[ o C-J-^^'

A PRACTICAL TREATISE

ON THE CAUSES, SYMPTOMS AND TREATMENT

SPERIATORRHCEA:

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

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

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

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<Thtly injected; the arachnoid was a little opaque near the falx,
but neither thickened nor granular ; two or three spoonfuls of limpid se-
rum were found in the ventricles, without any apparent alteration in their
serous lining; the brain was slightly injected and soft throughout, but with-
out appreciable alteration in any one particular part; the cerebellum, also,
was very soft, of natural size, neither more nor less injected than the brain,
and without any particular alteration. Three or four spoonfuls of serum
were found at the base of the brain and commencemerat of the vertebral
canal.

Chest. — Pleura pulraonalis everywhere adherent by a dense cellular tis-
sue to the pleura costalis ; lungs crepitant and pale, except at the posterior
part ; heart of the ordinary size, and firm.

Abdomen, tympanitic, green, and exhaling a very fetid smell ; liver of
natural color and very firm; a spoonful of bile in the gall-bladder; spleen
small and of a violet color; stomach distended by gas; mucous membrane
thin, soft, and of a brownish-gray color; small and large intestines equally
distended by gas, pale, and thin in their structure, containing a small quan-
tity of brown, excessively offensive liquid, fgecal matter.

Left Kidney of the ordinary size, of a healthy red, and very firm.

Riyht Kidney a third larger than natural, adherent by a dense, resistant
cellular tissue to the surrounding structures; containing in its parenchyma
about forty little abscesses, varying from the size of a pea to that of a nut,
some of recent formation, and without cysts, others old and encysted, all con-
taining thick and creamy pus; the structure of the kidney reduced in four-
fifths of its extent to a dense coriaceous membrane, full of cloacce ; the lining
membrane of its pelvis red and villous ; the ureter thin, distended, brownish,
and much injected on its mucous surface.

Bladder rising as high as the umbilicus, and containing two pints of trans-
parent urine. Its parietes thin ; the muscular fibres weak and scattered ;
mucous membrane rose-colored and slightly injected, but thin and scarcely
altered in appearance.*

Prostate projecting three or four lines behind the neck of the bladder,
over about an inch and a half in superficial extent. In the Trigone Vesicle
there was an effusion of albuminous matter, half a line in thickness and
about two inches in extent, uniting the seminal vesicles to the anterior wall
of the rectum.

The Left Seminal Vesicle small and brown, but in its normal position.

The Right separated from the corresponding A'as deferens, folded on the
posterior border of the prostate, atrophied and surrounded by a very dense
fibrous cellular tissue, which was very difficult of dissection.

• In order to examine the genital organs with greater care, I removed the parts
■with the rectum, by means of the section before described.

SPERMATIC ORGANS, 41

The Prostate double its normal size, and projecting into the rectum ;
hard on the sides of the neck of the bladder, soft in the centre. Its fibrous
envelope having been divided with a bistoury, an opaque, thick, ropy,
elastic matter escaped, like pus in color, and the mucus of the nostrils in
consistence. There was a cavity occupying the whole of the anterior and
middle parts of the prostate, about fifteen lines in size in every direction,
when the purulent matter had been removed ; the gelatinous mass was
observed to divide into a number of filaments which became impacted in
numerous small foramina; the canal of the urethra being closed, these
filaments came out by the openings of the mucous follicles of the prostate.
When this cavity was emptied it became evident that the two inferior
thirds of the prostatic part of the urethral mucous membrane had been
detached and had covered the cavity in the prostate in the same manner
that the cribriform lamella of the ethmoid bone covers the nasal fossae in the
dried skull.

The openings of the Ejacxdatory Ducts, in place of being circular and
nipple-shaped, formed a long slit, which was ulcerated, especially on the
side towards the bladder; two probes of considerable size introduced
through the vasa deferentia passed easily through these openings. The
ejaculatory ducts were long and thin, as though dissected, and formed part
of the superior wall of the cavity in the prostate. The posterior border of
the prostate was not destroyed, but was pale, soft, and easily torn, like all
the parts in the neighborhood of the principal abscess.

The Urethra presented no remarkable appearances.

The Testicles were small, flaccid, and pale.

I leave this case just as I wrote it when under impressions formed
at the time, because its recital is well fitted to show those serious
errors in diagnosis which are much more common than might have
been suspected.

Now that we have seen the move obscure parts of this case cleared
up by degrees, let us consider the chronological order of the facts : —

A urethral discharge, badly treated in the beginning, reappeared
from very slight causes, whose action, however, was easily appre-
ciable. The follicles of the prostate, from repeated attacks of in-
flammation, became disorganized ; the ejaculatory ducts were laid
bare, and their orifices became ulcerated ; the inflammation extended
to the seminal vesicles, and the peritoneum adjoining.

Soon after, a new train of symptoms set in, which became much
aggravated after the patient's marriage, in consequence of the unac-
customed exercise of the disordered organs. Ejaculation was rapid,
because the ejaculatory ducts were in a state of irritation. The
erections were incomplete, and at length ceased altogether, because
the semen was habitually expelled as soon as secreted. This dis-
charge was considerable, for the testicles shared the irritation of the
other parts. During all this time inflammation was creeping along
the urinary apparatus, and ended by destroying the right kidney.
Hence the symptoms observed previous to death ; hence the very
remarkable appearance of the urine, an excretion to whose changes
suflScient importance is not attached at the present day, from its exa-

42 INFLAMMATION OF THE

mination having been once rendered ridiculous through the preten-
sions of quacks.

CASE II.

Blennorrhagia — Spermatorrhoea — Hi/pochondriasis — Frequent attacks of
cerebral confjestion — Death.

Autopsy. — Suppuration in the seminal vesicles — Ossific deposit in the vasa
de/erenfia — Cystitis — Phlebitis — Old adhesions of the arachnoid and
pleurse — Abscesses in the muscles of the neck and shoulders.

On the 25th of September, 1825, Professor Brousonnet granted me the
examination of one of his patients who was supposed to have died from
cerebral hemorrhage. Before commencing the post-mortem I learnt the fol-
lowing particulars : —

Francis Maurice, aged seventy-three years, formerly a soldier, had com-
plained for some time of weakness in his legs ; he staggered whilst walking
as if he suffered from giddiness, and he would often have fallen if he had
not been assisted. Occasionally he had attacks of congestion in his head ;
his face became red, he lost his senses, and experienced very varying spas-
modic symptoms. After these his face became pale, and fainting occurred.
These attacks had been treated by bleeding, derivatives, antispasmodics, and
leeches.

At length, on the 22d of December, a violent attack of congestion in the
head occurred ; his face became purple, and the next day he died.

These symptoms seemed to indicate a chronic affection of the brain or its
membranes, producing attacks of congestion, the last of which terminated
in apoplexy. On inquiry I could not learn which side of the body had
been paralyzed ; but it seemed certain that no distortion of the face had
ever existed. This circumstance made me suspect that the paralytic symp-
toms had always been general.

The cause of the disease was attributed to some hidden care. The pa-
tient had spoken little, and always presented a sad and silent appearance :
he had complained of a host of different diseases, the greater number of
which seemed imaginary, or, at least, much exaggerated. He complained
of pain about the occiput, the neck, and the back ; colic, distention of the
lower part of his belly, and borborygmi affected him frequently. Notwith-
standing his weakness he had a constant desire for motion : he could not
remain quiet in bed, and often had recourse to the night-stool. lie had an
irritable manner ; he tormented the nurses and snubbed the pupils, and was
generally looked upon by the latter as a hypochondriac.

I learnt also that he had experienced several attacks of retention of urine,
and I recollected having introduced a catheter for him a few days before
his death.

I suspected, therefore, that the symptoms he had manifested arose from
unperceived spermatorrhoea.

The following are the results of the inspection of the body : —

i/eafZ.— Cerebrum and cerebellum slightly softened throughout, but not
more so in one part than in another; the cerebral substance slightly, but
equally, injected, especially in the posterior lobes ; several old cellular adhe-
sions, five or six lines in extent, in the inferior occipital fossae, intimately
uniting the corresponding surfaces of the arachnoid; the cerebellum equally

SPERMATIC ORGANS. 43

adherent to the pia matter in the same situation, and incapable of being de-
tached without injury to its structure. In the other parts of the interior of
the cranium there was not the least local change that could be considered a
result of recent disease.

Thorax. — Lungs healthy; a few old adhesions of the pleuras on both
sides; heart flaccid, of the color of wine lees, and easily torn ; the principal
veins without firmness, and of a dark violet color; the iliac and crural veins
presented the same conditions.

Abdomen. — The mucous membrane of the stomach slightly injected ; the
small intestines in much the same state ; nothing remarkable in the other
abdominal organs ; the kidneys and ureters healthy.

Pelvis. — The bladder, which contained a large quantity of muddy urine,
was united to the rectum by cellular adhesions ; its mucous membrane was
of a dark red, highly injected, and covered by small ecchymoses, from ex-
travasation of blood in its structure ; the prostate was of its natural size and
firmness.

The Seminal Vesicles were much dilated, their parietes were very thick
and dense, and they presented no markings or inequalities. These organs
were attached by strong and much injected cellular tissue to the neighbor-
ing parts, and each of them contained about a spoonful of thick yellowish
pus enclosed in three or four cavities communicating with each other and .
with the ejaculatory ducts. The inner surface of these abscesses was un-
even, rugous, and lined by a sort of false membrane formed by a layer of
thickened pus.

The Vasa Defereniia were tortuous, and completely ossified for the extent
of about three inches, but not obliterated. They contained a slightly viscid
fluid.

The mucous membrane of the urethra was much injected, especially from
the bulb as far as the bladder; the mucous follicles much developed. The
neck of the bladder was thickened, of a reddish brown color, without tena-
city, and fissured by several recent lacerations.

Some days after, the pupils, who were dissecting the muscles of this sub-
ject, told me that they had found the subscapularis, and the supra- and infra-
spinatus muscles on both sides, as well as several muscles of the neck, in a
state of suppuration.

Some time after I succeeded in learning the following facts.

Maurice whilst in service at the age of twenty-three years contracted a
violent blennorrhagia accompanied by orchitis and inflammation of the spongy
tissue of the urethra, which he neglected after the relief of the most urgent
symptoms. His character, previously very gay, now changed by degrees ;
he experienced attacks of profound melancholy, during which he imagined
that every one disliked hira ; when these attacks were over he gave himself
up to dissipation; he drank freely, but when no longer excited he relapsed
into melancholy, and often complained of pains in his head towards the oc-
ciput.

At first he experienced nocturnal pollutions, and soon after he perceived
that in evacuating his bowels, especially when costive, he sometimes had a
spermatic discharge. By degrees his digestion became much disordered,
constipation became habitual, and the spermatic discharges at stool in-
creased. He reformed and gave up drinking : his health was, however,
ruined ; he took cold easily, and suffered from pain in his side and frequent
pains in his limbs and loins; he was constantly tormented by flatulence,

44 INFLAMMATION OF THE

colic, and diarrhoea or obstinate constipation. His legs were weak, and his
body was frequently affected with tremors ; yet be could not remain in bed,
he was tormented night and day by a constant desire for motion, and being
very weak he frequently fell.

After some time he had difficulty in supporting his head, and he complained
of a constant pain in his neck and shoulders, accompanied by tenderness in
the vertebral column. The evacuation of urine, previously irregular and dif^
ficult, now became often impossible without the aid of a catheter.

Latterly, he became subject to frequent attacks of cerebral congestion,
during wliich his face was purple ; he was insensible, convulsed, and appeared
to be threatened with an attack of apoplexy. The practitioner, called under
these circumstances, never failed either to bleed from the arm, or to apply
leeches, and as the attack did not last long, he attributed its relief to the ab-
straction of blood. Immediately afterwards, even when bleeding had not
been practised, the patient remained exceedingly pale ; and at the close of
one of these attacks he died.

The same causes produced the same effects in this, as in the pre-
ceding case ; the same sym.ptoms led to the same errors in diagnosis :
it was just as difficult to discover the truth, and the same appear-
ances were found after death. Cases of this nature are not then so
rare as might have been expected.

Supposing that in these two cases, we had proceeded to examine
the bodies, with the pre-convictions arising from an observation of
the symptoms ; it is clear we should have found nothing in the cranial
cavity, which would have accounted for the cerebral symptoms, for a
general and uniform softness of the cerebral matter is observed after
all chronic diseases, especially when decomposition has made any
progress ; it is evident also that we should have found nothing more
satisfactory in the other viscera : who knows, then, to how many
errors these observations might not have given rise ?

Among the cases cited by the believers in nervous apojjlexy, and
special spasmodic affections, I am convinced that a great number arise
from spermatorrhoea ; but, from the non-examination of the genital
organs, it has been impossible hitherto to prove the correctness of
this opinion. I trust that soon all practitioners will be able to avoid
such errors. But let us reconsider the case of Maurice : — at the age
of twenty-three he had urethritis, accompanied by chordee and or-
chitis. As soon as the worst symptoms were relieved, he resumed
his old habits, and gave himself up to excesses of all kinds. By
degrees his health failed under the influence of nocturnal, and af-
terwards of diurnal pollutions; he became hypochondriacal, and not-
withstanding his forced abstemiousness, he at length died in the same
state as M. De S .

Why did this patient resist the action of the disease longer than
the first ? Because the alterations were much less serious, and even
the state of the pus found in the prostate seemed to announce that
the inflammation had taken on an acute character only during the
last stage of the disease.

SPEKMATIC OEGAlsrS. 45

Can diurnal pollutions, sufficient to destroy life, exist at the age of
seventy-three years ? Undoubtedly they can, since the vasa defe-
rentia still contain, at this age, a viscid secretion, consisting of badly
forir.ed semen ; besides, the patient had told his friends, shortly before
his death, that in going to stool he had passed semen in the palm of
his hand.

I have before said that Maurice passed for a hypochondriac, and
that his diseases -^vere considered imaginary, or at least very much
exaggerated ; nevertheless, we found, in various organs, recent and
old changes, to which we must refer his complaints.

By degrees, as his health broke up, he became more easily affected ;
he complained of pains in his side — his lungs were attached to the
walls of the chest by cellular adhesions ; he often complained of pains
in the head, fixed towards the occiput — the cerebellum was found ad-
herent to the meninges at several spots, at the same time that the
membranes were attached to each other : latterly, he complained of
constant pains in the neck and shoulders — the subscapularis and su-
pra- and infra-spinatus muscles of both sides, together with several
muscles of the neck, were found in a state of suppuration : the pa-
tient was subject to attacks of retention of urine — the neck of the
bladder, together with the urethra and vesical mucous membrane,
were thickened, and of a brownish red color.

I ought to add, that the principal abdominal, and even the femoral
veins, were softened, and of a violet hue, and presented traces of
phlebitis.

We see, therefore, that most of the disorders of which Maurice
complained depended on so many really existing local inflamma-
tions.

I know that many of the symptoms experienced by patients af-
fected with spermatorrhoea are purely nervous, and that we find often
after death, no trace of alteration in the organs which have been sup-
posed to be diseased ; but I also know bow the majority of post-
mortem examinations are conducted.

We forget that the slow and progressive weakening of the consti-
tution, following disordered digestion, causes an increased nervous
susceptibility in hypochondriacs; and that a less energetic resistance
of the different organs to the action of causes capable of altering
their health also results from it ; hypochondriacal patients are thus
much more liable to every disease, at the same time that they suffer
more from the diseases affecting them.

A few words more on the other lesions : the vasa deferentia were
ossified in several points : this ossific deposit was not the effect of
age, as might be supposed, for I have met with it under similar cir-
cumstances in very young subjects ; it must, therefore, be attributed
to old standing inflammation.

In the orchitis that follows blennorrhagia, the inflammation extends
from the mucous membrane of the urethra to the testicles, by the
ejaculatory ducts, seminal vesicles, and vasa deferentia ; the latter

46 INFLAMMATION OF* THE

are almost cartilaginous in their normal conditions ; in chronic in-
flammation, therefore, thej may easily become encrusted with phos-
phate of lime.

The neck of the bladder was fissured by several recent splits.
When the internes requested me to catheterize this patient, it was be-
cause they had been unable to enter the bladder. I learnt that they
had always used the smallest instruments ; by, on the contrary, using
the largest I could find, I reached the bladder without difficulty.

CASE III.

Blennorrhagia — Retention of Urine, &c. — Apoplexy — Death.

AVTOTSY. -^Efusion of Blood into the left ventricle of the brain — Hyper-
trophy of the heart — Gatro- enteritis — Abscess and tubercles in the kidneys
and prostate — Stricture, ^t'c.

Gojon, at the age of forty, contracted an acute blennorrhagia, with
orchitis. Treated by irritating medicines, which produced diarrhoea and
violent colic, it diminished, but did not entirely disappear, a slight urethral
discharge continuing for ten years, with pain in the prostatic region and fossa
navicularis. He was also annoyed by obstinate constipation. Between the
ages of fifty and sixty he experienced difficulty in discharging his urine, a
feeling of uneasiness in the urinary apparatus, weakness of the body, diffi-
culty of digestion, considerable loss of flesh, and a remarkable diminution in
his intellectual powers. Still later he had frequent attacks of retention of
urine, successfully treated by baths and demulcents, intolerable pain in the
kidneys and bladder, hypochondriasis, a strong aversion to frequent places,
melancholy, and serious debility.

On the first of February, 1827, retention of urine occurred, for which
leeches were applied to the perineum, and general baths and demulcents
were employed without relief; active inflammation of the perineum and
cellular tissue of the scrotum took place, for which fomentations were ap-
plied.

On the 5th the skin of the perineum gave way in three places, and a large
quantity of urine mixed with pus was discharged.

On the 10th of February this patient was brought to the hospital. He
was sixty-five years of age, his skin was warm, and his pulse full and sti'ong ;
cheeks red, eyes watery, with pain under the orbits ; ideas pretty clear,
tongue red and dry, severe thirst and a desire for cold drinks ; abdomen sen-
sitive on pressure, especially in the hypogastric region ; attempts at catheterism
unsuccessful. Fomentations were ordered to the abdomen.

On the 11th an attack of apoplexy occurred, and on the 12th he died.

POST-MORTEM APPEARANCES.

Head. — Considerable effusion of florid blood in the left lateral ventricle.
Chest. — Lungs crepitant. Hypertrophy of the left ventricle of the heart.
Abdomen. — Mucous membrane of the stomach red throughout its whole

SPERMATIC ORGANS. 47

extent; covered by little spots of ulceration scattered here and there; the
injectioa of the intestines becoming more and more remarkable in the
neighborhood of the anus. Some ulceration in the rectum.

Genito -urinary organs. — From ten to twelve abscesses were found in each
kidney; and in the left, ci'ude tubercles, about the size of a bean, existed.
The ureters were dilated, and their lining membrane red and injected.
Bladder hardened and columnar, an inch in thickness. Mucous membrane
of a violet color, thick, soft, and ulcerated in several points. Prostate
three times its normal size ; more developed under the neck of the bladder
than towards the rectum ; furnishing, by pressure, a very abundant purulent
discbarge, and containing about thirty little abscesses and as many crude
tubercles. This prostate resembled the tissue of a lung full of tubercles,
of which some are empty, others suppurating, and others immature. The
seminal vesicles and vasa deferentia thickened.

There was a circular stricture in the urethra, about half an inch in front
of the prostate, formed by a tissue of a horny consistence, and scarcely
permitting the introduction of a No. 2 catheter. An enormous dilatation
of the urethra was observed between the stricture and the neck of the
bladder, and the mucous membrane of this portion of the canal was thick-
ened, fungous, and softened, and presented in its posterior part a fissure
whence three fistulas took their origin.

The cellular tissue of the perineum and scrotum was full of pus. The
testicles were healthy.

This patient died the day after his entry into the hospital, and
during this short space his state had not permitted us to think of in-
voluntary spermatic discharges, always very difficult to detect in cases
of this nature. This stricture was, however, seated a little in front of
the orifices of the ejaculatory ducts, and the prostatic raucous mem-
brane was disorganized by inflammation ; nothing is more common
than spermatorrhoea under these circumstances. On the other hand
the prostate was considerably altered, and the seminal vesicles and
vasa deferentia were much thickened. It is then to be presumed that
the loss of intellect, the great debility of the system, &c., arose, as
in the preceding cases, from habitual spermatic discharges.

Death was caused by a large effusion of blood in the left lateral
ventricle. Was the hemorrhage the result of one of those cerebral
congestions of which we have spoken in the preceding cases ? Ana-
logy seems to indicate that it was.

Hypertrophy of the left ventricle of the heart was present, how-
ever, and the influence which the increased development of this
organ exercises on the brain is well known. If this hypertrophy
were not the sole cause of the effusion, it had, without doubt, a large
share in producing it. In obscure questions like that which occupies
us we must only admit facts that are incontrovertible, and we must
resist as much as possible the attraction of pre-conceptions. I have,
therefore, reported this case, because it confirms what I have stated
respecting the facility with which inflammation of the mucous mem-
brane of the urethra extends to all the other mucous membranes
connected with it.

48 INFLAMMATION OF THE

The first disease was urethritis with orchitis. Thus, at the he-
ginning the inflammation extended from the urethra to the testicles
by then- excretory ducts, and the manner of this extension cannot
be doubted, because twenty-five years afterwards the vasa deferentia
and vesiculge serainales were still thickened. The extension of the
inflammation in the direction of the urinary passages was still more
evident for not only the prostatic mucous membrane was thickened,
fungous, and softened, but that of the bladder was thick and softened,
also, violet colored and even ulcerated in several points; the ureters
were dilated, and their inner surfaces red and injected ; lastly, each
kidney contained ten or twelve abscesses, tubercles also existing in
the left.

The prostate is the principal seat of blennorrhagic discharges ;
being situated at the junction of the urinary with the genital appa-
ratus, it cannot fail to be affected by disorders which extend to tissues
very far from their points of origin ; thus it was still more diseased
than the kidneys. It was three times its normal size, and independ-
ent of the purulent matter furnished by its mucous follicles it con-
tained about thirty small abscesses and as many crude tubercles.

I shall remark, as I proceed, that the circumstances under which
the tubercles of the prostate and left kidney were developed, and the
existence of these tubercles by the side of recent abscesses, leave
no doubt as to the cause of their formation.

Before concluding these reflections, I must also notice that traces
of acute gastro-enteritis and even of ulceration of the rectum were
present. It is to this complication that we must attribute the red-
ness and dryness of the tongue, the extreme thirst, and the sensi-
tiveness of the abdomen to pressure — characteristic symptoms of
inflammation of the digestive organs, which we must not confound
with derangement of their functions, or with the gastralgia that so
frequently accompanies spermatorrhoea ; neither must we confound
the hemorrhage that caused death with the cerebral congestions of
which I have spoken in the two preceding cases.

Unfortunately, these distinctions are very difficult to be established
in some cases, as alterations of tissue often follow purely sympathetic
functional derangements so suddenly, that it is impossible to specify
the moment when the afi"ection becomes really idiopathic. This is,
above all others, the circumstance which has hitherto thrown so thick
a veil over cases of spermatorrhoea; and which renders the minute
examination of each case so necessary.

SPERMATIC ORGANS. 49

CASE IV.

Mental derancjement — Belief in a change of sex — Death.
Autopsy. — Thickening of the arachnoid — Great alteration of the prostate
— Atrophy and ohliteration of the ejaculatory ducts.

I find the following particulars related by Professor Rech respecting an
insane person who died under his care. " The intellect had been disordered
for a long time ; the patient believed he had changed his sex, and, thinking
himself a woman, spent much of his time in writing to an imaginary lover;
sometimes he fell on his knees and seemed to dig the ground for hours to-
gether. He had entirely lost the power of vision in the left eye. His death
took place from exhaustion after an obstinate diarrhoea. At the post-mor-
tem inspection, the dura mater was found healthy throughout; the arach-
noid was thickened in several points, and opacities were found on its sur-
face which obscured its transparency. The pia mater contained a consi-
derable quantity of serosity, especially between the cerebral convolutions.
The brain, cerebellum, and medulla oblongata were healthy in all their
parts. The optic nerve of the right side was atrophied behind the commis-
sure to the extent of half an inch, of a grayish color and very soft. In the
left eye, the retina was separated from the choroid by a considerable serous
effusion ; the vitreous humor, apparently atrophied, formed a reddish and
irregular mass. The lungs and heart were healthy, but the latter was re-
markable for its small size.

"The mucous membrane of the intestines, from the coecum downwards,
was red and thickened; and this alteration increased in intensity near the
rectum, in which numerous ulcerations existed.

"The prostate projected into the bladder, and was nearly two inches in
extent in its long, and fifteen lines in its transverse diameter; its structure
contained three small abscesses. The ejaculatory ducts were softened, atro-
phied, and obliterated. The vasa deferentia and the vesiculae seminales
were on the contrary larger than ordinary."

The patient died of a chronic diarrhoea, and the intestinal mucous
membrane was injected, thickened, and ulcerated ; he had lost his
power of vision in the left eye, and this eve was extensively altered,
as was also the right optic nerve, before its entering the optic com-
missure ; he believed himself to be a girl, and the functions of the
testes must have been abolished, since the ejaculatory ducts were
atrophied and obliterated. If this singular alteration of the genital
organs were not the cause of the patient's derangement, it must at
least have influenced its peculiar character.

SUMMARY OF THE PRECEDING OBSERVATIONS.

Symptoms. — In the first two patients only, were involuntary sper-
matic discharges discovered, and their general symptoms well de-
scribed. The other cases are hardly of importance, except in respect

50 INFLAMMATION OF THE

of their pathological illustrations. It is only in the first two cases
that the progressive deterioration of the spermatic organs can be
■well followed, from the first blennorrhagia to th^ patient's death ;
and that the ever increasing influence of spermatorrhoea over the
whole economy, but especially over the cerebro-spinal system, can
be appreciated.

The delusions produced in both patients by the last class of symp-
toms are well fitted to open the eyes of practitioners as regards cases
of this nature. The consequences resulting from them in a thera-
peutic point of view are so serious, that we cannot well attach too
much importance to their due consideration.

But how can extreme cases of spermatorrhoea so closely simulate
affections of the brain, or of its membranes ? and by what charac-
ters can we distinguish their symptoms from those arising from idio-
pathic aiFections of the same organs? In order properly to discuss
questions of this kind, it is indispensable to have before us all the
facts influencing them ; but in passing, we may hastily consider
those with which we are already acquainted.

In the first two cases, the cerebral symptoms were preceded, during
a long period, by a remarkable derangement of the other functions :
thus, digestion was performed badly ; the stomach no longer bore
fermented drinks, spiced meats, or very nutritious food ; stubborn
constipation supervened ; the intestinal tube was habitually distended
by flatus ; sexual intercourse became more and more rare, the act
more rapid, and at last entirely impossible. The patients, in these
cases, discontented with themselves and their friends, and tormented
by flatus, of which they want continually to relieve themselves, shun
society and its trammels ; they dislike everything which recalls to
them pleasures they are unable to share; they become melancholic
and irritable, misanthropic and hypochondriacal ; ever occupied by
the consideration of their health, they manifest the utmost indiffer-
ence for all things which do not affect it.

The cerebral functions are not more weakened than all the rest,
but their disorder produces more serious consequences, and is more
readily perceived. It is soon remarked, that memory becomes im-
paired, that the train of thought is easily interrupted, and that the
least excitement of the intellect induces congestion towards the
head. Difficult digestion, more obstinate constipation, and abdomi-
nal distension by flatus, supervene in these cases, which end by at-
tacks of congestion in the fatigued and weakened brain.

But these congestions are accompanied with a remarkable feebleness
of the pulse, chilliness of the limbs, general uneasiness, anxiety,
agitation in every sense, and a remarkable desire for motion. They
are immediately followed by pallidity of the countenance, general
debility, and alarming faintness, witJiout any one ijart of the body
being more affected than the rest.

Apoplectic congestions are never preceded for years by a progres-
sively increasing weakness of the economy; the pulse is lull, and
there is a tendency to drowsiness.

SPERMATIC ORGANS. 51

The patient whose case I have related in my third observation,
died in consequence of an extensive cerebral hemorrhage, which
came on suddenly in the left lateral ventricle of the brain ; but this
patient had hypertrophy of the heart, and the first attack promptly
caused death ; it is, therefore, probable that the congestion was not
due to the same cause, and it certainly did not present the same
characters as in the two preceding cases.

The disorder observed in the ideas of such patients cannot be
confounded with delirium ; whenever delirium has been really pre-
sent in these cases, true meningitis has been found to exist, of
which I have seen numerous examples. The state of the intellect,
in these aifections, manifests, perhaps, a greater resemblance to
deraency ; but demency commonly follows mental derangement ;
besides, it is always easy to obtain, in the cases I am considering,
clear and connected answers.

It is impossible also to confound the disorder of the digestive func-
tions with the symptoms of inflammation of these organs ; in all cases
in which inflammatory symptoms are observed, gastro-enteritis is
actually present.

Lesions. — It is chiefly on accouut of the alterations discovered
in the spermatic organs that the cases I have hitherto recorded are
of value. The influence of the urethra on all the organs which
open into it, is an important phenomenon in the history of sperma-
torrhoea. To have a clear idea of this influence, it is necessary
especially to prove the facility with which inflammation creeps along
the mucous membranes, to even their most distant continuations.

Prostate. — Blennorrhagic discharge arises from the mucous folli-
cles of the urethra, and of the prostate especially, where they are
most developed and most numerous : the prostate, in fact, is formed
of these follicles, united by cellular tissue.

During the first days after contagion, a tickling in the urethra
is felt, with itching heat and pain, especially during the emission
of urine. The secretion of the canal is increased, and changes its
appearance, but it is not until the inflammation has reached the
prostate, that the discharge acquires its greatest severity. It is
then principally secreted by the prostate, and experienced patients
seem to be aware of this, for in doubtful cases we see them com-
press the urethra from the perineum to the glans penis, in order to
expel the secretion. Besides, post-mortem examinations permit no
doubt to remain on the subject.

But the irritating m.atter which excites the disease is not deposited
on the surface of the prostate, and it is not because this matter con-
tains a contagious principle, that the inflammation is propagated so
rapidly from the orifice of the urethra to the prostatic mucous folli-
cles, for leucorrhoea, the menstrual discharge, or the lochia, are fre-
quently sufficient to excite a profuse discharge, the seat of which is
equally in the mucous follicles of the prostate.

52 INFLAMMATION OF THE

It is not the passage of the irritating matter from one point of
tlie mucous surface to another, that favors this propagation, for
the discharge passes from behind forwards, and the inflammation
extends in the opposite direction.

However it may arise, the fact is constant, and it clearly explains
the frequency of prostatic disease as a sequel to blennorrhagia.

In the beginning of a very acute inflammation, the prostatic folli-
cles are gorged with a thick adhesive pus, and form a firm and yel-
lowish body like a scrofulous tubercle ; the cellular tissue surround-
incr them is so far, however, perfectly healthy, so that the follicles
can be easily separated from one another throughout their extent,
and the nature and seat of their changes can thus be proved.

At a more advanced period of the disease, we find the prostate in-
filtrated with pus or a pultaceous matter, which may be pressed out
in the form of granules; the cellular tissue is now, therefore, attacked
by the inflammation, but suppuration is not yet well established.

At a still more advanced period, by slightly compressing the pros-
tate, pus may be made to exude from all its excretory ducts, and it
contains, besides, little abscesses from the size of a linseed to that of
a pea. Here the suppuration of the cellular tissue has begun to
form into distinct collections.

In the third case I have related, the prostate was three times its
normal size, and furnished, on pressure, a very abundant purulent
matter; it contained besides this about thirty little abscesses, and as
many crude miliary tubercles. We observe here the same progress
of the inflammation, but the abscesses, in place of discharging their
contents, were transformed into tubercles by the absorption of the
fluid parts of the pus.

In the first case I have reported the prostate was partly destroyed,
and contained in its fibrous envelope an elastic and purulent matter,
which passed into the canal of the urethra, through a number of
foramina in the mucous membrane. These foramina were the orifices .
of the mucous follicles whose parietes had been destroyed by sup-
puration.

We see by these observations, then, that the inflammation extends
from the urethral mucous membrane to that lining the mucous folli-
cles of the prostate, and afterwards to the cellular tissue uniting
them ; that abscesses form, and either discharge their contents by
the mouths of these follicles after having destroyed their parietes,
or in other cases form tubercles, which end in the same way ; that
the prostate becomes destroyed by degrees, and is reduced to a
fibrous envelope, quite perfect, and covered by a kind of perforated
membrane, the foramina in which vary in form and size, according
as the excretory orifices remain distinct, or are united together by
the destruction of the intervening tissue which separates them.

When the inflammation of the prostatic cellular tissue is less severe,
in place of pus, an albuminous matter is deposited, which infiltrates

SPERMATIC ORGANS. 53

the part and gives vise to indolent engorgement, and if this he not
dispersed promptly and entirely, induration of the prostate will re-
sult. I have seen many cases in which this has occurred.

Spermatic Organs. — The frequency of orchitis arising from blen-
norrhagia shows with what facility inflammation of the urethi-a extends
to the testicles. This extension takes place by means of the mucous
membrane. Injury, exposure to cold, &c., may indeed favor the
development of orchitis ; but its principal cause, often its sole cause,
is the influence of the urethral mucous membrane over that lining
the excreting organs of the semen.

Both patients and practitioners are in many cases much puzzled
to understand the appearance of orchitis, and they would be still
more so if preconceived opinions did not facilitate its explanation.
Sometimes it is from having walked too far, or from having sat too
long, sometimes from having worn too tight a pair of trousers, or
from having bruised the testicles by crossing the legs, that the dis-
ease has arisen. But who is not exposed to the action of such causes ?
I admit that it is often immediately after a circumstance of this kind
that the patient experiences, for the first time, a more or less sharp
pain in the testicle, which is soon afterwards followed by the other
symptoms of orchitis ; but those patients who observe carefully never
fail to remark, that they first experience a sense of weight in the
inguinal region, and of dragging and pain in the spermatic cord.
On examining the cord of the affected side, the vas deferens is then
found to be swollen and very sensitive, and it even sometimes hap-
pens that the swelling of the cord is so great as to cause a kind of
strangulation in the inguinal canal.

When, afterwards, the inflammation extends to the body of the
testicle, it is attributed to the first cause which drew attention to the
morbid sensibility of the organ, and then it is that the urethral dis-
charge diminishes or becomes suppressed, according as the new in-
flammation is more or less severe. The suppression of tlie discharge
makes the patient imagine that the afl"ection itself has attacked the
testicle, and many medical men even believe that the suppression
does give rise to orchitis. They are deceived by taking the effect
for the cause ; but it is not the less true on this account, that the
inflammation of the canal has originated that of the testicle ; indeed
the succession of the symptoms ought to be sufficient to show the
course the disease has taken.

When both testicles have been affected, both ejaculatory ducts
are found altered, and when both seminal vesicles or both vasa defe-
rentia have been inflamed, the same alteration is remarked in both the
ejaculatory ducts. When one only of the spermatic organs has been
inflamed, I have always been able to trace the inflammation to the
orifice of the corresponding ejaculatory duct, whilst the other has been
found unaffected. I have also seen the inflammation spread without
interruption as far as the tunica vaginalis of the testicle or of both tes-
ticles, according as the disease has extended on one side or on both.
4

54 INFLAMMATION OF THE

This affection of the tunica vaginalis may be easily explained since
any alteration of the glandular tissue is readily partaken by its
fibrous covering, which is intimately united with the serous tissue

coating the gland. i . ir- ^i

Inflammation of the seminal vesicles extends itself m the same man-
ner in some cases, to the adjacent peritoneum. In the first case I
have related this inflammation was quite recent ; the matter depo-
sited on the surface of the serous membrane was still albuminous,
soft, and unorganized ; and in the second case, the bladder was united
to the rectum by cellular adhesions, evidently due to the same cause.
These observations are of greater importance than they appear ;
they prove that general peritonitis might easily arise from the dis-
eases we have been studying. The old and circumscribed adhesions
of peritonitis which sometimes line the bottom of the pelvis, ought
also to be noted as being almost certain proof of old inflammation
of the seminal vesicles; they may, therefore, assist much in explain-
ing the symptoms observed during life, when the alterations of the
spermatic organs have passed away, or do not leave any very ap-
parent traces. However this may be, these alterations of the pe-
ritoneum and of the tunica vaginalis prove that the inflammation is
propagated by contiguity of tissue.

But it is necessary to examine a little more in detail the state of
the diiferent spermatic organs.

Orifices of the Ejaculatory Ducts. — In the patient who was the
subject of the first case, the orifices of the ejaculatory ducts, in place
of being circular, formed one elongated and irregular cleft. The
ducts themselves were very large. This enlargement has been no-
ticed by StolP in a case related by him ; and it was still more re-
markable in a body I once saw in the School of Medicine, in which
the opening admitted a goose-quill. In all these cases still more seri-
ous lesions existed, but it is easy to conceive that the dilatation or
ulceration of the sphincters which terminate the ejaculatory ducts,
may alone possess great influence over the production of spermator-
rhoea, and I should not be surprised if we should find sometimes no
other lesion capable of accounting for it.

The Ejaculatory Ducts generally share the alteration and dilatation
of their orifices ; besides which, they may be insulated, as though dis-
sected, by the suppuration of the prostate, or thickened, hardened,
and cartilaginous, or they may even contain osseous granules. These
alterations, much more serious than those of their orifices, must dis-
pose very much to the involuntary escape of the semen. The ducts
having lost their elasticity, and even their power of contraction, are
no longer able to drive back the semen into the seminal vesicles ; or
at least they are incapable of retaining it, however gently these re-
servoirs may contract, or however little they may be compressed.

' Pars prima rationis medendi.

SPERMATIC ORGANS. 55

The pressure exerted on these ducts, by the swelled tissue of the
prostate, may cause their atrophy or obliteration, whence, of course,
ensues the more or less complete loss of their functions.

Seminal Vesicles. — It would appear that pus formed in the seminal
vesicles should be easily expelled ; but these two receptacles, com-
posed of ramified cells, are placed out of the direct course of the se-
men, to be used as reservoirs for it ; and they only communicate
with the vasa deferentia and the ejaculatory ducts, by a very narrow
opening, in front of which the seminal fluid may pass to be discharged
directly from the testicles to the urethra; it seems that the swelling
produced by inflammation may so much lessen this opening as to form
an obstacle to the exit of pus, for a shorter or longer period : in one
case which I had an opportunity of examining, the pus had acquired
a considerable thickness, and that at the bottom of the cells was still
more thickened, exactly resembling tuberculous matter. The resi-
dence of the pus in this situation may be even still more prolonged,
should the watery part be more completely absorbed ; in these cases
we find only a yellowish homogeneous substance, soft, like plaster,
or even chalky, the true origin of which has been entirely mistaken.

It is almost unnecessary to notice that the presence of pus prevents
the entrance of the semen into the reservoirs intended for it, and
that it becomes, from this alone, an immediate cause of spermator-
rhoea. We can easily understand, also, that after the expulsion of
the pus, the parietes of the vesicles must be thickened, and that
they may always remain hardened, altered in shape, thickened, car-
tilaginous, or even bony. In more favorable cases, also, their
lining membrane must preserve, during a long time, an abnormal
sensibility, the influence of which must be very injurious.

It is not, however, necessary that such serious alterations should
exist in the seminal vesicles in order to account for the irregular and
spasmodic contractions of which they are sometimes the seat ; or for
their influence on the production of spermatorrhoea ; but it is useful
to understand fully the most striking changes in order the better to
appreciate the slighter ones.

The qualities of the semen found in the seminal vesicles should
also be carefully noticed : I have seen it resemble meconium in one
of these receptacles whilst pus existed in the other ; and it is probable
that the alteration of the secretion of the one testicle was due to a
similar influence which, in the same case, had acted still more
evidently on the opposite organ.

Vasa Deferentia. — Pus formed in the vasa deferentia is not in
all cases easily expelled ; swelling of their walls may bring about
complete obliteration of these vessels in one or more points, whilst
in others they are distended by the accumulation of the pus, so that
pouches, more or less dilated and separated by contractions, somewhat
resembling irregular chaplets, are formed. This disposition may
extend itself to the epididymis, and to the corpora Highmoriana,

5g INFLAMMATION OF THE

the mucous membranes of Avhicli are continuous with those of the
vasa deferentia at one part, and with those of the secretory tubes at

^^Pus^^thus separated and submitted for an indefinite time to the ac-
tion of the absorbents, becomes more and more solid, and gives rise
to deposits resembling those of tuberculous matter, the aspect and
consistence of which may present every degree of alteration in the
same individual, according to the age and size of the abscess.

From this obliteration of the vasa deferentia, retention ot the
semen in the testicles also results, so that the generative power is lost ;
but it does not necessarily follow from this that the patient should
be free from spermatic discharges. If the abscesses of the epididy-
mis open externally, we can understand that the semen will escape
immediately through this rupture of the excretory canal, and that m
this way a true spermatic fistula is formed ; and should this take
place on both sides, it is clear that the patients Avould be exposed to
the same phenomena as if they were affected by spermatorrhoea.

If the obliteration of the excretory canal be not followed by rup-
ture, it is probable that the secreting organ, after having been a long
time distended, swollen, and painful, will in the end diminish by de-
grees, and will become completely atrophied, as happens to other
glands under the same circumstances. Thus, certain cases of atrophy
of the testicles, after a very long and painful swelling of them, may
be accounted for.

When the vasa deferentia are felt hard and knotty there can be
no doubt as to the cause of this atrophy ; but sometimes the altera-
tion takes place in parts where manual examination is impossible,
and in these cases the state of the prostate will be likely to furnish
important information : when it is found irregular, swollen, and
enlarged, the atrophy of the testicles must be regarded as the conse-
quence of pressure on the ejaculatory ducts.

In an officer whose case I treated, the testicles were not larger
than those of a child of six years ; the patient had experienced a
continued dull pain in them for a long time ; the prostate was much
altered ; his moral faculties had experienced the same changes that
occur in cases of spermatorrhoea, but the physical man was not much
weakened ; the reason of this is evident.

Chronic atrophy of the testicles, following more or less acute pain
in them, is by no means rare : these pains are usually considered
nervous, and the insensible wasting which follows them has not been
as yet satisfactorily explained. All the patients of this kind whom
I have had an opportunity of observing, had suffered previously from
bldhnorrhagia, of which I am convinced this atrophy was the distant
but direct result.

We often find the vasa deferentia thickened, hardened, cartilagi-
nous, or even quite ossified, in patients who have had orchitis. These
cases confirm what I have stated respecting the mode of transmission

SPERMATIC ORGANS. ' 57

of inflammation from the urethra to the testicles, for all these shades
of induration are so many results of inflammatory action.

Testicles. — Every surgeon knows how slowly enlargement of the
epididymis and corpus Highmorianum, following orchitis, is dis-
persed. This fact alone is sufiicient to prove that it is by the vas
deferens that the inflammation reaches the testicles, because it is
by means of the corpora Highmoriana that the secretory tubes open
into the excretory ducts. It is not then surprising that this part
of the testicle should be the one most seriously altered, and often
even the only one aff"ected.

Purulent collections formed in the testicle are not able, like those
in the organs we have already considered, to empty themselves by
the excretory canals, and the fibrous envelop which incloses the
secretory vessels is very resistant ; it must, therefore, often happen
that slight and very circumscribed inflammations are arrested before
suppuration has been able to appear externally. If in these cases
complete absorption do not take place rapidly, the thicker part of
the pus may form tubercles, the presence of which will, in its turn,
be a cause of new inflammation, and the vessels secreting the semen
may, like the follicles of the prostate, be destroyed by degrees, so
that the gland may become reduced to its envelop only. Other
products besides pus may be formed in the cellular tissue of the tes-
ticle ; when the inflammation is slight, but of long duration, or fre-
quently recurring, a gelatino-albuminous matter is deposited, which
thickens and becomes a source of organic alterations like those in
the prostate, and the first cause of these also may be usually traced
to long-neglected chronic aff'ections of the urethra.

I have attached much importance to the thorough understanding
the mode of transmission of inflammation from the urethra to the
testicles, because the establishment of this point explains in the
most simple way why the presence of a sound in the urethra, or the
existence of a stricture, so often excites congestion and inflammation
of those organs, and even in some cases the development of hydro-
cele, as well as why the removal of the cause suffices generally to
make the eff"ect cease.

The conciliation of all these circumstances is especially of import-
ance to the study of spermatorrhcEa ; and the intimate connection of
the urethra with the testicles by means of the vasa deferentia should
suffice to forewarn us of the influence which the condition of the
mucous membrane surrounding the orifices of the ejaculatory ducts,
must exercise on the secretion and expulsion of semen.

Urinary Organs. — Analogous phenomena present themselves in
the organs secreting and excreting the urine. The inflammation ex-
tends from the urethra to the kidneys by means of the bladder and
ureters ; it is even easy to trace its progress, without interruption ;
hence the violet-colored spots of congestion, the ecchymoses, and
even ulceration of the mucous membrane lining these organs ; hence
the swelling and injection of the kidneys; hence the abscesses of all

53 INFLAMMATION OF THE

and of all stages, encysted and non-encysted, and mixed with

sizes

crude or suppurating tubercles, which have been found in the kidneys.
As a sequel to these successive attacks of inflammation, 1 have
seen the tissue of the kidney destroyed like that of the prostate or of
the testicle ; almost reduced, in fact, to its external fibrous envelop.
There is then an exact similitude between these two classes of or-
gans, and if the kidneys could be as easily examined as the testicles,
this resemblance would appear still more strikingly.

Ccmqyarison of the Hvo sets of Organs.— We often see, after expo-
sure to cold or excessive drinking, a blennorrhagia diminish or cease
entirely, and the patient experience at the same time violent and
deep-seated pain in the loins : the urine is scanty, and high colored,
and sometimes even bloody. If in these cases we could examine
the kidneys as we do the testicles, we should, perhaps, find that at-
tacks of nephritis following blennorrhagia are nearly as frequent as
those of orchitis.

I am convinced that, in the cases I have seen, alterations of the
kidneys have been more frequent than those of the testicles. It is
not only as a sequel to blennorrhagia or stricture that nephritis
takes place ; every inflammation of the urinary canals may extend
to the kidneys ; and this is why acute or chronic cystitis, and the
presence of stone in the bladder, are such common causes of inflam-
mation of these organs ; this is why the kidneys are so often found
disorganized when the bladder has been long irritated by the presence
of extraneous matters, or by repeated attacks of retention of urine.
I believe I have now more than sufficiently shown how easily acute
inflammation of the urethra extends to the secreting organs of the
semen and urine, by means of their excretory ducts ; I have com-
pared together the phenomena that occur in both classes of func-
tions, because they are presented at the same time, in very nearly
the same degree, and with analogous characters. But this resem-
blance is not observed in cases of acute inflammation only ; it is
more easily shown in these cases, and on this account I have com-
menced with their consideration. Similar phenomena are, however,
observed under the influence of less active causes.

When the bladder is irritated the secretion of urine is increased in
quantity and altered in quality ; and at the same time that it becomes
more abundant and more watery, it remains a shorter time in the
bladder ; the desire of micturition is felt oftener and more suddenly ;
however the patient may wish to retain the excretion, the sensation
is so painful, and the bladder contracts so violently, that the urine is
often expelled in spite of every eff'ort, and before the patient has had
time to prepare himself for its discharge. The fluid is passed each
time in small quantity, the jet is short and feeble, and falls within
a little distance of the patient's feet: should this state continue any
length of time, the muscular coat of the bladder becomes more deve-
loped, the parietes of the organ are thickened, and its capacity dimi-
nishes in the same proportion. Those who have noticed the coinci-
dence of this limpidity of the urine with its frequent expulsion, have

SPERMATIC ORGANS. 59

concluded that the more watery the fluid secreted the more it irritates
the mucous membrane. But it is impossible for us to admit that the
urine should irritate the bladder most when it contains least salts in
solution. It is evident that the effect has here been mistaken for
the cause. It is because the bladder is irritable that it cannot longer
bear the presence of the urine, and this fluid is more watery, because
the irritable kidneys secrete it in greater quantity, and it remains a
shorter time in the bladder ; that this view is correct, is proved by
the vesical mucous membrane, when it possesses its normal sensi-
bility, submitting for a long time to the presence of a large quantity
of watery urine, as occurs daily after meals.

If this irritation be prolonged, it may produce in the end a kind
of relaxation of the secreting vessels, and degenerate into diabetes.
The urine entirely loses its chemical characters ; the urea and uric
acids are replaced by a saccharine matter, and the system wastes in
consequence of furnishing so superabundant a secretion.

Exactly the same phenomena are observed in the spermatic organs
when they are submitted to the influence of a similar irritation ; the
testicles secrete an increased quantity of semen because they are
irritated, and their secretion is more watery, because it is less per-
fectly formed, and remains a shorter time in its reservoirs before
expulsion ; it is more rapidly expelled because the seminal vesicles
are more sensitive to the impression produced by its presence, and
are more readily excited to action.

The spasmodic contractions of which these organs become the seat
commence by producing ejaculation very rapidly either during sexual
intercourse or after erotic dreams ; this renders coitus rapid and in-
complete, and nocturnal pollutions very frequent ; afterwards the
weakness and irritability are increased, the semen becomes more
abundant, and still more fluid, and the convulsive contractions of the
seminal vesicles are more frequent; during this state the approach of
a female, or even a lascivious idea may suffice to excite ejaculation ;
but the semen is no longer projected with energy, erection is never
complete, and scarcely any sensation nccompanies emission.

These injurious contractions are at last excited even by still less
distinct causes ; the patients feel them come on when least expected,
they dread their consequences, and still they are quite unable to
prevent them. Lastly, there are cases in which the debility of the
genital organs is such that a true spermatic diabetes may be said to
be present, as well by the quantity and quality of the secreted fluid
as by the frequency of its emission.

We have been unable to make the same chemical experiments
on the altered semen that have been made on the urine of diabetic
patients ; but the semen in such cases contains no more spermatozoa
than the urine does urea. Let it not be thought that this statement
is founded only on analogy ; the fact really exists in practice. I have,
at this moment, a patient under my care, who is dying, worn out by
the effects of diabetes with diurnal pollutions of the same kind.

50 INFLAMMATION OF THE

Here then, we have, from the action of the sancie causes, the kid-
neys, testicles, bladder, and seminal vesicles affected in the same
manner, and producing analogous results ; and further, these affec-
tions seldom occur singly ; thus, in stricture, the urinary passages
are, indeed, chiefly affected, but I have seen cases in which the
spermatic organs have been almost as much disordered ; it is not in-
flammation alone which may extend in both these directions, but
even a simple irritation of the urethral mucous membrane.

Diurnal pollutions are too little understood to have been generally
noticed in these cases; they are always obscure, and the attention is
fixed usually on another object ; but I have so often satisfied myself
of their presence as a sequel to strictures, that I regard sperma-
torrhoea as the true cause of all the cases of hypochondriasis, ischuria,
and debility, which are attributed to affections of the urinary organs.
This position is, I think, proved by the weakness and rare occurrence
of erection, the rapidity of ejaculation, and the increased fluidity of
the semen observed in most of these patients.

Cases of diurnal pollution uncomplicated with chronic catarrh or
irritation of the bladder are sometimes rare ; and this often renders
diagnosis difficult, not only on account of the symptoms of catarrh
being present, but also on account of the mucus secreted by the
bladder and prostate. On this account, when I see the urine cloudy,
I always inquire respecting diurnal pollutions, so that I may not
confound mucus with semen.

It is very remarkable, also, that those who give themselves up to
venereal excesses or masturbation, frequently experience a desire
to micturate ; this fact gave rise to the saying of the ancients,
^'' raro mingitur castus." I have ever been struck by the truth of
this axiom ; and the fact proves how easily the urinary organs share
the excitement of the spermatic.

Another very important circumstance in the history of diurnal
pollutions proves how correct is the analogy I have established be-
tween irritation of the bladder and that of the seminal vesicles. It
is almost always at the end of the emission of urine that the semen
escapes ; the bladder then contracts forcibly to expel the last drops
of urine, and the seminal vesicles also enter into action, and expel
with the urine a greater or less quantity of their contents.

It has been wrong to attribute this viscid discharge to the prostate,
because it does not present all the qualities of ordinary semen ; the
evacuation is sometimes very abundant, and that it is semen, cannot,
in these cases, be mistaken. Besides this, when the patients have
their attention called to the circumstance, they know very well how
to estimate the contractions of the seminal vesicles, which are even
in general proportion to the extent of the evacuation.

Most patients remark also that when they are threatened with a
relapse, it is preceded by a more frequent and very sudden desire to
micturate, whether this increased sensibility of the bladder arise from
cold or from an excess either of drink or of coitus. This proves that
the same causes act at once on both sets of orsans.

SPERMATIC ORGANS. 61

Persons affected by diurnal pollutions experience, generally, in-
jurious effects from the use of diuretics. Nearly all those who have
taken squills, nitrate of potass, digitalis, &c., have noticed during
their use a remarkable increase of the seminal evacuations, and a
few, after having been cured during a longer or shorter period, have
experienced relapses which could not be attributed to any other cause,
and which have spontaneously passed off as soon as they have relin-
quished the use of these medicines.

It is also well worthy of notice that children subject to incontinence
of urine, are particularly liable to nocturnal pollutions at the age of
puberty ; and at a later period to diurnal pollutions.

Lastly, I cannot conclude this parallel of the two sets of organs
without mentioning that obliteration of the spermatic excretory
ducts may be followed by the formation of spermatic fistul;©, in
the same manner that strictures of the urethra give rise to urinary
fistulge.

To resume : — All the mucous surfaces of the genito-urinary organs
have the greatest analogy and the most intimate connection with one
another. It is by them that inflammation creeps by degrees to the
secreting organs of the urine and of the semen. The portion of this
membrane which lines the prostate, being in intimate connection with
that of the mucous follicles, with that of the ejaculatory ducts, and
with that of the bladder — this portion then is the one, the different
conditions of which have most effect on all the rest. This connection
takes place by means of the lining membrane of the ducts ; and is
by no means to be considered the result of sympathy, such as exists
between the uterus and breasts.

The excretory canal, transmitting the inflammation, must neces-
sarily share its influence. The seminal ducts and vesicles, then,
cannot remain unaffected by the action they transmit to the testicles,
and this is an important consideration when we recollect that these
are as much the acting organs in the emission of semen, as the blad-
der is the organ for the expulsion of urine.

We shall often find it necessary to apply these facts to the study
and treatment of diurnal pollutions, and in passing, it is as well to
notice that the influence of the excretory canals on the secreting
organs is not an isolated phenomenon occurring only in the kidneys
and testicles, but that it is the result of a general law, applicable to
all glands.

Suction excites the secretion of milk and changes its qualities ;
the first drops drawn from the nipple are watery, and the milk
afterwards becomes more abundant and better formed in proportion
as the suction continues. The introduction of extraneous bodies
between the eyelids increases the lachrymal secretion, which some-
times even is so changed, that it irritates and excoriates the skin
of the cheeks. The presence of food in the mouth, especially when
spiced and savory, increases the secretion of the salivary glands.
During digestion the liver and pancreas are excited ; and the use of

g2 CAUSES OF

emetics and purgatives produces the same effects. The ejaculatory
ducts open on the surface of the prostatic mucous membrane ; is,
then, the important part this membrane plays in the production of
spermatorrhoea, a cause for wonder ?

CHAPTEH III.

CAUSES OF SPERMATORRHCEA.
Blennorrhagia.

The first case of diurnal pollutions which I had occasion to treat
occurred in a student of medicine, twenty years of age, who studied
his disease with much care, and described its causes and symptoms
with remarkable perspicuity. The following are the facts: —

CASE V.

Li/mphatic temperament — Blennorrhagia — Orchitis — Nephritis — Nocturnal
and diurnal poUutions — Abuse of mercurials — Injurious effects of colds
and tonics — Cure hy means of leeches, the use of Jlannel, and milk diet —
Fresh attacks of Blennorrhagia — Same treatment, with the same result.

M. N , of lymphatic temperament, tall and thin, with a pale face, red

hair, white, and habitually cold skin, narrow chest, and soft, feeble voice,
had never suffered from any diseases except those about to be described. In

January, 1821, M. N contracted blennorrhagia, which was treated by

emollient drinks, general baths, and corrosive sublimate. In the month of
April, several doses of Chopart's* mixture were taken, and arrested the dis-
charge, after a duration of four months. Six weeks afterwards he contracted
a second blennorrhagia, and in September, swelling of the left testicle
occurred after horse exercise. This swelling was in a great measure
dispersed, but a flaccid state of the scrotum remained, causing painful drag-
ging pains in the spermatic cords, which were relieved, however, by the
use of a suspensory bandage. At the commencement of 1822, the dis-
charge still continuing, local astringents and mercurial frictions were em-
ployed, with iodide of potassium and bichloride of mercury internally.

1 The following is the composition of Chopart's mixture : —

"Sf.. — Balsam copuib.,

Alcoholis, sp. gr. 33°,
Syrupi simplicis,
Aq. menth. pip.,

Aq. flor. aurant., aa partes sexaginta;
Sp. Eether. nitr. partes octo.
M. ft. mist, cujus cochlear, minim, unum nocte maneque summend.

SPERMATOKRHOEA. 63

Under this treatment the discharge diminished, but did not entirely disap-
pear.

Whilst taking these remedies, M. N was exposed to severe cold.

Cutaneous exhalation was suppressed, and pain in the loins supervened.
This was generally of a dull character, but was rendered acute on the
least exposure to cold; about the same period M. N 's digestion be-
came impaired. He attributed this to weakness of the stomach, and sought
to stimulate the organ by a generous diet, and by the use of rhubarb and
wine. These means, however, only increased his disorder, and, about the
month of June, 1822, it became very serious. As soon as food reached
the stomach he felt an impression at the praecordia, with difficulty of breath-
ing, general lassitude, and sometimes a desire to vomit ; his tongue was
white and pasty ; his bowels constantly distended with flatus, and he suf-
fered from obstinate constipation, with occasionally slight fainting fits ;
he was quite unable to fix his attention on any subject requiring mental
exertion.

Although without appetite, he forced himself to eat to keep up his strength,
but his digestion became more difficult, and he felt himself much overcome
by lassitude after meals. He endeavored to assist digestion by the use of
coffee, and with the same view he bathed every morning in cold water; he
was, however, unable to remain immersed more than a quarter of an hour at
a time without shaking in all his limbs ; no reaction took place afterwards,
and he always remained a long time before he was able to regain a comfort-
able degree of warmth. He obtained relief from eating ices, however, and
took them frequently.

A slight urethral discharge still continued, and on waking in the morn-
ing he perceived a viscid pearly matter at the orifice of the glans. Part of
this matter, remaining in the canal, was expelled with the urine, and re-
mained suspended in the fluid like a cloud, which after some time was de-
posited on the bottom of the utensil.

Towards the close of the year 1822, when the cold weather commenced,
his bad symptoms increased ; he became sad and absent, was unsettled, with-
out fixed motives, and very timid. He became shivered on the least expo-
sure to cold, the rigor commencing in the lower extremities, and extending
over the whole body. He suffered severe pains in the loins, and passed
urine frequently, and he now had difficulty in expelling the last drops, which
were viscid and always partly passed on his shirt. He no longer had erec-
tions or sexual impulse. He often passed semen during sleep, without las-
civious dreams or any turgidity of the penis, and he constantly felt an irre-
sistible drowsiness. Towards the commencement of 1823 he perceived an
abundant reddish sediment in his urine.

About the end of February his state had become deplorable : he then ap-
plied to me, and I ordered the following treatment — twelve leeches to tho
anus, cold lotions to be applied to the scrotum and perineum three times a
day, iced milk, flannel next the skin, very little wine to be taken with his
meals, and, after a short time, complete abstinence from all fermented liquors.
A few days after he felt a remarkable change ; his digestion was performed
better; the pain in his loins and the lassitude disappeared. He became
less sad, less timid, and he applied himself to study with ardor ; his genital
organs acquired energy, and he threw aside his suspensory bandage ; his
urine no longer deposited a sediment, and erections reappeared. Leeches
were applied a second time, fifteen days after the first, and he continued

g4 CAUSES OF

the remainder of the treatment for two months. By that time— about the
end of April— his health was re-established, and the warmth of summer
proved sufficient to confirm it. In the month of July, 1823, however, he
contracted a third blennorrhagia which did not affijct his general health. A
month after its appearance it was treated successfully by means of leeches
and small doses of copaiba : but when he took the latter in too large quan-
tities he suffered acute pain in the loins. Sea bathing during the month of

September contributed much to strengthen the genital organs. M. N

was afterwards appointed, by concours, senior surgeon to a very important
hospital, which proves that he was able to apply himself, after his recovery,
to severe study. I have since seen him several times, and have learned that
his health continues excellent, but that he is obliged to guard carefully
against the effects of cold, and against every over excitement of the diges-
tive organs. He finds it necessary every winter to return to milk, with mild
and light food, and to drink water with his meals.

This patient while suffering under blennorrhagia used horse exer-
cise ; soon afterwards orchitis occurred ; painful dragging sensations
were experienced in the spermatic cords, even for a long time after
the abatement of the inflammation. It was then by the vas deferens
that the inflammation was transmitted from the mucous membrane of
the urethra to the testicle. A short time after from exposure to cold,
perspiration became suppressed, and pain in the loins was experi-
enced. This pain was probably situated in the secreting organs of
the urine ; since, simultaneously, its emission became very frequent,
the last drops were expelled with difficulty, and its composition was
much altered. The inflammation then extended by means of the
bladder from the urethra to the kidneys, in the same manner that it
extended by the vasa deferentia to the testicles.

The urine deposited an abundant gravelly sediment, and at the
same time contained semen in suspension. The bladder had become
more sensitive to the presence of urine, for the desire to empty it was
often and very suddenly renewed. The seminal vesicles were exactly
in the same condition, and the semen was passed without erection
during sleep ; in addition to which, the contractions of the bladder
necessary for the expulsion of the last drops of urine caused con-
tractions in the seminal vesicles, and the fluid expelled was viscid and
glairy. Both classes of symptoms ceased, reappeared, and were
cured at the same time ; and they were evidently due to a state of
inflammation, for the antiphlogistic treatment was the only one that
succeeded in removing them.

The injurious eflfects of cold were very evident in the case of M.

N , and may be attributed partly to his lymphatic temperament,

but we often find analogous phenomena in patients of a very diS"erent
constitution. However this may be, I am convinced that without

the habitual use of flannel next his skin, M. N would not have

been able to preserve himself from further relapses, or permanently
to strengthen his constitution.

^^' ^ liad undergone several courses of anti-venereal treat-

SPERMATORRHCEA. 65

ment, although he had only suffered from blennorrhagia, and the ef-
fects of mercury were very injurious to him, as his constitution was
little fitted to withstand its action. He fell also into other very
common errors, which are the ordinary result of an almost universal
false reasoning on the part of the sick. Perceiving that he lost flesh,
he ate heartily, and chose the most nutritious kinds of food : diges-
tion being performed badly, and accompanied with the development
of flatus, because the stomach shared the general weakness, he had
recourse to rhubarb, generous wines, and spices. Hence frequentlv
arise the attacks of chronic gastritis, which so constantly accompany
old cases of spermatorrhoea.

M. N 's intellectual functions were weak in common with the

rest ; he was habitually drowsy, and he took cofiee and tea to rouse
himself.

At length M. N , like many other practitioners, began to treat

symptoms, and allowed himself to be influenced by the names given
to medicines ; his urine was thick, deposited a sediment, and was
passed with difficulty ; he took nitrate of potass as a diuretic, with-
out reflecting that the increase of secretion which this medicine pro-
duces, is the result of excitement of the urinary organs, and that
his were already too much irritated. His bowels being constipated,
he took purgatives without seeking the cause of constipation, and
without troubling himself about the efiect which irritation of the
rectum produces on the bladder, the prostate, and the seminal vesi-
cles. These are errors of daily occurrence.

The abuse of cold in cases of nocturnal and diurnal pollutions is
very common. By bathing in the river M. N followed the ad-
vice laid down by all writers on the subject: it proved injurious to
him, however, because the genito-urinary mucous membranes were
too irritable not to receive a hurtful shock from immersion in cold
water. The patient should have foreseen this result from the bad
effects cold had always produced on him ; besides this, he was too
weak to obtain a proper degree of reaction after bathino-. I shall
show by and by that cold baths employed without distinction in cases
of spermatorrhoea, have done much more harm than good. Still the
patient found that sea-bathing at a later period gave tone to his o-eni-
tal organs, and he was unable to reconcile two efiects of so opposite
a nature ; yet nothing is more simple. When he took sea-baths he
was cured ; the irritation of the organs had passed off", and their
normal condition had returned ; the first shock of the cold then was
no longer injurious, and the consecutive reaction followed rapidly.
It is true that considerable diff"erence exists between sea and river
bathing ; but it is chiefly to the difi'erent states of the system that
the two very opposite eS"ects of cold on this patient must be referred.

From not having attended to this important distinction, general
directions have been given respecting the use of these powerful
agents — directions which daily lead to the most disastrous results.

CAUSES OF

CxiSE VI.

Masturhation — Blennorrhngia — Diurnal pollutions — Failure of the ordi-
nary modes of treatment — Cauterization of the prostatic portion of the
urethra — Rapid recovery.

Alexis Poit, set. 20, short, stout, and of a sanguineous constitution, ap-
plied at the Hotel Dieu, Moutpellier, to be cured of a venereal taint, which,
he said, existed in his system, in consequence of an attack of blennorrhagia
contracted three months previously, and cured in a few days by the simple
use of dandelion tea.

Nothing in the appearance of the patient confirmed this statement. He
complained, however, of violent pain in his head, pain in his bones, frequent
spasmodic tremors in his limbs, and a constant agitation which prevented
his enjoying an instant's sleep; of stunning sensations and vertigo, with
ringing in his ears ; of a sense of suffocation with palpitation of the heart,
and of itching in the skin : his eyes were injected, dry, and very sensitive
to the impression of light.

Out of all his symptoms, the ossific pain was the only one that could fa-
vor the idea of a venereal taint ; the patient said that he suffered most
during the night, but his answers were very obscure and often contradictory.
His skin, however, was hot and dry, and covered with pimples. I prescribed
for him venesection, baths, and refrigerant drinks.

The next and following days, discharges occurred, and he seemed still
more satisfied that he labored under a syphilitic taint. His constitution
seemed strong, and his appearance proclaimed health. I thought, therefore,
at first, that he had some motive for feigning various diseases, but as he
did not eat, and seemed inclined to suJbmit to moxas and other means of
the same nature, I observed him more closely. The pupils looked on him
as a hypochondriac or a maniac, because he complained of a fixed pain in
the hypogastrium, although his tongue was neither red nor dry ; and be-
cause he said he heard a continual noise in his belly, and felt a hand of
iron pressing on his intestines for several hours together, and then relaxing
them suddenly.

When this oppression came on, he felt something ascending from the epi-
gastrium that almost suffocated him, and ceased suddenly on his passing
flatus. He was habitually costive, his feces were very offensive. He passed
water very often, and complained of pain in the penis and bladder during
micturition ; this he attributed to the suppression of the blennorrhagic dis-
charge. Twelve leeches were ordered to the anus, with general baths, which
relieved the pains in the bladder and penis,

_ I advised the patient to get up and take exercise, but he pretended that
his legs were unable to support him, and he spent all his time with his
head under the bedclothes, groaning and sighing.

Having observed many of these symptoms in persons suffering from sper-
matorrhoea, I questioned Poit on this subject; but he had never noticed
any discharge resembling semen, either while passing urine or feces. He
had never had intercourse with any female, except her from whom he had
contracted blennorrhagia, and with her very rarely, and at very distant in-
tervals.

From the way he deplored the moment of folly to which he owed his

SPERMATORRHOEA. 67

sufferings, I suspected that he had been addicted to masturbation : be de-
nied it obstinately, however, before the pupils, but he told me privately that
he had practised it from the age of ten, even five or six times a day : at
first he experienced a very lively tickling sensation, accompanied by dis-
charge, and soon changing into a painful sense of burning. About the age of
twelve, having perceived that those injurious practices injured his health, he
became more careful ; but about fourteen he again gave himself up to the
vice almost madly. The irritation was now often carried so far as to produce
pain ; the veins of the spermatic cords swelled, and there existed in his whole
body, especially in his loins and joints, a sense of debility, attended by ob-
tuse pain. He had continual vertigo, with noise in his ears, and his me-
mory became impaired. From sixteen to eighteen he restrained himself by
degrees, and regained his strength and stoutness. At this time he first had
sexual intercourse, soon after which blennorrhagia came on.

I requested the patient to preserve his urine, and to notice carefully what
passed from the penis when he was at stool. I found the urine red, thick,
and muddy, with a flaky cloud suspended in it ; the sides of the vessel were
lined by a brick-dust-like powder, and a glairy and tenacious sediment was
adherent to its bottom. The patient noticed that the last drops of urine
were thick and viscid, and were passed with sudden and involuntary con-
tractions of the bladder. After passing feces he found a thick, granular,
and transparent matter at the orifice of the urethra.

I prescribed for him milk three times a day, taken as cold as possible,
and mixed with Eau de Spa or lime-water ; a vegetable diet ; two cold hip-
baths daily, each of a quarter of an hour's duration ; and a cold enema
night and morning, to facilitate the passage of the feces.

These means which I had seen recommended by Wickman and Saint
Marie, and which had succeeded in other cases, did not produce any im-
provement in this. The patient became more restless and hypochondriacal,
and did not sleep an hour during the night. Emollients and leeches re-
lieved his pain, but at the same time relaxed his system ; he suffered less,
but he passed much more semen. Tonics and cold diminished for a time
the seminal discharge, but they increased the pain and irritation.

After about three weeks of these fruitless essays, I gave up general means
altogether, and as I was convinced that the spermatorrhoea arose from a
state of chronic inflammation of the prostatic mucous membrane, the irrita-
tion of which extended to the ejaculatory ducts and seminal vesicles, I con-
sidered that by removing this state of the membrane by means of cauteri-
zation, I should put an end to the irritation of the spermatic organs, and
especially to the spasmodic contractions of the seminal vesicles.

The beneficial effects which I had obtained from the use of nitrate of sil-
ver in analogous cases of irritation, made me little dread the danger said to
be attached to cauterization of the prostatic portion of the urethra, on ac-
count of its vicinity to the bladder.

In order to empty the bladder, and to take the exact length of the ure-
thra, I was obliged to introduce a catheter, which had scarcely entered an
in'^h or two into the canal, when violent spasmodic contractions commenced,
which prevented it from advancing, and almost made me suspect the exist-
ence of stricture; after a few seconds these spasms ceased, and the cathe-
ter passed as far as the neck of the bladder. Here the pain and spasms
were redoubled, and the bladder seemed perfectly closed. At length, after
a considerable time, I was enabled to introduce the point of the catheter

58 CAUSES OF

into the neck of tbe bladder, and the instrument was immediately power-
fully drawn into the vesical cavity, as though by a kind of suction. When
untouched the catheter was several times suddenly attracted and repelled
alternately by the convulsive action of the muscles of the perineum_ and
bladder • and its extraction was almost as painful and difficult as its intro-
duction had been, so firmly was it held by the neck of the bladder. The
vesical contents were rapidly and forcibly discharged.

All these circumstances confirmed me in the diagnosis I had formed re-
specting the cause of the disease, and I immediately applied the solid nitrate
of silver to the prostatic portion of the urethra. The application was rapid-
lasting only long enough to incline the caustic to the right and left, so as
to make it pass quickly over the inferior surface of the canal.

During the first twenty-four hours, the patient suffered much while pass-
ing urine. On the second day, the pain was much less severe, and on the
third day, it was scarcely worth notice. During these three days, the urine
was thick and muddy, and the last drops were streaked with blood. ^ After
this time it became transparent, and the patient was able to retain it much
longer.

Twelve days after the cauterization, the urine was quite normal, without
either deposit or cloud — the last drops were expelled easily, and were as
transparent as the first. The patient no longer experienced tension or un-
easiness in the perineum, or involuntary contractions of the neck of the
bladder ; but when the bowels were confined, he still noticed a viscid matter
at the orifice of the urethra.

The first improvement noticed was in his sleep, which became sounder
and longer; then the moral and physical man became more energetic ; and
lastly, the activity of the digestive organs returned. Within fifteen days
erections reappeared, and after some time the patient experienced noctur-
nal pollutions, preceded by erotic dreams, and accompanied with lively
sensations. The intellectual powers were the last to be entirely re-esta-
blished ; but they did not appear to have ever been very active in this
patient.

At the expiration of a month, his health was quite perfect, and he wished
to resume his former occupation.

This patient was the first on whom I practised cauterization as a
remedy for spermatorrhoea ; and I have related his case chiefly to
show the active and painful contractions of the neck of the bladder
and urethra which occur in such cases. These facts may give an
idea of the extreme state of irritation of the urethral raucous lining,
and of the influence which this condition must exercise over the se-
minal vesicles.

The phenomena above described are very often observed in patients
affected by spermatorrhoea ; their study is therefore important in
deciding on its treatment — thus, for example, I have noticed that
the greater the state of irritation the more certain are the effects of
cauterization ; in these cases, also, tonics, ice, and cold hip-baths,
are by no means proper. In the case I have just related sperma-
torrhoea was, without doubt, caused by the blennorrhoea, but the
excessive masturbation to which the patient had been addicted, even

SPERMATORRHEA. 69

before puberty, must have contributed much to produce tbis unfor-
tunate disease, and, probably, from this circumstance it arose that
a cure was impossible by the employment of the usual simple means.

CASE yii.

Abuse of spi'rihioiis liquors — Blennorrhcujia — Xocturnal Pollutions — Im-
potency — Frequent discharge of urine — Cauterization — Cure.

J. D at an early age accustomed himself to an excess of alcoholic

drinks, but in other respects was remarkably abstemious : at the age of
twenty he contracted blennorrhagia, which disappeared of its own accord
at the end of about three weeks. A short time after he noticed that noc-
turnal pollutions occurred very frequently, sometimes happening eight or

ten nights consecutively. The day following these discharges I) was

depressed in spirits and suffered from headache, noise in the ears, and daz-
zling before the eyes : these sj-mptoms induced him to submit to venesec-
tion three times, and to apply leeches to the temples, after which D

entirely lost all virile power.

After the disappearance of the blennorrhagia a yellowish discharge from
the anus came on several times, and was accompanied with a very trouble-
some itching. Soon after this the patient had a tetter on the face, for which
he took alteratives and mercurials. The skin disease disappeared, but
symptoms of irritation of the bladder supervened.

In 1824, D , aged twenty-four, came to the hospital of St. Eloi, in

the following state. He was of the middle height, and well made, his skin
was pale, his hair black, his face very red, his manner gloomy and taciturn;
he was fond of solitude, showed perfect indifference towards women, and
great horror of masturbation. His intellect was dull, his digestion painful,
and his limbs weak. He passed urine two or three times an hour during
the day, and five or sis times in the course of the night, attended by scald-
ing and pain in the canal.

The introduction of a silver catheter of moderate size excited spasmodic
contraction and acute pain in the neck of the bladder, which induced me
to propose cauterization to the patient : he agreed to it without hesitation,
and I performed it immediately.

I introduced the caustic holder into the bladder so as to cauterize the
parts near its neck, and I passed the caustic over the prostatic surface as
well as over the membranous portion of the urethra in withdrawing it. Im-
mediately afterwards there was a pressing desire to micturate, and blood
passed with the urine. Baths and barley-water were ordered.

During the following night he experienced a painful seminal emission ;
he passed urine only once, but with an acutely burning pain.

On the following day the patient only passed urine four times, but
always with burning and a slight discharge of blood.

On the third day he no longer passed any blood, and the scalding was
very slight.

On the fourth day the emission of urine took place every three cr four
hours only, and the discharge arising from the cauterization had ceased.

On the following days emptying the bladder was performed less and less
frequently ; seminal discharge no longer followed ; the patient regained his
5

CAUSES OF

spirits; his health became perfectly re-established, and about the fifteenth
day after the cauterization he left the hospital.

In this patient the blennorrbagia had not been preceded by exces-
sive sexual intercourse or masturbation ; but the abuse of alcoholic
stimulants is almost as pernicious in its eflFects on the genito-urinary
organs ; besides this he possessed a strumous habit, which showed it-
self by' the tetter on the face and the abscess at the margin of the
anus. It is especially in cases of this kind, that tonics, ice, and
cold bathing fail, and are even injurious; happily, we possess a
powerful remedy in cauterization.

In this case the tetter on the face having disappeared, infiamnia-
tion of the vesical mucous membrane occurred ; this was very in-
tense, the patient passing urine two or three times in the hour ;
from this time the urinary symptoms predominated, on which ac-
count catheterism was accompanied with acute pain in the prostatic
region, and spasmodic contractions of the neck of the bladder.

Not long since cauterization of the prostatic portion of the urethra
was looked on as the extreme of rashness, so much was the introduc-
tion of the least particle of the nitrate of silver into the bladder dreaded ;
although these fears were only founded on argument, they were gene-
rally received, and seemed so natural that I was influenced by them
for several years. I have stated in another place the means by which
I shook off these foolish fears, and the successful results that have
followed the application of the nitrate of silver to the mucous mem-
brane of the bladder in catarrhal affections of that organ.' Since
that time, whenever I meet with cases in which the affection of the
prostatic mucous membrane extends to that of the bladder, I begin
by cauterizing the latter, and I continue the application as far as the •
bulb of the urethra whilst withdrawing the instrument, by inclining
it rapidly to the right and left. It is not to take the length of the
canal that I introduce a catheter in these cases, but in order to empty
the bladder completely, so that the nitrate of silver may act with
more energy. We have just seen the effect of this treatment : a
patient who previously passed urine two or three times in the hour
was enabled to retain the excretion as long as is usual, and at the
same time the spermatorrhoea from which he suffered was cured.

This case also confirms in a remarkable manner what I have above
stated respecting the relations that exist between the disease of the
urinary, and those of the spermatic organs.

' Vide Le9ons de Clinique, &c.

SPERMATORRHEA. 71

CASE VIII.

Masturbation — Blennorrhagia, repeated anti-venereal treatment — Diurnal
pollutions — Increasing iceakness, especially of the mental faculties — Ex-
treme emaciation — Cauterization, and cure after sixteen years. Venereal
excesses, relapse — Cauterization again performed with success.

M. V , of spare habit and nervous temperament, was addicted to mas-
turbation about the age of puberty, but abstained when he perceived his
health affected. He again practised it as soon as his strength began to re-
turn, and renounced it as soon as he perceived his health endangered. He
again regained his strength, and applied himself with diligence and success
to the study of law.

At the age of eighteen he contracted blennorrhagia, which was treated
during sis months with injections of acetate of lead, sulphate of copper, &c.
The discharge disappeared after a journey on horseback — again came on
soon after and again stopped. Urethral discharge was afterwards often ex-
cited by very slight causes.

Independently of tonics, injections, and astringents, which were prescribed
for this patient without the least discretion, bichloride of mercury, mercurial
pills, sarsaparilla, and friction with mercurial ointment, were recommended.
His health became more and more disordered; he was subject to headache
and pains in the limbs and loins, accompanied with debility, loss of sleep,
and frequent attacks of fainting.

M. V attributed all these symptoms to the presence of a venereal

virus of the system, and as they increased several times after sexual inter-
course, he was persuaded that he had on each occasion received fresh infec-
tion. At length the care of his health became quite a kind of monomania.
He abandoned the career he had followed for eight years, and came to
Montpellier to study medicine for the sole purpose of arriving at the cause
of his complaint, and finding a remedy for it. Returning always to the idea
of a syphilitic virus, he submitted himself successively to all the anti-
syphilitic modes of treatment he could discover recommended by authors,
and combined them together in various ways.

Still, however, his strength diminished by degrees; his digestion became
painful and laborious; and he was annoyed by flatus and obstinate constipa-
tion, which he combated by the frequent use of purgatives. His intellect
became so far weakened that he could not fix his attention during a lecture,
and soon even he became unable to comprehend what he read.

He attended the courses of the faculty, but he was unable to remain
during half a lecture without experiencing fatigue and impatience : his head
became congested, and he felt a constant desire to change his position, or to
walk.

Though formerly competent to argue with pleasure on the most abstract
propositions, he was now unable to follow the simplest reasoning; and the
most recent and important facts escaped his recollection. He was tor-
mented by attacks of vertigo, loss of sight, and noise in the ears. The
least intellectual excitement induced fits of pain in the head; and slight
congestions were often excited by the digestive process, by flatulence, or by
efforts at stool.

The patient having his mind continually occupied by these symptoms at

72 ' CAUSES OF ^

length persuaded himself that part of his cerebral substance had been ab-
sorbed and that his cranium only contained the nerves of sense ; he thought
ho could feel these bathed in serum, and he was obstinately of opinion that
he was threatened with an attack of apoplexy.

On the other hand, his character became sad, variable, and unsociable ;
he disliked music, of which he had previously been passionately fond ; he
slighted all his friends, and his misanthropy became so great that when he
an acquaintance in the street he turned on his heel in order to avoid

saw

him. Tormented by a constant desire for motion, Ije was unable to remain
long in the same place ; and this restlessness, together with his love of soli-
tude, made him wander constantly in all the by-ways of the neighborhood
of Montpellier. He was careless of everything, and often in distress from
having neglected his affairs.

At length, after remaining seven years at Montpellier, M. V came to

consult me. From the first words he said to me I suspected that he suffered
from diurnal pollutions, and I questioned him closely on this head ; but he
had never noticed spermatic discharges either whilst passing urine or feces,
and he persisted in the opinion that his disorder arose from a venereal virus
still existing in his system.

A short time afterwards, to relieve an attack of cerebral congestion, he
applied leeches to the anus, and was unable to leave his bed for three
months.

The observations he made during this period convinced him that my dia-
gnosis was correct, but he still wished to treat himself, and, among other
means, placed pounded camphor between the glans penis and prepuce, in
order to act directly on the genital organs : a few hours after, on going to
stool, he passed a large quantity of semen, fainted, and remained some time
before he was able to call assistance.

I never witnessed a more repulsive sight than that I saw on reaching M.

Y 's residence ; the disorder and dirt that surrounded him evinced the

most perfect carelessness. Muddy urine, of a fetid smell, filled a dirty ves-
sel placed near the head of his bed on a chair covered with dust and clothes.
He was extremely pale, and greatly emaciated; he threw himself about on
his bed like a person moribund ; his limbs were cold, and his pulse weak and
irregular.

As soon as he was able to understand me, I proposed cauterization of the
prostatic mucous membrane to him j he joyfully consented, and I performed
it the same day.

The moderate sized silver catheter, which I introduced first to empty the
bladder, excited spasmodic contractions of the canal, and appeared to give
considerable pain, especially in the prostatic region — further confirming me
in my opinion that the prostatic portion of the urethra had been a long time
the seat of chronic inflammation.

The application of the caustic presented nothing worthy of record.
Two days after the operation, the patient experienced a feeling of vigor
in the genital organs, and of general comfort which gave him hope. Soon
after he regained his spirits, appetite and sleep returned ; his voice acquired
strength ; he felt his taste for music return ; he sought out his friends ; his
face entirely changed its expression, and his mirth became even boisterous.
At the expiration of fifteen days from the operation he experienced ve-
nereal desires, and erections were frequent and energetic. His appetite was
good, and his digestion acted with an unusual energy.

SPERMATORRHCEA. 73

His health continued to progress favorably until, to hasten his restora-
tion, he introduced a paste containing acetate of lead and copaiba into the
urethra. After this the spermatic discharges reappeared, inflammation ex-
tended to the testicles, and suppuration occurred in the left, notwithstand-
ing active measures. An ounce of pus, which seemed to me to be dis-
charged from the tunica vaginalis, followed a puncture on the left side ;
after the escape of this, all the disorders disappeared by degrees, and con-
valescence proceeded rapidly. Within a month, all M. V 's functions

were performed with a regularity which he had not enjoyed for twenty
years previously.

M. V possessed considerable natural talents, and related the sensa-
tions he had experienced, the opinions he had formed on his disease, and
the motives of his most extraordinary actions, in a very lively manner.

Two months afterwards, however, M. V came to me as sad as ever.

He informed me that, being tormented by frequent erections, he had more
consulted his desires than his strength. This want of restraint had repro-
duced in a fortnight all the irritation under which he had previously suffered,
with the disorders following it. He had then broken off these habits, but
his health had not become re-established because diurnal spermatic dis-
charges had reappeared.

I performed a second cauterization similar to the first, and with an equally

good result ; and this time M. V , having gained experience, became

more moderate in his conduct and returned to his residence.

This case ought to be placed by the side of the first two I have
related in which the post-mortem appearances are recorded. The
symptoms were almost as severe ; they presented the same characters,
and gave rise to the same delusions as to the state of the brain.

The rapid re-establishraent of the intellectual functions in M.

V proves that he had no greater cerebral disorganization than

the other patients; it seems probable, however, that in the first
cases the alterations of the spermatic organs had proceeded further
than in the case just related.

The obstinacy with which M. V continued to treat an imagi-
nary venereal affection is remarkable ; we have already seen an in-
stance of it in the fifth case I have recorded. In neither case were
there syphilitic symptoms, either primary or secondary. Such pre-
convictions are very common in nervous patients, and their surgeons
sometimes share them. The wandering, dull, and deep-seated sen-
sations complained of are especially liable to be mistaken for the
pain in the osseous system which follows syphilis.

This case is well suited to show how difficult it is for patients to
discover those seminal discharges which take place whilst emptying

the bladder and rectum. M. V had only one wish — to discover

the origin of his disorder. To this desire he sacrificed every con-
sideration, and for this end he came to Montpellier to study medi-
cine: he was not far from the truth, for he thought constantly of
the blennorrhagia which had preceded the disease, yet after fifteen
years of daily observation and seven years of application to medical
studies be had not even suspected the existence of involuntary sper-
matic discbarges.

74 CAUSES OF

Let us judo-e by this how many hypochondriacs owe their torments
to the same cause.

CASE IX.

Blennorrhaqia., foUoioed hy excoriations of the qians penis — Spermatorrhoea
— Cauterization tmsuccessfid — Artificial sulphur baths — Cure.

M. B , Lieutenant of Light Cavalry, affected with varicocele, con-
tracted blennorrhagia in 1818. Emollient drinks and warm baths reduced
this attack at the end of a month to a slight discharge, which soon after
entirely ceased ; excoriations had, however, previously appeared around the
orifice of the glans penis. These excoriations healed in about twenty days,
under the use of cold lotions : they reappeared four months after, and were
cured by the same means; they afterwards showed themselves periodically
every three or four months, and were not in any way affected by anti-vene-
real treatment of a very active kind, which the patient submitted to. Each
time their appearance was preceded by pain in the perineum and testicles,
increased by the passage of feces.

After the expiration of five years, the excoriations ceased, and the pain,
which had previously been relieved by their appearance, became permanent,
and was accompanied by discharge of semen during defecation. The pa-
tient suffered pain in the region of the kidneys, which became insupport-
able after re-maining under arms for a few minutes ; his urine deposited a
whitish sediment.

Sea bathing increased the pain in the perineum, and the difficulty of
passing urine : fresh-water bathing increased the pain in the loins : his di-
gestion was disordered.

When M. B came to ask my advice, I at first suspected that a stric-
ture existed, and endeavored several times to examine the urethra with a
soft wax bougie; each time, however, the instrument was arrested in a diffe-
rent situation, and when withdrawn, presented a diffei'ent form. After a few
days' rest, I introduced an ordinary catheter into the bladder, without
meeting with any permanent obstruction, but with severe pain to the pa-
tient, especially in passing the bulb of the urethra. There was, then, in
this patient, only a state of extreme irritability of the urethral mucous mem-
brane. I hoped to cure this by means of cauterization with the nitrate of
silver, as I had done before; but, on this occasion, no eBFect was produced.

