa in the Urine ...... 266 XXVI CONTENTS. CHAPTER XIL SYMPTOMS OF SPERMATORRHCEA — CONTINUED. General Symptoms ...... 268 Infecundity ....... 268 Changes in the Characters of the Semen . . . 270 Fever" * 270 Symptoms affecting the Digestive Organs . . . 270 Symptoms affecting Nutrition .... 274 Animal Heat ...... 275 Symptoms affecting Respiration .... 276 Symptoms affecting the Circulation .... 276 Symptoms affecting Innervation ; . . . 278 Motih'ty . . . . . .278 Sensation ...... 279 Symptoms affecting the special Senses . . . 280 Taste 280 Smell . . . . . . .281 Hearing ....... 281 Sight .281 Symptoms affecting the Encephalon .... 284 Sleep and Waking . . . . . .284 Cephalalgia ....... 285 Cranial Congestion ...... 285 Alteration of Character ..... 287 Hypochondriasis . . . . . . 287 Memory . . . . . . .289 Intellect . . . . . . .290 Insanity . . . . . . .291 General and incomplete Paralysis of the Insane . . 294 General character of the Symptoms of Spermatorrhoea . 295 Effects of Masturbation on Children and Females . . 296 Progress of Symptoms . . . . . 296 Spontaneous Recovery ..... 297 CONTENTS. XXVU CHAPTER Xlir. TREATMENT OF SPERMATORRHEA. Pollutions arising from Direct Causes Pollutions arising from Ascarides Pollutions excited by Cutaneous Eruptions . Pollutions arising from altered or increased Secretion of the Sebaceous Glands .... Pollutions depending on Stricture of the Urethra Treatment of the various kinds of Stricture . Pollutions arising from Hemorrhoids . Pollutions caused by Cicatrices in the neighborhood of th Anus ...... Pollutions caused by Fissure of the Anus Pollutions produced by Constipation . CHAPTER XIV. TREATMENT OF SPERMATORRHEA — CONTINUED. Pollutions caused by Relaxation and Debility Pollutions arising from increased Nervous Susceptibility Acupuncture ...... Pollutions kept up by Habit .... Pollutions caused by Sleeping on the Back . 298 298 301 302 303 303 305 30G 306 307 309 313 315 316 316 CHAPTER XV. TREATMENT OF SPERMATORRHCEA — CONTINUED. Pollutions caused by Irritation or Chronic Inflammation . 317 Diet ........ 318 Cauterization ...... 319 XXviii CONTENTS. Action of the Nitrate of Silver .... 323 Cauterization in Chronic Vesical Catarrh . . . 324 Deviation of the Orifices of the Ejaculatory Canals . . 325 CHAPTER XVI. TREATMENT OF SPERMATORRHCEA — CONTINUED. Convalescence ...... 326 ox THE CAUSES, SYMPTOMS, AND TREATMENT OF SPERMATOERHCEA. CHAPTER I. INTRODUCTION. Involuntary discharge of the seminal fluid presents itself under various conditions, which differ much in their respective degrees of importance. When it occurs spontaneously during sleep in a healthj and con- tinent individual, it doubtless exerts a beneficial influence on the eco- nomy, by freeing it from a source of excitement, the prolonged accu- mulation of which might derange the animal functions. In these cases, it has an effect analogous to that produced by the epistaxis, common and beneficial during youth. But the discharge may become excessive, or, from the condition of the parts, it may outlive the state that excited it ; then, like repeated nasal hemorrhage, it gives rise to inconveniences proportioned to its frequency, its quantity, and the constitution of the individual. Involuntary seminal emissions may be caused by too great excitement of the genital apparatus, following venereal excesses or masturbation. A state of irritation remains in the spermatic organs after such excitement, which induces an increased secretion and hurried discharge of the secreted fluid, without com- plete erection, and almost without sensation. Lastly, the relaxation of the ejaculatory canals accompanying this state of irritation, may allow the expulsion of the semen without either erection or enjoyment, and this takes place especially during defecation and the expulsion of the urine. The transition between these different stages of seminal evacuation is sometimes so insensible, that it is impossible for the patient, or even for the medical attendant, to specify its exact period. Every extreme evacuation of the spermatic secretion, in whatever 34 INTRODUCTION. manner caused, is capable of producing the same effects on the sys- tem. The different species of spermatorrhoea need not therefore be separated either in theory or in practice. Ordinary nocturnal emissions are easy of diagnosis and of cure ; I shall therefore pass them over, and only treat of those evacuations which are sufficiently serious to injure the health, or which are con- nected with discharges not ordinarily perceived. I shall use the expressions diurnal and nocturnal pollutions^ be- cause involuntary discharge of the spermatic secretion certainly occurs during the night without erection and without pleasurable sen- sations, as well as in consequence of lascivious dreams after sunrise. Neology is only to be excused when used for the prevention of errors; and I think no one will be deceived respecting the meaning of these expressions, which, indeed, are at present generally understood. In order, however, to avoid the repetition of many words, I shall express, by the term spermatgrrhcea, every excessive spermatic evacuation, from whatever cause it may arise. Diurnal pollutions are ,not always, as is generally believed, the result of venereal excesses, or of vicious habits. Many other varied causes, whose influence may be single, successive, or simultaneous, also give rise to them. Some of these causes are already