Recollecting, then, that the disappearance of the excoriations on the glans
penis had been followed by an increase of the disease, I prescribed artificial
sulphur baths, containing two ounces of sulphuret of potassium in each.
At first, the baths produced an excellent effect, but afterwards a severe irri-
tation of the stomach, and the return of all the symptoms were occasioned.
I .discovered, however, that sulphuric acid had been added to the last baths :
this was omitted, and as soon as the patient resumed the use of the baths
containing sulphur of potassium only, his state improved rapidly.

At the expiration of a month, his pain had disappeared, his urine was
transparent, and the passage of feces was no longer accompanied by seminal

discharge; digestion became active, and M. B soon regained his strength

and stoutness.

SPERMATORRH(EA. 75

M. B , previously to the attack of blennorrhagia, had never

sufiered from any cutaneous aftection ; from this date ulceration ap-
peared periodically round the glans penis : this might be supposed
to have arisen from a syphilitic affection, but it resisted the most ac-
tive anti-venereal treatment. Its appearance put an end to the pain
in the perineum and testicles: as soon as the sores healed, these symp-
toms returned, and diurnal spermatic discharges accompanied them.

It seemed probable that the application of nitrate of silver would
lessen the morbid irritability of the urethral mucous membrane; it
produced no appreciable effect, however.

Artificial sulphur baths were used with advantage when they con-
tained only sulphuret of potassium ; when sulphuric acid was added,
in order to increase their activity, all the symptoms reappeared ; on
resuming the use of the sulphuret of potassium alone, the cure pro-
ceeded with rapidity.

It is remarkable, also, in this case, that river bathing always in-
creased the pain in the loins, while sea bathing aggravated the pain
in the perineum. Anomalies of this kind abound in the treatment
of spermatorrhoea, and much careful research is often necessary to
explain them ; the relation of such cases will, however, put practi-
tioners on their guard by furnishing analogies for their guidance.

Baths containing sulphuret of potassium are especially indicated
whenever a cutaneous affection coexists with considerable sensibility
of the mucous surfaces; but, when the irritation of the genital organs
is very severe, they are often contraindicated. In such cases cauteri-
zation, though it may not cure, at least will diminish the excessive
sensibility.^

Causes. — I have before stated that the cause of spermatorrhoea
is a most important circumstance for our consideration. The truth
of this becomes more evident as we proceed ; but it often happens
that several causes act simultaneously or successively, and that we
are not able clearly to discover which of them exercises the greatest
influence in the production of the disease.

Blennorrhagia is the most active and the most direct, as well as
the most easily appreciated, of all these causes, and this is why I
have commenced by reporting cases in which it has played a princi-
pal part. When these cases are examined separately with some
attention, we soon perceive that the discharge has been preceded,
accompanied, or followed, by some circumstances capable, by their
own action, of giving rise to spermatorrhoea. It is necessary to pay
attention to this point.

In one patient I had occasion to treat, hereditary predisposition

' M. Lallemand has reported many more cases of involuntary spermatic discharges
following blennorrhagia; as, however, they differ very slightly from one another, and
the same treatment was applied to all, I have thought it as well to omit the remainder
of them. In fact, the connection between blennorrhagia and involuntary spermatic
discharges, seems so well established by the cases above related, as to require no
further confirmation. — [H. J. McD.]

76 CAUSES OF

probably existed, for his father had been also affected by spermator-
rhoea; others had a very marked lymphatic temperament, as in the
fifth case I have reported. Many were naturally weak, delicate, and
nervous ; or their health had been injured by bad habits, or a too
sedentary life; others, again, suffered from tetters, haemorrhoids, or
varicocele.

By far the greater number of the patients who have come under
my care, had committed excesses, either in coitus, masturbation, or
the use of alcoholic stimulants.

Blennorrhagia in many cases is neglected ; patients are too timid
to mention it, or too careless, and too much occupied to pay attention
to it; in other cases, the treatment is rendered useless by imprudence
or excess; but, in many cases the inflammation produces injurious
effects by its simple presence for a short time.

Many of my patients had had two attacks of blennorrhagia, and in
one case as many as seven were experienced, before spermatorrhoea
commenced; but, I must remark, that in these cases, the recurrence
of the discharge is not always due to a fresh infection, as the patients
and many surgeons believe ; the facility with which blennorrhagia
often recurs without coitus, is sufficient evidence that it may return
spontaneously, or, at all events, from very slight excitement. This
disposition to a recurrence of the discharge may be easily understood,
if the increased development of the capillary system in the mucous
follicles after repeated or continued attacks of inflammation be taken
into consideration.

, These patients almost always in the end suffer from spermator-
rhoea. In fact it is difficult to avoid, sooner or later, an extension
of the inflammation of the prostatic mucous follicles to the spermatic
ducts. We must not, however, mistake for semen, the mucus which
constantly moistens the urethral orifice in such persons ; and, on the
other hand, we must be careful to guard against repelling too lightly
their apprehensions on this account, because chronic catarrh of the
urethra often accompanies spermatic discharges; and is a sign of their
presence by no means to be disregarded.

In some of the cases I have seen, involuntary spermatic discharges
seem to have been kept up by venereal taint, and such have been
relieved by anti-venereal treatment ; on the other hand, in some
cases, the seminal discharges have not seemed to be influenced either
by the venereal affection, or the means employed for its cure.

Anti-venereal treatment is frequently also employed in patients
who have suffered merely from blennorrhagia, and in a very nume-
rous class of cases it produces a serious increase of the irritation in
the genital organs, and causes the appearance, or exasperates the
effects, of involuntary spermatic discharges.

Cases of this nature often present considerable difficulties of diag-
nosis ; and the solution of these obscurities is always of much im-
portance in determining the treatment to be followed.

Anti-venereals are not the only therapeutic agents which produce

SPERMATOERHCEA. 77

such unfortunate effects ; those which <a blind routine of practice em-
ploys in cases of blennorrhagia have not been less injurious ; among
these it is especially necessary for me to mention astringent injections,
copaiba, cubebs, tonics, and bitters employed too soon, or in extreme
doses. All these means act more or less by exciting the genito-uri-
nary organs ; it is therefore easy to understand that their untimely
or immoderate use must favor an extension of the inflammation from
the urethra to the mucous membranes which are continuous Avith it.

I am far, however, from wishing to prescribe the use of these re-
medies, and I willingly bear testimony to their beneficial effects,
after the inflammatory symptoms have been subdued. A time ar-
rives when the- mucous membrane of the urethra, like all other
membranes of the same class, requires the employment of tonics
and astringents ; but in the way they are daily prescribed, I am
convinced more harm than good results from their use.

Lastly, spermatorrhoea is often made worse by the very means
employed for its removal, and among these may be ranked cold
baths, ice, tonics, bitters, sulphur baths, &c.

In all the cases I have so far considered, blennorrhagia has exer-
cised the chief influence in inducing spermatorrhoea ; it is, however,
rarely sufficient singly to bring on this fatal disease, and the causes,
which in the cases I have related have been accessory only, may ex-
cite, each by its own action, more or less serious involuntary seminal
discharges. These accessory causes exercise too great an influence
to be passed over in silence : they are numerous and various, and
succeed or are combined with one another in different ways — two
cases seldom occurring which resemble each other exactly.

The further we advance the more plainly we shall see how neces-
sary it is for the different forms of spermatorrhoea to be described as
simple affections — how necessary it is to regard them in all their
aspects, and to take account of all the circumstances which assist in
producing them. In practice we find it indispensable to weigh well
all the points connected with a case of spermatorrhoea, before de-
ciding on our diagnosis, prognosis, or, especially, on our treatment.

Mode of Action. — In all the cases I have related the urethra
retained an excessive irritability, especially in the prostatic region ;
the patients felt constant pain, weight, heat, darting or painful tick-
ling in this situation ; and these sensations were increased by the
passage of urine.

Catheterism, though performed carefully, always produced acute
pain and spasm, sometimes sufficiently violent to simulate stricture.
The catheter was especially arrested at the neck of the bladder, and
often it could only be passed on after waiting a considerable time.
The. patients felt as if the instrument had passed over spots of
ulceration. They were convulsively agitated, and all the power of a
determined will was often insufficient to restrain their expressions of
agony. Their faces were distorted, and their whole bodies covered
by a profuse sweat. As soon as the catheter was withdrawn, a con-
siderable quantity of florid blood was, in most cases, discharged.

T'g CAUSES OF

These different phenomena, which occur with more or less severity
in every case, sufficiently indicate that the mucous membrane of the
urethra possesses an extreme irritability, especially in the prostatic
region. Several of the symptoms are even sufficient to make one
suppose that it is granular, and very vascular or excoriated. A few
of the patients I have treated experienced symptoms indicating still
more positively an affection of the prostate, such as swelling of the
oro-an, sense of weight in the rectum and perineum, darting pains in
the neck of the bladder behind the pubes, &c., and, in one case, the
inflammation of the prostate ended in suppuration. In many cases
the testicles were swollen, inflamed, and painful (as in the fifth and
ninth cases). The spermatic cords also shared the condition of the
testicles, as in these cases. Lastly, in some patients who have con-
sulted me, the seminal emissions contained blood or pus.

Thus, in all such cases the blennorrhagia leaves great irritation
and morbid sensibility in the urethral mucous membrane, most se-
vere in the neighborhood of the prostate, the principal seat of the
primary disease. In many cases the inflammation extends its influ-
ence to the testicles by means of their excretory ducts, and this
should make us suspect that the spermatic organs may retain the
same irritability as the urethra.

The same phenomena are manifested in the urinary organs; indeed,
their resemblance to the spermatic is remarkable in more respects
than one.

Many of my patients had experienced acute inflammation of the
bladder (as in the seventh case). Others had suffered from symp-
toms of chronic inflammation of that organ. In a few, the inflam-
mation seemed even to extend to the kidneys, if we may judge from
the pain, spasm, and dragging felt in the loins, and the changes ob-
served in the urine.

These are the only circumstances which enable us to appreciate
the state of the kidneys — organs out of reach of physical examina-
tion ; but analogy confirms the results deducible from them. After
having unequivocally proved the presence of orchitis, under similar
circumstances we may well suspect the presence of nephritis, espe-
cially when we observe symptoms which are otherwise inexplicable.
Post-mortem inspections have shown, in many cases, that these
analogies do not deceive us, and I have found in the kidneys varied
and serious alterations of structure which could only have been pro-
duced by inflammation.

All such patients, without exception, pass more urine during the
twenty-four hours than natural : so that, although the kidneys may
not be actually inflamed, it is evident that they are in a state of more
or less active irritation, or, at least, of sufficient excitement consider-
ably to increase their action. The same condition obtains in the
testicles, for although they may not be the seat of either inflamma-
tion or pain, their activity is increased. The semen is not only ex-
pelled involuntarily, but it is also secreted in greater abundance

SPERMATORRHCEA. 79

than natural; for unless the secretion were increased the seminal
emissions would not be so frequent, and the weakening and ex-
haustion would not proceed so rapidly.

The urine is not only more abundant but its nature is also changed,
even after the pus and mucus contained in it have been removed.
It is paler and more watery, and contains less urea and uric acid
than natural.

The semen also loses its peculiar odor, its color, and its consist-
ence ; it is, in fact, less perfectly formed than it ought to be.

Lastly, all these patients experience a frequent desire to micturate,
depending on the irritation of the bladder. Some are unable to hold
their urine more than half an hour or an hour (case seventh). In
all, the desire of micturition, comes on sudilenly and imperiously ;
the spasmodic contractions of the bladder overcome all the efforts
of the will, and the emission takes place suddenly and convulsively.

This phenomenon gives us an exact view of what passes in the
vesiculse seminales during involuntary seminal discharge; some pa-
tients even feel distinctly the contractions which announce an emis-
sion as inevitable; others have not sufficient practical knowledge to re-
cognize them, but their statements show that the same phenomena
are experienced, even when analogy would not lead us to admit their
presence. The analogy is, however, very evident, for it is especially
during the expulsion of the last drops of urine that the spermatic dis-
charge takes place, and the two classes of symptoms are in general
relieved or exasperated at the same time and by the influence of the
same causes. This remarkable resemblance may be explained very
simply by referring to the fact, that blennorrhagia has its principal
seat in the prostate, Avhere the spermatic and urinary apparatus
meet, and the connection of the two classes of phenomena enables us
still better to understand the causes and mechanism of spermatorrhoea.

Treatment. — It is by no means astonishing that in this state the
application of the nitrate of silver to the prostatic mucous membrane
should produce effects more direct and powerful than those of any
other remedy. We know well how promptly and effectually nitrate
of silver acts on tissues which are granular, injected or swollen from
the effects of prolonged inflammation. Its results are especially evi-
dent in the chronic ophthalmia of scrofulous patients. Soon after
the nitrate has been applied, the tissues empty .themselves, contract
and become paler, and they retain an energetic action which pre-
serves them from a relapse, to which the patients are often liable
when a cure has been obtained by other means. On this account I
have employed nitrate of silver in the chronic inflammation of the
vagina and neck of the uterus, which keeps up leucorrhoeal discharge
in so many cases, and in chronic catarrh of the bladder, which is so
difficult of cure by other means ; and I have always had cause to be
pleased with its action in these affections. The nitrate produces the
same effects on the mucous membrane of the prostatic portion of the
urethra ; the organization and sensibility of the membrane are con-

80 CAUSES OF SPEEMATOREHCEA.

siderably altered, and this change is soon felt by the organs which
are immediately influenced by its condition.

Hitherto relaxation of the ejaculatory ducts have been alone thought
of in cases of spermatorrhoea, and this exclusive idea has been a
cause of much malapraxis ; but to attribute all cases of spermatorrhoea
to irritation of the spermatic organs only, would be quite as erroneous
and injurious. One patient I had occasion to treat was cured by
tonics, another by antiphlogistics (case fifth) ; and I shall have to re-
cord other cases of the same nature, but they are very rare. There
exist almost always at the same time irritability and debility, extreme
sensibility, and loss of tone in the spermatic organs. This state,
however, we observe in the chronic affections of all mucous mem-
branes ; indeed, we may even say, as a general rule, that the weaker
the organs or individuals, the more easily are they excited.

By acting on the surface of the engorged tissue, its morbid sus-
ceptibility is changed, and a contraction is afterwards excited in it,
which gives it energy. This is why one application of nitrate of
silver generally sufllices to produce a perfect cure.

But when the disease has existed a long time the genital organs
share the general debility of the system, and after the chronic in-
flammation has disappeared, it becomes necessary to aid the relaxed
tissues to resume their former energy ; nothing now contraindicates
the exhibition of tonics of 'all kinds, which complete the cure com-
menced by cauterization. This explains how cold and sulphur baths,
ice, &c., are useful after cauterization to individuals who were in-
jured by them at first (case ninth).

Symptoms. — Whilst examining the mode of action of blennorrhagia
in producing spermatorrhoea, I have already referred to the symp-
toms which occurred in the cases reported ; in the other cases 1 have
seen, the symptoms have been common to all kinds of spermatorrhoea,
and I cannot notice them here without being exposed, by and by, to
useless repetitions. I shall, therefore, only call attention at present
to the insidious character of the general symptoms produced by these
discharges, which often simulate the characteristic marks of cerebral
afi'ections, gastritis, diseases of the heart, urinary calculus, &c.

The real cause of the symptoms is very difficult of detection in
cases of spermatorrhoea : some of my patients had studied medicine
for many years, in the sole hope of discovering it (case eighth) ; we
may judge from this how frequently cases of spermatorrhoea are mis-
taken for other afi'ections.

( 81 )

CHAPTER IV.

CAUSES OF SPERMATORRHCEA.

Cutaneous Affections.

The follo^^■ing case is that of a student of medicine who came
under my care. At my request, he put it into its present form for
publication.

CASE X.

Itch during ten months at about the age of fourteen — Pain in the epigas-
trium — Tumor of the testicle — Chronic injiammation of the bladder —
Diurnal spermatic discharges — Jli/jwchondriasis — Cure hy Cauterization
at the age of twenty-eight.

" Up to the age of fourteen, my health was very good, but at this period
I was afflicted with psora, which continued for ten months in spite of va-
rious modes of treatment. Scarcely was this cured than I felt a sharp cut-
ting pain in the epigastrium, after a time becoming dull and extended. The
itching I had before felt over the whole body seemed to affect my head, and
when I had been exposed to cold or damp, or had kept my head uncovered,
the scalp became covered with little pimples, which, when scratched, formed
scabs.

" An induration of the left testicle, of about the size and shape of a bean,
appeared, and continued during eight months. My digestion became de-
ranged ; my complexion darkened, and my shoulders became round ; the
epigastric region was so tender that I could not bear the weight of the bed-
clothes, and when erect I seemed to have a weight suspended within me.
At this time I was at school, but during the vacation I took an opportunity
of consulting my family surgeon; he attributed all I felt to too rapid growth.
Not being satisfied with this explanation, I consulted a bone-setter well
known in the neighborhood, who said my breast bone was dislocated, pre-
tended to replace it, applied a plaster, and sent me away as I came.

" This state of things continued till I was eighteen, when I experienced a
slight pain in making water, and became very costive. The epigastric pain
diminished, however, and I gained flesh.

" At the age of twenty- two, after domestic trouble, and perhaps, also,
from the effects of some slight excesses, I experienced the following symp-
toms : Progressive emaciation ; lassitude after the least exertion ; yellow,
dry, and earthy skin ; burning heat, especially in the palms of the hands
and the soles of the feet; creeping sensations over all the body when I began
to perspire; habitual sensation of internal heat; constant pain in the epi-
gastrium and right hypochondrium ; obstinate constipation ; difficult diges-
tion, attended with -the secretion of flatus; acid eructations, smelling of

82 CAUSES OF SPEEMATOEKHCEA.

putrid eggs; sometimes cold and clammy sweats, especially when I had
taken any acrid or acid substance, or when I experienced the slightest
contradiction, for I had become very irritable ; impossibility of enduring
hunger ; difficulty of holding my urine, with pain at the base of the glans
penis, and spasm at the neck of the bladder during its emission ; the
urine presenting, when cold, a red muddy appearance, with an abundant
brick-dust sediment, and a cloud of flocculent matter in suspension ; vene-
real desires, with entire loss of the power of coitus ; a discharge of a trans-
parent and viscid matter after the least erection ; an abundant discharge
of a white, serous, slightly opaque matter from the urethra on going to
stool; scurf and itching of the hea4 ; noise in the ears; loss of memory;
feeling of discontent with myself ; extreme timidity ; dislike to all amuse-
ments save solitary walks; deep melancholy without cause ; loss of courage ;
sadness of countenance. All these symptoms were aggravated after horse
exercise.

" I consulted various practitioners, all of whom considered my state as
nervous, and told me I was hypochondriacal ; some, however, recommended
emollients, baths, a vegetable and milk diet, with exercise and amusement;
others prescribed bitters, tonics, alteratives, preparations of sulphur exter-
nally and internally, an issue, &c. All these modes of treatment were use-
less, or rather they increased my disorders, and in my painful condition I
tried to contract a new itch, without success.

"I now, at the age of twenty eight, came to consult you The

introduction of a catheter gave me violent pain, and caused spasm of the
urethra, especially near the bladder. The application of the nitrate of silver
dispersed the chronic inflammation which kept up the involuntary discharge
of semen, and eight days after the cauterization I felt stronger, my limbs
seemed more free, my urine became clear, and I began to hold it longer ;
my countenance appeared gay, and my complexion became fair. I had a
nocturnal emission, a thing I had not experienced for a long time. At the
expiration of three weeks I found myself in a perfectly new state ; during a
period of ten years I had never felt so well. The cerebral functions, and
those of the stomach, intestines, bladder, and genital organs, were performed
with an unaccustomed energy ; my skin had lost its yellow and earthy
appearance. The internal burning and the cutaneous tingling were removed.
Nocturnal emissions, however, have since become very frequent, and from
the fourth to this day, the twelfth of July, I have had four ; nevertheless,
my strength has continued to increase daily, and I hope that a second
cauterization will remove altogether a disease which all previous treatment
had only served to increase."

I cannot now say whether I yielded to this patient's desire for a
second application of the nitrate of silver, but I certainly did not
share his uneasiness respecting the nocturnal emissions. When these
Jollow involuntary diurnal discharges of semen, they show a considera-
ble improvement in the state of the genital organs ; they prove, in
fact, that the semen is no longer expelled as before in an almost con-
tinuous manner. Indeed the patient experienced from this moment
a rapid amelioration in all his functions, and an increase of strength
which would be inexplicable under other circumstances. The desire
for a fresh cauterization was not alone due to the fear of nocturnal

CUTANEOUS AFFECTIONS. 83

emissions ; it arose partly from a kind of blind faith in a remedy
"which had produced such prompt and satisfactory results.

The desire for a second application of the nitrate of silver is felt
by many of the patients who have once experienced its effects, and
I have often been obliged to resist it. We must only return to this
remedy when much remains to he effected^ and when all improvement
has been arrested for some time ; so long as progress is made, how-
ever slow it may be, there is reason for hoping that regimen, exer-
cise, and a moderate use of the organs, ^ill be sufficient to confirm
the convalescence.

The rapid cure of the hypochondriasis, treated for so long a time,
and with such little success, by so many different means, sufficiently
testifies that it originated in the involuntary loss of semen. But to
what cause can we attribute the spermatorrhoea? After the disap-
pearance of the cutaneous affection, symptoms of chronic inflammation
of the stomach, and afterwards of the bladder, appeared. Then a
tumor arose in the left testicle. The connection between irritation
of the skin and that of the mucous membranes is well known, and
I have shown the manner in which affections of the urethra extend
to the testicles. It is then easy to understand the course by which
irritation extended to the spermatic organs, and excited spasmodic
contractions of the seminal vesicles.

The pain which the patient experienced in the neck of the bladder
proves, also, that the involuntary discharge was really kept up by
chronic inflammation in that situation ; the frequent desire of mictu-
rition and the state of the urine, together with the sensations produced
by catheterism, and especially the rapid cure effected by the nitrate
of silver, are further evidences in support of this opinion.

CASE XI.

Cutaneous affections — Repeated attacks of urethritis — Application of nitrate

of silvei — Cure.

M. N , of an irritable constitution and subject to frequent and varied

cutaneous eruptions from bis infancy, suffered during youth from several
slight attacks of urethritis, which always passed off rapidly; at the age of
twenty-one he married. Still, however, the discharges reappeared several
times with various degrees of duration and intensity, alternating sometimes
with tetters and at others with boils. The urethritis supervened once on
an eruption of pimples on the head which had lasted very long and left
cicatrices similar to those of smallpox. At other times unyielding attacks
of ophthalmia and violent rheumatic pains came on during the absence of
the cutaneous affection. Several times slight excoriations became irritated
in a remarkable manner, and a simple scratch on the leg kept the patient
in bed for several months. In 1820, on an attack of numerous and large
furuncles, a more intense and painful urethritis than usual supervened. I

found M. N in an extreme state of prostration and agitation, excited by

harassing suspicions as to the nature of this discharge, which was abundant

84 CAUSES OF SPEKMATOREH(EA.

and greenish, and resembled in all respects that of an intense blennorrhagia.
As I knew my patient's constitution, I thought that the discharge depended
on the general cause which had excited the former attacks, and therefore
prescribed antiphlogistics and derivatives, to which it yielded.

I afterwards advised emollients and alterative drinks, and still later the

use of the warm sulphuretted springs : M. N went successively to Cau-

terets, Luchon, and Aries, near Perpignan.

At the expiration of three years his general health was improved, but the
attacks of urethritis reappeared from time to time, especially in winter,
when irritation no longer existed in the skin or any other organ; and he de-
sired much to rid himself of these periodic discharges which embittered his
existence. I had previously successfully used the nitrate of silver in sub-
stance in several cases of inveterate blennorrhagia, and I proposed its use to
him with the hope of considerably modifying the action of the urethral
mucous surface. He submitted to it with eagerness, and the results sur-
passed my most sanguine expectations.

Twelve years afterwards, M. N had not perceived the least trace of

his distressing discharges, although he had travelled much, and had not
restricted himself to any regimen or privation. But he soon perceived much
more important changes. His venereal desires became more active and
more imperious, his erections took on a new energy, and ejaculation no
longer took place so precipitately as before; in fact, he fouud himself at
the age of fifty-jfive more vigorous, in all respects, than he had been at
twenty.

This single cauterization produced, then, a perfect revolution in

the state of M. N 's genital organs, and its effects remained even

after the expiration of twelve years.

To obtain a correct idea of the importance of the change which
had taken place in the urethral raucous membrane it is necessary to

remark, that M. N remained subject to the same cutaneous

eruptions, and that they alternated as before with ophthalmia, at-
tacks of gout, wandering pains in the breast, abdomen, &c., but that
from this time the urethra was never the seat of the inflammation,
which still continued to attack the other organs. Thus, although
the first cause continued to act on the other organs, the part cau-
terized remained, after twelve years, free from its influence.

On the other hand, if we may be allowed to judge by analogy with
the preceding cases, and by the general symptoms which accompa-
nied the repeated attacks of urethritis, they must have produced
spermatorrhoea, although the patient himself did not suspect it. This
is the only way in which we can explain the increase of energy in
the genital organs notwithstanding the effects of age, and the in-
creased vigor of the whole economy in spite of more frequent sexual
intercourse.

In fact, then, the nitrate of silver not only put an end to the dis-
position to urethritis, but also destroyed a powerful and continually
debilitating discharge, which was undermining the patient's consti-
tution, without his being able to discover the cause of his weakness.

CUTANEOUS AFFECTIONS. 85

CASE XIL

Pniri(/iiioiis emption around the genital organs — Two attarJcs of hlennor-
rhagia — Nocturnal and diurnal emissions — Cure hy means of stdphu-
retted baths.

M. L , at the beginning of the year 1824, was attacked by a prurigi-

nous eruption on the scrotum, which extended rapidly and covered the
genital organs. After the least irregularity of diet, the surface of the
scrotum assumed an inflamed appearance, and secreted a fetid discharge
accompanied with violent itching. Baths, lotions of milk, decoctions of
various kinds, and sulphur ointment, only gave temporary relief.

In the month of June, 1824, four months after the first appearance of

the eruption, M. L contracted a urethral discharge ; the inflammation

accompanying this was very slight, and the patient subdued it by baths and
emollients. He attempted to take balsam of copaiba, but was soon obliged
to leave off its use on account of the irritation it produced in the digestive
organs. The urethral discharge diminished rapidly, but did not entirely
disappear, a slight oozing of a viscid pearly matter remaining, which formed,
at the orifice of the glans, a little crust which the patient was obliged to
remove in order to give passage to his urine. This discharge he neglected,
and shortly after he noticed that semen was passed in large quantity during
defecation. In the month of January, 1825, he contracted a second ure-
thritis, which was more severe than the first. Acute pain was present in
the fossa navicularis, and after a time in the region of the prostate. In a
few days the inflammation was accompanied by general fever. The patient
was then submitted to a rigid antiphlogistic treatment, and at the expiration
of a week the local and general symptoms were much relieved; shortly
after the discharge ceased entirely.

In the month of February, M. L rubbed in mercurial ointment in

order to prevent a venereal contagion. This inunction entirely removed
the cutaneous disease of the scrotum, but a few days afterwards the old
discharge reappeared, accompanied with itching of the anus, and contrac-
tion of the sphincter ani ; feeling of arterial pulsation in the lower part of
the rectum, especially after meals, when sitting, or during defecation ; ob-
stinate constipation; urine depositing a quantity of whitish flocculi, which
formed on cooling an abundant cloud suspended in the middle of the fluid ;
constant oozing of a fluid resembling semen, which formed a crust at the
orifice of the urethra ; abundant seminal emissions during defecation ; noc-
turnal emissions accompanied by pain of short duration, but suQiciently
acute to arouse the patient from a deep sleep; extreme sensibility of the
canal on the introduction of a catheter, with acute pain in the prostatic re-
gion ; the retina very sensitive to the effects of light ; noise in the right
ear, worse at night than in the morning, and difficult digestion accompanied
by abundant discharge of flatus

I ordered for this patient twenty-four sulphuretted baths containing at
first one ounce, then one ounce and a half, and afterwards two ounces of
sulphuret of potassium. These means alone sufficed to perform a perfect
cure at the expiration of two months.

It is impossible that both attacks of blennorrhagia in this patient were
contracted in the ordinary manner, by contact with blennorrhagic
6

80 CAUHKH OK HI'KTlTMATOUTlTTfKA.

virus; but at tlio sarno tiTrn; tluH dooH not, H(!(!rn j)r()]))iJ)lc, Ijochuho tlio
snpprcHsion of the Hkin (liHcaHO on tho Hcrotuin waH roll()W(;<l by n, re-
turn of tlio (liBcliargc. Tho mucous inctnhranos, too, Hccm to li!iv(!
poHHCHSf'd an extraordinary scnHibility, 8inco tho balsam of cojxiiba,
^ivori in tlio usual doso, induccMl fj:^ron.t irritability of tbn dif.f(!Htivn
ori!;iiiiH after a few days' adrninistriition. Tt is rcMnarlciible, too, tliat
tbe (les.Hiition of tlio (lisoliar/^o fol|{)vv(!d tho omission of tli(! r(!niedy.
This HUS(;(!f)tii»ilit-y of tho inuoous membranc^s is very common in oii-
tatieous afi'ections, and exjilains tho fre({U(!ney of non-contagious at-
tacks of urethritis in patients who suflor from them.

'I'he disappearance of the disease in the skin of the scrotum was
follow(Ml by tho return of tho nocturnal arid diurnal fioilutions, but
this time the irritation was more; sov(!ro than ev(!r, and was not con-
fined to the mucous membraiu! of the g(!nito-uriiiary organs ; it ex-
tended also to that of the rectum, and tho patient oxporionced itch-
ing of tho anus, S[)a8m of tho Sfihinctor, and a fooling of pulsation
in the lower part of tho intestine.

This coiiicidcMice cori(lrm(;d mo still more firinly in the opinion that
tho previous urethral discharge! had not been owing to blcnuoriliagic
contagion, and Icfl mo to onbir Bul[)hur(!tt(Ml baths ; cautcn'i/.alion of
tho urethra would have jiroducod no (dl'cct on tho irritation of tho
rectum, and tho latter would, alone, probably have sudiccd to repro-
duce involuntary spermatic discharges. Tho patient's rapid and
perfect cure shows that tho indication followed was tho correct one.

(!ASK xiir.

I/rrpcK prnji'iiti(r/in (i/f(rni(tfhi(/ in <i rcnuir/idhlr. manner vulli, lriit<il!iin. In.
l/u: prtmliUic portion of tlir. nrct/mi — Nnclnrndl and aflrrwunh (tiurnal
poll III ioHH — (JiniHioniil inipofnm — lin-cK/iihliithnicnt lij/ id iiliri:'.ntioii —
RcUi'pm — Cur I'. Ill/ Ihi: hittlm of Vcrnct.

M. 15 , a inngiHtrat(!, of ii, iyinpliatieo-Kanguirio tornp(!nmi<iil, Imd

ocofiHidiiully prttctiHod iiiiiHturliatidii, hut hud never eoiiiinil.ted any vetn^reai
cxcesHOHS. Ho was uttaekcd, for llw fir.st tiriu!, at the a/^e of m\i}\U'vm, with
an eruption on the prcpinu! wliicli diKa[)peanw| sp(>ntan(!OUHly, reliiriKMl hooii
al't.(!r, and again (liHapi)(ian!<l. TIiiH (truption waH (!all(!d by his ni(!ili(!al
attendant lierp(!H prie])utialiM. I^'roiii that time it continued to return at
poriodH of ineniaHing duration, and, at various tinioH, presented (;in;uiii-
.stan(;(!S worthy of notic.(!. 'riio (!riJ[)tioiis geiKirally a[)ii(!anid on dill'crent
Kpots, to tli(! miiiiber of live or six, and w(!r(! not, at lirnt, larg(!r tlian a. pin's
liCiad, but were aceotnpani(!d by violent itching; by degnuis the HjiotH in-
ereascd in size and becmiiK! unitcid, after whi(!li they were dried up, leaving only
a degree of nidiuiHS wliitdi soon pasHed off. Tho appcMiranco of these (jrup-
tioiiH waH always pnifieded, during three or four <iayH, by a seiiHation of
lassitude, and of weij!;ht at the root of the penis. J)uring the eruption the
lassitude left the paticitit entindy, and (lie sexual itnpulse and pow(!r were
much greater than usual. The njtuni of the eruption took plaee, at first,
every two or thnio inontlis, then (svery year, and aftfir that every two
years; and when M. jJ consulted inc it had not appeared for three

I'UTANEOUvS AFFECTIONS. 87

yo!U's. As the oruptioii Mpi^t'annl nicri* nircly i( losi, nlso, iiuirli of its duni-
tidii niul iiitiMisity. It alway.s yi''l<l«*tJ '" li^lions of I'old walor.

'l\\o yonrs ixUi'v tlio liist. nppoiiranoo of tho oruplioii, 1\1, I> IkkI nu

iilt'oratitin on tho penis. 'I'Ms wiis n'ijivriliHl n.s sypliilitio. Still Inh'r lio
liiul two attnoks ot' mi'lliml dischar^o, al'ltM* wliioli a. swollinu; at. tho anus
supcrvoiiiHl. All (hi'so syinptoius woro attacked hy a rii^id and loiij.!; eon-
tiimed anti-vonoioal lrt>atuuMit.,

I>iirinM; fho twclvo years that IM. 11 has boon married, he has very

rarely had sexual inteteourso, but he has j^eiiendly t>xpeiieMe(>d three or I'lmr
noeturnal pollutions in the lumrse of a. mouth.

l'\>r the last lour years he I\as felt. j);reater sense of \vei;!;hl, at tlu* root,
oflhepeuis; t>p()iil(tiii'()iiii ereelious have disapjieartMl ; those whieh he has
been able to exeito have been very rare, and seldom peri'eet., Mjaeulation
has always been hurried, and stunetimes oven has jtreeeded intromission.
Iti has never boon aeeoutpanied with aout.o sensation, lutereourso has been
followed by sloeplossnoss, jfojieral ])rostration, irritation and spasms in tho
stomaeh, espoeially if it has taken plaoo in the oveniuj^. Noeturnal pollu-
tions have boon very abundant, have ooe\u*red ahuost without ereetiou, and
havo been fidlowoil by mueh more serio\is symptoms than (Muissions foUow-
\u^ eoifus. b'or tho last two yi*ars, neeturnal emissions havo biuiouto

i;r;idMally n\oro rari>, and M. U has notieed, aeeidentally, on sovi'ral

oee.'isiuns, that he has jiassod semen whilst at stotd, allhou;i;h his bowels

have not been oimstipafed. On his arrival at Montpollier M. \i was

forty- two years of a>:;e ; his faeo was red, and he appeared in ji;ood hoaltli.
Mut his digestion was badly performed ; his sleep was disturbed ; and ht» felt
his memory and int(>lloet nuudi we.dvoned. The proi<;re,ssivt^ loss of power
ill the ;j;enital or<>;ans was n souree o[' mueh r(<j>;ret to him, His urine was
thick and very fetid; it eontained a lar;:;e quantity of mucous llocculi, and

deposited a .sediment of matter resomblinj^ semen. IM. H told me this

appe.'iranee had been present in itdurinii; twelve years. Thus the alteration
ill his urine dated from about the lime t)f his marriaj<;o.

On tho sixth of May, 1S!U», I eauteri/.od the urethra from the nock of
the bladder as far as tho nienibranous ptu'tion ; tho olVeot of the oporatiiuj
was }irompt and vory evident. Sixteen d.ays afterwards tho urine was
perfectly transparent, and tho i!;(>noral stato very salisfaetory. Il(^ w.as then
eompolleil to leave Monlpeiru'r sudd(>nly. Three months afterwards iM.

H inf(UMned mo that in spite of the irritation e!i\i,S(>d by travelliiii!;, his

uriiK* iuid eoutinuod trans|)arent, and that his genital orjj^ans had acipiired

an iMiacousloiuod (Miorjry. In fait M. H found himself so well that ho

oonsidured it nnnecess.iry to u.^e the niiiioral w.'itcrs as 1 had rceommciided
liim.

Two years afterwards IM. H had a sli;j;ht rel.'ipse, which yielded r.'ipidly

to tiie use of the sulphuretted waters of W'ruel, near l\>rpij:;uan.

1 shall ni>t iiKiuire, lierc, wliellier ihorc was r(*a.lly l)ItMinorrhM,>j;io
»'ontiij;i(m ill this caso. I shall only roiniirk tliiil; tho horpos ap-
peared a louii; time bofore any sexual inttu'eourso ha.d tukon plaoo,
and that its ret urn was aoeonipatiiod by vioKnit pruritus, and in-
ereaso of .'^exual inipnlso ; interoourso would in 0i)nstMjueiuH> tiiko
})liu'o uioro fretjuontly dnrine; iho presonco of tho eruption.

The singular fonnoetion of tho skin nlVi'ction, intorniittont with
attacks of blennorrluijjiii, is worthy of notico ; it shows a continual

88 CAUSES OF SPEKMATOEEHiEA.

metastasis of the irritation of the prepuce of the mucous membrane
lining the prostate. As soon, therefore, as the eruption appeared,
the habitual sense of weight in the prostatic region was relieved, and
the activity of the genital organs increased ; the symptoms connected
with the prostate reappeared when the herpes was cured. As the
eruption diminished in frequency and intensity, and the intervals
between its appearance became longer, the functions of the genital
oro-ans diminished, and at length, when the herpes had not come on
for some time, the patient's impotence was complete. The urine
was muddy from the period of the patient's marriage : it seems pro-
bable, therefore, that the greater frequency of sexual intercourse
contributed to the production of diurnal pollutions. It is also worthy
of notice, that as the nocturnal pollutions become rarer, the debility
of the genital organs was shown in a more striking manner, and
that from this period the seminal discharges during defecation were

sufficiently abundant to be remarked by the patient. M. B 's

impotence was not absolute, because the involuntary discharges va-
ried much in amount. This variation in the symptoms is a charac-
teristic feature of slight cases of spermatorrhoea, and very probably
explains the uncertainty of temper in such patients. In the case I
have just reported it is not to be wondered at, when the intermissions
of the cutaneous affection are taken into account.

Another very remarkable case in which blennorrhagia occurred
several times as a consequence of the metastasis of cutaneous affec-
tions, will be found in my 10th chapter.

CASE XIV.

Lymphatic temperamenl — Various cutaneous eruptions alternating with other
affections — Habitual had health — Hypochondriasis — Spermatorrhoea un-
discovered during twenty-five years — Cure hy sulphuretted baths,

M. D , of very lymphatic temperament, was subject, in bis childhood,

to chilblains and a cutaneous affection of the scalp j he had also many stru-
mous abscesses in his neck. About puberty his health became better, but
he was still subject to attacks of ophthalmia, discharge from the ears, and
frequent cutaneous eruptions of different kinds, which were very difficult of
cure, and alternated with sore throat or chronic affections of the different
mucous membranes. He married at the age of twenty-one, and never com-
mitted excesses of any kind. He has had several children.

About the age of thirty, tetters appeared on his face, neck, arms, legs,
scrotum, and perineum ; these were sometimes dry and squamous, and
changed their situation very rapidly. They were often followed by little
pimples which appeared in different parts of the body, causing great itching;
at other times boils followed them and lasted for months. M. D un-
derwent various modes of treatment in order to rid himself of these unplea-
sant eruptions, but without success — some of the remedies even increasing
his disease.

By degrees his health became disordered in a more serious manner; he
experienced successively symptoms of pulmonary catarrh, of gastro-ente-

CUTANEOUS AFFECTIONS. 89

ritis, and of chronic cystitis ; he was also subject to frequent attacks of
rheumatism, and was annoyed by obstinate constipation alternating with
diarrhoea. His digestion by degrees became diificult, and he was often
attacked with flatulent colic; bis bowels were, indeed, always distended by
flatus, of which he was obliged frequently to relieve himself. When attacks
of colic came on he seemed on the point of being suffocated ; blood rushed to
his head ; his face became purple ; but at length all passed off' on the dis-
charge of immense quantities of flatus, which often continued to escape for
several hours.

From this time he ceased to go into society, and saw only his most intimate
friends, and by degrees he became nervous and hypochondriacal. An excel-
lent man naturally, he now was ill tempered, peevish, and capricious, and
he showed great weakness of character and morbid sensibility. A slightly
interesting tale, or the recital of an instance of courage or devotion affected
him to a foolish degree, and he was particularly alive to anything he con-
sidered an injustice.

His face was often congested, and he complained of stunning sensations, for
the relief of which leeches were applied to the anus, and he used foot-baths
and other remedies without benefit. At length his legs failed, and he was
obliged to give up the frequent walks he had previously taken.

These symptoms were looked on as the forerunners of apoplexy. Leeches
were again recommended to be applied to the anus, but the patient refused,
because he had never been benefited by their application.

Under these circumstances I was consulted, M. D being then fifty-
six years of age. I was for several days unable to discover the cause of these
various symptoms, so long and complicated was the history of the complaint.
At last the patient mentioned a tetter which had covered all the scrotum, and
extended to the perineum and margin of the anus. I then inquired if he
had ever experienced spermatic discharges during the passage of feces, and
I soon learned from the details into which he entered that he had been sub-
ject to spermatorrhoea during twenty-five years without suspecting it. He
had always thought that the urethral discharge during defecation consisted
of mucus, and had never attached the least importance to it. These dis-
charges were not habitual nor equally copious at all times, and he was often
quite free from them during many months. As well as he could recollect,
these periods of immunity were when he was affected by cutaneous eruptions.
He even thought that his ''''humors" escaped with the urine when he saw the
spermatic discharges reappear, and he then experienced in the rectum and
bladder a heat and irritation which he was only able to relieve by means of
injections. From the first occurrence of these involuntary discharges his
erections and sexual desire had constantly diminished, and had left him
entirely for several years ; this he attributed solely to the effects of age.
His urine was often muddy and flocculent for a fortnight, and then became
limpid during a variable length of time.

AH these circumstances combined, were much too clear to leave the slight-
est doubt as to the nature of the disorder ; I therefore recommended him to
take the natural sulphuretted waters, and he went to those of Vernet, near
Perpignan. After seven or eight baths a lively itching came on in his skin,
especially on the legs. Numbers of small pimples appeared, from which
oozed for a month so considerable a quantity of reddish serosity, that the
patient was obliged to surround his limbs twice a day with several folds of
linen. At length this discharge gradually diminished, and the epidermis
came off in patches over the whole surface of the body.

90 CAUSES OF SPERMATOEEHCEA.

Durinw this time a complete change took place in the economy: the
feces were passed easily and regularly ; the appetite increased ; the invo-
luntary spermatic discbarges disappeared; the stomach digested with equal
facility all kinds of food, and bore the patient's taking wine ; his erections
reappeared, and in fact M. D at fifty-six years of age experienced al-
most a return to youth.

In this case spcrmatorrhoga was unsuspected during twenty-five
years, and the unhappy patient who thus suffered had passed during
all the time for a hypochondriac. Enemas and medicines had been
prescribed for him, without any attempt being made to seek the cause
of his disease. I hope that these cases will in future receive more
attention from medical men ; although they do not speedily cause
death, it must be admitted that they render existence wretched.

How was it that this patient could so long support so serious a
disease ? Probably because it was not constant. The spermatic dis-
charges, in the commencement, seem only to have appeared when
initation occurred in the genitourinary organs or rectum. At last,
however, they threatened the patient's life, and suspicions arose of
the presence of cerebral disease, or at least of the danger of apoplexy.

Causes. — The cases I have related are sufficient to show the inti-
mate connection that exists between the genito-urinary mucous mem-
branes and the skin, especially that of the scrotum and perineum.
I do not, however, mean to infer that the connection between the
mucous membrane and the skin is more intimate or special in the
genito-urinary than in the other organs of the body. It depends on
the same cause, viz : the analogy of function between the mucous
and the cutaneous tissues. In the tenth and eleventh cases which I
have related, the genito-urinary organs were the last affected ; the
law, therefore, is a general one, but I can only here consider that
part of it which relates to spermatorrhoea.

Nevertheless, cutaneous affections alone have not, in most cases,
been sufficient for the production of this disease, for I have already
stated that its causes rarely act singly. It is, however, necessary to
consider them singly when we wish to discover the influence due to
each, and we ought to take into account all the circumstances which
may contribute to produce so serious a disorder.

I have reported in the preceding chapter an example (case ninth)
of blennorrhagia complicated with cutaneous disease, for the cure of
which it was necessary to employ special remedies ; in the eleventh
and twelfth cases, urethral discharges were present in more or less
severity and frequency. It may appear that I should not have se-
parated cases so much resembling each other, but I have been guided
in so doing by the greater predominance of one or the other predis-
posing affection.

There is certainly no reason Avhy an individual affected by cutane-
ous diseases should not expose himself to the risk of blennorrhagic
contagion, and there is on the other hand every reason why he should

CUTANEOUS AFFECTIONS. 91

be easily infected by such exposure ; I think, liowever, that we too
generally confound the discharges to which such persons are subject
with ordinary blennorrhagia, and if the patients speak of old cutaneous
affections which have disappeared on the occurrence of the discharge,
we too often smile, and, without taking further notice, prescribe the
anti-blennorrhagic remedy whicb we are in the habit of using in all
cases. Even well educated and experienced practitioners constantly
act thus, from not having sufficiently considered special cases; these
cases, nevertheless, occur often enough to merit serious attention.

One of my friends, who had been aftected for a long time by a
pruriginous eruption, consulted an empiric, who ordered an ointment
to be applied over all his body for its cure. He was scarcely well
when he married. A few days after, an abundant greenish discharge
appeared from the urethra, attended by pain, and all the symptoms
of violent blennorrhagia. At this he was much alarmed, and con-
sulted me. Knowing his history, I did not share his suspicions, but
I recommended him to wear flannel from head to foot; in a few days
the eruption reappeared, and the discharge subsided spontaneously.

I have at this time under my care a patient who, at the age of
fourteen, suffered from an eruption on the scalp ; this disappeared
about the age of nineteen, and was followed by chronic inflammation
of the pulmonary mucous membrane. After the cure of this affection,
pain in the neck of the bladder, accompanied w^ith uneasiness, acute
cutting pain, and weight in the rectum, came on without any evident
causes; urethral discharge appeared; the spermatic cord and testi-
cles became swollen and painful, and the patient is now the victim
of spermatorrhoea, "^ith all its accompanying disorders.

In another case, for which I have been recently consulted, the
patient had never had sexual intercourse. He suffered from cuta-
neous aff'ections in early life, and at the age of eighteen experienced
inflammation of the testicles from excessive excitement caused by
reading an obscene book, and two years afterwards, after unsuccess-
ful attempts to obtain the favors of a female, a severe blennorrhagia
occurred, which lasted nine months.

After these facts, we should think twice before we pronounce on
the nature of a urethral discharge occurring in a person subject to
cutaneous eruptions, especially when their suppression has previously
been followed by inflammation of some other mucous membrane. Yet
we must always bear in mind that these persons are liable, in common
with the rest of mankind, to the occurrence of blennorrhagia, which
would even put on, in their particular cases, greater virulence than
usual, and must therefore greatly increase the predisposition of per-
sons subject to cutaneous diseases to suffer from spermatorrhoea.

We find in these cases, as in those recorded in the second chapter,
that anti-venereal treatment is useless, and frequently injurious.

Mode of Action. — In what manner do cutaneous affections operate
in producing spermatorrhoea? The cases I have reported are suffi-
cient to show that they act by a metastasis to the mucous membrane

92 CAUSES OF SPEEMATORRHfEA.

of the genito-urinary apparatus. Thus the patient suffered from re-
peated attacks of urethritis (as in the eleventh case), acute or chronic
cystitis (as in the tenth case), active irritations of the bladder, inflam-
mation of the testicles (tenth case), or the prostate, and pains in the
spermatic cords. We find then in these patients the same symptoms
that are manifested by those in whonj spermatorrhoea has arisen from
contaf^ious urethritis. The metastasis of cutaneous affections to the
urethral mucous membrane, therefore, produces the same effects as
the blennorrhagic virus, and the irritation extends in the same course
along the seminal passages.

Irritation of the Rectum. — Several of my patients have suffered
from affections of the rectum of which I have given no account in the
preceding chapters. These affections have consisted of a sense of
heat, darting pains, uneasiness, and a feeling of pulsation extending
more or less high in the intestine (as in the twelfth case). These
symptoms show that the cutaneous irritation had extended to the
mucous lining of the rectum, as well as to that of the genito-urinary
organs. Such a complication must increase greatly the chance of
spermatorrhoea occurring, by provoking a spasmodic contraction of
the rectum, whence results an obstacle to the passage of feces, and
a disposition to contraction in the seminal vesicles.

In the next chapter I shall consider the causes of spermatorrhcea
Avhich are connected with the rectum, and I shall only now observe,
in passing, that their symptoms must not be confounded with those
arising from irritation of the prostate. In both cases, constipation
and a sense of weight, heat, and uneasiness in the rectum, may be
present; but when these symptoms arise from a^ eruptive affection,
an intolerable itching, and heat at the edge of the anus are felt, and
on examining the parts, they are found red, excoriated, and wet ; on
drawing out the folds of the skin, a mucous and sometimes a puru-
lent discharge is perceptible, and the portions of mucous membrane
which can be brought into view are seen to be in the same condition:
in a word, the margin of the anus presents unequivocal marks of
cutaneous disease.

It is important to establish this distinction, because, in the first
case, cauterization of the prostatic portion of the urethra may put an
end to the chronic inflammation going on there ; but, in the second
case, symptoms which have their seat in the rectum are due to a
special affection of its mucous membrane. It is, indeed, true that
this affection is similar to that of the urethra, and that it arises
from the same cause; but the cure of the urethral inflammation would
have no effect on that present in the rectum, and we shall presently
see that the latter may suffice to excite or keep up spermatorrhoea to
a sufRcient extent to alter the health seriously.

Treatment. — The only means that have been successfully em-
ployed in cases of this nature, are cauterization and the use of the
sulphuretted waters.

( 93 )

CHAPTER V.

CAUSES OF SPERMATORRHOEA.
Influence of the Rectum.

I HAVE hitherto examined those causes which influence the sper-
matic organs by their direct action on the urethral mucous membrane.
1 now proceed to consider such as act on the seminal vesicles by
the mechanical and sympathetic influence of the rectum.

CASE XV.

Spermatorrhoea from a mechanical obstacle to defecation — Division of the
stricture — Rapid and complete cure.

Nicholas G , the guard of a diligence, of strong constitution, at the

age of twenty-five contracted a chancre, followed by bubo and warts. This
attack of syphilis was treated with mercurials, without the patient giving up
his employment, and, notwithstanding the fatigue consequent on his frequent
journeys, at the expiration of six weeks all the symptoms had disappeared.
Shortly afterwards he experienced difficulty in defecation, which slowly in-
creased, so that in the course of four or five years considerable efforts were
necessary to evacuate the rectum. The feces were flattened, like a ribbon,
four or five lines in width and about a line in thickness.

From this time G 's health became gradually disordered; his appetite

diminished, his digestion was impaired, and accompanied with the develop-
ment of flatus ; he lost flesh, and his weakness increased daily ; his memory
was impaired, and the genital organs underwent the same changes in their
functions. When he first consulted me he had scarcely any venereal desires,
his erections were imperfect, coitus was rarely possible, and ejaculation was
long in taking place ; sometimes it did not even occur at all, and it was
never accompanied by any lively sensation.

The concurrence of all these symptoms convinced me of the presence of
spermatorrhoea. The patient told me that for four years he had been in the
habit of passing semen while at stool, and that its discharge in general bore
a proportion to the efi"orts necessary for the expulsion of the feces ; on this
account, in order to render them as fluid as possible, he had reduced himself
to a vegetable and milk diet. He had often attempted to use enemata, but
had been unable to succeed.

The abundant spermatic discharges had so worn this patient out, that at
the age of thirty-four he presented the appearance of a man aged sixty.

On examination, I discovered, about two inches from the anus, a nearly
circular obstruction, of about half a line in thickness, having an irregular
opening in its centre which would barely admit the extremity of the fore-

94: CAUSES OF SPERMATORRHEA.

finger. This kind of diaphragm obstructed the passage of fecal matter ; it
was thin and soft, and felt like a cicatrix.

I made transverse incisions through the obstruction by means of a straight
probe-pointed bistoury passed along the index finger. These incisions
were of very trifling depth, and I afterwards dilated the opening by intro-
ducing- my finger deeply, and pressing it forcibly in the direction of each
wound, until by tearing I reached the walls of the intestine. Four loose
•flaps resulted from this operation, and I prevented their reunion by the
frequent introduction of my finger. The operation was attended with very
little pain or loss of blood. Some time afterwards I showed the patient
how to introduce a rectum bougie, of sufiicient size to dilate the portion
of gut which had been operated on ; this I advised him to practise daily for
some time. This simple means proved suflficient to procure separate cica-
trization of the four flaps, after which, the expulsion of the feces took place
without difficulty, and the spermatic discharges ceased. All his functions

were soon restored to their natural state, and Nicholas G resumed his

former occupation.

This case gives a very clear view of the mecbanical influence of
constipation in producing spermatic discharge during the passage of
feces. The sole cause of the spermatorrhoea was the membranous
obstacle above the sphincter ; and the discharge was caused simply
by mechanical pressure on the seminal vesicles during the violent
efforts the patient was compelled to make in order to force the feces
through a narrow opening. As soon as the obstacle was removed,
the spermatorrhoea ceased, and all the symptoms arising from it dis-
appeared. The effects of mechanical compression were in this case
then quite unmistakable.

Coitus was very long before ejaculation took place ; sometimes
even the completion of the act was impossible, and it was never at-
tended by lively sensations. The cause of all this was that the
seminal vesicles contained little and badly formed secretion ; but
these organs were not in a state of irritation, and the ejaculatory
canals were neither irritable nor relaxed. In most cases of diurnal
pollution, ejaculation is, on the contrary, very rapid, because the
spermatic organs are either irritated or relaxed, if they are not at
the same time in both these conditions.

CASE XVI.

Spermatorrlioea induced hy chronic diarrhoea, and hept up hy a mechanical
obstacle to defecation — Removal of a scirrhous tumor from the anus —
liajnd and perfect cure.

M , of good constitution, entered the army at the age of seventeen,

and served for eighteen years, during which he was exposed to considerable
hardships. He also committed excesses of all kinds. His health, however,

continued excellent. In 1814, M , then aged thirty-five, contracted

blennorrhagia, which he neglected; the discharge diminished, but did not
entirely cease before 1816, when he quitted the army. In 1820, M

INFLUENCE OF THE RECTUM. 95

luarried, but did not indulge in any excesses. Some time afterwards, having
been engaged as concierge to a club, be passed many nights almost without
lying down. In 1824 he was suddenly seized with violent colic, which was
relieved by means of emollient injections, repeated baths, and a severe re-
gimen, but which did not entirely leave him.

Two years afterwards he had a severe hemorrhage from the rectum, ac-
companied with very painful tenesmus, during the violent spasms of which
he noticed that he passed semen. This hemorrhage relieved the colicky
pains he had suffered from, but a dysentery remained, which kept up the
tenesmus and with it the involuntary seminal emissions, and caused the
prolapse of several hemorrhoidal tumors with eversion of the mucous mem-
brane of the rectum. From this period M 's health became more and

more disordered; he lost his habitual spirits together with his sexual appetite,
and his sight as well as his memory and physical strength became weakened,
so that in 1827 he was obliged to give up his occupation of concierge.
During the years 1827 and 1828, the chronic diarrhoea decreased in severity,
and in 1829, it had become much less frequent. At length, in 1830, it
was replaced by a very obstinate constipation, which in its turn also became
the cause of spermatorrhoea, and increased the swelling caused by the ha3-
niorrhoids and the prolapsed mucous membrane of the rectum. This swell-
ing was irreducible ; it increased in hardness, was irritated by the friction
of his clothes, and at last assumed a scii'rhous consistency. Its presence
alone formed a considerable obstacle to defecation. On the 28th of March,

1831, M applied at the Hospital St. Eloi, in the following condition:

He was fifty-one years of age ; extremely pale ; his face pale yellow ; skin
woolly ; hair black ; weakness excessive ; sensibility very great ; profound
melancholy; habitual hypochondriasis; digestion difficult, especially after
the use of animal food ; defecation rendered troublesome by a red, hard
swelling, five or six lines in diameter across its base, projecting about an
inch, and occupying about half the circumference of the anus; involuntary
discharges of semen during the efforts necessary to procure a fecal evacua-
tion ; the emission of urine followed by a discharge of a glairy, limpid, and
sticky matter; no erections during a long period; absence of all sexual im-
pulse; frequent attacks of vertigo; dazzling of the eyes; buzzing in the
ears ; attacks of heat towards the head from the slighest cause. The
tumor of which I have spoken resembled a large cock's comb; contracted
haemorrhoids were situated around it; and it seemed to have arisen from the
prolapsus of internal haemorrhoids, which had brought down with them a
portion of the mucous membrane of the rectum. The contraction of the
sphincter ani bad prevented the return of this tumor, and had increased
its swelling, and the friction of the patient's clothes had caused repeated in-
flammation and degeneration of its tissue. The base of the tumor occupied
more than half the circumference of the anus, and extended above the
sphincter ani. It was about six lines in thickness, and its feel was scir-
rhous ; a sanious discharge exuded from its surface, some points of which had
even begun to ulcerate. It was, therefore, evident that no time should be
lost if it were intended to remove this tumor; the patient was anxious for
the operation, and had previously asked several surgeons to perform it ;
but these gentlemen had refused on account of the depth to which the dis-
eased tissue extended.

By gentle and gradual traction on the tumor I was able to bring it en-
tirely through the sphincter, so as to bring the healthy mucous membrane

96 CAUSES OF SPERMATOKRHCEA.

into view. On the 25th of March, therefore, I commenced its removal by
an incision in the healthy mucous membrane, and to arrest the severe he-
morrhao-e which ensued, I cauterized the bottom of the wound with a fine
heated "iron. The tumor was then dissected out, the parts being touched
with the actual cautery as they were divided. After the entii-e removal of
the tumor, the greater portion of the wound ascended within the sphincter.

Slight inflammatory symptoms supervened, which yielded to bleeding, &c.,
suppuration was established, and the cicatrization of the wound was com-
pleted by degrees. The first few days after the operation the patient was
unable to void his urine without the use of a catheter, and for some time
afterwards he micturated very frequently.

On the first of May cicatrization was nearly completed, the feces had re-
gained their normal consistence and were passed daily without difficulty,
their passage no longer giving rise to involuntary spermatic discharge. The
patient regained his strength and spirits ; his appetite returned, and his di-
gestion was performed easily; his strength and stoutness increased daily.
About the middle of the month his erections reappeared during the night,
and afterwards became more frequent and prolonged ; his cerebral functions
followed the same course in their re-establishment ; the dazzling of sight

and cerebral congestions disappeared ; and M left the hospital on the

24th of May, perfectly restored to health.

Three years afterwards, when I was summoned to Clermont to preside
over a medical inquiry, M called on me; I recognized him with diffi-
culty, so much was his countenance changed. It is scarcely necessary for
me to say, that he had resumed his conjugal duties, and his occupation of
concierge. The cicatrix of the anus was thin and soft, and did not interfere
with defecation.

The latter part of this case exactly resembles the preceding one,
and the results of the operation prove that the involuntary spermatic
discharges were only kept up by the mechanical obstacle to defeca-
tion.

But the diarrhoea which had caused the prolapse of the hseraor-
rhoids, and the formation of the scirrhous tumor, was also accom-
panied by frequent involuntary emissions. At this time, then, the
seminal vesicles could not have been subjected to compression as the
feces were liquid, and remained a very short time in the rectum ;
we must, therefore, admit that the seminal vesicles participated in
the irritation of the rectum — that they were afi'ected by the spas-
modic contraction which took place in the gut — in a word, that they
were influenced by the tenesmus.

This case, then, presents a remarkable instance of the double in-
fluence possessed by the rectum over the seminal vesicles ; in the
beginning of the disease this influence was essentially vital ; at its
termination it was simply mechanical. Both phenomena produced
the same results, but they were quite sufiiciently distinguished from
one another not to be confounded together.

It was worthy of remark, also, that the patient, immediately after
the operation, was unable to pass his urine without the assistance of
a catheter, and that after a short time he experienced a frequent de-

INFLUENCE OF THE KECTUM. 97

sire to micturate. These two phenomena show the intimate con-
nection that exists between the anus and the neck of the bladder.

This case, then, exemplifies the influence of the rectum over the
urinary organs, in both its different forms.

CxiSE XVII.

Hsemorrlioich from the age of 'puheriy — Dificidty in evacuating tlie rectum
at the age of twenty-eight — Spermatorrhma — Cure.

M. A , of a sanguine temperament, at fifteen years of age was addicted

to masturbation ; soon after he had a discharge of blood from bssmorrhoids,
which he regarded as a consequence of his injurious habit, and consequently
abandoned it sufficiently early for his health to remain uninjured ; but the
haemorrhoids teased him much, especially when some time after he entered
the army. They were relieved, however, after a campaign in Spain, where
the patient suffered much from heat. By returning to his home and by
leading a less active life, he hoped with care to rid himself of his troublesome
affection ; the reverse happened, however — his diet being more stimulating
and his habits being sedentary, the haemorrhoids increased in number and
size. His stools were followed by a more or less abundant discharge of blood.
The internal hjemorrhoids were protruded and formed a voluminous and
painful mass, which could only be reduced by a long continued pressure.
After a time these hemorrhoidal tumors becoming irritated and swollen, pre-
sented an obstacle to the discharge of feces ; a larger portion of intestine
protruded, and was returned with great difficulty. The patient now perceived
that in his efforts at stool he passed a large quantity of semen, his health
broke up by degrees, he felt debilitated, his digestion became disordered,
his sleep was broken and unrefreshing ; his temper was soured, he often ex-
perienced sensations of stunning, vertigo, and sometimes even fainting fits.

Emollient injections, baths, and demulcents appeared to benefit him at
first, but he soon perceived that they increased the relaxation of the parts,
and favored both the prolapsus of the rectum and the spermatic discharges.

This state had lasted four months, when the patient first consulted me.
He was twenty-eight years of age, and had the appearance of being forty;
his muscles were well developed, but he was, notwithstanding, without
strength or energy. I first relieved the irritation of the rectum by lave-
ments of decoction of poppy-heads, and afterwards used slightly stimulating
ointment containing balsamic applications, at the same time that quinine
and preparations of iron were administered.

Under this treatment the mucous membrane of the rectum by degrees
regained its tone; the haemorrhoids became less sensitive and less volumi-
nous, and many of them withered away. The prolapsus of the rectum dis-
appeared gradually, and the seminal discharges diminished, at the same time
removing the symptoms that depended on them.

Haemorrhoids at the early age of fifteen are rare ; I cannot, how-
ever, believe that masturbation alone caused their appearance in this
patient, but I think it probable that he had a considerable predis-

98 CAUSES OF SPEEMATORRH(EA.

position to them. I do not suppose that the habit he practised for
a short time in his youth had any influence in causing the sperma-
torrhoea, for it is very easy to account for spermatic discharges in
such a case without referring to very remote causes. We must
then ref^ard this case as another example of the influence which ob-
struction to the passage of feces exercises on the seminal vesicles.

CASE XVIII.

Blennorrliagia — Constipation — Fissure of the anus — Discharge of semen at
stool — Profound hi/povhondriasis — Desire of committing suicide — Diar-
rhoea — Cure of the fissure of the anus — Disappearance of the other
symptoms.

At the age of twenty-four F. B contracted blennorrhagia, which was

accompanied with weight in the region of the prostate. By leeches and
baths the pains were relieved, and the discharge reduced to a slight gleet.
Soon afterwards the left testicle became swollen and very painful, and the
discharge increased in consequence of energetic and long continued erec-,
tions. The patient used leeches and hip-baths, and the swelling of the tes-
ticle diminished, but the discharge continued. For three or four years this
testicle continued very tender; it swelled on several occasions, and became
painful in consequence of slight venereal excitement, the urethral discharge
increasing at the same time. These phenomena returned every spring during
four years.

In order to cure these symptoms F. B took the Rob de Laffecteur,^

after the second bottle of which an obstinate constipation supervened.

Defecation now became very painful, and the feces were covered with
blood. The patient had recourse to enemata without benefifc; during their
administration he felt as if the "anus were torn by heated razors." This
state had lasted several months when he experienced attacks of vertigo
after going to stool, and sudden attacks of cerebral congestion, passing oif
rapidly, either while walking or engaged in any kind of employment: his
moral condition became affected ; he fell by degrees into a deep melancholy ;
depressing thoughts arose before him incessantly ; he seemed compelled to
seek solitude and darkness; he felt a horror of suicide, but nevertheless he
seemed always to be driven towards it. Wrapped up in his melancholy
thoughts he spoke to no one, and if his friends endeavored to attract his at-
tention he responded to them rudely; he felt his venereal desires constantly
diminish; but this did not aifect him so much as his moral position; he held
suicide in abhorrence, yet he felt impelled towards it in spite of his will; his
reason wandered, until at length he believed himself possessed by the devil,
and he spent hours together in praying to be delivered from his tempta-
tions. A constant feeling of hunger annoyed him, though he ate often and
greedily ; his digestion was painful and laborious. Notwithstanding the

' Rob (le LaflFecteur is composed of a strong decoction of the Arvndo Phragmitis,
or bulrush, with sarsaparilla and aniseeds, evaporated, and made into a Kobor syrup,
by the addition of sugar. To this a solution of the bichloride of mercury is after-
wards added.

INFLUENCE OF THE KECTUM. 99

repeated use of leeches, demulcents, and baths, these symptoms increased
to a frightful extent; his sufferings indeed were generally greatest on quitting
the bath. One day whilst at stool he noticed the evacuation of a quantity
of whitish and viscid matter which he fancied was semen ; from that time
his attention being called to the fact, he observed that he seldom had an
evacuation without more or less spermatic discharge ; he noticed also that
the matter in its passage produced a kind of tickling accompanied with heat
in the urethra.

After having passed sis months in this deplorable condition, the patient
suffered from a serious attack of indigestion, followed by a very copious
diarrhoea that lasted a fortnight, and reduced him to an extreme state of
debility; but after its relief the feces regained, by degrees, their normal
consistence and were then passed without pain or streaks of blood ; the
spermatic discharges, which had been excited by efforts at stool no longer
took place, and all the moral and physical symptoms above mentioned were,
by degrees, completely and spontaneously dissipated. Several years after-
wards F. B enjoyed excellent health, all his functions, without excep-
tion, being perfectly performed.

In this case the blennorrhagia caused inflammation of one testicle
and developed the susceptibility of the genital organs; consequently,
therefore, it predisposed them to the occurrence of spermatorrhoea ;
but the constipation brought on by the use of Rob de Laffecteur evi-
dently was its immediate cause. The symptoms which ordinarily
accompany fissures of the anus appeared soon after; and afterwards
those arising from spermatorrhoea. The course of events was pro-
bably as follows: after prolonged constipation, a hard copious mo-
tion distended the mucous membrane lining the anus, more than
usual ; it gave way ; from that day defecation having become painful
the patient put it off as long as possible ; the hardened and accumu-
lated feces in their turn increased the fissure in the mucous mem-
brane : thus it is that fissures of the anus are usually produced
and kept up. The diarrhoea, which lasted fifteen days, allowed the
cicatrix in the mucous coat of the gut to become firm. It is easy,
therefore, to account for the appearance and cessation of the semi-
nal discharges, together with the anomalous symptoms from which
the patient suffered during six months.

1 have already shown hypochondriasis, in many forms, as a conse-
quence of spermatorrhoea, but in no case previously reported did it
present characters like those in the case before us. This young man,
naturally of a good disposition, was beset during the whole course of
his disease, by the most frightful propensities ; he was so revolted by
them that the loss of his health seemed nothing when compared with
the mental torture they entailed on him. His reason was so shaken
that he considered the intervention of the devil to be the only mode
of explaining his evil impulses ! To what must we refer an aberra-
tion of intellect which might have produced such fatal results ?

But to return to the consideration of fissures of the anus. This
disease, without doubt, often excites spermatorrhoea. The silence of

100 CAUSES OF SPERMATORRHOEA.

authors on the subject proves nothing, for, notwithstanding the ac-
tivity with which during years I have sought the causes of sperma-
torrhoea, I rarely, until lately, profited by the opportunities I had
of questioning patients on this point. When the violent efforts
necessary to empty the rectum, the acute pain and spasmodic con-
tractions of which it becomes the seat, and the disturbances which
a very slight excoriation produces throughout the economy, are taken
into account, I think it will be readily allowed that fissures of the
anus may frequently induce abundant spermatic evacuations.

The patients fear to go to stool, on account of the pain the passage
of the feces produces ; these, therefore, accumulate and harden in
the rectum ; when at length the irritable intestine contracts to expel
its contents, their passage tears open the fissure ; the sphincter, irri-
tated by this increase of pain, contracts spasmodically, and a con-
test is thus established between the sphincter and the muscular walls
of the intestine, aided by the abdominal muscles. The efforts to
evacuate the intestine are so violent and prolonged that respiration
is suspended; the face becomes injected and purple, and blood appears
ready to start through the skin. It is difficult to conceive how the
seminal vesicles can, under such circumstances, escape compression.

We must, also, take into account the fixed pain at the verge of
the anus, and the spasmodic state of contraction into which all the
neighboring muscles are thrown ; for these phenomena act more or
less on the genito-urinary organs. Lastly, fissures of the anus are
soon followed by changes in the physical and moral state of the
patients, of too serious a nature to be attributed only to the pain
they cause. I have seen young men arrive at the hospital in a con-
dition of weakness and mental despondency, contrasting strongly
with the size of their muscles, and the color of their complexions.
It is especially after they have evacuated the bowels that such pa-
tients feel most worn out, broken-spirited, and depressed ; they have
generally lost all venereal desire ; their erections are weak, rare,
and incomplete. I regret that I have not recorded these cases, but
I remember their circumstances perfectly, and all things conduce to
make me attribute the symptoms to spermatorrhoea ; however this
may be, it is a subject for further research, to which I wish to call
the attention of the profession.

CASE XIX.

Horse exercise — Constipation — SpermatorrJicea — Imjyotence — Frequent and
violent attacks of cerebral cowjestiun — Ascending douches — Cauterization
— Sulphur baths — Hot and cold douches on the loins and perineum —
Cure.

M. De B consulted me in the month of May, 1834, respecting a

cerebral afteetion, on whose nature distinguished physicians could not agree,
but which all regarded as very serious.

He was of a middle height, with a large chest, aud a well developed
muscular system; his hair brown and curly, his beard thick, his face full

INFLUENCE OF THE EECTUM, 101

and deeply colored. Notwithstanding these signs of apparent strength and
health, I noticed that his knees were slightly bent, and that he was unable
to remain longer standing without shifting the weight of his body from one
leg to the other; his voice was weak and husky; the motions of his tongue
seemed embarrassed, and he articulated his words in a confused manner ; his
attitude was timid, and his manner had something of incertitude and fear ;
he had been married fifteen days.

His mother-in-law and his young wife, who accompanied him, informed
me that within this period he had several attacks of congestion of the brain,
during which his face was highly injected. At the first of these attacks
the surgeon, called in the night, had bled him to the extent of three pounds,
in order to prevent apoplexy ; repeated venesection, and the frequent ap-
plication of leeches, had relieved such attacks of congestion, but had not
prevented their recurrence. The patient had become subject to attacks of
vertigo, and was unable to look upwards without feeling giddy ; his legs
had become vso weak that he had fallen several times, even when walking
on level ground ; his ideas had lost their clearness, and his memory failed
rapidly.

These symptoms had spread consternation through both the family of my
patient and that of his wife, especially as several practitioners of reputation
were agreed as to the existence of some serious disease of the brain, although
they could not decide as to its nature. Most of them, however, were in-
clined to suspect ramollissement.

The countenance of the patient during this recital, the coincidence of the
congestion with the period of his marriage, and the bad effects of blood-
letting, made me suspect the nature of the disorder, and induced me to
question the patient separately. When we were alone, he told me, stam-
mering, that an unexpected occurrence, immediately after his marriage,
had at first prevented any conjugal intimacy, and that afterwards he bad
found himself completely impotent. He attributed this misfQrtune to the
attacks of cerebral congestion, and to the bleedings he had undergone. On
further inquiry, however, I discovered that he was affected by diurnal pollur
tions.

The following is the history I obtained from this patient by dint of ques-
tioning: At the age of sixteen he possessed a very strong constitution, and
an ardent and passionate character. At school he contracted the habit of
masturbation, and at the end of three months he had frequent nocturnal
pollutions, with pain in the chest, and troublesome palpitations, which
warned him of the danger of the vice, and he renounced it for ever. When
he became free from the restraints of school, he subdued the ardor of his
temperament by the most violent exercises — especially that of the chase —
and he attached himself to agricultural pursuits with much energy.

This new mode of life so completely re-established his health, that he was
tormented by energetic and continual erections, to subdue which he em-
ployed ryer baths, even in the coldest seasons. He never committed ex-
cesses of any kind, and had never suffered from any blennorrhagic or syphi-
litic affection.

In 1831, the erections were slightly mitigated, but he became very much
constipated, which he attributed to the constant use of horse exercise.

In 1832, he experienced some numbness and creeping sensations in his
feet and legs.

In 1833, frequent dazzling of sight occurred, with vertigo, difficulty of
7

102 CAUSES OF SPERMATOEEHCEA.

vision, and flushes of heat, towards the head and face ; the patient attributed
all these symptoms to the efifects of his still increasing constipation.

At the same time that these symptoms occurred, the patient's erections
became rarer, less energetic, and after a time incomplete; his fitness for
intellectual labor diminished ; the cerebral congestions became more frequent,
and more severe; his face became habitually very red; his head burning;
an almost constant fixed pain came on in the orbits, and his character be-
came fickle and contradictory.

His family physician, attributing all these disorders to a state of plethora,
caused blood to be drawn several times without benefit.

In March, 1834, M. De B engaged himself to a young lady, who

lived about two leagues from his estate ; and in order to visit her without
neglecting the care of his property, he was obliged to make long and fre-
quent journeys on horseback; shortly before his marriage, these journeys
became so frequent that he might be said to pass the greater part of his
time on horseback. His constipation now increased to such a degree that
he passed forty days without fecal evacuation; during his efforts at stool
he passed semen in large quantities, and in jets, although the penis remained
flaccid. He had previously, several times, noticed the same occurrence, but
as he attributed it to his long continued continence, he paid little attention
to the circumstance. His urine was constantly muddy ; it was passed slowly,
and with difl&culty, and threw down large quantities of thick and flocculent
deposit.

M. De B. awaited the period of his marriage with a vague uneasiness, of
which he could not imagine the cause ; he was much attached to his be-
trothed, but, nevertheless, he experienced more embarrassment than pleasure
in her society.

I have already stated what occurred after his marriage ; I should add,
that having examined the genital organs, I found them, contrary to my ex-
pectations, of unusual development, the testicles were large and firm, but
the scrotum was slightly relaxed. The patient experienced a strange ting-
ling in the organs, and at times felt as if they were compressed by a hand
of iron. These sensations increased when near his wife, and the penis di-
minished in size, and became retracted towards the pubes, in proportion as
he endeavored to excite erection.

The union of all these circumstances could not permit any doubt to remain
on my mind as to the nature of his disease ; it became evident that all idea
of cerebral affection must be abandoned, and that the diurnal pollutions with
all the symptoms of which they were the cause, must be referred to the
patient's constipation.

The first indication to be fulfilled, therefore, was to relieve the constipa-
tion ; indeed I hoped this was all that would be necessary ; the youth of
the patient, the development of the genital organs, and the strength of his
constitution induced me to suppose that his cure would be prompt and easy.
Things did not, however, follow so simple a course. •>

The next day the patient began to use ascending douches; and was put
on a vegetable diet, with iced milk.

The first douches caused the evacuation of an immense quantity of fecal
matter in lumps, as hard as bullets, and it was not until after the sixth
douche that the feces were of normal consistence ; I then caused the tem-
perature of the water to be lowered to 25° of Reaumur's^ scale, and after-

» About 88° of Fahrenheit.

INFLUENCE OF THE EECTUM. 103

wards to 20° Reaumur.* The last douches were given at 16° Reaumur.^
After the twelfth douche had been administered, they were omitted, the
bowels having acted regularly every day, without the necessity for the slight-
est straining.

By this time the patient's countenance had lost its purple tint, and pre-
sented a more natural appearance ; the stunning sensations of which he had
complained diminished by degrees, and at length disappeared entirely ; his
legs regained their strength, and he was able to continue in a standing pos-
ture for a long time without fatigue, and to take long walks without incon-
venience ; his voice resumed its natural tone, his eye regained its expression,
and all his motions acquired firmness.

At the expiration of a fortnight the spermatic discharges during defecation
had ceased entirely ; but his urine still continued thick. His erections had
already acquired sufficient energy to make him believe himself cured, but
ejaculation took place almost instantaneously. The use of ice and cold lotions
did not ameliorate his condition. •

Such was M. De B 's state at the end of a month ; when, in order to

act directly on the orifices of the ejaculatory ducts, I determined to cauterize
the prostatic portion of the urethra. As soon as the inflammation had sub-
sided, his erections became more perfect and energetic; yet ejaculation still
took place too rapidly. The period for using the mineral waters having

arrived, I sent M. De B to Aix, in Savoy, where I visited him shortly

after. He had experienced very little benefit from the use of the waters,
either externally or internally.

I now prescribed douches, alternately very warm and very cold, on the
perineum and loins, the spout being changed when the sensation, either of
cold or heat, became very intense. The bath was ended, after about twenty
or twenty-five minutes, by the cold douche, and the patient's skin remained
highly injected for some hours afterwards.

The effects of these douches were conclusive; after the first, the patient's
erections acquired a degree of vigor and duration which reminded him of
his early torments. He continued the use of the douches for some days
after his re-establishment ; and when he left Aix the functions of his genital
organs were perfect. Ejaculation was a good deal protracted by the use of
the douches.

I have entered into a somewhat lengthy detail of this case, because
the subject affects gravely the most serious interests of society, as
well as the happiness and peace of families. Besides I confess that
I was much interested by the unhappy position of a young man whose
misfortune was undeserved, and could not have been foreseen, as well
as by that of his wife — a young woman scarcely of age, who was
obliged to enter into the most unpleasant details.

It is evident that in the case of M. De B , the constipation was

the cause of the involuntary seminal discharges. The patient had
practised masturbation it is true, and nocturnal emissions followed ;
but he had continued the vice only three months, and his health,

» About 81° of Fahrenheit. ' About 68° of Fahrenheit.

104 CAUSES OF SPEEMATOEKHCEA.

though disordered for a short time, was soon re-established by the use

of violent exercise. M. De B was even tormented during several

years by erections which must have been very energetic, if we may
]udge by the means he took to subdue them. From this time he had
never committed any kind of excess, and he had never suffered from
either blennorrhagia or syphilis. There is then no circumstance in
the history of his life, except his constipation, which would account
for the involuntary discharges.

But to what is this constipation to be referred ? After all I could
learn from the patient concerning his mode of life, I could only refer

it to his constant horse exercise. In fact, M. De B sometimes

passed whole days on horseback, either for the purpose of hunting,
or of superintending the management of his property. Shortly
before his marriage his rides became more frequent and longer, and
his bowels at this time did not act'during forty days. The weakness
of his legs, the stunning sensations, &c., increased in proportion as
his costiveness became more confirmed.

This case recalls to my mind the well known observation of Hip-
pocrates on the impotence of the Scythians, and I have no doubt
that his opinion was founded on analogous facts. I shall treat this
subject more fully in another place ; but since at present I am con-
sidering the causes of spermatorrhoea which act on the seminal
vesicles through the influence of the rectum, I report this striking
case, showing the effects of long continued horse exercise.

M. De B was accustomed to nutritious food, and of a well

marked sanguineous temperament ; he had a large chest, powerful
muscles, and a highly injected countenance ; it is therefore by no
means extraordinary that he should have 'been bled frequently for
the relief of the cerebral congestions to which he was subject. On
the night of his marriage the blood rushed to bis head with greater
force than ever, so that an attack of apoplexy was much feared ; the
weakness of the legs, the frequent falls, and the attacks of vertigo,
were therefore afterwards attributed to an advanced stage of disease
of the brain. This was a very natural opinion, but it was an incor-
rect one ; I doubted it from the commencement, although the patient
was brought to me in consequence of a supposed cerebral affection.
I formed a different impression, because I had previously seen many
analogous cases. There exists in all these patients something pe-
culiar in the expression of the eyes, in the position, in the voice,
and in the general appearance ; something of timidity and bashful-
ness which I am unable to express, but which is instantly recognized
by the experienced, although perhaps it is incapable of explanation.
However this may be, the relation of the above case should draw
attention to the subject.

I admit that venesections s^f-mec? to be clearly indicated in the case

of M. De B , but the loss of blood never produced good effects,

either immediate or remote ; and by analyzing the case carefully his
attendants would have seen that under this treatment the attacks in-

INFLUENCE OF THE EECTUM. 105

creased in frequency. But pre-convictions throw a thick veil over
the most acute perceptions.

The ascending douches put an end to the constipation ; but free-
dom of fecal evacuation did not suffice to cure the disease. The
seminal discharges, during the passage of feces, diminished, indeed,
or, perhaps, entirely ceased, but the patient's urine remained thick
and muddy, and his erections were incomplete. The application of
ice and of the nitrate of silver, and the use of sulphureous waters
.were not sufficient to effect his cure; yet there could not have ex-
isted any organic change in his genital organs. We can therefore
only attribute the continuance of the seminal discharge, during the
emptying of the bladder, to relaxation of the ejaculatory canals,
produced by their long habit of allowing the semen to escape in a
passive manner — showing how necessary it is to put an end to the
habit as early as possible.

The alternate use of hot and cold douches on the loins and perineum
produced a sudden and decisive change in this as in many analogous
cases ; I shall therefore return to their consideration by and by. At
present I must only remark, that they should never be employed so
long as any irritation of the genital organs exists, as under such cir-
cumstances they produce the most unfavorable effects,

CASE XX.

Lengthened exposure to severe cold — Incomplete paralysis of the rectum —
Seminal discharges during defecation — Cure hi/ the application of gal-
vanism.

M. V , aged twenty-nine, a captain in an infantry regiment, had suf-
fered from five to six attacks of blennorrhagia, and afterwards from a chancre,
for the cure of which he took a considerable quantity of the bichloride of
mercury. At the end of the treatment, in 1822, he left Metz, to go to
Spain. During his journey he was detained three weeks at Lyons, in con-
sequence of a disorder of which the most prominent symptom was obstinate
costiveness accompanied by fever. During the remainder of his journey he
was obliged, for the first time, to support his left testicle, the veins of which
were varicose. During the whole campaign he did not suffer from any other
disease except occasional haemorrhoids.

After having endured the fatigues of war without disorder, M. V ,

whilst returning to France, was exposed during an entire night to ex-
treme cold, being at the same time very lightly clothed. The next day he
felt acute and darting pains in his legs, and these were soon followed by a
feeling of cold, referred chiefly to the under part of the left hip-joint, and
to the hypogastrium.

From this period a new train of symptoms appeared. The patient felt
his legs daily becoming weaker j he was subject to obstinate constipation.
It seemed to him as if the powers intended for the expulsion of the feces
were paralyzed; and he experienced, moreover, in the distended intestine,
a feeling of elastic reaction, rather than one of muscular contraction.
Abundant seminal discharges attended his efforts at stool. Agitation gene-

106 CAUSES OF SPERMATORRHCEA.

rally followed the evacuation of any feces. The venereal impulse was nearly
lost, erections occurred seldom, and were incomplete, and coitus was im-
possible, except under very extraordinary circumstances, and very rarely.
The patient's digestion became difficult ; flatus accumulated in the intes-
tines distended his abdomen, and caused pain in his epigastric and hypo-
chondriac regions; his skin became habitually dry and harsh. He wished
to take exercise to favor cutaneous transpii-ation, and was in a continued
state of agitation as soon as he remained still for a few minutes ; he was
easily affected by cold, and his temper became very irritable.

The suspensory bandage he wore inconvenienced him, and he left it off
before taking a long walk. Shortly after his return, a considerable swelling
came on in the left testicle, to disperse which leeches were applied five times
unsuccessfully.

About this time bichloride of mercury was administered in solution for
the treatment of some supposed venereal vegetations around the margin of
the anus, but which, in reality, were only contracted haemorrhoids. The
different means pursued increased', to a great degree, the patient's weak-
ness of the legs and digestive disorder.

"When Captain V came to the hospital of St. Eloi, I was struck by

the pallidity of his countenance, and the flaccidity of all his tissues. His
form was rounded, with the cellular tissue very abundant and slightly infil-
trated with serum, especially in his legs ; his skin was white, thin, trans-
parent, and habitually cold; his pulse small and feeble. The tumor of
the left testicle was evidently only a common hydrocele.

Taking into consideration the order of appearance, and the general charac-
ter of the symptoms, I thought that the intense and lengthened action of
cold had produced a deep and lasting effect on the inferior portion of the
spinal cord, as I had before seen in a few cases. Weakness seemed to me to
be the symptom predominating, no appearance of irritation being present,
either in the rectum or the genito-uniary organs; and I consequently
decided on submitting the affected parts to the action of galvanism.

The first sitting took place on the 11th of February. The current was
established, during twenty minutes, between the sacrum and hypogastrium ;
and afterwards, for the same period, between the hips. The shocks were
very weak, only sixteen drops of sulphuric acid having been added to the
quart of water ; yet, on the following day, the patient experienced less sen-
sation of cold, less numbness in his left leg and in his genital organs, and
less difficulty in emptying his bladder ; besides which he had a stool.

On the 12th a second sitting took place. The shocks were directed
through the same parts, and applied during the same length of time ; eighty
drops of sulphuric acid being used on this occasion.

On the 13th a third sitting was held, a hundred drops of acid being used.
Stronger shocks were administered. Impressions were now more acutely
felt, and the patient's improvement seemed progressively increasing.

On the 14th, galvanism was again applied, a hundred and forty drops of
sulphuric acid being added to the quart of water. The current was esta-
blished occasionally between the loins and the perineum, and the surface of
the hydrocele. The following day the patient had a free evacuation with-
out enema; he experienced a feeling of power in the rectum, with less
numbness in the lower extremities, from the pelvis as far as the knees ; the
legs and feet were in the same state as before ; there was a considerable
diminution in the size of the hydrocele; the patient's erections had become

INFLUENCE OF THE EECTUM. 107

more energetic, and he was altogether more cheerful, notwithstanding the
fatigue caused him by the -violent shocks to which he had been subjected.
He spoke of the galvanism with pleasure, but requested two or three days'
rest before being again subjected to its action.

From the 15th to the 19th galvanism was not employed. No improve-
ment took place during these days.

From the 20th to the 24th five sittings similar to the preceding took
place, the quantity of sulphuric acid being increased on each occasion. Af-
ter these the bowels were opened freely every day, without straining or
seminal discharge. His ui'ine was discharged easily, in a full stream. The
liquid effused in the tunica vaginalis was completely absorbed. The pa-
tient's digestion became active; the intestinal flatulence disappeared, and the
warmth and strength of the inferior extremities were restored.

Shortly afterwards M. V rejoined his regiment, and resumed his

duties as before. Four or five years afterwards I met with M. V , who

had attained the rank of general. He told me that his health had not un-
dergone the least alteration.

This patient had suffered from five or six attacks of urethritis,
besides a chancre, and he had undergone many energetic courses of
anti-venereals, of which one course only would have been useless,
and even injurious. There are, therefore, many reasons why his
case should have been placed among those of which I have treated in
the third chapter. On the other hand, he had suffered for a long
time from haemorrhoids, which were on one occasion even mistaken
for syphilitic vegetations, a mistake by no means uncommon. The
seminal discharges were, however, due to the distension of the rec-
tum (as in case ifourteen), yet it seems probable that the other circum-
stances had some share in bringing on the disease, because Captain

V had suffered from obstinate constipation when at Lyons.

These circumstances must, therefore, be taken into account ; but the
determining cause was, evidently, the extreme cold to which he was
exposed during the whole night. This gave the disease a peculiar
character, which is not otherwise met with.

The first time I saw this patient, I attributed the weakness of his
lower extremities, his constipation, &c., to the seminal discharges ;
but on more mature reflection respecting the sudden effect of this
lengthened exposure to cold, I recollected other cases of the same
nature, in which cold had left a serious impression of debility in the
parts which had chiefly suffered. I was struck by the general and
truly characteristic state of the constitution, by the infiltration with
serum of the affected parts, by the temperature of the skin, &c. ; I
concluded, therefore, that the pollutions arose from distension of the
rectum, and that this was kept up by a kind of torpidity which the
cold had produced in the nerves arising from the inferior portion of
the spinal cord. This chain of reasoning led me to think of gal-
vanism — a remedy from the use of which I had seen benefit arise in
analogous cases.

The result proved this indication to be the right one, and the cure
was even more rapid and decided than I had ventured to hope for.

108 CAUSES OF SPEEMATOERH(EA.

The hydrocele which existed in this pcatient seemed to have been
caused by the repeated attacks of urethritis ; and the rapidity with
which the eifusion was absorbed under the use of galvanism, was
very remarkable. This circumstance proves galvanism to have been
the remedy best suited to the case. I shall relate here another case,
illustratino- the eifects of cold, and which is also remarkable in other
respects.

CASE XXI.

Intemperance — LengtJiened exposure to cold — Chronic inflammation of the
bladder — Invohuitary seminal discharges, cCr. — Cauterization — Cxire —
Relapse — Same treatment loith the same result — Remarkable influence of
the bladder on the rectum.

G , a soldier in the 4th regiment of light infantry, much addicted to

intemperance, enjoyed pretty good health, with the exception of two or
three slight attacks of blennorrhagia, until the age of thirty. At this age,

however, when intoxicated and in an excessive state of perspiration, G

plunged into cold water as far as his middle, and afterwards allowed his
clothes to dry on his person.

Shortly afterwards G felt acute pain in the lumbar region, with weight

in the hypogastrium, and a frequent desire to make water, which he passed
with some little diflBculty. Camphorated frictions on the loins, with rest,

and an antiphlogistic regimen, gave him momentary relief; but G- soon

perceived that he was more easily fatigued than before, and especially that
his legs daily grew weaker. He continued to perform his military duties
during eigliteen months, though with great and increasing difSculty ; and at
length he became so weak that he was obliged to apply for his discharge.

Having returned to his native town, he commenced business as a tailor,
and he had not long followed this employment when he perceived that he
passed semen frequently, without either erection or pleasure. These dis
charges grew more and more frequent, and were accompanied by an irresisti-
ble and frequent call to empty the rectum ; his urine was passed with much
difficulty, requiring efforts which were very fatiguing.

During the years 1830 and 1881, the weakness of his legs continued to
increase. His digestion was difficult, and his genital organs were much
relaxed.

In March, 1832, after a fit of intemperance, G was seized by a com-
plete retention of urine, for which baths, fomentations, and emollient drinks
were prescribed. This state gave place to one of strangury, soon followed
by incontinence of urine.

In May, 1832, artificial sulphuretted baths were employed without bene-
fit, and in September, the baths of Balaruc, with no better result.

On the 4th of October, G was admitted into the hospital of St. Eloi.

Two moxas were applied to his loins, and shortly afterwards four i.ssues
lower down.

On the 1st of November, G took some soup and wine, and the fol-
lowing day acute irritation of the neck of the bladder came on, for which
he was treated by leeches to the hypogastrium, baths and camphorated
drinks. The pain diminished, but the passage of urine was preceded by a
discharge of milky fluid.

INFLUENCE OF THE EECTUM. 109

At this time the patient first came under my care. I found him in the
following state. He was thirty-five years of age, of moderate stature ; his
skin white, face pale, hair black and scanty, voice feeble and rather husky,
digestion difficult, especially after the use of animal food ; he was frequently
compelled to go to stool, the presence of a little fecal matter in the rectum
inducing a painful feeling, which caused its involuntary expulsion. lie
passed urine every ten minutes or quarter of an hour, without being aware
of its escape, and the fluid contained an abundant deposit of a greenish-white
color, which appeared flocculent. The urine decomposed very rapidly. He
had no venereal desires, and not the least appearance of erections. His lower
extremities were so weak as scarcely to support the weight of his body. His
legs were the constant seat of osseous pains, and his feet were habitually
cold. He seemed indifferent to everything.

On the 14th of November I performed a slight cauterization of the neck
of the bladder, and of the surface of the prostate. The patient experienced
little pain during the operation ; there was no discharge of blood and but
little burning afterwards.

On the 2'2d the urinary deposit had considerably decreased in quantity.

By the 26th the deposit had entirely disappeared.

On the 28th the urine appeared quite limpid, and the patient was able to
retain it for half an hour, but it was still passed involuntarily. The feces
were not passed so often, and the lower extremities were a little stronger.

Ou the 29th I performed a second and more complete cauterization of the
same parts. The pain was considerable, and followed by burning. Bloody
urine was afterwards passed very frequently. On the 4th of December
the patient was able to walk without the aid of crutches ; his appetite and
his spirits returned. On the following days the urine and feces were held
longer.

On the 11th of December a third cauterization was practised, beginning
by the bladder, and ending at the bulb of the urethra.

On the 18th the patient was able to retain his urine, which was quite
limpid, for an hour; animal food was well digested; his erections returned;
his legs regained their normal strength ; his face acquired color and ani-
mation, and his spirits had returned. The feces, were retained as long as in
health.

On the 20th the patient felt so well that he left the hospital ; his con-
valescence continued, and indeed, seemed to make more rapid progress in
proportion to the amount of exercise he took.

In the month of February, 1833, G having occasion to take a long

journey during very severe cold, drank a considerable quantity of wine.
In the month of May he re-entered the hospital, in almost the same state as
at first. I performed a fourth cauterization similar to the last and with the
same good effects.

I afterwards prescribed tar-water and the use of artificial sulphuretted
baths, and at the end of two months all the symptoms had disappeared, and
the patient left the hospital quite re-established.

A lengthened exposure to cold was followed in this, as in the pre-
vious case, by diurnal pollutions, and bj almost complete paralysis
of the lower extremities. But here all resemblance between the two
cases ceases.

110 CAUSES OF SPERMATOERHCEA.

In Captain V the cold had acted especially on the nerves

which are given off by the lower portion of the spinal cord ; these
had been affected with a loss of power, from which the rectum had
chiefly suffered : hence, its distension by feces, and the consequent
compression of the seminal vesicles. There was not the slightest
appearance of irritation in the parts, and, for this reason, the gal-
vanism produced such beneficial effects. In the patient G , the

cold chiefly acted on the bladder, and the chronic cistitis resulting
from it extended its influence successively to the seminal vesicles and
the rectum. The extreme weakness of the lower limbs arose from
the repeated seminal discharges, which wore the patient out. Hence
cauterization was followed by the happiest results. I am convinced
that in this case galvanism could not have been borne.

It is easy to explain why, in the latter case, cold acted so directly
on the bladder — the patient's intemperance predisposed that organ

to disease. G was intoxicated when he went into the water ;

afterwards, when he experienced a rapid increase of his bad symp-
toms, he had taken wine with his soup ; and still later, in the jour-
ney during the winter, which was the cause of his relapse, he had
drunk a considerable quantity of wine. It is, therefore, by no means
easy to separate the effects of cold, in this case, from those of intem-
perance, the action of which on the urinary organs is easily explained.
When considering the effects of blennorrhagia, I reported a case in
which cold exercised a considerable influence in the production of
spermatorrhoea (case fifth), but this effect was shown by very differ-
ent symptoms. Strangely enough, the treatment which cured these
three patients was quite different in each case — showing the indis-
pensable necessity of observed numerous cases, and of examining
minutely all their peculiarities.

A phenomenon was present in the case of the patient G , which

shows that the influence of the rectum on the genito-urinary organs
is quite equalled by that of the genito-urinary organs on the rectum.
The mucous membrane of the intestine was in this case so irritable
that the gut was unable to bear the presence of fecal matter ; imme-
diately that the feces reached the level of the bladder, convulsive
contractions of the muscular coat of the rectum were excited, causing
their immediate and involuntary expulsion. The stools were not
liquid, or mixed with mucus, as in diarrhoea, though, in consequence
of their short stay in the rectum, they were by no means solid.

No particular treatment was pursued for the removal of the irri-
tation of the rectum ; it diminished after each cauterization, and dis-
appeared at the same time as the inflammation of the bladder. The
longer the patient was able to hold his urine, the less frequent his
stools became ; and both bladder and rectum seemed to return under
the influence of the will at the same time.

But if the inflammation of the bladder could produce such an effect
on the rectum, it must have acted with still greater power on the
seminal vesicles. What, then, was the cause of the patient's expe-

INFLUENCE OF THE RECTUM. Ill

riencing constant discharges of semen, both by clay and night, with-
out erection, without pleasure, and in the midst of the most perfect
repose as regarded venereal excitement? A certain quantity of the
spermatic fluid having reached the seminal vesicles, produced in them,
by its mere presence, involuntary and irresistible spasmodic contrac-
tions, similar to those of the bladder and rectum ; the semen was
expelled in the same manner as the urine and the feces, and with-
out the characters which it would have acquired after a longer de-
tention in the reservoirs destined for its reception.

It is evident, then, that an intimate relationship exists between all
these parts, and that it is necessary to connect their phenomena in
order to obtain a correct and perfect idea of their influence.

It must by no means be thought that this effect of the genito-uri-
nary organs on the rectum is of rare occurrence ; it is, on the con-
trary habitual ; but it is seldom so strikingly shown as in the pre-
ceding case. I have not hitherto noticed it, because I wished to
render the subject as simple as possible ; but it is to this intimate
connection that the sensation of uneasiness and weicrht at the margin
of the anus, the habitual contraction of the sphincter, and the ob-
stinate constipation, which are so often observed in patients affected
by spermatorrhoea, must be attributed. All those on whom I have
practised cauterization of the neck of the bladder, have experienced
a sudden burning at the margin of the anus, and a sensation of heat
in the rectum immediately after the operation ; on the following day
they have had greater tone in the rectum, and their stools have
very soon become more free. I must not, however, at present enter
into further details on this subject.

CASE XXII.

Unsuspected sperviatoi'vhoea — Attacks of cerebral congestion — Disorder of
the general health — Ascarides expelled from the rectum with immediate
recovery,

M. C , a Captain of Engineers, aged about thirty-two, nearly bald,

very thin and pale, with sunken eyes surrounded by dark circles, a feeble,
shrill voice, and a timid, embarrassed appearance, consulted me respecting
bis health on several occasions : I never attached much importance to his
complaints, but always attributed them to the melancholy bias of his cha-
racter. In 1824, however, his digestion became disordered in an alarming
manner, and was always accompanied by the disengagement of much fla-
tus; even the ingestion of soup into the stomach was followed by oppres-
sion in the epigastric region, and diiEculty of respiration, which was. espe-
cially felt in the situation of the oesophagus, and terminated in the pharynx.
This sensation diminished considerably as soon as the patient was able to
pass flatus. He felt himself overcome by a sense of general debility, and
especially experienced a feeling of weakness in his legs, which contrasted
strikingly with his continual desire for motion, and his custom of taking
long walks. He sufi"ered from frequent attacks of giddiness, with conges-
tion in his bead, especially when he stooped, or read, even for a few mi-

112 CAUSES OF SPERMATOERHCEA.

nutes, and he consequently thoup;ht himself threatened by an attack of apo-
plexy. His usual spareness of habit had increased ; his testicles had dimi-
nished sensibly in size, and his genital organs always felt cold. His pulse
was weak and soft ; his tongue palepnd moist, and pressure on the epigas-
trium did not give him the least pain. I could not participate in this patient's
fears respecting the probability of an attack of apoplexy or the existence of
gastritis, for I attributed all his symptoms to excessive discharges of semen,
although he would not admit the correctness of this opinion.

He iiad abstained from coitus during a long time, from the fear of injuring
his health, and expressed a horror of masturbation : he was not subject to
nocturnal emission, and he had never noticed any discharge of semen when
passing urine or at stool. I sent him for change of air during the heat of
the summer, to Vigan in the Cevennes, requesting him at the same time to
watch himself carefully while at stool, and to send me an account of the ap-
pearance of his urine.

A few days after his arrival at Vigan he sent me word that after each
stool he had a discharge of thick, whitish, slightly unctuous matter, of a very
weak spermatic odor, and which stained his linen a pale yellow. This
discharge was especially abundant whenever his efforts at stool were very
violent. It was not, however, during the actual passage of fecal matter
that the discharges of semen occurred, but shortly afterwards ; and he ex-
perienced at the same time a sense of weight in the rectum, and a spasmodic
contraction accompanied by itching and heat. The symptoms were then,
as I suspected, really due to excessive spermatic discharges. Yet I did not
attach sufl&cient importance to the singular circumstances which accompa-
nied these discharges, and I was satisfied when prescribing cool injections,
cold lotions, and vegetable and milk diet, with the intention of relieving the
constipation, and of giving tone to the genital organs. These means pro-
dux;ed no remarkable change in the seminal discharges ; after a time I re-
ceived another long letter, which was full of minute and uninteresting de-
tails ; on the back, however, the patient had written a postscript, stating
that in one of his stools he had passed a number of little worms, and that he
frequently felt an itching in the rectum, which he attributed to a herpetic
affection. A slight discharge occurred from the rectum, and the feces were
mixed with a good deal of purulent mucus. The parts surrounding the
anus were gorged. This state had been present from 1818, and had first
appeared after a violent intestinal inflammation, accompanied with colic and
tenesmus, which latter reappeared in 1822. The cause of the spermator-
rhoea, now, was evident, and I also understood how it was that the seminal
discharge did not take place exactly at the same time as the passage of the
feces, but a little after ; these discharges were not produced by mechanical
compression arising from such passage, but they were the result of a state
of irritation produced by the presence of worms; the sensation of pressure,
the spasmodic contraction, the itching, and the heat, which were felt in the
rectum, proved this.

The patient took, fasting, on three successive mornings, four grains of
calomel, and during the day three or four glasses of decoction of Corsican
moss, and a tepid enema, followed by a cold one ; he once took a small
enema of warm milk, and soon after a second, composed of a strong decoc-
tion of garlic. At the end of three days, perceiving no more ascarides in
his stools, he left off treatment for a week, after which he took, at bedtime,
four grains of calomel followed by six drachms of sulphate of magnesia the

INFLUENCE OF THE RECTUM. 113

next morning. Four copious stools were obtained, which presented no ap-
pearance worthy of note. 8oon after this, Captain C wrote to me

stating that his strength had returned ; that his stomach performed all its
functions properly ; that the spermatic discharges had ceased, together with
the discharge from the anus, and the itching, &c., with which he had pre-
viously been tormented.

The ascarides reappeared every year, however, at a stated period, and
sometimes even twice a year, but the patient was able to treat himself, and
immediately that any symptoms announced their presence, he got rid of them
in two or three days — his health never becoming disordered.

CASE XXIII.

Masiurhation at nine years of age — Constant nocturnal emissions — Ascarides
— Cure in eight days.

Henry B , a sergeant of engineers, at the age of nine, was addicted

to the vice of masturbation, which he continued to practise up to the age of
fifteen, when he corrected himself. From this time he experienced frequent
nocturnal pollutions. Loss of flesh followed, with pains in the chest and a
fixed pain in the middle of the back. The whole nervous system was dis-
ordered, and the patient's eyes were injected and surrounded by dark circles.
After the occurrence of a nocturnal emission, the patient often noticed that
he had pricking sensations, as though he had been stung by ants, with acute
pain in the lower part of his abdomen, and in his loins.

He was completely overcome by fatigue in the morning, and felt, when
he rose from bed, as though his legs and arms had been bruised ; he com-
plained also of oppression at his chest, and a sense of suffocation. He felt
buzzing in his ears in the evening j he lost his memory, was unable to at-
tend to his affairs, and performed his military duty with much difficulty. This
state had continued for several years, and became daily more serious.
Various modes of treatment had been employed by different medical men
whom the patient had consulted; among other remedies used may be
named quinine, oxide of iron, ferruginous water mixed with wine of Bor-
deaux, lime-water in milk, and Hoffmann's anodyne at night. Eiver-bathing
and cold enemata had also been tried, and the patient had applied, during
the coldest season, snow and ice over his kidneys and genital organs. No
advantage whatever was derived from all these means, and sal-ammoniac dis-
solved in water, to form a cold lotion, only irritated the skin of the penis and
scrotum.

Henry B was twenty years of age when he first consulted me ; his

face appeared colored and healthy, and his form announced health and
vigor. It was therefore difficult to guess the cause of the deep melancholy
which his features showed. After much questioning, I at length learnt that
he had been subject to worms from his childhood — that he passed them
every time he went to stool, and that his feces were sometimes quite
covered with them. From the description he gave me, I was convinced
that they consisted of oxyures, with perhaps a few trichocephali. I pre-
scribed for him four grains of calomel night and morning, with half a
drachm of mercurial ointment to be introduced into the rectum night and
morning, and enemata composed of potentilla anserina in decoction. Eight

114 CAUSES OF SPERMATOEEH(EA.

days afterwards he told me that his pollutions had ceased, and that his health
was quite restored.

CASE XXIV.

Hmocliondriasis — Impotence — Attacks of cerehral congestion — Ascarides —
Cure within eight days.

A , a gardener of large and well formed frame, and dark complexion,

two years married, perceived, seven or eight months after marriage, that
he lost by degrees his virile power ; that his appetite at the same time
became capricious, and his digestion difficult and accompanied with pain
in the epigastrium, the development of flatus, and frequent attacks of
vomiting.

Pills containing cynoglossus, sedatives, and demulcents of all kinds, had
been prescribed for this patient by a distinguished practitioner of Montpel-
lier, in order to relieve the irritation of his digestive organs ; but his general
weakness, and that of the genital organs in particular, increased daily. A
feeling of lassitude constantly came over him, he was habitually sleepy, and
had frequent attacks of vertigo. These symptoms led other practitioners
whom he consulted to fear the occurrence of apoplexy, and consequently
venesection was prescribed; but the patient, notwithstanding his uneasi-
ness, refused to be bled, saying that he was convinced he had no blood to
lose. In 1833, A consulted one of my pupils, who, after long ques-
tioning, learned that he suffered from obstinate costiveness, with troublesome
itching in the rectum, and that he frequently passed a number of oxyures
with his feces. Believing that these oxyures were the cause of seminal dis-
charges which the patient had not discovered, an infusion of mentha viridis
was ordered for him, with aromatic enemata, and afterwards enemata of cold
salt water, sufficiently copious to distend the gut and to be expelled with
some violence. These injections caused the expulsion of a large number of
entozoa.

The patient's digestive disorder ceased almost immediately; his erections
soon returned, and coitus took place a few days afterwards. He soon re-
covered his strength ; his spirits resumed their wonted gayety, and he recom-
menced his work with pleasure. This change was the result of only eight
days' treatment.

CASE XXV.

Nocturnal pollutions, resisting all modes of treatment during six years —
G7'eat physical and moral depression — Expulsion of ascarides with com-
plete relief.

M. D , the son of healthy parents, at the age of eleven, contracted, of

his own accord, the habit of masturbation ; but he soon discovered its per-
nicious effects, and corrected himself; his strength returned, and up to the
age of fourteen he continued in perfect health. At this period, after reading
an erotic book, he relapsed into his former habits. He also formed a con-
nection with a female, who excited his passions without gratifying them.
These sources of excitement so enervated him, that palpitation of the heart,
and tremors in his limbs, supervened.

Up to this period M. D had never had an involuntary seminal emis-

INFLUENCE OF THE KECTUM. 115

sion, and he still retained sufficient power over himself, only to practise
masturbation once a week. The irritation he experienced in the genital
organs was so great that he was often forced to plunge them into cold water
for its relief. He was stout and tall, and his health was robust.

On the 25th of October, 1815, on waking in the morning, M. D

found that he had experienced a copious seminal emission unconsciously
while asleep. On every one of the eight following nights he had several
involuntary emissions. These discharges produced a remarkable state of
weakness, and he lost flesh visibly ; still he hoped that the discharges would
cease spontaneously, and false delicacy prevented him from mentioning his

state. Absorbed in the consideration of his own condition, M. D now

withdrew himself from his companions, and occupied himself in devising
means for the relief of the discharges. He attempted numerous ingenious
contrivances to prevent the penis from becoming erect during sleep, but none
of them succeeded; the disorder of his health continued to increase, until the
year 1820, when his condition was deplorable, and he came to Montpellier
to place himself under my care. From his account of the sufferings he had
endured, I at first thought that the involuntary emissions from which he had
suffered, arose from a preternatural sensibility of the genital organs, increased
by their premature use. Before commencing any plan of treatment, however,

I caused M. D to draw up a history of his case, in order that I might

have all the facts before me at one view. While reading his history, my
attention was arrested by the mention of numerous small worms, which were
passed with the feces, and which were looked on by the unfortunate patient
as a sign of speedy dissolution. I examined the anus, and was unable to
discover the eruption which he mentioned in his memoir, as giving rise to
acute irritation in that neighborhood, besides which, this eruption would
not have produced the itching of the nose of which he also complained. I
suspected, therefore, that the involuntary emissions might be kept up by
irritation from ascarides, and I drew the patient's attention to the circum-
stance. He told me, immediately, that he passed them habitually in his
stools ; and that frequently, from the violent natui*e of the itching, he had
been compelled to scratch until blood flowed, and even to introduce his finger
nail within the margin of the anus, when on withdrawing it, he had removed
a living oxyuris. About ten o'clock in the evening the oxyuris especially
tormented him by descending into the lower portion of the rectum, and even
within the contracted sphincter. He had, besides, a constant acid taste in
his mouth, and he passed a large quantity of saliva on his pillow, during the
night.

Of all the means prescribed for this patient, the administration of cold
enemata, and the exhibition of calomel, were the most efficacious. The
first injections were employed at a temperature of from 18° to 20° of
Keaumur,^ and they were afterwards used at 15° and even at 12° of the
same scale.^ Experience soon taught the patient that he received most
benefit from their administration about ten o'clock in the evening, at the
time when the ascarides descended near the anus, of which he became
aware, by the increased itching excited. He found also that in order to
obtain the utmost benefit from the injections, it was necessary to throw a

' Between 70° and 80° of Fahrenheit.

2 About 59° and 68° of Fahrenheit's scale.

116 CAUSES OF SPERMATOERHCEA.

large quantity of water into the intestine, as high as possible, and after-
wards to pass it suddenly so as to expel the ascarides inhabiting the upper
part of the intestine, at the moment when they are benumbed. By these
means large quantities of the entozoa were passed on several successive days;
after their expulsion the involuntary emissions diminished rapidly and per-
manently, and all the accidents arising from them disappeared ; the patient's
strength and embonpoint, especially, returned very quickly. The involuntary
emissions, however, only ceased entirely under the influence of a natural
exercise of the organs, with the use of cold bathing, and gymnastic exercise.
The patient had previously been obliged, on two occasions, to give up the
use of the cold bath — once during the heat of summer, because he was un-
able to obtain a proper reaction on quitting the water; yet immediately that
his system had recovered a little strength, he found himself much benefited
by cold bathing ; indeed, after the expulsion of the ascarides, it produced
more benefit than any other means employed, and he even commenced the
use of the cold plunge during the winter, with considerable advantage.

Walking exercise was also very useful, and this perhaps it was that in-
duced M. D , after having completed his medical education at Mont-

pellier, to turn his attention to the study of natural history. He has since
undertaken long and dangerous travels in the service of science, and the
works he has published bear the stamp of an observing mind, and a high
range of thought. His labors have always been favorably received by the

academy of sciences. M. D 's health has been completely re-established

twenty-five years.

The history sent to me by M. I) was full of interest; it showed

a kind of fatality pursuing him, although he struggled with courage
and perseverance against troubles which he had not deserved. It is
necessary to have undergone such sufferings, and to write under their
immediate influence, in order to relate all their circumstances with
correctness. An uninterested observer would be unable to do justice

to such a recital. How many such persons as M. D do we not

meet with, constantly exposed to the relentless animadversions of
society, when they ought to be regarded with pity, and to be relieved
from their sufferings by the healing hand of the physician !

Two of the patients, whose easel have just related (cases twenty-
three and twenty-four), who suffered in infancy from ascarides, were
addicted to masturbation, even before the age of puberty. They
afterwards reproached themselves bitterly, and attributed all their
misfortunes to this fatal habit. But it appears to me that in order
to induce such a habit spontmieously, at so early an age, long before
the full development of the genital organs, a degree of abnormal
irritation must be present in them.

The irritation caused by stone in the bladder often excites, in
male infants, premature erections, and pain referred to the fossa
navicularis; this they relieve by elongating the penis, so that in such
patients, as is well known, the prepuce is of unnatural length. These
manoeuvres naturally lead them to habits for which they ought not,
under such circumstances, to be held morally responsible.

INFLUENCE OF THE RECTUM. 117

The irritation produced by ascarides in the rect«m constantly ex-
cites the same phenomena, and I have frequently seen children two
or three years of age affected with priapism, which could be referred
to no other cause. This circumstance is so common, that it has been
frequently mentioned to me by nurses, who even employ a popular
remedy to relieve it, showing, at least, that the influence of the asca-
rides is well known. Nurses introduce a suppository of lard into the
rectum, under the impression that the ascarides come there in search
of food, and that they will be able to remove them together with the
lard, on withdrawing it. The cause of these premature erections
cannot, therefore, be doubted.

Such children must, in consequence of the irritation of the parts,
possess an irresistible tendency to handle them, just as they have,
under the same circumstances, to scratch and rub the nose ; and the
sensation resulting from the friction of the genital organs being very
acute, is likely enough to form the basis of a more mischievous habit.
When, on reaching puberty, reason assumes its empire, the patients
often acquire sufficient command over themselves to renounce these
fatal practices, and they then suffer from involuntary emissions
arising from the same cause that excited the masturbation ; that is to
say, from the irritation of the genital organs by the worms inhabiting
the rectum.

Ascarides produce nearly the same effects in the female ; I have
seen many little girls of tender age, who were tormented by irresistible
itching of the pudendum, and profuse leucorrhoea, often accompanied
with redness and excoriation of the clitoris and labia minora, all
arising from the same source of irritation.

The involuntary emissions of semen which accompany defecation
in those patients who are affected with ascarides, cannot be attributed
to mechanical compression of the seminal vesicles, for costiveness is
not present, nor could constipation account for the nocturnal emis-
sions ; it appears to me that the titillation constantly exercised on
the rectum and margin of the anus, by the ascarides, extends its
influence to the genital organs, and excites spasmodic contractions of
the seminal vesicles.

CASE XXVI.

The liahit of masturbation contracted sponta^ieousJy at the age 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, cC-c — Cauteri-
zation performed toithout henefit — The expidsion of ascarides folloiced by
rapid recovery.

M. E , a student of medicine, enjoyed good health ia his childhood,

but about the age of fifteen was tormented by frequent and prolonged erec-
tions. One evening, for the relief of the itching, of which the extremity of
the penis was the seat, he rubbed the organ violently between his hands.
This led to the establishment of masturbation as a habit or rather as a paa-
8

113 CAUSES OF SPERMATORRHCEA.

sioD, the patient practising it sometimes as often as eight or ten times a day.
His health by degrees beeame so altered that one of his friends suspected his
practices, and told him the danger of his situation. By degrees he cor-
rected himself, though not entirely, before he had attained his twentieth
year. On his renouncing masturbation, nocturnal emissions supervened,
and often occurred two or three times a night. They diminished after a
time but without ceasing entirely, and seminal emissions during defecation
and the emission of urine were added to them. Thus his health became
daily more and more disordered for nine years, notwithstanding absolute
continence, a severe regimen, and the use of sedatives, tonics, and anti-
spasmodics. At length he grew incapable of any mental exertion. In
1837, he came to Montpellier, at the age of twenty-nine, in the following
condition : Extreme emaciation ; face pale ; appearance stupid and con-
fused; intellect dull; reasoning powers much affected, the patient being
incapable of connecting two ideas on the most simple topic of conversation ;
loss of memory ; constant headache referred to the forehead and temples, and
increased by any mental excitement, being then accompanied by nervous
tremors, and an almost idiotic state ; sleep broken and unrefreshing ; con-
stant sighing ; frequent attacks of congestion of the head, especially at night ;
violent noise in the ears resembling the sound of a waterfall ; vertigo; stun-
ning sensations giving rise to a constant fear of apoplexy ; timidity carried
to a ridiculous extent ; panics of fear even during the day ; character
gloomy, taciturn, restless, and irritable ; horror of the least noise, and of all
society; irresistible restlessness; great weakness; abundant sweats after
very slight exertion ; almost constant coryza ; frequent dry and hard cough ;
pains in the base of the chest, the region of the heart, and along the spinal
column ; appetite voracious ; dragging at the pit of the stomach ; difficult
digestion, accompanied with the development of flatus ; grinding of the
teeth during sleep ; burning at the point of the tongue ; darting pains in the
bowels, especially in the rectum ; obstinate constipation alternating with
violent attacks of diarrhoea ; stools containing much mucus, and sometimes
streaked with blood; periodical pains at the margin of the anus, in the
perineum, penis, and testicles; urine passed in large quantities, and very
frequently, always throwing down a whitish, thick, and very abundant
deposit; involuntary emissions during defecation, both when constipated and
relaxed ; frequent and prolonged erections by day as well as by night ; with
constant presence of erotic ideas.

On sounding this patient, I found the urethra very sensitive, especially
towards the neck of the bladder, and I consequently thought that the noc-
turnal and diurnal pollutions were kept up by a state of irritation arising
from masturbation. I therefore proposed cauterization. This was performed
on the following day, and produced the usual immediate eflFects, but its
curative effects did not take place as I had anticipated. I then directed the
patient to notice his feces, and a few days afterwards he told me that he
had observed numerous little worms passed in his stools. I now ordered
enemata of cold water, and salt and water, which, however, produced only
a momentary effect — probably because the ascarides inhabited the upper
part of the intestine. A few doses of calomel, however, caused them to
disappear without returning ; and from this moment the involuntary diurnal
emissions ceased entirely, the nocturnal emissions became more and more

rare, and the patient's re-establishment progressed very rapidly. M. R

returned to his studies with ardor, and long afterwards all functions were
perfectly well performed.

INFLUENCE OF THE KECTUM. 119

It appears evident that the irritation caused by the ascarides in
the rectum first led this patient to practise masturbation, and after-
wards kept up involuntary seminal discharges. I did not discover
this at first, because the history of his case, sent me by the patient,
was so long, and was characterized by such disorder and want of
clearness, that I was unable to arrive at any satisfactory conclusions
from such a chaos ; his answers were still more vague and uncon-
nected, so that my attention had been chiefly attracted to the state
of his intellect, and the abuses he had committed. But after seeing
the little success of cauterization, and again reading his notes, I paid
more attention to the circumstances attending the commencement of
his practising masturbation, and I noticed several symptoms to which
I had not before attached importance, such as grinding of the teeth
during sleep ; burning pain in the point of the tongue ; pain in the
rectum, and at the margin of the anus; the stools always containing
mucus, and sometimes being streaked with blood; and especially the
frequency and duration of the erections, and the constant presence
of erotic ideas.

When costiveness is present the stools rarely contain any quantity
of mucus ; its presence alone, therefore, in such a case, would indicate
that the rectum is irritated. by ascarides. But a still more character-
istic point is, the long duration of the erections. When involuntary
spermatic discharges are induced by any cause except this, the erec-
tions diminish in proportion as the disease advances, first becoming
incomplete, and afterwards disappearing entirely. When, therefore,
energetic and obstinate erections continue, in spite of the great wast-
ings of the body produced by them, they must be kept up by some
other stimulus to the organs than the natural one, and I believe
irritation by ascarides to be the only cause capable of producing this
effect. This, on the other hand, agrees perfectly with what I have
already stated concerning their influence on the genital organs.

CASE XXVII.

Masinrhation at the age of fifteen — Serious disorder — The application of
a, blister folloived hy involuntary nocturnal emissions — Cauterization,
douches, &c., unsuccessful — Expulsion of ascarides, followed hy a rapid
recovery.

Situon G , a vine dresser, short, stoutly formed, and of sanguineous

temperament, reached the age of fifteen without suffering from any disease.
At this period, while watching goats with other children, he was led by their
example to practise masturbation. At first, no emission took place, but at
the end of about a month, his manceuvres caused the discharge of a few
drops of blood, with burning at the root of the penis, and pain in the testi-
cles. Soon after, a general lassitude supervened, with a sense of fatigue in
all his body, and cold sweats. No semen was discharged for a long time,
and during the first five months that seminal emissions occurred, the dis-
charge was very fluid, and produced very little sensation.

120 CAUSES OF SPERMATOEEHCEA.

After Simon G- bad followed these mal-praetices for a few weeks, he

experienced darting pain in the stomach ; flushes of heat in the face, and
chilliness about the feet. At the age of sixteen, pain and creeping sensa-
tions along the spinal column were added to these symptoms; and still later,
severe cramps in the limbs, and weakness of the lower extremities. At the
a^e of seventeen, the patient was much troubled with palpitations of the
heart, especially after masturbation. His stools were costive, passed with
difliculty and pain, and often streaked with blood. These symptoms were
followed by lassitude, pains in the shoulders, difficult digestion, accompanied
■with acidity and development of flatus, with increased palpitations 3 his sleep
was no longer sound and refreshing.

At the age of eighteen, congestions of the head supervened, with burning
and redness of the face, occurring as often as five or six times a day ; the
patient suffered from heartburn, and difficult respiration, with a sensation as
though his throat were compressed.

At the age of nineteen, he carried masturbation so far as to produce san-
guineous emissions. His debility now became so great, that he was unable
to follow his occupation, or even to walk a short distance without frequently
resting. The use of wine, even in small quantities, always increased his
debility, and his other disorders. At this time leeches were applied to the
anus ; blisters to the epigastrium, nape of the neck and shoulders ; and re-
frigerant drinks were ordered. Shortly after the application of the blisters,
nocturnal emissions, preceded by erotic dreams, occurred for the first time,
and were followed by cramps in the legs, and griping pain in the stomach.
From this period the nocturnal emissions occurred nearly every night, and
frequently several times a night.

At this time his disorder increased so much, that a medical man was con-
sulted. G confessed the cause of his illness ; promised to correct him-
self, and kept his word. The treatment consisted of leeches to the back of
the neck ; syrup of quinine ; about two hundred aromatic baths ; friction
with camphor over the back of the neck, the spine, and limbs ; sleeping on
a very hard bed, &c.

After having employed these various means during eighteen months, with-
out receiving the least benefit, G left off all treatment, and at length

came to Montpellier, and was admitted into the hospital St. Eloi, on the
14th of February.

G was then twenty-two years of age, and his external appearance

announced strength and health; his embonpoint was considerable, and his
face full and red ; yet he was sad, weak, and without courage, in fact his
state had not improved in the least during the two years that he had ceased
to practise masturbation ; and his nocturnal emissions had ceased for six
days at a time, or longer, without his becoming any better. This last cir-
cumstance made me suspect that he suffered, at the same time, from diurnal
pollutions. His stools were often very constipated; and the hardened feces,
accumulating in the rectum, were discharged with difficulty and pain —
semen always escaping, at the same time, in greater or less quantity. The
desire of micturition was frequent and sudden, and it generally aroused
the patient four or five times during the night; the last drops of urine were
thick, viscid, and followed by a still more consistent matter, which remained
at the orifice of the glans. The urine itself contained an abundant thick,
whitish, and flocculent deposit, like that thrown down by a strong decoc-
tion of pearl barley. The mucous membrane of the urethra was very

INFLUENCE OF THE RECTUM. 121

sensitive, especially towards the prostate ; and the passage of a catheter was
arrested by spasmodic contraction of the neck of the bladder.

After observing these symptoms for seven or eight days, on the 22d of
February I performed cauterization from the neck of the bladder to the
membranous portion of the urethra. The following night two very painful
nocturnal emissions occurred ; two more took place on the third night, and
they were renewed every second or third night, notwithstanding the use of
baths, enemata, cold douches, camphorated emulsions, and morphia. The
urine was little altered in appearance, and there was little, if any, iqiprove-
ment in the general symptoms. The sleep continued broken and unrefresh-
ing. The patient was always disturbed by painful erections, and an uncom-
fortable itching at the orifice of the urethra. At length, one day, he informed
me that he had observed in his feces numerous little worms about six lines
long, and pointed at both ends. It was plain, therefore, that ascarides were
present in the rectum, and that before benefit could be derived from any
other means, it would be necessary to expel them.*

^ The effects produced in the followinjif remarkable case, which has recently come
under my notice, appear to me to have been due, in a great measure, to the irritation
excited by ascarides ; and the circumstance so well illustrates the connection between
the rectum and genito-urinary apparatus, that I am induced to break through my
original intention, of not adding any of the results of my own experience to M. Lalle-
mand's very full and complete treatise, and to publish the case as it is contained in
mj note-book. Mr. M , aged about thirty, of florid complexion, two years mar-
ried, called on me in a state of great mental excitement and distress, in the beginning
of March, 1846. He told me thnt about a week before, while getting up one morning,
he had observed a slight gluey discharge between the lips of the urethra, that he had
taken no notice of the circumstance, but had employed himself about his affairs as
usual. He was in perfectly good health, and in fact had forgotten the occurrence,
until on the third morning it was recalled to his recollection by the appearance of a
considerable discharge in the same situation, accompanied with pain during micturi-
tion. As he had a slight cold at the time, he attributed these symptoms to its effects,
and contented himself, for that day, with remaining within doors, and restricting his
diet to vegetables and slops. Still, the pain during micturition continued, the dis-
charge increased in quantity, and became thicker and greenish. He now became a
prey to the most harassing suspicions, though he still was unwilling to seek advice, in
the hope that the discharge would cease spontaneously, as it had arisen. In this state
the patient continued, viutil the morning of the 10th of j\Iarch, by which time he was
wrought to the highest pitch of mental excitement by the thoughts that constantly
obtruded themselves on his mind.

He told me that he had suffered from three attacks of blennorrhagia : the first, a
very severe one, about the age of nineteen ; the last about twenty-five. He had
never had any syphilitic affection. With the first attack of blennorrhagia, he had
been confined to his bed nearly a week, from irritability of the bladder attended with
strangury, &c., and that he had frequently, since that time, suffered from slight
attacks of vesical irritation, after exposure to wet or cold, or after very slight excess
at table. He could not account for the present symptoms in any way, unless by re-
ferring them to a very slight cold which had entirely passed off, or by giving credit to
suspicions which would entirely overthrow his domestic happiness, and for which he
had, otherwise, not the most remote cause.

From the state of my patient's feelings, I saw that something must be immediately
done, to remove suspense ; I, therefore, assured him that cases of urethral discharge,
from slight excitement, were not uncommon, especially in persons like himself, who
had repeatedly suffered from blennorrhagia, and were predisposed to irritability of
the organs. When he became a little more composed, on examining the genital organs,
I found a viscid greenish discharge from the urethra, not exactly resembling the ordi-
nary thick, dark discharge of blennorrhagia, but containing a considerable quantity
of mucus, and of a glairy consistence. The orifice of the urethra was neither swollen

122 CAUSES OF SPERMATORRHEA.

I accordingly ordered four, sis, and eight-grain doses of calomel, to be
followed by injections for this purpose. The patient's condition immediately
began to improve rapidly; his nocturnal emissions ceased; his urine became
transparent- the local and general symptoms disappeared; and he left the
hospital on the 1st of April quite re-established in health.

Masturbation, excited by bad example, produced from the first a
serious disorder in this patient's health. On two occasions the prac-

nor red, and on inquiry I found that, althougli the patient suffered from painful erec-
tions, they by no means resembled the chordee from which he had suffered on previous
occasions, but that the pain was rather situated in the prostatic and membranous
portions of the urethra. He suffered much from strangury, and his urine was highly
acid. The chief pain that occurred during its emission was felt in the perineum, and
the scalding near ther orifice of the urethra, which usually attends blennorrhagia, was
scarcely sufficient to attract his notice. Under these circumstances, believing the case
to be .simply irritation of the neck of the bladder from cold, I considered that I might
at once relieve his anxiety as to the nature of the discharge, by positively assuring
him that it was not venereal, and that with care he would probably be well in a few
days.

I ordered for him a warm hip-bath, and some bicarbonate of potass in gum-water,
with tincture of henbane, and requested him to abstain from all stimulants, and to be
careful to avoid exposure to cold or damp. The following day he called on me, con-
siderably relieved from his strangurj', and with his urine in a much more healthy
state; but the discharge continued as severe as before, and there was still consider-
able paiu in making water. A continuance of the sam& remedies was prescribed, and
patience enjoined. The two following days the patient did not call, and I had begun
to suppose that he was quite recovered, when on the 15th he returned, almost as much
excited as at first. He was convinced, he said, that his disease was more serious than
I had led him to believe, and that there was only one way of accounting for it ; he
was a ruined man, &c. After he had become a little calm, he stated to me, that the
irritation had returned, that the discharge was more abundant, and he was convinced,
that had it been simple irritation of the neck of the bladder, all these symptoms would
have ceased long before. He complained of a burning heat, and a sense of weight in
the rectum, which induced me to request an examination of the prostate. When pro-
ceeding to do so, I observed the parts in the neighborhood of the anus red, hot, and
excoriated, and, on questioning, he told me that he had long suffered severely from
itching in the neighborhood, but that he had omitted to mention it to me, as he had
not considered it of any importance, believing it to arise from little worms which he
often passed in his stools. This fact threw a new light on the case, and I began to
suspect that the irritation produced by ascarides was the cause of the vesical irritation
and urethral discharge. On being questioned, he recollected that the strangury al-
ways increased towards night, when he generally suffered most from the itching of the
rectum, and that he had felt itching and severe burning pain in the neighborhood of
the rectum long before the occurrence of the present attack of irritation, and before
the appearance of the urethral discharge. I now ordered, in addition to his former
medicines, a dose of calomel at bedtime, to be followed by a smart purgative in the
morning, and a copious injection of salt and water to be thrown into the rectum as
rapidly as possible, whenever he found the irritation and itching very troublesome.

The following day the patient called to let me know that he was much improved.
The purgative, and one injection which he had used, had brought away a perfect nest
of ascarides. The injection was repeated on the second night, and a few entozoa were
discharged. On the 22d of March, Mr. D called to say that the urethral dis-
charge, scalding and vesical irritation, had entirely ceased, and that he no longer suf-
fered from the intolerable itching that had previously almost constantly annoyed him ;
I advised him to use an enema occasionally, for a month or two, to prevent a return
of his tormentors ; this he has done, and the last time I saw him, some months after
his recovery, he was in excellent health and spirits, and able to enjoy all the comfort
of domestic felicity.

INFLUENCE OF THE KECTUM. 123

tice was carried so far as to induce emissions of blood. His testicles
became painful ; his urethra was exceedingly sensitive ; and the ap-
plication of blisters induced nocturnal emissions for the first time. It
seemed, therefore, unnecessary to seek further for the cause of the
seminal discharges which wore the patient out; yet the result proved
that they were kept up by the presence of ascarides in the rectum,
the expulsion of which was followed by a sudden change and rapid im-
provement, whilst no other treatment had produced the least amend-
ment. This case shows how important it is to seek all the causes
which may either excite or keep up involuntary seminal emissions.

I say excite or keep up, because in this case the ascarides do not
appear to me to have at all contributed to produce the disorder at its
commencement. It was by the influence of bad example that Simen

G was led to practise masturbation, and not by the presence of

priapism, as is the case when the habit is excited by irritation from
ascarides. The first nocturnal emissions too, followed the applica-
tion of blisters ; and I shall, in a future chapter, have occasion to
relate other cases of the same nature : such occurrences are easily
explained by absorption of the cantharides. It seems likely, then,
that the ascarides were only developed at a later period, and perhaps
as a consequence of the deranged state of the patient's digestive
organs. As they were not present in any very great quantity it
appears likely that they would not have produced such serious effects,
if the spermatic organs had not been previously in a state of irrita-
tion ; but I believe that in the existing state of the parts, the presence
of the worms was sufficient to keep up involuntary nocturnal and
diurnal emissions. By reflecting on a few of the symptoms that
attended the spermatorrhoea in this case, I might have earlier dis-
covered the presence of ascarides ; thus, the erections were frequent,
prolonged, and importunate — circumstances the opposite of those
observed in patients worn out by ordinary pollutions. The trouble-
some itching, also, which constantly existed at the root of the penis,
should have aroused my suspicions.

CASE XXVIII.

Masturbation at the age of ten — Seminal emissio7is produced hy horse ex-
ercise — Nocturnal, and afterwards diurnal, pollutions — Constant erec-
tions — Stools relaxed, and containing abundance of mucus — Burning in
the amis. Cauterization icitli slight benefit — Expidsion of ascarides fol-
lowed by rapid and complete recovery.

Alexander A , of moderate stature, the son of robust peasants, en-
ticed by the example of his companions, contracted, when about ten years
old, the habit of masturbation, which he practised for a year before he ob-
tained any seminal emission. From seventeen to eighteen he had sexual
intercourse, but he afterwards returned to his former habits. He soon
complained of general lassitude, weakness of the extremities, shortness of
breath, and a sense of suffocation after the least exertion; loss of appetite ;

124: CAUSES OF SPERMATORRHEA.

difficulty of digestion. Very abundant seminal emissions were frequently
excited by borse exercise, and occurred without erection, although not
without slin-ht sensation. At a later period he suffered from severe and
prolonged palpitation from slight causes; frequent colds, and an almost
habitual cough, attended with expectoration of mucus mixed with much

blood. At this period, A mentioned his condition to a medical man,

who explained the cause of his disorders, and A at once corrected him-
self; but nocturnal pollutions soon appeared. At first these were very fre-
quent, but after a short time they only occurred three or four times a week,
and at last only three or four times a month. Still the patient's palpitations,
difficulty of breathing, and digestive disorder, continued to increase. Flushes
of heat to the head were added to these symptoms, together with pain in the
loins, which extended, with a creeping sensation, along the vertebral column,
and was distributed to the shoulders and arms ; frequent cramps and chilli-
ness of the extremities ; extreme weakness of the legs, and a frequent desire
to micturate and defecate. The patient gave up music, in which he was a
proficient, and took a dislike to society, especially that of women: timid,
irritable, and unsettled, incessantly occupied by thinking of his disease, he
was unfit for any occupation, became a prey to despair, and was several times
on the point of yielding to the impulse to suicide, which constantly obtruded
itself before him.

In this condition A came to consult me, in the month of October,

1836, being then twenty-one years of age. T at once perceived that the noc-
turnal emissions bad given place to diurnal ones, and the minute details into
which the patient entered, confirmed me fully in this opinion. Each time
that he went to stool, he had an emission from the penis of a greater or less
quantity of viscid matter, which presented the characteristics of badly formed
semen. His stools were repeated two or three times a day ; they were liquid,
contained a large quantity of mucus, and left a severe burning pain in the
rectum. His urine was habitually muddy, thick, and of a disagreeable smell,
and after its emission a thick gummy matter, which left a mark on his linen,
remained at the orifice of the glans The patient was, besides, annoyed day
and night, with incomplete but very constant erections.

Having observed, for several days, the presence of semen in the urine, I
performed cauterization of the prostatic portion of the urethra. Fifteen days
afterwards, a sensible improvement was evident in almost all the symptoms ;
yet no further progi'ess was made, notwithstanding the use of Spa water, iced
milk, &c. The stools still continued liquid and mixed with mucus, resem-
bling a thick solution of soap in water. This really dispiriting condition
continued during three months, when I learned that the patient had several
times noticed ascarides in his stools.

In a few days after he was freed from this .source of irritation by means of
injections, and from that moment his re-establishment progressed rapidly.
His love of occupation soon returned, and he applied himself diligently to
the study of pharmacy.

This, then, was a case in Avhich the involuntary emissions were
kept up by the irritation of ascarides in the rectum, although it would
appear that masturbation was the cause of their origin. I have re-
cently been consulted by one of my former pupils, for a similar case,
in which the discbarges were very serious, and had resisted the most

INFLUENCE OF THE RECTTJM:. 125

various modes of treatment. They were attributed to masturbation,
and the patient's confessions justified this opinion ; yet a passage in
his letter convinced me that a mistake had arisen on, at least, one
point. After speaking of supposed hremorrhoids, which irritated the
margin of the anus, the patient added that the pain and itching he
felt there were such, that he often introduced his finger forcibly into
the rectum, and had several times brought down ascarides on with-
drawing it. This circumstance, previously neglected, caused me to
think that the ascarides, if they had not caused the pollutions, at all
events kept them up, and I prescribed accordingly, with success.
We must remember, then, that the emissions may be kept up in per-
sons who have practised masturbation, by the presence of ascarides,
even in cases in which these entozoa have not excited the habit;
and on this account it is necessary to consider their presence with
much attention. On the other hand, we must be on our guard against
attaching too much importance to the occasional presence of one or
two of these worms in the feces. In such cases, the want of success
of vermifuge remedies shows that the ascarides are not of so much
importance as they may have been considered. We must, therefore,
be careful in all cases, not to draw conclusions too precipitately from
first appearances. No disease, in fact, requires more patient research
and greater tact in its diagnosis and treatment, than are necessary
in complicated cases of spermatorrhoea.

To resume. The cases reported in this chapter show that affec-
tions of the rectum excite involuntary emissions. First, mechani-
cally ; by compressing the seminal vesicles diiring the passage of
feces. Secondly, vitally ; by the extension of irritation from the
rectum to the seminal vesicles.

All causes which oppose an obstacle to the exit of feces act in the
former manner. I have recorded cases in which the mechanical
obstacle was placed at the margin of the anus (cases 15, 16, 17, and
18), because, in such cases, the cause is perfectly isolated, and its
action is evident ; but it is also evident that any physical action like
that resulting from horse exercise (nineteenth case), from carriage
exercise, or from remaining too long in a sitting posture, as well as
all medicines which tend to produce constipation, may be followed
by the same effects. In all cases of this kind the influence of the
rectum on the seminal vesicles arises from its distension by feces,
and is a perfectly mechanical action.

The other phenomenon is essentially vital. The diarrhoea (case
sixteenth), the ascarides (cases 22, 23, 24, 25, 26, 27, 28), and the
eruptions at the anus (case twelve), could only act in this manner.
The same may be said concerning the action of injections, either too
hot or too cold, and of certain drastic purgatives.

In many cases, too, the distension and the irritability of the intes-
tine act simultaneously on the seminal vesicles. Haemorrhoids and
fissures of the anus, for instance, cause pain and irritation, and give
rise to spasms of the sphincter, at the same time that they form an

126 CAUSES OF SPERMATOERHCEA.

obstacle to defecation. Obstinate and continued costiveness, too, is
rarely exempt from heat and irritation in the rectum and its neigh-
borhood ; and eruptions about the anus are often accompanied by an
irritability of the sphincters, opposing defecation.

We have seen (case twenty-one) that chronic inflammation of the
urinary organs may excite, by its influence, so great a susceptibility
of the rectum, that the feces are no longer able to be retained ; and
here cauterization of the mucous membrane of the genito-urinary
passage sufficed to dispel the irritation of the rectum, so that the
patient got rid, at once, of his diarrhoea, his incontinence of urine,
and his involuntary seminal discharges. The influence of the rec-
tum on the genito-urinary organs is then reciprocal ; and it plays a
much more important part in causing spermatorrhoea, than if it
acted only by mechanically compressing the seminal vesicles. Its
due consideration is, therefore, of much importance in the treatment
of these cases.

CHAPTER VI.

CAUSES OF SPERMATORRHEA.
Abuse.

I UNDERSTAND by the term abuse, when applied to the organs of
generation, any irregular or premature exercise of their functions ;
any application of them which cannot have, as its result, the propa-
gation of the species. There are, undoubtedly, many points of re-
semblance between such abuses and venereal excesses, but the plan
of this work requires that I should examine them separately.

I concluded the last chapter by relating some cases in which the
presence of ascarides in the rectum, more or less connected with
masturbation, induced or kept up involuntary spermatic discharges ;
I shall commence the present one by relating some cases in which
the spermatorrhoea was due to masturbation alone.

CASE XXIX.

Masfurhation — Nocturnal pollutions — Palpitation and dyspnoea, simulating
cardiac disease — Repeated venesection, folloioed by increased disorder —
Sulphuretted baths and rapid recovery.

M. D , of nervous temperament, and energetic and restless charac-
ter, contracted the practice of masturbation while at school. Shortly after-
wards he suffered from a severe attack of fever, which occasioned his re-
moval ; this fever was followed by loss of voice, and afterwards by rheu-

ABUSE. 127

uiatic pains, pain in the chest, sensation of suffocation, habitual shortness
of breath, and violent palpitations, which were increased on_ the slightest
exertion. At the age of nineteen he broke himself of his habits ; but, soon
afterwards he experienced nocturnal pollutions, which became daily more
and more frequent. About this time an issue was inserted in his loft thigh.
The following winter the palpitations and difficulty of breathing increased,
and his legs became slightly oedematous ; he was treated by repeated vene-
sections, and the administration of diuretics, and at the approach of summer
he became a little better, the improvement being of course attributed to the
effects of the medical treatment.

The following winter the same symptoms reappeared, and were again
combated by venesection, with a severe regimen. The patient now became
exceedingly emaciated. His nocturnal emissions increased in frequency, and
his dyspnoea and palpitations were aggravated. For these symptoms he was
again hied three times.

At the age of twenty-three M. D came to Montpellier. A minute

examination of his chest assured me that his lungs were perfectly healthy,
and that the heart's action was neither more violent, nor heard over a greater
extent than natural ; still, notwithstanding his emaciation and extreme
debility, and the oedematous state of his legs, he was constantly recurring to
the supposed plethora, to which his attendants had attributed his symptoms.
I found it difficult to prevent him from having recourse to further abstrac-
tion of blood.

The use of artificial sulphuretted baths gave tone to his genital organs,
and diminished their excessive irritability. The nocturnal pollutions be-
came less frequent ; the patient's appetite returned, and his digestion was
performed with greater energy. After a month's treatment, I sent him to
the sulphuretted waters of the Pyrenees, where his cure was soon com-
pleted.

This is one of the most simple cases of nocturnal pollutions in-
duced by masturbation. It is chiefly remarkable on account of the
predominance of the palpitations and dyspnoea over the other symp-
toms, and the grave errors which have been committed in its diag-
nosis and treatment.

CASE XXX.

IJaRtiirhdtion at the age of eight years — At twelve very frequent emissions
of xirine — At sixteen, coitus impossible — Nocturnal, and afterwards, diur-
nal pollutions — Cauterization at the age of twenty-eight followed hy rapid
recovery.

M. D , of Philadelphia, of a very robust constitution, contracted the

habit of masturbation at school, when only eight years old. The first effect
produced was a frequent desire to pass urine, and at twelve years of age
this irritability had become so great, that he was sometimes unable to retain
his urine a quarter of an hour. Before entering a house he always took
care to micturate several times in rapid succession ; and, notwithstanding
this precaution, he soon experienced renewed uneasiness. He felt as
though his bladder was never entirely empty, and the smallest quantity of
urine induced spasmodic contractions. The irritability of the urinary

128 CAUSES OF SPERMATOERH(EA.

organs diminished by degrees after the period of puberty, but never ceased
entirely, notwithstanding the various means which were employed on differ-
ent occasions.

At the ao-e of sixteen, M. D endeavored to break off his injurious

habits by sexual intercourse, but he found himself completely impotent, and
shame induced him to return to masturbation. He afterwards made further
attempts to correct himself, but he experienced nocturnal pollutions, which
often made him lose courage. At length, after many relapses, he succeeded
completely, without observing any further nocturnal emissions. Still his
health, instead of improving, became more and more impaired. His erec-
tions were less frequent, less prolonged, incomplete, and at length gradually
ceased, together with all venereal desire.

At the age of twenty-eight, the state of his urine, its frequent discharge,
and the wandering pains in the perineum and testicles, induced a fear of cal-
culus ; sounding, however, only showed a morbid sensibility of the urethra,
especially towards the neck of the bladder.

In the beginning of May, 1837, M. D came to Montpellier, in the

following condition : — much debilitated ; unsteady in his walk ; easily chilled,
and taking cold very quickly ; wandering pains all over his body ; skin dry ;
memory impaired ; digestion difficult ; extremities cold ; scrotum relaxed,
and testicles soft, very sensitive, and often causing a dull pain, as if they
were forcibly compressed ; the semen (from the account he gave of the last
nocturnal pollutions he had experienced), clear, aqueous, and inodorous ;
seminal emissions with the last drops of urine, which were clammy, and
passed with difficulty, and excited a sensation of tickling in the neighbor-
hood of the anus, which extended to the orifice of the urethra; he often had
diarrhoea, but at other times was very costive, and his stools were passed
with difficulty and pain. He did not, however, often pass semen while at
stool.

I discovered, several days following, the presence of semen in M. D 's

urine, and catheterism showed an excessive irritability of the urethi-a, espe-
cially in the neighborhood of the prostate, which, on examination, was
found slightly enlarged. Nearly a tablespoonful of blood followed the
withdrawal of the catheter. These circumstances did not leave the least
doubt on my mind as to the state of the mucous membrane in the vicinity
of the ejaculatory ducts ; and, consequently, I immediately performed cau-
terization, from the neck of the bladder, as far as the membranous portion of

the urethra. Twenty days afterwards, M. D left Montpellier for Italy,

and when he returned, three months afterwards, he was completely cured —
no involuntary seminal Amissions having afterwards appeared. His urine
was transparent, and could be retained seven or eight hours without incon-
venience ; its discharge took place without effort, and was not accompanied
by any remarkable sensation. Lastly, the patient's impotence, which had
been present nearly twelve years, had given place to a virility previously un-
known to him : I need hardly state that his physical and moral energy had
shared in this regeneration.

I have often had occasion to notice the connection that exists be-
tween the spermatic and urinary organs ; and I have shown that there
is scarcely a cause of spermatorrhoea which does not act more or less
on the bladder and kidneys. The cause I am now investigating

ABUSE. 129

affords us numerous examples of this connection — of which the case
I have just related is a remarkable instance — the irritation of the
urinary organs having been developed very rapidly, having shown
very marked symptoms, and having existed alone during several
years. The patient was only eight years of age when he first became
addicted to masturbation ; at this early age the urinary organs alone
possessed activity, and therefore they alone were able to suffer dis-
turbance of their functions ; on this account the symptoms were con-
fined for a long time to the urinary organs. The character of the
symptoms showed that they arose from a chronic state of inflammation,
or from an acute irritation of the urinary organs, and this state must
have extended also towards the spermatic organs. Thus the in-
creased secretion of the kidneys, and the extreme irritability of the
bladder, would give a very clear idea of what took place in the sper-
matic organs at the period of puberty. As soon as the testicles began
to act, they fell under the same influence as the kidneys ; the semi-
nal vesicles were in the same condition as the bladder ; in other words,
the semen was secreted in large quantities, and was retained a very
short time in its reservoirs. Being, therefore, imperfectly formed,
the usual effect on the erectile tissues produced by its presence, did
not take place, and coitus was impossible at the age of sixteen. The
occurrence of impotence at so early an age is sufficient to show that
diurnal pollutions had already commenced, although the patient did
not discover them for a long time afterwards. He was still, how-
ever, able to practise masturbation ; and this is a circumstance which
has great effect in preventing persons addicted to the vice from re-
nouncing their fatal habits. At a later period, nocturnal pollutions,
which occurred after a few days' care, shook the patient's resolution.
This is a much less serious circumstance than the one just mentioned,
but at the same time much more common. At length the patient
left off his habits, and nocturnal pollutions disappeared ; yet the dis-
order of his health continued to increase. His prudence, exercised
too late, did not arise from the strength of his will, but from the
weakness of his genital organs ; the disappearance of his nocturnal
emissions did not arise from the remedial measures used, but from the
increase of his involuntary diurnal discharges, of which he only be-
came aware long afterwards. These common errors are the more dan-
gerous, because medical practitioners are apt to participate in them.

In the case of M. D the irritability of the canal was very

great, and the effect of the cauterization was correspondingly prompt
and decided.

130 CAUSES OF SPERMATORRHCEA.

CASE XXXI.

Masturliation at the age of seventeen, carried so far as to cause emissions
ofhlood, hut soon afterwards abandoned — Increasing debility during four
years — Symptoms of jjJithisis laryngea and chronic, gastritis — Extreme
prostration — Cauterization, folloiced by rapid re-establishment.

I am indebted for the following remarkable case to the kindness of Dr.

Daniel, of Cette. " On the 26th of May, 1836, I was called to F , a

baker, aged twenty-two. I found him in bed, in the following condition :
great moral prostration, carried even to a hatred of existence ; prostration
of strength ; emesia ; lips pale and shrivelled ; remarkable pallidity ; eyes
sunken; expression of countenance dull; great emaciation; skin hot and
dry; pulse small ; voice hoarse, and so low that it was with difficulty a few
words could be heard by approaching the ear; constant cough, scarcely per-
mitting an instant's repose ; general wandering pains, most severe in the
loins and the sides of the chest ; great irritability of the stomach — vomiting
being excited after taking almost any kind of liquid or solid food.

" At first I thought that I recognized in this patient the symptoms of
phthisis laryngea, complicated with chronic gastritis ; but the examination
of his chest and abdomen did not support this opinion. The epigastric re-
gion was not painful on pressure; the respiratory murmur was heard all over
the chest, and percussion emitted a healthy sound, except under the left false
libs, where it was slightly dull, and the patient felt pain.

" His debility did not permit me to practise abstraction of blood ; and,
indeed, the pleuro-pneumonia of the left side did not seem either very ex-
tensive or very acute; I therefore ordered a large blister to be applied over
the affected spot, and prescribed a solution of tartar emetic, and a strict
diet. The pain in the side disappeared, and two days afterwards the sto-
mach could retain milk and barley-water. Still nothing explained the
patient's emaciation ; his almost total loss of voice, hoarseness, and constant
cough. His parents attributed these symptoms to hereditary phthisis, and
mentioned that several members of the family had died of that disease.

Minute and repeated examination of F 's chest, however, assured me

that this was not the case. On the other hand, the symptoms were very
severe, and I could not discover any visceral lesion sufficient to account
for them. In this state of uncertainty, your views on spermatorrhoea at-
tracted my attention. I immediately questioned the patient respecting his
past life, and learned that at the age of seventeen he had practised mastur-
bation with such fury that he had frequently passed aqueous semen, mixed
with blood; frightened by these accidents, he had corrected himself com-
pletely. But, after about a fortnight's abstinence, he noticed that his urine
contained a deposit of thick, whitish, flocculent matter. He never attached
any importance to this, although during four years he observed it con-
stantly, and noticed that it was more abundant after he had been much
fatigued in his business. He observed also, that the last drops of urine
were thick and viscid, and that a small quantity of viscid matter generally
remained at the orifice of the urethra. His bad symptoms first commenced
at this time; his erections and desires entirely disappeared; and, by the
time he had attained the age of twenty-one, he was obliged to give up his

ABUSE. 131

employment, and shortly afterwards, his symptoms becoming aggravated, he
was unable to quit his bed.

" I examined his urine, and found it in the condition he had described;
the deposit contained in it being about an ounce in quantity. I noticed
that his testicles were soft, and his scrotum flaccid. He agreed to ray
proposition of cauterizing the prostatic portion of the urethra with eager-
ness, and I performed it on the following day. The eifect of the cauteriza-
tion was rapid ; the second night afterwards, the patient slept soundly ; the
third day, a change was observed in his voice j and erections occurred
during the night. On the fourth day, the patient was able to get up and
take some light food, which was well digested; his wandering pains had
disappeared ; and by the ninth day after the cauterization, the patient's
strength had returned. Tonic regimen, and the use of sea bathing, con-
firmed his restoration."

Dr. Daniel added to the history of this case a detailed statement
drawn up by this patient himself: as it contains no important facts,
I have omitted it here. I have, however, several times myself exa-
mined this patient, and have assured myself of the exactitude of the
report.

F had carried masturbation to such an extent, that he passed

aqueous semen, mixed with blood ; the seminal vesicles were there-
fore in a morbid condition when he left off the habit. A fortnight
afterwards, he noticed a deposit in his urine, which he had never
before perceived, and which continued constantly afterwards. During
four years, he never relapsed into his former habits, and he was not
affected by nocturnal emissions; yet he continued to lose flesh. Im-
mediately after the cauterization he became convalescent. Is it not
evident, that the absence of venereal desires and of nocturnal emis-
sions during so long a period, was owing to the occurrence of invo-
luntary diurnal pollutions? Is there any other mode by which we
can explain the continued disorder of the patient's health, and its
sudden restoration ? The answer is evident.

Whenever F — — fatigued himself more than usual, the urinary
deposit became more abundant. This may appear to be an excep-
tion to the usual good effects which patients experience from pedes-
trian exercise. Everything depends on the strength of the system,
and on the quantity of that strength expended. Fatigue is as hurt-
ful in such cases, as exercise is beneficial.

CASE XXXII.

Masturhation from twelve to twenty-two years of age — Melanclwly — In-
clination to suicide — Serious alteration of the health — Monomania —
Unperceived diurnal pollutions — Cauterization followed hy "perfect re-
covery.

At the beginning of April, 1836, M. Emile Gr was sent to consult

me, by Dr. Cauvi^re, of Marseilles. He was twenty-five years of age, and

132 CAUSES OF SPERMATORRHCEA.

had attracted notice from the brilliancy of his intellect. At twenty-one
vears of age, he had been admitted an advocate in a highly flattering man-
ner.

He stooped much, and though his bony system seemed to announce a
strong constitution, his limbs were small, and his muscles soft. His hair
was black and thin, his skin was pale, and his face without expression.
His eyes were dull, and constantly cast down ; his voice weak and husky ;
and his general appearance announced great timidity. His legs were con-
stantly in motion.

I learned that M. Gr had contracted the habit of masturbation at

school, at twelve years of age; and that whilst studying law at Paris, at
the age of nineteen he found a change in his character commencing : this
I will describe in his own words : At first I felt a gradually increasing
disgust of everything and a constant sense of ennui. From that period I
only saw the dark side of life. Thoughts of suicide soon afterwards oc-
curred to me, and this state of mind continued for twelve months, after
which other ideas took the place of those respecting suicide. I considered
myself a subject of ridicule, and fancied that the expression of my counte-
nance, or my manner, excited an insulting gayety in the persons I met.
This notion each day acquired new strength, and often when in the street,
or even when at my own house, or in a room surrounded by my relations
and friends, I fancied I heard in.sults which were aimed at me. / think so
iffiU. At length, as my state became worse, I thought that every one in-
sulted me, and I still think so. If any one expectorates or blows his nose,
coughs, laughs, or puts his hands or his handkerchief before his face in my
presence, I experience the most painful sensation. Sometimes, I feel en-
raged, but more frequently a depression of spirits, ending in involuntary
tears. I look at no one, and my eyes are never fixed on any object.
Wrapped up in my own thoughts, I am indifferent to all external impres-
sions. These signs are evidently those of imbecility. I admit that I may
have had, and that I may even now have, halliiciuations, but I am fully
persuaded that these ideas are not without foundation : 1 am convinced that
the expression of my countenance has something strange in it, that people
read in my looks the fears which agitate, and the ideas which torment me,
and that they laugh at this unhappy weakness of intellect, which they ought
rather to pity.

The patient experienced a sense of heaviness and oppression in his head,
and although fatigued by slight exercise was constantly in motion. Two
years before he consulted me he began to correct himself by degrees; and
for nine months he had entirely renounced the practice of masturbation,
yet notwithstanding this, his state daily grew worse. His digestion was
disordered; he suffered from obstinate constipation; and his erections and
venereal desires had left him for a long time. Yet he did not mention the
last facts in the written statement of his case which he sent me; they were
minor evils; one idea alone absorbed him — the conviction that he was an
object of contempt and ridicule to all who approached him ; this idea was
aggravated by the knowledge of his impotence, and by shame for the cause
which had produced it.

This patient's urine usually contained an abundant flocculent deposit,
resembling a thick decoction of barley; it decomposed very i-apidly, and
emitted a disagreeable smell. After every stool the point of the glans penis
was covered with a clammy viscid matter, resembling a thick solution of
2um.

ABUSE. 133

These circumstances confirmed me in the idea that the involuntary seminal
discharges alone opposed the patient's recovery. The frequent emission
of his urine ; the sensibility of the spermatic cord, of the testicles, and
especially of the urethral mucous membrane, and the injected state of the
orifice of the urethra, made me attribute these evacuations to irritation of
the spermatic organs rather than to their relaxation.

As, however, the patient refused to submit to cauterization, I ordered him
iced milk mixed with Spa water, cold lotions, &c. ; but he found himself
much worse after the use of these means ; all his symptoms were aggra-
vated ; his urine became thicker, and left a glairy deposit adhering to the
bottom of the vessel.

At length, on the 23d of April, I persuaded M. Gr to submit to cau-
terization, and I performed it immediately, chiefly on the neck of the bladder
and the prostatic portion of the urethra: nothing particular occurred, except
that the inflammation of the urethra, which followed the application, was
not entirely removed for three weeks. This, I believe, arose, in a great
measure, from the severe weather which prevailed at the time. I ordered
two or three warm baths to be taken in the week, an a few warm injections
and demulcent drinks. At the expiration of a month, the patient took
pleasure in going out, and occupied himself with gardening ; he felt stronger,
and took longer walks ; he was able to employ himself longer without
fatigue; he also experienced nocturnal emissions, preceded by erotic dreams
and lively sensations. At this he was at first alarmed, but he gained cou-
rage when he saw that he was not injured by them. I had not seen him
for more than a month, when one day he called on me quite dispirited, to
say that he should never get well, as he was relapsing into his former habits.
I blamed him, but at the same time I explained to him that the fact was a
proof of his having gained his former virility, of which he should make

moie proper use. M. G 's mother came to me soon after to speak of

the propriety of marriage for her son, whom she saw exposed to various
dangers. I easily persuaded her, that before deciding on marriage, it would
be necessary for him to be firmly assured, during a considerable period, of

his perfect and decided recovery. M. G had then regained his spirits,

his boldness, and his position in society, and eighteen months afterwards,
all his functions being performed with energy, he married. Six months
after his marriage I heard that his health had not for a moment been dis-
ordered.

With this patient I received the following consultation from Dr.
Esquirol. "The undersigned cannot mistake a case of ht/pochondriasis
which has lasted three years. It is evident that the nervous affection
was produced by the habit of masturbation to which the patient was
addicted from the age of puberty, and of which he only succeeded in
breaking himself seven months since. The hypochondriasis continues
very obstinately, as the cause which produced it acted for a long time,
and very seriously weakened the nervous system. The undersigned
attributes the little success attending medical treatment to the unfa-
vorable weather, to the indocility of the patient, who lives in seclu-
sion and in physical and moral torpor, and to the weakness of his
mother, who allows herself to be led away by the sight of false or
exaggerated sufferings. The means advised are those usually ordered
9

134 CAUSES OF SPEEMATOREHffiA.

in cases of hypochondriasis : Tonics, antispasmodics, leeches to the
anus, purging, change of scene, travelling, sulphuretted baths, sea-
bathing," &c. Dr. Esquirol sums up his opinion, in concluding, as
follows : " I must repeat what I have said above: weakened innerva-
tion is the cause of the disease, and everything which can strengthen
the nervous system will be useful." It was clear that masturbation
had been the first cause of the physical and moral derangement, called
hypochondriasis ; but the patient had renounced this vice during nine
months, and his state became worse daily, instead of improving. It
was evident, therefore, that some other cause acted in keeping up the
disorder ; and it was just as evident that this cause was involuntary
diurnal seminal discharges. It is not necessary for me to show that
masturbation can, acting alone, induce involuntary discharges, or that
the cure was due to cauterization only, although its effects were not
manifest for a month after the application of the caustic ; but I must
insist on the pathological condition of the genital organs exciting these
involuntary evacuations, since they have been too frequently ascribed
to a state of debility or relaxation of the tissues. The tonics ordered
by Esquirol had produced no benefit : I have described the symptoms
which led me to suspect acute irritation of the prostatic portion of
the urethra, and I have since shown the injurious effects of cold lotions,
iced milk. Spa water, &c. It was, then, not by causing contraction
of the orifices of the ejaculatory canals, that the cauterization pro-
duced its beneficial effects, but by dispersing the chronic engorge-
ment of the mucous membrane. The advantage derived from warm
baths during convalescence corroborates this opinion.

In M. G 's case a predominating symptom attracted the atten-
tion of the practitioners ; hence they looked on the disease as being
hypochondriasis, monomania, or hallucination, continuing after the
cessation of its exciting cause, and becoming, consequently, an idio-
pathic affection. I have, however, shown that all the functions had
been altered more or less ; I should add, that the digestion was the
last to be re-established perfectly. Such mistakes are very common,
and very serious, and I cannot too strongly impress their importance
on the attention of the profession. Esquirol justly stated that the
hypochondriasis took its origin from masturbation ; that the nervous
system was weak and excited ; but he mistook the cause which kept
up this condition of the brain. When masturbation has not induced
involuntary seminal emissions, recovery soon follows, on leaving off
the habit which has destroyed the health; within a week the patients
begin to experience a notable improvement, and in a very short time
they are hardly recognizable, whatever may have been the degree of
weakness to which they were reduced. But when Dr. Esquirol wrote

his opinion, seven months had elapsed, during which M. G 's

conduct had been irreproachable, and when I saw him two months
later, his state was even worse, although he had never resumed his
former habits. The symptoms were, however, kept up by involun-
tary diurnal discharges.

ABUSE. 135

The effects of the cauterization were very conclusive, and as soon
as its curative action was felt, the patient, of his own accord, took
various kinds of exercise, aud sought out the different amusements,
which had been, in vain, ordered for him previously; he entered into
society, and did, without being pressed, all that he had before re-
fused to do ; his ideas and his necessities altered in proportion as
Lis functions were re-established.

It is in vain that we say to the so-called hypochondriac — amuse
yourself, employ your mind, go into society, seek agreeable conver-
sation ; so long as we have not removed the cause of his disorder, he
is unable to profit by our counsels. How can we expect that when
a man is fatigued by the least exercise, he shall occupy himself with
walking or gardening ? How can we desire him to go into society,
when the simple presence of a woman intimidates him, and recalls all
his former misfortunes? How can we expect him to enjoy conversa-
tion, when he loses its thread every moment ? When his memory
leaves him, and when he feels his nullity ? We persuade him to
seek amusements and pleasures, but are they such to him ? Is not
the happiness of others his greatest punishment ? Because he is una-
ble to follow our advice we accuse him of unwillingness, and we wish
to compel him. Let us first remove the cause of our patient's dis-
ease, and we shall soon see that his character and conduct will
change, and that he will return to his natural tastes and habits.

It is not long, in such cases, before we are embarrassed by ques-
tions about the propriety of marriage being put to us: this is a matter
which is serious in all its aspects, and on which the least scrupulous
should not pronounce, without having had sufficient assurance of
their patient's return to health. The question of our patient's health
is now not the only one, nor is even his future happiness alone impli-
cated ; the fate of the innocent being who is about to be associated
with him, is the matter of chief importance, and justice to her de-
mands that we do not counsel matrimony, until sufficiently long proof
has been given that our patient's re-establishment is permanent.

CASE XXXIII.

Abuse caused hy sleeping on the helly — Effects of reading erotic vjorks —
Putoer of habit — Alteration of the intel/ectucd and moral faculties — Im-
potence — Chronic Irritation of the bladder — Xocturnal and diurnal pol-
lutions — Cauterization folloiced by prompt recovery.

Eugene C , at seven years of age, was strong and healthy, but about

this period he contracted the habit of lying on bis belly at night. In this
position the genital organs were heated during sleep, and the penis became
erect, although the boy did not present the least sign of puberty. Pressure
against the bed produced titillation, and induced a habit of abuse, as in-
jurious in its effects as masturbation. The child was perfectly free from
any sexual feelings, and had never been exposed to the influence of bad
example ; besides which, he was naturally modest and reserved. The first

136 CAUSES OF SPERMATOREH(EA.

impression was, therefore, quite instinctive and accidental, but the habit
was soon confirmed into an irresistible passion.

Between the ages of nine and eleven the child's character changed ; he
became restless and quarrelsome, but his intellectual faculties were active,
and he was able to keep up with his companions in their studies, and to make
himself feared by them, on account of his quarrelsome disposition. Be-
tween the ages of eleven and thirteen, however, he yielded to the practice,
two or three times a night, and became idle, timid, and weak ; he fell behind
his fellow students in his studies ; and though he was easily provoked to
quarrel, he found himself always beaten. On this account he sought soli-
tude. At the age of fourteen, the habit he had contracted was temporarily
broken oif, by his brother's sleeping with him ; but at the expiration of
three months, when left to himself, he relapsed. At the age of fifteen, a
remonstrance received before his fellow students by one of his masters,
caused him to abstain during eight months ; he regained his strength, his
character altered, and he made up for the time he had lost in his studies.

At the end of the year he even wrote so remarkable an essay at the com-
petition for prizes, that he was supposed to have copied it. On this account,
at another competition some time afterwards, he was separated from his
companions, and carefully watched. In the mean time, however, some
obscene books had fallen in his way, and excited his imagination. He re-
sumed his habits with fury, and when the day of competition arrived, his
condition had become worse than ever. He passed all the time allowed for
the trial in a state of febrile excitement, without writing a word. Some
time afterwards, he made a strong resolution to correct himself, but the habit
had become so strong, that he often had recourse to it, unconsciously, dur-
ing sleep. By degrees, however, he corrected himself, but very frequent
nocturnal pollutions supervened, and destroyed all the benefit that arose
from the change.

At the age of seventeen the patient came to Montpellier to obtain the
degree of bachelor of letters : the state of his intellectual faculties prevented
this ; indeed, out of ten hours spent in his study, nine were passed in think-
ing of his condition, and of the different means by which ho could commit
suicide. He attempted sexual intercourse, but found himself quite impo-
tent. Horse exercise, and the various tonics and stimulants which were
prescribed for him, only increased his disorder.

I need not relate all the functional derangements which the patient un-
derwent ; but it is necessary that I should notice a chronic inflammation of
the bladder, of which the cause was unknown, and diurnal pollutions, which
he did not discover, although they were much more serious than the noc-
turnal emissions which had become more and more rare during the previous
twelve months.

About the end of November, 1836, I cauterized the neck of the bladder,
and the prostatic portion of the urethra. Fifteen days afterwards, the pa-
tient was better, and he immediately went into the country, where his cure
was soon confirmed.

M. C has since studied medicine with much energy ; and has

passed the examinations of B. L. and B. A. with credit. His character
has become frank and kind, and it is evident that he is in good health and
spirits.

This case shows the importance of the apparent trifles that occur in

ABUSE. 137

childhood, and at the period of puberty ; and the serious effects which
a slight neglect of them may produce during the whole of after life.

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, hut progressive improvement.

M. A , when a child, was remarkable for precocity of intellect ; but

was troubled with worms during the early years of his life. Being allowed
to sleep with his governess, when about eight years of age, he remarked
differences of form, which he had never before seen. His active imagina-
tion dwelt on these incessantly, and at length he fell into a state of melan-
choly, of which the cause was far from being suspected. At the age of
thirteen, a young female took advantage of him, but without permitting
intromission. Shortly afterwards, when at school, these circumstances
constantly recurred to his imagination, and during the night he took care
to place himself as much as possible in the same position, in order to renew
the same sensations. He thus contracted a habit quite as injurious as
masturbation. His health became affected, even before any seminal emis-
sion had taken place ; his growth was arrested ; his sight, memory, and
intellect, became weak. At the age of seventeen, emissions occurred during
defecation, and were followed by a diminution of the patient's erections and
venereal desires, as well as of his abuses. At nineteen years of age, he had
a chronic gastritis, headache, pain in the hypochondriac regions, and noc-
turnal pollutions. For these symptoms, a milk diet was prescribed, and
adhered to for a year, together with baths, enemata, and country exercise.
At the age of twenty-two, chronic gastro- enteritis supervened, and was fol-
lowed by inflammation of the bladder, which passed into a state of chronic
vesical catarrh. After about two years, the patient's health was restored.
By degrees, his old habits and nocturnal pollutions returned, and induced
a new derangement of his health ; at the age of twenty-five, chronic inflam-
mation of the digestive organs and bladder again appeared, but was re-
lieved by emollients and a severe regimen. About the age of twenty-eight,
his health partially returned, but his sleep continued heavy and unrefresh-
ing, and was often interrupted. At thirty, his digestion was much disor-
dered ; constipation and diarrhoea occurring alternately.

The patient's condition gradually became worse, until he came to Mont-
pellier, in February, 1836. He was then thirty-two years of age, and pre-
sented the following symptoms : appearance, sad, restless, and timid ; legs
weak : constant restlessness ; feeling of icy coldness in the thighs ; lower
part of the belly, and genital organs ; appetite capricious ; digestion labori-
ous, and accompanied with discharge of flatus ; memory treacherous ; dis-
like of society; irritability of temper; overruling egotism; constant pre-
sence of lascivious ideas, contrasting strongly with the weakness of the
genital organs ; mental debility; sleep broken, and unrefreshing; frightful
dreams ; frequent desire to micturate, especially during the night ; urine
thick and muddy, generally presenting an abundant flocculent precipitate,
and giving off a disagreeable smell ; genital organs very little developed ;
prepuce long ; and testicles small.

After observing the patient for several days, I cauterized the bladder and

138 CAUSES OF SPEEMATOEEH(EA.

prostatic portion of the urethra ; the operation was followed by a more in-
tense inflammation than usual, probably due to the bad weather. As soon
as he was able, the patient quitted Montpellier, to return home.

Not having heard from him, I augured that the cauterization had been
unsuccessful, when one day, several months afterwards, as I w'as passing

throuf^h Lyons, I was accosted by M. A , who was so changed that I

hardly recognized him. He stated that a slow, but progressive improve-
ment had taken place after his leaving Montpellier ; the pollutions he had
before experienced during defecation disappeared ; his ui-ine became clear,
and was passed less often and less suddenly ; nocturnal pollutions occurred
seldom, and his erections became energetic.

The abuses practised on the genital organs had the same cha-
racter in this as in the preceding case ; and in both, they produced
the same effects as masturbation. We observe in the last case,
that sexual ideas preceded for a long time the development of the
sexual organs ; and that the venereal desires had no relation what-
ever to the amount of development of the generative organs.

The influence of a premature liaison on these abuses is also
worthy of notice. The remembrance of such irregular and prema-
ture enjoyments constantly presented itself before the patient's im-
agination, and caused his frequent relapses. The habit at length
overcame the will, and even took its place, provoking the same acts
during sleep. The power of habit was just the same as in the pre-
ceding case.

At the age of seventeen, M. A noticed that he passed semen

while at stool ; he had, therefore, thus early, diurnal pollutions. He
did not pay attention to these, because he was not aware of their
importance ; but it is evidently to the occurrence of such discharges
that we must attribute the feebleness of his erections, the impossi-
bility of coitus, and the long series of sufferings he afterwards en-
dured.

As to the other symptoms presented by M. A , I need not

enter into their consideration — I have already done so several times
— such symptoms being common to all cases of spermatorrhoea.

Were the discharges in this case due to a state of atony ? This
would seem to be the case, if we only regarded the small develop-
ment of the organs, and the habitual weakness of the erections ; but
the acute attack of cystitis, and the chronic catarrh of the bladder,
showed clearly enough, that the seminal vesicles and ejaculatory
canals must have been also in a state of irritation. •The curative
effects of cauterization were postponed for a considerable time, so
that I almost despaired of benefit from the operation ; yet, no other
treatment having been employed, the improvement was evidently
due to the cauterization alone. In case thirty-two, I have already
noticed the same circumstance, and it is worthy of remark, that
both these cases were operated on during a very wet and cold sea-
son. Whether this be the correct explanation or not, such cases
are not rare, and I -wish particularly to point them out, because I

ABUSE. 139

have met with many patients affected with spermatorrhoea, who had
been cauterized three, four, or five times, or even still more often,
in the space of a month. This subject I shall treat fully, when
speaking of the treatment of spermatorrhoea.

CASE XXXV.

Masturbation at sixteen years of age — At twenty-one, compression of the
urethra (luring ejaculation, followed hy a sensation of tearing, and acute
pain — Urethral discharge recurring frequently — Discharges of semen
during defecation and the emission of urine — Reciprocal influence of
these discharges on the digestive organs — Chronic catarrh of the bladder
— Cauterization — Recovery after several relapses.

M. G , of sanguineous temperament, and robust constitution, con-
tracted the habit of masturbation when about sixteen years old. The fol-
lowing year, he was troubled with disordered digestion, oppression, and
difl&culty of respiration. At the age of twenty-one, he determined to con-
quer bis propensity, but after a few days' continuance, he relapsed, in conse-
quence of the violent erections he experienced. During this contest between
his will and his passion, be one day compressed the urethra forcibly, when
on the point of ejaculation. On the instant, he experienced a sensation of
tearing in the interior of the canal, followed by acute pain, which afterwards
frequently returned ; the following day, after an erection, he felt the glans
wet, and found the orifice of the urethra filled with a viscid matter, resem-
bling a very thick solution of gum. From that time, this kind of discharge
always continued, varying only a little in appearance and quantity, according
to circumstances; the patient's erections became less energetic, and the
sensations produced by ejaculation grew progressively weaker : at the same
time, the functions of his stomach were disordered and frequent attacks of
indigestion took place. At the end of two years, the urethral discharge
increased suddenly after coitus; at the same time assuming a blennorrhagic
appearance. This was treated by emollients and copaiba, and at the end
of three months, the former state returned ; the discharge was easily in-
creased however, by the least error of diet, as well as by very slight venereal
excitement. The patient's erections now became less energetic and incom-
plete ; and, on the other band, his digestion was more and more disordered
and accompanied with colic, flatulence, and constipation — the efforts at stool
giving rise to seminal discharge. Various remedial means were adopted
but without success. At the age of twenty-eight, the patient, after a slight
error of diet, experienced an exacerbation of all bis symptoms, and in addi-
tion, his urine became thick, muddy, and fetid, and its discharge very fre-
quent, and accompanied by an acute pain at the root of the penis, and in
the bladder. In this state the patient came to Montpellier, on the 19th of
April, 1826, being then about thirty. After observing him for several days,
I noticed that his urine was constantly muddy and fetid, and contained a
red sediment, which adhered to the sides of the vessel, and a thick and
flocculent deposit, which fell to the bottom ; a slightly opaque cloud occu-
pying the upper part, while on the surface a thin iridescent pellicle floated.
The urethral mucous membrane was also very irritable, especially towards
the neck of the bladder. On the 2d of May, I slightly cauterized the bladder

140 CAUSES OF SPEEMATOERHCEA.

near its neck, and more severely the prostatic portion of the urethra, closing
the instrument before it reached the bulb. The operation produced its
usual effects. Five days afterwards, the urine no longer contained blood,
and within fifteen days it was passed without pain or inconvenience. A
month after the operation the urine was quite clear, the digestive organs
had regained their energy, and the patient was able to eat heartily without
being inconvenienced. His stools became regular, and were passed easily;
the seminal discharges diminished; his strength returned and allowed him
to take long walks, and his sleep became sound and refreshing. In this

state of convalescence M. G left Montpellier, about six weeks after the

cauterization.