understood, but of many others, the medical world is completely ignorant ; and these are the most dangerous, because their influence is the most difficult of appreciation. In all sciences the study of causes is the most important and the most difficult. This is true of medicine, and especially of the affec- tion forming the subject of this work ; for it is principally from the cause of the spermatorrhoea, that we learn its therapeutic indications. It is true that we must also, in each case, take into account the parti- cular condition of the genital organs, and the constitution of the indi- vidual ; but these considerations are of little importance with respect to the treatment to be employed, and it is especially in a practical point of view, that I wish to consider this disease. In consequence of not having properly distinguished its causes, explanations, as often false as true, have been published respecting spermatorrhoea, and modes of treatment have been recommended, whose general applica- tion has been sometimes useful, but more often injurious. It is, however, of great importance to study attentively the symp- toms of involuntary spermatic discharges ; they are little known, very varied, and capable of simulating a host of other affections; but their character is independent of the first cause of the disease, and they furnish few indications for the regulation of its treatment. On the other hand, the history of this affection is so much in its infancy, that I feel the necessity of proceeding as if I were treating an entirely new subject. I shall, therefore, relate many single cases, before I attempt to arrive at general conclusions. As these cases are very numerous, I must classify them according to some arrangement, and I shall place the causes first in this classification, since they are INTRODUCTION. 35 the most important part of it. Proceeding from the evident to the doubtful, and from the simple to the compound, I shall examine first the causes whose action is most direct and undoubted ; and whilst studying the influence of each cause, I shall bring forward the cases in which its action has been energetic, isolated, and, when possible, proved by post-mortem inspection, and I shall afterwards cite cases in which several causes have acted successively or simultaneously. After having examined many cases in this manner, I shall make a general resume, in the course of which, I shall comment on whatever relates to the symptoms of the treatment. I shall also pay attention to the analogous phenomena which may be observed in the female. I propose then to consider this affection of the genital organs in all its varied phases ; I shall pass rapidly over what is already known ; I shall, on the contrary, insist on the most remarkable er- rors, and comment fully on all that may seem doubtful or obscure. If I were to relate all the cases that have come under my notice, tiresome repetitions would result : I shall, therefore, choose only those which best show the characteristic features of the most import- ant distinctions.' ' I have thought it advisable, on account of the great number and length of these cases, to select a few of the most striking only. In answer to a communication from me on this subject, M. Lallemand has favored me with the following observation. " As regards the cases, their number may be reduced, now that facts are being daily multiplied in confirmation of those I have related ; it will be sufficient for you to give the most characteristic." — [H. I. M'D.] ( 36 ) CHAPTER II. INFLAMMATION OF THE SPERMATIC ORGANS, Pathological Anatomy. Inflammation of the organs for the secretion and excretion of setnen, is the most frequent and most active cause of spermator- rhoea. The influence of this cause may be very easily conceived, and its traces may be detected in the organs after death ; I shall, therefore, commence the subject by its consideration. Works on pathological anatomy have hitherto afforded us very little information respecting this important and delicate matter ; the omission arises from several circumstances. Inflammation of the spermatic organs does not threaten life at its commencement ; when the patient dies at an early period of the affection, it is in consequence of some other more serious disease, which engrosses the care of the attendants, so that after death ex- amination of the spermatic organs is neglected. When the continued influence of this inflammation produces diurnal pollutions sufficiently serious to destroy life, the periods of their occurrence are very distant ; the symptoms are insidious, and their true cause, in many cases, is not even suspected. Whatever the care taken, then, in examining the body, it generally happens that every part is inspected, except the genital organs ; incomplete cases are thus published, which are received with the more con- fidence, because the dissection of the viscera, generally, has been made with care. The situation of the prostate and seminal vesicles is another rea- son why their examination is neglected. In order to inspect these parts with the minute care requisite, it is necessary to divide the crural arch near its centre, to remove the abductor muscles of the thighs, to cut through the horizontal rami of the pubes, and the rami of the ischia, so as to remove the testicles, the vasa deferentia, the rectum, and the perineum undisturbed. It is by this means only that we can obtain a good view of the organs situated in the lower part of the pelvis, examine their rela- tions with care, or observe their color, consistence and dimensions — circumstances requiring attentive study — since serious symptoms may follow almost imperceptible lesions. Thus, for instance, the orifices INFLAMMATION OF THE SPERMATIC ORGANS. 