Five months afterwards, I received a letter from M. G in which he

stated that his recovery had proceeded by degrees, and that his health had
been excellent during three months, when he had eaten a large Cjiaantity of
grapes, some of which were not ripe ; a severe attack of indigestion resulted,
after which his old symptoms returned, and strangely enough, he felt, during
the emission of urine, a sensation in the prostatic portion of the urethra re-
sembling that produced by the application of caustic. He had scarcely re-
covered from his relapse, when he a second time committed an error in diet,
which brought on a more serious indigestion than the first, and was followed

by an aggravation of all his former symptoms. In this condition M. G

wrote for advice. Four months afterwards, I received another letter from
him, stating, that before he had received my previous answer he had en-
tirely recovered ; but that, forgetful of the past, he had suffered from ano-
ther indigestion, with another slight attack of his former symptoms. I in-
sisted on the necessity of strict diet, and further recommended a trial of the
sulphureous waters of the Pyrenees. As I have not since heard from this
patient, I am warranted in supposing that his health is at length perma-
nently established.

This case shows us the dangers which may arise from an impru-
dent compression of the urethral canal during the ejaculatory or-
gasm. Such attempts have been made for various reasons — some-
times in the hope of preventing a nocturnal pollution — and they are
generally followed by the same result.

At the moment of emission a kind of tearing of the canal takes
place ; this is attended with acute pain, and, in the case before us,
was followed by a mucous discharge, which continued nearly ten
years.

The patient, as well as the different surgeons who attended him,
regarded his discharge as spermatic, because it was increased by ve-
nereal excitement, and because the patient's virility constantly dimi-
nished, at the same time that the general symptoms of spermatorrhoea
were present. But the circumstances which preceded the discharge
were sufficient to show that it arose from the mucous follicles, inflamed
or irritated by a laceration at some point of the passage. Was it
astonishing, then, that every excitement of the organs should have
increased this discharge ? The blennorrhagic character which it pre-
sented for some time proves, even still more certainly, that the dis-
charge was not spermatic. The changes that took place in the

ABUSE. Ml

patient's health, and in his generative functions, are explainer! by
the occurrence of diurnal pollutions, both during defecation and the
emission of urine ; and the occurrence of these diurnal pollutions
after chronic inflammation of the urethra is easily explained, by re-
ferring to the tendency of irritation to extend from the prostatic
mucous membrane to the adjacent tissues.

In consequence of this disposition, the urinary organs presented
well marked symptoms of chronic inflammation, and the state of
these gives a good idea of what was going on in the spermatic or-
gans.

We must conclude, then, that the constant discharge from the
canal was only an ordinary blennorrhoea, and that the patient's im-
potence, and the derangement of his health, are to be attributed
solely to the spermatic discharges which took place during defeca-
tion and the emission of urine.

I have attached considerable importance to the right understanding
this fact, because attacks of blennorrhagia are often complicated with
diurnal pollutions, and this frequent coincidence has caused the utmost
confusion in the opinions given on the subject, since Aretoaus first
spoke of a constant seminal discharge. It is at once evident, that
the semen being contained in distinct reservoirs cannot constantly
run off" like the secretion of the open mucous follicles. I shall examine
this simple question more fully in a future chapter, but, as I proceed,
I shall show, as opportunities occur, that the symptoms attributed
to these constant discharges arise really from unsuspected pollu-
tions happening during defecation and the emission of the urine.

Another result of this easy extension of irritation from the prostate
to the adjacent mucous membrane in the case under consideration,
was the chronic afi'ection of the bladder, and probably also of the
kidneys. I mention this circumstance here, to show how diSicult
all these complications render the diagnosis of diurnal pollutions.
The urine contained an abundant lithic acid deposit, and was covered
by an iridescent pellicle ; it was also muddy from the presence of a
large quantity of mucus, a thicker deposit occupying the lower por-
tion of the fluid. The abundance of salts contained in the secretion
arose from the irritation of the kidneys; the bladder and the prostate
furnished the greater part of the other matters ; but did the urine
contain semen ? I believe that neither chemical analysis, nor mi-
croscopical research, would have been able to decide this point.

The last drops of urine emitted were of the viscid consistence of
a solution of gum or starch, and this matter could only be semen.

It is unfortunate that these complicated cases should be the most
common, as well as the most serious. But of what importance to
the practitioner is the existence of blennorrhagia, or the mixture of
vesical mucus, of prostatic fluid, or of different salts, with the urine ?
It is not from one symptom only, that he should judge of the disease,
but from the whole. The most important point in these embarrass-
ing cases, is to understand fully the cause and connection of such

142 CAUSES OF SPERMATOEEHGEA.

complications, in order to ascertain a means of cure. Happily, the
same treatment is suited to all the symptoms, because they all de-
pend on the same cause. In this case, for example, the cauteriza-
tion put a stop at the same time to the blennorrhoea, the chronic
affection of the bladder, and the diurnal pollutions — diseases that
had existed nine or ten years.

I may remark, in passing, that the curative effects of cauterization
did not'show themselves, in this case, until a month had elapsed ; and
that from this time they progressed slowly, but steadily, so that the
recovery was complete at the end of three months. This shows the
impropriety of repeating the use of caustic without waiting to see
the effects of the operation.

Two remarkable features in the case were, the influence exer-
cised by the spermatorrhoea over the digestive organs, and the effect
which disordered digestion produced on the genital organs. The
stomach was the organ which first suffered from the masturbation ;
and which, afterwards, was chiefly affected by the spermatorrhoea ;
whilst, on the other hand, a violent indigestion much increased the
severity of the symptoms ; and at a later period, when the cure
seemed perfectly established, four attacks of indigestion were fol-
lowed by an equal number of more or less serious relapses, and by
diurnal pollutions, and irritation of the bladder, with pain in the
urethra, resembling that caused by cauterization. But I shall re-
sume the consideration of this sympathy between the generative
and digestive organs when speaking of the symptoms and treatment
of spermatorrhoea.

The cases which I have related — few in number, but circum-
stantial and varied — are sufficient to give an idea of the principal
abuses of which the generative organs are the seat, and of the man-
ner in which such abuses bring about more or less serious and re-
sisting spermatorrhcea. Of all the causes capable of producing
this unfortunate result, none is, at present, more common. I ought,
perhaps, only to consider here the mode by which abuses act in
producing spermatorrhoea, such being the object of this chapter ;
but the complicated chain of circumstances attaching to the subject,
forbids this ; and I must ascend by degrees to the causes of the
abuses, in order that they may be avoided, or, at least, that their
danger may be diminished. Of such an occurrence it is especially
of importance to prevent the evil, inasmuch as, when once esta-
blished, it is occasionally without remedy, and generally leaves its
traces during the rest of the patient's life. There is, perhaps, no
single question of more importance to the happiness of families, or
to the welfare of society, than this. In order, then, to examine
the numerous facts I have collected in their proper order, I shall
first speak briefly of the causes of abuse.

Causes of Abuse. — These may be divided into two classes :
First, causes inherent in man, or those acting from within ; these
may be considered as predisposing causes; secondly, external

ABUSE. 143

causes, or those arising from accidental circumstances ; and these
may be considered as exciting causes.

Internal or Predisposing Causes. — Of the first class of causes, the
most important is undoubtedly due to the human organization. In
the lower animals the male and female live together, as if there were
no difference of sex, except during the short rutting season. This
period passed, perfect calm is restored. In the human species, the
secretion of semen constantly goes on, from the time of maturity
until extreme old age ; the secretion may indeed be increased or
diminished by excitement or repose of the organs, but, during this
period, it is never entirely suspended as long as the secreting tissues
are healthy. Still, this universal and important fact has been much
neglected : its application is evident.

The form of the superior extremities in the human race also pos-
sesses considerable influence in predisposing to abuse. Many animals
are always fit for fecundation — spermatozoa being found in them at
all seasons. They are, however, unable to excite seminal emissions
without the aid of the female. Other animals, again, which, during
the rutting season, show an almost incredible amount of erotic fury,
are still unable, by their own actions, to cause spermatic discharge ;
their form alone prevents this, for they often attempt it, and a few
even succeed. It is well known with what fury apes are addicted to
masturbation ; the ape being, of all the lower animals, the nearest to '
man in form.

To this original disposition, more perfect in man than in any other
animal, must be added the influence of pathological causes. I
have already spoken of the irritation caused by ascarides in the rec-
tum, of the erections they excite, and of the abuses induced by them.
We shall see, by and by, that herpetic eruptions on the penis and
prepuce may produce the same effects, and I shall show, also, that
an accumulation of sebaceous matter between the prepuce and glans
may have a similar influence. I must also mention irritation of the
cerebellum, as inducing serious abuses, of which I shall give cases in
their proper place.

There is even some connection between the organs of generation
and distant diseases ; for Dr. Desportes has mentioned a kind of
angina, which is frequently preceded by a considerable increase in
the venereal desires, and consequently by a disposition to all kinds
of abuses.

Pulmonary phthisis, also, is often attended by considerable vene-
real excitement. It may as well, then, be at once admitted, that
causes predisposing to masturbation exist in the human organization
itself.

External or Exciting Causes. — Of these, I shall lay particular stress
on such as act before puberty, because they have hitherto attracted
very little attention. The most anxious parents believe that there is
no occasion to watch over the actions of their children with regard to
their genital organs, previously to the epoch of puberty ; and few,

144 CAUSES OF SPERMATORRHOEA.

even of our own profession, are led to suspect bad habits before that
period. This is a fatal error, against which it is necessary to be on
our guard : numerous causes may give rise to abuses, at a much ear-
lier period — infancy being hardly exempt from them. I saw one
unfortunate child, which, while still at the breast, nearly fell a victim
to the stupidity of its nurse. She had remarked, that handling the
genital organs appeased its cries, and induced sleep more easily than
any other means, and she repeated these manoeuvres, without no-
ticing that the sleep was preceded by spasmodic movements. These
increased, and took on a convulsive character, and the child was
losing flesh rapidly, and becoming daily more irritable, when I was
consulted. At first I attributed the disorder to Avorms, teething, &c.,
but my attention being attracted by certain signs, I examined the
genital organs, and found the penis erect. I was soon told all, for
the nurse had no idea she was doing wrong. It was necessary to
dismiss her, for her presence alone sufiiced to recall to the child's
memory sensations which had already become a habit. Time and
strict watching were required before these early impressions were
entirely effaced, Dr, Deslandes relates two similar cases, and Pro-
fessor Halle, in his lectures on hygiene, used to mention many such ;
Chaussier, too, has told me of several that came under his notice ; and
both these observers believed such cases to be less rare than they are
usually considered. These manoeuvres quiet the children very rea-
dily, and nurses always endeavor to obtain quiet at any sacrifice ;
they have no idea of the consequences of their conduct. At a later
period, children are exposed to the same dangers, on the part of the
servants having charge of them ; and in these cases, it is not of igno-
rance that the attendants are to be accused. Many patients have
consulted me, who owed their disorders to this cause ; and in case
61, I have shown the influence which such early abuse exerts on after
life. In some children there is a kind of precocity of sexual instinct,
which leads to very serious results. In these, it often happens that
the sexual instinct arises long before puberty ; such children manifest
an instinctive attraction towards the female sex, which they show by
constantly spying after their nurses, chambermaids, &;c. These freaks
of children are usually laughed at ; but if they were regarded with
more attention, it would become evident that the sexual impulse has
been already awakened. Rousseau, in his confessions, has well
described the influence which early sexual impulse exercised on his
whole life, and I have received numerous confidences of the same
nature, which, however, it would be of no service to relate here.
One case, however, is so remarkable, that an abstract of it may be

instructive. M. D , the son of a distinguished physician, between

five and six years of age, was one day in summer in the room of a
dressmaker who lived in his family; this girl, thinking that she might
safely put herself at her ease before such a child, threw herself on her

bed, almost without clothing. The little D had followed all her

motions, and regarded her figure with a greedy eye. He approached

ABUSE. 145

her on the hed, as if to sleep, hut he soon hecame so hold in his he-
havior, that after having laughed at him for some time, the girl was
ohliged to put him out of the room. This girl's simple imprudence
produced such an impression on the child, that when he consulted
me, forty years afterwards, he had not forgotten a single circumstance
connected with it.

The continual occupation of his mind by lascivious ideas did not
produce any immediate effect, but about the age of eight, the most
insignificant occurrence served to turn his recollections to his destruc-
tion. Having mounted one day on one of the movable frames
which are used for brushing coats, he slid down the stem which
supports the transverse bar, and the friction occasioned caused him
to experience an agreeable sensation in his genital organs. He
hastened to remount, and to slide down in the same manner, until
the repetition of these frictions produced effects which he had been far
from anticipating. This discovery, added to the ideas constantly
before him, gave rise to the most extraordinary abuses, and, after a
time, to excessive masturbation.

I need not mention all the miseries which followed this fatal pas-
sion ; it will be sufficient for me to relate the means to which he had
recourse for its correction. He slept on a very hard bed without a
shirt, in order to avoid all friction, and covered by a single coverlet
sustained by a cradle ; his arms were raised, and crossed over his
head ; a servant remained by his side during the night, with orders to
awake him if he changed his position. When he got up, he put on,
next his skin, a shirt of mail weighing twenty-two pounds, resembling
those worn by the knights of old, except that it had no sleeves, and
that it was attached, at its lower extremity, to a silver basin, fitted to
receive the genital organs, and provided with openings for the thighs.
This shirt of mail was open in front, in order to be easily put on and
taken off; and when on, it was laced up with a steel chain, a padlock
being attached to the end, the key of which was kept by the servant,
who had orders not to give it up on any pretence whatsoever. Guarded
by the silver basin, the genital organs were completely removed from
the touch, a little opening only being left for the discharge of the
urine. As a still greater precaution, the patient had caused four
sharp points to be fixed in front of this case, in order directly to op-
pose any erection. This apparatus he continued to wear for nine or
ten years, although it frequently caused inflammation of the testicles
and spermatic cord, by its pressure. Notwithstanding all these pre-
cautions, the patient's moral and physical condition were deplorable,
which led me to suspect the presence of diurnal pollutions.

I should observe, that in all the cases of which I have just spoken,
the children were five or six years of age — at most eight — that they
did not show signs of puberty for several years afterwards, and that
they were not exposed to the influence of bad example. Their sexual
ideas were, therefore, spontaneously developed, several years before
the development of the genital organs. The same precocity is often

146 CAUSES OF SPEEMATOKEHCEA.

observed in children of the other sex. Of this I shall treat more fully
hereafter; at present, I shall merely call attention to the case related
by Parent du Chatelet/ of a little girl, who, from the age of four
years, gave herself up to the most unbridled abuses.

From these facts an important scientific conclusion may be deduced,
viz., that in many children the genital instinct shows itself with
much energy many years before the age of puberty.

A no less important practical precaution presents itself, viz., that
the age of puberty should not be waited for, in order to surround
children with prudent circumspection, and to prevent their curiosity
from being gratified.

Many parents are remarkably careless on the latter point ; they
permit children of both sexes to play together, promiscuously, for
hours, without any surveillance, provided that they are removed from
all danger of accident, and that their noise is not annoying. The
confidence of many parents, also, in the ignorance of their children,
makes them careless of the marks of familiarity which are given to
each other in their presence ; children's sleep i^ not always so real
or so sound as it seems.

It is sufficient to point out these facts; every person can deduce
the conclusions ; and now I hasten to consider a question, the gravity
of which has been allowed by all who have written respecting mas-
turbation — I mean the influence of example in educational establish-
ments.

If I may judge from my own observations, out of ten persons whose
health has been deranged immediately or remotely from the effects of
masturbation, nine first contracted the habit at school. All that I
have read on the subject has led me to conclude that this proportion
is not exaggerated. A child brought up in the bosom of his family
is, it is true, surrounded by many causes sufficient to arouse his curi-
osity and excite his imagination ; but such causes act accidentally,
and in an isolated manner ; they only produce a serious effect on a
few ardent imaginations ; a thousand circumstances may remove the
attention from them. At school it is admitted that such causes
do not exist, but there are others, less numerous and less varied, but
which operate in a much more active and continuous manner ; the
effects of these are direct, and almost inevitable. The child finds,
on his first arrival, a focus of contagion, which soon spreads itself
around him ; the vice is established endemically, and is transmitted
from the old pupils to those newly arriving. If a few privileged indi-
viduals escape being initiated, they are only such as do not experi-
ence any gratification. But their time will come at a later period ;
when the passions make themselves felt, the same circumstances will
be presented to the mind, under a less disgusting aspect. I shall not

1 Annales d'Hygifene Publique et de Medecine Legale, torn. vii. Ire Partie, 1832,
page 173.

ABUSE. 147

enter into details on this subject ; but from all that has come to my
knowledge, from various and direct sources of information, I do not
hesitate to affirm, that nowhere are obscene books circulated more
freely and boldly, than in educational establishments; that the origin
of the vice is not solely in the scholars, but also in the ushers and
servants ; that the abuses are not always confined to masturbation:
and that they are not always propagated by example or persuasion,
but are sometimes enforced by threats and violence. Let it not be
thought that I am now speaking of rare and exceptional cases, or
that I exaggerate ;^ I possess multiplied and convincing proofs of
my assertions. I would not, either, that I should be misunderstood.
I am far from denying the advantages of education in a public
school ; and I am ready to admit that the competition among a num-
ber of children produces emulation, forms the future character, early
shows each his own value, and lays the foundation of friendships
which endure through life.^

A too sedentary life is injurious at all ages, especially in child-
hood, when there exists such constant desire for exercise and change.
Gymnastics, therefore, should on this account alone occupy an im-
portant position in the system of education; but they must be viewed
under a much more serious aspect. Nothing can prevent the genital
organs, at the time of their development, from reacting on the eco-
nomy and giving rise to new sensations and ideas. It is impossible
to prevent the attention from being attracted by the impressions
caused by these organs ; impossible to restrain the imagination and
to prevent it from frequently dwelling on such impressions. The
slightest circumstances may, in such a case, lead to a fatal discovery,
even if the information be not transmitted directly, and enforced by
example. How are such discoveries to be prevented ; or rathei-, how
are their results to be guarded against? Study gives us no aid here;
indeed the continually sitting necessarily heats the organs already too
excited. The eyes may be fixed on the book, the ears may appear to
listen to the master, but who can guard against the wandering of the
imagination ? At night it is still worse ; no surveillance can prevent
this. There exists only one means capable of counteracting it, and

• M. Lallemand, of course, speaks of the colleges and private schools in France. I
regret to say that his statements apply with nearly the whole of their force to the
schools of England. Vice is common in them, neglect of physical education and the
contracted nature of the studies to which pupils are confined in our classical semina-
ries — the understanding being unappealed to, and the reasoning faculties unexercised
— the natural sciences neglected, and the whole of the pupil's life until the age of
seventeen employed in the study of the dead languages — are matters of vital import-
ance to which society has only recently begun to direct its attention. [H. J. McD.]

* M. Lallemand enters very fully on the subject of education as conducted in France,
and well exposes the errors of the system. Most of his remarks apply to our own
educational system, yet, as the subject is not strictly medical ; and as, moreover, M.
Lallemand has treated it at considerable length, I think it best to refer those of my
readers who may wish information on it to the original work. Vol. I. page 425.
[H. J. McD.]

148 CAUSES OF SPERMATOEEHCEA.

that is, muscular exercise carried so far as to induce fatigue. This
alone is able to deaden the susceptibility of the newly acting organs
which excite the economy ;' exercise alone, by requiring matter for
the repair of the muscular waste it causes, withdraws a stimulus from
the genital organs, and induces sound and refreshing sleep.

Varieties of Apuse, — I think it will be useful for me to give a
few details, respecting the different kinds of abuse which have come
under my notice, and of which I have seen the hurtful influence on
the genital organs. I shall omit all such remarks as have not a
strictly practical bearing.

We have already seen the dangers to which compression of the
urethra, to prevent the discharge of semen during ejaculation, may
give rise (case thirty-five). In the case I have related, it seems likely
that a rupture took place in the mucous membrane, because the
patient felt, at the instant, an acute pain, and the following day a
discharge commenced, which continued until the application of the
nitrate of silver. Soon after the commencement of the discharge,
involuntary seminal emissions occurred, attended with serious
symptoms. It was immediately behind the glans that this patient
compressed the urethra, and it is quite conceivable that the sudden
and violent distension of the canal might cause a tear in the mu-
cous membrane. But this is not always the case ; one of my patients
writes as follows : "At the age of fourteen I practised masturbation
three or four times a week, and sometimes frequently during the day.
In order to prevent the discharge of semen, I compressed the root
of the penis firmly. Nothing escaped at the time, but I soon ob-
served that the semen was discharged with my urine, the first time I
passed it. I followed this practice for about two years."

Diurnal pollutions soon appeared, and grew more and more seri-
ous. The remainder of the case presents nothing which is not met
with in all cases of spermatorrhoea. What I wish to call attention
to here, is, that the compression was made close to the orifice of the
ejaculatory ducts, and that the patient thought at first that his ma-
noeuvres were not followed by any loss of semen, although he at
length discovered the contrary. Fournier and B^gin report a similar
case.* It was that of a young man who, at the moment of ejaculation,
compressed the most remote p;irts of the urethra, so that not a single
drop of semen could escape. Yet the result was the same as in ordi-
nary cases. Notwithstanding his precautions, his strength dimin-
ished, and his disorder made just as rapid progress as if the seminal
emission had been perfect.

The following is even a more remarkable case. I shall allow the
patient to speak for himself "I am thirty-two years of age, and I
have had nocturnal pollutions from the age of fourteen ; I have also
suffered from discharges while at stool, for ten years. The cause of
these pollutions cannot be referred to masturbation, for I have not

' Dictionnaire des Sciences M^dicales, art. Masturbation, page 125.

ABUSE. 149

practised it twenty times during my whole life. The pollutions are
rather owing to reading obscene books, for they commenced soon
after. At first, ejaculation was preceded by dreams, and accompa-
nied by active erections and acute sensations, the semen being ejacu-
lated with force. I tried various means to prevent these discharges.
I have slept, during whole nights, with my penis dipped in cold
water, or compressed between two pieces of wood formed on purpose.
I have tried to keep myself awake in order to prevent an emission,
because, when I succeeded, the following day I felt stronger, but
after two or three nights, sleep always overpowered me ; I often
awoke, however, in sufficient time to prevent the catastrophe of my
dreams, but frequently it was too late ; on such occasions, to delay
the discharge or render it less copious, I compressed the base of
the penis firmly; but it seems that these compressions greatly injured
the parts, without preventing or diminishing the discharge, which
took place inwardly, as I have often been convinced by inspecting
ray urine. From that period the pollutions have no longer been pre-
ceded by dreams ; and the sensations have left me, so that I am not
now aroused from sleep. My erections diminished, and have even,
latterly, ceased entirely. For three years erections have rarely ac-
companied the emissions ; when they do occur I am always less
fatigued.

" There is one thing which I have not been able to understand,
and which will, without doubt, appear absurd to you ; it is, that I
experience pollutions without erection, sensation, or the escape of
semen by the urethra. I believe that the discharge passes in a retro-
grade direction, and becomes mixed with urine, because, the next
morning, I find little globules, a cloud and filaments, in that. fluid,
just as when I formerly prevented ejaculation by compressing the
root of the penis; whilst my urine contains nothing during the day,
or the next morning when I have not experienced these pollutions.
On waking, I am perfectly aware of what has occurred, by the sweat
that covers my face, the fatigue I feel in all my limbs, the headache
and dazzling that affect me, the dark circles that surround my eyes,
&c. I have tried cold and iced applications, with slight benefit.
For some time the pollutions were rarer, and were accompanied with
erection and sensation; but soon they became as before, and emission
did not take place outwardly. These internal pollutions have always
been the most weakening. Whenever I succeed in passing the night
without sleep, my urine is transparent in the morning, and I feel
strong. After several nights without sleep, I generally have an ener-
getic emission, which fatigues me little; but soon those witliout erec-
tion and without external discharge return, and then I always feel
worn out on waking."

This patient's medical attendant would not believe in the possi-
bility of pollution without external discharge ; but it seems clear that
the patient really had internal emission, without perceptible dis-
charge ; that is to say, that the semen passed into the bladder, and was
10

150 CAUSES OF SPEEMATORRHCEA.

discharged with the urine, as had occurred before when ejacuhition was
prevented by pressure on the perineum. This compression was made
in front of the ejaculatory canals, and was very often repeated. It
seems, therefore, likely that it was the frequent repetition of these
manoeuvres that, at length, caused the spontaneous passage of the
semen into the bladder. But this is a question to which I shall have
occasion to return.

Yet all these manoeuvres scarcely differ from the various means
recommended by some surgeons for preventing nocturnal pollutions;
and we may thus perceive how little confidence is to be placed in the
instruments invented for that purpose, and the inconveniences to
which they may give rise. It seems likely that the dangers would
be nearly the same, in whatever part of the penis the compression is
made ; except that if there be sufficient space in the urethra, between
the point compressed and the ejaculatory ducts, to contain all the
semen, it would be discharged directly the compression is removed.
When on the other hand, the compression is made immediately in
front of the orifice of the ejaculatory ducts, the semen flows back, at
least, in great measure, so as to induce the patient to believe that the
discharge has been stopped, or at all events, in great measure di-
minished, and to induce a degree of security which leads to further
abuses.

But to return to the description of the abuses which have been
admitted to me by so many other patients.

One of these informed me, that about the period of puberty, while
hanging one day by his arm, he experienced an energetic erection
accompanied with pleasure, and that by his efforts to raise his body,
he caused an abundant seminal emission. This was the first. The
next day he repeated the same motions, and noticed the same phe-
nomena, and from that time he knew no other pleasure. From the
principles which had been early instilled into him, he would have
thought himself degraded by connection with a female, or by the least
mutual contact with his genital organs ; but his conscience was quiet
with regard to these practices, because they had not been forbidden
him. He continued, therefore, to hang by the hands, from the fur-
niture, doors, &c., without being suspected by any one, and fell, by
degrees, into a state of debility and wasting equal to those caused
by the most unbridled masturbation. After a time, from weakness,
the patient lost the power of hanging, and his voluntary emissions
ceased ; but they were soon replaced by nocturnal emissions, which
were very difficult of cure.

The following are a few passages from a letter I have recently
received. "Being of an ardent temperament, I abused myself, from
the age of eight years, by practising masturbation, or rather, by still
more hurtful manoeuvres. By compressing the penis between my
legs, or against the seat on which I was sitting, I produced excite-
ment, which was commonly followed by the discharge of a few drops
of a viscid and transparent fluid. This practice I repeated several

ABUSE. 151

times a day, up to the age of sixteen, when I ceased entirely, having
been frightened by the discharge of nearly pure blood, which occurred
several times. From this time I only sought natural enjoym.ents, but
I found it impossible to obtain a complete erection. This state was
attributed to weakness, and was combated by tonics, stimulants, and
even irritants of all kinds, which have done me much injury. I used,
also, cold bathing and cold lotions.''

1 have seen an officer of high rank who had fallen into the same
condition, from the practice of similar manoeuvres. He experienced
his first sensation against the leg of a table, at the early age of ten
years, and continued for several years to employ the same means. I
have already related the case of another child, who allowed himself
to slide down a wooden pole, and the deplorable influence which this
circumstance exercised on the remainder of his life.

In a few of my patients, horse exercise caused the first seminal
emissions. I shall relate, by and by, the case of one of these who
knew scarcely any other pleasure, and who became quite impotent at
the age when virility is generally greatest. The extreme suscepti-
bility which the genital organs manifest at the period of puberty,
should prevent horse exercise from being commenced about this
period, as is usually done. It should be begun a few years earlier,
or a few years later.

I have already spoken of the danger of allowing children to sleep
on the abdomen (see case thirty-three); I should add, that many of
my patients thus contracted habits which ruined their health. Inde-
pendently of the inconveniences to respiration, digestion, &c., which
arise in this position, erections are favored. The least friction
awakens new sensations, and once on the track, progress is soon
made. Sometimes recollections have caused the choice of this, posi-
tion ; of this I have related a remarkable example (see case thirty-
four) ; at other times, scruples early instilled by a sage foresight, but
which the violence of the impulse has at length succeeded in eluding,
have induced it. Thus, I have been told respecting one of my
patients, that he would suffer death rather than defile himself by
touching the genital organs, yet, for five or six years, he seldom
passed a night without working his own destruction while lying on
his abdomen. It is not necessary for me to enter into a description
of the other means by which patients have sought to satisfy their
genital impulses, without transgressing the religious and moral prin-
ciples which had been taught them from infancy. Suffice it to say,
that if they have succeeded in satisfying their consciences, they have
not succeeded in preserving their health.

But to abstain from all direct action on the genital organs, is not
always sufficient to preserve the patient from serious disorders. A
purely nervous exitement, awakened by the other senses, or directly
produced by erotic ideas, may bring the same results as the worst
abuses if prolonged or repeated erections are caused by it. The
following are a few such examples: —

152 CAUSES OF SPERMATOERH(EA.

A student, aged twenty-two, born in Switzerland, of sanguine
temperament, and great muscular power, fell into the most complete
state of impotence, after having been for some time exposed to un-
gratified excitement. He had never practised any solitary vice; but
violent and prolonged erections came on, and were produced during
the day by the influence of the memory. These erections caused
abundant and frequent nocturnal pollutions. Absence put an end to
the excitement. The nocturnal pollutions diminished by degrees, and
at length ceased entirely. Yet this patient fell into the same state of
impotence as if he had committed the greatest excesses in masturba-
tion, and at the same time preserved the appearances of health and
strength. The cause of his impotence was evident on examining his
urine, and causing him to watch for diurnal pollutions while at stool,
but the cure of these pollutions was only perfect after two years'
treatment.

I have seen another case of the same kind, in a young man who
passed from a state of habitual priapism to one of absolute impotence,
without any other cause than violent excitement of the genital organs
by an ardent attachment ; he had never given way to excess of any
kind. I shall record by and by another case of the same kind. I
also had under my care an English officer, who left Calcutta in per-
fect health and arrived in London completely impotent, after having
suffered during two months from almost constant erections, excited
by the presence of a female on board ship. This state, so opposed to
that which had preceded it, continued for two years — the whole of
this time not being marked by the least sign of virility. It is scarcely
necessary to add, that this state was produced by diurnal pollutions.

I related a case, a few pages back (page 136), in which nocturnal
pollutions were caused by reading an obscene book : I have seen a
multitude of cases of this nature. From these I conclude, that in
certain very excitable individuals, reading such works, the sight of
voluptuous images, lascivious conversation, in a word, all things that
can excite or keep up irritation in the spermatic organs are capable
of producing the same effects as actual abuse, even when the will is
sufficiently powerful to prevent the thoughts from leading to the acts.
On the other hand, an abundant secretion of semen with importunate
erections, irritation of the urethra and prostate, always results under
such circumstances ; and these favor the occurrence of nocturnal and
diurnal pollutions as serious, and perhaps more difficult of cure than
those produced by masturbation, because it is impossible to act di-
rectly on the memory or the imagination.

It is not sufficient then to prevent all material action on the genital
organs ; it is necessary also to prevent all erotic excitement of the
senses and all concentration of the ideas on lascivious objects. For-
tune's favors are so distributed that numbers live in absolute indo-
lence without being blamed by the world, because they demand
nothing of any one. This inaction produces results, the only remedy
for which that I am aware of, is daily fatigue of the body by various
kinds of exercise.

ABUSE. 153

Effects of Abuses. — The effects produced by the different kinds
of abuse of which I have been treating, vary according to the age of
the patient, his idiosyncrasy and the different organs chiefly affected.
I have laid particular stress on the causes which may lead to bad
habits some time before puberty ; I must now consider their effects
during this period.

The symptoms arising from masturbation in the child have been
always hitherto confounded with those produced in the adult ; they
present certain distinctive characters, however, which require our
consideration. However young they may be, children lose tlesh, and
become pale, irritable, morose, and passionate; their sleep is short,
disturbed, and broken. They fall into a state of marasra, and at
length die, if not prevented from pursuing their courses. Examples
of such a termination are so well known that I forbear to quote them.

Analogous symptoms are shown in the adult — follow nearly the
same course — and may lead to the same termination ; but in infancy
more or less severe nervous symptoms are superadded, which are not
found in those who have commenced the practice after puberty, or
which at least are not in the latter case manifested to the same extent.
Such are spasms and partial or general convulsions, eclampsia,
epilepsy, and paralysis, accompanied with contraction of the limbs :
these phenomena were present in all the children whose cases I have
noticed, and numerous similar facts have been published by different
authors.

Contractions of the limbs have been well investigated by Dr. Guer-
sent,^ and he notices that they especially affect such children as are
lank, unhealthy-looking, nervous, and worn out by bad habits.

The following case is sufBciently remarkable. In 1824 a woman
brought her son, aged eight, to the hospital St. Eloi ; he had lost
the use of his lower extremities for some months. The limbs were
fixed, and drawn together, and all the muscles contracted. The child
was extremely thin, and his intellect was much-disturbed. Mastur-
bation, the cause of all these disorders, had only been discovered by
his mother a few weeks before she placed him under my care, but she
had used every means she could devise to prevent it, without effect.
After two or three trials I found it was of no use trusting to the
strait-waistcoats and other means usually employed, and accordingly
I determined to pass a gum-elastic catheter into the bladder, and to
fix it so that the patient should be unable to withdraw it. The pre-
sence of the foreign body excited inflammation of the urethra, as I
expected : when this occurred, I withdrew the instrument, but re-
placed it as soon as the inflammation had subsided. I kept up, in
this manner, a constant state of inflammation for a fortnight, which
rendered the parts so painful that the child was unable to touch them.
This treatment produced more decisive success than I had ventured

1 Gazette Medicale de Paris, Fevrier, 1842.

154 CAUSES OF SPEEMATORRHCEA.

to hope; within eight days the lower extremities had regained suffi-
cient streno-th and mobility to allow the child to get up, and in ano-
ther fortnight he was able to run about the wards. I then sent him
away, threatening him with a return of the same treatment if he re-
lapsed. The pain caused by the catheter seemed to have removed
all the other impressions, for his health continued good, and growth
followed its ordinary course,

I have since employed the same means in many cases, with just
as much success, and I think it more sure than any other, because it
is impossible to rely on the patient's will, or on the assiduity of those
who are appointed to watch over him. In children too, it leaves an
impression on the memory, which is often sufficient to destroy the
empire of habit, and to prevent a return to the former manoeuvres.

But to resume the consideration of the symptoms observed in chil-
dren. In childhood, seminal emissions are never experienced, but
nevertheless the patients fall into a state of marasm, to which some
even succumb. These effects, like those observed under the same
circumstances in the female, have induced some authors to leave out
of their consideration the seminal discharges which are produced by
the same acts at a later period. They have attributed the debility
which follows all abundant discharges of semen to the nervous ex-
citement and convulsive motions, which usually accompany the dis-
charge. The accidents observed before puberty are evidently only
due to the effects on the nervous system ; and, the same sensation
accompanying voluntary emissions after puberty, it is natural to sup-
nose that the nervous system plays as active a part then, as in child-
hood. I willingly admit the importance of this nervous exhaustion,
in whatever manner it may be supposed to operate ; and supposing,
even, that its action on the economy is just as important as during
childhood (which is not the case, as I shall presently show), this is
no reason why the actual discharges should not be taken into account,
seeing that they greatly modify the character and consequences of
the nervous disturbance.

I have already noticed that the symptoms produced by abuses
during childhood present a spasmodic character : this character, with-
out doubt, is derived from the predominance of the nervous system
at that period, rendering children so alive to external impressions.
This excessive sensibility also explains the great disorder of the eco-
nomy which children suffer from such manoeuvres. Deslandes^ re-
lates a case, showing that any action of the same kind may produce
the same effects at this early age. He says: " An observer worthy of
credit. Dr. Nurambeau, has communicated to me the case of a child
who procured himself similar sensations by drawing out the navel.
His health became much disordered from the effects of this strange
habit, which had such a power over him, that coercive measures were

' De rOnanisme et des autres abus v^neriens, page 462.

ABUSE. 155

required for its correction. It is worthy of remark that this patient
showed neither erection, nor any other phenomenon of the generative
organs, which at all referred to sexual intercourse." The organs of
generation, therefore, had no influence in producing the sensations
experienced by this child ; but the repeated titillation of a very sensi-
tive part produced the same disorder as masturbation.

It was proved jn the debates on a recent criminal trial that death
may be caused by prolonged tickling the sole of the foot. Nervous
disorder, arising from such proceedings, may then be carried so far
as to cause death, and from this may be imagined the effects of the
multiplied convulsive shocks which irritable children produce/ by
acting on the most sensitive organs in the economy.

Every excessive loss of semen also, even when unaccompanied by
sensation, is followed by debility, and this may be carried so far as to
cause death ; I have related several such cases in the beginning of
this work.

There exist, then, two distinct causes ; nervous disturbance and
debilitating discharges, and both these act at once, when seminal
emissions are produced by the influence of the will. It is not to be
wondered at, that both these causes should produce nearly the same
symptoms, because they both weaken the economy. The action of
the first on the nervous system is direct and immediate, and the
symptoms that result from it are of a more spasmodic character. It
is very easy to confound these two causes when they act simultane-
ously ; but I have just shown that they can be considered separately.
The following reason shows the importance of so doing.

Whenever we succeed in entirely putting a stop to the habits of
abuse in children, we may make sure of obtaining their return to
health, and that very quickly. This I have remarked in all the cases
of children that have come under ray care. I do not mean to infer
that the disorder done to nutrition during the progress of development
is easily repaired, but that the acute symptoms rapidly disappear, and
that all the functions are quickly re-established. If the effects pro-
duced are active and serious they cease very rapidly, as soon as the
cause is removed, and return to health becomes certain. Unfortu-
nately, matters do not follow so simple a course after puberty.

What I have just said respecting children, applies equally to
females : this is easily shown by examining the cases in which excision
of the clitoris has been performed for the cure of nymphomania. The
state of these unfortunates must have been deplorable indeed, to justify
the resort to such means ; yet they recovered very rapidly.

Why in these two classes of cases, is the cure certain and the
return to health rapid, as soon as the vice has been mastered ? It is
that the cause of the weakness immediately ceases to act on the
economy. Why is it that so many men continue to waste away after
they have entirely left off their habits of abuse ? It is because diurnal
pollutions have commenced, which are even more debilitating than
the abuses which gave rise to them.

156 CAUSES OF SPERMATOERHCEA.

Dr. Deslandes and many others have discovered that there is a
great difference in the conditions of persons who have practised
masturbation for some time, and then renounced it ; but they have
not sought the explanation of this fact. It is, however, very im-
portant to know why some are cured rapidly and completely, while
others continued to suifer and languish during the remainder of their
lives. The symptoms^experienced by the latter ^-e those produced
by diurnal pollutions.

But if we inquire why some should be affected by diurnal pollutions
while others are exempt, we discover that we have been comparing
two very different classes of patients. The one class conquered their
bad habits by the force of their will ; the other class were compelled
to renounce them by impotence. The former resisted their desises
while they were yet active ; they required much perseverance and
moral energy in order to succeed; the latter only left off as they were
less tempted — the progressive decrease in their erections being due
to the presence of undiscovered diurnal pollutions.

Such patients deceive themselves as to the cause of their changing
their habits, and are astonished at not iSnding any benefit arise from
such change. Some of them even remark to their medical attendants
that it is after they have left off their mal-practices that their health
has become altered.

All these circumstances, embarrassing at first sight, are easily ex-
plained on a little reflection. At first the genital organs are healthy ;
the constitution is uninjured ; no seminal emissions occur except
those that are induced voluntarily ; and the activity of the digestive
organs permits a rapid repair of the losses. But as soon as irritation
is set up in the spermatic organs, a large quantity of semen is secreted
and escapes every day, and several times a day, without the patient's
knowledge; the digestion is disordered; the erections and voluptuous
sensations diminish, because the semen is less perfectly formed ; the
provocatives are therefore weakened by degrees, and the patient
renounces, without difficulty, habits which only inspire him with dis-
gust. He wonders that his health still continues to grow worse, for
he has not discovered that he passes daily, by often repeated evacua-
tions, more semen than he formerly passed in a perceptible manner,
and he does not take into account the difficulty felt by his economy
of repair'ing these frequent discharges.

We must not, then, confound those, whose virility leaves them, with
those whom the power of their will causes to recover, and we must
not be surprised at seeing the alteraiion in the habits of each followed
by very different consequences.

In order to make the distinctive characters of these two positions
clear, I have laid stress on their most striking points, but there are
numerous slight shades of distinction, which I have not mentioned.
For instance, in some cases the two classes of phenomena occur suc-
cessively in a very distinct manner, at very near periods. Many
patients having corrected themselves once, find their health promptly

ABUSE. 157

re-established. But when, after recovering their strength, they have
relapsed into their former habits, on renouncing them a second time
thej obtain no benefit. These different results under apparently
similar circumstances can only be explained by the occurrence of
diurnal pollutions in consequence of the return to the habits of abuse.

Case thirty-one is a clear and perfect proof of the correctness of
this explanation ; the patient recovered twice after having twice
conquered his passion, but the third time he only gave it up through
disgust, and his health continued to deteriorate until cauterization
arrested the diurnal pollutions from which he suffered.

There are many circumstances which interfere with the good reso-
lutions of those addicted to masturbation. After a few days of abso-
lute continence, attained with much difficulty, they frequently suffer
from nocturnal pollutions, the more frequent and the more abundant
in proportion as the spermatic organs have been much irritated: the
patients always feel more debilitated by these involuntary discharges,
than by those which they previously excited. Instead of combating
these pollutions by suitable means, or after having employed one or
two plans unsuccessfully, they think they will be able to diminish the
evil by recurring to their former habits at distant intervals, and they
thus relapse, increasing still more the irritation of the parts. Soon
after diurnal pollutions commence, and rapidly produce their effects,
but as these are not discovered, the patients rejoice to find the noc-
turnal discharges gradually disappearing. But their health daily
grows worse : this they cannot comprehend, and are frequently led
to imagine that they have mistaken the cause of their disorder.

Sexual intercourse has been generally recommended in such cases,
and sometimes with advantage; but this means is like all others, the
patient must be able to employ it, and even then it is necessary to
distinguish the circumstances in which it is hurtful, from those in
which it is advantageous. Very often the patients find intercourse
impossible; while, on the other hand, many of those who have been
able to accomplish the act, have had an exacerbation of their symp-
toms as the result.

Whence arises this difference of result, in individuals placed in ap-
parently similar circumstances? Some have diurnal pollutions kept
up by the irritation of the organs, while others are exempt from them.

All authors consider masturbation to be one of the most frequent
causes of hypochondriasis, but the reason why this affection con-
tinues so long after the patients have left off the habit has not been
hitherto explained. If it only arose, as has been supposed, from
weakness of the system, or disorder of the nervous functions, how
is it that the various modes of treatment employed — the travelling,
exercise, and amusements of every kind, should produce no effects ?
In every case of this nature that I have met with, I have found the
hypochondriasis kept up by diurnal pollutions, which were unsus-
pected by most of the patients ; the intellectual and moral faculties,
together with the digestion, sleep, kc, improved in such patients in

158 CAUSES OF SPEEMATOEEH(EA.

proportion as the pollutions diminished, and the return to health was
complete as soon as they had entirely disappeared. The thirty-
second case is a remarkable instance of this kind, and shows the
strano-e monomania which accompanied hypochondriasis, as well as
the rapidly beneficial effects derived from cauterization of the urethra.
Many authors have noticed the indifference which persons addicted
to masturbation show towards the opposite sex. This sentiment is,
indeed, very common in those who have carried their abuses to a
great extent; but I do not think it arises, as has been stated, from
the long habit of solitary vice: at all events, I can assign a more
direct cause for this indifference, viz., the relative impotence of the
patients ; I say relative impotence, because they possess sufficient
power of erection to permit the practice of masturbation, but not
enough to admit of sexual intercourse ; and such patients seldom
manifest any dislike to the opposite sex until they have experienced
several disappointments, the remembrance of which constantly haunts
them. Their views change immediately that the diurnal pollutions
which kept up this impotence are arrested.

Effects of Temperament, Idiosyncrasy, cbc. — The effects of abuses
vary much in their characters and intensity according to the indivi-
duals attacked. Some persons are uninjured by the most unbridled
abuses, even when long continued, whilst others are very quickly
disordered by slight abuse. In this respect I have witnessed very
opposite cases with every variety of intermediate degree.

Temperament seems to have little influence in producing this ine-
quality of resistance. Strength or feebleness of constitution is not of
so much importance as might be supposed. The very unequal power
of the genital organs affords the only satisfactory explanation. I
shall refer to this point more fully when treating of venereal excesses.

Idiosyncrasy: in the same individual all the organs are not equally
affected by abuse ; this is shown by the frequent predominance of
certain symptoms which give to the case a particular appearance, and
are apt to lead to grave errors of diagnosis and treatment. I have
related many cases in which this occurred. The presence of special
symptoms, whenever a generally debilitating cause acts on the eco-
nomy, arises from inequality of development, or of activity, existing
in certain organs. I shall, at present, only consider the direct and
immediate action of abuses on the genital organs, so as to show the
mode in which they produce nocturnal and diurnal pollutions.

Urethral discharges. — Attacks of blennorrhagia are more frequent
in persons addicted to masturbation, than is generally supposed.
Cases of this kind have frequently fallen under my notice ; in the
greater number of these patients the discharge was small in quantity,
viscid, and nearly transparent, or very slightly colored. It scarcely
differed in appearance from the prostatic secretion. But in many
patients the discharge was abundant, more or less colored, and
attended with pain in the urethra, especially during the passage of
urine. Several suffered from all the symptoms of a contagious

ABUSE. 159

blennorrhagia; in others the same symptoms recurred two or three
times, and in one patient the discharge reappeared as many as five
times, always from the same cause. It is worthy of notice, that there
existed a kind of intermittence in the habits of the last mentioned
patients ; after having been moderate or even quite continent for
some time, they recommenced masturbation with fury, and the ure-
thral • discharges supervened on these relapses. Two of my other
patients suffered from stricture of the urethra after one of these at-
tacks of blennorrhagia, just as occurs after contagious blennorrhagia,
and in one of these cases, the stricture was very tight and very dif-
ficult of cure.

I should remark, that I am now speaking of patients who had
never had sexual intercourse, and that I leave out of the question
such as had suffered from cutaneous affections, in which the urethral
mucous membrane might have participated. I must add that thirteen
of such patients had not reached the age of puberty when the dis-
charges occurred.

These discharges not having been excited by any virus or by any
constitutional disposition, must be referred to the effects of mastur-
bation. Many of them having occurred before the age of puberty,
it is evident that they could not consist of semen.

Prostatitis. — Several of my patients suffered from retention of
urine after the most frightful abuses ; and it was necessary to relieve
some of them with the catheter. In one patient an abscess formed
in the prostate, and discharged through the perineum.

Cystitis. — I have related many cases of acute and chronic cystitis
of which masturbation was the sole cause.

Emissions of Blood. — Some of my patients had carried their pas-
sion so far as to provoke emissions of pure blood, or of semen mixed
with blood. Authors contain many such cases, which show that the
pathological condition of the urethra has extended itself to the lining
of the seminal vesicles. Other patients suffered from more or less
severe attacks of hgematuria ; many experienced irritation of the
bladder and kidneys, attended with an abundant secretion of bloody
urine and constant desire to pass water ; sometimes even micturition
was involuntary. Thus the inflammation or irritation caused by
masturbation, may, like that accompanying blennorrhagia, extend by
degrees, until it reaches the kidney. It will be easily believed
that the irritation does not extend in this direction only.

Orchitis. — I- have seen several cases in which the patients suffered
from acute attacks of orchitis, after furious masturbation ; and fre-
((uently such orchitis has required very active treatment for its relief.
In one case the patient had not reached puberty when this occurred.
In many such cases no doubt accessory circumstances existed, al-
though the patients attributed the development of the orchitis only
to masturbation. Others more slightly affected experienced pain in
the testicles and spermatic cord, accompanied with swelling of the
epididymis. Others, again, suffered a painful sense of tension. They

160 CAUSES OF SPERMATORRHCEA.

felt as if the testicles were held in a vice or squeezed by a hand of
iron. In many, the least contact of the parts with the clothes was
insupportable, and the weight of the testicles caused very severe
dra'Tcrintr pain. In all such cases the patients were obliged to wear
suspensory bandages, and often to guard the testicles from friction,
with cotton, wool, or swansdown.

These symptoms, which I have considered separately, generally
occur together, and often form varying groups,»which present special
appearances, depending on the predominance of one of the symptoms.
Sometimes the patients mention one circumstance only, because that
one alone has attracted their attention; but when questioned, they
recollect many others which appeared trifling by the side of the more
serious one. It is also important to remark, that diurnal pollutions
generally follow very soon after the appearance of these symptoms,
and that the patients are a long time without discovering them, and
sometimes only detect them when taught what to expect.

The more we reflect on these morbid phenomena, and the course
of their appearance, the more striking is the resemblance between
the efi"ects of excessive masturbation, and those of blennorrhagia. I
admit that the symptoms do not always present the characters of
well marked inflammation, but they at least show those of active
irritation of the parts. It is easy enough to give a clear explanation
of what passes in all cases of this kind, with perhaps some slight
shades of difference. The testicles secrete more semen, which is im-
perfectly formed ; the seminal vesicles, participating in the state of
irritation of the neighboring organs, do not easily bear its presence ;
they contract more readily, as they are more easily affected by
external impressions. Hence, it becomes more and more difficult
to avoid nocturnal pollutions; after a little time diurnal pollutions
occur, and become more and more frequent and abundant ; that is
to say, there is a constant disposition in the seminal vesicles to con-
tract spasmodically and expel their contents.

On the other hand, the semen, ill-secreted by the testicles, and
remaining a shorter time in its reservoirs, becomes thinner and more
watery ; and by degrees, as it loses its physiological characters, it
also loses its normal properties ; it becomes, therefore, unfit to pro-
duce its efi'ects on the seminal vesicles. The erections are conse-
quently less energetic and less lasting, and after a time incomplete
and fleeting ; whilst in the end, in severe cases, they disappear al-
together. Hence tne embarrassment and timidity of such patients
in the company of females, and the fear they experience of finding
themselves in a position to expose their impotence ; and hence their
indifference and even aversion for the sex, and the constantly in-
creasing difficulty they experience in changing their habits. Such
abuses, then, because their eff'ects remain long after the habits have
been altered, bring on symptoms, of which the cause is unsuspected.
This is the reason why the health of some continues to deteriorate,
whilst that of others is re-established as soon as they have renounced

VENEREAL EXCESSES. 161

their mal-practices : this is -why tonics, aphrodisiacs, cold bathing,
and iced drinks, produce effects so different from those expected.

There are undoubtedly cases in -which the spermatic organs are
weakened and relaxed ; I shall relate several instances of this in a
future chapter ; but we shall then see that such a state arises from
primary relaxation of habit and rather from want of use of the
organs than from their abuse.

In concluding my remarks on the subject of masturbation, I may
observe, that it is the most dangerous of all vices of this nature, be-
cause it is the most difficult to discover and to prevent, and because
it does not require any assistance for its consummation. From the
cases I have seen, I conclude that the irritation excited by such
manoeuvres very easily induces involuntary discharges ; that the ap-
pearance of nocturnal pollutions in those who attempt to abandon
the vice often causes them to return to their former habits, and that the
diminution of virility which follows, far from favoring the patient's
amendment, frequently hinders it by proving an obstacle to their
having sexual intercourse, while it does not prevent them from con-
tinuing their bad practices. This circumstance is a powerful cause
of the disorders which attend such as are reduced by vicious habits.

CHAPTER VII.

CAUSES OF SPERMATORRHEA.

Venereal Excesses.

I consider venereal excesses to consist of all sexual intercourse
carried beyond the actual wants of the system.

CASE XXXVI.

Nervous temperament— ^Excessive intercourse at the age of twenty-one, con-
tinued during eighteen montha — Increasing derangement of health — Si/mp-
toms of gastritis, and. of disease of the heart — Repeated abstraction of
hlood — Nocturnal and ajterwards diurnal pollutions ; Milk diet, &c. —
Acupuncture followed hy perfect recovery.

Whilst in Paris, in 1822, I was called in consultation with MM. Dupuy-
tren, Broussais, and Kecamier, to consider the case of a young man who
was supposed to be affected with cardiac disease, accompanied with chronic
gastro-enteritis. We could not quite agree on the importance of the two
orders of symptoms, but the indications appearing the same in each, a
course of treatment and regimen was determined on, which I undertook to put
into execution. Before proceeding, however, to repeat the abstraction of

162 CAUSES OF SPERMATOREHCEA.

blood, which had already been practised several times, and from which the
patient had never experienced relief, I questioned him further. My opinion
respecting his disorder changed from the information I then received. The
following are the facts : —

]y[_ E. g_ . wa.s short, thin, and very dark ; of a nervous temperament,

and an ardent and bold character. His parents were healthy : he had been
early inured to exposure to the weather, and to the rudest exercise ; and
by an active life had avoided all bad habits, as well as all commerce with
women.

At the age of twenty-one he married, and during eighteen months, carried
sexual intercourse to excess. At first, all his functions became more active ;
he felt gayer, and more energetic ; and his appetite was much increased.
But after a time, this excitement began to diminish, and by degrees gave
place to the opposite state. .His sleep was broken and unrefreshing; he felt
heavy during the day, and his thoughts constantly wandered ; his digestion
became disordered, and he lost flesh as well as intellectual activity and mus-
cular power.

Intercourse being for a time prevented by the occurrence of pregnancy,
these first symptoms disappeared, but they returned some months after de-
livery, and from that time rapidly increased. The use of nutritive and
abundant food, in place of repairing the patient's strength, increased his
digestive disorder; stimulant drinks, taken with the intention of assisting
digestion, only excited irritation; severe attacks of indigestion occurred,
and brought on gastritis, which was combated by leeches to the epigastrium
and anus. Obstinate constipation came on, and after a time was succeeded
by diarrhoea. Feelings of sufi'ocation next came on, with palpitations, which
seemed to threaten disease of the heart. These symptoms were treated by
further abstraction of blood. At the same time the patient's venereal
desires grew weaker; his erections diminished; ejaculation took place more
and more rapidly, and scarcely excited any sensation. The acts of coitus
were several days apart, and sometimes did not take place for a week or
fortnight.

A second pregnancy afi'orded several months of absolute cessation from
intercourse ; but this time the patient did not regain his health. Nocturnal
pollutions had commenced ; these he regarded as the results of continence ;
but coitus, however rarely practised, always increased his weakness; the
nocturnal pollutions diminished, and then disappeared entirely, but still the
palpitation and digestive disorder continued to increase. The coincidence
of these circumstances led the patient's suspicions from the true cause of
his disorder. He attributed the inactivity of his genital organs to the ex-
treme weakness of his system, which he thought arose from the leeching
and diet he had been subjected to, and, consequently, omitted to speak of
his impotence to his medical attendants, who, on the other hand, knowing
that conjugal intimacy had ceased, did not inquire further. These symp-
toms increased, until, at the age of twenty-five, the patient came to Paris.
He had then suffered during three years. The following were the symp-
toms : —

Excessive emaciation and pallidity; considerable tenderness of the epi-
gastrium ; the abdomen constantly distended by flatus ; tongue red' at its
borders, and towards the point; anorexia; digestion of animal food almost
impossible, and that of vegetable difficult, and accompanied by flatulence
and flushing of the face ; obstinate constipation alternately with diarrhoea ;

VENEREAL EXCESSES. 163

flatulent colic, often sufficiently alarming, returning at variable times, and
without apparent cause. These colics commenced by rapid distension of
the stomach with flatus, accompanied with spasm in its cardiac extremity,
and in the large intestines, with oppression at the diaphragm threatening
suS'ocation. The palpitations, together with the precordial anxiety, then
became doubly severe, sudden congestion in the head took place, the shivering
which had been present before gave place to a burning heat, followed by
abundant perspiration ; after a longer or shorter time a sudden discharge of
flatus occurred, both by the mouth and by the anus, which was followed by
softening of the abdomen and immediate relief. The general prostration
which followed these attacks was proportioned to their intensity and duration.
At the same time the patient suflered from constant palpitation of the heart,
increased by any exertion, by any excitement, physical or moral, and espe-
cially by the process of digestion. The heart's action was rapid and irregular,
but not stronger nor heard over a greater extent of the thorax than natural ;
and there was neither friction sound, nor bruit de souffle. The pulse was
small and weak.

Besides these symptoms, the patient complained of general weakness,
especially in the loins and legs, of a sense of lassitude, loss of memory, fre-
quent sighing, irritability on slight contradiction, light, broken, unrefreshing
sleep, and great sensibility to cold or damp.

These symptoms had been noticed by all the practitioners previously con-
sulted. The following they had not discovered : During the passage of
the feces, the emission by the urethra of a thick, viscid, unctuous, slightly
opaque matter; frequent desire of micturition, the urine being passed in
small quantities, and with little force, the last drops thick and viscid ; and,
after cooling, the urine being muddy and fetid, and depositing a flocculent,
thick, whitish sediment; a feeling of uneasiness in the perineum, with pains
in the spermatic cord and testicles, and spasmodic contraction between the
sphincter and the neck of the bladder.

After reflection on these symptoms, I did not hesitate to attribute them
to involuntary seminal discharges; and I accordingly prescribed iced milk
mixed with lime water or Spa water; vegetable diet; cold lotions on the
perineum night and morning, and before and after defecation ; an active
country life, with often repeated exercise of short duration.

On seeing the patient the following year, I found that these means had
produced slight improvement, but that the progress towards recovery had
been arrested for some time. I now, therefore, determined to try acupunc-
ture. This I performed with two long needles, introduced about the middle
of the perineum, so as to traverse the prostate in the direction of the ejacu-
latory ducts.

From this time the diurnal pollutions ceased almost suddenly; a few noc-
turnal emissions then occurred, attended by dreams, energetic erections,
and acute sensations ; the sexual appetite returned, the patient's desires
became imperious, and his re-establishment progressed rapidly. During six-
teen years, M. B has since enjoyed the full activity of all his functions

— the gastric and cardiac symptoms have disappeared, together with the
diurnal pollutions.

The lively interest which I took in this patient, made me discover,
by dint of patient questioning, what had escaped the other practi-
tioners he had consulted. At that time my attention had not been

164 CAUSES OF SPEEMATOREHCEA.

attracted to the effects of diurnal pollutions, which I had no idea
were so common oi' capable of assuming so serious an aspect. This
case struck me forcibly : indeed, I may say, that it in great measure
enlightened me as to the cause of a crowd of symptoms of the same
nature, which I met with in other patients, and that it led me to
msike the researches Avhich I now publish.

In this case there was not the slightest complication. The first
intercourse took place at twenty-one years of age ; the constitution
was remarkably robust, and the genital organs had been preserved
from all abuse : thus, the orgasm which seized them carried their
activity to the highest degree, and all the economy was for some
time in a state of active excitement ; all the functions were performed
with more energy ; the losses caused by the discharges were rapidly
repaired ; and health continued in all its vigor. How theil should
danger be feared ? The excesses were continued until the patient's
health became disordered ; and now, pregnancy having occurred, he
had a period of rest, which caused these first accidents to disappear —
showing they were only due to the venereal excesses. A second
pregnancy, however, did not produce the same results — diurnal pol-
lutions having already appeared. The local and general effects of
these, with the errors of treatment that followed them, I need not
comment on.

Milk diet and exercise produced slight, but very slow improvement,
which had entirely ceased when I saw the patient a year afterwards.
The same results did not take place after acupuncture ; its action was
rapid, and its results lasting. The spasmodic contractions experi-
enced in the perineum, or rather between the bladder and rectum,
that is to say, in the seminal vesicles, induced me to try this remedy.
It struck me that these symptoms were purely nervous, and that
habit had a good deal to do with their persistence. Success attended
their trial, and the prompt action of the remedy can only be explained
by the nervous disorder which it caused in the parts. Such a result
made me hope much from the effects of acupuncture, in cases of
spermatorrhoea, but it has succeeded in only a few ; and by com-
paring the symptoms, the reason of this apparent anomaly is evident,
seeing that, in most cases, diurnal pollutions are kept up by chronic
inflammation, or acute irritation of the parts, and to remove this the
operation has no power. Acupuncture, too, does little good in cases
of atony of the ejaculatory canals ; so that there only remain such
cases as are due to a purely nervous state, or a habit of spasm, and
these are by far the least frequent. To these may be added cases
in which the nervous disorder persists after the removal of the irri-
tation, but these are still more rare.

I have, at present, before me, the memoir of a master of a school,
who married very young, after having resisted all temptation to bad
habits, but who yielded, as in the preceding case, to immoderate in-
tercourse, of which he soon felt the effects on his health. This patient
took nutritive food to keep up his strength, and stimulant drinks to

VENEEEAL EXCESSES. 165

assist his digestion. An attack of gastritis resulted, ^vhich -was
treated by leeches, baths, and vegetable diet. Two months passed
in an excursion to the mountains, re-established his health, but on
his return he relapsed into the same state ; constipation supervened,
and his intellect was weakened. Three times, however, he obtained
considerable benefit during the vacations, which he passed away
from his wife, but at last, nocturnal pollutions commenced, and he
was obliged to resign his occupation. This case resembles the one
just related, except that the head and stomach were the organs
chiefly affected.

Simple cases like these are very common : they were even de-
scribed by Hippocrates ; but, however common they may be, they
are very serious, and of much importance to society generally.

CASE XXXVII.

Robust constitution — Venereal excesses continued till the age of twenty-four
— Chronic Inflammation of the bladder — A^octurnal and diurnal j^ollu-
tions — Cauterization followed by perfect recovery.

Dr. D , short, dark, and robust, of a lively disposition, and much

addicted to sexual intercourse, practised great excesses, which he some-
times carried so far as to cause eruissiou of blood. His health became
disordered, his desires diminished, and at length ceased entirely. Notwith-
standing absolute continence, his condition daily grew worse, and when he
came to consult me, in 1832, at the age of twenty-five, he presented the
following symptoms : great emaciation ; face pale and sad ; eyes sunken ;
urine passed from twenty to thirty times a day, and its discharge attended
by scalding and lancinating pains in the neck of the bladder, the stream
small, weak, and crooked, and the last drops passed with difficulty, inducing
spasmodic contractions of the neck of the bladder, and the expulsion of a
thick viscid matter, which stopped at the orifice of the canal j the urine
abundant in quantity, muddy, and sometimes containing blood, always de-
composing rapidly, exhaling a disagreeable smell, and throwing down an
abundant deposit of thick and flocculent matter ; a feeling of weight in the
rectum, and at the margin of the anus ; spasmodic contraction of the sphinc-
ters ; habitual and obstinate constipation, notwithstanding the repeated use
of lavements ; defecation difficult and painful, and causing the expulsion,
by the urethra, of more or less viscid matter resembling semen (this was
easily observed by emptying the bladder before going to stool) ; the passage
of flatus sometimes produced a similar evacuation, but less abundant ; the
nocturnal pollutions, frequent at first, had been rare during several months ;
pain in the testicles and spermatic cord, diminishing by the use of a sus-
pensory bandage ; digestion difficult, and accompanied with the develop-
ment of flatus, griping pains, and flushing of the face ; loss of memor}' ;
intellectual* excitement producing headache, dizziness, and noise in the ears ;
restlessness, contrasting strongly with the weakness of the lower extremities;
sleep unsound, and often broken by calls to micturate ; lassitude greater in
the morning than in the evening ; catheterism very painful from excessive
sensibility and spasmodic contraction in the neck of the bladder.
11

166 CAUSES OF SPERMATOREHCEA.

From these symptoms I proposed cauterization, which waa performed
rapidly over the neck of the bhidder, and more slowly over the mucous
surface of the prostate; the pain was very severe, but diminished very
quickly. The immediate effects of the operation presented nothing unusual;
long-continued baths, abundant drinks, and repeated injections, sufficed to
relieve the inflammation produced. From that time I lost sight of Dr.

D , until one day I met him accidentally ; he was so changed that I

talked to him some time without recognition. His face was red and healthy-
looking, his voice loud and sonorous, and he had grown stout to a degree
uncommon at the age of twenty-seven ; his return to health had been slow,
but progressive, and was perfected without the use of any other treatment
than the cauterization. He bore cold and damp with impunity, although,
previousl}', he had always been very sensitive to them, and all his functions,
without exception, were performed as well as before his illness.

In this case, an affection of the urinary organs acconapaniecl that
of the spermatic, and the seminal vesicles were probably in a condi-
tion similar to that of the bladder ; indeed, the excesses had been
several times carried so far as to cause emission of blood ; abnormal
irritability existed in the prostatic portion of the urethra ; the sper-
matic cords and the testicles were the frequent seat of pain. The
irritation, therefore, passed through the ejaculatory ducts and semi-
nal vesicles, to the spermatic cords and testicles.

To this irritation the nocturnal and afterwards the diurnal pollu-
tions must be attributed. The constipation, too, undoubtedly fa-
vored the occurrence of pollutions during defecation ; but the con-
stipation itself arose from the irritation in the prostatic region, as
was indicated by the spasmodic contraction of the sphincters, and the
sensation of weight in the neighborhood of the rectum, and at the
margin of the anus. All the symptoms disappeared after cauteriza-
tion — another proof that they all arose from the same cause.

In these two cases, venereal excesses acted alone in the produc-
tion of spermatorrhoea. In the cases I am about to relate, such
excesses were complicated with other causes.

CASE XXXVIII.

Three attacks of Uennorrhagia — ni/poclioiulriasis — Danger of sulcuh:
— Recovery — Marriage a few months after — Change in the moral
faculties — Disordered digestion — Constipation — Agitation — Insomnia —
Fits of passion — Si/mptoms of mental derangement — Impotence — i^x/c-
turnal and diurnal pullntions — Cauterization followed hy rapid recovery —
Excesses repeated — Relapse.

M. N , of strong constitution, and sanguineous temperament, passed

his childhood without suffering from any disease, and attained a tall stature
and an unusual amount of strength. He rarely practised masturbation, and
seldom had intercourse with women : at the age of twenty, he contracted
blennorhagia, which was cured in a month by the use of copaiba. At the
age of twenty-three, he had a second attack, which was treated like the

VENEREAL EXCESSES. 167

first, and cured in six weeks. At the age of thirty, a third attack occurred ;
this was treated by the same means, and cured in about the same time.

From this period, M. N experienced frequent desire to make water,

and only passed a small quantity at a time ', his digestion became dis-
ordered ; constipation supervened ; his venereal desires diminished ; his
sleep was disturbed and unquiet ; and his character, previously very gay,
completely changed. By degrees, he entirely separated himself from his
friends ; he sought solitude, and read only the most serious books. At
length, he seemed pursued by an almost irresistible desire to commit suicide.
His father having perceived this, took him to Paris, Switzerland, &c., ia
the hope that he would be benefited by change of scene ; but whenever he
passed over a bridge or near a lake, or any precipitous place, he felt a desire
to throw himself down. But these symptoms passed off by degrees, and at

the end of six months, M. N resumed his duties as a notary, although

he showed a somewhat dreamy air occasionally. Eighteen months afterwards
he married, at the age of thirty-two. Sexual intercourse took place twice a
day for some time, but always very rapidly. At the end of three months,

M. N experienced a great desire for motion and change, and considerable

agitation. He sometimes showed an extraordinary degree of gayety, but the
least contradiction threw him into a terrible passion. His actions and his
conversation had something strange about them. He even felt this himself,
and frequently exclaimed, "Absurd ! I am losing my senses; I am becoming
a fool." His wife became pregnant, and afterwards suffered from peritonitis;
hence a long suspension of intercourse took place, with remarkable improve-
ment in M. N 's health. But after a few returns of intimacy, his diges-
tion again became deranged, and his constipation returned and became more
and more obstinate. A second pregnancy, by preventing intercourse, pro-
duced the same results as the first. But on again resuming intimacy, an
indefinable sense of uneasiness came on in the patient's abdomen, which was
habitually distended with flatus ; he frequently complained of cramps ; of
pressure in the chest ; of difiiculty of breathing, and palpitation. He felt
suffocating; his head was hot; his face red and injected; his mind disordered —
he constantly repeated " that he was lost." At times he rolled about and
tore his clothes, and when in these paroxysms, there was considerable diffi-
culty in preventing him from doing himself injury, and from breaking
everything within his reach. Friction on the limbs and abdomen, and
warmth, appeared to relieve the fits. When they were over, the patient
shed tears in abundance, and shut himself up for a long time, without seeing
any one. Such attacks became daily more frequent, and were sometimes
repeated several times a day.

A remarkable change also occurred in M. N 's intellect ; his memory

and power of composition diminished, and he was obliged to give up his
profession. His writing even became changed, and was almost illegible.
He neglected music, previously his favorite amusement, and his voice lost
its brilliancy and correctness of tone. He was generally taciturn, though
sometimes he showed extraordinary loquaciousness, and his conversation
was unconnected. Being unable to sleep, he rose often in the night, and
walked about the room nearly naked, and if kept in bed by force, he tossed
about, complained of suffocation, and demanded every minute what time it
was.

These symptoms seemed to point out a case of insanity. The patient was
bled several times, and leeches were applied to the epigastrium and anus ;

168 CAUSES OF SPERMATOERHCEA.

but abstraction of blood only aggravated his condition. Injections did not
relieve his constipation ; five or six were sometimes necessary to procure an
evacuation.

The patient's linen being constantly stained by semen, sometimes mixed
with blood, his attention was attracted to the genital organs ; and he soon
discovered that he had frequent nocturnal pollutions, without erection or
sensation. He immediately informed his medical attendant of this fact, and
that gentleman further discovered the presence of diurnal pollutions, both
while at stool and during the emission of urine. He accordingly sent M.
N to consult me.

I found the patient's urine thick and muddy, and containing a considera-
ble deposit of semi-transparent granules, resembling grains of rice. I was
unable to ascertain, certainly, the presence of seminal discharge during
defecation, but nocturnal pollutions occurred almost every night ; the dis-
charge was very abundant, and often mixed with blood. On the 30th of
December, therefore, I performed cauterization from the neck of the bladder
as far as the membranous portion of th« urethra.

During five days, the urine was bloody; the patient's agitation was
increased, and other accidents occurred, but from the sixth to the fifteenth
day these symptoms rapidly diminished. The stools became more regular ;
the urine transparent, and the patient's sleep sound and refreshing. Ene-
mata were, from this time, no longer necessary ; the patient's bowels acted
freely every day ; his appetite increased ; digestion was rapid ; and his
sleep became daily longer and more deep; the patient hastened to bed at
night,, and rose late ; he seemed to be in a state of narcotism from six at
night till nine or ten in the morning. . By degrees, however, this desire to
sleep diminished ; the patient rose early in the morning, walked all the day,
and went into society in the evening ; he wrote well expressed and sensible
letters; his character resumed its gayety ; and he was tormented by venereal
desires.

Six weeks after the cauterization, all his functions were re-established;
no discharge appeared in his urine; the nocturnal pollutions no longer took
place, and no pollutions occurred during defecation. On the 12th of Feb-
ruary, the patient returned to his family.

When M. N quitted Montpellier his health Avas quite re-esta-
blished: I dreaded his return to bis wife, but I was obliged to yield
to the impatience of his relatives, after having explained to them the

origin of my fears. M. N himself promised the utmost reserve,

and for a short time he kept his word ; but he soon committed further
excesses which the irritable state of his organs would not bear, and
at the expiration of two months, a change again commenced in his
character. The nocturnal pollutions reappeared, together with most
of his former symptoms. Three months later, the patient again
visited Montpellier.

From the time of the cauterization, his stools had continued free
and regular ; his sleep had been sound ; his appetite large ; and his
digestion regular. He daily took long walks. His condition, there-
fore, was by no means so bad as at first ; yet the nocturnal pollutions
were repeated four or five times a week, and were very abundant; his

VENEREAL EXCESSES. 169

intellect was much disordered; and his speech was rendered difficult
bj a very decided stammering.

I performed cauterization a second time, but its effects were nei-
ther so marked nor so lasting. The period for the mineral waters
having arrived, I recommended the use of those at Aix in Savoy,
both in baths and douches. I learned afterwards, that these means
were employed without success ; and that the disorder of the pa-
tient's intellect continued gradually to increase.

This case much resembles that of M. De S , which I have

related in my second chapter, page 37.

I have before me the histories of many cases like the preceding.
I shall not report them in detail, because they are less characteristic
and less serious than that of M. N , and because I have, in a for-
mer chapter, spoken of the influence exercised by blennorrhagia in
producing irritation of the spermatic organs. The following is a
summary of the chief symptoms presented by such patients as have
come under my care : —

After having had one or more attacks of blennorrhagia, more or
less easily cured, the patients continued in good health so long as
they contracted no permanent liaisons. In some of my patients, dis-
ordered health caused such liaisons to be broken off, the health be-
coming re-established by a prolonged continence ; after which, slight
intercourse again caused an obstinate urethral discharge. After
having led a regular life for some time, such patients believed them-
selves sufficiently well to marry ; but after a longer or shorter time,
their health became deranged, although they did not think themselves
committing excesses. By degrees, the intercourse became less fre-
quent, the act very rapid, and after a time, quite impossible.

In all these patients, the impotence was the result of diurnal pol-
lutions which had been sometimes preceded by nocturnal pollutions.
The diminution of virility is attributed, by such patients, to their
disordered health, to the regimen, or treatment employed to cure an
attack of gastritis, of irritation in the chest, of palpitation, cerebral
congestion, or of commencing disease of the medulla spinalis, accord-
ing as such or such symptoms have predominated. Not only are
the patients ignorant that their state arises from diurnal pollutions,
but I have even found it difficult, in many cases, to make them
believe that such is the case, because they have always thought
themselves very moderate in their sexual intercourse.

If these observations be compared with those related in my second
chapter ; and if the pain and swelling which these patients felt in
the spermatic cord and testicles when they have not had severe
attacks of orchitis following blennorrhagia, be taken into considera-
tion ; it will be evident that such inflammations may leave a parti-
cular susceptibility in the mucous membrane of the genital organs,
which only awaits an exciting cause for its development : that slight
excitement from sexual intercourse, rather frequently repeated, may
set up an irritation in the tissues which the same act would not have

170 CAUSES OF SPERMATORRHOEA.

produced before the organs were thus affected ; and lastly, that
these tissues not being in the same condition, the individual must
not reason from what he was able to do previously, to know whether
he is committing excesses, or whether he is still within the limits of
his powers.

It thus becomes evident, why the most serious and obstinate
svmptoms are developed after marriage.

I have already shown that masturbation may produce the same
immediate effects on the spermatic organs as the most violent blen-
norrhagia; I now proceed to show, that under similar circumstances,
it may predispose to exactly similar remote results.

CASE XXXIX.

Strong constitution — Mastiirhation at the age of seventeen — Se7-ious disorder
of the health, until ticenfy-six — Marriage — Rapid improvement — Gra-
dual relaj)se after three years, notv:ithstanding the cessation of coitus —
Seminal discharges during defecation and, the emission of urine — Hypo-
chondriasis — Infiammation of the genito-urinary organs — Cauterization
— Rapid and complete cure.

M. C , a land surveyor, of sanguineous temperament and large frame,

practised masturbation with such fury that he brought on vomiting of blood,
and became exceedingly weak, pale, sallow, and much emaciated. At the
age of twenty his extreme weakness, notwithstanding his height and the
size of his frame, made him reform after three unsuccessful attempts. He
relapsed, however, and the same cause continuing, during six years his
health was much disordered. At the age of twenty-six he married.

During two years, intercourse took place daily, and frequently several
times a day, yet the patient's health improved rapidly, and his vigorous con-
stitution reached all the development of which it was capable.

In the course of the third year he perceived that his health became gra-
dually disordered, and shortly after he noticed that he passed small quan-
tities of semen while at stool. Soon the semen passed in larger quantities,
and his health became more and more disordered. At length, obstinate
constipation supervened, which rendered the seminal discharges still more
abundant. They were accompanied with a slight, not unpleasant sensation.

The patient experienced a constant itching in the scrotum and perineum,
although there was no appearance of eruption, and felt a sort of creeping
which extended towards the bladder and the root of the penis. His diges-
tion was difficult, and attended by the development of flatus, and his sto-
mach could only retain very light food, in very small quantities ; his sleep
was short, and disturbed by frightful dreams, and on waking he felt lassi-
tude, soreness of his limbs and depression of spirits; during the day his
thoughts were sad — he presented, in fact, all the symptoms of confirmed
hypochondriasis.

He felt a constant desire to walk, but was soon tired ; he bungled in his
professional operations, lost his memory, and performed the most trifling
calculations with difficulty.

When M. C came to consult me in the beginning of August, 1824,

he had relapsed into nearly the same condition as before his marriage. He

VENEREAL EXCESSES. 171

had, however, totally abstained from sexual intercourse for more than a
year, because his venereal desires and erections had almost ceased. The
orifice of the urethra was injected and irritable ; the scrotum flaccid, and
the testicles large but soft. The urine was passed often and with difficulty ;
the first jet requiring considerable efforts for its expulsion ; the last drops
caused spasmodic contractions in the bladder and neighboring parts, and
were thick and viscid, appearing like a thick solution of gum. The patient
felt as if something always remained in his bladder. The urine was usually
red and fetid ; it deposited a thick flocculent cloud, which was sometimes
accompanied with glairy matter, like white of egg.

These deposits I believed to contain semen, vesical mucus, and prostatic
fluid, and their presence in the urine seemed due to chronic inflammation of
the mucous membrane lining the prostate of the neck of the bladder. The
seminal discharges during defecation were more abundant than ever. These
alone would have been quite sufiicient to account for the patient's state.

I proposed cauterization as the best means of altering the condition of
the affect-ed tissues; and the patient consented. On introducing the ca-
theter I found the canal extremely sensitive ; the spasms were so severe,
especially on approaching the neck of the bladder, that the whole of M.

C 's body was covered with a profuse sweat, and I found it necessary to

delay the cauterization. Three days afterwards the same catheter was in-
troduced with much less pain, and the urine having been completely eva-
cuated I cauterized the bladder near its neck, and the prostatic and mem-
branous portions of the urethra. The operation was performed rapidly, and
scarcely gave more pain than the introduction of the catheter; but it caused
a kind of very acute pinching pain at the margin of the anus and in the
rectum.

Soon after the operation the patient experienced a feeling of strength in
the genito-urinary organs, which increased as the pain passed off. The con-
stipation ceased spontaneously; the urine, by degrees, regained its color and
transparency, and at the end of the thirteen days the patient was compelled
to return home. The journey (about sixty miles) did not produce any of
the inconveniences I had feared ; and two months afterwards I received a

letter from M. C , stating that he was perfectly well, and had recovered

his strength, and the perfect use of all his functions.

This patient was not more moderate in sexual intercourse than he
had previously been in his bad habits ; yet marriage benefited his
health. This change, which lasted three years, shows the great
difference that exists between the effects of sexual intercourse and
masturbation.

Why did not this improvement continue ? Simply because the
frequency of the acts exceeded the real wants of the patient ; and
because the organs had previously been weakened by serious and
long-continued abuse. This circumstance is enough to show how
complicated the important question of marriage becomes in such
cases. I shall by and by relate some others which will perhaps
make those pause and reflect, who thoughtlessly recommend so se-
rious an engagement as a remedy for masturbation.

Was there any semen in the urine in this case ? The quantity of
vesical mucus and of the prostatic secretion did not permit of a

172 CAUSES OF SPERMATOERHOEA.

certain decision on this point. The last drops passed from the
urethra were viscid, like solution of gum, and abundant seminal dis-
charges took place during defecation. In cases of this nature it is
evident that chronic inflammation extends from the mucous surface
of the prostate to the neighboring tissues ; cauterization is a certain
means of getting rid of this with all the symptoms depending on it.
Whether there be or be not semen in the urine, the indication is
always the same.

I have more than once referred to the connection that exists
between the neck of the bladder and the anus; this patient showed
it in a high degree. At the moment of the cauterization he com-
plained of a severe pinching pain in the rectum and at the margin
of the anus ; and, in proportion as the inflammation was dispersed,
the sphincters became relaxed and the constipation ceased sponta-
neously.

CASE XL.

Sanguineous temperament — Masturhation from fourteen to eighteen years
of age — Marriage at nineteen — Immediate improvement in the health
— Aftericards, disorder of the system — Hypochondriasis — Inclination to
suicide — Symptoms of chronic gastritis , treated for six years with leeches,
blisters, &c. — Nocturnal and diurnal pollutions — Frequent discharge of
urine — Cauterization followed by rapid and complete cure.

M. C , of sanguineous temperament and robust constitution, at the

age of fourteen was five feet six inches in height, and of great muscular
strength : at this time be contracted the habit of masturbation at school,
and continued it till the age of eighteen. At nineteen he married, although
he was very thin, and weakened by his previous abuses ; but he regained
his strength by degrees, and applied himself to agricultural pursuits with
energy and success. He had two healthy children, the first years after his
marriage.

Nevertheless, although he had no cause for trouble, the patient's character
changed by degrees. His gayety and activity diminished, together with his
strength and appetite. Sexual intercourse became less frequent. He suf-
fered from nocturnal pollutions — rare at first, but afterwards more frequent.
His stomach became disordered. He was constipated ; his feces were fre-
quently streaked with blood, and during the straining necessary for their
expulsion, he passed a considerable quantity of matter by the urethra, which
he recognized as badly formed semen. He became careless, indolent, and
timid; he neglected his aifairs, and even the management of his farm. His
aflfection for his wife and children diminished, and at length he fell into a
profound state of hypochondriasis, and thought of nothing but his health.

For sis years he was treated for a supposed gastritis by the application of
leeches, blisters, and issues ; he was sent to the mineral waters, &c. He
spoke of his seminal discharges to all the practitioners he consulted, but
they were attributed to the gastritis, or his continence, even although he
asserted that they were the cause of what he suffered. At length, at the
age of thirty-five, he was sent to me by a young surgeon — one of his
friends. He was then in a deplorable state of mind; his constipation was

VENEREAL EXCESSES. 173

obstinate, notwithstanding the habitual and immoderate use of enemata ;
spermatic discharges occurred during defecation ; micturition was repeated
as often as fifteen or twenty times a day ; the stream was feeble and broken,
and the excretion abundant and pale, generally containing a flocculent de-
posit. Nocturnal pollutions were frequent, and always occurred when the
patient lay on his back, on which account he contrived a piece of wood to
be fixed along the spine, to prevent him from assuming that posture. Ca-
theterism was exceedingly painful.

I cauterized the urethra from the neck of the bladder as far as the bulb.
The ordinary immediate effects took place; at the end of eight days, the
inflammation had nearly subsided, and the erections were violent and pro-
longed without pollutions ; the patient's appetite returned ; his digestion im-
proved ; his constipation diminished ; his sleep became sound and healthy ;
his strength increased; and the emission of urine became less frequent.
Within a fortnight, his erections had become importunate during the day,
and almost constant at night, attended with erotic dreams, but no pollutions
occurred after the cauterization. Kecovery of strength was rapid ; and the
desire of occupation and business returned. The patient went home on the
twenty-second day.

Four months afterwards, M. C wrote to ask me if he need go to the

mineral waters as I had recommended him; he did not think it necessary,
his health and strength being completely re-established.

This case scarcely differs from the preceding ; I shall, therefore,
only call attention to the obstinacy with which the supposed gas-
tritis was treated. It is difficult to form an idea of the tortures
which this patient suffered during six years, or of the variety of means
which were put in practice to combat his disease. Of these, abstrac-
tion of blood, by increasing his debility, and the application of blis-
ters, by the action of the cantharides on the genito-urinary organs,
did the patient most injury.

CASE XLI.

JV^ervoiis temperament — Delicate health — Masturhation he/ore puherfy —
Urethral discharge after sexual intercourse — Orchitis — Nocturnal pollu-
tions — Absolute impotence — Injections icith solution of nitrate of silver
unsuccessful — Cauterization followed hy rapid cure.

M. S- , a doctor of medicine, short and thin, and of a nervous tempera-
ment, was subject, from infancy, to various nervous diseases. He was
addicted to masturbation long before puberty, which occurred at twelve
years of age, and he continued the practice until the age of sixteen. At
this period he had sexual intercourse, and after several weeks of daily con-
nection, an abundant discharge came on, which he neglected for a long
time. On returning to school, he felt pain in the right testicle, followed by
.acute inflammation, with considerable swelling of the spermatic cord. This
was relieved by the usual means. The following year he experienced
acute pain in the same situation, with a dragging sensation in the spermatic
cord. These symptoms diminished by the use of a suspensory bandage,
but the epididymis permanently acquired nearly double its normal size ;
the vas deferens continued very sensitive, and the urethra was irritable.

174 CAUSES OF SPERMATOEEHCEA.

From that date, darting pains, accompanied py spasms, were felt in the
prostatic region during micturition, especially whilst discharging the last
drops. Sexual intercourse always left a sense of weight and heat in the
organs.

Before the occurrence of the urethral discharge, nocturnal pollutions had
happened several times : these afterwards became more frequent, and after
a time they took place without erection, motion, or sensation. During two
years, the patient's erections grew less frequent and daily more imperfect,
and at length ceased altogether.

M. S for a long time treated the pollutions by hygienic means alone ;

contrary to his expectations, he found that a very hard bed invariably pro-
duced them, and that they were increased by any fatigue, especially by
pedestrian exercise. He also found himself much worse after cold bathing.
These circumstances made him suspect that the pollutions arose from a state
of irritation.

All his organs were almost equally debilitated ; and all his functions were
badly performed, and with difficulty • his sleep was broken and unrefreshing ;
his temper dull and irritable. The least serious occupation gave him head-
ache, and a desire for change j slight exercise induced fatigue ', his eyes
were very weak and injected.

On the 22d of February, 1836, the patient injected a solution of nitrate of
silver (a quarter of a grain to the ounce) into the urethra. About half the
injection entered the bladder, and remained there for two hours. He passed
a bad night, with acute pain, and had a pollution. On the 25th, he used
another injection, stronger than the first; the same phenomena followed.
On the 2d of March, he had another pollution. On the 6th, his urine was
thick, fetid, sanguinolent, throwing down an abundant deposit and giving
acute pain during its discharge. Thirty leeches were ordered to the hypo-
gastrium, to be followed by a hot bath and emollient cataplasms. The
symptoms diminished under this treatment. On the 24th of March, another
pollution occurred, and from this date, they took place as often as before ;
complete impotence was established. In this condition, the patient came to
consult me at the age of twenty-three. His urine contained a white deposit,
which led me to suspect that he had diurnal pollutions. In the beginning
of July, 1836, I applied the nitrate of silver from the neck of the bladder as
far as the bulb of the urethra. The usual phenomena occurred. A fortnight
afterwards, all the inflammation had disappeared, and re-establishment had
commenced. Six months afterwards, I received the following note from M.

S . " For five months my nocturnal pollutions have ceased — at least, I

have only had one every ten days or fortnight, which appears inevitable,
from my continued continence. My urine is perfectly transparent ; my tem-
per is improved, and I study with pleasure, and without fatigue. My erec-
tions have become frequent and long continued, which I fancy is the best
proof of an absolute and permanent cure." By the use of sexual intercourse
the patient's health continued to improve for two years, during which time
I saw him frequently.

This patient told me that he had not practised masturbation more
frequently than his companions, but he had commenced long before
puberty, and his constitution was naturally weak. He also asserted
that he had been moderate in his first intercourse with the other sex,

VENEEEAL EXCESSES. 175

but his organs had been previously weakened by premature abuse.
These circumstances account for the disastrous effects produced by
so few connections, so soon left off.

A hard bed, cold bathing, and prolonged exercise, produced bad
effects on this patient, which he explained correctly by referring the
symptoms he experienced to a state of irritation of the organs in-
stead of one of atony.

Tlie mode in which the inflammation extended from the mucous
membrane of the urethra to the spermatic organs is very evident in
this case ; the painful spasm which was present in the neighborhood
of the prostate, the habitual irritability of the urethra and vas deferens,
and the swelling of the epididymis, show clearly that the pollutions
were maintained by a state of irritation. It is remarkable, that injec-
tions with solution of nitrate of silver should have caused so much
pain, and produced cystitis without any permanent benefit, whilst the
nitrate, applied in substance to the disordered tissues, completely
changed their action, without producing any untoward results.

The cases I have related show at once how far masturbation may
weaken the most active genital organs, at the period of their greatest
energy, and the necessity of taking into consideration the actual
condition of the parts, in order to appreciate the effects of sexual
intercourse.

I have so far shown that blennorrhagia and masturbation mav leave
a degree of irritation in the spermatic organs, or perhaps, a peculiar
susceptibility easily increased by coitus. Hence it happens, that the
virile power differs much, not only in different individuals, but in
the same individuals at different periods.

Independently of the changes which may occur before the act, the
organs may be temporarily exposed to others just as hurtful. And I
now proceed to point out, by two or three cases, the chief circum-
stances which may thus render coitus injurious.

CASE XLII.

Masturbation — Venereal excesses — Prolonged liorse exercise — Blennorrliagia
— Nocturnal and diurnal polhuions — Two caiiterizations — Recovery —
Premature excesses — Relapse — Cure hy another cauterization.

M, T , of robust constitution, and bilio-sanguine temperament, con-
tracted the habit of masturbation at school. At the age of fifteen, he cor-
rected himself, but committed venereal excesses. Still bis health did not
undergo any notable change until some time after, when he was obliged to
pass the greater part of the day, and often part of the night, on horseback.
After several months of this kind of life, he felt weight and heat in the
perineum, with pulsation and darting pain at the margin of the anus.
Hasmorrhoids appeared, and his sexual feelings diminished by degrees, and
at length entirely left him. He detested the sex ; and became morose,
taciturn, and irritable; all his functions were disordered; he felt cast down.

176 CAUSES OF SPEKMATOEEHCEA.

careless, physically as well as morally depressed, and sought solitude. At
length he commenced the study of medicine.

A professor, whom he at first consulted, believed him afflicted with gas-
tritis, afterwards, with chronic enteritis ; still later, he thought him hypo-
chondriacal. In this condition, at the age of twenty-five, he consulted me.
His symptoms were much the same as those I have related in so many
other cases; but he had, in addition, a constant urethral discharge.

I performed two cauterizations for this patient, sis months intervening
between them. The urethral discharge and diurnal pollutions disappeared
completely ; and his nocturnal pollutions became much rarer ; he regained
his embonpoint, and his former strength and activity.

Unfortunately M. T yielded with little discretion to the venereal

desires, which resumed their empire over him. A relapse resulted, requiring
another cauterization, which produced the same 66*6013 as the former ones ;
although more slowly. His health was afterwards undisturbed by any simi-
lar accidents.

The masturbation and venereal excesses which, in this case, pre-
ceded the long continued horse exercise, must be taken into ac-
count ; they certainly predisposed to the occurrence of blennorrhagia
and nocturnal and diurnal pollutions.

The mode of action of horse exercise on the genital organs is so
evident, as not to require explanation. The fact is worthy of notice,
because it explains the advantages or inconveniences of this exercise
in cases of spermatorrhoea, according as they arise from atony or
phlogosis of the spermatic organs.

The excitement produced by horse exercise must also be noticed
as a circumstance which may deceive the patient. The signs of
virility which it excites are too often taken for natural desires. Even
when these natural desires exist at the same time, they should not
be satisfied while the organs are in a state of irritation and fatigue
from riding, because the act itself tends to produce the same effects.
Thus, the union of the two circumstances may produce more or less
severe urethritis and its usual results. In the foregoing case, as in
many others, I have seen irritation of the urethra accompanying
the same state in the spermatic organs ; this is a very common co-
incidence, and one very easily explained.

The relapse this patient suffered is worthy of notice on account of
the difficulties which a convalescence from spermatorrhoea presents.
Scarcely has the cure begun to progress, than the semen is retained
longer in its reservoirs ; it is consequently better formed, the more
fluid part being absorbed ; hence frequent, energetic, and prolonged
erections are excited. A time may arrive when these will become
weakening and hurtful ; the testicles continue to secrete, and the
seminal vesicles have only a certain capacity ; evacuations must,
therefore, take place ; if normal ones be prevented, they will occur
abnormally, and the pollutions we are endeavoring to cure will re-
appear. Hence moderate exercise of the organs is the best tonic in

VENEREAL EXCESSES. 177

this Stage of the case. A return to the exercise of their functions is,
therefore, beneficial — indeed, indispensable. It is difficult for the
practitioner to point out the exact moment -when such return should
take place, and for the patient to prevent himself from overstepping
the bounds of the most importunate necessity. Unfortunately the
same thing occurs in these cases, that we see daily after other dis-
eases — gastritis for instance; when a little food is allowed, an excess
would recall all the irritation of the stomach ; but the patient often
consults his appetite more than his power of digestion, and hence
disorder sometimes arises more severe than the first. In such cases,
however, the meals may be watched, the food chosen, and the por-
tions doled out. In the cases under consideration such watching is
impossible.

CASE XLIII.

Lymphatic temperament — Early and long continued masturhation —
Horse exercise — Infrequent coitus — Urethritis — Repeated attacks of
inflcimmation in the testicles — Frequent discharge of urine — Pollutions
during defecation — Imperfect ejaculation — Two cauterizations followed hy
perfect recovery.

Berthelot, aet. twenty-three, of lymphatic temperament, the son of robust
peasants, enjoyed perfect health during his infancy. Between the ages of
ten and fourteen he practised masturbation frequently with the other chil-
dren of the neighborhood, although he experienced little sensation, and did
not pass any semen. At a later period, he addicted himself to the vice as
often as two or three times a day. Still his health underwent no alteration.
At the age of twenty-one, he entered a cavalry regiment, and soon after-
wards had cholera, on recovering from which he was sent to his native
village for change. He hunted much at this time, and was constantly on
horseback. About three months afterwards, he had sexual intercourse
once or twice a day, and on the fifth day he experienced very acute pain
in the urethra during the passage of urine, but no discharge occurred. He
resumed his habitual horse exercise, but abstained from the use of alcoholic
drinks. About two months later, B observed that he passed a con-
siderable quantity of semen while at stool, even although his bowels were
not constipated; and at the same time his calls to urinate became more
frequent and more sudden, so that he passed water eight or ten times a day,
and four or five times in the night. Soon afterwards, after a long ride, he
felt pain in the course of the left spermatic cord, which soon extended to
the epididymis and testicle of the corresponding side. Orchitis was esta-
blished, but yielded to the usual treatment, leaving, however, a chronic
enlargement of the epididymis. Afterwards the patient wore a suspensory
bandage, rode on horseback again, and again practised masturbation. He
now, for the first time, experienced an extraordinary change in ejaculation.
Very little semen was passed by the urethra, although he felt internally a
sensation which announced abundant discharge. The greater part of the
emission remained in the urethra, and was discharged after the subsidence
of the erection ; even then the patient was obliged to assist its escape, by
making pressure on the urethra. This occurred even during nocturnal
pollutions. The diurnal discharges during defecation, and the frequent

178 CAUSES OF SPEEMATORRHCEA.

desire to micturate continued ; the patient's health became again disordered,
and when he returned to his regiment, he was just as weak and thin as when
recovering from the effects of the cholera.

After a few days' active service, swelling again attacked the left testicle :
this was relieved by rest and emollients, but frequently returned again, after
slight horse exercise. Acute inflammation also attacked the right spermatic
cord, epididymis, and testicle. The inflammation was dispersed by leeches,
but enlargement of the cord and epididymis remained. Some time after, the
patient complained of pain in his chest, sense of suffocation, and frequent
attacks of digestive disorder, and on the 6th of August, 1886, he was ad-
mitted into the hospital St. Eloi, under the care of Professor Serre, in much
the same condition that we have so frequently described.

M. Serre cauterized the prostatic portion of the urethra, after which, the
patient's efforts during defecation, together with the quantity of semen
passed at stool, diminished. Micturition became less frequent, and his diges-
tion and moral condition improved. In this state I saw him a month after
the cauterization : hoping that the amendment would continue to progress, I
merely prescribed cold ascending douches every second day. Some time
after, I found a slight diiEculty in passing a catheter into the bladder. The
instrument was caught near the neck of the bladder by a band, which caused
a kind of starting upwards of its point.

In any other part of the canal I should not have considered this obstacle
worthy of notice, but its seat being near the orifice of the ejaculatory ducts,
I questioned the patient further. From what I then learnt, I was induced
to leave an instrument in the urethra for an hour, and to repeat this once
a week. The ascending douches seemed to give tone to the rectum, and
the introduction of the catheter freedom to the urethra. The seminal dis-
charges diminished, and remarkable improvement in all the functions took
place. On the 15th of October, however, a pollution occurred during defe-
cation, and was repeated on the 19th. At the same time, the desire of
micturition became more frequent. On the 21st of October, therefore, I
determined on again performing cauterization of the prostate, applying the
caustic especially to the membranous portion of the urethra in front of the
orifice of the ejaculatory ducts. This second cauterization perfected the
benefit begun by the first. Defecation was performed easily, and the pol-
lutions accompanying it ceased, the urine became quite transparent, and was
passed at normal intervals in a full stream, and without pain. A few abun-
dant nocturnal emissions occurred at intervals of ten and fifteen days, but
they were always preceded by erotic dreams, and accompanied with lively
sensations, the seminal emissions taking place very freely and entirely. And

on the 6th of December, B left the hospital, having been quite well for

more than a month. I advised him, however, to exchange from a cavalry
to an infantry regiment.

Berthelot was of a very lymphatic temperament, and he had con-
tracted habits of abuse four years before puberty. These circum-
stances must have had their influence in determining the effects
produced on the spermatic organs. But the immediate cause of the
disease is very evident. Coitus was only repeated a few times, but
whole days were passed on horseback. Riding exercise aggravated
the disorder, and produced relapses. To its effects on the perineum

VENEREAL EXCESSES. 179

the urethritis, and the repeated attacks of orchitis must be attri-
buted.

It was not by exposing the testicles to friction, as may at first
sight be supposed, that the horse exercise induced orchitis ; the in-
flammation commenced in the vas deferens, extended to the epi-
didymis, and thence to the testicle. The action of the saddle on the
perineum, therefore, increased the urethral inflammation, and favored
its extension to the neighboring mucous membrane. The irritation
extended, not only to the testicles, but towards the kidneys. The
seminal vesicles were then in the same condition as the bladder, and
presented the same phenomena — their situation between the ejacu-
latory ducts and the testicles being the same as that of the bladder
between the urethra and the kidneys. What passed in the bladder
was only the exaggeration of what took place in the seminal vesicles.
The influence of this phlogosis even extended to the sphincters of
the anus, since the expulsion of relaxed motions required consider-
able efforts.

I have already related (page 148) a case of nocturnal pollutions,
in which no external evacuation took place, all the semen passing into
the bladder, and being afterwards expelled with the urine. This
occurred in consequence of compression having been made on the
perineum to prevent ejaculation. I have seen another case, in which
the same thing happened after blennorrhagia, and Berthelot presented
something similar, but in him all the circumstances were still more
marked. There could be no doubt as to the observations he made
during masturbation. He always experienced the same voluptuous
sensations, which were accompanied by a kind of internal perturba-
tion, and he observed the discharge at the time of only two or three
drops of semen. After nocturnal pollutions, he constantly found on
waking, a considerable quantity of semen in the urethral canal.
These phenomena were easily observed, and he did so many times.

I have frequently seen the same effects take place in very long and
tight strictures of the urethra; but in Berthelot, a No. 12 catheter
passed easily into the bladder. The orifice of the ejaculatory ducts
must, therefore, have been altered by some cicatrix in the neighbor-
hood of the verumontanum. The presence of this was made evident
by the slight deviation of the point of the catheter before entering
the bladder. The presence of such a cicatrix, in this situation, in-
dicates clearly enough that inflammation has been active near the
orifice of the ejaculatory ducts ; hence it may be supposed, that the
effects of horse exercise on the perineum must have contributed to
its development, and to the extension of the inflammation so fre-
quently to the testicles.

I have shown in another place (page 100) that horse exercise may
contribute to produce diurnal pollutions by its action on the margin
of the anus causing obstinate constipation ; and I have also pointed
out that it may have very injurious effects about the period of puberty
(page 151) by inducing accidental emissions, or leading to bad habits.
These cases, with those I have just related, show that horse exercise

180 CAUSES OF SPEEMATOEEHCEA.

may cause hurtful excitement of the genital organs ; first, by inducing
obstinate constipation ; secondly, by producing abnormal excitement,
•which may lead to abuse ; thirdly, by rendering coitus irritating ;
fourthly, by increasing irritation previously set up by recent excesses.

I do not pretend to assert that horse exercise often produces such
unfortunate results, but it is important to know how and under what
circumstances they may be produced — in a word, what influence
horse exercise may have in causing spermatorrhoea. All that I have
now said of course applies to the other exercises which act on the
genital organs, and whose action, though less energetic, may be more
prolonged.

Every one knows the effect produced by long journeys, even in the
easiest carriages. The increase of temperature which all the parts
that bear the weight of the body experience, and the continual shaking
to which they are submitted, excite importunate erections, which are
commonly followed by fatigue and irritation. The increased flow
of blood often suffices to reproduce urethral discharges which had
ceased for some time. I have been consulted many times in cases
of this nature — indeed, there are some persons who cannot pass a
few days in travelling, without having a slight gleet. These effects
are not equally severe in all, but all experience an increased excite-
ment, which it is necessary to be guarded against, because it excites
desires which may be easily mistaken for real necessities. There is
more importance in these apparently trivial circumstances, than is
generally supposed. Hence I have called attention to them en
passant.

I have already shown, that the action of alcoholic liquors on the
genital organs may induce spermatorrhoea (see case twenty-one). I
now proceed to show the influence they exert on the venereal act.

CASE XLIV.

Lymphatico- sanguineous temperament — Coitus lohen nearly intoxicated, at
the age of tioenty-tico — Blennorliagia — Pollutions during defecation —
Disturbance during ejaculation — Band in the membranous portion of the
wethra — Cauterization — Cure.

Gros, a soldier in the 57th regiment, set, twenty-five, of lymphatico-san-
guineous temperament, always enjoyed perfect health, until, in 1833, after a
debauch he had sexual intercourse. He only remembers that the coitus was
very long and slightly painful. Immediately afterwards, he felt pain in the
pelvis, which soon extended to the testicles, and never entirely left him
afterwards. The following day a clear urethral discharge came on, which
soon, however, became greenish. This varied much in its after appearances,
and sometimes passed off entirely for a day or two. This blennorhagia drew
the patient's attention to a discharge from the urethra during defecation.
At first, a few drops of a viscid fluid like white of egg were discharged, and
these were followed by an abundant evacuation of semen. This evacuation
always took place, varying in quantity according to the efforts required
during defecation.

VENEREAL EXCESSES. 181

From this time the patient practised masturbation, and at the moment of
ejaculation, he felt a kind of commotion in the urethfd, and observed that
nothing was passed externally. After the erection had subsided, the semen
escaped gradually. This he always noticed, though sometimes the semen
remained in the canal for half an hour. When nocturnal pollutions occurred,
the greater pai't of the emission remained in the urethra until the patient
awoke.

During eighteen months, Gros underwent no medical treatment; after-
wards he took emollients, preparations of iron, mercurial pills, large doses
of copaiba and cubebs, and of Chopart's mixture; injections of all kinds
were also employed without benefit. About the end of August, 1836, he
came to consult me. He had frequently had sexual intercourse without
communicating any disease to the female. The urethral discharge, and
the pollutions during defecation, continued to the same degree; the urine
was passed very frequently, and was generally rendered opaque by a thick
cloud. Still, however, the patient's functions were performed pretty regu-
larly, and he had not lost flesh ; but his muscles were soft and flabby, his
thoughts gloomy, and his voice weak and husky. Constant pain had an-
noyed him for two years in the joints, groins, and along the spermatic cords
to the testicles. His eyes were intolerant of light, and constantly afl'ected
by a prickling pain.

The introduction of a catheter gave acute pain; the instrument was arrested
for a moment in front of the neck of the bladder, by a little band, which
tilted up its points.

On the 7th of October, I cauterized the membranous portion of the canal ;
acute and long-continued pain followed, and the urine was bloody and abun-
dant. This inflammation had entirely disappeared at the expiration of three
weeks, when the discharge rapidly diminished and soon disappeared. The
eff'orts at stool, and the seminal discharges which accompanied them, had
ceased much earlier, and the pains in the groins, spermatic cords, and tes-
ticles, as well as the sensations the patient experienced in his eyes were
relieved.

When Gros left the hospital, he was free from all the appreciable symp-
toms which he had on entering; as regarded ejaculation, of course he was
unable to give any information, but he promised to let me know if he found
the discharge arrested in the canal as before, and from that time I have heard
nothing from him.

This patient was in the hospital at the same time as the subject
of the preceding case, and I placed them in adjoining beds, in order
the better to contrast their symptoms. Both were of the same age,
and both experienced the same pollutions, and the same difficulty of
ejaculation after an attack of non-contagious urethritis. The point
of the catheter communicated the same sensation of obstruction in
both, and the same treatment cured them both.

I need not at present recur to what I have stated respecting a
cicatrix situated in front of the orifice of the ejaculatory ducts. The
most simple and direct means by which to obviate its effects is an
active cauterization in front of the verumontanum. On this account,
in these two patients I more particularly cauterized the membranous
portion of the urethra.
12

182 CAUSES OF SPEEMATOERH(EA.

In the case of Gros, a single connection gave rise to all the acci-
dents; therefore, it can scarcely be said that he committed excesses ;
but the act was not brought about by a natural necessity ; it was
accomplished in a laborious manner ; under circumstances very likely
to prolong its duration, and whilst the mucous membrane of the
genito-urinary organs was exposed to considerable over-excitement.
The act was therefore inopportune, and as such, it produced the
effects of an excess. The urethritis following it seems to have been
produced by the excessive duration of the act, and by the excitement
of the organs by alcoholic stimuli before they were submitted to
this fatigue. The color of the discharge showed that it was not
spermatic. It seemed to be an ordinary gleet, arising from the same
cause as the chronic vesical catarrh and the involuntary seminal dis-
charo-es.

CASE XLV.

Coitus in a state apirroachivg inehriety — Gleet increased hy a Journry —
Diurnal pollutions — Cauterization, icith rapid improvement — Relapse
from premature fati(jue of the onjans — Cure hy means of antiphlogistics
and rest.

M. R , a student of medicine, a native of the tropics, and of a very

nervous temperament, addicted himself to masturbation about the period of
puberty, and later to venereal excesses and the use of alcoholic liquors.
His health became disordered, but by a regular life and exercise he strength-
ened his constitution, and for several yeai-s his health was excellent.

In 1836, after a debauch, when nearly intoxicated, he repeated coitus
twice during the night, each time with unusual difficulty. On the fourth
day he experienced pain in the canal, and scalding during the passage of
urine. A. slight mucous discharge soon appeared, and became more abun-
dant by degrees. Baths and emollients diminished the irritation; but it in-
creased afresh during a long journey, which the patient was obliged to take.
After his return, he often applied leeches, and took copaiba, without being
able to lessen the discharge. Every morning and evening and during the
day, the point of the glans was moistened by a drop of viscid fluid. This
circumstance would not have attracted his attention if he had not at the same
time noticed a remarkable diminution in his virile powers. Ejaculation be-
came very rapid; the erections remained incomplete; and several times the
act was impossible. The patient had pain in the spermatic cords and testicles ;
a sense of weight in the perineum, and at the margin of the anus ; both his
limbs and his intellect grevv' weak. Absorbed, in spite of himself, in con-
sideration of his condition, he was unable to pay attention to anything else.
He lost his memory, was constantly abstracted, and incapable of applying
himself in any intellectual employment, or bodily exercise. This mental and
physicalweakness, together with the disorder of all his functions, had increased
rapidly, when the patient came under my care. It was not difficult to dis-
cover the origin of his disorder. Each stool was accompanied by more or less
abundant seminal discharges, and the patient's urine constantly contained a
considerable quantity of well formed semen, full of granules like boiled rice.

VENEREAL EXCESSES. 183

In the beginning of June, 1837, I cauterized the prostatic portion of the
urethra. The operation produced its ordinary immediate effects. As soon
as the inflammation had passed off, the diurnal pollutions disappeared, and
energetic erections returned. The premature use of coitus, however, added
to over fatigue during very hot weather, reproduced the irritation in the
urethra, together with the diurnal pollutions, and the general symptoms that
accompanied them. This relapse I treated with leeches, baths, enemata,
and strict repose, which simple means soon brought about a perfect cure, and
rendered a second cauterization unnecessary, although the patient pressingly
demanded it.

Under other circumstances M. R had committed considerable

excesses without experiencing any ill effects. To what, then, can
we attribute the occurrence of the urethritis and the diurnal pollu-
tions following it, but to the effects of the alcoholic stimuli ?

The last part of this case shows how necessary it is not to disturb
the effects of cauterization by any circumstances which may re-excite
the irritation. It would be dangerous to recur to the same treat-
ment, when irritation is again set up a few days after cauterization
by the influence of exciting causes. When on the other hand, under
such circumstances, antiphlogistics are employed, and rest is^enjoined,
the symptoms disappear rapidly; the cure is, therefore, only retarded :
a second cauterization in such a case might be expected to produce
much disorder.

These effects from the excessive use of stimuli are by no means
rare, judging from the number of cases I have met with ; the two
related are, however, sufficient to give an idea of the general circum-
stances attending such cases; I shall, therefore, only extract the
most important features of the others of which I have notes.

None of my patients were completely intoxicated at the moment
of coitus, but all were more or less approaching that state. Few
repeated the act ; and some even were unable to terminate it. In
all it was long, laborious, and attended with little pleasure ; and
the inflammation or irritation of the urethra came on very quickly.
Urethral discharge did not invariably arise : when it did occur, it
appeared very quickly. The pain produced, as well as the color of
the discharge, differed much in different individuals. In two cases
retention of urine occurred on the day following, and in another,
prostatitis was set up. Several patients passed dark-colored and
even sanguinolent urine for several days.

All fermented drinks are not equally hurtful, and according to my
experience, beer produces the worst eflfects, especially when new.

To resume : a state approaching intoxication may be hurtful in
two ways ; first, by diminishing the sensibility of the nervous system :
secondly, by favoring the occurrence of irritation in the genito-uri-
nary mucous membrane. As this double action may appear contra-
dictory, I will explain it.

During complete intoxication coitus is impossible, because the
functions of the cerebro-spinal system are suspended. But when

184 CAUSES OF SPERMATOERHCEA.

fermented liquors have produced effects short of stupefaction, when
excitement is followed by a commencintr weakness, with a disposition
to somnolency, venereal excitement is frequently manifested, on the
nature of which it is very easy to be deceived, because in this state
nothing is feared.

Indifferent erections occur. These may suffice to permit the com-
mencement of coitus, but the sensibility of the genital organs is
blunted, for the same reason that all other sensations are vague and
dull. The pleasurable feeling may be sufficient to keep up the erec-
tion, but does not suffice to produce that high state of excitement
which is necessary for the acccomplishment of the act. This diminu-
tion of sensibility then, renders coitus incomplete, or retards its
consummation, sometimes even rendering it impossible. It becomes
evident, therefore, that such ineffectual efforts must favor the deve-
lopment of irritation in parts which are at the same time in a state
of more or less active congestion.

Again, on the other hand, it is well known that fermented liquors
irritate the genito-urinary organs, and that those who take them in
excess frequently lose their virility. It is well known too, that
drunkards are subject to chronic catarrh of the bladder, to engorge-
ment of the prostate, dysuria, retention of urine, and chronic gleet ;
and I have before shown that wine is hurtful to patients laboring
under spermatorrhoea (see case 21).

Fermented drinks, then, taken in excess, produce an excitement in
the genito-urinary organs, which is very likely to run into a state of
permanent irritation, at the same time that they disturb the intellect,
blunt all sensations, and prolong the efforts of coitus by postponing
the convulsive action which concludes the act. Hence it occurs that
these tissues, already irritated by the direct action of the fermented
liquors, are still more disordered by the violent and prolonged action
of such unsuitable efforts. It is not wonderful, then, that coitus
under such unfavorable circumstances should often produce hurtful
results.

Characteristics of venereal excesses. — The immoderate and conse-
quently injurious use of a thing, useful within proper limits, consti-
tutes an excess. We must, therefore, consider the act of sexual
intercourse under two points of view, in order fully to understand
its different effects. It is widely different from all abuses, which can
never be of service, however rarely they may be practised.

But to what extent may intercourse be regarded as moderate and
useful, or at all events as not hurtful? When do excesses and con-
sequently danger commence? These important questions have never
been clearly resolved. In such a consideration each consults his own
experience, and arrives at a different conclusion. The power and
activity of the organs of generation, as I have already stated, vary
extremely in different individuals, and even in the same individual at
slightly distant periods. No other organs in the economy present
so great a variety in the activity of their functions. It is, therefore,

VENEREAL EXCESSES. 185

evident that any statement in numbers would be incorrect as regards
the majority of cases.

The tvants of the genital system can alone furnish data applicable
to each case. But the appreciation of these wants is not so easy as
might be supposed. They vary with the individual, with the age,
and a host of other circumstances, the combinations of which are
almost infinite.

The genital ivants may be factitious ; a violent attachment may, in
this respect, give rise to great illusions ; the direct irritation brought
on by Herpes preputialis, or by the presence of ascarides in the rec-
tum, may excite morbid erections which have no connection with the
real wants of the system. Irritation of the cerebellum, the spinal cord,
or the nerves supplying the genital organs, may produce the same
effects, so that the frequency and duration of the erections will not
always show the amount of the true powers. In many persons the
desires are greater than the powers of fulfilment; the imagination of
such is constantly occupied by erotic ideas whilst their physical pow-
ers are very little. The impulse in these persons is purely derived
from the brain, and their immoderate desires cannot, therefore, fur-
nish a measure of their real wants.

On the oth-er hand, a too absolute and lengthened continence may
end by throwing the genital instinct into a state of inertia, which
might be mistaken for impotence, and which may lead to it, as we
shall see by and by.

Excessive spermatic plethora is generally accompanied by a feel-
ing of uneasiness and anxiety, with general discomfort, headache, lazi-
ness, and somnolency, or perhaps, in other cases, agitation, sleep-
lessness, impatience in temper, inaptitude for intellectual employ-
ment, despondency, love of solitude, and swelling and pain of the
spermatic cords and testicles. These symptoms are especially seen
about the age of puberty, in lads who have escaped falling into bad
habits, and who have never had sexual intercourse ; they are not rare
in persons more advanced in life, who have been suddenly deprived
of intercourse which had become habitual to them. It is remarkable
that many of the same symptoms are found in cases of spermatorrhoea.
It is sufficiently astonishing to find such opposite causes producing
similar results, yet we see the same thing occur daily in other cases.
For instance, too large or too often repeated bleeding constantly pro-
duces vertigo, dizziness, noise in the ears, convulsions, palpitation of
the heart, &c., although these symptoms usually depend on a state of
plethora. I have related many cases in which extreme weakness was
accompanied by symptoms likely enough to cause a dread of apo-
plexy, cerebral affections, or disease of the heart.

From such facts, then, we may conclude, that opposite conditions
of the economy may produce phenomena sufficiently alike for skilful
practitioners to be mistaken in them ; and we must not be astonished
at finding that a too long continence should bring on phenomena
similar to those observed after too often repeated seminal discharges.

186 CAUSES OF SPERMATOEEHCEA.

It is difficult, then, to judge a priori of the real wants of any indi-
vidual, because the frequency and duration of the erections, the
activity of the venereal desires, and the phenomena observed in the
dififerent functions of the economy, may prove deceitful. This is not
the case, if we only consider the effects that immediately follow the
venereal act. It is then always easy to foresee the remote conse-
quences which are to be expected from more frequent sexual indul-
gence. The following signs cannot be misunderstood, and are appli-
cable in all cases.

When coitus is followed by a sense of happiness, of general com-
fort, and of increased strength ; when the intellect is more acute, and
the body more active; when an inclination to take exercise, or to
engage in intellectual excitement is observed, together with increased
activity of the genital organs, it is evident that an imperious want
has been satisfied within the limits necessary to health. The happy
influence all the organs experience from the act is similar to that
which follows the accomplishment of every other function necessary
to the economy.

When, on the contrary, coitus is followed by a feeling of sadness,
of uneasiness, fatigue, or satiety ; when heaviness of the head and a
disposition to sleep occur, with confusion in the ideas and disinclina-
tion for exercise, it may be presumed that the act has been too often
repeated, or performed under unfavorable circumstances ; and erec-
tions, however energetic, which occur soon afterwards, should be
considered as excited by the commencement of irritation, and not by
the return of the want.

It is only when coitus is followed by all these marks of debility,
that it is injurious ; indeed, sadness, ill-temper, and regret are never
shown, unless the act be too often or unseasonably repeated. Such
conditions, therefore, should be sufficient to show that there has been
either excess or unfitness — which produce the same effects.

These two classes of phenomena, however, are rarely of so striking
a nature as I have just supposed, because on the one hand, the want
is seldom very imperious, and on the other, the excess is seldom very
great ; but at the same time there are few who have not experienced
something analogous to the one case or the other. Cases intermediate
between these extremes, constitute the ordinary course of life ; then
coitus is followed by no remarkable phenomena, and hence we must
conclude that in the majority of cases it is far from exerting the
hurtful influence on the economy that has been attributed to it. It is
true, that I have related cases in which coitus seldom repeated was
attended by the most unfortunate results ; but in such cases the pre-
vious or concomitant circumstances must be taken into consideration.

The causes capable of rendering coitus hurtful are very various
and frequent. I have hitherto only considered a few of them. I
now proceed to comment on others, which may act indirectly in
bringing on spermatorrhoea, either by inducing excesses or by dis-
ordering the act itself.

VENEREAL EXCESSES. 187

Causes of Venereal Excesses. — In a former chapter I have
pointed out the pathological causes that may bring on accidental
irritation of the genital organs and excite abuse : it is evident that
the same circumstances may equally lead to venereal excesses: what
I have already said, therefore, applies to the subject specially under
our consideration.

Age. — The sensibility which the genital organs acquire at the age
of puberty, the kind of habitual orgasm of which they become the
seat, the confidence in strength imparted by an unusual sense of vi-
gor, together with the want of experience, may cause the youth to
be carried away by the violence of his first feelings. But generally
from our social state, he experiences obstacles sufficiently powerful
to subdue his passions more or less completely. This would be
highly advantageous, if the desires did not break forth at a later pe-
riod, in a manner even still more dangerous. It is rarely, then, that
the youth meets with circumstances favorable to habitual excesses
capable of injuring his health. I have met with few such examples
at this early age, in comparison with the number of cases of mas-
turbation.

When, however, the development of the man is completed, and the
law sanctions his emancipation from authority, he enjoys perfect
freedom in his actions, or he marries ; and then it is, that free from
all restraint, he gives license to his previously subdued passions.
But if sexual intercourse is more frequent now than at an}'^ other
period, the virile power also exists in greater energy, and the resist-
ance to the causes of injury is more active : if the excitement, there-
fore, arise only from the genital organs, there will be no greater ex-
cesses now than at any other time, because the real wants are
greater.

At a later period the powers diminish by degrees, until they be-
come extinguished in old age, but the desires follow the same course.
Thus then the energy of the genital organs, at the period of the
greatest virility, would not suffice to induce excesses, if other causes
were not superadded ; and, on the other hand, the diminution of their
power, with advancing age, would not render coitus more dangerous,
but more rare.

Teynperament. — The predominance of the lymphatic temperament
renders the economy little capable of supporting venereal excesses,
but at the same time, this temperament predisposes to them loss than
any other. All other circumstances being equal, individuals, in
whom the lymphatic temperament is very marked, are less excitable
and less susceptible of being carried away by their passions.

The sanguineous temperament seems to be the one most favorable
to activity of the genital organs ; but at the same time this tempera-
ment supports such activity better than any other.

In persons of nervous temperament the action of the genital
organs is apt to be confounded with that of the brain ; of which I
shall speak shortly.

188 CAUSES OF SPERMATORRHEA.

Neither ace nor temperament, then, can be set down as the true
cause of venereal excesses, and of the disorders to which they give
rise.

Genital Instinct. — The organs composing the reproductive system
may be divided into two very distinct systems, the one destined for
the material performance, the other for manifesting the impulses and
directing the actions which lead to it. Proper harmony generally
exists between these two systems at the periods of evolution and
diminution of power in the organs, as well as at the time of their
greatest power and activity : this is why the phenomena having refe-
rence to generation have been generally attributed to the exclusive
influence of the sexual organs, such influence being more easily
observed than that of the encephalon. I have, however, shown that
tlie genital instinct may be developed long before the epoch of
puberty ; I now proceed to show that the two systems have not inva-
riably an equal degree of development or activity, and to point out
the results of the preponderance of one system or the other.

Genital Organs. — No other organs present such considerable difi'er-
ences either in development or power. I have met with individuals
who early addicted themselves to unbridled masturbation, and who
afterwards committed great venereal excesses, continued even to the
age of sixty, without notable injury to their health ; whilst on the
other hand, I have seen others, who experienced very serious noc-
turnal and diurnal pollutions, as a consequence of very slight errors
of conduct.

These diff"erences of constitution are not always marked by charac-
ters announcing a predominance of one of the elements which con-
stitute the organs ; still less are they shown by the development of
the frame or the muscular sysrem. Thus, with a sanguineous, a ner-
vous, or a lymphatic temperament, and with either a robust or a de-
licate constitution, the genital organs may present all the varieties
of size, power, or activity.

The condition which predisposes least to sexual excesses is that
in which development of the genital organs predominates over that
of their encephalic organ. I have met with young men of extraor-
dinary virile powers, who were only impelled by their physical wants.
They experienced frequent and importunate erections, but their ima-
gination remained unexcited. They practised masturbation, or had
recourse to sexual intercourse, to free themselves from uneasiness,
and thought no more of the act as soon as this uneasiness had ceased.
Such patients have always consulted me for syphilis or blennorrhagia.
The opposite conditions are those which predispose to excess.

Eiiceplialio Organs. — I do not pretend to give an opinion here on
the part of the brain which receives the sensations derived from the
sexual system. It is enough to know that some such organ exists,
and that its action may precede that of the genital organs, and con-
tinue after it, or in other words, that this action of the brain may pre-
dominate. Such predominance of the genital instinct over the mate-

VENEREAL EXCESSES. 189

rial instruments, is in general shown very early. The chil'lren we
see occupied with women, five, six, or even ten years, before puberty,
almost always show, during the rest of their lives, the same suscepti-
bility for all that may produce or recall erotic ideas, whether such
impressions arise from the genital organs, or are excited by the senses.
They preserve a very lively and enduring remembrance of these im-
pressions ; their imagination gloats over them, and considers them in
a hundred different ways : voluptuous images are mingled with their
most serious thoughts, disturb all their meditations, and are present
even in their dreams. They covet all women ; but their virile powers
do not suffice for the activity of their desires. Coitus fatigues and
enervates them ; they are aware of this, but are drawn into excess in
spite of themselves, and as often as they are physically able. Such
persons have no more power over their will than the insane ; when
they feel worn out after coitus, they make the best resolutions, which
they break as soon as they are able, at the same time foreseeing that
they will experience injurious effects from such infringement.

When desires are only excited by spermatic plethora, they are
appeased as soon as the want is satisfied, and only return when the
loss is repaired. There could, therefore, never be a real excess in
such a case, if other causes did not determine the more frequent repe-
tition of the act. Grave excesses, however, are almost inevitable,
when the desires are found in great disproportion to the real wants of
the system. A brilliant and active imagination, an exquisite sensi-
bility, and great brilliancy of ideas are often joined to this predomi-
nance of the sexual instinct. Individuals imbued with the spirit of
poetry, whom we call nervous, frequently attach the most seductive
colors to their recollections, and embellish them with imaginary
charms ; but their devouring passions are badly supported by their
weak and irritable organs.

Such predominance of the nervous system too, renders the organs
exposed to abuse or excess more impressionable ; and as their func-
tions may be easily perverted, it is evident that such individuals are
very liable to the occurrence of spermatorrhoea. Other impulses
derived from the faculties of the mind, may also induce an individual
to overstep the limits of his true necessities. Of these I shall now
speak.

Vanity is perhaps the most common cause of venereal excesses.
Man covets the esteem of his race; and especially that of woman,
of whom he is the natural protector. It is when in the presence of
woman that he is proud of his intellectual and physical superiority,
and of his social position ; but it is his virile power of which he is
especially proud, and which he endeavors to prove — those who are
the least strong in this repect, fear the most to allow their weakness
to appear. Hence excesses arise, which are not caused by the real
necessities, and which do not spring from a violent passion. Young
men who have given themselves up to the ardor of their passions
soon after their marriage, endeavor to sustain the excesses with

190 CAUSES OF SPERMATOREHCEA.

which they commenced. They dread causing a suspicion of cool-
ness, or of infidelity, though they very soon repent their first impru-
dence — their irritated organs being no longer in the physiological
condition which at first permitted them to support excesses. If I
may judge from the facts I have learned from patients, their venereal
excesses have been caused more frequently by an unfortunate vanity
than by an ardent attachment. I admit all that an exclusive and
blind passion concentrated on one object is capable of ; but this does
not prevent the impulses of which I have just spoken from acting at
the same time ; it must even lend them more energy.

Excitement caused by an ardent attachment undoubtedly exposes
to great excesses, and it is not less evident that these excesses may
become hurtful ; but they are not so much so as if, were it possible,
the same individual had committed them with perfect indifference.
This is easily explained by referring to the excitement which the
whole economy receives from feelings of joy and pride.

The sensations are more lively in proportion as the semen is better
formed, and has remained (within certain limits) longer in its reser-
voirs. The excitement caused by its long continued presence, may
even proceed so far as to bring on a state of erotic fury almost resem-
bling mania. On the other hand, the sensations lose their acuteness
when the semen begins to lose its stimulating properties, and coitus
becomes more and more insensible, in proportion as the semen be-
comes more watery. All those who have consulted me in conse-
quence of spermatorrhoea following venereal excesses, had remarked
this diminution of pleasure long before any change took place in their
health. At the same time that the sensations diminish, the erections
become less perfect, and of shorter duration ; they may even become
so precipitate, that intromission is impossible. However rarely prac-
tised, coitus now is always followed by serious and general disorder,
which passes off very slowly, sometimes even continuing ten days or
a fortnight.

The diminution of pleasure is, therefore, the first sign which indi-
cates that the individual has exceeded the limits of his real wants.
The danger increases with the imperfection of the act.

What I have just stated is applicable to all seminal discharges, in
whatever manner they may be produced ; but by comparison, it be-
comes clear, that they are more dangerous in proportion as they take
place with less energy and afford less pleasure.

I need not repeat what I have already stated respecting the effects
of coitus, as compared with those of masturbation ; most surgeons
agree on this point ; but the same differences exist with regard to
involuntary discharges. The same individual who could repeat coitus
several times without inconvenience, often feels worn out after a sin-
gle nocturnal pollution. Advantage is always found to arise from
substituting the natural mode of dischage for nocturnal pollutions,
when those do not arise from irritation. The normal excitement
resulting from coitus in such cases, gives tone to the whole economy,

VENEREAL EXCESSES. 191

and especially to the genital organs ; the discharges that take place
are more easily compensated, and contraction of the ejaculatory
ducts more actively opposes involuntary discharges. Nocturnal
pollutions, on the contrary, leave the tissues in a state of atony,
increase the relaxation of the ejaculatory ducts, and expose the pa-
tient to a return of the same accidents, and afterwards, to diurnal pol-
lutions. When nocturnal pollutions arise from irritation of the
genital organs, coitus, by increasing that irritation, proves injurious ;
but when they are due to habit or to relaxation of the parts, coitus,
even when often repeated, is of service as a substitute for them.

Nocturnal pollutions, when compared together, are liable to the
same observations. All the patients who have consulted me in such
cases, have noticed that at first the emissions were accompanied with
dreams, violent erections, and lively sensations, and that they were
then borne without injury ; but that in proportion as these pheno-
mena of excitement diminished, the pollutions produced more serious
and lasting effects. Those which took place without erection or
sensation were the most depressing. Diurnal pollutions, too, cceteris
'paribus, are more serious and more difficult of cure than nocturnal
ones ; and those which accompany the discharge of urine are more
distressing than such as take place during efforts at stool. In a
word, experience has convinced me that involuntary seminal dis-
charges are serious in proportion as they occur easily.

To sum up then : whether the excitement arise from the cerebral
system, the passions, &c., or from the presence of well formed semen,
emissions accompanied with the most energetic phenomena can alone
be useful or uninjurious : and, cseteris j^aribus, seminal discharges are
more hurtful in proportion as they are accompanied by less ener-
getic erections, and less lively sensations : in a word, as they are
more j^assive.

I consider it of some importance thoroughly to establish this as
a general principle, both because it is opposed to the ideas usually
entertained on the subject, and because it is of daily application to
the study and treatment of both voluntary and involuntary seminal
discharges.

Accidental injluences. — I have already spoken of the immediate
efi'ects of horse exercise, and alcoholic stimulants, as well as the
remote ones of masturbation, and blennorrhagia. One or two phe-
nomena arising during sleep, deserve mention.

Accumulation of urine in the bladder during the night, is a power-
ful cause of excitement of the genital organs — another proof of the
intimate connection between the genital and urinary systems. This
influence is well known to all who suffer from nocturnal pollutions ;
nearly all such, warned by their own observations, take care to empty
the bladder before going to bed, and every time they wake. Some
even get into the habit of waking at stated periods for this purpose,
and abstain from taking fluids in the evening. Others have told me
that the presence of feces in the rectum produces the same efi'ects.

192 CAUSES OF SPERMATORRHCEA.

The heat of the bed is also a powerful stimulus to the genital organs.
It is not, therefore, surprising that the morning should be the period
most to be feared by those addicted to masturbation, or tormented
by nocturnal pollutions. Such erections, in most cases, do not arise
from real wants, and therefore coitus becomes injurious. The act
is indeed more or less an excess according to the weakness of the
individual, and must be avoided.

General Effects of Venereal Excesses. — From the most re-
mote ages a striking contrast has existed between the inhabitants of
the east and those of the west. The following characters mark the
different types. On the one hand, their habitual idleness and inac-
tivity ; dread of physical disturbance, or moral agitation ; of change
of any kind ; and of all employment either of the body or mind ; a
dreamy existence ; the life passed apart from men, and shut up
among women ; while on the other hand, their restless and constant
activity ; love of independence and liberty ; an active life ; aptitude
for business ; love of glory and aggrandizement ; boldness and per-
severance in enterprise ; devotion to country and to principles ; ardent
desire of improvement, and of conquest, both by prudence and in-
dustry, and by war and colonization, by the patient observation of
facts, and by the constant searching after truth. These characters
have continued among all the changes of religion and politics, and
are even more marked than ever at the present day. Considering
all circumstances, the differences appear to me to arise almost en-
tirely from the difference between the eastern and western nations
in respect to marriage. On the one hand, there is polygamy, and
on the other, monogamy. Throughout the east polygamy is encou-
raged ; hence we see cowardly despots with crowded harems among
the rich, and an impoverished and debased population, with a scarcity
of females among the poor ; from the latter circumstance the most
revolting vices arise. In the west, on the contrary, monogamy is a
strictly preserved institution ; and we have domestic felicity, moderate
governments, energetic and active lives ; science flourishes ; and the
western nations have gradually become the mistresses of the world.

A circumstance remarked by many travellers in the east is, the
anxiety with which cantharides and all other aphrodisiacs are sought
after. Impotence arising from venereal excesses is common at an
early age. The generative functions, then, appear to possess a very
powerful and direct influence on the state of society, by affecting the
physical and moral strength of those who compose it.

Special Effects of Venereal Excesses. — The influence of venereal
excesses in producing involuntary seminal discharges was perfectly
well known to Hippocrates : it is probable, however, that he was aware
of other causes.

How do venereal excesses act in inducing spermatorrhoea ? By
the influence of habit ? by causing atony and relaxation of the parts ?
Doubtless we must take these circumstances into consideration ; but
there is a much more serious and much more frequent one. The

VENEEEAL EXCESSES. 193

local phenomena that immediately follow coitus, may be modified by
the circumstances which preceded or accompanied the act; but they
always present more or less increased action in the genital organs ;
the effects that result may then be referred to excitement, to irrita-
tion, or even to inflammation.

Whilst the organs are healthy, and intercourse is proportioned to
the wants of the system, its eff"ect is simply tonic and stimulant.
The semen is more abundantly secreted and more energetically
retained in the seminal vesicles, and so far the influence is useful,
being within proper bounds. Coitus therefore is, under favorable
circumstances, the natural excitement of the genital organs.

This is not the case with regard to masturbation, and the other
abuses of which I have spoken, and hence such habits are so perni-
cious. Disturbance, disorder, and irritation alone result from unna-
tural abuses ; a tonic effect is never produced. Intercourse, there-
fore, is substituted with advantage for either voluntary or involun-
tary discharges, so long as there is no irritation in the organs,' but
when irritation has once been set up, intercourse always increases the
nocturnal and diurnal pollutions. A single connection, if there be
irritation of the organs, may produce the most unfavorable results.
Excesses, therefore, when the organs are healthy, (To not produce
their effects at first. But when they have been continued for some
little time symptoms of irritation supervene, ejaculation takes place
very rapidly, and there is often heat felt during micturition ; the
urine is more abundant, and there is frequent desire to pass it ; the
orifice of the urethra is red and injected. This irritation extends to
the prostate and margin of the anus, as shown by a feeling of weight
and uneasiness in the rectum and perineum, and by contraction of
the sphincter ani, producing constipation. The spermatic cords and
testicles are painful on pressure, and require to be supported by a
bandage.

Sometimes chronic or even acute inflammation of the urethra may
arise. In 1831, I was consulted by a peasant, about thirty years of
age, for urinary fistula in front of the scrotum. He married at the
age of twenty-two, and never had intercourse, except with his wife,
who, on the other hand, never suffered from leucorrhoea, or vaginal
discharge. The patient committed such excesses, that soon after his
marriage inflammation of the urethra came on ; this was situated
chiefly in the spongy tissue, for there was very little discharge, and
the chordee very severe. The passage of urine became diflicult, and
an abscess formed and broke in front of the scrotum. From careful
and repeated examinations, I am convinced that the urethra was
completely obliterated to the extent of five or six lines, about half
an inch in front of this fistula. The inflammation in this case then
must have been severe, and it would appear that it was produced
solely by excessive coitus.

The inflammation of the prostate is not always confined to its
mucous follicles ; it extends sometimes to the cellular tissue unitino-

194 CAUSES OF SPERMATORRHCEA.

them. Hence results more or less severe and complete retention of
urine. In such cases catheterism should be avoided if possible.

Venereal excesses may also produce acute or chronic cystitis. I
have lately treated a severe case of chronic cystitis, which had lasted
five years and came on soon after a second marriage at the age of
forty-five.

I have also several times met with symptoms of nephritis in indi-
viduals who had committed great excesses, and in whom no other
appreciable cause seemed to have acted.

Inflammation of the vasa deferentia and testicles is by no means
rare as a sequal to venereal excesses. The manner in which such
inflammation is produced is well known.

Serious effects are, however, by far the most rare. I have not
laid stress on them in order to show what ordinarily occurs, but that
which takes place when the symptoms are less severe may be under-
stood. Since irritation from venereal excesses passes so readily to
the prostate and bladder, the seminal vesicles cannot escape, and
this explains why involuntary emissions supervene. It is evident
also from this fact that the involuntary discharges do not arise from
atony or relaxation.

It is, however, diflicult exactly to determine where the excitement
of the genital organs that follows coitus begins to pass into irritation.
As it is of much importance to decide this point, I shall describe the
most usual symptoms that are manifested during the change.

At first the erections are more frequent and more energetic, and
lead to a belief in a vigor which does not exist. New excesses are
committed at a period when intercourse ought to be left off.

Frequent desire of micturition is the symptom that most frequently
precedes involuntary discharges produced by venereal excesses. I
have frequently been consulted by patients for this symptom alone,
who had already suffered in health from unsuspected spermatorrhoea.

The changes in the phenomena of the act also merit serious at-
tention. The erections, after having been frequent, long continued
and importunate, become rare, incomplete, and of short duration ;
ejaculation takes place with increasing rapidity, so that at length
intromission is scarcely possible. The sensations also diminish in a
very remarkable manner, and coitus becomes very fatiguing.

The first changes announce that irritation is being set up by the
over excitement of the parts ; the second, that diurnal pollutions
have already occurred.

AVhen these symptoms first show themselves, the disorder would,
in many cases, be arrested spontaneously, provided the patients would
put a check on their desires. This rarely occurs, however ; and on
the other hand, most of those who have sufficient power over them-
selves to preserve absolute continence, suffer at first from nocturnal
pollutions, which cause them to relapse.

But as the economy becomes weaker, the patients are more conti-
nent; their desires diminish ; their nocturnal pollutions are less fre-

YEXEEEAL EXCESSES. 195

qnent, and at length cease altogether, being replaced by diurnal ones.
The patients are now strictly continent, yet derive no benefit ; and
hence, they often believe that the disorder of their health has caused
the diminution in their virility. Some patients have no nocturnal
pollutions, or, at all events, such pollutions continue a very short
time ; this arises from their tendency to constipation. The efforts
necessary at stool bring on emissions rare at first, but afterwards
frequent and abundant, in spite of enemata, and even when diarrhoea
takes the place of constipation. In a short time these discharges
occur also during the emission of urine.

Patients rarely have any suspicion of such evacuations ; and when
their health is so much deranged that they obtain medical aid, they
are unable to give any exact details as to the origin of their disorder.
According to the symptoms most apparent, therefore, the practitioner
consulted diagnoses, chronic gastritis, commencing cardiac disease,
threatening apoplexy, or pulmonary irritation. He bleeds, or ap-
plies leeches and blisters : if, on the other hand, he considers the
case one of hypochondriasis, he prescribes mineral waters, amuse-
ments, travelling, &c. Still the disorder progresses, or at least, only
a momentary amelioration occurs ; consultations are held, but if any
suspicion of venereal excess arise, it is always overthrown by the
specious objection of which I have already spoken, while describing
the effects of masturbation, viz : that intercourse has ceased for a
long time, and that the health has from that period become still
more disordered. The details given are precise and circumstantial ;
the patient has high interest in confessing all the truth ; he has
nothing shameful to hide; his statement is, therefore, received
without hesitation by his medical attendants. Hence we may ima-
gine the errors which are likely to arise in the treatment of these
cases.

( 196 )

CHAPTER VIII.

CAUSES OF SPERMATORRHCEA.

Action of Certain Medicines.

Certain medicines — as astringents, purgatives, narcotics, stimu-
lants, and diuretics especially — may bring on conditions from which
spermatorrhoea may arise.

^flstringents.

CASE XLVI.

Intermittent fever — Large doses of Jjoi-h — Obstinate con&tijwtion — Diurnal
pollutions — Symptoms of chronic gastritis, and of disease of the heart —
Tlie use of douches followed hy rapid improvement.

M. S , an oflBcer, about thirty years of age, consulted me in 1828,

for supposed disease of the heart, from which he had suffered for about
eighteen months. He was tall, thin, and very pale j his voice husky, and
his manners timid. On examining the cardiac region with the stethoscope,
I found that the pulsations were rapid and tumultuous, and occasionally
intermittent and irregular, but there was neither abnormal force nor extent
of action, and there was no friction sound, nor bruit de souffle. The palpi-
tations were much increased by active exercise, especially by mounting a
hill, but they came on frequently whilst the patient was in a state of absolute
repose, being excited by any unexpected noise, or by slight moral emotion.

1 was convinced that M. S had no organic disease of the heart, and

soon after he had been told so, his pulse assumed its normal characteristics.
He gave me the following history of his case.

During the winter of 1826, whilst at Corsica, he assisted in extinguishing
a fire which occurred during the night, and took a severe chill. Shortly
afterwards, he suffered from a very obstinate intermittent fever, for which
he took large quantities of bark, always in the form of bo%ses. From this
period, he became subject to obstinate attacks of constipation, his stomach
became very irritable, and his digestion disordered. Several times he had
symptoms of chronic gastritis, which was treated by leeches, antiphlogistic
regimen, and baths. At length palpitations and difficulty of breathing came
on gradually, tending to create a suspicion of cardiac disease, to combat
which, small bleedings were frequently practised, and digitalis given without
benefit. The patient attributed his constipation and digestive disorder to
the bark he had taken, and the disorder of his heart to the excitement he
had experienced during the fire.

ACTION OF CERTAIN MEDICINES. 197

By a little attention, I discovered the mode in which the bark taken had
induced the symptoms the patient suffered from ; obstinate constipation
supervening, brought on involuntary emissions during defecation ; these
were at first slight and rare, but they afterwards became more abundant,
and after a time quite habitual, notwithstanding the frequent use of ene-
mata. The patient had been aware of these discharges from their com-
mencement, but he attributed them to his prolonged continence. The urine
also frequently contained semen. On the other hand, his erections had
diminished by degrees, and had left him entirely, together with his venereal
desires, for more than a year. He had never committed any excess, or prac-
tised any abuse, and had never had either blennorrhagia or syphilis.

Cold ascending douches, iced milk mixed with lime water, and cold
lotions on the perineum, produced a rapid improvement, and the season for
using mineral waters having arrived, I advised the springs of Bareges.
From that time I have had no communication from the patient.

Palpitations in this case, as in many others that I have related,
arose from diurnal pollutions. These discbarges could only have
been caused by straining at stool, the patient's constipation being
evidently attributable to the prolonged use of bark in substance.
From analogy we may suppose that many other remedies may pro-
duce the same effects.

Purgatives.

I have already shown that irritation from spasmodic contractions
of the rectum may extend to the seminal vesicles, and produce just as
serious diurnal pollutions as those which arise from mechanical com-
pression of the same organs. Therefore, if ascarides, diarrhoea, ifec,
can excite involuntary emissions, as well as a mechanical obstacle
to defecation does, we may easily understand that drastic purgatives,
by irritating the rectum, may expose the patient to the same dangers
as astringents do by bringing on constipation. Drastic purgatives, as
is well known, act chiefly by irritating the large intestines. Spasmodic
contractions of the rectum may, therefore, be excited, and may induce
.diurnal pollutions, the severity of which will be proportioned to the
extent and duration of the irritation, but as this irritation usually con-
tinues a very short time, the seminal discharges which result from it
scarcely deserve to be considered as a disease. It is, however, easy
to conceive that the too frequent repetition of drastic purgatives, or
their too active character, may bring on in the rectum and neighbor-
ing parts, a more permanent state of irritation, which may become
habitual, and may continue after the cessation of its exciting cause.

If, however, the abuse of purgative medicines may bring on sper-
matorrhoea in persons not previously affected by it, it is evident that
those who were previously affected by the disorder, must be much
injured by their use. This fact becomes very important, because in
almost all cases of spermatorrhoea the constipation is very obstinate,
and the patients regard it as the primary cause of their sufferings. It
13

198 CAUSES OF SPEEMATOKRHCEA.

is to obviate this constipation that they seek medical advice; and the
symptoms of hypochondriasis and cerebral congestion they manifest,
induce the gentlemen consulted to administer purgatives freely. The
patients themselves constantly recur to purgatives, and although
often worse after their use, they hope that the remote effects ■will
prove more favorable. Under no pretext should the medical at-
tendant permit the administration of anything more active than
mild laxatives in these cases. Indeed, it is even doubtful whether
laxatives can be used with impunity.

Narcotics.
CASE XLVII.

Frequently repeated narcotism at the age of sixteen from the vapor of to-
bacco — Dilatation of the pupils — Vomiting — Constant headache — Con-
stipation — Nocturnal and diurnal pollutions — Impotence — Cauterization
at the age of nineteen — Rapid recovery.

M. S , of Stockholm, short and stout, and of lymphatico-sanguineoufs

temperament, enjoyed escellent health from childhood, until at the age of
sixteen, he entered a tobacco manufactory in May, 1835, and was employed
in a small room were newly made cigars were dried at a high temperature.
At least ten thousand cigars were constantly in the stove. At first, M.

S did not suffer any inconvenience, because the doors and windows

of the drying room were left open ; but about the beginning of November
he was attacked by headache, which was felt principally behind the ears.
This increased by degrees in severity and duration, and by the end of the
winter had become constant ; the patient was neither able to employ him-
self during the day, nor to sleep by night. Leeches were applied behind
the ears, and on the following day he was seized by general indisposition,
frequent vomiting, as well before as after meals, dilatation of the pupils,
and constipation.

From this time the patient fell into a profound melancholy ; he became
excitable, timid, and incapable of any serious occupation. A seton was
inserted in the nucha, and the application of leeches was repeated. No
improvement took place, however, and blisters were applied behind his
ears : these were followed by retention of urine. Soon afterwards, weakness
of the lower extremities, loss of flesh, and pallidity of the countenance,
were added to the patient's other symptoms. The mineral springs of
Carlsbad and Ems, and the use of sea bathing, with cold douches on the
head, relieVed the vomiting; but the other symptoms still continued.

In this condition, the patient came to consult me in July, 1836. From
information received from the medical gentleman under whose care the
patient had been at Stockholm, Paris, &c., I imagined the sea bathing had
been most useful of all the means previously tried. I therefore advised M.

S to continue taking salt water baths until the end of the season, and

consequently I did not see him again until the beginning of winter, when
his weakness was much increased ; his headaches continued unrelieved; his
countenance was pale and livid; his intellect very sluggish; his memory
uncertain ; his sleep short and broken, with constant drowsiness ; the pupils

ACTION OF CERTAIN MEDICINES. 199

extraordinarily dilated, and vision very imperfect; in fact, tbe patient seemed
to be still laboring under tbe effects produced by tbe cigar stove.

The primary cause of this patient's condition could not be doubted ; but
the effects of narcotic poison usually pass off in a day or two. In this
case, on the contrary, the headache had been combated by various means
for two years. I was, therefore, considerably embarrassed as to what I
should advise, when accidentally I saw the patient's urine. I was much
surprised to perceive an abundant deposit resembling semen, at the bottom

of the vessel, and on questioning M. S I learned, that, although he had

never been addicted to masturbation, and bad very rarely had sexual inter-
course, shortly after the symptoms of narcotism first confined him to his
bed, he had experienced abundant nocturnal pollutions, which increased in
frequency. In November, 1836, he had as many as three each night ; after
this they gradually decreased in frequency, so that he had then only three
or four weekly ; he remarked that he was always worse on the following
day. At first these pollutions were accompanied by energetic erections,
and lascivious dreams ; but these phenomena had greatly diminished, and
the pollutions were no longer appreciable, except by the marks left on the
patient's linen. For a long time M. S had neither experienced vene-
real desires nor erections, although he was only nineteen years of age. Spa
water, iced drinks, cold lotions, &c., having produced no benefit, in the
beginning of December I introduced a catheter. The sensibility of the
urethra was such that I determined on cauterizing the prostatic surface. I
had little hope of benefit arising from this operation, but a remarkable effect
was produced. From that moment the nocturnal pollutions became more
and more distant, and the constipation ceased spontaneously. On the tenth
day the patient's urine was perfectly transparent, and from that time, his
headache, which had been unsuccessfully treated for two years, disappeared
entirely; his sight became gradually stronger, and his pupils contracted;

his ideas became clearer ; employment was sought ; and M. S was

soon able to resume his occupation. His virility returned with great en-
ergy ; during six months, obstinate erections were established every night,
and often during the day, on the least cause of excitement, but no involun-
tary discharges took place. These violent erections, arising from the unac-
customed retention of the semen in its reservoirs, diminished by degrees ;
the wants became less imperious, and the functions returned to their normal
condition.

I have seen M. S frequently since his recovery, and I am able to

state that during two years his health has been perfect. In a letter which
I have recently received from him, dated Stockholm, he informs me that the
change of climate has not been injurious, and that he never enjoyed better
health. He has resumed the habit of smoking, for which he felt insur-
mountable disgust during his illness.

This case shows very clearly the injurious influence of tobacco on
the genital functions. The question arises, whether this influence is
due to the action of tobacco on the cerebro-spinal system, or to the
direct action of the agent on the spermatic organs ? The first symp-
toms manifested presented all the characteristics of poisoning by
narcotic substances ; and these symptoms were very intense, and
much prolonged; headache, too, was constantly present, and situated

200 CAUSES OF SPERMATORRHEA.

behind the ears : these circumstances might lead us to suppose that
the pollutions were caused by some special action of the tobacco on
the cerebellum. But cauterization alone arrested the spermatorrhcea ;
the effects of the nitrate of silver were sudden, complete, and perma-
nent. Impotence was, in a few days, replaced by violent and pro-
longed erections, which diminished only after six months ; and it is
worthy of notice, that the cephalalgia and dilatation of the pupils,
which had continued from the commencement of the narcotism, only
disappeared after the spermatorrhoea had been relieved.

There was, then, an idiopathic affection of the ejaculatory ducts,
which was cured by the local action of the nitrate of silver ; and the
cephalalgia, dilatation of the pupils, &c., were kept up by the invo-
luiitary seminal discharges. The persistence of the symptoms for
two years after the patient was removed from the influence of the
tobacco, is thus explained.

The mode in which certain stupefying poisons act on the economy,
and especially the dilatation of the pupils, might induce us to believe
that the spermatorrhoea arose from relaxation of the ejaculatory

ducts ; but in the case of M. S , the nocturnal pollutions were

at first accompanied by phenomena which indicated active over-
excitement of the genital organs. The application of blisters was
followed by retention of urine, and exacerbation of all the symp-
toms ; but if the involuntary discharges had arisen from relaxation,
they would have been diminished by the absorption of cantharides.
The excessive irritability present in the urethra too, especially near
the bladder, leaves no doubt as to the existence of acute irritation in
the prostatic portion of the canal, and this irritation would of course
extend to the spermatic organs. Thus we may account for the re-
markable success of the cauterization.

CASE XLVIII.

Nervous temperament — Repeated narcotism heticeen the ages of twenty and
tv:enty-two from smoking — Impotence, &c.

I have a young man of very nervous temperament at present under my
care, in whom nocturnal and diurnal pollutions have brought on pain in the
loins, palpitation, difficulty of breathing, &c., symptoms which were sup-
posed to arise from disease of the spinal cord, cardiac affection, and com-
mencing phthisis. Among the exciting causes of these involuntary dis-
charges, the effects of smoking occupy the chief place. The following is
the patient's statement.

" At twenty years of age I wished to accustom myself to smoking ; but a
day never passed without my experiencing complete intoxication, attended
with vomiting, vertigo, and trembling of the limbs. I continued the
habit, however, and I soon began to perceive that my sight became weak,
and that I lost my memory; my hands shook; and my digestion became
much disordered. I noticed, also, great debility of the genital organs ; my
erections ceased : and at the age of twenty-two I found myself completely

ACTION OF CEETAIN MEDICINES. 201

impotent." This patient had rarely practised masturbation, and had never
committed any excess when he first began to smoke ; his health had previ-
ously been excellent. It is, therefore, evident that the impotence, as well
as the other symptoms, arose from the action of tobacco. Impotence at the
age of twenty-two can only be produced by involuntary seminal discharges,
provided there be no physical disability. In the present case, there was
no doubt on the point, the patient himself having discovered diurnal and
nocturnal pollutions.^

The action of tobacco on those ■who smoke for the first time is
too well known to require description : more or less disorder of all the
functions, varying according to the constitution of the individual, in-
variably arises from it ; and this disorder always presents more or
less of the characteristics of poisoning by narcotics. These effects
go off by degrees, as the patient becomes habituated to the use of to-
bacco, and generally after a time cease to be manifested at all. Some
nervous and excitable individuals are unable to accustom themselves
to the habit, as in the case just mentioned ; in others again, smoking
becomes an artificial habit, which in many cases is almost a necessity.

But this empire of custom has its limits, beyond which the nar-
cotic influence reappears. In such as are not easily affected, this
acquired habit is generally supported with impunity ; but even then,
if it is indulged in to excess, it must after a time be injurious.
Thus it is that the most accomplished smokers often experience
vertigo, cephalalgia, anorexia, &c., when they have remained long
in an atmosphere densely filled with smoke, which is then drawn
into the lungs, and probably produces worse effects than when merely
drawn into the mouth, or swallowed, as in smoking.

In a word, then, if the power of habit can prevent the momentary
effects of smoking from showing themselves, the frequent repetition
of the use of tobacco produces more lasting effects on different or-
gans. Disorder of the digestive organs is well known as occurring
in inveterate smokers ; that of the genital organs has not hitherto
been noticed.^ I believe, however, that it is by no means rare.

Cantharides.

I have already noticed that the application of a blister frequently
contributes to increase or develop involuntary seminal discharges.
But cantharides are not employed as a blistering agent only ; they
have been administered internally for the relief of impotence and to
cure seminal discharges, which have been supposed to arise from
atony or relaxation of the genital organs. None of the patients by
whom I have been consulted had ever received even momentary
benefit from the administration of cantharides; many experienced

' This case being still under treatment, I have omitted its further details.
- Many inveterate smokers among my professional friends, liave mentioned to me
the diminution of their venereal desires, as one of the effects of tobacco. [H. J. McD.]

202 CAUSES OF SPERMATORRHCEA.

serious increase of all their symptoms — complete impotence taking
the place of weakness of the organs. One patient for whom an in-
jection into the urethra of tincture of cantharides diluted with water,
had been ordered, received no benefit from any of the means I could
devise for the cure of involuntary discharges brought on by such
imprudence. The unsuccessful employment of cantharides, in cases
of spermatorrhoea, might be taken as further evidence, were any re-
quired, that the disease does not generally arise from atony, or
relaxation, but from irritation of the genital organs.

Oamphor.

The action of camphor is the very opposite to that of cantharides.
It is by sprinkling camphor over blisters that the irritating action
of the cantharides on the genito-urinary organs is avoided. Cam-
phor relieves, more than any other remedy, the priapism and great
pain in the genito-urinary organs induced by the internal adminis-
tration of cantharides. Hence it is generally and with reason con-
sidered as an anti-aphrodisiac.

I believe, then, that in moderate doses and under certain circum-
stances, camphor may be employed with advantage in the treatment
of spermatorrhoea; I have, however, remarked that in too large doses,
or when continued for a long time, camphor may induce more or less
serious and obstinate involuntary discharges. One of my patients
who put camphor between the prepuce and the glans penis, suffered
from such serious diurnal pollutions that his life was in danger ; he
had, however, previously suffered from involuntary discharges.

Nitrate of Potass.

I should not mention this preparation did I not consider it neces-
sary to point out a grave error in the opinions generally received
respecting its action on the genito-urinary organs. Nitrate of potass
is supposed to possess the property of quieting the organs, and of re-
moving venereal desires. Saline mixtures containing nitrate of potass
are prescribed every day for the relief of the inflammatory symptoms
in the first stage of blennorrhagia — there cannot be a greater error.
Nitrate of potass is also regarded as a diuretic, because ordinarly it
increases the flow of urine ; and this is precisely why its sedative
properties should be doubted. The quantity of urine can only be
increased by stimulating the functions of the kidneys, or in other
words, by acting on them as an excitant ; when administered in too
large a dose it produces hematuria, pain, &c. But it is not on the
kidneys alone that nitre produces this stimulating effect; it increases
all inflammations of the bladder, whether acute or chronic ; it is even
contraindicated in the most simple case of vesical irritation.

I have seen nitrate of potass produce the same effects in diseases
of the prostate ; it increases the stabbing and pricking pains, and the

ACTION OF CERTAIlSr MEDICINES. . 203

sense of weight, which the patient always feels in that region. The
following case shows that nitre may act in the same manner on the
urethra.

A merchant of Genes, wishing to take a purgative, sent to a drug-
gist for an ounce of sulphate of magnesia. By mistake an ounce of
nitrate of potass was returned by the messenger and taken. Violent
inflammation of the urinary passages, accompanied with a discharge
resembling blennorrhagia resulted, swelling took place in about the
centre of the urethra, and when the acute stage of inflammation had
passed off, a circumscribed induration, which obstructed the discharge
of urine, remained. Twenty years afterwards the patient still suffered
from this obstruction, for the formation of which there had been no
other cause than the inflammation produced by the nitrate of potass.
The patient had never had blennorrhagia, either before or after, and
had never suffered any injury of the part.

It appears then that the nitrate of potass acts as a stimulant of
the whole urinary apparatus, and it is at least probable that it pro-
duces the same effect on the spermatic organs. I am led to this
opinion partly by analogy, but chiefly, because more than forty of
the patients whom I have treated for involuntary seminal discharges
had taken nitrate of potass in some form or other, and all, without
exception, found themselves worse afterwards. Many of them also
observed the same effects from preparations of squill, and, in fact,
all other diuretics.

Ergot of Rye.

This singular production seems to act with as much energy on the
genital organs of man as on the female uterus. In the districts
where spurred rye is common, and the peasantry are not careful to
separate the diseased grain from the healthy, the men show a con-
siderable disposition to commit venereal excesses, and the women
frequently abort. The population, generally, also present signs of
premature decrepitude, which we can easily imagine may arise from
involuntary seminal discharges brought on by the excesses they
commit.-^

Coffee.

The effects of coffee on the cerebro-spinal system are well known;
but sufficient attention has not been paid to its action on other organs.
Taken in moderate quantities, coffee excites the bladder and kidneys,
increases the secretion of urine, and renders its discharge more fre-
quent. It acts in the same manner on the spermatic organs, augments

1 M. Robert, iu the Annales de Th^rapeutique, relates a case in which the ergot
of rye is said to have cured spermatorrhoea, after cauterization and other means had
failed. The medicine was given in pills in two grain doses, combined with one grain
of camphor. One of these pills was taken twice a day. The details of the case,
however, are by no means clearly given. [H. J. McD.]

204 CAUSES OF SPEEMATOERHCEA.

the venereal desires, favors erections and accelerates ejaculations
taken in excess, however, it seems to produce injurious effects.

CASE XLIX.

Excessive use of coffee — Frequent and profuse discharge of urine — Noctur-
nal, and afterwards diiirncd, pollutions — Impotence, &c. — Cauterization
— Sulphuretted baths — Recover!/.'

A professor, get. thirty, engaged in a new method of tuition, had recourse
to very strong coffee to keep himself awake, and took eight or ten cups
every night. A large quantity of urine was secreted, and micturition
was much increased in frequency. After a few weeks the desire of emptying
the bladder became so frequent and imperious, that the patient was obliged
to leave his class several times during their meeting. Soon after he suifered
from constipation and disordered digestion, attended with great discharge of
flatus. His intellect and memory declined, so that he became unable to
finish his course of instruction, and sleep had left him entirely, although
he had for some time given up taking coffee.

On his consulting me, he confessed that he had become completely
impotent, after having experienced frequent and abundant nocturnal pol-
lutions, which diminished by degrees, and had not appeared for three months.
I found his urine perfectly transparent, almost colorless, and very abundant;
there was not the least cloud perceptible, but at the bottom of the vessel
there were numerous transparent granules, which left no doubt as to the
existence of diurnal pollutions.

Catheterism showed excessive sensibility of the urethra, especially near
the neck of the bladder ; and on this account I performed cauterization.
The operation was followed by rapid improvement, and a few months after-
wards the cure was perfected by the use of sulphuretted springs.

It is evident that the diurnal pollutions in this case arose onlj
from the immoderate use of coffee; the first symptoms appeared soon
after, and the patient had been subjected to no other cause capable
of producing this affection. The irritation continued for six months
after he had left off taking coffee ; thus the effect was prolonged
quite independently of its first cause, and in a manner which would
lead one to suppose that it would not have ceased spontaneously.

What passed in the urinary organs is a good index of what was
going on in the spermatic : the secretion of semen was increased as
well as that of urine, and its excretion also became more frequent.
The nocturnal pollutions diminished by degrees, because they were
replaced by diurnal ones, which became more and more frequent and
profuse. Perfect similitude, therefore, existed between the urinary
and spermatic symptoms ; their respective progress and characters,
and the extreme sensibility of the prostatic portion of the urethra,
show clearly enough the mode in which coffee brought on spermator-
rhoea. It is likely enough that the occasional or moderate use of coffee
should stimulate the venereal desires, whilst they are diminished, and

ACTION OF CEKTAIN MEDICINES. 205

even completely extinguished by it when taken in excess. Its ac-
tion is the same in both cases — that is to say, it excites the genito-
urinary organs.

I have seen many other cases in which spermatorrhoea followed the
immoderate use of coffee, but other causes acted simultaneously, so
that the effects could not be traced so distinctly to one single cause
as in the case I have just related. Almost all the patients, however,
were scientific or literary men who wished to keep up mental activity,
in order to prolong their hours of study. Some of these patients
recovered by the use of baths and regular active exercise combined
with a strict regimen : others required various kinds of treatment —
the natural sulphuretted waters being the most generally successful.
Weak, delicate, and excitable constitutions appear most easily af-
fected.

Another circumstance having reference to coffee is worthy of
notice. All those who have consulted me for serious nocturnal or
diurnal pollutions had given up its use of their own accord : they
noticed that after taking coffee they experienced agitation, disor-
dered vision, involuntary contractions in their muscles, and espe-
cially a notable increase in the secretion of urine, and in the invo-
luntary seminal discharges.

Tea.

Analogy leads me to suppose that tea taken in excess may pro-
duce the same results as coffee ; I have not, however, met with any
well marked cases illustrative of its action.^

There are many other agents which may excite or increase in-
voluntary seminal discharges, but their action is not sufficiently en-
ergetic or often enough repeated to cause serious disease. I do not,
therefore, mention them specially here, but shall take occasion to
comment on them as cases present themselves.

I have now examined all the causes of involuntary seminal dis-
charges which act from without. I have still to speak of those causes
which may be attributed to the influence of other organs, and to
congenital predisposition.

• Experience enables me to confirm' M. Lallemand's opinion, as to the injurious
effects of tea on persons affected with involuntary seminal discharges. Several of
my patients had discovered that tea and coffee always proved hurtful to them, and
had renounced their use before consulting me. Such patients have found no ill effects
follow the use of cocoa. I have not, however, met with any case in which the origin
of involuntary discharges could fairly be attributed to the abuse of tea or coffee. [H.
J. McD.]

( 206 )

CHAPTER IX.

CAUSES OF SPERMATORRHCEA.

Action of the Cerebrospinal System.

Cerebellum. I have already stated that sexual ideas may precede
the evolution of the genital organs, and always remain predominant,
so as to produce a kind of erotic excitement quite disproportioned to
the real wants. I may add that these precocious and excitable indi-
viduals are most alive to the diminution of their virility. In general,
when this diminution arises from age, it is insensible, because the de-
sires diminish in an equal proportion. But the persons I have de-
scribed are more sensible than others to this change, and when it
occurs rapidly and prematurely, it produces a deep impression on
them, and frequently drives them to commit suicide.

Most surgeons have noticed the depression of spirits caused by
amputation of the penis or testicles ; but in this respect, also, there
is a great difference between different individuals. A few years ago
I removed the penis of a man, set. forty-five, for cancerous disease.
He recovered, and was fit to leave the hospital, when his wife came
to see him for the first time after the operation. During the rest
of the day he was silent and sad, and the following morning he was
found dead. A post-mortem examination, made with the utmost
care, failed to show any appreciable lesions of important organs.

Such striking cases of despair following the loss of the functions,
are rare ; but it is very common to see grief derange the health, and
thus shorten the patient's days. Old people, from whom portions of
the genital organs have been removed, rarely experience this moral
impression. I have always noticed, in such cases, that the joy of
being cured is not broken by any regret. Whence does this indif-
ference to the loss of virile power arise, if not from the weakening
of the venereal desires produced by old age.

I have had a patient, set. thirty, in the hospital for some time, who
received an enormous sabre wound on the nucha. A long cicatrix
exists across the back of the neck from ear to ear. "Venereal desire
has entirely left him, and his testicles are atrophied. Erections, of
course, have disappeared ; yet this patient experiences more pleasure
at having reformed^ than sorrow at the loss of his virility. He always
jokes when speaking of the wound and its consequences. I can only

ACTION OF THE CEREBRO-SPIN AL SYSTEM. 207

attribute this carelessness to his sexual ideas having left him at the
same time as his virile powers.

From these facts, then, I conclude that the generative function
requires not only the instruments necessary for the accomplishment
of intercourse, but the organ in the encephalon destined to receive
the sensations from these parts, and to direct their functions ; that
these two systems exercise a reciprocal influence over one another,
in which influence the encephalic organ may preponderate either con-
stantly or accidentally, according as the organ is developed prema-
turely, and in excess, or as it enjoys a momentarily increased activity.

Gall and his followers have regarded the cerebellum as the organ
of ph3'sical love and the regulator of the genital functions, and on
this point they have shown more unanimity than on any other ; this
is not the place to discuss the correctness of their hypothesis, but I
must say, that from my own experience, I consider it at least probable.

CASE L.

Masturbation — Extreme weakness of the limhs and senses — Erections excited
by percussion of the occiput — Catheters left in the urethra — Rapid reco-
very.

Dubourdeaux, aet. twenty-one, a soldier in the 36th regiment of infantry,
of strong constitution, practised masturbation at the age of fourteen as
often as three or four times a day without much injury to his health. At
the age of twenty, he entered the army. A few months afterwards, he
contracted a blennorrhagia, and, while suffering from it, performed a long
march. He was scarcely cured when he took another long march, bivouack-
ing at night, for about a month. Otitis occurred, and was treated with
leeches and blisters, but ended in suppuration. After this was cured, the
patient suffered much from noise in the ears and vertigo, and his sight be-
came very weak.

On the 21st of December, 1830, D came to the hospital of St. Eloi,

in the following condition : itch ; enlargement of the prostate ; sense of
weight in the rectum; extreme weakness of all the limbs; serous infiltration of
the hands, legs and feet ; and almost entire loss of vision. After the itch
was cured, the paralysis of the inferior extremities increasing, issues in the
loins were prescribed, but produced no benefit.

When the patient came under my care, he could neither stand, nor
disiinguish the numbers on the beds in his ward. He told me, that on
accidentally striking his occiput, he had experienced a lively sensation re-
sembling that produced by ejaculation, together with injection of the corpora
cavernosa, producing more or less complete erection. He had since fre-
quently repeated percussion of the occiput, which was always followed by
the same phenomena; the voluptuous sensation induced seemed to pass
through the whole length of the spinal cord, to the extremity of the sacrum.
Some circumstances leading me to believe that the patient abused this dis-
covery, and practised manoeuvres he did not admit, and the swelling of the
prostate at the same time rendering the discharge of urine difficult, I left
catheters in the bladder, increasing their size gradually, and taking care to

.208 CAUSES OF SPERMATORRHCEA.

withdraw them as soon as sufficient inflammation had been excited, and to
replace them when the pain in the urethra had subsided.

The result soon convinced me that my suspicions had been correct.
By degrees the paralysis of the lower extremities, the oedema of the hands,
and the weakness of vision were relieved. After introducing the catheter
six times in as many weeks, the patient had recovered his strength, stout-
ness, and the free exercise of all his functions. He left the hospital a few
days after, confessing his errors and promising not to repeat them.

From the first information given by this patient, I thought that
the attack of otitis had probably produced some chronic affection of
the brain or its membranes, but the sequel showed that the almost
perfect paralysis of the lower limbs, the swelling of the hands, and
other symptoms, exclusively arose from masturbation. I have al-
ready mentioned the advantages derivable from the presence of a
catheter in the urethra, in checking masturbation ; but in the present
case, a very remarkable circumstance offered itself, viz., the influ-
ence exercised on the genital organs by percussion of the occiput.
The effects of this procedure were so constant, that the patient was
able to procure himself erections at will, and to give himself up to
his passions without restraint.

CASE LI.

SichJy childhood — Nervous temperament — Masturhation 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 followed hy considerable improvement.

A tax-gatherer, ast. thirty-four, of nervous temperament, whose childhood
had been very delicate, from his having suffered from digestive disorder,
with frequent vomiting, consulted me. He had practised masturbation
occasionally about the age of sixteen, and at a later period had had sexual
intercourse, but never more frequently than three or four times a week. At
eighteen years of age, he suffered from palpitation of the heart, attended
with oppression of breathing, pain in the stomach, and involuntary muscular
contractions. These symptoms gave rise to suspicions of aneurism, gastritis,
&c.; in consequence of which, frequent abstractions of blood, both locally
and generally, and the use of blisters and issues, were prescribed ; with the
exception of the issues, these means all proved injurious. The blisters evi-
dently seemed to favor the occurrence of nocturnal pollutions, which tqok
place three or four times a week about this time, taking the place of volun-
tary emissions. Shortly before he consulted me^ this patient attempted
sexual intercourse by the advice of his physician, but found himself much
worse afterwards. All the precautions recommended to prevent the return
of the nocturnal pollutions had also proved unsuccessful, and the patient
had remarked that these were more debilitating in proportion as they took
place with less signs of erection or feelings of pleasure. Their effects were
often felt for several days.

The extraordinary presence of erotic ideas in this patient struck me
forcibly. Notwithstanding the small development of the genital organs,

ACTION OF THE CEEEBKO-SPINAL SYSTEM. 209

notliing could remove lascivious images from his imagination ; they were
present during the most serious study. In vain he gave up theatres and
amusements; in vain he had recourse to serious books, and religious or
scientific discussions; he was constantly assailed by libidinous thoughts,
which presented themselves under a variety of forms, and were ever present
in his dreams. He experienced also, an habitual sense of tension and unea-
siness in the posterior and inferior region of the head. Of all the means
employed, cold lotions applied to this region alone produced any notable
diminution in the frequency of the nocturnal pollutions; but this effect was
never of long duration.

In this patient the causes by no means tallied with the serious
effects produced, or with the persistence of the disease. Numbers
have practised masturbation and coitus much more frequently with-
out experiencing any ill effects. On the other hand, the constant
presence of erotic ideas showed an activity of the genital instinct,
which was by no means in relation with the condition of the genital
organs. The sensation referred to the nucha, and the effects of cold
lotions applied to this part seem to indicate that the affection was
produced, or at least kept up, by abnormal excitement of the cere-
bellum.

In several cases of involuntary seminal discharges, I have found
the patients complain of habitual heat, dull pain, and sense of ten-
sion in the occipital region ; sometimes accompanied with pulsation
of the arteries. One of my patients experienced a nocturnal pollu-
tion Avhenever his head rested on a soft pillow. I must admit, that
in such cases I have not obtained much success by using applications
to the nucha and its neighborhood ; indeed, I have only once seen
temporary improvement result from this treatment.

On the other hand, these symptoms are much more rare than any
others of which I have hitherto spoken. Thus, for example, symp-
toms which "we may refer to the brain, are much more frequently
presented. There are few patients who do not experience diminu-
tion of memory and intellect, pain in the frontal region, pulsation in
the temporal, and weight in the anterior and lateral parts of the head,
with attacks of vertigo, dazzling of sight, and cerebral congestion ;
some even have serious falls ; and the integuments of the face are
much more frequently red and burning than those of the nucha.
Symptoms of chronic stomach disorder are still more common, and
it is by no means extraordinary to see accidental irritation of the
stomach increase or re-excite involuntary seminal discharges. The
influence of the cerebellum in causing spermatorrhoea is, therefore, a
subject which requires further research, with varied and numerous
cases, in order for it to be properly understood.

In such cases my experience leads me to recommend the applica-
tion of ice and leeches to the nucha, when particular symptoms are
observed in this region, or when other means have failed. But in
order to judge the effects of these remedies fairly, it is necessary to
abstain from all other treatment at the same time, and to guard

210 CAUSES OF SPERMATORRHCEA.

against preconceived opinions. Exaggerated opinions have done
more injury to the truth than the most violent opposition.

It is impossible, for instance, to admit, with Gall, Voisin, Londe,
Chauffard, &c., that we should always direct our remedies towards
the cerebellum in cases of satyriasis, nymphomania, &c,; or that the
cerebellum is always the origin of the phenomena which take place
in the genital organs. Such an assertion scarcely requires a serious
consideration. It is hardly necessary to refer to the powerful and
immediate influence exercised over the thoughts, dreams, venereal
desires, erectile tissues — indeed, over all the functions, and all the
organs of the economy — by the presence of well formed semen in its
reservoirs. Such effects are seen daily, and constantly, and have
been well understood for a long time. Ascarides, by causing irri-
tation in the rectum, suffice to excite long-continued erections, even
in children, and to incline towards abuses and excesses ; or, by acting
directly, to bring on debilitating involuntary emissions. Sebaceous
matter retained between the prepuce and glans, may produce the
same effects. In women, excision of the clitoris takes away the pas-
sion for masturbation. It is well known too, that the presence of an
eruption on the labia often excites nymphomania. How do these facts
accord with the opinions of those who would refer all such influence,
and would direct all their remedial measures, to the cerebellum ?

There are other arguments which I regret to see incessantly
brought forward to prove the action of the cerebellum on the genital
organs. As an example of these, I may mention the effects which
sometimes accompany apoplexy of this organ.

Gall well explains the proneness to masturbation in such hydro-
cephalic children as attain the age of puberty, by remarking that
this affection, acting only on the brain, allows the cerebellum a pre-
dominating influence. This deduction seems correct, and may be
applied with just as much truth to idiots and cretins. But apoplexy
of the cerebellum instantly abolished the function of the part
attacked : to explain pathological erections by this alteration, and
to conclude that the cerebellum is the exciting organ of the genital
functions is, therefore, an evident contradiction. Instead of laying
stress on such facts as these, Gall and his followers should have
regarded them as serious objections to their system ; they should
have sought to discover how erections could take place in spite of
the greater or less destruction of the cerebellum ; they would then
have seen that such erections are less common than they are sup-
posed to be in cerebellar apoplexy, and that they much more fre-
quently accompany injuries of the spinal cord, &c. — circumstances
which the adversaries of phrenology have taken care to remark : so
true is it, that truth makes itself known by all ways.

The exaggeration and false reasoning that have obscured all dis-
cussions relative to the true seat of the genital instinct must not, how-
ever, induce us to forget the importance of pathological facts. What
I have said, should make the profession take into consideration the

ACTION OF THE CEREBBO-SPINAL SYSTEM. 211

influence the cerebellum may possess in causing involuntary dis-
charges of which they are unable to discover the cause, especially
when such discharges are accompanied with special symptoms re-
ferred to the occipital region.