37 of the ejaculatory ducts may have been rendered uneven by some sliglit ulceration ; their form may have been altered, or their size in- creased, of which I have met with several cases ; and we can easily conceive the consequences which may result from even the partial destruction of their little sphincter muscles. The color, firmness, and exact size of these canals also furnish information of much im- portance. The examination of all these parts requires considerable time, pa- tience, and skill; it is necessary to inspect them thoroughly, in order to appreciate all changes affecting them, and this is impossible if the removal of that portion of the pelvis, to which they are attached, be omitted. Thus the section I have described becomes in a measure indispensable; nevertheless, in general practice it is never had recourse to, except for the purpose of examining some rare affection of the bladder or prostate. In order to understand, thoroughly, the condi- tions of these parts when diseased, it is necessary, also, to have seen them very frequently while healthy : this is neglected even by men who devote themselves specially to the study of pathological anatomy. On this account I shall illustrate their pathological changes by some cases which would under other circumstances be devoid of interest. CASE I. Blennorrhagia — Diurnal pollutions — Hj/pochondriasis — Chronic affection of the Brain and its Membranes — Death. Autopsy. — Right kidney in a, state of suppuration — Prostate nearly de- stroyed — EJacuIatory ducts ulcerated — Seminal vesicles altered. Nothing remarkable in the other organs. In the month of January, 1824, I was requested to see M. De S , affected wish symptoms of cerebral congestion, from which he had suffered for some time. During several consultations I gathered the following facts. M. De S was born in Switzerland, of healthy parents, and his father died suddenly of affection of the brain. M. De S , possessing a strong constitution and an active mind, received an excellent education, and at an early age turned his attention to the study of philosophy and metaphysics; he afterwards studied moral philosophy and politics. After having spent some years in Paris pursuing his favorite subjects, he was obliged to undertake the management of a manufactory, and to at- tend to details which wounded his pride. He became, by degrees, peevish and capricious — passed, without apparent cause, from an extravagant gaiety to a profound melancholy — was irritated by the slightest contradiction — showed no pleasure at fortunate events — and gave way to anger on improper occasions: at length he appeared to feel disgust and fatigue at correspondence or mental exertion. At this period he married, and Dr. Butini, of Geneva, his medical attend- ant and friend, wrote respecting him as follows : — " With this marriage the most happy period of his existence seemed to 38 INFLAMMATION OF THE commence ; but soon the germs of the disease, which so many causes bad contributed to produce, became rapidly developed. It was perceived that ]VI. De S wrote slowly and with difficulty, and his style presented signs of the decay of his faculties; he stammered and expressed his ideas very im- perfectly ; he experienced, also, at times, attacks of vertigo, so severe as to make him fall, without, however, losing sensibility, or being attacked by convulsions." One day an attack which frightened the patient seriously, and left a deep impression on his family, came on whilst writing an ordinary letter. His medical attendants attributed his attack, which left a weakness of the right side of the body, to apoplexy. Twenty leeches were applied to the anus, and the danger seemed at an end. Similar attacks, however, occurred at Geneva and Montpellier, and seve- ral distinguished practitioners were consulted: some of these, struck by the misanthropic irritability of the patient, and his solitary habits, regarded the affection as purely hypochondriacal or nervous; others, taking into consider- ation his digestive disorder, considered it an affection of the liver; but the greater number were of opinion that there existed a chronic affection of the brain, such as encephalitis, or chronic meningitis, arising from hereditary predisposition. This last opinion was held by Dr. Builly, (of Blois.) At all these consultations, the necessity of abstaining from serious occu- pation, the utility of travelling — of various amusements, and of a strict re- gimen — and the importance of free evacuations from the bowels by means of purgatives and injections, were agreed on. Many of the practitioners recommended the frequent application of leeches to the anus, with milk diet, &c. ; others thought that assafojtida, baths, and camphor, were indi- cated. None of these modes of treatment produced any considerable amendment; the leeches weakened the patient, and the milk diet disordered his stomach. His constipation continued. Cold plunge baths, and cold affusion to the head, relieved the insupportable spasms M. De S experienced in his legs and face : the waters of Aix, in Savoy, and the use of douches also appeared