Spinal Cord.

The opinion has been given, that diurnal pollutions are sometimes
the cause, and sometimes only a symptom of atrophy of the medulla
spinalis. The following case, which has come under my observation,
I think throws some light on this subject.

A private in the engineers wishing to get out of his barracks to
visit a female, fell from a great height on his buttocks. Serious con-
cussion resulted, but no fracture. Notwithstanding bleeding, leeches,
cupping, issues, &c., the lower extremities remained paralyzed.
After a time, however, galvanism restored slight motion, and obscure
sensibility. Still the glans, the prepuce, and skin of the penis and
scrotum, remained completely insensible. Pinching, and pins driven
into them were unperceived by the patient. Catheterism, which at
first was frequently necessary, never induced complaints. But
chronic vesical catarrh supervening, I cauterized the bladder and its
neck, and this operation gave just as much pain as in other patients.

The same phenomena followed. At first the urine was sanguino-
lent and thick, but soon lost this appearance, and was passed with
greater force and facility. Whilst treating this patient, I often found
the penis in complete, and indeed remarkable erection. I mentioned
this to the patient, who told me that he often suffered from this state
of priapism, which he found very disagreeable on account of the ob-
stacle which it formed to the discharge of urine. In order to relieve
himself, he had several times tried masturbation, but had never been
able to procure ejaculation, notwithstanding the erection was perfect,
and he had persevered in his manoeuvres. He experienced no plea-
sure, and only attempted it in the hope of relieving the priapism.
Having one day obtained permission to leave the hospital, he visited
the female, to see whom he had scaled the barrack walls in so unfor-
tunate a manner. He passed several hours with her in almost con-
tinual connection, without being able to procure ejaculation, and
without experiencing the least sensation. On the other hand, all his
functions were well performed, with the exception of slight costive-
ness ; he gained flesh daily, ahd his moral faculties were not afi'ected ;
abundant nocturnal pollutions took place at long intervals, and were
preceded by erotic dreams, but accompanied with little pleasure.

This case shows clearly the special influence of the spinal nerves
in contradistinction to that of the branches of the sympathetic, dis-
tributed to the different parts of the genital apparatus. In fact, in
this patient, all the phenomena dependent on the cerebro-spinal ap-
paratus were abolished, whilst the others had not experienced the
least change. Voluntary ejaculation was impossible, because the

212 CAUSES OF SPERMATOEEHCEA.

penis had lost all sensibility, and consequently, all its influence over
the seminal vesicles. This confirms what I have already stated re-
specting the difficulty of ejaculation caused by intoxication or nar-
cotism. It is sufficiently evident, that alcoholic drinks, &c., when
the stupor is perfect, may retard ejaculation, or even render it im-
possible, although erection may be complete. In this patient, there
was constant and energetic priapism, which was not accompanied by
any lascivious ideas, because it was produced directly by the accu-
mulation of semen in its reservoirs, without any sensation being
transmitted to the encephalon, at least during the waking state. But
during sleep, all the senses being inactive, as well as the cerebro-
spinal system, and the nerves derived from it, sensations transmitted
by the branches of the trisplanchnic, might awaken images and as-
sociations of ideas, as well as produce from time to time lascivious
dreams and nocturnal pollutions — proving that these phenomena are
directly under the control of the great sympathetic.

On the other hand, this patient never had diurnal pollutions, not-
withstanding the complete paralysis of the nerves given to the genital
organs by the spinal cord ; we may conclude, therefore, with every
show of reason, that involuntary diurnal pollutions cannot be symp-
tomatic of atrophy of the spinal cord, or of the nerves arising from it.

I do not imagine that the same thing holds good as regards irrita-
tion or excitement of the spinal cord, Avhich may be transmitted to
the genital organs by the nerves which are distributed to them. I
believe that serious seminal discharges may arise from this cause —
founding my opinion on the injurious influence produced in some
cases by issues or cutaneous eruptions in the lumbar region, as well
as by the manner in which lying on the back produces nocturnal
pollutions, and the incontrovertible benefit derived in some cases of
spermatic discharges, from douches and cold applications on the lower
portion of the spinal column. I have, however, no records of any
case in which this spinal irritation was sufficiently marked and isolated
to merit its being related here.

CHAPTER X.

CAUSES OP" SPERMATORRHEA.

Congenital Predisposition.

The causes of which I have yet to speak are very various, and for
the most part, sufficiently obscure. The facts which I shall have to
relate are even less known than those I have treated of hitherto.
They are more difficult of appreciation, and probably they present

CONGENITAL PREDISPOSITION. 213

also greater interest. They refer, in fact, to unfortunates, ^hose fu-
ture is seriously affected by causes entirely independent of their con-
duct, but -which weigh down all their lives like a kind of fatality.
They differ from all the causes I have hitherto examined, by being
inherent in the organs of generation themselves. But they may pre-
sent themselves under very different aspects ; they may arise either
from vicious conformation, from a condition of original debility, from
a congenital relaxation, or irritability of the organs, or from heredi-
tary predisposition.

In examining these various congenital causes, I shall, as before,
pass from the more evident to the more obscure ; and I shall take
this opportunity of commenting on the characters, by means of which
we can sometimes estimate, with some degree of precision, the powers,
so unequal, of the generative organs. This is of considerable import-
ance in the study and treatment of involuntary seminal discharges.

Sebaceous Matter.
CASE LII.

Natural Phimosis — Frequent nocturnal pollutions from the age of puberty
— Abundant and fetid sebaceous secretion beticeen the glnns and pre-
puce — Circumcision at the age of twenty-three followed by immediate
relief.

M. B , aet. twenty-three, of nervous temperament, having enjoyed

good health up to the period of puberty, from that time presented a yellow
and leaden appearance, with sunken eyes, forehead covered with acne punc-
tata, and timid manners. For a long time he had appeared as if plunged
into deep melancholy, and constantly sought solitude. He was restless, but
was unable to bear fatigue. Digestion was difficult, and his intellect dull.
This disorder had lasted four or five years, but had increased sensibly during

the last year before M. B came to consult me. I suspected him of bad

habits, but he assured me that he had escaped them from want of desire, and
that he had never had sexual intercourse. From the period of puberty, how-
ever, M. B had been subject to nocturnal pollutions, the frequency and

abundance of which had progressively increased; and in spite of the meaas
generally recommended in such cases, pollutions occurred every night, and
sometimes two or three times during the night. He had never noticed asca-
rides in the feces, nor experienced itching at the anus.

I was uncertain to what cause to attribute these pollutions, when on exa-
mining the genital organs, I noticed that the opening of the prepuce was
very narrow, and that abundance of sebaceous matter escaped. Pressure made
from behind forwards produced the discharge of a large quantity of matter of
milky appearance and considerable fetor. I concluded, therefore, that the
natural phimosis, by preventing the discharge of the sebaceous secretion, was
the cause of involuntary discharges, and in consequence recommended cir-
cumcision, which was performed immediately. I found a large quantity of
sebaceous matter resembling soft cheese in color and consistence, and of a
very disagreeable smell, covering the surface of the glans, and especially col-
lected round the corona glandis. The glans itself was vividly red, almost
14

21-i CAUSES OF SPEEMATOREHCEA.

entirely deprivccl of its epithelium, extremely sensitive — the least friction
causing a discharge of blood.

From this moment, M. B passed a fortnight at a time, and sometimes

longer, without having nocturnal pollutions, which afterwards only arose
from spermatic plethora. A rapid change took place in his health and habits,
so that at the end of the month he was scarcely recognizable.

This case is the most simple and perfect of the kind that I have
met with. It shows clearly enough, that natural .phimosis may be
sufficient to bring on pollutions, for the patient had never practised
masturbation, nor had sexual intercourse. It was evident that the
prolonged retention of the sebaceous matter gave it an acrid and
irritating character — the constitution being free from humoral dispo-
sition, or cutaneous affection. On the other hand, the genital organs
were well developed, and the health was not very seriously affected,
so that excision of the prepuce produced a sudden and durable effect.
I have seen many analogous cases, but in these the effects of this
mal-conformation of the prepuce in causing involuntary discharges,
were not so marked, because other causes were usually superadded.
Thus, in one case ascarides were present at the same time, and in
many others, the patients had practised masturbation. Masturbation
in such cases was generally excited spontaneously, and it is likely
enough that the phimosis should contribute to this result. Irritation
of the glans by sebaceous matter excites importunate erections and
titillations, which attract the attention of children to the parts, and
induce handling and friction. We may, therefore, attribute the
spontaneous occurrence of masturbation in young children who are
thus formed, to the too long continued presence of the sebaceous
matter between the glans and prepuce. ISIumerous examples have
left me no doubt on this subject.

The following case, which is still under ray care, presents remark-
able circumstances.

CASE LIII.

Natural phimosis — Erections at the age of eight — Attempt at coitus at nine
— Vesical catarrh — Diurnal pollutions — Parajileyia, &c.

A peasant consulted me for his son, ast. fifteen, who, for two years had
experienced a constantly increa.sing paralysis of the lower extremities. On
his sides and loins were murks of numerous issues which had been tried
during two years. Large excoriations had formed on the sacrum and tro-
chanters.

On examining the genital organs, I noticed that the prepuce was very nar-
row ; and on pressing it to get rid of the sebaceous matter which presented
at its orifice, the penis became erect. I learnt from the parents that this
boy had erections at the age of eight; and that at nine years of age, he bad
been found attempting coitus. The boy himself admitted that the itching
with which he was tormented led him to rub the genital organs, and thus
induced manoeuvres which he had since continued.

CONGENITAL PKEDISPOSITION. 215

The first symptom that presented itself was frequent desire of micturition,
and this was followed in about a year by complete incontinence of urine.
In the course of the second year, the patient's legs grew weak; he lost his
intellectual capacity ; digestion became disordered ; diarrhoea came on ; and
the discharge of urine and feces caused excoriation of the skin. Salt and
aromatic baths, tonics, excitants, &c., had been just as useless as issues.
The cause of the disease was unsuspected.

Masturbation had become very rare, but the urine was thick, muddy, and
very fetid — so much mucus was passed, that I was unable to make sure of
its containing semen — but the patient had constant pollutions at stool.

I first performed ablation of the prepuce ; and eight days after, I caute-
rized the bladder and surface of the prostate. A month afterwards, the
urine was perfectly transparent, and presented a healthy appearance ; it was
no longer passed involuntarily. Sensibility of the skin of the lower extremi-
ties had returned. Improvement was here arrested, however, and I lost sight
of the patient.

This patient had never been subjected to the influence of bad ex-
ample, and had always been well cared for. He explainly clearly
how he was led to practise masturbation ; and circumstances gave
an appearance of truth to his recital. It is, then, to the irritating
action of the sebaceous matter that we must attribute his unfortu-
nate condition.

Natural Phimosis. — In the venereal wards at the hospital St. Eloi,
numerous soldiers present themselves yearly for attacks of balanitis,
which they consider bastard clap. Certainly, in many of these cases,
the discharge arises from the action of blennorrhagic virus ; blennor-
rhagia is present at the same time, and both discharges have super-
vened on impure connection. But in many other cases, the inflam-
raation arises from the acridness of the sebaceous matter, caused by
its too long retention between the glans and prepuce. Such cases of
balanitis are rarely observed, except in persons whose prepuce is too
contracted to permit the glans being uncovered. Sometimes they
occur as the result of drinking or of fatigue, without any connection
having taken place. These inflammations rapidly disappear when
the prepuce has been removed, or even when the parts are kept con-
stantly washed — leaving no doubt as to their true cause.

In many cases, when I have practised circumcision for congenital
phimosis, I have found the glans and prepuce adherent to a greater
or less extent, especially in the neighborhood of the corona glandis,
around which the sebaceous matter accumulates most readily, and
whence it is most diflicult of removal. In some cases I have seen
these adhesions extend over half the extent of the glans, and they
were always situated in the parts furthest from the preputial orifice.
In a few cases, I have only found the point of the glans free from
adhesions. Such adhesions could only be established by the destruc-
tion of the mucous linings of the parts — these linings never becoming
adherent so long as they retain their mucous structure. The inflam-

216 CAUSES OF SPERMATOERHCEA.

mation of the surfaces of the glans and prepuce must therefore have
been sufficiently severe to cause superficial ulceration.

I have frequently seen the surface of the glans excoriated, with
elevated papillge and drops of blood exuding from them ; at other
times I have found the glans deprived of epithelium with excavated
ulcers. In such cases, the corresponding surface of the prepuce was
always more or less excoriated, or ulcerated also ; and these excoria-
tions were often accompanied with inflammatory swelling of the lym-
phatic glands in the groin. These ulcerations have been confounded
with chancres ; but their edges are thinner, and they are less deeply
excavated ; the neighboring parts, too, are covered with a layer of
sebaceous matter of caseous aspect and fetid smell. Such ulcerations
disappear after the removal of the prepuce, their appearance be-
coming changed even in twenty-four hours. Fomentations and
cleanliness do all the rest.

Such is the condition which the parts present in cases of recent
balanitis ; and these are the inflammations and ulcerations that cause
more or less extensive adhesions of the prepuce to the glans; such
adhesions are generally cellular, but sometimes fibrous or even carti-
laginous, according to the severity and frequent repetition of the
inflammation.

Various degrees of induration also result, according to the intensity,
the duration, and the frequency of the phlogosis. Thus, I have often
found the mucous membrane hardened, thickened, and covered with
numerous papilloe, sometimes fibrous or even cartilaginous, with three
times its natural thickness. I have also met with cases in which the
prepuce has become cancerous. I have operated in several cases of
cancer of the penis, too, which certainly arose from no other cause.
The patients were generally peasants between fifty and sixty years
of age, who had never known other than their wives, but who had
frequently suffered from balanitis, attended by abundant discharge,
swelling of the prepuce, and excoriation of its opening, which was so
contracted as to prevent the passage of the glans. I have seen one
case also, in which balanitis, irritated by a forced march, and the
abuse of alcoholic stimulants, passed into gangrene, by which the
greater part of the glans was destroyed.

Such have been the accidents which I have observed in those
whose prepuce was too narrow to permit the glans being uncovered ;
accidents which I can only attribute to the long retention of the
sebaceous matter in a kind of cul-de-sac, into which a certain quan-
tity of urine passes every time the patient makes water.

But natural phimosis is not the only cause of the injurious effects
produced on the genital organs by the sebaceous matter ; as the fol-
lowing case will show.

CONGENITAL PKEDISPOSITION. 217

CASE LIV.

Yery long 'prepuce — Badly developed genital organs — Childhood delicate —
Incontinence of tirine — Sebaceous discharge from the orifice of the pre-
puce at the age of ten — Nocturnal pollutions increasing in frequency —
Hypochondriasis — Loss of memory and failure of intellect — Constipation
— Diurnal pollutions — Constant application of lotions attended by relief
— Circumcision at the age of twenty-eighty followed by cure.

M. J. B , of Amsterdam, of delicate constitution and lymphatic tem-
perament, was subject during childhood to incontinence of urine, and always
suffered from frequent desire to make water. About the age of ten, a
whitish matter formed, and was discharged from underneath the prepuce ;
after which erections occurred, and were soon followed by emissions : a very
disagreeable smell accompanied the preputial discharge. The seminal dis-
charges increased as the patient's passions were roused, and he grew sad,
silent, discontented, and constantly occupied with the origin of his disoi'der.
He imagined that the whitish discharges arose from venereal disease, although
he had never had connection. His health became much disordered, and at
the age of nineteen he mentioned his condition to his medical attendant.
Lotions were prescribed, which removed the sebaceous matter and produced
considerable improvement in the patient's health.

M. B 's bowels became constipated, however, and he perceived that

be passed semen while at stool, in consequence of the efforts necessary.
The nocturnal pollutions diminished in frequency, but still occurred occa-
sionally.

When M. J. B consulted me in November, 1836, he presented the

following condition : small stature, limbs slight and chest narrow ; skin
fair and soft ; hair white and thin ; face very pale ; manner timid and em-
barrassed ', hesitation ; habit of stammering, arising from disorder in the in-
tellect and loss of the memory ; genital organs remarkably small ; penis
small and short, hidden among long scanty white hairs ; prepuce very long,
forming numerous folds in front of the glans ; surface of the glans covered
by a thin layer of sebaceous matter, notwithstanding the utmost cleanliness
on the part of the patient ; scrotum compressed and much folded, containing
only the right testicle, about the size of an almond, the left being felt in the
inguinal canal attached to a portion of omentum. No spinal curvature
(which the patient had feared), his mistake arising from the projection of
the hips and pelvis, which resembled those of a woman.

I removed the prepuce entirely in order to put an end to the influence of
the sebaceous matter on the glans ; catheterism not giving much pain, I did
not consider cauterization necessary ; but in order to give tone to the
organs I left a catheter in the bladder for an hour or two at a time once a
week, and ordered the free use of cold douches to combat the constipation.
The patient's temperament being exceedingly lymphatic, I afterwards pre-
scribed three or four aromatic baths weekly, with the habitual use of Spa
water.

These means lengthened the periods between the nocturnal pollutions,
diminished the constipation, and lessened the involuntary discharges that
took place when the efforts at stool were considerable. Acupuncture of
the perineum and prostate produced more rapid and decided effects. After

218 CAUSES OF SPERMATORRHCBA.

this had been practised, sixteen days were passed without nocturnal pollu-
tions, and the efforts at stool did not cause any seminal discharge. By de-
grees the patient's face became more healthy-looking and animated ; his
strength and energy returned ; his character regained its boldness and
gayety ; erections became frequent and energetic ; and his health altogether

having become as good as could be desired, M. B returned to his

home.

Six months afterwards I accidentally met M. B in Paris; he frequented

theatres and amusements, and went into society ; indeed his character was
quite changed.

I have seen few men so badly developed as M. B . It was

certainly to the poor development of the penis that the length of the
prepuce was attributable — the skin of the penis not being longer
than natural, though it proved exuberant when compared with the
parts it was intended to cover. The scrotum presented the same
appearance as the prepuce, and from the same cause. It was re-
tracted towards the pubes, and formed numerous and deep folds —
the testicles not being more developed than in a child of eight years ;
the left one, too, was entangled in the corresponding inguinal canal.
This slow descent of the testicles is a sign of weakness, which cor-
responded with their small dimensions.

The incontinence of urine to which M. B was long subject,

announced debility of the urinary passages, from which no opinion
could be drawn in favor of the power of the spermatic. The con-
nection between the two systems showed itself to the last — a frequent
desire to micturate accompanying the seminal discharges.

The fancied deformity of the spinal column was merely a projec-
tion of the hips, which gave the form of the female sex — a conforma-
tion which I have frequently observed with extreme weakness of the

genital organs. I should notice that M. B was born and brought

up in Holland ; that his childhood was delicate, and that his tempe-
rament was very decidedly lymphatic.

It may be readily conceived, that with these predispositions M.

B escaped all bad habits, and that he continued continent ; yet

at ten years of age he was subject to frequent nocturnal pollutions.
How was this ? The pollutions seem to have arisen from the stimu-
lating influence of the sebaceous matter collected between the pre-
puce and glans. The improvement derived from the use of lotions
at the age of nineteen corroborates this opinion. These means,
however, only gave momentary relief; circumcision at the age of
twenty- eight, did not suffice alone to bring about perfect re-establish-
ment, in consequence of the debility of the genital organs and the
obstinate constipation which had excited diurnal pollutions, added to
the difficulty of breaking a habit which had continued eighteen years.
Aromatic baths, Spa water, frequent douches, and lastly, acupuncture,
were employed to combat these complications. The remarkable
effect of the last remedy shows that habit had much to do with keep-
ing up the pollutions.

CONGENITAL PREDISPOSITION. 219

CASE LV.

Very long prepuce — Badly develo2)ed erectile tissues — Ahinidant secretion
of sebaceous matter — Semincd emissions induced hy horse exercise, and
afterwards hy incomplete intercourse — Marriage unconsummated during
Jive years — Diurnal pollutions — Circumcision followed hy rapid cure.

M. C , of robust constitution, born in Switzerland, the son of healthy

and strict parents, was early imbued with rigid moral and religious princi-
ples. At the age of eighteen he experienced for the first time, while on
horseback, an abundant seminal emission, and he afterwards frequently had
recourse to the same means to excite a return of the voluptuous sensations,
against which he had never been warned. After a time, too, he found a
means of procuring them by other manoeuvres. Still he did not practise
these abu.ses very often, often abstaining for a month or two at a time;
and consequently his health was uninjured. At the age of twenty-five,
having never had sexual intercourse, he married. Four years afterwards,

being disappointed at not having children, M. C consulted his medical

attendant, who, by dint of questioning, discovered that the marriage had
never been properly consummated. Frequent and abundant emissions had
indeed taken place, even with much facility ; but they had been produced
by simple pressure, or at most, by slight external friction. Unfortunately

for 31. C his erections, which had been very energetic at first, had

progressively diminished, so that he was now quite unable to profit by the
instructions he received.

Ferruginous preparations, friction on the loins, cold injections into the
urethra, and various tonics were employed, and did more harm than good.

M. C was, therefore, sent to consult me in July, 1837, five years after

his marriage.

He was then thirty years of age, tall, strongly built, and apparently in
excellent health ; he experienced, however, a degree of debility in his hands
and legs; all his functions, with the exception of those belonging to gene-
ration, were well performed. The penis was remarkably small; the prepuce,
on the contrary, much longer than the erectile tissues, formed numerous
folds in front of the glans, and was lined with a large quantity of sebaceous
matter; several thick layers of it were also accumulated on the surface of
the glans, which was much injected and extremely sensitive. The urine
always contained a more or less abundant flocculent deposit, in which I
invariably discovered spermatozoa.

I immediately performed excision of the prepuce, and a few days after-
wards, the urine became transparent, and the erections reappeared — weak
at first, but soon acquiring energy. The object of marriage was at length
properly fulfilled.

I have recently learnt that M. C is about to become a father.

The abuses to which this patient was impelled spontaneously were
too rarely practised to have had any power in producing this singular
affection ; besides, immediately after his marriage his erections were
frequent and active enough, but ejaculation took place too rapidly:
by considering this in connection with the fact of seminal emissions

220 CAUSES OF SPERMATORRHCEA.

havlnty been excited by horse exercise, we must arrive at the opi-
nion that the penis was excessively sensitive. This could not be
attributed to predominance of the erectile tissues, these being, on the
contrary, remarkable for their paucity ; some irritating cause must,
therefore, have excited and kept up the abnormal sensibility of the
glans, and this irritation could only arise from the sebaceous matter
on its surface being altered by too long retention. This opinion is
strengthened by the simple excision of the prepuce sufficing to arrest
the diurnal pollutions, and to bring about complete performance of
the genital functions.

Exuberant Prepuce. — In the cases I have just related the genital
organs were remarkable for their small development. The corpora
cavernosa were small and short, and were surmounted by a very
small glans, the whole forming a kind of vermiform appendage in
front of the pubes, composed almost entirely of corrugated skin, and
nearly hidden among long and scarce hairs. The scrotum presented
an analogous disposition ; it was retracted towards the pubes, and
formed numerous and deep folds. The testicles were remarkably
small, and in the 54th case, one of them had not passed the inguinal
canal. The extreme length of the prepuce, as well as its numerous
folds, must be attributed to the small development of the erectile
tissues ; and the numerous and deep folds of the scrotum arose from
the smallness of the testicles. These circumstances are, therefore,
frequently met with together, and very often congenital hernia, vari-
cocele, or great width of the pelvis, with the rounded form of the
female, are superadded.

All the patients of this kind that I have met with have possessed
a delicate constitution^ and had passed a sickly childhood ; they were
generally, too, of nervous or lymphatic temperament. Most of them
had received a very strict education.

Still, these patients have generally suffered from nocturnal pollu-
tion arising, without any kind of excitement, about the ages of ten
or twelve ; or they have been led spontaneously to commit serious
abuses before the age of puberty (one of my patients committed
venereal excesses at a very early age) ; and they all fell promptly
into a state of complete impotence, arising from diurnal pollutions.

The premature erections from which these patients suffered are
certainly not attributable to the rudimentary condition of the genital
organs, nor to their sickly infancy ; the circumstances in which
they were placed, too, had no influence in causing abuse ; and the
patients did not suffer from ascarides. The premature activity,
therefore, arose from simple local excitement of the penis ; and this
was not produced by the presence of semen, because in many cases
the testicles bad not begun to secrete. The accumulation of the
sebaceous matter around the glans, is the only sufficient explanation
of this habitual abnormal irritation ; and this opinion is strengthened
by the more or less frequent occurrence of discharges, and by the
habitual excoriation of the opening of the prepuce ; by the frequent

CONGENITAL PEEDISPOSITION. 221

attacks of inflammation, by the tenderness of the glans, and the
injection of its surface. The remarkable effects produced by clean-
liness, and by excision of the prepuce, leave no doubt on this
subject.

Such persons, then, as have the prepuce very long and folded in
front of the glans, are exposed quite as much as those who have a
natural phimosis to all the inconveniences which arise from the col-
lection and putrefaction of the sebaceous matter ; and the irritation
in both cases extends to the urinary and spermatic organs.

There is, however, one point of difference between natural phi-
mosis and exuberant prepuce, which it is of importance to notice.
Excessive length of the prepuce generally depends on paucity of
erectile tissues, and is frequently coincident with rudimentary testi-
cles ; it results, therefore, that in this case the irritation acts on weak
and mal-formed organs, which are easily affected by the abuses or
excesses which it excites : the involuntary seminal discharges that
occur in these cases are, therefore, very difficult of cure. In cases
of natural phimosis, on the other hand, circumcision alone generally
suffices to bring about a cure, because the narrowness of the pre-
puce does not, like its exuberance, accompany a small development
of the genital organs.

In cases of exuberant prepuce, things are not so simple, for it does
not suffice to remove the part, or even to relieve the irritation of the
urethra and bladder ; congenital debility of the genito-urinary
organs remains, which it is often very difficult to remove by tonics,
on account of the susceptibility of the tissues arising from their long
irritation ; this debility, too, arises from the primary organization of
the parts, and is consequently difficult to cure entirely. Such pa-
tients seldom possess extraordinary vigor.

I have still to speak of cases in which there is an excessive or
vitiated sebaceous secretion, although the prepuce may be of proper
form.

Abundant and vitiated secretions of sebaceous matter. — In many
cases the sebaceous matter is not confined by a too narrow or too
long prepuce ; it seems rather to be reproduced very rapidly, or its
properties to be modified by some pathological condition. The
mucous follicles of the glans and prepuce are much more developed
and more active in some individuals than in others, and furnish ha-
bitually a much greater quantity of sebaceous secretion. This parti-
cular disposition shows itself early, and continues during the whole
life; it is a permanent condition, and its effects may show themselves
at any moment. Extreme cleanliness might perhaps prevent any in-
convenience being felt ; but as the gravity of the consequences that
may result is not suspected, and as besides, this peculiar predisposi-
tion cannot be foreseen by parents, there is no motive for causing
children to practise ablution, or friction- of the parts — which indeed,
by drawing their attention, might be dangerous. These cases are
not practised then at the period of puberty ; yet it is then especially

222 CAUSES OF SPERMATORRHCBA.

that they are requisite in cases where the sebaceous secretion is dis-
ordered, on account of that orgasm which at that age seizes the whole
of the genital apparatus. I am thoroughly convinced that this par-
ticular circumstance is the direct cause of numbers of cases of in-
voluntary discharges, as well as very frequently of the spontaneous
abuses of which young lads are the subjects.

There are other cases in which the secretion is increased or altered
by a morbid condition, which is ordinarily intermittent, arising almost
always from a special disposition of the economy, particularly from
cutaneous diseases, often enough hereditary ones. The constitution
of such patients is ordinarily weak and delicate ; their childhood,
sickly. The first symptoms of these cutaneous affections which
generally sooner or later attack the mucous membranes, are mostly
experienced in the head or face. The children are subject to ring-
worms, acne, tetters, abscesses in the neck, alternately with attacks
of ophthalmia, otorrhoea, coryza, angina, &c. At the approach of
puberty, these weakly constitutions generally improve, and seem
about to become hardy ; but the revolution effected by that important
crisis has not always the durable and salutary effect on the constitu-
tion that could be desired. The genital organs become the centre,
and attract the congestion which formerly acted chiefly towards the
head ; and hence cutaneous eruptions occur in the neighborhood of
the anus, in the perineum, on the interior of the thighs, or the
scrotum, at the base of the penis, and more than all, on the prepuce
— bringing the most unfortunate consequences. Whatever may be
the species of these eruptions, however unimportant they may ap-
pear, it is of the utmost consequence to pay attention to them when
they attack the prepuce or glans.^ From them arise frequent ba-
lanitis, more or less abundant, and acrid sebaceous discharge, ex-
coriations, herpes, erysipelatous redness of the prepuce and glans,
frequent attacks of urethritis, often as severe as virulent clap, and
almost always more difficult of removal, frequently also giving rise
to serious errors of treatment. This irritation, too, sometimes sud-
denly attacks parts at a considerable distance from the orifice of the
excretory canal ; hence the sudden appearance of pain in the peri-
neum, or neck of the bladder ; hence the painful swelling of the vasa
deferentia and testicles ; hence also the no less sudden disappearance
of these symptoms, on the unexpected appearance of inflammatory
disorder on some other part of the body.

It is easy to conceive that these irritations may provoke abuses or
temporary excesses, as well as more or less serious occasional semi-
nal discharges ; but as these are not merely nocturnal pollutions,
and as diurnal ones are more common, more serious, and very dif-
ficult of discovery by the patients — their existence is seldom sus-
pected ; so that they do not know how to account for the periodical

* 1 See Chapter V.

CONGENITAL PEEDISPOSITIOX. 223

derangement experienced in their health precisely at the times when
they are not troubled with apparent disorder. Their friends under-
stand still less the frequent and sudden changes of character they
experience — the alternations of gayety and hypochondriacism, of ac-
tivity and torpor. Such patients are, therefore, very often regarded
as maniacs ; their peevish restlessness, and strange paroxysms, are
attributed to wrong-headedness, to attempts at originality, or to some
other equally erroneous explanation.

After a time diurnal pollutions occur almost constantly ; and now
there are only slight remissions in the symptoms ; the health remains
imperfect, and the paroxysms occur more and more frequently ; at
last matters grow still worse, and the patient's disorder becomes
constant.

Both the patients and their medical attendants are led astray during
the most severe periods of the disease, by the diminution or entire
cessation of the nocturnal pollutions ; diurnal discharges, whose
effects are much more serious, take their place ; and this is why, on
the entire cessation of nocturnal pollutions, the disorder becomes
permanent, and complete impotence is often established. Lessening
of the nocturnal pollutions is not likely to lead the patients to suspect
the true cause of their disorder ; they imagine themselves the victims
of a syphilitic affection, founding their opinions on the discharge and
excoriations that occur in the neighborhood of the glans and pre-
puce, or on the attacks of urethritis to which they are subject. I
have met with many patients who had spent a considerable portion
of their lives under courses of mercurial treatment, which had been
repeated over and over again, because intercourse scarcely ever took
place without producing excoriations ; these they fancied were
chancres, however little cause there might have been to suspect
syphilitic contagion. In such patients, too, the mucous membrane of
the urethra becomes altered in structure, so that they are more and
more exposed to urethral discharges from very slight causes ; and
the repetition of such discharges confirms their belief in a syphilitic
taint.

In these cases cauterization is the most powerful means we can
employ. Still it is necessary, after considerably modifying the con-
dition of the urethral mucous membrane, not to neglect acting on the
skin and on the whole economy by means of the sulphuretted baths.
It is wiser also to perform circumcision, than to trust to the patient's
cleanliness, in order to guard against the inconveniences arising
from superabundant secretion of the mucous follicles of the pre-
puce and glans, and to remove the parts beyond the possibility of
further irritation.

I have spoken several times of the influence exercised by excre-
tory canals on the glands that supply them ; on comparing the glans
penis with other openings to excretory ducts, we see that it alone
possesses an extensively developed erectile and nervous tissue. It
is true the nipple presents something similar, and its influence over

22-i CAUSES OF SPEEMATOREHCEA.

the lacteal secretion is well known ; but there is vast difference be-
tween the vessels and nerves of the nipple and those of the glans
penis. In the glans everything seems arranged to increase the ex-
quisite sensibility of the surface. Is it to be wondered at, then, that
the functions of the seminal vesicles and testicles are much influ-
enced by every action on so impressionable a surface ? and that the
accumulation of sebaceous matter provokes importunate erections
before puberty, and abuses or precocious excesses, in persons who
would seem to be out of danger of them, on account of the small de-
velopment of their genital organs ?

The divisions under which I have treated this subject are intended
to show that the irritating action of the sebaceous matter may arise
either from its too long retention, from a local affection, or from a
general disposition. In the first case excision of the perpuce is in-
dispensable, and when there is simply a natural phimosis, this is gene-
rally sufficient. But when the prepuce is excessively long, after its
removal, and even after cauterization of the prostatic surface, we
have still to combat the natural debility of the organs — a debility
sufficiently evident by the exuberance of the skin in front of the ru-
dimentary erectile tissues. In cases of superabundant secretion of
sebaceous matter, of herpes preputialis, or other skin affections,
having a tendency to fix themselves on the prepuce, it is more pru-
dent to circumcise the patient than to trust to the most careful clean-
liness ; there is no comparison between this trifling operation and
the importance of the involuntary discharges which may return with
a return of the preputial irritation, even if once relieved by the use
of sulphuretted waters or other means. Indeed, after having long
and seriously reflected on the numerous cases that have come under
my notice, I have arrived at the opinion, that the discontinuance
of the practice of circumcising children is to be regretted ; the ope-
ration is, without doubt, unnecessary in many cases, but it can
never be injurious, and in a great proportion it would be exceedingly
useful.

Congenital Debility.

CASE LVI.

Relaxed genital organs — Spermatic cords varicose — Few hut debilitating
nocturnal pollutions — Opposite effects of coitus — Unsuspected diurncd
pollutions — Constant headache — Disordered senses — Intellectxial dehility —
Hallucination — Tonic treatment at the age of twenty-one, folloiced by re-
covery.

In the month of June, 1835, General Mina placed under my care the
son of one of his friends, who had been treated unsuccessfully for a chronic
cerebral affection by distinguished practitioners, both in England and Ger-
many.

M. P. G , twenty-one years of age, was well made, of moderate

height, and robust appearance; his face and embonpoint bespoke • health,

CONGENITAL PEEDISPOSITION. 225

although he had complained of headache for several years, and often showed
serious derangement of his ideas, which were generally wandering and ob-
tuse. His feeble and husky voice, and timid and embarrassed manners, led
me to suspect masturbation ; I was completely mistaken, however. Whilst
examining an inguinal hernia, which had come on without apparent cause, I
noticed evident marks of semen on the patient's shirt ; and he told me that
while travelling the night before, he awoke deluged with this ylairi/ matter ;
that he often experienced similar evacuations without dreams, erections or
any other sensation sufficient to awake him. Further examination convinced
me that the patient passed semen also at stool, and that his urine constantly
contained a considerable quantity. I was, therefore, convinced that the sup-
posed chronic cerebral affection was nothing more than mistaken spermator-
rhoea — which the result soon confirmed.

The cause of these discharges was sufficiently obscure. The patient's
parents were strong and healthy, and he had ten brothers and sisters all in
good health ; there was no hereditary disease in his family, and his infancy
had been passed without ailment. At the age of sixteen nocturnal pollu-
tions had occasionally appeared, without dreams, and without sensation ; the
patient was completely ignorant of everything appertaining to sexual
intercourse, as well as masturbation. He was passionately fond of study.
At the age of seventeen he had frequent headache, and disordered vision ;
obtuseness in his ideas ; loss of memory; intellectual employment fatiguing
and unrepaying ; he had several times, too, long fits of unconsciousness

without apparent cause. At the age of eighteen, M. P. G was placed

in a commercial school at Paris ; two months afterwards he left his studies
one evening on account of a violent headache ; a vague but imperious feel-
ing, to which he yielded, impelled him towards the other sex. The following
day he was much better; he felt more vigorous both physically and morally.
But notwithstanding this beneficial effect, the patient yielded only once
more, although he felt much relieved on that occasion also.

Soon afterwards, M. P. Q was placed in a commercial house in Lon-
don, where he worked assiduously for two months, at the end of which
time he suffered from headaches, giddiness, disordered vision, noise in his
ears, &c. ; residence in the country produced a slight improvement, which
was, however, lost on the patient's returning to the same occupation ; so
that after a short time he was unable either to write or to keep his accounts.
He experienced such frequent giddiness, and so great weakness in his legs
that he dared not go out alone. At length his intellect became deranged
to such an extent that he doubted everything he heard or saw, all that he
did, and even his own existence. By degrees his digestion also became
deranged, and his medical attendants sent him to travel in Belgium and
Germany. During this long journey he became more and more disordered;
everything seemed illusory and fantastic ; he fancied himself in a painful
dream. He imagined too that every one was ridiculing him, and conspiring
against him ; and he especially suspected three Englishmen who followed
the same route, and who he thought were plotting together against him.
One of these was especially hateful on account of his ironical manner ;
and the patient was a hundred times tempted to precipitate this gentleman
into the Rhine as he passed him on board the steamboat; these hallucina-
tions remained on the patient's memory after his recover}^, like a kind of
nightmare. At the close of this journey he was brought to consult me.

226 CAUSES OF SPERMATOKRHCEA.

When I saw him his nocturnal pollutions recurred only at intervals of
eight or ten days, which did not, however, prevent their debilitating effects;
these were the more remarkable when contrasted with those of coitus, al-
ready mentioned. The patient too experienced the same state of weakness
when he had erotic dreams or venereal desires, even although no apparent
discharge took place.

These phenomena were easily explicable by the presence of diurnal pol-
lutions ; but there was nothing to account for the early development and
constantly increasing recurrence of these abundant discharges. The exa-
mination of the inguinal hernia gave some information. I have already
stated that it came on without appreciable cause ; announcing great re-
laxation in the inguinal rings; the opposite side too showed a marked
disposition to the occurrence of hernia; the veins of both spermatic cords
were varicose ; the penis of moderate size, was very long and soft, and the
scrotum was so relaxed that the patient was obliged to wear a suspensory
bandage. I passed a very large catheter, too, into the bladder, without
experiencing the least resistance, and without the patient's giving the least
sign of pain.

The union of all these circumstances led me to conclude that the sper-
matorrhoea was exclusively due to atony of the ejaculatory ducts; and con-
sequently, I daily left a catheter in the urethra for two hours at a time ; at
the same time the patient took iced milk three times a day ; and iced wine
mixed with Spa water at his meals ; and used cold lotions frequently, with
a hard bed, and horse exercise. These means brought about a prompt and
decisive change ; within a fortnight the patient's headache had left him, to-
gether with the aberrations of intellect which had accompanied it ; his per-
ceptions became clear, his ideas precise, his motions prompt and decided ;
the use of mineral waters, especially of alternate hot and cold douches on
the loins and perineum, consolidated his cure.

I saw M. P. G the following year, and also in August, 1838 ; his

diurnal pollutions have not reappeared ; nocturyal pollutions happen after
prolonged continence; they are energetic, and do not injure the health. All
his functions are perfectly well performed.

This case is another example of the powerful effects produced on
the brain by involuntary seminal discharges. In the present case
the pollutions evidently arose from congenital atony of the genera-
tive organs. It is like enough that I should not have discovered
these debilitating discharges, had I not done so accidentally while
examining the patient's inguinal hernia. Nothing in the patient's
conduct could have led me to suspect the presence of pollutions,
and his constitution, as well as the history of his family, did not
point out any local weakness. On the contrary, circumstances were
present which would lead away from the true cause of his disorder;
his nocturnal pollutions were very rare, and coitus was on both occa-
sions followed by remarkable improvement in the health. This may
be easily explained by bearing in mind what I have already said
respecting the different effects of different kinds of spermatic dis-
charges ; — the excitement produced by the normal act diminishing
the relaxation of the tissues and the abundance of the involuntary
discharges.

CONGENITAL PEEDISPOSITION. 227

How was it that this patient did not show more inclination towards
the other sex, especially after having noticed the beneficial effects
of his first intercourse ? He attributed this indifference to the pro-
found melancholy which possessed him from the period of puberty ;
but this sadness disappeared, and his ideas completely changed after
his cure. The indifference, then, arose from the diurnal pollutions
of which he was the victim.

This patient's hallucinations were of the same nature as those of
Esquirol's patient (Case thirty-two), only that the conviction of a
general conspiracy against him was more confirmed. If in one of
his moments of rage he had thrown his supposed enemy into the
Rhine, would this hallucination have been admitted ? If so, would
its cause have been even suspected ?

Varicocele. — I have met with many cases of involuntary seminal
discharges occurring in patients who were affected with varicocele.
I have at present before me three consultations and numerous notes
of such cases ; but they are for the most part incomplete, because I
am ignoranj; of the results of the means employed. I will, however,
briefly relate all that can be gained from them relative to sperma-
torrhoea.

One of these patients was addicted to masturbation about the age
of ten ; he practised it, however, much less frequently than the ma-
jority of his companions; and corrected himself at the age of fifteen.
Another committed some slight venereal excesses, but very irregu-
larly and for a very short time on each occasion. A third suffered
from simple blennorrhagia, after which swelled testicle came on the
day after a ball. A distinguished barrister first experienced noctur-
nal pollutions during the period of his examination; afterwards he had
numerous relapses, following the excitement of important causes, and
was obliged to give up his profession, notwithstanding his talent, be-
cause the pollutions, becoming diurnal, weakened his memory. It
is probable that in these cases no bad effects would have been pro-
duced if the patients had not been predisposed to them. Other
patients affected with varicocele and pollutions pursued courses of
life which might be considered exemplary, if compared with the
lives led by hosts of individuals who never suffer any bad effects
from such proceedings. I have besides questioned those patients
who have consulted me for varicocele alone, and I have found that
the greater number complained of want of power in the organs. Del-
pech made the same remark; and he attributed this want of power
to the torpidity of the venous circulation which retarded the sperma-
tic secretion ; he thought too, that by taking away the varicose veins
he would be able to restore the functions to their normal condition ;
the unfortunate death of the author of this proposition is sufficient
to show its fallacy.' As far, however, as regards the debility of the

' The unfortunate Delpech was assassinated in tlie middle of the day by a patient
from Bordeaux, on wliom he had previously operated for varicocele. The murderer
immediately afterwards blew his own brains out.

228 CAUSES OF SPERMATORRHCEA.

spermatic organs in such persons, I agree with him perfectly ; in-
deed, it is a point which I have observed too often to admit of my
doubting it. I have also remarked that in many of these cases the
testicles are soft and small, and when the spermatic veins of one
side only were varicose, I have invariably remarked that the testi-
cle of that side did not correspond in development to that of the
other. Pott has related several cases of the same kind.

If masturbation, venereal excesses, orchitis, &c., favor the devel-
opment of varicose veins in the spermatic cords, this can only take
place in persons who are predisposed to that disease by congenital
weakness of the parts ; for many persons are exposed to the opera-
tion of all these causes without having varicocele, which disease often
comes on without appreciable cause. The same thing happens here
as in varicose veins of the lower extremities ; fatigue of the parts,
as well as everything which hinders the free return of blood, un-
doubtedly contributes to render the veins varicose ; and yet are
there not many who pass hours together standing, and who wear
tight garters, but nevertheless do not suffer from varices ? whilst
there are numbers on the other hand who are victims of this in-
firmity without being particularly exposed to the action of such
causes. It must, therefore, be admitted in the- latter class of cases,
that there is some primary weakness or congenital disposition in the
affected veins to become varicose.

Since, then, we see want of energy in the genital organs so fre-
quently accompanying varicocele, it is evident that the venous sys-
tem is not alone in a state of atony or relaxation ; and it is, there-
fore, of consequence to pay attention to the condition of the veins
in order to judge of the power of the genital organs as well as of
the predisposing causes of involuntary emissions. Such signs point
out the remedies to be used in these cases.

CASE LVII.
Hypospadias — Impotence — Frequent seminal discharges.

Morgagni relates with bis customary precision, an interesting case of im-
potence, which he attributes to the malformation of the glans, but which
was evidently due to involuntary discharges ; the following are the princi-
pal circumstances.

The patient was scarcely thirty ; he was by no means strong, and was
affected with an old ophthalmic disorder. He admitted that although he
bad been married two years, he had never had sexual intercourse ; this he
attributed to the glans penis being curved downwards, and perforated near
its base, instead of at its point. The infei-ior wall of the urethra was in
fact wanting in the neighborhood of the glans, and a little behind it ; the
prepuce was divided in the same manner and resembled that of the clitoris.
The penis was of its natural development, the testicles were large, but the
scrotum appeared relaxed. At the period of pubert}', the erections had
been complete, the glans being fully injected as well as the rest of the penisj
an uncomfortable sensation even arose in the part where the urethra was

CONGENITAL PREDISPOSITION. 229

wanting; but this sensation diminished by degrees in proportion as the glans
entered less into erection. At the time of the patient's marriage the tume-
faction of the glans took place very rarely; at last it ceased entirely; "the
glans remaining flaccid and insensible from the time when, in useless efiforts
at intercourse, the patient discharged large quantities of semen, which escaped
very promptly."

Morgagni is inclined to think that the absence of the urethra
underneath the glans was the cause of its not becoming erect in this
case ; the rest of the penis was capable of erection, but the glans
being a portion of the corpus sjjongiosum, and receiving its blood
from the bulb, was incapable of becoming so. This explanation,
although plausible and founded on the distribution of the arteries
of the penis, rests on an incorrect hypothesis ; for in cases of this
nature the parietes of the urethra are not wanting, there is only de-
fective union in the median line, which by no means interferes with
the presence of the corpus sjjongiosum, nor with its receiving its
proper arteries. Besides, the malformation in Morgagni's case was
equally fwresent at the age of puberty, yet the patient experienced
erections at that time into which the glans entered, so much so, in-
deed, as to cause a painful sense of dragging in the situation of the
urethra. The patient's impotence was, therefore, due to some other
cause, and this cause was evidently the same that acted in case fifty-
five. The impotence, therefore, arose from habitual and unperceived
seminal discharges, favored by the congenital debility of the organs.
Morgagni's last sentence is sufficient to prove this. When did the
glans entirely cease to become erect? "From the time when in useless
eff"orts at sexual intercourse, the patient discharged large quantities
of semen, which escaped very promptly." These repeated and
abundant seminal discharges then rendered the erections less and
less energetic, and at last thoroughly imperfect.

The rapidity with which ejaculation took place is observed in all
cases of this nature ; and this hasty emission, whether it arise from
irritation or debility, or both, which opposes intromission as much as
the insufficiency of the erections, is always accompanied by diurnal
pollutions : to these, therefore, the impotence is due (although very
often they are unsuspected), and they are invariably exasperated by
unavailing efiforts at coitus, which increase the irritation and debility
of the parts. On the other hand, too, such appreciable discharges
joined to those which are unsuspected, sufficiently explain why the
erections become daily less energetic, and the formation of the semen
less perfect.

The remarkable coincidence of hypospadias with debility of the
genital apparatus has induced me to quote the above case. Hypos-
padias is a rare malformation, and has never been studied in reference
to its connection with weakness of the organs. It is well known that
Louis XVI. had hypospadias, and the Memoirs of Madame de Cam-
pan leave no doubt that his marriage was not consummated for
15

230 CAUSES OF SPERMATOREHCEA.

several years. I have met with one case of hypospadias in the
hospital St. Eloi ; it was accompanied with nocturnal and diurnal
pollutions, but I only had an opportunity of observing the patient
for two or three days, and I cannot say decidedly that these pollu-
tions arose solely from a natural weakness of the organs.

CASE LVIII.

Atrophy of one testicle at the oge of eight — Nocturnal and afterwards di-
urnal pollutions — Frequent desire of micturition, &c.

I have at present a student, act. twenty-seven, under my care, who, from
the period of puberty, has been troubled with nocturnal at first, and after-
wards with diurnal pollutions. All his functions are deranged, and he is now
incapable of any intellectual employment. He has never had sexual inter-
course, and he has not been addicted to masturbation. When about eight or
nine years of age he suffered from inflammation of the left testicle without
evident cause. After having continued very large for some time,, the organ
atrophied by degrees, so that it is reduced to the size of a horse-bean, the
spermatic cord being also very thin. The urethra is extremely sensitive,
especially in the neighborhood of the prostate, and the patient makes water
very frequently — this symptom dating from his childhood.

There existed without doubt in this unfortunate individual a con-
genital disposition to phlogosis of the genito-urinary organ ; this
showed itself at the age of eight, by spontaneous inflammation of the
left testicle ; from that time irritation continued in the neighborhood
of the bladder, and extended its influence to the right testicle. This
accounts for the occurrence of nocturnal pollutions at the age of
puberty. Spontaneous inflammation of the testicles in childhood is
then a sign of a morbid condition of the genital organs, and the de-
struction of one of the testicles does not remove the patient from
the danger of involuntai*y seminal discharges, which may even be
suflSciently abundant to injure the health.

Natural Relaxation of the Ejaculatory Ducts. — There are a cer-
tain number of cases of involuntary seminal discharges, which it is
impossible to attribute to any satisfactory cause ; which are not
accompanied by any sign of irritation ; and to explain which we
are obliged to admit a natural disposition, debility or congenital re-
laxation of the spermatic organs, and especially of the ejaculatory
ducts. This condition sometimes coincides with more or less cha-
racteristic external signs, but in other cases it is only shown by its
efi"ects. The following remarkable case will explain what I have to
say on this obscure but important subject.

CONGENITAL PEEDISPOSITION. 231

CASE LIX.

Lymphatic temperament — Incontinence of urine — Neither masturbation nor
sexual intercourse — More and more frequent nocturnal pollutions — Relaxa-
tion of the sphincters of the anvs and neck of the bladder — Treatment
unsuccessful.

M. M , of very marked lymphatic temperament, was subject to in-
continence of urine up to the age of twelve or thirteen. His religious
enthusiasm induced him to embrace the ecclesiastical profession. He had
never practised masturbation nor had sexual intercourse. Puberty did not
take place until the age of eighteen, but was accompanied with nocturnal
pollutions — rare at first — then more frequent ; and at length occurring daily
and quite passively. All his functions were successively deranged, and at
thie age of twenty-three, five years from the commencement of the disorder,
M. M consulted me in the following condition.

Skin white, cold, and clammy; limbs rounded; hair white; no beard;
pelvis very large ; hips projecting ; flesh soft ; genital organs pretty well de-
veloped, but very flaccid; scrotum much relaxed; hair very scanty ; blindness
nearly total ; enormous dilatation of the pupils ; considerable decrease of in-
tellect and memory ; extreme weakness of the limbs ; progression almost
impossible without the support of a stick; digestion difficult; involuntary
discharge of feces several times a day ; micturition frequent during the
day ; incontinence of urine at night ; nocturnal pollutions repeated several
times at night without erection or sensation ; semen very fluid ; urine often
muddy. I passed an immense catheter into the bladder without experienc-
ing the least resistence, or giving the patient the slightest pain ; the anus
was almost wide open, permitting the introduction of three fingers into the
rectum, without the least difficulty, and without exciting any action of the
sphincters.

I prescribed aromatic baths, stimulating frictions and applications; ice
internally and externally, Spa water, quinine, &c. ; and 1 performed two
cauterizations of the urethra, all without the least success ; after four months'
treatment I lost sight of this unfortunate patient, leaving him in just the
same state as when he first consulted me.

All circumstances combined in this case to convince me that the
patient spoke truth when he asserted that he was ignorant of mastur-
bation and had never had sexual intercourse. The incontinence of
urine and feces ; the form of the pelvis ; tJie flaccidity of the genital
organs; the general state of the economy; all seemed to show that
the ejaculatory ducts shared the relaxation of the sphincters of the
anus and bladder, and that this original atony was the sole cause of
the nocturnal and diurnal pollutions. This case is the most remark-
able one of the kind that I have ever met with, on account of the
combination of circumstances that accompanied the relaxation of the
ejaculatory ducts, and from the absence of every complication that
could have excited involuntary seminal discharges ; it enables us to
understand cases in which there are similar but less marked predis-

232 CAUSES OF SPERMATORRH(EA.

positions, and which are accompanied by less evident or even nearly
inappreciable signs.

CASE LX.

SicMy cMldhood — Extraordinary nocturnal 'pollutions at sixteen — Some
time after, pollutions during defecation — UJaculation impossible — Slow
discharge of semen after the subsidence of erection — Urethral canal very
slightly sensitive — Prostatic surface hard and cartilaginous.

In the year 1825, I was consulted by a medical student, set. twenty-one,
of small stature and spare habit, in consequence of deafness, which had
made considerable progress during two years. After injecting the Eusta-
chian tube a few times, applying a seton, &c., the beneficial efiects of which
were very trifling, the patient spoke to me about nocturnal and diurnal pol-
lutions which were accompanied by extraordinary circumstances. The fol-
lowing are the chief facts of the case.

The patient's health was weak until the age of sixteen, when puberty
occurred, and he suffered from frequent erections and nocturnal pollutions.
These discharges continued from that time ; they were often excited by
lascivious dreams, but were not always preceded by erections ; when erec-
tion occurred, it was not during its continuance that the discharge of semen
took place, but only after the swelling of the penis had passed off, the
matter discharged dribbling over the neighboring parts instead of being
forcibly thrown off as in true ejaculation. This matter resembled white
of egg, and stained the linen in the same manner ; it was often so abun-
dant that the patient was compelled to change his shirt. The evacuations
were followed by debility, languor, and headache. Whatever quantity of
semen was passed he never experienced the slightest voluptuous sensation,
so that at first he thought himself affected with incontinence of urine, and
when these abundant discharges took place, not being able to prevent them,
he rose suddenly to micturate. Often while at stool a similar discharge
took place in greater or less quantity, according to the degree of constipa-
tion.

Sexual intercourse had been very rare, and always accompanied with
similar circumstances ; the erections were energetic and long continued ;
indeed, they lasted an indefinite time, for fatigue alone put an end to the
act : seminal discharge never under any circumstances took place until the
cessation of the erection. The same thing occurred during a few attempts
at masturbation, which the patient practised from curiosity, for he never
experienced sufficient pleasure either in these manoeuvres or in coitus, to
practise them from inclination ; he had an ardent desire to get rid of his
nocturnal pollutions, which he believed arose from defective contractility in
the seminal vesicles.

This patient was very thin and remarkably pale ; his digestion was much
disordered; his memory treacherous; his intellect weakened; and the least
application to study excited obstinate and almost constant headache. He
experienced noise in his ears ; and this deafness was very probably due to
the same cause, although he imagined himself the subject of some local
affection.

I did not observe anything particular in the patient's form nor in the size
and consistence of the external organs of generation, but on passing a

CONGENITAL PREDISPOSITION. 233

large catheter into the canal, I remarked that it possessed very little sensi-
bility; and especially in the prostatic region, where the instrument was
arrested. On taking a smaller one I succeeded in reaching the bladder ;
and in passing the prostate, the instrument seemed to rub on a hard carti-
laginous surface, which, however, was quite smooth and regular. The
patient remained quite passive during this examination, which lasted a long
time. The prostate examined through the rectum did not seem larger or
less regular than natural. Its firmness presented nothing remarkable.
These examinations, repeated at the intervals of several days, always gave
similar results.

I performed cauterization of the prostatic portion of the urethra in the
hope of modifying its abnormal condition, but no benefit was obtained.
Dilatation by means of gum-elastic catheters was not of great service.

This is the only case of the kind of which I am aware ; it presents
characters quite different from those which generally accompany
nocturnal and diurnal pollutions ; but it does not the less belong to
the class of such cases caused by original disposition in the spermatic
organs. The patient's statements bore the semblance of truth. He
suffered from pollutions many years before attempting either coitus
or masturbation ; indeed, it was only in the hope of relieving his
disorder that he committed these acts ; for he was not enticed to
them by any feeling of pleasure. His remarkable seminal discharges
seem to have arisen from the induration and loss of sensibility of the
surface of the prostate and neighboring parts, and this condition
seems to have been congenital.

Symptoms of Debility of the Genital Organs. — Before proceeding
further, it may be as well to consider for a moment the characteristics
we have already noticed, as showing debility of the genital organs.

We have seen that excessive development of the prepuce arises
from smallness of the penis, and that in the same individual the
scrotum is often much folded and retracted towards the pubes, be-
cause the testicles are very small. Such an elementary condition of
the erectile tissues and secreting organs necessarily augurs little
energy in these fundamental parts of the genital apparatus, and
must prove an unfavorable prognostic as regards the condition of
the ejaculatory ducts, seminal vesicles, and other parts removed
from external examination. But these characters are not always
equally marked, and do not always stand alone.

Hypospadias arises from defective union of the opposite parietes of
the urethra ; and whatever may have been the cause of this arrested
development, it indicates debility of the parts, because their forma-
tion has not been completed. The parts have wanted energy or vital
force from the beginning. Is it likely that this condition will be
altered later in life ? All I have seen of these cases, leads me to
a negative conclusion. Cases of epispadias, too, consisting of defec-
tive union of the corpora cavernosa, and, still more serious, eversion
of the bladder arising from a similar cause, support this opinion ;

234 CAUSES OF SPEEMATOEEH(EA,

such individuals are even more feeble, in respect of their genital
functions, than those afflicted with hypospadias.

The following circumstance, too, may be referred to the same
cause, although it is less evident. All surgeons who are frequently
in the habit of passing instruments into the urethra, are aware that
great differences exist with respect to the size of the meatus. In
some cases it is exceedingly small, and placed at the summit of the
glans ; in others, again, it is large, gaping, and extends from the apex to
the corona glandis, or even lower. It is evident, that this increased
size of the meatus arises from the same cause as hypospadias, that
is to say, from defective union of the two walls of the urethra. In
some cases, it seems a commencing hypospadias, the opening descend-
ing lower than the glans. Now, I have met with few cases of in-
voluntary seminal discharges where the urinary meatus was very
contracted, and in all cases of this kind that I have seen, the disorder
had been produced by repeated attacks of blennorrhagia, serious and
long continued abuses, or great sexual excesses, thus showing con-
siderable activity of the genital functions ; whilst, on the other hand,
I have met with numerous involuntary discharges in those whose
meatus was larger, and such discharges have been produced by com-
paratively slight causes, and were much more difficult of relief.

My practice of examining all such patients with a large catheter,
in order to ascertain the degree of sensibility of the urethral mucous
membrane, led me to make this observation long since, and I have
since found it remarkably constant. Generally, in cases of large
orifice, the remainder of the urethra as well as the neck of the blad-
der is also very large, which might leave one to suppose that the
ejaculatory ducts may partake of the same condition. However this
may be, I believe I may mention extended orifice of the urethra, as
a sign of congenital debility of the organs, and consequently of pre-
disposition to involuntary discharges.

The firmness of the erectile tissues, also, differs much in different
individuals, independently of their size and form. Whenever I have
observed the penis resting on the scrotum, the corpora cavernosa
empty, soft, flaccid, and without resistance or elasticity on pressure,
I have remarked that the organs possessed little energy, and that the
powers of resistance to causes capable of inducing involuntary dis-
charges was very slight, whilst these were always difficult of cure.

In cases, too, where the glans presents a remarkable development
in proportion to the penis, the latter being long in the corpora caver-
nosa, whilst the former is swollen, overshadows the corpora caver-
nosa, and is always uncovered, or, at all events, badly covered by
the prepuce ; the parts want energy. The erections are often in-
complete in such cases, especially towards the base of the penis.

As regards the testicles, their smallness is not the only circum-
stance worthy of consideration. Many of my patients have been
afflicted with inguinal hernia, frequently congenital.

CONGENITAL PREDISPOSITION. 235

Congenital hernia must be attributed to one of the following causes ;
either the inguinal canal has wanted contractile power, the process
of peritoneum accompanying the testicle has been distended with
serum, or the testicle has descended late into the scrotum. Under
all these circumstances there is evidently radical debility of the parts.
It may, indeed, diminish considerably as age advances, but we can
never expect to find the parts remarkable for their energy. Since I
have directed my attention to this subject, I have constantly noticed,
that patients afflicted with congenital hernia presented much smaller
testicles than those of healthy persons of corresponding age. The
following fact, too, is very decisive. When hernia is present on one
side only, the corresponding testicle is always smaller than the op-
posite one, and frequently this difference extends to half the size of
the organs. For a long time I fancied this small size of the testicle
arose from compression of the parts by the hernial sac, but I have
met with the same circumstance in persons who early wore a truss.
I then thought that compression of the cord by the pad of the truss,
might give rise to this defect, but I have not noticed corresponding
conditions in those who have worn a truss for accidental hernia. The
descent of the testicle into the scrotum often does not take place until
long after birth, and in one of the cases I have related, it was not
complete until the age of twenty-eight (case fifty-four). In all the
cases of this kind that I have had opportunities of observing, the
organ has been far from possessing its normal size and form ; and
still further, in cases where I have had an opportunity of examining,
after death, the bodies of those whose testicles had not descended, I
have invariably found the body of the gland small, soft, and elongated,
and the epidid3'mis deformed and unfolded. I have frequently, too,
ascertained the exactitude of the opinions of Cloquet on the causes
that oppose the descent of the testicle ; this distinguished observer
has pointed out that the testicles are always detained either by some
malformation or adhesion, and such alterations must necessarily in-
fluence the functions of the organ.

To resume, then ; congenital hernia, slow descent of the testicles
into the scrotum, or their final retention in the abdomen, must be
attributed to debility of the parts, to adhesions or to alterations in
their structure, which must more or less injure their functions.

The form of the testicle is also of considerable importance. The
body ought to be ovoid, regular, and smooth ; the least inequality
observed on its surface denotes some internal organic alteration.
The size of the epididymis should be proportioned to that of the
gland itself; any swelling of this part shows that inflammation has
taken place, and has not been entirely removed. Such inflammation
may have left marks of its presence in other parts through which
the semen passes, and consequently, in the seminal vesicles, and
even after it has been completely removed, is very likely to return
in the altered tissues. It often happens that neither children nor
their parents are able to assign any cause for the occurrence of these

236 CAUSES OF SPEEMATORRHCEA.

inflammations either because they take place during early childhood,
or because they come on without any appreciable injury. I have met
with more than one patient who fancied that he had three testicles,
and this delusion has generally arisen from the increased develop-
ment of the epididymis forming a kind of supplementary swelling
attached to the testicle. Whenever I have found this swelling con-
siderable, the true testicle has been smaller than natural, and in a
few cases it was completely atrophied. The investigations I have
made in such cases have convinced me that the organ did not act,
or acted badly. The patients are not, however, removed from the
dangers of involuntary discharges by this circumstance, because the
two organs are not equally affected. I have related a case, in which
one of the organs was completely atrophied from infancy, notwith-
standing which obstinate nocturnal pollutions occurred at puberty :
these were only attributable to active irritation of the other organ.

Every alteration, then, in the form of the testicles, must be attri-
buted to some old standing affection, and announces some internal
lesion, which necessarily injures the functions of the part, and warns
us of the possible occurrence, at some time or other, of other affec-
tions of the same organs. However slight it may be, this alteration
in the form of the testicles merits serious consideration in attempting
to appreciate the amount of the virile powers, and the disposition to
other diseases of the spermatic organs.

I may make just the same remark concerning the vasa deferentia.
When they are so thin that difficulty occurs in distinguishing them
from the other structures of the spermatic cord, it is a sign of de-
bility; but this sign is never met with alone ; the testicles are always
small, sometimes even rudimentary ; all the secreting apparatus
seems to remain in the same condition as before puberty. When, on
the other hand, the vasa deferentia are swollen, knotty, or enlarged,
towards the epididymis, it is evident that they have been previously
the seat of some inflammation.

Softness and flaccidity of the testicles also show little energy in
the gland whatever may be its size. I have met with this symptom
in many patients remarkable for their continence, and the severity
of whose voluntary discharges bore no relation to the slight acci-
dental causes that excited them. On the other hand, this flaccidity
of the testicle is usually accompanied by a similar condition of the
corpora cavernosa, which justifies one in presuming that the portions
of the genital apparatus which are removed from external examina-
tion, partake of a like disposition.

I have already stated, that varicocele must be regarded as a sign
of debility of the genital organs. The debility of the venous system
of the testicle justifies us in supposing a want of energy in the re-
mainder of the secretory apparatus ; besides which the stoppage of
the circulation through the veins of the cord must injure the capil-
lary circulation in the testicles, and consequently, retard the secretion
of semen. I have noticed this in cases of simple engorgement of

CONGENITAL PEEDISPOSITION. 237

the veins of the cord, especially when coincident with considerable
elongation of the organ.

Encysted hydrocele developed in the midst of these vessels pre-
sents the same indication for the same reasons.

Again, all the parts of which I have spoken may possess their ordi-
nary volume and natural form, but yet may present a decided flac-
cidity announcing serious debility. This relaxation especially, is
easily noticed in the scrotum. Not only does this organ extend to
a great length, but is soft, smooth, and without hair or folds ; its
surface is moist ; no motion occurs in it from the contraction of the
dartos or cremaster muscle, and its cellular tissue is often infiltrated
with serum. The most remarkable case of this kind that I have
met with, is that related at page 231, case 59, in which no sexual
desire was ever manifested, but the subject of which, at the age of
puberty, became subject to pollutions which nothing relieved.

Lastly, all my patients whose virile powers were originally weak,
had very sharp intonation of voice, sometimes quite falsetto. Their
hairy system, too, was little developed. One patient, at the age of
seventeen, had not a single hair on his chin or his genital organs.
These characters resemble those found in eunuchs, with this differ-
ence, that the health of eunuchs does not become disordered.

Symptoms affecting the Urinary Organs during Childhood. — The
spermatic apparatus does not attain its full development until the
age of puberty, but the urinary organs perform their functions from
the period of birth. The connection that exists between the two
systems is so intimate, that the observations drawn from the one
first in action foreshadow the affections to which the other may
become liable.

Incontinence of Urine. — It must have been noticed, that in several
of the cases in which involuntary discharges were manifested spon-
taneously or from very slight causes, the patient had been subject
to incontinence of urine from infancy. I have met with numerous
cases in which this was the case, and they were all remakable for
the facility with which involuntary discharges occurred. I shall,
therefore briefly review such circumstances in these cases, as may
throw any light on the connection existing between congenital affec-
tions of the urinary passages and involuntary seminal discharges.

In proportion as the child's intellect becomes awakened, he un-
derstands the care lavished on keeping him clean, and accustoms
himself to assist, until at length he arrives at an age when he has
acquired suflScient empire over his habits to avoid soiling his bed
or his clothes, at least except in cases of accident. This period
varies according to the child's education and mental progress. But
when the cerebral functions are thoroughly developed, and the most
determined will, and best sustained attention, are not sufficient to
prevent the untimely discharge of the urine, there is a more or less
disgusting infirmity. Punishment has no effect ; it is from the me-
dical man that aid must be sought.

238 CAUSES OF SPEEMATORRHGEA.

This condition of the urinary organs may present infinite shades
of variety ; the worst is that in which the child is unable to hold
his urine, even when awake, so that it escapes in an almost continu-
ous manner without his knowledge. This degree of incontinence is
seldom observed, except in idiots, whom we must leave out of- the
question, because of their want of intelligence, leaving them in
precisely the same condition as the infant in the cradle. Next
come those cases in which the neck of the bladder does not contract
strongly enough to prevent, for any length of time, the passage of
urine, even during walking ; so that when the desire cannot be im-
mediately satisfied, the want of power in the neck of the bladder al-
lows a portion of the urine to escape, notwithstanding all the efforts
of the will. It is evident, that in such patients the urine will escape
much more readily during the night. When it is only during sleep
that the escape of urine takes place, the infirmity is grievous enough,
but even then it may present many shades of severity. In some
cases, the involuntary emission takes place every night ; in others it
only occurs when the bladder was not carefully emptied before the
patient went to sleep, or because a large quantity of fluid had been
drunk during the evening. And lastly, in a few cases, the discharge
is nearly voluntary, because it follows some dream excited by the
distension of the bladder ; in these cases it may be considered ra-
ther as an accident than as a habit.

Great difference also exists in the duration of this infirmity : in
the worst cases it continues after puberty — more or less changed,
however, according to the influence which this important period of
life exercises on the constitution. In all my patients who had pol-
lutions after incontinence of urine, I have remarked that the latter
infirmity continued at least until the age of seven or eight years ; in
many it continued until the approach of puberty, and such patients
always retained a frequent desire of emptying the bladder, as well
as considerable difficulty in resisting that desire, especially when
acting energetically.

It is evident, from what I have just stated, that incontinence of
urine diminishes in proportion as the constitution gains strength,
and that it generally ceases entirely at the age of puberty, or is, at
least, always considerably modified ; and this is enough to show, that
the infirmity arises from original debility of the urinary passages.
The treatment, too, that is most successful, supports this opinion.
All useful remedies are derived from the tonics and astringents. I
have invariably found benefit from aromatic baths in such cases,
and I have now treated a vast number of them. I consider, there-
fore, that hicontinence of urine arises from atony or debility of the
neck of the bladder.

It is not without reason, then, that the approach of puberty is con-
sidered likely to efi'ect a cure in such cases : such a result is explained
by the urinary passages sharing the excitement set up at this period
in the genital organs ; and this intimate connection is sufficient to

CONaENITAL PREDISPOSITION. 239

point out that incontinence of urine in childhood is a bad symptom,
when considered in connection with the powers of the genital organs,
in after life. The cases I have seen leave no doubt on my mind on
this subject ; and I should add that aromatic baths have been very
useful in cases complicated in this manner. After aromatic baths I
may mention cold bathing, ferruginous preparations, quinine, co-
lumba, &c., which are also useful in relieving the incontinence of
urine itself. Sulphuretted baths have also frequently produced good
effects.

Retention of Urine. — This accident is very rare in childhood, I
have, however, notes of two cases of obstinate involuntary discharges
in which it occurred. In the first case, frequent retention took place
about the age of two years, and was occasionally so serious that
the aid of the catheter was required for its relief. Up to the age
of sixteen, too, the patient was never able to pass urine without
making ineffectual efforts for a quarter of an hour or more ; and
even when he consulted me he was obliged to wait five or six mi-
nutes before the discharge took place. He was also subject to hse-
morrhoids from infancy, which is very rare. The susceptibility of
the genital organs was so great in this patient, that pollutions were
produced by viewing lithographic plates showing the anatomical de-
tails of pregnacy.

The other patient was a young man, ast. twenty-one, who con-
sulted me for pain in his chest and stuttering, which had come on
after puberty. Retention of urine occurred occasionally during his
childhood up to so advanced a period that he was able to furnish an
exact detail. At the age of fifteen, after having travelled some time
with a female — causing him considerable excitement — he passed a
large quantity of semen with the last drops of his urine ; afterwards
the same circumstance frequently occurred without any previous
excitement. He noticed also that he passed semen during efforts at
stool. He occasionally practised masturbation, but at very distant
intervals, and he never passed on such occasions more than two or
three drops of semen. He had opportunities of sexual intercourse
six times in four years, and on each occasion found himself completely
impotent. This patient deceived himself curiously as to the cause
of his want of power : once he imagined that it arose from the dis-
gust inspired by a prostitute ; once from the respect he felt towards
a mistress ; on another occasion he eat too much before going to his
rendezvous ; at other times he had drunk too much punch, eaten too
many strawberries, &c. I mention these subterfuges, because pa-
tients who are in this unfortunate position take vast trouble to de-
ceive themselves.

The impotence in this case arose from diurnal pollutions which
had evidently long preceded the rare attempts at masturbation which
the patient committed. He came to consult me for an affection of
the chest, and stated that he should return shortly. Two years after-
wards, however. I learned from his elder brother, who consulted me

240 CAUSES OF SPEEMATORRH(EA.

for a similar affection, that he became so ill as to be unable to under-
take the journey, and that he died at the expiration of three months.
His brother strikingly resembled this patient, not only physically
but morally ; he was also affected with stuttering. There was, there-
fore, in these two brothers, a congenital predisposition to involuntary
seminal discharges, shown in the younger by very early retention of
urine. The younger one, too, died, while the other recovered easily
enough.

The following consultation has recently been sent me. The pa-
tient's grandfather died of a calculous affection ; his father is of very
nervous temperament, and subject to retention of urine arising from
affection of the prostate ; the patient himself, born during the dis-
turbances in La Vendue, has always been delicate and very irritable.
He has never been able to empty his bladder completely, whatever
efforts he may make for that purpose, and the first jet of urine is
always long in appearing. He practised masturbation very rarely
when between fourteen and fifteen years of age. He is, however,
subject to debilitating nocturnal pollutions, which have injured his
health. Warm baths, abstinence from wine, and a non-stimulating
diet, together with refreshing beverages, were the means which pro-
duced most benefit.

In all cases of early retention of urine, a decided disposition to
irritation of the prostate is to be suspected, instead of debility and
relaxation of the parts such as are found in persons who have been
subject to incontinence when children.

To resume, then : incontinence of urine is a symptom the more
serious in respect to the genital functions in proportion as it is more
complete and prolonged, and the pollutions which follow it so easily
are to be attributed, in a great majority of cases, to congenital re-
laxation, or debility. Such pollutions are always very obstinate.

Retention of urine announces just as surely a disposition to phlo-
gosis in the prostatic portion of the urethra ; and this is more marked
in proportion as the retention occurs early in childhood, a period at
which the organs are not exposed to the irritations that act on them
after puberty.

Hereditary Transmission.
CASE LXI.

Blennorrhagia at the age of twenty-one — Pains in the testicles — Pollutions
during four years — Serious gastric and cerebral symptoms occurring in
paroxysms — Hereditary predisposition — Iced milk — Cauterization —
Acup u ncture — Sulphu retted ha ths — Peco very .

In November, 1835, Dr. Guillemot requested my opinion on a patient of
his, whom he thought affected with chronic cerebral affection. The fol-
lowing are the chief facts.

CONGENITAL PREDISPOSITION. 241

M. M , of lymphatico-nervous temperament, and excellent disposition,

whose father had been weak and unhealthy, passed his childhood without
suflfering from any serious disease, but was always subject to diarrhoea, ac-
companied by very painful tenesmus, which generally yielded to slight me-
dical treatment, but was reproduced from very slight causes. He led a
sedentary studious life, and had never committed excesses of any kind.

In 1827, at the age of twenty-one, he contracted simple blennorrhagia,
which yielded quickly to the use of demulcents ; soon after, he experienced
a vague dull pain in the testicles, which troubled him much on account of
its seat and its constancy, although his medical attendants did not consider
it of consequence. He had also repeated nocturnal pollutions, followed by
fatigue and general uneasiness, especially when they occurred very frequently.
His erections, too, were sometimes painful. During four years, he suffered
constantly from indisposition ; he had frequent attacks of indigestion, repeated
headache, and sudden attacks of giddiness, although these were slight and
passing. His memory and aptitude for intellectual employment wore dimi-
nished. In 1831, he had strange noises in his right ear, accompanied with
buzzing and momentary deafness, which went off" and returned without evi-
dent cause. The attacks of cerebral congestion became more severe, but
were still of short duration.

In March, 1832, the first serious attack occurred ; it was ushered in by an
abundant discharge of urine with notable digestive disorder, and was after-
wards marked by violent spasms and constant giddiness, which did not allow
the least motion of the head without loss of consciousness. Venesection and
leeches were had recourse to, with marked increase of the agitation and
other symptoms. Blisters and a seton in the nucha were followed by mo-
mentary relief; but similar attacks soon recurred.

In 1833, the patient experienced much dread of the cholera ; he had symp-
toms of hypochondriasis, which were attributed to fear, and completely lost
his hearing on the right side. In November, he was bled in the foot, and
injections of vapor and fluid into the ears were practised without benefit.
Russian and Egyptian baths were used ; immediately afterwards, several
violent attacks occurred, exactly similar to those before suffered. A severe
regimen was now ordered, together with a large issue in the nucha ; no
benefit resulted. A venereal taint was now suspected by Recamier, and mer-
curial baths ordered without any eff"ects worthy of notice. The attacks w«-e
now supposed to be periodical, and sulphate of quinine was ordered ; but on
the third day of this new treatment, a still more serious attack occurred, and
Marjolin and Baudelocque were consulted. Fresh issues were made in the
nucha, and mercurial pills and decoction of sarsaparilla were ordered. During
three months little change occurred. There was violent pain in the right
shoulder, with an eruption in the neck.

In the spring of 1834, a slight improvement took place, which lasted two
months, after which, the same attacks returned with increased frequency and
severity. Valerian and belladonna were now prescribed without benefit. In
the spring of 1835, another remission in the symptoms took place; but at
the end of the summer, the same accidents recommenced.

When I saw the patient, his last attack had continued upwards of a
month almost without remission ; his emaciation and pallidity were striking ;
he lay on his back quite motionless, not daring to lift his head from the
pillow, or even to turn from right to left ; on the least attempt at motion all
things around him seemed to turn at the same time that he turned with

242 CAUSES OF SPEEMATORRHCEA.

them, and the room appeared to sink with him; his cephalalgia was intense
and constant, and especially felt in the region of the right ear; the corre-
sponding temporal region was more sensitive than the other, and the mouth
was drawn to the opposite side when his lips were in motion. There was
constant stiffness of the neck ; he was unable to bear the least light or noise,
and even a slight motion of the air increased his irritability, and caused
serious symptoms. His pulse was feeble and remarkably slow ; his urine
passed abundantly, was muddy, and deposited much sediment, containing
phosphate of lime, with a thin mucus uniformly mixed, and a denser de-
posit which occupied the lower layer.

It seemed evident that this deposit contained semen in abundance,
although I was unable to satisfy myself completely of the presence of sper-
matorrhoea, on account of the quantity of urinary salts present. The
patient asserted, that several of his most severe attacks had come on imme-
diately after abundant nocturnal pollutions, and that he always felt worse
the day after they had taken place. Still the deafness on the right side, the
pain in the neighborhood of the right ear, and the deviation of the mouth
to the opposite side, seemed to indicate a chronic affection of the right in-
ternal ear, which probably had extended to the membranes of the brain in
the neighborhood. On the other hand, both the patient and Dr. Guillemot
had noticed that every attack had been preceded by an abundant secretion
of clear colorless urine, with marked disorder in the digestive organs. I
still feaj-ed that I might be misled, by having my mind preoccupied with the
subject of spermatorrhoea, and I therefore, at this time, declined to advise
cauterization.

Iced milk, however, I ordered, and it re-established the functions of the
stomach in a short time, and increased the patient's appetite, which he was
obliged to satisfy frequently under the penalty of again suffering from cere-
bral symptoms. Camphor was insupportable on account of its influence on
the head, and opiate enemata produced constipation. Syrup of uymphea,
however, had a better effect. After its use the nocturnal pollutions
became more rare, and the urine, after several variations, at length con-
tinued perfectly transparent (excepting on the days following nocturnal
pollutions), during forty days. By degrees, the severe attacks became less
frequent, and the patient at last passed two months without experiencing
ai% : his deafness was less complete ; his attacks of giddiness ceased, and
at length he had resumed his ordinary diet, and thought himself cured,
when in the middle of March, 1836, his nocturnal pollutions again became
more frequent ; the urine constantly contained an abundant spermatic de-
posit ; his digestion grew difficult, and with the symptoms of gastric derange-
ment, the giddiness and cephalalgia returned. Decoction of nymphea in in-
jections, and the presence of a catheter in the urethra for an hour or two at a
time, caused these nocturnal and diurnal pollutions to diminish considerably,
but the coincidence of new disorders accompanying the return of the pollu-
tions, left no doubt as to the origin of the disease, and I therefore advised
cauterization. This was performed some time afterwards, and still later, I
used acupuncture.

These means produced a profound and lasting change in the functions of
the spermatic organs ; for, from this time, the nocturnal pollutions became
more and more rare, and the urine rarely contained either spermatic deposit
or^ mucous cloud. The other symptoms also gradually diminished from
this period, clearly showing that they arose from involuntary seminal dis-

CONGENITAL PEEDISPOSITION. 243

charges. The attacks of giddiness disappeared so completely, that M. M-

in travelling through Switzerland shortly after, was able to pass on a mule
along narrow precipices, and on the brink of torrents, without suffering the
least inconvenience.

M. M being convinced of the return of all his functions, has married,

and became a father a few mouths since.

From the conclusion of this case, it is impossible to doubt the true
cause of the gastric and cerebral disorder, and it is evident, that
their habitual coincidence was owing to their arising from the same
cause. The frequent intermittences of the disorder are not wonder-
ful after the cases I have already related, besides, during these inter-
vals of a month or two at a time, the health was never perfectly
re-established. The patient was only less ill than usual. Before
having severe attacks, too, the patient had suffered from slighter
ones, to which he paid no attention, but which only differed from
those which occurred afterwards in their intensity and duration.

M. M had complained for a long time of dull and wandering

pains in his testicles, painful erections, and frequent debilitating
nocturnal pollutions. If, therefore, his medical attendants had paid
attention to these symptoms, they must soon have discovered the
cause of his disorder.

It was impossible to mistake the influence of blennorrhagia in ex-
citing these nocturnal and diurnal pollutions, and I did not seek
any other cause; but Dr. Guillemot sent me some very judicious

observations, which I must mention here. M. M 's father was

always an invalid ; he was subject to frequent and obstinate catarrhs ;
his appetite was irregular and his stomach very inactive. The state
of his digestion, too, exercised great influence over his character.
All his family noticed the analogy between his symptoms and those
of his son.

M. M has also a brother who resembles him physically as well

as morally, and who suffers from frequent' but less severe attacks of
giddiness. He is also subject to nocturnal pollutions, especially
when travelling, and Dr. Guillemot has often found traces of sper-
matic deposit in his urine. He is frequently constipated, and passes
a certain quantity of semen during his efforts at stool. He is subject
also to eruptions on the glans and prepuce. For these symptoms
he has quite recently consulted me. The similarity of these cir-
cumstances recurring in M. M 's father and brother is worthy

of notice; indeed, there is no reason why the genital organs should
not partake of the family resemblances, that exist in features, height,
temperament, &c.

I think, therefore, that in this case the involuntary discharges,
and the serious disorder to which they gave rise, depended more on
hereditary predisposition than on the blennorrhagia.

The following is a very remarkable circumstance of the same kind,
which came under my notice in 1830.

244 CAUSES OF SPERMATOREHGEA.

CASE LXII.
Nochirnal and diurnal pollutions occurring in three hrothers.

In 1822, M. C , aet. nineteen, suffered from frequent nocturnal pollu-
tions, although he had frequent sexual intercourse. One night on awaking
he endeavored to prevent ejaculation from taking place, by firm pressure on
the bed ; he succeeded ; but the nest morning, without any other evident
cause, the passage of urine was painful ; the second day the pain in the
urethra increased; the patient had discharge, fever, dysuria, and even
strangury. These symptoms lasted a month and more, their severity being,
however, diminished by demulcent drinks, local and general baths, and a
strict regimen. Before the patient was quite well he attempted coitus, which
was accompanied with severe pain in the urethra. A little while after there
was abundant deposit in the urine.

In 1823, after a very tiring walk, this patient experienced a lively
burning in the urethra during the passage of urine. The discharge, too,
returned, but passed off without' any treatment. During the five years
following, although he was strictly continent, he suffered from constant
burning in the urethra, with from time to time dysuria, pain in the loins,
and abundant deposit in the urine.

In 1829, he was in a state of profound melancholy and depression ; he
suffered from difficulty of breathing, a sense of weight at the epigastrium,
anorexia, frequent liquid stools, and heavy pain in the lumbar and hypo-
gastric regions. Whenever he went to stool, a considerable discharge of
watery semen took place, and the same thing happened frequently during
the emission of the last drops of urine, as well as after he had experienced
the least venereal excitement, although he had not had erection. The
prostate was not enlarged, but painful on pressure.

This patient's elder brother, set. twenty-five, of robust constitution and
remarkable muscular strength, possessed active virility at the age of nine-
teen, when he had daily meetings with a female whom he endeavored to
seduce, often renewing his attempts three or four times in a few hours. At
first, obstacles only arose from the pain caused, and the unfavorable cir-
cumstances that accompanied \hese meetings, but after a time his erections
became incomplete, ejaculation took place very rapidly, and at last took
place on the first approaches. Afterwards he addressed himself to other
females, but then he perceived that his erections were incomplete, rare, and
of short duration ; he experienced frequent and almost passive nocturnal
pollutions, with pain in the testicles and spermatic cords, and at last, invo-
luntary discharges during efforts at stool ; his health, however, was not
much disordered.

The younger brother, aet. nineteen, also suffered from nocturnal pollutions
without erection, involuntary discharges at stool during the emission of
urine, and even while in company with a female. These he attributed to
considerable ungratified venereal excitement, which he had experienced
daily for a long time together.

The coincidence of nocturnal and diurnal pollutions in three
brothers, the eldest eet. twenty-seven, the youngest nineteen, is
remarkable enough; — all three being strong and well made, ,It is
worthy of note also that the gravity of the symptoms was exactly pro-

CONGENITAL PREDISPOSITION. 245

portioned to the age of the individuals, and consequently to the dura-
tion of their disease ; for it seemed to have commenced in each case
at about the same age.

The causes which favored the development of the disease in these
three brothers were too slight in each case not to require the hypo-
thesis of congenital disposition to account for its appearance. Cases
of this kind are rare, but those above related are sufficiently charac-
teristic to leave no doubt of the possibility of hereditary predispo-
sition to involuntary discharges existing without any sign in the
genital organs denoting its presence.

Congenital increased Nervous Susceptihility . — I have met with a
considerable number of patients in whom involuntary discharges were
referable rather to an originally excited sensibility of the genital
organs, than to congenital relaxation. None of these patients had
been exposed to the influence of any cause sufficient to account for
the occurrence of spermatorrhoea.

In general such patients were of sickly constitution, and more or
less marked nervous temperament ; they had been delicate from child-
hood, and subject to various spasmodic disorders. Some of them
presented involuntary twitching of the muscles of the face, hesitation
of the speech, &c. ; their imagination was active, and their moral
and physical sensibility very acute. They were very restless, and
bore contradiction, or mental excitement, badly.

In childhood they presented local symptoms, which indicated
peculiar susceptibility of the urinary organs, every impression of fear
or anxiety showing itself in this direction. What would have pro-
duced shuddering, or palpitation in other children, in them caused a
secretion of clear watery urine, which they were obliged to discharge
frequently ; a sense of constriction of the hypogastrium, and a sense
of titillation generally accompanied its discharge. This condition of
the urinary organs continued more or less severe in all the cases
until after puberty, when it became joined with other symptoms.
One of these patients one day experienced at the age of sixteen a fit
of irritability and impatience, which, however, he succeeded in re-
pressing ; and he then felt sudden and impetuous desire of micturi-
tion : whilst emptying his bladder he perceived a large quantity of
pure semen discharged with the last drops of urine. This occurrence
was the forerunner of nocturnal and diurnal pollutions, which at the
age of twenty-seven had entirely ruined his health. Another, at the
moment of competition for a college prize, was unable to find an ex-
pression he wanted : at the same time he felt a want to make water,
which he resisted by firmly crossing his legs ; but his impatience
increased, and he shortly experienced an abundant emission without
either erection or pleasure. A third patient suffered in the same
way under similar circumstances ; he saw the moment approach for
sending in his thesis ; the more he endeavored to hurry, the less freely
his expressions flowed ; at length, on hearing the clock strike, he
suffered from so great mental disorder that he nearly fainted : at this
16

24:6 CAUSES OF SPERMATOERHCEA.

moment emission took place. A fourth having mounted on a high
gutter of a house to take some sparrows' nests, looked down into the
court below, and was suddenly seized with such terror that he fainted;
on recovering and escaping from his dangerous situation he found that
he had had an abundant seminal emission. The same circumstance
occurred to a fifth, who, in descending a ladder, missed his footing
and fell. Another patient told me that if he looked down from a
height, or only fancied himself on the brink of a precipice, he felt
a sense of contraction in the genital organs, which passed rapidly
to the base of the penis, and ended by causing emission. The motion
of a swing produced the same effects in a seventh.