to produce some improvement. Still M. De S became more irritable, and at the same time more apathetic. His attacks were more frequent and more violent, and he mani- fested greater indifference towards the persons and things he had before been partial to. The weakness of his limbs increased to such an extent that he frequently fell, even on the most level ground. His nights were restless, his sleep very light and often interrupted by nervous tremors, or acute pains accompanied with cramp. The cerebral congestion increased, and the imminent fear of apoplexy rendered leeches to the anus, venesection in the foot, tartar-emetic ointment, blisters, mustard pediluvia, and the application of ice to the head, necessary. Notwithstanding the employment of these energetic measures, another violent attack of congestion occurred. I was summoned on this occasion, and I found the patient restless, agitated, and incapable of remaining two minutes in the same place ; his face was red, his eyes projecting, injected, and fixed; his physiognomy expressed extreme dread; his walk was uncer- tain, his legs bending under the weight of his body ; his skin cold, and his pulse small and slow. The last circumstance attracted my attention, and I also recommended the application of leeches to the anus. M. De S immediately threw SPERMATIC ORGANS. 39 himself into a violent passion, and asserted that leeches had always weak- ened him without giviny him any relief. I was too much afraid of the oc- currence of apoplexy to pay attention to this assertion ; and I succeeded in obtaining the application of six leeches. The next day I found the patient very pale, and so weak that he was un- able to walk — a source of much annoyance to him, as he manifested a con- stant desire for motion. An oedematous swelling of the parotid gland and of the right cheek followed, which was succeeded, a few days after, by a similar state of the left leg and foot. Sleep had become indispensable, and the patient was much reduced from the want of it; he told me, with tears in his eyes, that he had lost his appe- tite, and could no longer relieve his bowels. I also learned that he was ha- bitually costive and flatulent; that he often had recourse to injections and purgatives in order to relieve his obstinate constipation ; and, lastly, that his walks, and the evacuation of his bowels had lately become the sole objects of his thoughts and conversation. Having observed analogous symptoms in almost every person affected by diurnal pollutions, I made further inquiries respecting the attack, in which it was supposed that the right side had been paralyzed, and I was soon con- vinced that the intellectual powers had been wanting, and not the power in the hand which held the pen : both sides of the body had, in fact, retained an equal degree of strength. Struck by a remark of Dr. Butini's respecting the progress of the disease soon after marriage, I made inquiries of Mme. De S , and learned that the character of her husband had become so uncertain, irritable, and tor- menting, that his friends thought he must be unhappy in his marriage. I then suspected that the origin of the patient's disease had been mistaken, and I requested that his urine might be kept for my inspection. The ap- pearance of the urine was suflBcient to convince me that my suspicions were well founded ; it was opaque, thick, of a fetid and nauseous odor, resembling that of water in which anatomical specimens have been macerated. By pouring it off slowly, I obtained a flocculent cloud, like a very thick decoc- tion of barley ; a glairy, ropy, greenish matter remained, strongly adherent to the bottom of the vessel, and thick globules of a yellowish white color, non-adherent, like drops of pus, were mixed with this deposit. I was there- fore convinced that spermatorrhoea existed, together with chronic inflamma- tion of the prostate and suppuration in the kidneys. Notwithstanding the state of M. De S 's intellect, I was able at a favorable moment to obtain further information. At the age of sixteen he had contracted blennorrhagia; this he carefully concealed, and succeeded in curing by the use of refrigerant drinks. The following year the blennor- rhagia returned, and was removed by astringents. Two years afterwards, from drinking freely of beer when heated, the discharge again appeared, and after some time it again returned, from the effects of horse exercise. Since that time, M. De S had felt little sexual desire, and had abstained ' from intercourse without regret. Ejaculation during coitus had always been very rapid. Fully convinced by combining all these circumstances, I ex- plained to M. De S the nature of his disease, and he promised me to observe carefully. The next day he called me aside, and told me that the last drops of urine were viscid, and that during an evacuation of the bowels, he had passed a sufficient quantity of a similar matter to fill the palm of his hand. 40 INFLAMMATION OF THE Eight days after, another attack of cerebral congestion occurred, fol- lowed by stertorous breathing, cold skin, and an inappreciable pulse ; the patieut fell into a kind of syncope, of which he died on the 1st of March, 1824. Post-mortem inspection, twenty-six hours after death. — The general emaciation of the body was extreme. JJead. — Between the dura mater and the arachnoid several bubbles of air appeared, mixed with a viscid serosity; the vessels of the pia mater were sli