Almost all these excitable persons were exposed to erection, and
even to pollutions whenever they rode on horseback.

Although all these involuntary discharges were caused by extra-
ordinary circumstances, I should not have paid much attention to
them if they had not been followed by nocturnal and diurnal pollu-
tions, which the most trifling circumstances rendered very serious.
The disease, however, did not always put on a serious aspect imme-
diately after these singular accidents ; very often, indeed, it only
injured the patient's health long afterwards ; but as its gravity could
not be explained by any occasional cause, I feel myself compelled to
admit the existence of a congenital increased nervous susceptibility
of the genito-urinary organs. Everything indicates, in fact, that the
organs of these patients were rather excitable than weak and relaxed ;
and this condition was congenital because manifested from the earliest
infancy. This excessive sensibility of the genital organs is, however,
not always preceded by a similar condition of the urinary apparatus.

In all these cases, tonics and excitants always produced bad
effects ; proving that the genital organs were not suffering from
atony.

Long-continued Continence. — I have already shown the vast ad-
vantage of chaste habits, strict principles, and moderate desires ; I
have now to point out the inconveniences resulting in certain cases
from absolute and long-continued abstinence from sexual intercourse.
The effects produced by complete privation afford the most certain
evidence of the original strength or debility of the genital organs.
If they are powerful, such privation proves a kind of torture which
may induce the most serious abuses, or disorder in ainhe functions;
if irritable, prolonged abstinence causes abundant and frequent
nocturnal pollutions ; if weak and little developed, such privation is
not painful ; the pollutions are rare and in small quantity at first, but
still they produce a serious effect, and after a time they become more
and more severe and difficult of cure.

These signs of energy, irritability, or weakness in the genital
organs, are more certain than those drawn from their external
appearance.

The patients of whom I am about to speak are all remarkable for
the facility with which they support privation from sexual intercourse.

CONGENITAL PEEDISPOSTTION. 247

Their lives are exemplary in all respects ; not only have tliey never
committed excesses or practised abuse, but for the most part they have
never even had any relations with the opposite sex. In these cases
the temptation is so slight that to conquer it is not any great merit.
Such constant and easy continence is an unfavorable sign when
considered in reference to the powers of the genital organs ; and we
should much deceive ourselves if we adopted, without examination,
the explanation the patients give of their conduct. They generally
attribute their continence to strict morality, to religious principles
inculcated in early infancy, or to the effects of good example; they
omit altogether to mention the little desire they have had to combat.
Buf when such patients wish to break their long and easy continence,
they find themselves completely unable; not on one occasion only,
but habitually ; not under unfavoi-able circumstances, but during
many years of marriage. Such a state of things during the period
of the greatest virility completely explains the ease with which
they maintained their former long continence. Most of these pa-
tients, too, feel a strange presentment of the catastrophe which
awaits them. They have a suspicion of their weakness, and hence
they manifest an instinctive repugnance to marriage, and hesitate
long before they are able to make up their minds to enter that state.

A great facility, then, of supporting absolute continence, ought
to lead us to suspect want of power in the genital organs ; as well
as diurnal pollutions when nocturnal ones do not occur, because the
continued presence of semen will stimulate the least powerful organs
into occasional action.

Let us now see what are the effects of such long continence, es-
pecially in these weak individuals. If fatigue be hurtful to all
organs, so moderate exercise is necessary to them as soon as they
are in a condition to act. The generative organs are not beyond
the influence of this general law. All surgeons admit that prolonged
inaction produces the same effects on the genital organs as on any
other : that is to say, that it diminishes their energy and activity.
The inactivity of these organs in children and eunuchs arises from
the non-secretion of semen; no pollutions can therefore arise in such
cases, and the health does not become disordered. On the contrary,
in the unmutilated adult, want of power can only be attributed to
very serious diurnal pollutions, often very difficult of cure. As soon
as the evolution of the genital organs commences, the testicles begin
to act ; if their structure be not accidentally injured, they continue
to secrete until a very advanced age. This secretion, it is true, may
be diminished by the absence of all excitement, direct or indirect, or
by momentary weakening of the system, or by the special action of
certain medicines ; but it never ceases entirely from the age of pu-
berty to the commencement of old age. Hence results an evident
deduction, viz. : that in the absence of all voluntary evacuation the
seminal vesicles must become filled more or less rapidly, and after a
time must become distended ; so that if the secretion be not evacu-

248 CAUSES OF SPERMATOREH(EA.

ated in quantity in an open and sudden manner, it must escape by
degrees at periods more or less close, and under circumstances which
render this evacuation difficult to be ascertained. In other words,
if nocturnal pollutions do not occasionally occur, it is because diur-
nal ones exist.

From the numerous cases I have related, it is evident how slow
and insidious the progress of this disease may be, and it is remark-
able that those who have fallen into the most deplorable condition,
and whose cure has been most difficult, have been precisely such as
had supported the disease longest without suffering much.

In studying the cases attentively, it becomes evident that the dis-
ease commences by nocturnal pollutions, accompanied with lascivious
dreams, energetic erections, and a lively sense of pleasure. But this
orgasm diminishes by degrees, and the emissions at last take place
without erection or sensation ; such nocturnal pollutions become
more rare, and sometimes cease entirely, and then the health of the
patients becomes seriously and rapidly affected, much to their
astonishment, as they have no suspicion that diurnal pollutions have
been added to the nocturnal ones, and at last have entirely taken
their place.

By reflecting on the succession of the phenomena in individuals
who have done nothing to aggravate their condition ; and taking
into the consideration the salutary effects which sexual intercourse
produced in many of the cases that have come under ray notice (see
case fifty-six), it is impossible not to admit that prolonged inaction of
the genital organs diminishes the tonic resistance of the ejaculatory
ducts, disorders their sensibility, and perverts their functions without
being able to prevent the formation of semen by the testicles, or its
passage into the seminal vesicles. Absolute continence, therefore,
renders the expulsion of semen more and more easy in these cases
without diminishing its secretion in an equal proportion.

The striking and numerous cases of this kind that I have met with,
leave no doubt on my mind as to the true cause of the deceitful calm
of the genital system. The erections and the desires undoubtedly
cease ; impotence is established ; the organs no longer give the least
sign of activity ; nothing can remove their torpidity ; all this is incon-
trovertible ; but this condition is far from one of rest, especially of
reparative rest ; no advantage to the economy can result from it, in
whatever manner the other functions may be performed ; it is truly
a pathological state ; and it may exist long without appearing seri-
ous or sensibly affecting the constitution. But it becomes aggra-
vated with the prolongation of the continence, and grows daily more
difficult of cure.

The good health of such patients is only apparent ; the least cir-
cumstances disorder it, and what they suffer is unsuspected ; their
parents, their most intimate friends, are ignorant of the cause of the
various disorders they complain of ; the medical man who possesses
their confidence is not better informed, because the patients them-

CONGENITAL PREDISPOSITION. 249

selves do not suspect it ; thus their indispositions are set down to
ennui, tendency to melancholy, or hypochondriasis. When their
diseases become more serious, their constitutions are said to be deli-
cate, impressionable, or unhealthy, or they are considered malades
imaginaires. They are told that they pay too much attention to
themselves, or that they have fondness for medicines. Medical men
in large practice get tired of hearing their long series of inexplica-
ble complaints, and get rid of them by advising travelling, or change
of air. Charlatans rob them ; officious friends advise marriage, or
occupation to fill the void in their existence ; every one blames, be-
cause no one understands them. Incapable of all serious occupa-
tion or deep affection, they grow discontented with themselves and
still more so with others ; absorbed by one sole thought, they return
unceasingly to themselves to seek the cause of their condition, and
soon become misanthropical.

When the disease has arrived at this point, it must make progress,
because the normal exercise of the organs is indispensable to give
them tone and to put an end to the involuntary seminal discharges ;
but these no longer permit the erectile tissues to pass out of their
torpidity. We must, therefore, commence by arresting these pollu-
tions ; but when they have become diurnal their existence is easily
mistaken, and their cure is more difficult in proportion as the period
of inaction has been more prolonged.

From these facts it results that the least excitable and the most
continent and timid individuals are precisely those for whom habi-
tual continued continence is most injurious ; they endure it with less
immediate inconvenience than others ; and although any excess
would be very prejudicial to them, absolute privation possesses the
greatest dangers. In fact, natural moderate exercise can alone
give to their organs sufficient energy, and sufficiently regular habits
to arrest nocturnal pollutions, and to prevent the occurrence of
diurnal ones. No one would think of depriving a delicate child of
exercise simply because he shows less disposition for it than his com-
panions. Every one, on the contrary, would understand that it is
the only means by which his weak constitution can be strengthened,
if not rendered hardy. The same reasoning holds good in respect
to the cases under consideration.

General Review of the Causes of Spermatorrhcea, — It has
been seen that the causes of involuntary seminal discharges are very
numerous, and that their mode of action varies much. Hippocrates
wrote only of venereal excesses. Tissot and his successors added
masturbation — the incompleteness of this list is evident. These two
causes were supposed to act invariably in the same manner ; whereas
I have proved that their influence varies in different individuals, and
even in the same individual at different times. All pollutions, too,
whether nocturnal or diurnal, were referred to relaxation of the
genital organs ; but I have shown that a very opposite condition pro-

250 CAUSES OF SPEEMATOREHCEA.

duces the same effects; indeed, that this supposed relaxation seldom
exists alone, especially under the circumstances stated.

I will now briefly recapitulate these causes. The first I considered
was hlennorrhagia — tracing the inflammation from the orifice of the
glans penis, and considering all the changes produced by it in the
tissues. Secondly, I spoke of cutaneous affections, pointing out the
mode in which, by propagation of the cutaneous irritation through
its continuity with the mucous lining of the urethra, involuntary se-
minal discharges arise. Thirdly, I considered the influence of the
rectum. This I divided into two kinds : the one being mechanical,
arising from an obstacle to defecation or from constipation, the
other a vital action, producing its effects by the extension of irri-
tation from the rectum to the prostate and seminal vesicles. The
fourth cause of which I treated, was abuse. Here I pointed out the
various causes of abuse, their importance, and the varieties of abuses.
On these points I laid considerable stress, on account of their im-
portance to the well being of the human race ; I also pointedout
the effects of abuses, and the means to be taken to prevent them.
The fifth cause that came under my notice consisted of venereal ex-
cesses, and here I showed the circumstances which constitute ex-
cesses, and the conditions in which slight sexual intercourse may be
injurious. I showed, also, that factitious desires may arise and carry
intercourse beyond the actual wants of the system. The general
and special effects of venereal excesses also occupied my attention.
Sixthly, I considered the action of certain medicines inducing in-
voluntary seminal discharges. I showed the effects of astringents,
purgatives, and medicines which stimulate the urinary organs, such
as nitrate of potass, &c. I also mentioned the action of coffee and
tea, when taken in excess. Seventhly, the action of the cerebro-
spinal system occupied my attention. I here considered the action
of the cerebellum and spinal cord. Eighthly, I considered conge-
nital j^redisjyosition ; and here malformations came under my notice,
with phimosis, exuberant prepuce, vitiated secretion of sebaceous
matter, hereditary predisposition, congenital debility, &c. I also
passed rapidly over the symptoms by which debility of the genital
organs may be recognized, and the conclusions to be drawn from in-
continence of urine during childhood. I also made a few remarks
on disorders of nervous susceptibility, and on the effects of con-
tinence on cases in which the genital organs are originally in an
atonic condition. I have, in this first part of my work, related
many cases — too many perhaps to suit the taste of some readers —
but I found myself under the necessity of treating the subject of
involuntary discharges as an entirely new one, and of proving each
proposition as I proceeded — the scanty writings on the subject that
have hitherto appeared, being not only useless, but worse — full of
errors.

LOCAL SYMPTOMS. 251

CHAPTER XI.

SYMPTOMS OF S P E RM AT R R H (E A.

I HAVE hitherto been occupied only in considering the cause3 of
spermatorrhoea ; its symptoms now claim more special attention.

A cursory glance at the symptoms of involuntary seminal dis-
charges is sufficient to show, that some may be referred exclusively
to the genital organs, while others extend to all the functions of the
system. The first constitute the disease, the second are only its
more or less remote consequences. I divide the symptoms, therefore,
into two great groups of local and general symptoms, in order to
approximate, in their natural position, those phenomena which are
most nearly connected among themselves. Both divisions are, never-
theless, intimately connected.

While considering these symptoms singly and in order, I shall
avoid all those subtle divisions that have been proposed, into pollu-
tions attended with erection, pleasure, spasmodic contraction, &c. ;
such being, in my opinion, only useless complications of the subject.

LOCAL SYMPTOMS.

Nocturnal Pollutions. — Those involuntary discharges that take
place during sleep are easily ascertained ; but it is not always so
easy to appreciate the degree of importance to be attached to them,
because they are not all equally injurious; under some circumstances
they are even useful. The most abundant nocturnal pollutions are
far from being always the most hurtful. When they arise from true
spermatic plethora, they often relieve erotic excitement, with its
accompanying agitation, anxiety, uneasiness, and indefinable trouble
in all the functions. They are followed by a general feeling of
comfort ; the head becomes clearer, the ideas more rapid, and the
motions more nimble; there is more inclination to amusement, and
to every kind of occupation. I admit that nocturnal pollutions do
not often produce such good efi"ects, but then they are not often the
result of spermatic plethora ; they may, too, easily lose their char-
acter, so that habit alone tends to make them more and more fre-
quent. In the greater number of cases, however, these evacuations
are of very little importance.

But this state of excitement is too violent to last long : by degrees
the organs become fatigued. Deprived of their natural functions,

252 SYMPTOMS OF SPERMATGRRHCEA.

and consequently, being unstrengthened by regular exercise, they
may at last fall into a state of atony, or the seminal vesicles may
preserve the habit of contracting, under the influence of slight or
indirect excitement. The evacuations now produce the effects quite
opposite to those experienced in the beginning. There are, on wak-
ing, feelings of discontent, idleness, weight in the head, disorder in
the ideas, &c., but this condition passes off in the course of the day,
and the patient is quite well on the following morning, if no further
emission take place. After a time, these effects become more serious
and lasting, and two or three days are required to remove them
completely. There is, however, no disease as yet, because the eco-
nomy is not as yet permanently disordered; but there is a degree of
instability in the patient's health, a valetudinary condition, the pro-
gress of which it is necessary to arrest.

In these simple and early cases moderate coitus is useful ; it gives
tone to the organs, and breaks off the habit of involuntary emissions.
At a later period coitus has its dangers.

When nocturnal pollutions are excited by abuse, by venereal
excesses, or by the irritation of ascarides, they frequently produce
serious disorders soon after their appearance, and the disease rapidly
progresses. By degrees all the phenomena of excitement which
preceded or accompanied the crisis, disappear entirely ; emission
occurs without dreams, erections, pleasure, or, indeed, any particular
sensations ; so that the patients only discover what has taken place
by finding the marks on their linen when they awake. At the same
time, the seminal fluid loses its consistence, color, smell, and even sper-
matozoa by degrees, and more and more resembles mucus or prostatic
fluid. It is impossible to doubt its identity, however ; the changes
take place slowly, and frequently patients are able to follow their
progress. These watery evacuations are followed by similar but
more violent effects ; besides, the seminal vesicles alone can furnish
so abundant a discharge of viscid matter. The emission is sudden, the
patients never having a constant seminal discharge. A similar evacu-
ation does not always take place every night, though sometimes dis-
charges may happen frequently in one night ; and this the patients
are easily able to ascertain, because their sleep is light and broken.
As to the absence of erection during these discharges, it cannot be
doubted, as the matter is found in the hair around the base of the
penis, in the perineum, and even on the thigh. When it becomes
dry after flowing over the skin, it forms a thin, brilliant pellicle,
resembling the mark left by the garden snail. Generally, a good
deal of this matter, too, is found on the interior of the prepuce ;
sometimes even the prepuce is entirely filled with it, showing the
flaccidity of the penis, and the little energy of the seminal vesicles.
This kind of progressive decrease in the excitement of the genital
organs, with the corresponding increased alteration in the qualities
of the semen, is accompanied with notable increase in the severity of
the general symptoms, and in the difliculty of treating them.

LOCAL SYMPTOMS. 253

In nocturnal pollutions, and, indeed, in all involuntary seminal
discharges, the semen rarely undergoes any other alterations than
those of which I have spoken ; even when the patients have prac-
tised masturbation or coitus so furiously as to cause emissions of
blood. I have only met with one case in which the pollutions were
sanguinolent, and that only for a few days. The semen is also rarely
purulent or sanious, at least during any length of time, in patients
affected by involuntary discharges ; such characters evince a pro-
found lesion of the spermatic organs, which would be soon followed
by death if it continued in so great intensity. It often happens that
ordinary spermatorrhoea follows these sanguinolent or sanious emis-
sions ; but so long as the disease preserves the characters of a sim-
ple inflammation it must be considered as such, and treated accord-
ingly. The effects of nocturnal pollutions are generally supposed
to be proportioned to their abundance, frequency, and the energy
of the phenomena that precede and accompany them : this conclu-
sion is, however, extremely false. In all the cases of nocturnal pol-
lutions related by authors, occurring critically, and putting an end
to alarming symptoms, the discharges have been very copious, and
often repeated in a single night. It may easily be conceived, there-
fore, that it is only in an extreme state of spermatic plethora that
such frequent discharges can take place. But, putting aside these
exceptional cases, we may often be deceived as to the importance of
nocturnal pollutions when considered only with respect to the
abundance and frequency of the discharges ; for the virile powers
vary much in different individuals, and we have no certain means of
establishing the relation between this power and the constitutional
strength of the patient. Besides, on the other hand, it is generally
when the pollutions become less frequent and abundant that they are
followed by serious and long-continued general symptoms. This
anomaly is, however, only apparent, because the nocturnal pollutions
become joined with diurnal ones that occur insensibly. It is, there-
fore, of importance to warn both surgeons and patients of the errors
they commit daily in estimating the value of nocturnal pollutions
by their abundance and frequency.

It is generally believed that erotic dreams excite nightly dis-
charges, and they are consequently considered very dangerous. But
the lascivious images that present themselves during sleep arise from
excitement of the genital organs in the same way as the erections
and the contractions of the seminal vesicles. These phenomena all
coincide ; they all arise from the same cause ; but one does not de-
pend on the other.

Two kinds of these dreams may occur ; the one arising from true
spermatic plethora, and presenting pleasant images unmixed with any
disagreeable sensation ; the other, excited by irritation of the organs,
and mingled with filthy or disgusting ideas. After a time too these
dreams may degenerate into true nightmare, accompanied with ter-
rible sensations and difficulty of respiration, and in the middle of

254 SYMPTOMS OF SPERMATOERHCEA.

the agitation the seminal emission takes place unaccompanied by any
lascivious idea or voluptuous sensation. The danger commences when
the erotic dreams diminish in vigor, and their return is one of the
most certain signs of improvement.

The same thing may be said of the energetic and long-continued
erections, and the active contractions that take place under similar
circumstances. The diminution of the energetic phenomena alone
should cause uneasiness, the most debilitating discharges, and those
most difficult of cure being those that take place most passively.
The more the seminal fluid too loses its distinctive characters and
becomes watery, the more hurtful are the effects of the discharges
on the system.

Diurnal pollutions are distinguished from nocturnal ones by their
taking place during the waking state. They may be divided into
two classes : those that happen during defecation, and those that
occur during the emission of urine.

The diurnal pollutions that happen during defecation are more
easily discovered than those that take place during the emission of
urine ; they do not, however, always constitute a disease, although
they can never be critical or useful like certain nocturnal pollutions.
So long as they happen rarely, and are accidental, the health is not
injured ; but when they do not cease on the removal of the acci-,
dental exciting cause, they incline to become more and more fre-
quent, and to continue from habit, and after a time constitute a
disease which may become serious and obstinate. The transitions
are sometimes so insensible, that it is difficult to establish fixed cha-
racters for them, which shall be constantly applicable to practice.

When a robust individual has been submitted to unusual conti-
nence, and to the long-continued motion of a carriage, he may ex-
perience, after a few days' travelling, an abundant discharge of semen
during the violent efforts excited by accidental constipation. This is
not a matter for much alarm ; all will disappear as soon as the cause
is removed. But habitual and constant travelling in a carriage may
bring on permanent constipation, and a habit of involuntary dis-
charges, very difficult to break off. The diminution of the erections
under these circumstances is not always attributable to the genital
organs becoming accustomed to the heat and motion of the carriage;
but very often to the frequent repetition of unnoticed diurnal pollu-
tions. The same thing may happen with respect to daily and long-
continued horse exercise. Generally the organs habituate themselves
to the action, but occasionally diurnal pollutions come on, and do
not readily pass off, although their cause may have been removed.

The same may be said of the effects of long-continued sitting, in
literary men and others. After having produced increased heat in
the margin of the anus and perineum, with frequent and prolonged
erections, sedentary habits are often followed by a completely oppo-
site condition, without the transition from one state to another being
appreciable. The long use of astringents and bitters, together with,

LOCAL SYMPTOMS. 255

in fact, all causes capable of inducing constipation, tend equally to
transform diurnal pollutions, which were harmless at first, into serious
and intractable disease.

In all cases of this nature, it is not habit alone that tends to per-
petuate the evacuations ; there is also want of power in the rectum,
which continues to increase in proportion as the system becomes
weaker. Defecation requires the assistance of powerful efforts of the
abdominal muscles, and this produces compression of the seminal
vesicles.

On the other hand, all causes irritating the rectum may produce
spasmodic contractions in the seminal vesicles, so that diurnal pol-
lutions may be produced as well during diarrhoea as during consti-
pation : such an effect is generally of short duration ; but it may be-
come permanent provided the rectal irritation be long continued, or
return frequently. Such susceptibility of the seminal vesicles, too,
announces an unfortunate disposition to the occurrence of these dis-
charges ; and this is the point of chief importance in the considera-
tion of pollutions produced by a hot, cold, or irritating injection, by
an active purge, &c.

The same remarks hold good when applied to the pollutions ex-
cited by hsemorrhoids ; very often they only come on when such
heemorrhoids are increased accidentally, but they may continue after-
wards, a'hd even become habitual.

In all such cases as I have just been considering, it is for the prac-
titioner to appreciate the importance to be attached to the discharges,
and it is by their effects that he must judge them, rather than by
abundance ; for some patients support their effects better than others,
and the danger varies according as they are accompanied or not with
other pollutions — as, for instance, with those that occur during the
discharge of urine.

The seminal vesicles sometimes contract from sympathy, rather
than from being compressed by the rectum. This is easily observed,
in some patients, who never pass semen during the efforts at defeca-
tion, but only after the passage of feces, and even sometimes whilst
adjusting their dress. In such cases a sudden convulsive shock is
felt betAveen the perineum and neck of the bladder, sometimes with
slight turgescence of the penis and a certain amount of pleasure; and
the fluid is discharged by two or three spasmodic contractions which
may even project it a short distance. If these discharges always
occurred after defecation they would be as easily discovered as noc-
turnal pollutions, for the fluid could not escape the patient's observa-
tion. But such cases are the rarest; and in all others the discharges
are generally the less suspected in proportion as the disease becomes
more serious. In fact, at first, when the discharges depend on long
continence, accidental constipation, &c., they are very copious, and
generally attended with more or less turgescence of the penis and
slight sensations, which attract attention. The semen, too, possess-
ing its normal characteristics, cannot be mistaken in these cases, and

256 SYMPTOMS OF SPERMATOREH(EA.

the sensation it produces in passing through the urethra is very dif-
ferent from that excited by the passage of urine. But as I have
before stated, in proportion as the disease progresses, the semen
becomes more aqueous ; it is expelled with less effort and less
copiously. Thus, supposing that the small quantity of fluid dis-
charged be not passed together with the urine, the patient may
imagine that he has only passed mucus or prostatic fluid — an opinion
which, if he mention the circumstance to his medical attendant, is
very likely to be confirmed.

It is well known that after violent efforts at defecation, a small
quantity of viscid matter may be expressed from the follicles of the
prostate, and may form, with the mucus of the canal, a drop of
thick and stringy fluid which stops at the orifice of the glans ; but
is this the reason why every one who states that he has passed se-
men while at stool, should have his assertion contradicted without
examination? This, nevertheless, happens daily. Patients who
take the precaution of emptying the bladder before going to stool,
are not to be so easily deceived ; for the prostatic fluid, joined with the
urethral mucus, never furnishes more than one or two drops of thick
thready matter, which is almost always transparent ; and the most
simple reasoning suffices to show that these fluids never can be expelled
in any quantity at one time, because they have no reservoirs to ac-
cumulate in. Whenever, therefore, a quantity of fluid amounting to
a spoonful is expelled at once, there can be no chance of its con-
sisting merely of prostatic fluid and mucus.

Seminal discharges that take place during the emission of urine
are the most serious and most obstinate of all, because they are the
most often and most easily repeated. They are also very obscure
on account of the alterations the semen undergoes, and of its mix-
ture with the urine — at least, in the majority of cases. I must there-
fore lay considerable stress on the means by which the presence of
these discharges may be ascertained.

First, the semen never mixes with the urine at the commencement
of the discharge. It only escapes with the last drop, and when the
bladder finishes emptying itself by energetic and spasmodic contrac-
tions ; sometimes even it escapes by itself after the bladder has been
completely emptied. The desire of making water occurs very often
in these cases, and sometimes, though comparatively seldom, the
penis becomes slightly turgescent, and two or three convulsive mo-
tions expel the fluid in jets. Generally, however, there is no in-
terval between the discharge of urine and the seminal flow, and the
phenomena are so connected that they cannot be separately distin-
guished. I have verified the fact of the semen being only expelled
during the last contractions of the bladder, so often, however, that
there can be no doubt on the point.

Habitual gleet is liable to become aggravated from very slight
causes, and may give rise to a cloud in the urine, which it is possible
may be taken for seminal fluid ; to avoid this error, it is sufficient to

LOCAL SYMPTOMS. 257

recollect that in gleet it is always the first jet of urine that is cloudy
— the cloud consisting of cast off epithelial scales, mucus, and pros-
tatic fluid, which have accumulated since the previous act of mictu-
rition. Whenever the bladder, too, contains blood, pus, mucus, &c.,
these extraneous matters, being heavier than the urine, are collected
near the neck of the bladder, and consequently are discharged first
when the patient is standing. The contrary takes place with regard
to semen. These remarks will be found of considerable importance
in practice, for gleet and vesical catarrh are often present at the
same time with diurnal pollutions, and render the diagnosis very ob-
scure. In simple and early cases, on desiring the patient to make
water in a bath, it is very easy to distinguish the semen discharged
with the last drops. In such cases it possesses considerable opacity,
andcontains a number of granules which become dispersed in the water,
troubling it very considerably. In older cases it is still easy by a little
attention to prove the presence of semen: — the urine suddenly ac-
quires greater density ; besides, the semen is seldom so totally changed
as no longer to contain whitish particles, or distinct granules.

It must be borne in mind, however, that the variations are very
great between one day and another, so that pollutions may not be
noticed on every occasion.

In most cases the presence of semen in the urine maybe discovered
at the first view. In cases that are recent, small semitransparent
irregularly spherical granules of variable size, somewhat resembling
bran, are seen at the bottom of the vessel. These cannot be con-
founded with any urinary salt, because they appear before the fluid
has cooled ; they are soft, and do not adhere to the sides of the vessel.
On the other hand, neither urethra, prostate, bladder, nor kidneys
can furnish similar granules, especially when the urine is transparent;
they must come, therefore, from the seminal vesicles, and may be
regarded as a sure proof of diurnal pollutions. The patients, too,
are generally made aware of the passage of the semen by a peculiar
sensation, arising from the unaccustomed density of the urine; they
often distinguish also the spasmodic contractions of the seminal ve-
sicles which produce these diurnal pollutions. It is worthy of re-
mark too that such pollutions occur almost always after some vene-
real excitement, as, for example, after an erotic dream, lascivious
conversation, &c. ; or, after some mechanical excitement of the ge-
nital organs ; and often while the erectile tissues are more or less
turgescent, the desire of micturition is felt. The union of these cir-
cumstances sufficiently indicates that such pollutions are the least
passive of those that occur during the passage of urine ; they are
also the least serious and the most rare.

Other patients experience very difi'erent phenomena. The penis
shrinks towards the pubes in consequence of the pain that extends
from the neck of the bladder to the glans. The passage of the urine
over a very irritable point of the canal causes the spasmodic con-
tractions into which the sphincters and seminal vesicles soon enter.

258 SYMPTOMS OF SPERMATORRHEA.

DiiFerent sensations sometimes announce the occurrence of a pollu-
tion ; sometimes it is a sense of heat at the margin of the anus ;
sometimes a shiver or general uneasiness; and, occasionally, a dart-
ing pain in the nipple, &c. Patients who are accustomed to these
particular occurrences well know that they will find a deposit of
flocculent matter in their urine after experiencing them.

When the disease has made further progress the passage of the
semen is hardly appreciable by the patients, and the urine no longer
deposits such large granules at the bottom of the vessel. There is,
however, a thick homogeneous whitish cloud sprinkled with little
brilliant points which descend to the bottom of the vessel, and have
been compared, with justice, to the deposit formed in a strong de-
coction of barley or rice. Repeated microscopic examinations have
left no doubt on my mind that such clouds are in a great measure
due to much altered semen, and that the brilliant points come from
the seminal vesicles.

Certain precautions are necessary in order to observe all the cha-
racteristics of which I have spoken. In the first place each dis-
charge of urine should be collected in a separate vessel, because the
excretions passed at different parts of the day do not often present
the same appearances. The morning urine generally contains most
deposit, especially when the night has been restless. Urine passed
after moral or physical excitement of the genital organs also con-
tains a large quantity, as well as that after a sudden chill, an attack
of indigestion or violent emotion of any kind. Often the urine is
perfectly transparent during a whole day, or several days, and the
patients under these circumstances experience a remarkable im-
provement in their symptoms.

This method of studying the urine permits us therefore to follow
all the oscillations of the disease, and to appreciate those causes
which act most energetically on each individual. Such causes may
be very different, and even opposite to one another ; thus, for in-
stance, in one person, cold dry weather is injurious ; in another,
warm and moist.

The vessels to receive the urine ought to be quite transparent.
Round bottomed glasses like exaggerated and much deepened watch
glasses are useful ; but champagne glasses are more advantageous
when the deposit is wanted for microscopic research.

Other Diurnal Pollutions. — Certain other diurnal pollutions may
occur, but in such cases there are generally involuntary discharges
during defecation and the emission of urine, present at the same
time.

Such pollutions may take place during horse exercise, from the
jolting of a carriage, the friction of the clothing, mental excitement,
and in a few very rare cases without either moral or physical provo-
cation. In the last cases the patients experienced suddenly, while
engaged in study, a pinching in the prostatic region, with a sense of
spasmodic contraction between the bladder and rectum; perhaps they

LOCAL SYMPTOMS. 259

get rid of these sensations by chano;e of posture, pinching the skin,
&c. ; but the discharge of semen takes place with the next emission
of urine. I can only attribute these phenomena to some special irri-
tation of the seminal vesicles, or of the nerves distributed to them.

Impotence. — Loss of virility, when not attributable to any evident
cause, must be considered a local symptom, and one of the most
certain of involuntary seminal discharges. The effects of age, of
serious diseases, and of lesions of the testicles are of course left out
of the question in this statement : and there are also other cases which
must be carefully distinguished from habitual and acquired impotence.

Under the influence of powerful moral impressions, of whatever
kind, the genital organs may occasionally not respond to the most
energetic desires. Sometimes even the violence of the excitement
may prevent its external manifestation. But this condition passes
off with its exciting causes, and the same individual under other
circumstances regains his normal vigor. Such accidental occur-
rences must, therefore, be distinguished from habitual impotence.

In other cases, too, the evolution of the genital instinct never per-
fectly takes place ; some even never experience a commencing pu-
berty. I once saw a man, thirty years of age, very fat, without beard
or hair on the pubes, whose testicles and penis appeared to belong
to a child of seven or eight years ; he had never experienced either
erections or venereal desires. This case may be considered as the
type of congenital impotence. It is rarely so complete, but in no
case must it be confounded with the acquired condition.

On the other hand, again, acquired impotence presents different de-
grees which are important. Some patients never have complete erec-
tions, others only experience them accidentally, as, for instance, at
the moment of waking, or when the rectum or bladder is distended.
But such erections never acquire the same degree of energy as
normal ones. In other persons again the morbid sensibility of the
organs is so great that emission takes place on the least contact, with-
out perfect rigidity of the corpora cavernosa. In this case — the least
serious and the most common of all — there is yet impotence, even
although intromission be possible, because fecundation cannot be the
result of so precipitate an act, by means of which the seminal fluid
cannot pass into the neck of the uterus. These are cases of only
commencing impotence, which may be as slight as possible ; but
when it has continued some little time, Ave may be sure that involuntary
discharges are present. Those involuntary discharges which take
place during defecation and the emission of urine being the only
ones of which the patient may not be aware, we may infer whenever
any notable and permanent diminution of the genital functions oc-
curs, that the patient suffers from diurnal pollutions. •

The presence of well-formed semen in the seminal vesicles is the
cause of all normal erections, and without this essential condition
either direct or indirect excitement would have no action on the
erectile tissues ; habitual and acquired impotence, therefore, arises

260 SYMPTOMS OF SPERMATOEEH(EA.

from the want of the normal stimulus in the vesicles, and is, conse-
quently, one of the most certain signs of the presence of diurnal
pollutions.

I now proceed to consider the means by which the actual presence
of semen in the urine, or under other circumstances, can be unequi-
vocally demonstrated.

Chemical Analysis. — The analysis of animal matters is too com-
plicated a process and too uncertain in its results to permit of its
employment by practical men in distinguishing semen from mucus
or prostatic fluid. The use of warm water applied to stains on the
linen in order to favor the evaporation of the odoriferous particles
cannot strictly be considered a chemical process, and the odor of
semen passes off" too rapidly to allow of its being always ascertained
by our obtuse olfactory organs. It is, therefore, a distinctive cha-
racter of little importance, whatever acuteness the sense of smell
may acquire from long habit.

Microscopic Examination. — Since the discovery of the spermatozoa
their presence in the seminal fluid has attracted the attention of all
who have sought means of distinguishing it from other fluids. Micro-
scopic examination of the spermatozoa, however, not only requires an
excellent instrument, but certain precautions which may be dispensed
with in the investigation of coarser objects. As the spermatic ani-
malcules can be only seen by means of transmitted light, it is neces-
sary that the glass on which the fluid to be examined is placed should
be of uniform thickness, and without bubbles or strips. The fluid to
be examined should be covered by another layer of extremely thin
glass made on purpose, and not by portions of mica, which are seldom
free from cracks, and never perfectly transparent. This thin layer of
glass is indispensable in order as much as possible to diminish the
thickness of the fluid, to render it perfectly uniform, to hinder eva-
poration and prevent the object glass from being soiled by it. A
single drop of fluid suffices for a complete observation, a larger quan-
tity always proving inconvenient. The little glass that covers the
liquid must be firmly pressed down so as to spread it out, arrest the
currents that take place in it, and drive out the air bubbles. Although
the glasses should seem to touch each other, the spermatozoa move
with perfect freedom in the space between them, so long as they
preserve their energy and evaporation has not proceeded too far ;
should such be the case, however, a drop of tepid water favors and
much prolongs their motions. However thin the layer of fluid may
be, it is impossible to comprehend its whole thickness at once with a
very high power, and it is, therefore, necessary to alter the focus
frequently in order to be sure that nothing escapes observation. And
this is especially important in examining a drop of fluid obtained from
diurnal pollutions, because there are frequently only two or three
spermatozoa contained in it. It is also necessary to change the posi-
tion of the reflector frequently in order to vary the direction and
intensity of the light. The spermatozoa are often exceedingly trans-

LOCAL SYMPTOMS. 261

parent in cases of disease, and a very bright perpendicular light is
by no means the best for showing them. Varying the density of
the fluid under examination, either by adding water or by permittino-
evaporation, is also often useful. The semen contains matters fur-
nished by the seminal vesicles, the prostate and the urethra, and
when the fluid is too thick these matters hide the animalcules. A
drop of water applied to the edge of the covering-glass penetrates
underneath it, and the spermatozoa are more isolated, at the sam.e
time that their contour is rendered more defined by the diminution in
density of the fluid. On the other hand the refractive power of the
spermatozoa difl"ers little from that of the fluid in which they are con-
tained, and their thinnest portions are traversed by the light without
aff'ording any distinct images to the eye. In this case there are only
seen very small ovoid brilliant globules terminated by a little point.
As soon as the water begins to penetrate between the glasses, the
rapid motion set up prevents the objects from being clearly distin-
guished ; but as soon as rest has been re-established the tails of the
animalcufes appear, and their dimensions seem to have increased in
consequence of the diminished density of the surrounding fluid; water
suffices to produce this result. It is more sensible, however, when a
small quantity of alcohol is added : but the forms of the animalcules
are, after a time, altered by this agent; and it is, therefore, advisable
to use water only when it is intended to keep the preparation.

Evaporation sometimes produces not less remarkable changes in
the seminal fluid. I have frequently in cases of spermatorrhoea failed
to perceive anything in the fluid under examination for half an hour,
an hour, or more ; then suddenly an animalcule has made its appear-
ance ; then a dozen, and then perhaps a hundred in the space of a
few minutes. The following morning, when desiccation has become
complete, there are no longer any traces of these animalcules, or, at
all events, I have been only able to distinguish their tails, the other
parts of them being fixed in the dried-up mucus. The absorption
of a drop of water has restored the phenomena observed the night
before.

These phenomena are easily explained: when the refractive power
of the spermatozoa is the same as that of the circumambient liquid,
the light traverses the whole in the same manner, and the mass ap-
pears homogeneous. But evaporation acts more rapidly on the liquid
than on the organized bodies contained in it ; and when the diff"erence
of density alters the refractive power the forms of the spermatozoa
are momentarily defined because they have become more transparent
than the remainder of the fluid. When desiccation is complete,
however, the animalcules again disappear, because the refractive
powers of mucus and dried animalcules are again equal. The ab-
sorption of a small quantity of water reproduces the same pheno-
mena, which may be repeated almost indefinitely, since the matter
confined between the two layers of glass undergoes no other appre-
ciable alteration.
17

262 SYMPTOMS OF SPERMATOREHCEA.

In order to be enabled to discover spermatozoa quickly in cases
of disease, it is necessary that they should be well studied in healthy
cases. This may be accomplished in the following manner : After
coitus there always remains a sufficient quantity of seminal fluid in
the urethra to serve for precise and complete microscopical exami-
nation. This may be obtained by pressing the canal shortly after
the act, and receiving the drop of fluid from the orifice of the glans
on a plate of glass. In this drop of fluid thousands of animalcules
may be seen, agitating themselves like so many tadpoles in a pool of
stagnant water, only that the tails of the spermatozoa are relatively
longer and thinner, and that the head presents a brilliant point near
its insertion. Generally the number of these animalcules prevents
them from being easily examined, and it becomes necessary to spread
them out by introducing a small quantity of water, and pressing
firmly down the thin glass that covers them ; they are found most
separated on the edges of the fluid. If the water added be of the
temperature of the body their motions become free and lively, and
continue so until cooling and evaporation aff'ect them. By avoiding
these two causes of disturbance the motions of the spermatozoa may
be kept up during several hours.

However long a time may have elapsed after coitus there are al-
ways spermatozoa in the urethra, provided they have not been washed
away by the passage of urine. Although the point of the glans may
be quite dry, and pressure along the whole length of the canal
may not produce the least dampness, still on passing urine living
animalcules may be obtained from the first drop which escapes.
This may be received on the glass, and is perhaps the earliest and
most natural mode of obtaining spermatozoa from microscopic exa-
mination.

It is evident that the same experiments may be applied in the case
of nocturnal pollutions as well as in all other seminal discharges in
whatever manner they may occur. But many errors may arise from
commencing with cases of disease, for it is during perfect health that
the spermatozoa are most active, and their development most com-
plete, and they live longer after coitus than after any other kind of
seminal discharge.

Having thus described the means by which my microscopic obser-
vations may be verified, I proceed to show their results.

Spermatozoa. — Out of thirty-three bodies which I have examined
for spermatozoa, I only twice found these animalcules in the testicles.
In one of these cases the patient died from the eflfects of a fall on the
day following it ; in the other acute gastro-enteritis was the cause of
death. The seminal fluid was most abundant, and contained the
greatest number of animalcules in the former case. The other pa-
tients died of chronic diseases after protracted sufferings. One only
among them died on the second day of acute peritonitis, but he was
seventy-three years of age. In thirty- one of these patients the tes-
ticles were soft, pale, and as though withered. On section they pre-

LOCAL SYMPTOMS. " 263

sented a grayish aspect, and did not furnish any liquid ; the structure
was almost dry, and contained few blood vessels ; the secretins^
canals were easily separated from one another, and could be spread
out under the microscope without breaking. They presented very
brilliant granules, all of exactly the same appearance, about the size
of the head of a spermatozoon, ten times smaller than corpuscles of
blood or mucus, and differing from the latter by the constancy and
regularity of their form. These brilliant bodies which occupied the
place of the spermatozoa, arc worthy of notice, because they offer
considerable analogy to the appearances presented by the semen
under certain circumstances.

In order to observe what is present in the secreting canals of the
testicle it is necessary to spread out a portion of one of them under
the microscope, after having examined it dry to allow a drop of
water to penetrate between the two glasses, and to follow the changes
which take place; then to press down the glass so as to flatten the
parietes of the canal, rupture it, and press out a portion of its con-
tents ; lastly, these must be examined again when desiccation is
complete, for the spermatozoa found in the canals are then best seen.

In the epididymis I have never found spermatozoa, except in the
two cases in which they were also found in the testicles. In all the
others I met with these animalcules only in the vasa deferentia or
seminal vesicles. There were no animalcules at all to be found in
the patient who died at the age of seventy-three. It has always
seemed to me that the animalcules were less numerous in proportion
as the patients had suffered long ; and in extreme cases I have gene-
rally found them only in the seminal vesicles. The fewer the sper-
matozoa the more difficult were they of detection on account of their
extreme transparency. In some cases I have only suddenly dis-
covered them after examining for an hour or two, the liquid having
previously appeared quite homogeneous. The dimensions were the
same as those of the best developed animalcules, but they were pale
throughout their whole extent, and more transparent than the sur-
rounding fluid. Complete desiccation often caused them to disap-
pear altogether; but the same phenomena could be reproduced by
the absorption of a small quantity of water.

In cases of phthisis, caries of the vertebrae, white swelling, &c., I
have had great difficulty in distinguishing the animalcules, probably
because these diseases do not cause death for a long time.

I have almost always found in the seminal Vesicles, especially at
the bottom of any depressions, a thick, grumous, brilliant matter,
varying in its aspect and color, but considerably resembling thick
paste, and more or less transparent ; with a high power the granules
of this matter appear large, iiTegular, more or less opaque, and with-
out any constant shape. They are evidently the products of the
internal membrane of the vesicles, for they are found with similar
characters in the accessory vesicles of the hedgehog, rat, &c., which
never contain seminal animalcules, and do not communicate directly

264 SYMPTOMS OF SPERMATOEEHOEA.

with the vasa deferentia, which, again, never contain any similar
substance. This matter is, therefore, analogous to that secreted
by the prostatic follicles, Cowper's glands, &c. Its functions are
the same, and for many reasons it merits special attention.

The secretion of semen diminishes in all serious diseases, and
seminal evacuations become very rare, especially towards the last.
It is not, therefore, astonishing that the products of the mucous mem-
brane predominate in such patients over those of the testicles, and
that such mucus should become more consistent during its long
residence in the depressions of the vesicles. Hence the difference
observable between the semen obtained from the vesicles after death,
and that which is passed by a healthy person. Nevertheless, after
long-continued continence more or less large granules are often seen
in the semen of a healthy person, and these are perfectly distinct
from the fluid part. When the emissions are more frequent, gra-
nules of the same kind may be observed, but much smaller. These,
facts are important when applied to explain several symptoms of
diurnal pollutions.

I have already stated that on causing the patients to make water
in a bath, the semen passed may be easily recognized by means of
its globules which whirl about in the middle of the cloud formed to-
wards the close of micturition. From what we have just seen it is
evident that these globules come from the internal membrane of the
seminal vesicles. They may be wanting in very severe cases where
the semen has no time to acquire consistence ; but their presence
leaves no doubt as to the existence of diurnal pollutions, because
they can only be furnished by the seminal vesicles. On the other
hand, I have invariably found spermatozoa in the urine of patients
who observed this phenomenon in the bath. The same remarks hold
good when applied to the globules which the urine deposits in cer-
tain cases of diurnal pollutions, and which have been compared by
some to grains of bran, by others to millet-seed, pearl barley, &c.,
according to their size. These globules are perceived as soon as the
urine is passed ; they are roundish, very soft, and do not give any
sensation when squeezed between the finger and thumb ; they can-
not, therefore, be confounded with urinary salts which are deposited
only when the urine is cooled, have a crystalline form, and give
the sensation of a hard body to the finger. The vesical mucus also
is only deposited on cooling, and does not furnish brilliant granules.
As to pus, its appearance is easily determined. I have found animal-
cules whenever these globules appeared in the urine ; and hence it is
that I have pointed them out as certain signs of diurnal pollutions.

I have also noticed that in some cases the urine, when held against
the light, presents in the middle of a flocculent cloud multitudes of
quite characteristic brilliant points. These are smaller, and conse-
quently lighter globules than those which in other patients fall to the
bottom of the vessel. They are neither observed in the mucus of the
bladder nor in the prostatic fluid, which alone present clouds analo-

LOCAL SYMPTOMS. 265

gous to those of diurnal pollutions. Such brilliant points also arise
from the seminal vesicles, and their presence is, therefore, an indi-
cation that the urine contains semen. This I have often verified with
the microscope. I should, however, warn those who wish to repeat
my experiments, that it is not in the midst of the flocculent cloud
that the zoosperms are to be sought, but at the bottom of the vessel,
to which they soon fall on account of their greater specific gravity.
The results of all my observations on the dead subjects, therefore,
convince me of the influence of serious and long continued diseases
on the functions of the spermatic organs. But it is not only in the
morbid state that these experience great variations ; remarkable
differences may exist between healthy individuals not only in the
quantity of semen secreted in a given time, but also in the number,
appearance, and dimensions of the spermatozoa. In this respect I
have observed differences amounting to a third, and, in some cases,
to half. The comparison is very easily established. When the semen
is kept under a thin glass, as I have before described, it is not in
danger of undergoing any changes, and may be always, by the ad-
dition of a drop of water, compared with a recent specimen.

Notwithstanding the facility with which nocturnal pollutions may
be recognized, I have submitted the semen collected after them, by
individuals in various conditions of health, to microscopic examina-
tion. At first, when the evacuations are still rare, and the semen
preserves its ordinary characteristics, the animalcules do not present
any remarkable circumstance in regard to their number, dimensions,
&c.; but when the disease has reached a sufficient degree of gravity
to affect the rest of the system, the semen becomes more liquid, and
the spermatic animalcules less developed and less lively. Their
number, however, does not as yet sensibly diminish ; indeed, in some
cases it seems increased. As the disorder advances, the erections
diminish, the semen becomes more watery, and the animalcules are
often a fourth or a third less than natural, and the tail is often dis-
tinguished with difficulty under a power of three hundred diameters.
At a still later period the animalcules become fewer, and in two
individuals in the last stage of the affection the semen no longer
contained animalcules, although it retained its characteristic smell.
Examined with high powers and every proper precaution, I only
found in this semen brilliant globules, all exactly alike, and about
the same size as the head of a spermatozoon.

The microscopic examinations which I have made of semen passed
during efforts at stool give analogous results. When such discharges
only take place accidentally and at long intervals, the semen is thick,
whitish, impregnated with a powerful smell, and abundantly furnished
with well developed animalcules. I have sometimes even found a few
alive after an hour or two. But when these discharges become so
frequent or habitual as to constitute disease, they become less abun-
dant and the semen loses its normal properties. The spermatozoa

266 SYMPTOMS OF SPEEMATORRHCEA.

are generally smaller than in the healthy condition, and always
less lively. I have some preparations in which they are only of
half the ordinary size, and I have never been able to find a single
lining animalcule a few minutes after the fluid had been expelled.
When the disease has become much aggravated, the spermatozoa be-
come rare, and they are sometimes replaced by ovoid or spherical
globules similar to those of which I have already spoken. In three
patients in an extreme state of disease I found nothing else, although
they passed as much as a dessertspoonful of semen at each stool.
Such cases, however, are exceedingly rare.

In diurnal pollutions happening during the passage of urine the
following means may be employed to show the presence of sperma-
tozoa.

The urine should first be filtered in a conical filter, when, on ac-
count of their weight, the greater number of the spermatozoa will
remain on the lowest part of the paper. By taking this portion and
turning it upside down in a watch-glass containing a few drops of
water, the animalcules become detached from the paper by degrees,
and fall to the bottom of the fluid in the glass, iifter twenty-four
hours' maceration in this position, the paper may be taken away and
the spermatozoa may be readily obtained by using a drop from the
bottom of the fluid in the watch-glass for examination. This mode
of proceeding is a sure one, but it re(i[uires considerable time and
trouble for its performance. I have already stated that the urine
does not always contain spermatozoa in cases of diurnal pollutions ;
therefore, the urine of the same individual would perhaps require
examination on many occasions before the certainty of their presence
could be established, and few medical men in active practice have
time to devote to such experiments. I for one should have long
since given up treating these patients had I been obliged to repeat in
every case such long and tiresome examinations. Ten days or a fort-
night are sometimes passed without the appearance of spermatozoa
in the urine, and hence all who are accustomed to microscopic re-
searches will admit the indefinite amount of trouble and time required.

Fortunately, however, there is a more simple method by which
such examinations may be conducted. It will be recollected that the
semen always escapes either with the last drops of urine or imme-
diately, or soon afterwards. By directing the patient, therefore, to
compress the urethra immediately after micturating, and to receive
the drop of fluid pressed out on a piece of glass, sufficient animalcules
will be obtained from the walls of the urethra for microscopic obser-
vation. These being covered with a thin lamella of glass may be
either at once placed under the microscope, or may be allowed to
dry, and examined at a future time, a drop of water being previously
added. This mode of examination is, therefore, easy for all practi-
tioners who possess a good microscope, after they have accustomed
themselves to the inspection of the spermatozoa in their natural state.

LOCAL SYMPTOMS. 267

The changes which I have mentioned as occurring in the semen must
be borne m mind, however, and the animalcules must not be expected
to appear either so large, so well defined, or so numerous as in cases
where there is no disease.

Some interesting microscopic researches have been made on the
stains of semen appearing on linen, but as these are too complicated
for ordinary cases, and are chiefly of use in medico-legal investiga-
tions, I need not give any account of them here.

263 SYMPTOMS OF SPERMATOREHCEA.

CHAPTER XII.

SYMPTOMS OF SPERMATORRHGE A.

General Symptoms.

Infecundity . — Impotency is an absolute cause of infecundity, be-
cause it prevents the conditions necessary to fecundation from taking
place ; but although the act of coitus may be accomplished, it does
not follow that the person should always be able to perpetuate his
species. Stricture of the urethra may prove an obstacle to the dis-
charge of seminal fluid ; or the fluid may be directed towards the
bladder on the parietes of the urethra, by deviation of the orifices of
the ejaculatory ducts. The secretion may be altered in its nature,
it may only contain imperfect spermatozoa, &c. A man may, there-
fore, be unfruitful without being impotent. On the other hand, I
have met with many patients suff'ering from diurnal pollutions who
had children exactly resembling them, even during the duration of
their disease. Indeed, I have seen several cases in which the dispo-
sition to involuntary discharges was hereditary, and they afi'ected
both father and son. The disease is, however, essentially irregular
in its progress ; it may continue long without doing serious injury
to the health ; long remissions may be experienced, or even a perfect
cessation of the complaint for a longer or shorter time ; we may ea-
sily conceive, therefore, that in the first degree, or during one of
the periods of remission, fecundation may take place. When the
disease is further advanced, however, many causes concur to render
coitus unfruitful. Ejaculation is weak and precipitate, so that the
seminal fluid cannot be thrown into the cavity of the uterus ; it is
not sufficient, in order to fecundate, simply to spread the fluid over
the vagina ; it must be projected with sufficient force to pass through
the orifice of the uterine neck. Besides, in these cases the erections,
even when they permit sexual intercourse, are incomplete and of
very short duration ; emission takes place without energy and very
soon ; so that during such rapid acts the uterus and Fallopian tubes
have not sufficient time for their office : the semen itself undergoes
great changes, to which perhaps the loss of the fecundating power is
chiefly attributable. Microscopic researches have elucidated this
formerly obscure subject ; I have discovered, for instance, that the

GENERAL SYMPTOMS. 269

spermatozoa undergo changes similar to those of the fluid which
serves as their vehicle ; these changes are exceedingly important,
and are owing to defective formation. Spermatozoa may be met with
in a less thick and less opaque fluid than natural for they are not
produced by the same parts, or in the same manner ; but when the
secretion is perfectly thin and watery, the functions are so seriously
aflfected that the animalcules are altered ; they are less developed,
less opaque, and less active than natural; indeed, they are so trans-
parent that peculiar precautions are necessary in order to make sure
of seeing them ; their motions are weak, slow, and cease very soon ;
and they rapidly undergo decomposition. All these characteristics
show how much their texture is relaxed, and how imperfectly they
are organized.

It is evident that the least arrest of development in the sperma-
tozoa must prove an insurmountable obstacle to fecundation, even if
the only function of the animalcules be to carry the liquor seminis
to the ovum. When, however, their imperfect development only
arises from a too rapid formation, it may soon be obviated. It
suffices that the involuntary discharges should cease for a few days
only, in consequence of some accidental cause, or of one of the spon-
taneous changes of this extraordinary disease, in order for the desires
to become more lively, the erections more energetic and prolonged,
and for the function to be accomplished in a natural manner. Fe-
cundation is, therefore, possible, as I have previously stated, during
the whole duration of one of these intermissions.

This is not the case when the spermatozoa are malformed, rudi-
mentary, more or less deprived of tail, &c., for these changes only
take place when there is a serious alteration in the structure of the
testicles. I have taken every opportunity of dissecting the testicles
altered in these cases, and I have always found the secreting struc-
tures paler, drier, and denser than natural, and the cellular tissue
more resisting, and with difficulty allowing the secreting ducts to be
separated one from another. Sometimes half or two-thirds of the
testicle were transformed into a fibrous or fibro-cartilaginous tissue,
mixed in a few cases with tuberculous matter, to experience the
excitement necessary to carry the semen to its destination even
when it passes the neck of the uterus. Nor is it especially in the
epididymis. I have even seen traces of ossific deposit in the midst
of cartilaginous indurations. These changes, caused by previous
inflammation, perfectly explain why the development of the sperma-
tozoa can no longer proceed normally.

Although in such cases the secretion of semen may be more or less
diminished, pollutions may still be present if the seminal vesicles have
shared the inflammation by which the testicles have been aff'ected, as
happens in most cases of orchitis arising from blennorrhagia. I have
at present a patient who presents a remarkable example of both these
efi'ects arising from this cause : he is now forty-one years of age,
and had blennorrhagia followed by inflammation of both testicles at

270 SYMPTOMS OF SPERMATORRHOEA.

twenty-five. Soon after his recovery, he married, but has never had
children, although the act has been performed regularly if not
frequently. He became subject to nocturnal, and sometimes diurnal
pollutions, which increased by degrees. His health became disor-
dered, but coitus was still possible. The semen passed, although it
presented its characteristic odor, never showed under the microscope
other than very small and brilliant globules without any appearance
of tail, but easily distinguishable from globules of mucus, the dimen-
sions of which are five or six times larger. The epididymis of both
sides is voluminous and irregular. One testicle is adherent to the
skin of the scrotum, and the other appears smaller than natural.

Malformation of the spermatozoa, therefore, arises from deep-
seated changes in the tissues of the testicles, changes which do not
permit the animalcules to resume their normal form, and, therefore,
render infecundity permanent.

To sura up, then. Involuntary seminal discharges may oppose
fecundation previously to actually producing impotence, by diminish-
ing the energy of all the phenomena that concur to the accomplish-
ment of the act, and by preventing the complete development of the
spermatozoa, as well as the elaboration of the fluid which acts as the
vehicle for them.

These conditions may be rapidly altered by the simple diminution
of the involuntary discharges, and fecundation may again become
possible.

This cannot be the case when infecundity depends on malforma-
tion of the spermatozoa — such malformation arising from permanent
alteration in the organs that supply them.

Fever. — Whatever may be its characters, fever can never be con-
sidered as a symptom of involuntary seminal discharges — such eva-
cuations, however serious they may be, never producing febrile excite-
ment. Patients suffering from spermatorrhoea, however, are not
exempt from fevers arising from other causes ; indeed, they become
more liable in consequence of their constitutions resisting such causes
less directly. These fevers must, therefore, be considered as acci-
dental complications, and treated as such.

Symptoms affecting the Digestive Organs. — At first venereal
excesses are generally accompanied with an increased appetite from
the necessity the economy experiences of making up its daily losses,
and from the excitement of the genital organs. Masturbation often
produces analogous effects ; sometimes, too, voracity or boulimia
results from it.

After a longer or shorter time, according to the power of the
stomach, the patient's digestion becomes less easy, and after a time
very laborious. In this condition, if the excesses or abuses cease,
the disorder of the digestive organs is soon repaired, and all again
becomes natural. This cannot take place when once involuntary
discharges have supervened.

Still the patients continue to eat as usual, or even more than usual,
either because they wish to repair their strength by abundant and

GENERAL SYMPTOMS. 271

succulent food, or because they feel a real appetite. The sensation
experienced in the latter case is not precisely that of common hun-
ger ; it is, rather, a sense of gnawing and heat, referred to the epi-
gastrium, or a kind of uneasiness or sinking which sometimes nearly
causes faintness. A small quantity of food puts an end to this sen-
sation, and soon afterwards disgust is felt. But the patients compel
themselves to eat against their will, or they increase the number of
their meals in proportion as the uneasiness in the stomach becomes
more frequently repeated. By some means or other they generally
take during the twenty-four hours more food than their stomachs are
able to digest.

Almost all, too, seek the most spiced and most savoury kinds of
food, and take alcoholic drinks, coffee, &c., in order to favor the di-
gestive process. But these dangerous auxiliaries cannot restore the
original vigor to their digestive organs ; they only beget excitement,
not healthy strength. Hence, the illusions produced by this stimu-
lating diet are not of long duration. Those who expected the
greatest benefit soon find their digestion more difficult and painful ;
they have thus increased the irritation of the stomach.

A constant and remarkable increase in the involuntary discharges
results as much from the effects such excitants produce on the whole
economy, as from the special influence of the stomach on the sper-
matic organs, for there is a reciprocal action as usual.

In perfect health, excitement of the genital organs is soon fol-
lowed by increased appetite ; and, on the other hand, a succulent
meal disposes to coitus long before any increased secretion of semen
can result from it. The same relations exist when the functions are
disordered, for, if abundant involuntary discharges provoke painful
sensations in the stomach, attacks of indigestion equally increase
these involuntary discharges. I have related a case in which three
relapses occurred during convalescence from spermatorrhoea, simply
from attacks of indigestion.

Various phenomena of considerable importance accompany these
indigestions. The meal is not followed by that vague sense of com-
fort which attends reparation of the economy ; on the contrary, a
sense of weight is felt in the epigastrium, and produces a degree of
uneasiness and of restlessness which induces the patient to change
his position : the pulse is quickened, and sometimes beats violently ;
the face flushed ; confusion of ideas follows, with noise in the ears
and vertigo ; and sometimes symptoms of cerebral congestion which
may proceed so far as to induce a fear of apoplexy.

An increasing degree of torpidity succeeds this excitement in pro-
portion as the disorder of the stomach becomes more fatiguing ;
hence the tendency to inactivity and sighing. Besides which, acid
eructations, and an acrid burning heat at the top of the oesophagus,
with a species of pyrosis, sufficiently point out how disordered is the
digestive process.

When this badly formed chyme passes into the duodenum, it pro-

272 SYMPTOMS OF SPERMATORRH(EA.

duces abnormal impressions which are transmitted to the liver and
pancreas by their excretory ducts ; hence the secretions of these
glands are altered. The digestive process carried on in the small
intestine is thus still more deranged than that in the stomach ; hence
arises evolutions of flatus, with its accompaniments, colic, griping, &c.
After causing borborygmi, the flatus becomes collected in the stomach
and large intestines from their greater size, and distends them fully
on account of the laxity of their muscular coats. Frequently local
spasmodic contractions, however, oppose the passage of the flatus,
and these are produced by the irritation of the mucous membrane.
Tlie distension is most marked in the epigastric and hypochondriac
regions, from the stomach and colon being situated in those locali-
ties. Hence, the pressure on the diaphragm and the difficulty of
breathing, as well as the constant uneasiness which exists in the parts
until the flatus has been expelled. Hence the necessity which the
patients feel of passing the flatus as soon as possible, and the dis-
orders to which they are subject when any circumstances compel
them to oppose this desire. *

The dislike such patieri"ts manifest for society is also explained by
this circumstance. They feel the necessity of being alone after their
meals, in order to be perfectly free to expel the flatus without shame.

Independently, too, of these daily inconveniences, such patients are
occasionally exposed to very severe attacks of colic. After a con-
siderable collection of flatus in the intestines, a kind of cramp seizes
on the cardiac and pyloric extremities of the stomach and the ileo-
caecal valve, or on some other part of the intestine, and prevents any
passage just as much as internal strangulation. The distension in-
creases rapidly, and with it local pain and difficulty of breathing.
The heart's action becomes rapid and irregular ; the patients throw
off" their clothes ; ihe least pressure on the abdomen is insupportable ;
they feel as though their bowels were torn or dragged ; abundant
perspiration covers their faces, and indeed their whole bodies. In
the midst of this torture, however, a low grumbling shows that the
flatus is making a passage, the spasmodic contraction becoming re-
laxed. The pain passes off" by degrees, and the attack generally
ends in the expulsion of large quantities of flatus.

When such violent attacks only continue an hour or so, no bad
eff'ects remain ; but when the attacks are of longer duration they are
followed by general debility during several days, with a yellowish
skin and more marked derangement of the stomach, with a notable
increase in the diurnal pollutions.

It is self-evident that the frequent return of these colics must
affect the whole system. Thus the patients dread what they call
their " crisis" or " attacks ;" and as they are attributable sometimes
to cold and sometimes to the eff'ects of moral emotion, the patients
are careful to avoid these causes. Hence their lives are passed in
a series of trifling cares, of which their friends cannot understand
the necessity.

GENEEAL SYMPTOMS. 273

Sometimes too such patients suffer from spasms of the oesophagus,
which suddenly prevent deglutition, especially when very hot or very
cold drinks are taken. A complete obstacle is thus sometimes put
to the passage of any matter, fluid or solid, during several minutes,
just as though a knot had been tied in the oesophagus, and generally
at its cardiac extremity.

There is not only, therefore, diminution of the digestive powers,
but they are at the same time disordered. The organs are not only
weaker, they are also more easily deranged. The symptoms vary
much in different individuals, and in the same individual on different
days. Notwithstanding the patients' endeavors to discover the causes
of these variations, the most important one generally escapes them ;
for it is almost always the occurrence of a diurnal pollution that
increases their digestive disorder, and suddenly alters their characters
and conduct.

At length the more intelligent of these patients perceive that they
eat too much; that. certain kinds of food and drink do not suit them ;
and by degrees, they impose on themselves a more and more severe
regimen. They begin by giving up food of high flavor, such as
game, &c., then nourishing food, as meat ; afterwards lighter kinds,
as vegetables ; and at length they become reduced to a milk diet
only. As regards fluids : at first they renounce spirits, coffee, and
tea ; afterwards wine ; and at length are reduced to drink water. I
have met with several patients who only took gum, milk, and sugar,
and one of these had lived on such food two years when he con-
sulted me. By this rigorous self-denial they escape the indiges-
tion, &c., which too nutritive food produces in them, but they are
exposed to a sense of sinking in the stomach, brought on frequently
by hunger, and they are also frequently annoyed by flatus. In these
cases it is no longer during the progress of digestion that the flatus
is developed, but, on the contrary, after the stomach has continued
a long time empty. The ingestion of a small quantity of food soon
relieves.

Other not less important changes take place at the lower extremity
of the digestive canal. Incomplete digestion brings to the intestines
badly formed chyme, which acts irritatingly on the mucous surfaces,
and increases their secretion, and hence arise liquid and unnatural
stools — a kind of transient diarrhoea which returns with every slight
imprudence. The diarrhoea increasing on each occasion may be-
come permanently established, and after a time present the ordinary
chronic symptoms. MM. Fournier and Begin' state that they have
seen the same result from excessive masturbation.

Diarrhoea kept up by ulcerations in the intestines becomes alto-
gether an idiopathic disease, the indications of which are peculiar
and proportionably urgent, because the inflammation of the rectum

1 Dictionnaire des Sciences Medicales. Art. Masturbation.

274 SYMPTOMS OF SPERMATOEEHCEA.

increases the diurnal pollutions by its action on the seminal vesi-
cles : hence two debilitating diseases arise and rapidly increase the
wasting of the body. But such cases are rare, and are only no-
ticed in persons who do not check their voracious appetites.* These
are few.

After numerous alternations of irritability and sluggishness of the
intestines, constipation becomes permanently established, and grows
more and more obstinate ; or, at all events, only ceases for short
periods to give place to diarrhoea after some error of diet. Con-
stipation, therefore, almost always attends old cases of involuntary
seminal discharge, and contributes to maintain the pollutions.

The influence of this constipation is still more injurious than that
of the stomach disorder, and hence the patients soon discover that
there is a constant relation between the act of defecatioYi and all they
suffer from. They are perfectly aware that with soft, easy, and
regular stools their strength returns, and their activity increases,
their sensations are more lively, and their ideas clearer. Experience
soon shows them the bad effects of long constipation : they are de-
bilitated after laborious attempts at defecation. They are, however,
for the most part ignorant that abundant diurnal pollutions result,
although the constant repetition of the same phenomena at length
fixes their attention on the importance of defecation, and that func-
tion absorbs all their attention. Hence they are constantly occupied
in seeking laxative food, slightly aperient medicines, enemata,
&c., and frequently speak of these things from, habit, and without
considering the effects of such conversation on others. The further
we advance, then, the more we find that these general symptoms of
involuntary seminal discharges are those which have been generally
described as hypochondriasis. It is evident also, that, according to
the predominance of certain symptoms, our profession have usually
been in the habit of diagnosing pyrosis, disorder of the liver, nervous-
ness, chronic gastritis, or gastro-enteritis, &c., in these cases. There
is considerable correctness in these diagnoses ; but the futility
of the treatment shows that the cause is very frequently unascer-
tained.

Nutrition. — The whole economy necessarily soon feels the effects
of serious digestive disorder; for the condition most essential to
nutrition is good digestion. The phenomena which follow meals in
such cases show clearly enough that digestion is incomplete ; absorp-
tion can, therefore, obtain only little reparative matter from a mix-
ture of useless or even injurious material : hence the structures of the
body necessarily lose substance, and the functions languish. Not
only does the embonpoint diminish, but also the energy and activity
of all the organs ; for it is necessary that all, in order to act well,
should constantly receive a supply of rich blood.

Still, however, it is far from an invariable rule that patients suffering
from involuntary seminal discharges should be emaciated, or that they
should all have a yellow or leaden appearance, or sunken hollow eyes.

GENERAL SYMPTOMS. 275

Many even preserve their embonpoint^ fresh color and healthful ap-
pearance, although they may be impotent, weak, and troubled with
considerable disorders ; and although they may even contemplate
suicide. These are the patients who are considered as malades ima-
ginaires, whose friends wish to marry them against their will, in order
to draw them out of their isolation and melancholy. The constant
persecution of their friends and relations increases the unhappiness
of such patients by recalling to their recollection the bitter truth
v/hich they are unwilling to confess. Often have I heard these
patients complain — " that I were thin and yellow, that I had the
appearance of a sick person ; I should then be pitied and permitted
to follow my own inclinations."

Whence arise such apparent anomalies ? From congenital predis-
position. The digestive organs of some individuals are sufficiently
strong to resist the influence of involuntary discharges, which on the
other hand, seriously disorder all their other functions. There are
others again whose assimilative powers are so active that the strictest
diet is necessary in order to prevent extreme corpulency; others too
who are of marked sanguineous temperament never lose the redness
of their cheeks and the size of their muscles.

Animal Heat. — As soon as the digestion becomes deranc^ed and
the evihonpoint decreases, the patients become more sensible to the
influence of cold. They soon find that they must clothe themselves
more warmly, keep out of draughts, and use increased precautions of
every kind, in order to prevent pains in the limbs, catarrhal afl'ec-
tions, &c. But being very warmly clothed they are unable to take
any active exercise without being covered with perspiration, which
comes on very rapidly. On the other hand, again, warmth durino-
the night exposes them to the occurrence of pollutions. They are,
therefore, continually endeavoring to reconcile these difficulties, and
the importance they attach to trifling circumstances appears ridicu-
lous to an uninterested spectator.

It is evident then that the weakening of the body and its incom-
plete repair, by means of badly formed matter, renders such patients
more easily affected by the action of external agencies. Being de-
bilitated they are more exposed to disease than other people, and
the complaints that aff'ect them are less quickly cured, and, indeed,
often pass into a chronic state.

To the diminution of the nutritive powers must be attributed the
early loss of hair which many of such patients experience, and which
equally follows all diseases capable of producing serious disorder of
the economy.

The voice too is much afi'ected by every prolonged action capable
of debilitating the economy ; and it is not, therefore, remarkable that
it should often lose its power and quality of tone in these patients.
But the voice is not only low and husky ; it presents a degree of
uncertainty of tone which doubtless arises from the agitation the

276 SYMPTOMS OF SPERMATORRHCEA.

patients constantly experience. The least emotion too makes them
stammer.

Respiration. — Not only while running or ascending a hill or stairs,
hut even on taking very slight exercise, patients affected with sper-
matorrhoea become out of breath ; sometimes, even, they feel op-
pressed breathing during absolute quiescence ; they frequently sigh
also. These symptoms, however, are by no means always well
marked. The same thing occurs with regard to the respiratory as
in all the other systems. Variations take place in accordance with
the constitution of the individual. These phenomena are produced
in the following manner : —

The muscles which perform the function of respiration, participating
in the general debility of the system, contract less energetically and
less frequently than natural ; the respirations, therefore, become
shorter and less frequent : hence the necessary changes in the blood
are not properly performed, and there is defective equilibrium be-
tween the respiration and circulation, with habitual sense of uneasi-
ness and oppression in the chest. Hence arises the necessity for
deep voluntary inspirations or sighs, to re-establish this equilibrium
occasionally, and to fill the extreme pulmonary vesicles with air.
The patients are apt to call these sighs involuntary, because they are
forced to make them without knowing why. On the other hand,
again, being deeply afflicted at their condition, and incessantly occu-
pied in seeking its cause, the patients sometimes suspend the motions
of the thorax, and this habit increases their habitual oppression.
Lastly, it is necessary to take into account the influence of the pul-
monic nervous system. It is not probable that the pulmonary nerves
should escape the generally debilitating influence of involuntary
discharges. Dr. Deslandes indeed thinks that the nervous asthma
may be produced by masturbation and venereal excesses, inasmuch
as these attacks only seem to him to be aggravations of their ordi-
nary symptoms. This opinion is strongly supported by what I have
seen in many patients. The effects of exercise are the same in these
as in all other cases of extreme debility.

Patients suffering from spermatorrhoea often experience other
symptoms of which it is necessary to be aware. Sometimes they
have a predisposition to pulmonary catarrh, with coryza, loss of
voice, &c. ; in other cases there is a constant dry cough ; in others,
again, fixed or wandering pains in the thorax ; and in a few cases a
sudden pain seizes on the heart or diaphragm, and for a minute or
two causes great agony. Most of the patients whose respiratory ap-
paratus is thus disordered believe themselves the subjects of phthisis.
The symptoms, however, only differ in situation from the other nu-
merous irritations and pains which successively attack all parts of
their bodies.

Circulation. — The disorders of the circulating system in these cases
may give rise to errors of much importance. I have seen more than

GENERAL SYMPTOMS. 277

thirty of these patients wYiO had been long treated for disease of the
heart of which there did not exist the least traces. The symptoms
which had increased after every bleeding disappeared as soon as the
involuntary discharges were arrested. It is indisputable that abuse,
venereal excesses, and involuntary discharges often excite more or
less alarming palpitations ; but can we attribute the origin of organic
diseases of the heart to such causes ?

Even when an organic lesion of the heart or large vessels does
occur in a patient who has practised masturbation, or committed ve-
nereal excesses, is it necessary that the disease be referred to these
causes alone? Certainly not : for among the immense number of
those who are exposed to the debilitating action of these causes it is
unreasonable to expect that none should be found with cardiac dis-
ease. I admit, however, that the momentarily increased rapidity of
the circulation may aggravate organic diseases already existing; but
certainly the diseases themselves would be much more frequent if
they could be brought on by such common causes.

The functional derangement of the circulation is, however, some-
times so alarming and long continued that it may be easily mistaken
for an idiopathic disease ; but these symptoms are more common in
children than in adults, and in adults than in persons of mature age
— a circumstance which alone is sufficient to show that the symptoms
do not arise from organic lesion of the heart or large vessels. The
same remarks apply to involuntary seminal discharges.

Five of my patients had never committed any abuse or remarkable
excess. One of them fell into the sea in very cold weather; another
was exposed to cold in helping to extinguish a fire ; a third had used
constant horse exercise ; and the two others had only suffered from
blennorrhagia, yet all five experienced such palpitations of the heart
that their attendants had not doubted the existence of an organic
lesion. This palpitation, however, was purely nervous, and could
not even be attributed to the perturbation of the circulatory system
during voluntary seminal discharges.

It is to the debility and disorder of the system, and especially to
the disorder of the nervous system, that these symptoms must be
referred. As a proof of this there is the fact that they may be pro-
duced by any other debilitating causes ; whilst they are never ob-
served in robust individuals who take even the most violent exercise.

It may be supposed that nervous palpitations would be distin-
guished with difficulty from organic diseases of the heart : such is
not the case, however. In organic diseases of the heart the face is
habitually injected, the lips and tongue are violet-colored from the
obstruction to the venous circulation. Nothing similar occurs in
nervous palpitation. If the cheeks become injected occasionally, they
are red, and the injection soon passes ofi", the face resuming its na-
tural tint afterwards. In either hypertrophy or dilatation the pul-
sations are always proportioned in strength and frequency to the
motions of the patient, because the obstruction to the circulation,
18

278 SYMPTOMS OF SPEKMATORRHfEA.

whatever may be its seat or nature, is permanent ; whilst the quan-
tity of blood driven towards the heart increases in proportion to the
muscular efforts. The primary cause of such palpitations being
therefore in constant action, the secondary one must always produce
effects in proportion to its intensity.

Nervous palpitations are far from following the same course. It
is true that the least motion often increases them to an alarming
extent, but this is by no means either constant or in proportion to
the muscular efforts. At one time active and long continued exercise
may produce no more effects than in a healthy individual ; whilst
at another, sudden and violent disorder may come on, even when
the body is in a state of repose, either from the sight of an unex-
pected object, from a sudden noise, or from the passage through the
mind of an involuntary idea.

We see, therefore, that a superficial examination is sufficient to
point out the difference between organic and functional diseases of
the heart. Physical exploration is of course more certain.

INNERVATION.

Motility. — The weakness of patients suffering from involuntary
seminal discharges does not arise from their loss of flesh only. Many
of them possess embonpoint, healthy appearance, and even volumi-
nous muscles, although quite unable to bear active and prolonged
exercise. Debility always precedes the loss of flesh : it is invariable
and marked ; but at the same time disappears very quickly. When
the patients have passed a few days in succession, without suffering
from pollutions, they manifest rapid increase of strength and acti-
vity : a single discharge again reducing them to their debilitated
condition. The weakness of their muscles, therefore, depends on a
cause distinct from atrophy ; it arises from flaccidity. Let us con-
sider how this weakness is produced.

Masturbation is generally commenced before puberty, and the fe-
male sex is not exempt from it. In these cases, therefore, seminal
emission cannot occur. Nevertheless, functional disorders of the
spinal cord may arise, similar to those produced by passive discharges.

I have related at page 153 the case of a boy, eight years of age,
whose lower extremities were bent and drawn together, and in a state
of paralysis, or rather of contraction, which prevented their use.
This state ceased entirely a few days after masturbation had been
completely prevented, the cure not being assisted by any other ex-
ternal or internal treatment. I have met with several such cases in
children before the age of puberty, and I should add that in most
of them the arms were pressed against the body, the forearms bent
on the arras and crossed on the breast, the fingers stiff, &c.

On the other hand, again, I have seen patients from thirty to forty-
five years of age who had fallen into a similar condition from diurnal
pollutions. Almost all had had leeches, cupping glasses, and issues

GENERAL SYMPTOMS. 279

not only on the loins but along the whole length of the vertebral
column : all had found bad results from these means ; whilst the
cessation of seminal discharges was immediately followed by free
use of the extremities.

The most passive pollutions act, therefore, on the nervous system,
just as the most convulsive voluptuous sensations not followed by
seminal emissions; and the disordered powers of the lower extremities
no more depend on the existence of organic disease of the spinal
cord, than palpitations depend on organic disease of the heart.
There are, however, many intermediate shades between this extreme
condition and ordinary cases. On the other hand, there is not only
muscular debility in such extreme cases, there are also stiffness and
involuntary contraction of the muscles. It is not only in the lower
extremities, too, that the symptoms are manifested, but throughout
the whole muscular system.

In many cases, there is more irregularity and disorder than actual
weakness in the muscular system, and hence many such patients suffer
from involuntary trembling and uncertainty, with a loss of precision
in their motions that renders them awkward. Any slightly continued
action induces trembling, to control which they have no power.
These tremblings resemble the mercurial palsy of gilders, or the deli-
rium tremens of drunkards. Hence many authors believe with rea-
son, that masturbation and venereal excesses are two of the most fre-
quent causes of chorea. Epilepsy even, may be induced — the same
phenomena becoming more violent but less continuous. Epilepsy is
brought on much more frequently by masturbation than by venereal
excesses, probably for the following reason. Venereal excesses ge-
nerally take place later in life than masturbation, consequently the
constitution is stronger. Cases of epilepsy, too, are more frequent
after masturbation, in proportion to the youth of the parties. The
same thing holds good with regard to all the other nervous symptoms
produced by masturbation, and, indeed, with all nervous symptoms,
whatever may have been their cause. Here we again see the great
importance of taking the state of the system into consideration in all
these cases, in order to appreciate the different results that may arise.
Sensation. — There are other nervous symptoms which seem the
counterpart of those happening in the muscular system. I have met
with two patients in whom the hands were insensible, and the hands
only : in these cases, accidental burns took place without causing
pain ; but the motions were perfectly free. Other patients that I
have seen, experienced a diminution of touch only ; a layer of gauze
seeming to be interposed between the object and the fingers. In
other cases, one side of the chest or abdomen was more or less de-
prived of sensation ; or perhaps a circumscribed portion of the skin
either on the trunk or extremities. This anesthesia changes its po-
sition and character frequently — quite enough to show that it does
not arise from any organic lesion of the spinal cord or nerves.
Other patients experience disorders of sensation, varying greatly in

280 SYMPTOMS OF SPERMATORRHOEA.

their character and seat, not only in different individuals, but in the
same person at different times. Sometimes there is a sensation of
local heat or burning; at others, a kind of current which seems as
if caused by the air, by water, or by electricity ; or there may be a
feeling of bruises, cold, or pressure, affecting the back and loins.

Hippocrates described another sensation which I expected to find
very frequently. I allude to the feeling of ants running along the
vertebral column. I expected to find this symptom very common in
cases of spermatorrhoea, but I have hardly met with it in one case
out of twenty. Nervous pains, often confounded with wandering
rheumatism on account of their uncertain seat, are met with much
more frequently. They differ from rheumatism in not being caused
by cold or damp, and in not being especially seated in the joints.
The patients generally suffer most from these pains on rising in the
morning. They generally follow the course of a nerve, and some-
times resemble electric shocks. These characteristics are sufficient
to distinguish such pains from rheumatism.

The loins are especially the seat of these pains. They are not so
acute as those that arise from lumbago or a violent muscular effort,
but they continue longer. Some of my patients had been teased by
them for many years, almost continuously. Their seat is not in the
muscles, for the motions of the spinal column are not affected ; they
are not caused by the kidneys, for they do not pass in the course of
the ureters — the testicles are not retracted, and the urine is not
purulent — symptoms by which affections of the kidneys accompany-
ing spermatorrhoea may be easily distinguished. It seems, there-
fore, that these pains must be especially referred to the nerves sup-
plying the lumbar region.

It is diflScult to doubt the existence of a special sympathy between
the genital organs and the spinal cord, when we take into conside-
ration the influence of flagellation, urtication, &c., applied on the
loins ; the frequent nocturnal pollutions excited by heat of this re-
gion and the opposite effects of cold. On the other hand, again, this
influence is reciprocal, for it is after abundant pollutions that the
pains in question occur or increase, and it is of this region that
patients complain, who have committed excessive abuse or venereal
intercourse, or who have suffered several pollutions in one night.

SENSES.

Taste. — The changes experienced by these patients in the organs
of taste correspond with those that are going on in the digestive
organs. In some the appetite is disordered from the first, and when
the disease has made considerable progress, the mouth is often clammy
with a bitter, salt, or earthy taste. Food and drink appear less
sapid, and do not give any agreeable sensation. Under these cir-
cumstances the patients generally restrict themselves spontaneously
to a vegetable diet, or even to milk.

GENERAL SYMPTOMS. 281

Smell. — I have paid little attention to the alterations of this func-
tion in these patients ; but I have heard many complain of a notable
change in their power of appreciating odors, and even of an entire
loss of the sense of smell.

Hearing. — The sense of hearing suffers more changes than the
preceding. In general, like the others, it loses its acuteness, and
this loss sometimes approaches a state of deafness. These symp-
toms vary, too, according to the individuals affected, and the differ-
ent decrees and oscillations of the disease, and even sometimes from
day to day, without appreciable cause.

Some patients, again, seem to possess an extreme sensibility of
hearing — the least noise irritates them, especially if continued so
that they cannot put a stop to it. It seems, however, that this
symptom must be referred to the change that has taken place in the
character of the patients. It is not because the organ has become
more acutely sensible that it is offended, for these patients do not
hear better than other people, and the most harmonious sounds pro-
duce just the same feeling of impatience when slightly prolonged.

Another annoyance felt by such patients results from the different
noises they have in their ears. In some there is a constant whist-
ling ; in others, a sullen rumbling like the distant roll of. the drum ;
in others, again, the noise resembles that of a waterfall, mill, &c.
Some patients hear many of these noises at the same time. Deaf-
ness or difficulty of hearing accompanies these sounds. In propor-
tion, therefore, as the normal functions of the auditory apparatus
become weak, its pathological susceptibility augments.

Sight. — The first change produced by involuntary seminal dis-
charges is a diminished brilliancy of the eyes. These organs soon
lose their brilliant, piercing expression, and appear dull, although
they may not yet be either sunken, or surrounded by dark circles.
There is always more or less marked dilatation of the pupils under
these circumstances, and this probably conduces to give the eyes
their singular appearance.

To the want of expression there is also joined a timidity or ap-
pearance of shame, especially in such as practise masturbation.
Their eyes never meet those of another with confidence ; they are
turned away hastily, and after wandering about, are at length di-
rected to the ground. There is in this uncertainty of the organs of
vision something analogous to the trembling of the voice, hesitation
of speech, stuttering produced by emotion, and instability of the
lower extremities, habitual agitation of the hands, palpitation, &c. —
all common symptoms in these cases. Importance attaches to these
circumstances, because we frequently meet with patients who wish
to conceal bad habits, besides which, most of those who suffer from
diurnal pollutions are not aware of their existence.

In order that the eyes should become sunken and hollow, emacia-
tion must have made considerable progress, and this emaciation may
depend on various causes. On the other hand, the eyes may be sur-

282 SYMPTOMS OF SPERMATOKRH(EA.

rounded with dark circles in consequence of recent abuse or excesses,
althouf^h the health may not be disordered; fatigue and want of sleep
induce the same results. The conjunctiva is sometimes disposed to
become injected from slight causes in these patients, but this is not
a very constant symptom. Most of them present a dull and wan-
derinty eye, with a vacant expression, and these symptoms increase
with the disease, and follow all its oscillations. Sometimes, too,
the patients complain of involuntary contraction of the muscles of
the eye ; now and then there is spasmodic trembling of the upper
ird ; at other times, the orbiculares and corrugatores superciliorum
contract spasmodically ; at other times, again, the muscles of the
eyeball enter into disordered action, and produce strabismus.
These symptoms are especially observed in nervous patients who
lead a sedentary life, and use their eyes much.

At the same time that the previously described symptoms show
thetaselves, the patient's vision becomes disordered ; first at varying
intervals ; afterwards, continuously. The sight becomes progres-
sively weaker ; small objects are defined with less clearness, and
seem to shake, probably from want of precision in the contraction of
the recti muscles. The patients are unable to fix their eyes on mi-
nute objects without soon experiencing fatigue, headache, vertigo,
and congestion of the head. After reading for a short time, the lines
seem to oscillate, and the words become confused. More or less
marked diplopia is momentarily established — probably arising from
divergence of the visual axes caused by unequal contraction of the
motor muscles. Other patients, again, see spots, cobwebs, or flying
points, which are constantly in motion before their eyes ; then sud-
denly, they only see a portion of the objects looked at ; perhaps all
on the left or right side, or all the upper or lower half, or sometimes
the centre or circumference; the remainder disappearing completely
for several minutes, half an hour, or perhaps an hour.

Both eyes are rarely affected in this way at the same time ; when
this happens, however, the disorder of vision is almost as serious as
if complete blindness were momentarily established.

These nervous disorders are frequently accompanied with cepha-
lalgia, vertigo, noise in the ears, coldness of the extremities, vomit-
ing, &c., and sometimes syncope occurs. The patients are natu-
rally much alarmed at these accidents, although they do not last
long, and the practitioners consulted seldom fail to diagnose conges-
tion of the brain, and to practise abstraction of blood. This error
arises from certain symptoms being regarded singly ; if the accom-
panying phenomena were taken into account, and especially the
general state of the economy, it would become evident that all the
symptoms resemble one another, and that they all depend on the
nervous system ; if, therefore, the origin of the nervous disorder
were not discovered, at least the symptoms would not be aggravated
by the abstraction of the blood.

Independently of these momentary and partial attacks of paralysis

GENERAL SYMPTOMS. 283-

of the retina, this organ by degrees loses its sensibility, the pupil at
the same time becoming dilated. Small and delicate objects are
distinguished less clearly, and slightly continued attention brings
fatigue. This weakening of the sight is one of the most constant
effects of masturbation, venereal excesses and involuntary discharges;
it follows the loss of brightness in the eye and of firmness in the ex-
pression ; and it is one of the most certain signs of abuse.

The disorder of the sight, like all the other general symptoms,
varies in different individuals, and at different periods of the disease.
In the worst cases complete blindness may be established. Of this
I have recently seen a very remarkable example. Amaurosis
brought on by masturbation or venereal excesses has long been re-
cognized by writers on diseases of the eye, and if they have omitted
to mention the amaurosis arising from involuntary seminal discharges
the explanation must be referred to their ignorance of the occur-
rence of such discharges.

It has been generally admitted by writers on the eye, that amau-
rosis caused by masturbation, or venereal excesses, is very difficult
of cure ; the reverse obtains. Amaurosis is always a very obstinate
disease when .its cause is unknown. If the functions of the optic
nerves are impaired by cerebral disease, by serous effusion, tumors,
disease of the meninges, or of the bones of the head, it is evident
that the organs cannot be readily restored to their normal condition,
even when an exact knowledge has been obtained of the seat and
nature of the disease. Unfortunately numerous amauroses are due
to causes of this nature. But when the amaurosis arises from an
easily discoverable cause and one easily removed, the results are
different. Thus, I have on two occasions seen almost complete
blindness disappear by degrees, after the relief of diurnal pollu-
tions, which kept it up. Nocturnal pollutions alone do not produce
such marked effects, because they are far from being so serious ; but
they often cause considerable weakening of sight. In cases of this
nature I have always seen the ocular functions restored after the
cure of involuntary discharges ; and I have obtained similar results
in cases which arose from masturbation and venereal excesses by
inducing the patients to alter their habits.

On the other hand, other patients experience very different symp-
toms. Some are painfully affected by any bright light, whether
natural or artificial. Some even are unable to bear any light more
brilliant than twilight. Notwithstanding the use of colored glasses,
shades, &c., they are obliged to avoid mid-day ; and sometimes even
to deprive themselves of artificial light. The retina will not even
bear the light of a bright fire. This photophobia probably arises
from the increased dilatation of the pupil, observable in most of
these patients. Dilatation of the pupil is an important symptom in
such cases, because it affords a means of diagnosis between this kind
of photophobia, and that which arises from irritation of the retina —
irritation always causing extreme contraction of the pupillary opening.

284 SYMPTOMS OF SPERMATOEEHCBA.

To conclude, then. Among the changes observed in the organs
of vision, those that are attributable to masturbation, venereal ex-
cesses, or involuntary seminal discharges, consist in a diminished
activity, with disorder of the functions, defective harmony of ac-
tion, &c. Sometimes weakness predominates, sometimes disorder,
according to the temperament or idiosyncrasy of the patient ; but
their co-existence is not always easily made out. Both depend on
the nervous system.

ENCEPHALON.

Sleep and Waking. — The opposite conditions of sleep and waking
are marked in proportion as the health is perfect. Sleep is long
and sound, after active and continued exercise. Hence the robust
individual, who undergoes great fatigue, rests long and well. The
first effect of prolonged inaction is to render the sleep lighter and
less long. Whilst, on the other hand, broken and disturbed sleep
disinclines the person to activity on the following day.

This effect is very remarkable in persons debilitated by masturba-
tion, venereal excesses, or involuntary seminal discharges. They
sleep little and badly during the night, and habitually pass the day
in a state of somnolence and torpor. There is good reason to sus-
pect abuse in a child who remains motionless in a corner whilst his
companions enjoy their noisy sports ; who sighs over his lessons and
sleeps over his books. This sign is a strong one, and easily disco-
verable ; sleep during the night may be easily stimulated. I have
recently seen a child of seven years of age, who practised masturba-
tion and passed five months without sleeping during the night, with-
out being discovered. Venereal excesses produce the same results,
but in this case the truth is easily ascertained.

The sleep of patients suffering from spermatorrhoea is generally
light, broken, and unrefreshing. They get up more fatigued than
they went to bed. Hence, they go to bed late and get up with un-
willingness, even when they are unable to obtain sleep in the morn-
ing. Their sleep is unrefreshing because it is continually broken
by nightmare and frightful dreams, which increase as the disease ad-
vances. Painful sensations arise in the stomach, and intestines,
liver, kidneys, or bladder, the functions of which are deranged ; pal-
pitations and sense of suffocation are felt — the functional disorder of
the respiratory and circulating systems coming on as during waking.

At a still more advanced period of the disease, sleep leaves the
patient entirely. They often pass a whole night in agitation without
being able to find a comfortable posture ; they get up and lie down
again, walk about, or roll on their beds ; at one moment their bodies
and temples are on fire, at the next they are chilly, and covered with
cold sweat. During these long nights they constantly dwell on sad
thoughts, and are especially tempted to commit suicide. Such dis-
turbed nights must produce the worst consequences on the cerebral
functions, for sleep alone could put an end to the nervous debility

GENEEAL SYMPTOMS. 285

and restore its activity to the brain. Hence the loss of sleep is the
chief cause of the torpor and somnolency observable in these patients
during the day.

Clieplialalgia. — Patients suffering from involuntary seminal dis-
charges generally experience heaviness in the head and sense of
compression of the brain, as if the organ were swollen ; others, on
the other hand, complain of a feeling of void in the head. To these
sensations dull pains succeed, and these are seldom fixed.

Such symptoms are often attributed to accidental causes, the
patients being for the most part unconscious of their true origin.
Some patients, too, suffer from fixed and almost continual pain in a
certain spot. I have generally found that the supra-orbital region
is complained of in these cases. As the disease progresses, these
symptoms become more severe, and are conjoined with vertigo, noise
in the ears, flushing, heat of the head, disorder in the ideas, stam-
mering, &c., and hence very often structural disease of the brain is
suspected, especially if the cephalalgia comes on habitually in the
same region. I have met with many cases in which this happened,
and which had been treated for years by distinguished practitioners
without benefit.

Cranial Congestion. — Although patients suffering from sperma-
torrhoea are generally pale, they are exposed to attacks of cerebral
congestion, generally slight and of short duration, but sometimes
very alarming. At first these attacks are limited to flushed face,
brought on by constipation, difficult digestion, the collection of flatus
in the intestinal canal, &c., at other times, by the heat of a room,
acute emotion, sudden disorder of the circulation, or momentary
difficulty of breathing. When the health is deranged, constipation
considerably increases the flow of blood to the head, and constipation
is one of the most common symptoms of the disorder of which I am
treating. Apparently trifling causes produce serious effects in these
cases, owing to the increased weakness and susceptibility of the
organs. In the latter stages of the disease, the congestion may be
carried so far that the whole head appears swollen, of a dark red
color and burning heat.

Such attacks of congestion are not confined to the skin ; every
thing concurs to show that the same phenomena take place in the
very substance of the brain. There are present at the same time,
vertigo, dazzling of sight, noise in the ears, and a sense of internal
pulsation with great anxiety, agitation, and uneasiness, and, in some
cases, the intellectual faculties are deranged. When the congestion
is severe, the patients do not recognize arwr one; they know not
where they are or what they do ; but they want to change their pos-
ture, to breathe the fresh air, and especially to walk, although their
legs can scarcely support them, and if not closely watched they are
liable to fall. In a few cases the patients became quite insensible,
and fall into a condition exactly resembling apoplexy.

The medical man, called during one of these alarming attacks, is
at first struck with congestion of the face and the increased rapidity

286 SYMPTOMS OF SPEEMATORRHCEA,

of the pulse. He is told of frequent giddiness experienced by the
patients, of embarrassed speech, and momentary stuttering, of weak-
ness of the limbs, and even of frequent falls, of constant headache,
&c. He naturally, therefore, concludes that the case before him is
one presenting imminent danger of apoplexy.

During these attacks, the brain is indeed the seat of congestion,
as well as the face, and the medical man called is not deceived on
this point. His error consists in not recognizing the cause of the
congestion, in not foreseeing its short duration, in exaggerating its
consequences, and especially in treating it by the most fatal means.
In fact, these attacks of congestion are brought on by the debilitat-
ing discharges ; they are alarming in proportion to the patient's
weakness ; they never terminate in cerebral hemorrhage ; and no
treatment can be worse than abstraction of blood.

It seems astonishing that debility, should produce congestions,
which are generally looked on as the results of plethora ; but on
careful examination it will be seen that important points of difference
exist between them. Besides this, it is by no means remarkable to
see similar phenomena produced by opposite causes.

It often happens in the commencement of cerebral affections, that
a copious abstraction of blood is followed by sudden congestion of
the head with convulsions. No one doubts that plethora frequently
produces palpitation of the heart, sense of suff'ocation, &c., yet we
have just seen that the same results may be caused by an opposite
state. The same remarks apply to the dizziness, noise in the ears,
partial and momentary paralysis of the retina, photophobia, &c.

These attacks of congestion become more frequent in proportion
as the weakness progresses, but they are generally of short duration,
because they depend rather on the irritability of the circulating sys-
tem, than on a too great impulse given to the blood, or over-fulness
of the vessels. There is not, therefore, the same danger of capillary
hemorrhage as in ordinary congestion, and still less of any consider-
able eff*asion taking place.

An attack of apoplexy may cause death in a plethoric individual
without producing effusion, the vessels of the brain being sufficiently
distended to hinder the functions of the organ. When hypertrophy
of the heart is not brought on by some obstruction to the circula-
tion situated near the^commenceraent of the aorta, the impulse of
the blood may be sufficiently violent to cause extravasation in the
extreme vessels ; and when the latter are diseased, a less powerful
impulse may cause a rupture in any point of their coats, followed by
a considerable clot. Nothing of this kind exists in persons suffering
from spermatorrhoea, and hence congestion does not produce any of
these effects, although the attacks may take place frequently, and
become more alarming in proportion as the disease advances. When
the patients die, it is rather in consequence of a slow wearing out
than from the immediate attack ; they generally expire in a kind of
syncope, after all the congestive phenomena have passed off — not
the least trace of them being found in the brain or its membranes.

GENERAL SYMPTOMS. 287

It is evident that these attacks differ greatly in their indications
from other congestions of the brain. Abstraction of blood may
prove fatal, and, unfortunately, this is the first idea that presents
itself. The practitioner called for the first time to a patient with
such an attack, must take into consideration the general appear-
ance of the system, the state of the strength, the embonpoint, and
especially the condition of the circulation. The pulse is generally
hurried and irregular, but never full, distended, or resistant. Slight
pressure on the artery arrests the pulsation altogether ; indeed, it
can hardly be felt, unless the finger barely touches the skin. With
such a pulse there can be no danger of cerebral hemorrhage, and
the abstraction of blood would be extremely injurious if not fatal.
The pulse, therefore, is the chief guide in such cases.

Alteration of Character. — In general, the moral susceptibility in-
creases with the progress of physical weakness. But those patients
who are naturally hasty, become the most -impatient and irritable.
They are restless, exacting, unjust ; trifling circumstances sour and
irritate them, drawing from them complaints and reproaches. The
least delay in complying with their demands, or a slight awkward-
ness in waiting upon them, throws them into a fury.

I have seen such patients sometimes roll themselves on the earth
in furious and prolonged agitation, when unable to obtain what
they desired. These violent scenes of nervous excitement happen
especially after abundant or frequent pollutions. As soon as con-
valescence commences, a rapid change takes place. The predomi-
nance of such symptoms undoubtedly arises in a considerable degree
from the patient's natural impatience ; but they increase or diminish
in a remarkable manner, according to their strength ; that is to say,
according to the frequency of the involuntary discharges. When
spermatorrhoea commences after marriage it produces an unexpected
change in the character of the husband, which contributes even
more than impotence to domestic unhappiness. Frequent marks of
ill humor, bitter words, and violent discussions, soon succeed indiffer-
ence — contrasting strongly with the conduct before the commence-
ment of the disease, and consequently producing a highly unfavor-
able impression.

Most of these patients, too, experience a profound sense of lan-
guor, discouragement, and melancholy, giving a peculiar stamp to
their character, with which all observers have been struck. The
commonness of these symptoms, the importance that has always been
attached to them, and the discussions to which they have given rise,
require special attention ; otherwise they ought not to be considered
separately from the other functional disorders of which I have
already treated. But they have always been considered as a spe-
cial malady, or idiopathic affection: I mean hypochondriasis.

Hypochondriasis. — The patients of whom I am at present speaking
are continually beset by bitter regrets, sombre thoughts and horrible
presentiments. They feel a void in all their affections ; nothing in-

288 SYMPTOMS OF SPEEMATOEEHCEA.

terests them ; everything fatigues and annoys them ; existence weighs
them down without any other apparent cause than a deep disgust
for everything which can make life pleasant. This vague and in-
stinctive feeling, this tsedium vitse, which they are not able to explain
to themselves, follows them everywhere and constantly tempts them
to commit suicide. Nevertheless these same persons are most occu-
pied about their health, and dread the greatest misfortunes. I need
not reconsider the minute care they bestow on their digestion, the
state of their bowels, &c., and I shall only add a few words to what
I have already said concerning their varied and continued fears.

During the night they fancy they see thieves and murderers every
where ; when travelling they fear being upset, falling down precipices,
being drowned, &c. ; those who are in business fancy themselves
ruined, or on the point of being so — the clearest and most rigorous
calculations failing to reassure them — at all events their fears soon
return, even if once convinced. Land proprietors, whose immense
incomes are imperishable, are nevertheless haunted by the fear of
dying of hunger. It seems at first difficult to reconcile such constant
cares for self-preservation, with disgust of life, and inclination to
suicide. This contradiction would in fact be inexplicable if jt arose
from reason or will. But the two contrary impulses which govern
these patients are equally instinctive, and depend on the same dis-
ease. They are not opposed in reality, for the derangement of all
the functions, and the cares, wants, and constant apprehensions
arising from it, contribute greatly to the dislike of life and to the de-
sire to put an end to such great physical and moral suiferings.

It is evident that these impulses are independent of reason, be-
cause they reappear with equal force, whenever the patients experi-
ence a relapse, although they may know perfectly well that their
former fears were ill-founded, and their disgust of life arose entirely
from the presence of involuntary seminal discharges. They admit
even that it is natural to attribute the reappearance of such ideas
to the return of their former complaint, but at the same time they
believe themselves threatened by other dangers and under more
unfavorable circumstances ; and above all things they regard their
disorder as incurable, because it has returned. In a word, past
experience fails to convince them, if ever they fall a second time
under the influence of the disease.

I have seen such relapses last only a few days, and take place for
the fortieth or fiftieth time, and nevertheless the same sadness, dis-
couragement and despair, have returned on each occasion. Some-
times two or three nocturnal pollutions occurring in a short space of
time suffice to work a complete change in the character of the patient.
But, on the other hand, spermatorrhoea never pursues a uniform and
continuous course. The discharges diminish, or cease entirely for a
short time, without the patient being able to explain the cause of such
variations. During these intermissions a rapid improvement takes
place in all the functions — especially in the digestion ; a general

GENERAL SYMPTOMS. 289

feeling of comfort and vigor is experienced. Tiie patients believe
themselves cured, or on the point of being so, and the joy they ex-
perience is manifested vi'ith extreme vivacity, in proportion as their
temperaments are lively.

The next day these appearances of happiness may again give way
to melancholy and despair without the possibility of any person's
divining the cause of so sudden and complete a change — effects
which are mostly produced by the occurrence of diurnal pollutions
— generally unperceived by the patients.

As the disease makes progress, the periods of remission become
rarer and shorter ; still there are always times when the patients
are better, and times when they are much worse, following the acci-
dental diminution and increase of the involuntary discharges. Hence
the inequality of temper, the strange changes of determination, the
variability of inclinations, conduct, and affections, which make the
characters of these patients an incomprehensible enigma.

By recollecting what I have already stated respecting the constant
and minute attention such patients are obliged to pay to their food,
drink, clothing, &c., to the state of their digestion, their alvine dis-
charges, and their urine; to all the changes of temperature, moisture,
and electricity ; by taking into consideration all the symptoms that
are referred to the liver, the intestines, the stomach, the spleen; the
annoyance of flatus ; the palpitations and oppression of the chest; it
will become evident that the reunion of all these symptoms constitutes
the most perfect description of what is called hypochondriasis.

3Iemo7'y. — Patients suffering from spermatorrhoea, like old people,
by degrees lose their memory for facts, dates, numbers and even
words ; and this greatly increases their repugnance to conversation.
After beginning a sentence they often forget what they wished to say,
or are unable to find the particular expression they desire ; they
become nervous and begin to stutter, as if the articulation of sounds
were difficult. This difficulty of articulation, however, really does
exist in the advanced stages of the complaint; the tongue then shar-
ing in the disorder of the other parts of the muscular system, and
the irregularity of its motions being increased by the want of preci-
sion in the ideas.

These patients also forget their promises, arrangements, and en-
gagements, in fact everything which ought to be of chief interest
to them, just like individuals in a state of deraency.

This forgetfulness, however, does not exclusively arise from loss
of memory ; the carelessness of the patients, and their constant pre-
occupations, are an important cause of it. The concentration of
'their thoughts on their health renders them indifferent to other
things, and when they neglect the most important matters, it is fre-
quently because they do not feel interested ; for the same reason,
too, they do not understand what is said to them, and do not con-
sider their actions. It seldom happens, then, that loss of memory
is the only cause of all the irregularities these patients commit.

290 SYMPTOMS OF SPERMATORRHOEA.

Masturbation, even before puberty, produces exactly the same
eifects as spermatorrhcea ; the same forgetfulness and neglect result
from it, and there is especially great difficulty in retaining even the
most simple lessons, notwithstanding the power of the memory for
words at that age.

Intellect. — The intellectual faculties differ greatly in different in-
dividuals not only from difference of education, but also from pri-
mary development. The results of spermatorrhoea therefore vary
with these varying conditions ; generally speaking, congenital defi-
ciencies chiefly appear. In all classes of society there are, naturally,
powerful intellects like strong constitutions ; such advantages,
whether they receive all the development of which the individuals
are susceptible or not, are maintained better under all circumstances
than those which have been acquired by education and exercise.

Age also must be taken into consideration. The effects of invol-
untary seminal discharges are the more injurious in proportion as
the patients are further removed from' that period of strength and
energ}' during which the constitution possesses all its natural vigor.
Hence it arises that the most rapid and serious intellectual changes
take place at the beginning and towards the close of life. I have
seen children, previously very intelligent, almost suddenly fall into
a state of idiocy, the cause of which was little suspected on account
of their early age, the other functions not suffering proportionately.
When a child, after having afforded evidence of strong intellect and
memory, experiences from day to day more difficulty in retaining
what he is taught, we may rest assured that this does not arise from
indisposition or from idleness, as is often supposed. On the other
hand, the slow but progressive derangement of his health, his con-
stantly increasing loss of activity and application, arise from the
same cause. The intellectual faculties are simply the first to feel
disorder, and show it more than the others.

Of course I do not here refer to idle or dull children, who have
never been able to keep pace with their companions ; I speak of
such as show at first the most happy qualities, after a time relax
their endeavors more and more without evident cause, and over-
throw the hopes of their instructors. In such cases, diminished
aptness for learning ought to be held quite sufficient evidence to in-
duce inquiry and careful watching.

At a later period venereal excesses may suddenly cut short, in a
brilliant career, those who have escaped the dangers of masturbation.
All such unexpected reverses are easily explained by those who are
aware of the influence of the genital system over the intellectual
faculties. Correct information Avould clearly show why some chil-
dren cease to carry off the prizes of their class ; and why at a later
period, some young men fail in studying the law, medicine, or the
sciences, after having successfully commenced such studies.

Nevertheless these first failures would be only momentary if they
were not afterwards kept up by the occurrence of involuntary dis-
charges ; most of the patients succeed in correcting themselves,

GENERAL SYMPTOMS. 291

although perhaps only when they are no longer ahle to continue their
habits ; after which they are almost invariably ignorant of the cause
that prevents the return of their former intellectual energy. On the
other hand, again, involuntary seminal discharges do not always arise
from masturbation or venereal excesses ; they require particular at-
tion therefore on all accounts.

I have already spoken of congenital weakness of the genital organs,
and the disposition to involuntary discharges arising therefrom ; I
have mentioned, too, that intellectual excitement of all kinds, when
carried too far, irritates and weakens such organs. Hence it is clear
that literary men, artists, savans, &c., by giving themselves up too
ardently to the study which interests them, are exposed to involun-
tary discharges, however little they may be liable to them from other
causes. Active cerebral excitement at first produces increased ac-
tivity in the sexual organs, especially if a sitting position be long
maintained — a slight increase of virility resulting. Long continued
application, however, added to want of exercise, &c., weakens all
the functions, commencing with the least energetic. The erections
diminish and disappear, which seems natural enough when the ab-
sorption of the thoughts is taken into consideration ; but after a short
time mental application becomes less easy and more fatiguing, and
its results are not so satisfactory.

In this condition exercise and relaxation may re-establish the cere-
bral functions ; but after a time these means only produce slight
improvement. All those notions of advancement, which had sus-
tained the powers under intense study, must be abandoned, and give
place to the constant care of health, which deteriorates daily.

What has taken place in these cases? Involuntary discharges are
established, or have notably increased in frequency. These dis-
charges keep up the weakness of the previously over-worked brain,
and oppose the re-establishment of its functions, notwithstanding the
most constant hygienic care. Such patients are generally in the prime
of life, and completely absorbed b}^ their studies, when they first feel
their intellectual powers rapidly decline. The absence of all appa-
rent symptoms on the part of the genital organs prevents the patients
from there seeking- the cause of the disorder : they only regard it as
the effect of an overworked nervous system, which, in a few in-
stances, is actually the case. Under these circumstances, however,
a short respite from study, combined with exercise, restores the pa-
tient for a time ; but he relapses after further application, and these
means are of no service ; involuntary discharges are now established,
and alone oppose the patient's recovery. The nocturnal pollutions
diminish, but the symptoms increase — diurnal ones have commenced,
and become daily more frequent, and consequentl}? more injurious.

Insanity/. — Many patients had been treated in lunatic asylums
before they came under my care. In these cases the disorder of the
intellectual, moral, and affective faculties varied from severe hypo-
chondriasis to violent mania. Strange hallucinations, together with

292 SYMPTOMS OF SPEEMATOEEH(EA.

inclination to suicide, temptation to commit murder, and violent fits of
rage, were common. For these reasons the patients had been placed
in asylums, and treated like ordinary madnfien;. but in all the cases
that have come under my notice, the mental derangement followed
the variations of the involuntary seminal discharges in all respects.

Mania, however, is the least common of all disorders of the brain,
produced by spermatorrhoea. The chronic form of derangement is
much more frequent. This disorder corresponds in a remarkable
manner with that described by Pinel as melancliolia ; by Dr. Rush as
tristimania or hi/pochondriasis, and by Esquirol as lyijomania. In all
cases of this disorder the distinctive characters are — an irresistible
sadness, melancholy and depression of spirits, fondness for silence
and solitude, with thoughts constantly engaged in imagining dreadful
events about to happen ; universal distrust, often carried as far as the
most savage misanthropy ; extreme timidity of character ; a series of
hallucinations, generally bearing on plots against life or imaginary
persecutions ; and lastly, above all, a profound disgust of life ; and,
in consequence, an instinctive and continual impulse to suicide.

Such are the symptoms given by all authors as characterizing this
particular class of mental diseases. I need scarcely remark that they
coincide exactly with those of patients suffering from spermatorrhoea.
We must therefore admit, that spermatorrhoea remarkably favors
the development of lypomania. I confine myself to asserting that
the development of lypomania is favored by spermatorrhoea, because
it is necessary to admit that a primary disposition to cerebral dis-
order must be present in these cases. Without this we should not
be able to explain why, in certain cases the patients escape all dis-
order- of the cerebral functions; why, in other cases, these disorders
present infinite varieties of degree ; and why the same symptoms
come on under other circumstances. We must, therefore, only de-
fine spermatorrhoea to be a determining cause of lypomania.

The influence of involuntary discharges is, however, so powerful
and direct, that reason is soon re-established as soon as they are ar-
rested ; whilst other modes of treatment are of little or no efficacy.

Pinel and Esquirol remarked the influence of masturbation and
venereal excesses in causing melancholia or lypomania. Dr. Des-
landes extends his observations to all kinds of mental derangement ;
and, among other facts, he calls to the support of his arguments the
statistics of asylums for the insane. Out of 256 individuals admitted
into the asylum of Cbarenton, during the years 1826, '27, '28, there
were 44 men whose insanity was attributable to masturbation or
venereal excesses ; whilst only three women owed their derangement
to similar causes. Dr. Hoist, too, has given similar information, de-
rived from the insane in the kingdom of iNlorway. Dr. Deslandes,
however, remarks that this cannot be regarded as an exact relative
proportion, on account of the objections women would have to aff'ord-
ing such information. Esquirol thinks, too, that masturbation is
more frequently concealed among females than among males.

GENERAL SYMPTOMS. 293

Although the observers, of whom I have just spoken, have men-
tioned the influence of abuses or excesses in causing insanity, they
have completely mistaken the cause which afterwards keeps up the
mental disorder. In asylums venereal excesses cannot continue, and
sure means of preventing masturbation are at hand ; it even happens
most frequently that both have ceased a long time without the least
improvement in the symptoms being observed, because they are kept
up by diurnal pollutions, as I have already shown. None of the
authors referred to have, however, mentioned these ; indeed they
are not even hinted at in any work on insanity.

It is perhaps to the presence of such pollutions that we must
attribute the relative paucity of cures in the male — for all who have
made statistical researches on insanity, assert that in all countries,
and under all kinds of treatment, there are fewer recoveries among
men than among women.

But all mental affections do not consist of disorde?' of the intel-
lectual, moral, or affective faculties ; there maybe also debility, and
this may be the predominating phenomenon, or may exist alone.
Dementia is the worst degree of this affection, just as mania is the
most severe degree of insanity. Incurable cases of vesania termi-
nate in dementia ; but it has long been known that dementia is not
always preceded by mania or delirium, and that it may even reach
the last degree of severity without being complicated with any dis-
order of the kind. Such cases, then, only differ from senile dementia
by the youth of the patients ; and this early debility may make
rapid progress, constituting acute dementia.

On comparing the descriptions which have been given of the dif-
ferent kinds of dementia with the symptoms of patients suffering
from spermatorrhoea, it is impossible not to be struck with their
similarity. What is called simple dementia really presents no diffe-
rence from what is observed in the last stages of spermatorrhoea.
In both cases there is invariably a progressive loss of the memory
of facts, dates, words, &c., with loss of imagination, power, intellect,
and determination.

We have just seen that many observers have admitted the influence
of masturbation and venereal excesses in the production of mania and
lypomania. Dr. Deslandes believes that these causes also frequently
bring on dementia. I am strongly of his opinion, because the loss
of their reason removes from the insane as well as from the idiot the
strongest check the passions possess. Esquirol very judiciously ob-
serves, that masturbation is the greatest obstacle to the cure of the
insane on account of the stupid, brutish condition into which the
habit throws them. From this it is evident that diurnal pollutions
must still more favor and hasten dementia, because they act much
more energetically and without encountering any check. Persons
addicted to masturbation are watched and mechanically guarded ; but
diurnal pollutions are not even suspected, much less guarded against.
They are, on the contrary, favored by certain circumstances affect-
19

294 SYMPTOMS OF SPEEMATORRHCEA.

ing the insane. Sexual intercourse is denied them ; they are con-
demned to inaction, or, at all events, are unable to obtain regular
and active exercise ; they frequently suffer from prolonged consti-
pation, &c. These causes are sufficient to bring on involuntary dis-
charges even in cases where there had been no previous bad habits,
or venereal excesses ; still more, then, must they increase sperma-
torrhoea, when once set up by previous irregularities.

These reasons lead me to conclude that dementia is frequently
caused by diurnal pollutions; and this conclusion seems more strongly
confirmed by the debility of the muscular system; for dementia
bears the same relation to paralysis that delirium does to epilepsy.

General and Incomjylete Paralysis of the Insane. — This generally
accompanies and follows the same course as dementia ; both are phe-
nomena of the same nature, and both arise from weakness of the
cerebral organs. General and incomplete paralysis, first noticed by
Pinel, and studied with much attention by Esquirol, has since been
the object of special research by MM. Delaye, Bayle, Calmiel, and
Foville. The descriptions of all these authors agree remarkably
with the symptoms observed in the last stage of spermatorrhoea.

At first there is only observed slight embarrassment of the tongue,
with stiffness in all the emotions — a general awkwardness attended
with more or less trembling. After a time certain letters or words
are not distinctly articulated. There is still more stiffness than weak-
ness in the limbs ; and a yet more remarkable symptom observed in
these patients, until extreme weakness prevents it, is their constant
desire for walking or motion. Dr. Foville, after noticing this, adds,
"One of my patients, when first attacked by this complication, would
not remain in the same place ; he walked from morning till night with
extreme rapidity, and seemed compelled to this constant exertion
more by a mechanical impulse than by a voluntary determination."^

The same author also notices another symptom of general para-
lysis of the insane, which I have described as frequently occurring
in cases of spermatorrhoea, " In the course of this disorder I have
frequently observed attacks of cerebral congestion followed by convul-
sions or coma ; these lasted several hours, and were frequently repeated
during several days. After such attacks the intellectual debility
and the disorder in the motions, the progress of which is generally
equal, become more marked. In many patients intervals of variable
duration, during which the disease made no progress, were inter-
rupted by these attacks."

I have quoted these passages literally, in order to show how far
the symptoms, which I have described as belonging to spermator-
rhoea, resemble those which have been noticed by the best observers
of the insane. On the other hand, all authors admit that such de-

• See Dictionnaire de ]Meclecine, et de Chirurgie Pratiques, art. Alienation
Mentale.

GENERAL SYMPTOMS. 295

bility of the muscular system does not exclusively belong to insanity,
and that it occasionally precedes for some time the disorder of the
intellectual faculties.

Lastly, all who have paid attention to the general paralysis of the
insane, have been struck with the great difference in the number of
the two sexes attacked by this serious symptom. In a statistical
return referring to 334 cases of insanity, Dr. Foville remarks that
out of 31 cases of paralysis, 22 were men and only 9 women. Re-
ports presented by various other observers give nearly similar pro-
portions, notwithstanding differences of climate, manners, &c. Prof.
Rech has stated the disproportion to be even more considerable in
the lunatic asylum at Montpellier. So remarkable and constant a
difference cannot arise from any accidental cause, for the number of
insane females surpasses that of males. It seems to me, therefore,
that the great frequency of general paralysis in the male, should be
attributed to the presence of diurnal pollutions.

I have just stated that in the asylum at Charenton, 44 males owed
their insanity to masturbation, or venereal excesses, whilst only
three women were similarly situated ; and I have also noticed the
greater frequency of recoveries in females than in males. It is im-
possible not to be impressed with the harmony that exists between
these three important facts, constantly and generally observed, and
to which no cause has hitherto been assigned.

Alterations in the structure of the brain are indeed sometimes,
found in cases of general paralysis of the insane, but even those who
have laid most stress on them do not agree as to their importance.
I have not found such alterations in patients dying from spermator-
rhoea who were affected by the same muscular weakness. Besides,
these alterations do not explain why the general paralysis of the
insane should affect males in so much greater proportion than females.

I conclude, therefore, that among cases of incomplete paralysis
of the insane, there are a certain number depending on diurnal pol-
lutions, or which are aggravated by this disease, as I have already
stated with regard to dementia.

Dementia and general paralysis of the insane have been generally
regarded as certain signs of the incurability of the insanity, even
when only slight embarrassment in the pronunciation, hesitation in
the motions, or trembling of the limbs existed. Nevertheless, simi-
lar symptoms have always disappeared in patients suffering from
spermatorrhoea as soon as the diurnal pollutions were arrested.
This is a subject, therefore, which demands the earnest attention of
practitioners who have opportunities of studying it.

General character of the symptoms. — Notwithstanding the number
and variety of the effects produced by spermatorrhoea, it is evident
that all arise from changes in the functions of the different organs ;
and by comparing these changes one with another, the same cha-
racters of debility and disturbance are strikingly seen throughout.

296 SYMPTOMS OF SPERMATOERHCEA.

If disorder only appear to be present in certain cases, a little atten-
tion will show that it is accompanied by weakness also.

Involuntary seminal discharges therefore act essentially by pro-
ducing debility. We must also admit that these discharges excite
a powerful and rapid influence over the nervous system ; hence they
have always been justly considered enervating. We are thus able
to explain the numerous and varied symptoms resulting from sper-
matorrhoea, as well as their resemblance to the symptoms produced
by all other debilitating causes.

Effects of masturbation on children and females. — In children,
even at a very early age, masturbation produces the same effects as
diurnal pollutions ; only that the spasmodic symptoms are generally
more marked than those of paralysis. This arises from the pre-
dominating power of the nervous system at this early age ; for the
same tendency is evinced in all the diseases of children, and even in
their slight indispositions. On the other hand, however, cases more
or less marked, of paralysis, weakness of sight, &c., are not rare ;
and loss of memory, of intellect, and of the affective faculties, are
frequently met with, and may reach complete brutishness.

This unfortunate passion produces exactly the same effects in the
female sex at all ages ; — the relative frequency of spasmodic pheno-
mena arising from the greater nervous susceptibility of the female.
On the other hand, the general and local weakness, occasional in
the female, also resembles paralysis. I have recently seen a case of
amaurosis, arising from masturbation, in a female thirty-six years of
age, who confessed the vice when leaving the hospital, after having
submitted to issues, setons, moxas, &c.

In these numerous cases, therefore, seminal discharges can have
no influence in producing, or keeping up the disease, although the
symptoms are the same as those caused by spermatorrhoea.
* After having long reflected on these facts, I am convinced that
the effects produced by seminal discharges may be brought on by any
other debilitating cause, whose action on the economy is rapid and
important ; and that of all such causes those which have their seat
in the genital organs are the most enervating, and consequently the
fittest to produce debility and functional disorder.

Progress of the symptoms. — In examining the effects produced by
spermatorrhoea, I have for obvious reasons generally supposed that
the disease progresses regularly and continuously : such is not the
case, however ; the symptoms seldom present any uniform progress
during the course of the disease ; nothing, indeed, can be more
irregular, even in the most severe cases, which might even be con-
sidered continuous when compared with others. Among these vari-
ations some may be considered of daily occurrence, and these are
not well marked ; others, again, happen less often, but last longer,
and are most important. Numerous causes produce these irregu-
larities in the progress of the disease ; variations of temperature,

GENERAL SYMPTOMS. 297

hygrometric influences, atmospheric pressure, electrical tension,
varieties of food, state of the bowels, and numerous other trifling
circumstances produce extraordinary effects on persons debilitated
by involuntary seminal discharges : every observing practitioner
will note these ; I need not, therefore, enter further on their consi-
deration.

Spontaneous Recovery. — Many diseases when left to themselves
work their own cure, provided only they be not exasperated by the
imprudence of the patients. This is not the case with spermator-
rhoea — chiefly, perhaps, because the effects produced by the disease
itself are favorable to the increase of the involuntary discharges.
The natural tendency of this disease to become aggravated, as the
result of its own effects, frequently leads to fatal termination. The
patients under these circumstances generally expire in one of the
attacks of syncope that follow the congestion of the brain, of which
I have already spoken. In this way, also, such of the insane who
have fallen into a state of dementia, generally expire. Death, how-
ever, in cases of spermatorrhoea, is much more frequently caused by
some acute, or chronic accidental complication, which absorbs all
the attention of the attendants on account of its being more evident
and better known. The system is unable to resist such complica-
tions on account of its previous debility. I have in this manner
recently seen a student, who was debilitated by severe diurnal pollu-
tions, carried off by phthisis after only two months' illness. In such
cases, unfortunately, the spermatorrhoea is generally unsuspected.

298 TREATMENT OF SPERMATORRHCEA.

CHAPTER XIII.

TREATMENT OF SPERMATORRHOEA.

Pollutions arising from direct causes.

In the treatment of involuntary seminal discharges, it is of less
consequence to seek their primary than to discover their maintain-
ing cause. For instance, pollutions may have been primarily ex-
cited by masturbation or venereal excesses, and afterwards be kept
up by affections of the skin, haemorrhoids, kc. In such cases it is
evident that the practitioner must treat the existing cause. Invo-
luntary discharges may either arise from actual debility, or relaxa-
tion of the spermatic organs, or from a state of irritation, or chronic
inflammation of the parts, after having been first produced by very
different remote causes ; in treating such cases, then, the remote
causes are not to be considered, while too much importance cannot
be attached to the actual condition which keeps up the disease. It
is this actual condition of these spermatic organs that m.ust be altered
in order to obtain a cure.

This point must never be lost sight of in considering the means
to be employed for the treatment of spermatorrhoea. The reme-
dies are numerous, and of very opposite classes, requiring consider-
able experience and skill in their adaptation to the temperament or
idiosyncrasy of each patient, as well as to the different stages of
the disease.

I shall arrange these remedies in different groups, according to
the indications to be fulfilled — beginning by considering those pol-
lutions whose causes act most directly.

Pollutions arising from ascarides. — The most constant symptom
experienced in these cases is an insupportable itching at the anus.
The parts on examination present no signs of eruption, but the
mucous membrane lining the sphincter is red, injected, and covered
with thick mucus, sometimes mixed with blood. There are also
numerous little red points, which, as well as the itching, arise from
the pricking produced by the tails of the worms. Sometimes pa-
tients, annoyed at the constant itching, introduce the finger into the
anus, detach some ascarides, and bring them away under the nail.

POLLUTIONS ARISING FEOM ASCARIDES. 299

The sensations experienced are not the same at all times ; they are
generally much more severe at certain parts of the day, apparently
depending on the times of taking food ; — the itching notably in-
creasing about four or five hours after dinner. The stools are ge-
nerally passed easily, are soft, very fetid, and covered with a large
quantity of thick ropy mucus, often filled with blood.

Diarrhoea frequently occurs, constipation under these circum-
stances being very rare.

In these cases, therefore, the pollutions are, as I have before said,
not caused by pressure on the seminal vesicles, but by their spasmo-
dic contraction produced by the irritation of the surrounding parts.
The pollution generally occurs while, the patient is occupied in ad-
justing his dress ; it takes place suddenly, and is ordinarily preceded
by two or three spasmodic contractions of the rectum.

Darting pains from the base of the penis to the extremity of the
glans, are also frequently felt in these cases: these pains bear con-
siderable analogy to those caused by the presence of stone in the
bladder, the patients elongating the prepuce for relief in the same
manner as in that disease. These pains are most likely caused by
the ascarides pricking that portion of the rectum which covers the
prostate.

Ascarides always inhabit the lower portion of the large intestine,
and may, therefore, be attacked by direct means — the most simple
of all, without exception, being injections of water. When thrown
up at a sufiiciently low temperature, water kills these worms, or at
least stupefies them, and when injected in considerable quantity, so
as to be returned with some force, they are frequently passed even
whilfe alive. The injections may be commenced at a temperature
of 75° Fah. and may afterwards be reduced to 60° or even 70° of
the same scale. It is important to throw up as much water as pos-
sible, because by this means the worms furthest from the anus may
be reached, and those which are adherent to the walls of the in-
testine may be detached. Ascending douches are very useful in
these cases — their action being that of a powerful and long con-
tinued enema syringe.

These injections should especially be used in the evening, five or
six hours after the last full meal, because this is the time when the
itching at the anus caused by the worms is chiefly felt ; besides
which, cold injections administered at this period are of use to the
patients for other reasons. They render the worms which remain
less lively, cool the irritated intestine, diminish the erections, and
place the patients in the most favorable condition to obtain that
sound sleep of which they are greatly in need.

Cold water is, perhaps, the least active injection we can employ,
since it has no action except that derived from its low temperature ;
but on this account alone it is often preferable to injections that act
chemically. The latter are always more or less styptic, acrid, or
irritant, and cannot destroy the ascarides •without acting on the

300 TEEATMENT OF SPERMATORRHCEA.

mucous membrane of the intestine, which is already irritated and fre-
quently even inflamed : it is, therefore, prudent to begin by copious
injections of water, which should at first even be used at a moderate
temperature, as a very cold injection, Avhen the intestine is unaccus-
tomed to it, may produce a very injurious irritating effect. When
the mucous membrane of the intestine has in some degree recovered
its tone, salt and water injections may be used — the quantity of salt
being gradually increased from one to three tablespoonfuls to the
quart of water. Two or three of these injections should be adminis-
tered in rapid succession, or, better still, should be retained so as
to carry the fluid as high up the intestine as possible ; care must,
however, be taken that the solution does not contain too much salt,
which would irritate the mucous membrane.

Decoctions made from plants of the genus artemisia are very use-
ful as injections in these cases ; some of them, however, are some-
what irritating to the mucous membrane. The class Lahiata are less
irritant, but their vermifuge power is less also. Whatever be the
injection employed, care must be taken that it be not too concentrated.
When this is the case, the intestine may become irritated, and this
irritation may extend to the bladder, producing very annoying
symptoms and rendering narcotic and emollient injections and baths
necessary.

A small quantity of the unguentiim liydrargyri mitius introduced
into the intestine, often puts an immediate stop to the annoyance
produced by ascarides ; the itching returns, however, the worms in
the immediate neighborhood of the anus being alone affected by
this remedy. The bichloride of mercury in very diluted solution
is also an active remedy, but it requires great care and circumspec-
tion in its use.

All purgative enemata destroy ascarides, but at the same time irri-
tate the mucous membrane. Oily injections are, however, unirri-
tating, and consequently very useful. Camphorated solutions have
been recommended ; but although their action on the ascarides is
very prompt, I think there are sufiBcient reasons to contraindicate
their employment.

In very young children baths may be employed containing an in-
fusion of one of the genus artemisia. I have even frequently seen
these followed by the expulsion of hLinhrici, when no other means
had been employed.

It seldom happens, however, that injections alone suffice for the
entire removal of ascarides, some of which often inhabit the upper
parts of the large intestine, and are consequently unaffected ; it is
therefore generally necessary to administer vermifuge remedies by
the mouth. Calomel has always appeared to me to be the most effi-
cacious of these : when the stomach is much disordered it is best to
give from two to four grains of calomel at bedtime; and this may
be followed by a moderate dose of castor oil taken early in the morn-
ing.

POLLUTIONS CAUSED BY CUTANEOUS ERUPTIONS. 301

At the same time that these remedial agents are employed, means
must be taken to improve the general health, and especially the
state of the digestive organs. It must be recollected that the pre-
sence of worms is a sure sign of deficient energy in the intestinal
tube ; and this is generally conjoined with constitutional debility,
and is only to be remedied by fortifying the whole system.

Pollutions excited hy Cutaneous Eruptions. — Eruptions occur at
the margin of the anus, causing insupportable itching, with abundant
ichorous discharge, and excoriation of the skin and raucous membrane
lining the sphincter ani. Sometimes the affection extends more
deeply in the intestine, and then an increased secretion of mucus
takes place. The irritation set up under these circumstances excites
spasmodic contractions of the seminal vesicles, and consequently,
pollutions, especially those which occur during defecation.

Other eruptions occur on the prepuce (herpes preputialis). These
consist of furfuraceous patches, little pointed pimples, or phlyctenoid
swellings resembling the effects of stinging by nettles ; or again in
more or less lively erysipelatous redness. These different eruptions
are generally attended by swelling of the prepuce, with hardening
or infiltration of the loose cellular tissue of the part, and increased
secretion of the sebaceous matter, with intolerable itching. This
sebaceous secretion often becomes acrid enough to excoriate the glans
and internal surface of the prepuce. The patient cannot keep his
fingers from the parts, which again grow more disordered in propor-
tion to his attempts to obtain relief from the itching. Sometimes,
too, a degree of salacity is present, which has no relation whatever
with the patient's real powers. Eruptions occurring on the skin of
the penis, scrotum, perineum, groins, pubes, and the insides of the
thighs, may produce nearly the same effects.

Sometimes urethral discharges just as profuse and painful as those
caused by blennorrhagic virus occur in these cases ; and these may
be followed by inflammation of the testicles or bladder, or even
nephritis.

The eruptions may also suddenly leave the genital or^ajis and
commence in some other part of the body ; and when this hA'^pens,
the pollutions generally cease for the time, to return again with the
return of the disease to its old seat.

In the treatment of these cases it is always necessary to begin by
using baths of either the natural or artificial sulphuretted waters.
Care must be taken that these baths be neither too strong nor too
hot ; artificial sulphuretted baths should at first only contain a
small proportion of sulphuret of potassium, and their strength and
temperature may be gradually increased. The natural waters are
frequently of too high a temperature for these excitable subjects ;
from 80° to 90° Fah. is generally quite sufficiently warm for the
first trials.

After the natural sulphuretted waters have been used as baths

302 TREATMENT OF SPERMATORRH(EA.

for some little time, they may be taken internally and employed as
douches on the perineum and loins, and as enemata, or as ascending
douches, into the rectum. The direct action of douches on the cuta-
neous tissues is very important ; in consequence of the percussion,
the water stimulates the skin much more than when simply used in
baths. I have often seen eruptions that had long withstood the
remedial action of sulphuretted waters taken internally, with the
simultaneous use of baths, cured in a few days by douching the
affected part.

In eruptions about the anus, we have no remedy equal to ascend-
ing douches, especially where the disease extends to the mucous
membrane of the gut — this structure being acted on as well as the
skin of the anus. Injections into the bladder by means of a double
catheter are useful in some cases of chronic discharge from the lining
membrane of that organ ; but here great care is necessary, and the
stream should be rather continuous than powerful.

Sometimes the immediate effect of sulphuretted waters is to pro-
duce a degree of excitement that increases the involuntary discharges.
The final results are, however, almost sure to be favorable.

Occasionally, again, good effects are experienced at first, but after-
wards disappear : new attacks of urethral irritation come on accom-
panied with discharge, »Stc., as before, and referable to contagion. I
have known such relapses occur four or five times, notwithstanding
the annual use of sulphuretted waters, and other treatment.

In such cases it becomes necessary to remove the condition of the
mucous membrane that keeps up the irritation ; and this result can
only be permanently obtained by cauterization.

On the other hand, again, the use of sulphuretted waters is often
highly advantageous in cases that do not depend on cutaneous dis-
ease — those that are due to a too great susceptibility of the genital
organs for instance. The mildest class of waters should be chosen
under such circumstances, and great circumspection is necessary in
their employment.

In all cases in which the sulphuretted waters are employed, care
must be taken to warn the patient against the injurious modes of life
so frequent among the society frequenting mineral springs.

Pollutions arising from Altered or Increased Secretions from the
Sebaceous Grlands. — The sebaceous matter of the prepuce and glans
is sometimes very abundant in quantity, and remarkably acrid
especially in individuals subject to cutaneous eruptions. In other
cases it may be retained by great length of the prepuce, or nar-
rowness of the preputial orifice. Under such circumstances, the
irritation of the glans penis may bring on very serious nocturnal and
diurnal pollutions.

Whenever the prepuce is too long or its orifice too narrow, it is
indispensable to commence the treatment by its removal. This in
many cases suffices; others, however, require astringent lotions, sul-

POLLUTIONS DEPENDING ON STRICTURE. 303

phuretted baths, lotions containing a small proportion of spirit, &c.
Simple division of the prepuce does not suffice in these cases; in-
deed, for reasons well known to surgeons of the present day, its
entire removal is generally to be preferred. Where the preputial
orifice is very narrow, and the part itself so scanty as to be firmly
applied over the glans, this can only be accomplished by first slitting
up the organ and afterwards removing the flaps thus made. The
operation being a familiar one, further details are unnecessary.

Pollutions depending on Stricture of the Urethra. — Spermator-
rhoea may either be brought on by stricture of the urethra, or being
brought on by some other of the various causes, may be kept up by
this disease. In both cases the most urgent indication is the same.
The involuntary discharges cannot be removed without first removing
the obstacle to the free discharge of urine.

Various means have been employed for this purpose, some of
which are specially suited to particular cases.

In an immense majority of cases, dilatation properly applied, is
all that is required ; and again, dilatation may be employed by two
different methods, the comparative merits of which I must hastily
glance at.

Formerly, strictures were always treated by dilatation continued
over a period of two or three months, and this alone was supposed to
preserve the patients from the danger of a relapse. This dilatation
was generally performed by means of gum-elastic catheters retained
in the passage. Chronic vesical catarrhs very frequently resulted —
continuing after the removal of the instrument ; and the mucous
membrane of the urethra was generally much altered in structure,
becoming fungoid and injected. The pressure of the extremity of
the catheter on the walls of the bladder, too, often had dangerous
results ; and more than once the vesical coats have been perforated —
becoming softened by inflammation — and effusion of urine into the
peritoneal cavity has taken place, of course followed by speedy death.

Abscesses in the prostate, also, have frequently formed, and either
discharged into the bladder, or rectum, or, producing hard swelling
in the perineum, been promptly opened by the surgical attendant.
The serious results of these abscesses are well known to all practical
men.

Inflammation of the testicle, too, is a frequent attendant on the
slow dilatation of strictures ; and even when this does not take place,
the mucous membrane of the prostate is generally thickened and
altered in structure — the ejaculatory canals and vasa deferentia par-
ticipating in the morbid action.

Inflammation is frequently set up in the corpus spongiosum and
cellular tissue surrounding it ; and this may either go on to suppu-
ration, and, if not opened early, ultimately form urinary fistula, or,
the inflammation becoming chronic, one of the hard tumors found
in such cases may result.

By rapidly dilating the stricture, these inconveniences are avoided.

304 TREATMENT OF SPEEMATORRH(EA.

A metallic catheter should always be employed, because it is more
easily directed and the surgeon is better able to feel the progress he
makes. When the stricture is situated in front of the scrotum, how-
ever, a straight instrument may be used. Whenever the contraction
is passed, the instrument should be retained during seven or eight
hours, after which a gum-elastic catheter of the same size may be
substituted. The stricture is thus compressed, and the gorged cel-
lular tissue subsides, so that after three or four hours more the in-
strument becomes loose and may be easily replaced by one of a size
larger. If, however, the instrument be not loose in the passage at
the expiration of this period, it should be left a few hours longer.
By proceeding in this manner every four hours within two days, the
largest catheter the urethra will contain, may be easily passed into the
stricture — each new introduction of a larger instrument being easier
and less painful than the preceding. As a rule, strictures which are
not very narrow or resistant, are cured without relapse by this simple
proceeding, but old, resistant, and lengthy strictures again contract.
After a certain time, the patients perceive a diminution in the stream
of urine, and when this takes place slowly and without evident
cause, dilatation must again be had recourse to, commencing by the
introduction of the largest catheter which will pass the contraction.
Sometimes, however, the stream of urine becomes suddenly diminished
after excesses of any kind, horse exercise, &c., and under these cir-
cumstances, baths should be used with emollients, to remove the ac-
cidental irritation. Where it is necessary to have recourse a second
time to mechanical dilatation, perfect results are generally obtained
in half a day, or at most in twenty-four hours, the stricture not
having been permitted to attain its former degree of contraction. The
patient may now be instructed to pass the instrument for himself, and
recommended to have recourse to the method of rapid dilatation
whenever the same indications present themselves. The periods of
contraction of the stricture become more and more distant, and
even in the most refractory cases, perhaps, do not recur for years.

The plan of rapid dilatation possesses, therefore, all the advan-
tages of the slow process, without" its inconveniences.

Cases of traumatic stricture, such as those caused by a fall on the
perineum, &c., are exceptions to this rule. The long-continued
presence of a catheter is indispensable in these cases ; indeed, they
are difficult of cure by any means.

There are some cases of stricture, however, in which, notwithstand-
ing the numerous advantages of rapid dilatation, it must give way to
other means. When the stricture is situated at the orifice of the
glans, dilatation cannot be had recourse to without causing extreme
pain, besides which the contraction readily returns. Incising the
stricture in the direction of the frsenum, is a much simpler and more
rapid means of cure. The union of the wound must be prevented
by passing daily, for a week or so, the extremity of a large bougie
just into the canal. The lips of the wound being prevented from

POLLUTIONS DEPENDING ON STRICTURE, 305

uniting, cicatrize separately, and there is no danger of a return of the
contraction. Even when the stricture is situated two or three lines
within the orifice, incision with a straight probe-pointed bistoury may
be had recourse to with advantage.

There are also some annular strictures which, from their elasticity,
return rapidly to their former degree of contraction, as soon as the
dilating instrument is removed. These strictures should be scari-
fied in different parts of their circumference, by a bistouri cachee
adapted to the purpose,^ and afterwards full-sized instruments should
be introduced daily for an hour or two.

Some strictures bleed from very slight causes, and others, again,
are extremely sensitive. In both these cases dilatation is objection-
able — indeed, in certain cases of irritable stricture, the patients are
unable to submit to it on account of the agony produced, frequently
followed by fever, rigors, &c. In these cases cauterization of the
irritable surface with the nitrate of silver is the only means by which
a prompt and permanent cure can be obtained.

Lastly, there are impediments to the discharge of urine situated
externally to the mucous membrane. These consist of little tumors
developed in the spongy tissue of the urethra, or even still more
superficially ; these tumors can only be dispersed by external inci-
sion. A large catheter should be passed into the urethra, so as to
cause the tumor to project beneath the skin, which should then be
freely divided with a straight bistoury; the cellular tissue and tumor
are in their turns to be treated in the same manner. The tumor
afterwards suppurates and disappears completely.

Pollutions arising from Haemorrhoids. — Hemorrhoids may cause
involuntary seminal discharges in two ways — by the irritation they
excite — and by acting as mechanical impediments to defecation.

In the first case the tumors become swollen and painful, and the
irritation extends to the prostate and neck of the bladder. Vegetable
and milk diet should be used in these cases, with warm baths, cold

' The instrument to be used for this purpose should not be constructed on the
principle of a lancet-shaped stilet. In pushing forward the pointed extremity of such
an instrument it is almost impossible to be assured of the direction in which the in-
cision is made ; besides which the elasticity of the stricture will allow it to give way
before the point of the instrument, however well set, when the thrusting motion alone
is depended on to produce the required effect. In all cases, too, for which this opera-
tion is suited, it is possible to dilate the stricture by means of a somewhat conical in-
strument. It is far better, therefore, that the bistouri cach(^e should be sheathed in
the substance of a solid sound, and made to project slightly by means of a screw, after
the instrument has been passed entirely through the stricture, the incisions or notches
in which may thus be made while withdrawing the instrument, and with a proper cut-
ting motion. For strictures in front of the perineum, a straight instrument may be
used, and this will have the advantage of being turned round in the urethra so as to
notch several parts of the stricture. For strictures nearer the bladder several instru-
ments will be required, if it be necessary to incise more than one aspect of the stric-
ture. In all cases the projection of the bistouri cachee should be regulated by means
of a screw, so that the exact depth to which the incision will extend, may be known
by a single glance at the handle of the instrument. [H. J. McD.]

306 TREATMENT OF SPERMATOERH(EA.

and opiate enemata, and emollient poultices when the tumors be-
come prolapsed and painful. In this state, too, much and immediate
relief may be obtained by puncturing the most distended tumors with
a lancet ; the swelling goes down, the pain is relieved, and often the
hcTemorrhoid withers away and becomes completely obliterated. The
practice of applying leeches to these tumors cannot be too much
reprobated. The leech-bites increiise the irritation, and it is evident
that the effect desired, viz., that of emptying the tumor of its con-
tents, cannot be accomplished by these creatures, their bite not being
sufficiently deep to extend through the coats of the tumor.

When the hgemorrhoids are sufficientl}' large and numerous to im-
pede defecation, they must be unhesitatingly removed — especially
when they become hard and begin to dege'nerate. Care must be
taken in operating for the removal of these tumors when internal to
the sphincter, to cauterize the bleeding surface with the heated iron,
after each stroke of the knife.^ There is no occasion to form a deep
slough — it is simply necessary to close the oriSces of the bleeding
vessels. For this purpose the small olive-shaped cauterizing irons
are the most convenient.

Pollutions caused by Cicatrices in the Neigliborhood of the Anus.
— Accidental cicatrices in the neighborhood of the anus, or within
the rectum, may cause very serious pollutions on account of the ob-
stacle they present to free defecation. It is evident that these pollu-
tions can only be relieved by incising such cicatrices, and prevent-
ing the union of the incisions by introducing an instrument capable
of dilating the part to the full dimensions of the rectum.

Pollutions caused hy Fissure of the Anus. — I need not repeat what

' When hoemorrhoius are situated ■within the sphincter ani, their removal by the
knife is dangerous with any amount of caution. It is fur better, by directing the
patient to strain as at stool, to cause the tumors to project beyond the sphincter, and
then to transfix them through the base with a fixed needle carrying a double ligature.
An unarmed needle maj' be passed underneath the first, and the ligatures tied on each
side, underneath the second needle. This proceeding causes little pain when the por-
tions strangulated consist only of mucous membrane ; should, however, a portion of
sliin be included, the suffering is generally intense — ample reason for avoiding the ap-
plication of a ligature when the piles are external. The strangulated portions seldom
give any further trouble, and unless the stools be carefully examined, even the liga-
tures are generally discharged unnoticed.

The ligatures for this purpose should consist of fine, smooth, even, and very strong
whip-cord. Silk, however often doubled, will seldom bear the force required to draw
the ligature tight, and, besides, this repeated doubling makes a thick cord which does
not so perfectly' strangulate the tumor. In external haemorrhoids, when recent and
inflamed, the practice of puncturing with a lancet cannot be too strongly recom-
mended. The hemorrhage that takes place relieves the congestion of the haemor-
rhoidal veins as well as the irritation of the neighboring parts, and by gently pressing
the tumor, if it have not already disappeared on the following day, a small clot will
generally be discharged, after which the pile will for the most part shrink up and
give no further trouble. When, however, external piles are of long standing, they
should be freely removed by the knife. Smart hemorrhage sometimes follows, con-
tinuing for a few minutes ; no danger is to be apprehended from this, as it soon ceases
spontaneously, or at all events, may be immediately arrested by light pressure with
a compress of lint. [H. J. McD.]

POLLUTIONS CAUSED BY CONSTIPATION. 307

I have already said respecting the diiferent modes bj means of which
anal fissures may cause pollutions. The action is precisely the same
as that of heeraorrhoids.

The indication to be fulfilled is of course to obtain a cure of the
fissure, and this is only to be accomplished in severe cases by di-
viding the sphincter ani.' This operation must be performed to-
wards the side opposite to that on which the fissure is situated.^
With regard to the treatment after the operation I must remark,
that I consider the plan of stuffing the wound with charpie injurious
and inconvenient ; great irritation often results from it, and fre-
quently hemorrhage is kept up, which would otherwise speedily cease.
The wounds heal just as perfectly without this dressing, and I have
lately given up its use in all cases where division of the sphincter
ani is required.^

There are some cases of anal fissure which apparently depend on
a syphilitic taint. These are readily cured by the introduction of a
small suppository containing mild mercurial ointment.^

Pollutions produced by Constipation. — Constipation is sometimes
the cause of spermatorrhoea ; but it is much more frequently one of
the results of the disease; at all events, costiveness is almost always
an accompaniment of it. In all cases it is undoubtedly of importance
to relieve the constipation, even when it is not the primary cause of
the disease. Both surgeons and patients, however, have for the
most part fallen into a strange error in considering that to cure the
pollutions it is sufficient to procure free evacuations of the bowels.

Diurnal pollutions, indeed, which are simply accidental, disappear
as soon as the momentary costiveness causing them has been relieved ;

1 The free application of the nitrate of silver in substance will relieve many cases
of fissure of the anus, even when very severe. The application gives sharp momen-
tary pain, but this soon passes off, and great relief is immediately afterwards expe-
rienced. [H. J. McD.]

2 When the fissure is not situated in the anterior portion of the anus — the direction
of the urethra — this operation may be performed by simply dividing the parts through
the fissure. The irritable surface is thus converted into a simple wound, which in-
flames, suppurates, and generally heals without further trouble.

In all cases of fissure of the anus, as well as in cases of haemorrhoids — indeed, in
all affections of the lower bowel — too much attention cannot be paid to the state of the
digestive organs and liver. It must be recollected that disorder of these viscera is
by far the most frequent cause of rectal disease, and that without first removing
such cause no local treatment can be permanently successful. [H. J. McD.]

3 There can be no doubt as to the propriety of avoiding the filthy dressings still too
often used, and the abominable practice of stuffing up wounds made by operation on
the lower bowel. In all cases when any dressing is required, a narrow strip of lint,
dipped in a little tepid water, suffices. In the after treatment of divided sphincter
ani, an aromatic lotion — the red wash of the University College Hospital — consisting
of about a scruple of sulphate of zinc, four drachms of spirits of rosemary, one drachm
of compound tincture of lavender and ten ounces of water — is generally the only ap-
plication necessary. [H. J. McD.]

* The origin of such fissures from a syphilitic taint, I cannot but consider very
doubtful. Certainly the local application of the mild mercurial ointment would, ac-
cording to the generally received notions of constitutional syphilis, be of very little
efficacy in curing a secondary sore. [H. J. McD.]

808 TREATMENT OF SPERMATORRHCEA.

but in such cases spermatorrhoea has not become a confirmed disease,
and the health is not seriously disordered.

On the other hand, I have met with cases in which diurnal pollu-
tions brought on by old standing and obstinate costiveness, continued
after the bowels had been restored to their normal action. Case
nineteen is a striking example of this.

The means generally employed to relieve constipation are so well
known, that I need not consider them separately. Ascending douches
are in my opinion by far the most efficacious and useful in all cases.^
Purgatives on the other hand are injurious, however administered
and of whatever nature they may be ; laxatives, such as castor oil,
magnesia, &;c., are less injurious, but these possess the notable in-
convenience of adding to the gastric disorder. Saline purgatives,
such as sulphate of soda and magnesia, irritate the mucous membrane
of the alimentary canal, which is generally very easily affected in
these cases. Aloetic purgatives have, in addition to this, the great
objection that they act chiefly on the lower intestines, especially the
rectum.

I have formerly stated that active purges may excite pollutions in
persons previously free from them, from the facility with which spas-
modic contractions of the rectum extend to the seminal vesicles ; and
I have shown that pollutions brought on in this way may continue
after the action of the exciting cause has passed away, so that a
serious case of spermatorrhoea may remain, the progress of which
afterwards becomes independent. It is, therefore, evident enough
that the abuse of purgatives may seriously increase previously exist-
ing involuntary discharges, which were more the cause than the
effect of the constipation.

On the other hand, most of these patients are in the constant habit
of swallowing purgatives, not only because they are obstinately cos-
tive, but also because, from the remotest records of medical science,
it has been laid down as a rule that hypochondriacs cannot be too
much purged — most persons affected with spermatorrhoea, as I have
before said, being more or less hypochondriacal. The profession
cannot, therefore, be too much on their guard against yielding to the
solicitations of such patients, who, perhaps, only complain, or com-
plain chiefly, of constipation.

' The power of the douche bath in relieving constipation, has been very generally
overlooked in this country. Ascending douches directed against the anus seem, from
the experience I have at present had of their use, likely to be a very valuable remedy
in cases of deficient action of the colon and rectum. The temperature of the douche
should be from 80° to 90° Fah., and it should be continued about ten minutes. The
direction of the spout may be varied, and the water thrown on the abdominal parietes,
with very good effect. [H. J. McD.]

POLLUTIONS FROil RELAXATION AND DEBILITY. 809

CHAPTER XIV.

TREATMENT OF SPERMATORRHOEA.

Pollutions caused hy Relaxation and Debility.

Involuntary seminal discharges arising from general atony and
following serious acute diseases are very rare. The same indica-
tions are presented as in other prolonged convalescences. To the
general means proper to restore the strength may, however, be added
such special ones as act chiefly on the genital system ; such are Spa
water mixed with generous wines, most of the gum resins, canella
bark, highly seasoned dishes, game, &c.

Pollutions are much too frequently attributed to debility of the
genital organs ; nevertheless in certain cases such local atony may
either originate or keep up spermatorrhoea, which then frequently
yields to the simple administration of general or special tonics.
Debility may continue also after other causes have ceased to operate;
the same indication is to be fulfilled when this is the case.

This simple atonic condition is to be suspected when there are no
symptoms of local irritation — especially in such as have suffered
during infancy from incontinence of urine, in those whose genital
organs are not perfectly developed, or whose temperaments are
markedly lymphatic. When the scrotum is pendulous and cedema-
tous, and the veins of the spermatic cords are varicose, with the
glans penis pale at its orifice, and urethral canal little sensitive to
catheterism, there can be no doubt of the presence of atony.

The effects produced by atmospheric changes give us important
information on this head. We may be convinced that pollutions
arise from atony when they are increased during mild and damp
weather, while, on the other hand, they decrease during dry winds,
with sharp cold. These opposite effects show clearly enough that
tonics are indicated.

Galvanism may be employed very advantageously in torpidity of
the genital organs ; the shocks should especially be passed between
the loins and pubes and afterwards between the loins and perineum.
After each sitting the patients experience a feeling of strength and
warmth in the pelvis, which constantly increases ; the bladder and
rectum contract more energetically, and the constipation ceases. It
20

810 TREATMENT OF SPERMATOERHCEA.

is evident enough that galvanism would be injurious in cases where
there is the least irritation.

Cantharides are constantly ordered by charlatans in cases of im-
potence. I have never met with a single patient who did not regret
this treatment, and suifer from it. The remedy is one which should
never be administered to persons suffering from spermatorrhoea.

Phosphorus, which has been recommended in these cases, falls
under the same denunciation.

The ergot of rye has recently been recommended in cases of sper-
matorrhoea, and from experiments I have instituted, I am inclined
to think that it will prove of much service in pollutions arising from
atony. The dose should be from four to twenty grains, night and
morning, and the best method of administration is by suspending
the freshly powdered ergot in a glass of water.

Cold, fresh, and salt water bathing have been so generally recom-
mended in cases of involuntary seminal discharges, that I feel it
necessary to insist strongly against their indiscriminate employment.
Bad results arise from them when there is either great constitutional
debility, or too great susceptibility of the genital organs. Of these
different classes of patients, the one is compelled to give up bathing
because sufficient reaction does not take place, and the other be-
cause the involuntary discharges are considerably increased. The
abstraction of heat can never directly augment animal strength and
activity. The tonic effect resulting from cold bathing is, therefore,
due to the vigorous reaction that follows, and it is the duty of the
medical man to consider the constitution of each individual in order
that the bath may be employed with the most suitable effect in each
particular case. My experience has taught me that the ordinary
mode of cold bathing is chiefly useful in cases of masturbation, or of
venereal excesses ; in these cases, too, the exercise of swimming may
be advantageously added. Cold bathing is also useful in recent cases
of nocturnal pollution, but care must be taken, provided debility
have made even slight progress, not to permit more than sudden
immersion into the water ; and even this must be left off when
reaction is slow in taking place. When diurnal pollutions have
commenced I consider cold bathing highly injurious. If it be neces-
sary to stimulate the cutaneous surface in such cases, other and
more direct means must be had recourse to. We may, for instance,
employ warm aromatic baths — especially in patients who suffered
from incontinence of urine during childhood.

In all cases care should be taken to employ active friction on the
skin when the patients leave the bath ; after which flannel should be
immediately put on.

In some cases, cold applications, or lotions to the genital organs,
are borne when general bathing would be injurious, on account of
the amount of heat abstracted from the large surface exposed. Ana-
logous but more powerful effects are produced by friction with ice,
&Q., applied over the same parts; or a small quantity of pounded ice,

POLLUTIONS FROM RELAXATION" AND DEBILITY. 311

inclosed in a bladder, may be allowed to melt on the loins, or pe-
rineum. These means have been especially recommended before
going to bed, for patients who suffer from nocturnal pollutions :
their effects, however, often exceed what is required, and at best are
very uncertain ; sometimes, too, disagreeable irritation of the urinary
organs follows.

Cold douches on the lumbar and sacral regions are more certain
in their action, on account of the shock produced. I have frequently
employed these douches with success — extending their application
to the perineum. They have appeared still more useful when alter-
nated with sulphuretted waters employed as hot as possible in the
same manner. Reaction is much more rapidly established after
these means.

The first application of the douches should not exceed five
minutes in duration. The skin will be found very red, and a feel-
ing of heat and vigor in the parts will take place, even before this
short douching is ended : a very powerful tonic result may be ex-
pected as regards the genital organs, and for this reason the duration
and force of the douches must only be increased after carefully watch-
ing their effects for several days. After this, if not contraindicated,
the number and duration of the cold douches may be increased.

I have seen these alternated douches produce a state of priapism,
even in persons who were perfectly impotent on the previous day.
The medical attendant must, therefore, be cautious during their em-
ployment that he does not over stimulate his patient.

Cold drinks are generally useful and seldom injurious in these
cases. They take the place of spirits, &c., from which the patients
are generally obliged rigorously to abstain. Ice and iced drinks
have of course the most powerful action, but are not proper in all cases.
"When the stomach is very irritable the use of ice soon causes pain
and tenderness of the epigastrium, with heat of skin, red tongue, and
quick pulse — indeed, all the symptoms of more or less severe gas-
tritis. In other cases, again, the use of ice causes troublesome erec-
tions followed by weight in the prostate and frequent discharge of
urine, sometimes with diminution of the stream, and redness at the
orifice of the glans penis; sometimes, too, mucous discharge from the
urethra is set up, and even vesical catarrh has occurred in more than
one case in my practice. It is evident, therefore, that in order to
use ice, or iced drinks with success, the digestive and genito-urinary
organs must not be in an irritable state. The season of the year too
must be considered ; in summer reaction is rapid, and the heat
abstracted by the use of ice is soon compensated ; in winter, on the
contrary, there is a constant struggle on the part of the system to
maintain the animal heat, and it is evident that the administration
of substances calculated to abstract heat must be injurious.

In the internal administration of ice, we may without inconvenience
consult the taste of the patient. A spoonful may be given several
times a day, pounded with sugar, or little portions of ice may be

312 TEEATMENT OF SPERMATORRHOEA.

sucked ; the common ices of the pastry-cooks maj be used, or better
still, iced milk may be administered. In all cases it is proper to
begin by, small quantities at a time, and the action of the remedy
must be carefully watched.

Ferruginous waters have been very generally recommended in
cases of debility of the genital organs. Such debility, however, when
ret^arded as the sole cause of involuntary discharges, is very rare : or
at least it rarely exists alone ; and hence it happens that waters
containing iron so frequently fail, although in a few cases they pro-
duce remarkable eifects. In these cases, too, attention to the state
of the digestive organs is necessary.

Of the natural ferruginous waters, that of Spa is the most em-
ployed. Of all mineral waters, however, those containing the oxide
of iron are the most common, besides which they are easily manu-
factured artificially, and the artificial waters are quite as good as
the natural — indeed, in some cases they are better, because a larger
quantity of carbonic acid may be forced into them. Some of the
natural mineral springs are sufficiently warm to be used as baths,
and this is a very useful mode of administration when the stomach
of the patient is irritable.

Spa water may be taken in cases of atony, mixed with wine at
meals, and with milk, or sugar and water, during the rest of the
day. It is probably the best and most agreeable mode of adminis-
tering iron ; but the common forge water may be substituted for it
without inconvenience, or better still, a solution of lactate of iron.
Indeed, all ferruginous preparation may be used in atonic cases,
care being taken at the same time to regulate the bowels, and to
watch the general effects of the remedy.

Tonic or astringent bitters may also be employed in cases of sper-
matorrhoea decidedly depending on an atonic condition of the
genital organs, and may sometimes be advantageously combined with
preparations of iron. These remedies have one great inconvenience,
viz., their tendency to bring on constipation.

Numerous general and special excitants are contained in the
materia medica. Almost all the labiate and umbelliferous plants
possess high stimulating properties, and they have accordingly been
strongly recommended in cases of impotence — which, it will be re-
membered, was formerly always supposed to arise from atony of the
ejaculatory ducts. From my experience, however, even when in-
voluntary seminal discharges are caused by debility of the sper-
matic Organs, excitants are more frequently injurious than useful.

The oleo-resins, such as copaiba, turpentine, &c., are more useful
in cases of debility, accompanied with abnormal sensibility of the
_^enito-urinary mucous membrane. These remedies should be com-
menced in small doses, which should be increased very slowly. But
notwithstanding these precautions, the oleo-resins often disorder the
digestive organs, and prove repugnant to many patients, of these
remedies, copaiba is, perhaps, to be preferred. It may be given

POLLUTIONS DEPENDING ON NERVOUS SUSCEPTIBILITY. 313

mixed with magnesia, or in gelatine capsules, one only of which at
first should be taken at bedtime, increasing the dose according to the
effects observed. Tar water too may be given in doses of one or
two tablespoonfuls mixed with water, three or four times a day.

Nervous Susceptihility. — There are certain cases of involuntary
seminal discharges which seem to arise from the action of the nerves
of the genital organs, rather than from debility, or irritation. This
disposition, however rare, merits particular mention, because it pre-
sents special indications. The genital organs sometimes possess such
a high degree of susceptibility, that the least touch produces extra-
ordinary sensations in them. Very slight friction suffices to cause
incomplete erections with seminal emissions. Catheterism gives
intolerable pain, even at the orifice of the urethra, although there is
no redness perceptible ; painful dragging sensations are felt in the
testicles and spermatic cords, as well as along the penis ; darting
pains, with pulsation and sense of spasmodic contraction come on
frequently without evident cause, in the perineum towards the neck
of the bladder — fJrobably in the semi^ial vesicles, because involuntary
emissions often result without erection, or lascivious ideas, and not-
withstanding efforts made to prevent them. These phenomena are
especially observed in irritable individuals, who have shown from
infancy a degree of morbid sensibility, and whose first seminal dis-
charges were caused by unnatural excitement — especially by irrita-
bility of temper, or lively emotions. In such patients spermatorrhoea
becomes much aggravated in stormy weather : cold baths, applica-
tions of ice, (fee, are injurious, and tonics, internally administered,
do not succeed better in these cases. Sedatives and narcotics may
be employed with the best effects; preparations of opium should be
commenced in very small doses, however, on account of the tendency
to headache, and the nausea they produce, as well as their increasing
the patients' constipation. I have more than once seen such patients
experience all the bad effects of an overdose of opium from the exhi-
bition of an enema, consisting of a decoction made from a sincrle
poppy-head.

It might be supposed that camphor would be especially useful in
these cases, on account of its particular action on the nervous system.
I have rarely obtained good effects from it, however, and such of my
patients of this particular class who took it in large doses, experi-
enced nausea, headache, and very painful agitation ; in some even an
increased seminal discharge took place. Nevertheless, camphor
generally diminishes erections arising from a state of irritation ; un-
fortunately its effects are very uncertain, and hitherto no rules have
been laid down by which to predicate its action. On one point,
however, I am satisfied ; it is, that camphor should never be given
in large doses to these patients, as bad effects are almost invariably
produced. I generally recommend five or six grains only at first in
the course of the day.

Counter-irritation on the perineum and thighs may be sometimes

314: TREATMENT OP SPERMATORRHCEA.

advantageously employed to relieve the spasmodic contractions that
cause diurnal pollutions ; but the use of cantharides for this purpose
must be avoided.

The introduction of a catheter into the bladder possesses the
advantage of putting a stop at once to the nervous phenomena of
which the genital organs are the seat, and also of lessening the in-
creased sensibility of the urethral mucous membrane. A moderate-
sized gum-elastic catheter should be at first employed ; the introduc-
tion should be performed slowly, stopping from time to time, both to
allow the pain to pass off and to get rid of the spasm of the passage.
This spasm frequently lasts more than a minute, and during this time
all attempts at passing the instrument on must be absolutely ab-
stained from. Some patients suffer such pain during the passage of
the instrument, that the whole body becomes agitated, and covered
by cold sweat, and it is precisely in these cases that the catheter
produces the most marked and lasting effects ; when the suffering is
very acute, however, we should not persist in reaching the bladder
the first time of using an instrujjaent.

At first the instrument should not be retained more than an hour,
and in many cases it is necessary to withdraw it earlier ; at all events,
it should always be removed as soon as its presence excites new
spasms. It is remarkable, that notwithstanding the severe pain caused
by its introduction, the patients invariably experience a sense of
comfort immediately after its removal ; this is owing to the relief of
the painful sensations which they previously felt in tlie genital organs
— sensations which were by no means acute, but very disagreeable
on account of the constant anxiety they caused.

The effects of the first introduction must be completely allowed to
pass off before having recourse to the instrument a second time; a
day or two should even be allowed to elapse after the passage of
urine has ceased to be painful, before again using the catheter.
Generally from five to ten days would be a proper interval, varying
with the peculiarities of the case. And now the period of removing
the catheter may be left to the discretion of the patient, silways
advising him to retain it as long as possible, or until very violent
spasms commence — which happens generally in these cases in from
one to two hours.

The swelling which follows the introduction of the catheter ne-
cessarily extends to the orifices of the ejaculatory ducts, and thus
lessens the disposition to diurnal pollutions. The disordered nerv-
ous action is also modified by the presence of the instrument, and
the sensibility of the urethra returns by degrees to its normal condi-
tion. The catheter does not simply dull, by its continued presence,
the morbid sensibility of the part; it produces at first momentary
excitement, accompanied by swelling, and followed by a permanent
tonic effect. Hence the introduction of the instrument may be
advantageously applied in cases of atony.

Some patients, however, are so excitable, that they cannot bring

POLLUTIONS DEPENDING ON NEEVOUS SUSCEPTIBILITY. 315

themselves to submit to the pain caused by passing the catheter ;
others again, are unwilling to await the tardy results that follow this
plan of treatment, which is necessarily lingering, on account of the
time required to elapse between each introduction of the instrument.
In these cases, therefore, other means must be had recourse to.

Acupuncture acts with much promptitude and energy on the nerves
of the perineum and neighboring parts. It should be performed in
the following manner : —

The needles should be as fine as possible, and long enough to pene-
trate nearly into the bladder ; they should be tempered by heating
until they change color, so that there may be no danger of their
breaking, and a large head of sealing-wax should be formed for them,
so that they may be easily managed ; a little oily matter should be
rubbed over them before using.

After having caused the patient to make water, the first of these
needles is to pass through the raphe of the perineum, midway be-
tween the root of the scrotum and the margin of the anus; the point
must be kept in the direction of the median line, so as to traverse
the inferior lobe of the prostate, nearly as far as the neck of the
bladder. The second is next to be introduced between the first and
the margin of the anus, its point being directed in the same manner;
and the third may be inserted in front of the first, the point being
directed obliquely towards the lower part of the neck of the bladrler.
By this means the prostate would be traversed in the course taken
by the ejaculatory ducts in their course to meet at the verumonta-
num. It is difficult, therefore, for the ducts to escape being acted
on by the needles, even supposing they should not be actually punc-
tured.

I allow the needles to remain at least one hour, and at most three;
they may be retained longer, however, for the only inconvenience
they occasion arises from their requiring perfect immobility. The
extraction is generally painful.

The patients experience, immediately after the removal of the
needles, a sense of comfort and suppleness, which extends from the
perineum to the neighboring parts, and probably depends on the dis-
appearance of the painful sensations previously suffered ; and re-
markable improvement in all the phenomena caused by disordered
innervation in the genital organs usually results ; sometimes, indeed,
such disorders do not reappear.

The influence exercised by acupuncture over the involuntary dis-
charges, is by no means so constant. These seldom yield completely
after the disappearance of the nervous symptoms, although I have
seen a few cases in which the pollutions ceased after a single appli-
cation.

I have also several times used acupuncture of the spermatic cord,
and even of the testicle, with advantage in cases of neuralgia in
these parts, taking care to pass the needles between the epididymis
and body of the testicle. In one case the pain ceased after four

316 TREATMENT OF SPERMATOERHCEA.

repetitions of the operation, and I have since learned that the patient
married a few months after leaving the hospital. Neuralgia of the
spermatic cords and testicles is not always accompanied with sper-
matorrhoea ; but, as may be supposed, the disorders are very fre-
quently connected. In all these cases, the first indication to be
fulfilled is the same.

Acupuncture has unfortunately lately fallen into disrepute; at one
time it was sadly abused, being recommended in all classics of local
pain, whatever its nature or cause : hence the present neglect into
which it has fallen. Of course discrimination is required in its use ;
but in cases of spermatorrhoea arising entirely from nervous disorder
(which indeed are not common), its effects are as prompt and durable
as beneficial.

Pollutions arising from Hahit. — To the cases I have just been
considering as suitable for acupuncture, must be added those in
which pollutions are kept up by habit. Not only must these cases
be referred to the influence of the nervous system, but similar means
of treatment are applicable in both. I have obtained good effects
from catheterism and acupuncture, in patients whose genital organs
were not very excitable, but in whom the disorder was of very long
standing, or arose from old and long-continued abuse or venereal ex-
cesses.

It is very probable that the spasms of the seminal vesicles were
kept up in these cases by the influence exercised on all organs, and
particularly on those of generation, by the periodical repetition of
the same acts.

Catheterism and acupuncture should, therefore, be employed in
these cases, when there is no more evident indication to fulfil.

Pollutions caused by Sleeping on the Back. — There is still another
phenomenon which appears to me to arise from nervous influence,
I mean the effect produced by heat of the loins during sleep.
Amongst such as are affected with nocturnal pollutions, the greater
number only suffer from these accidents when lying on the back.
These cases are not generally very serious, and they may be relieved
by the following simple means : —

The bed should be very hard, and a piece of leather or oiled silk
should be placed between the blanket and sheet. If this do not
succeed, it will be proper to apply a sheet of lead over the loins, and,
better still, to adapt to the centre of this sheet a perpendicular piece
of light wood, so that the body never can remaiu on the back how-
ever sound the sleep may be. The sheet of lead may be fixed to a
linen girdle and tied in front ; and it is evident, that for the patient
to lie on his back, he must rest equally balanced on the edge of the
wood fixed to the centre of the leaden plate. The use of lead pre-
vents the loins from being overheated by the presence of the appa-
ratus, which might happen if some metallic substance were not used.

I have always found this simple apparatus successful in nocturnal
pollutions caused by heat of the loins during sleep.

POLLUTIONS CAUSED BY lERITATION. 317

CHAPTER Xy.

TREATMENT OF SP ERM ATORRHCE A.

Pollutions caused hy Irritation or Chronic Inflammation.

In by far the greater number of cases, the involuntary seminal
discharges are kept up by a state of irritation of the spermatic organs;
and this irritation may present various degrees of severity, varying
from simple excitement to well marked inflammatory action. Noc-
turnal pollutions brought on by simple excitement of the genital
organs, are not in general either lasting or serious ; these discharges,
therefore, as I have before stated, only merit attention on account
of their tendency to become habitual.

Irritation of the genital organs generally shows itself by more or
less vivid redness at the extremity of the glans penis, by abundant
secretion and frequent discharge of urine, by acute sensibility in the
prostatic portion of the urethra, and by a sense of weight and dis-
comfort in the perineum and rectum.

In chronic inflammation the prostate is, besides, sensible to pressure
and perhaps swollen, which may be easily ascertained by an exami-
nation per rectum. The patients suffer from mucous urethral dis-
charge, generally the sequel of old blennorrhagia, and which becomes
aggravated from very* trifling causes. The testicles are often mor-
bidly sensitive, painful, and perhaps swollen.

Spring is unfavorable to all patients whose involuntary discharges
arise from hypersthenia ; dry and cold weather is equally injurious ;
in general they feel better in warm damp seasons. Cold lotions,
cold bathing, tonics, and excitants, are all equally hurtful. Moment-
ary benefit may, however, occasionally arise from these means, and
this happens because debility generally accompanies the irritation
of chronic inflammation ; but such momentary benefit is rapidly fol-
lowed by marked increase of the bad symptoms. It is often diffi-
cult to distinguish chronic inflammation from irritation, and the
indications to be fulfilled are the same in both states, therefore I
shall consider their treatment together.

Hippocrates recommended that at first the whale surface of the
body should be fomented, that lavements should be given, and after
a time tepid baths used. The moderns, on the other hand, have with
one accord recommended cold bathing in all cases of spermatorrhoea,
and this has arisen from their constantly and falsely attributing the

318 TREATMENT OF SPERMATORRHCEA.

disorder to atony of the genital organs. The temperature of the bath
should be that most pleasant to the feelings of the patient: too high a
temperature causes agitation ; too low, on the other hand, increases
instead of relieving, local irritation. Emollient baths, containing
vegetable decoctions, are indicated when the skin is dry, irritable, or
covered with eruptions ; but with the exception of these cases, they are
not more useful than baths of plain water. The advice of Hippo-
crates relative to the diet and general regimen of such patients,
harmonizes with the employment of these emollient means. After
having prepared the stomach by a mild emetic, he recommends skim
milk as a beverage, ass's milk, and during forty days cow's milk.
" So long as this milk diet shall continue," he adds, "administer
barley water in the evening, and forbid all solid food ; afterwards
give soft food in small quantities at first, and fatten the patient as
much as possible." This fluid regimen is certainly the fittest to
assist the baths, fomentations, &o., in calming the irritation of the
genital organs, by favoring abundant secretion of unstimuluting
urine. It has also the advantage of furnishing the digestive organs
with nutriment suited to their weakened powers.

The stomach must not be over fatigued with the use of milk, how-
ever, and in order to prevent this, di9"erent means may be employed.
At first new milk may be given, as soon as possible after it has been
drawn, and this may be varied by changing from goat's milk to
ass's milk, and from the milk of cows to that of sheep. Afterwards
the milk may be boiled, or given cold, or iced ; sugar may be added
to it, or jam, water and sugar. If acid eructations follow its use, a
few grains of magnesia may be mixed with it, or two or three spoon-
fuls of Spa-water, or, better still, of lime-water. A few drops of
rum may be added to it to give flavor, or a laurel leaf, or a sprig of
fennel may be allowed to infuse in it while it cools. Tea and cofl"ee
must not be given with the milk, on account of their injurious action
on the nervous system, but chocolate may be used in small quantities.
The stomach is generally so capricious in these cases, that a milk
diet could not be long submitted to unless it were constantly modi-
fied. As, therefore, it is the most suitable diet in severe cases, care
must be taken to vary it frequently.

The soft food, recommended by Hippocrates to follow milk diet,
should consist of decoctions made from barley, beans, &c., or of the
dried juices of feculent vegetables. Of all feculent roots the potato
is the best suited to follow the use of strict milk diet in these cases.
The most simple mode of its preparation is the best. The potato
is easily digested, and besides, it modifies the secretion of urine.
Strawberries possess a similar property, and very soon relieve irrita-
tion of the bladder and urethra. There are some patients whose
urine is quite transparent, but who nevertheless cannot retain it long ;
thej sufi"er from pain and heat in the neck of the bladder and pros-
tate, together with darting pains in the same region, but without any
symptoms indicative of inflammation. This particular kind of irritu-

CAUTERIZATION. 319

tion is difficult to relieve by pharmaceutical means, but it often yields
readily enough to the abundant use of strawberries ; raspberries and
cherries produce somewhat similar, but much less active effects.

The advice given by Hippocrates, " to fatten the patient as much
as possible," is by no means opposed to the diet I have recom-
mended, for it is well known, that matters containing sugar and fe-
cula in abundance, favor the formation of fat.

Hippocrates adds, that wine should be abstained from during a
year, and I have frequently had opportunities of remarking the
wisdom of this advice. Many patients, indeed, grow abstemious as
the result of their own experience. The prohibition of wine should
include all other fermented liquors, as well as tea and coffee — indeed,
all exciting drinks. But there are cases of spermatorrhoea, arising
from irritation, in which wine may be allowed, and in these cases it
may be advantageously taken iced, or mixed with an alkaline, or
carbonated water.

In cases of well established spermatorrhoea, all excitement of the
genital organs increases the pollutions ; the patients must, there-
fore, not only abstain from coitus, but from everything which may
excite venereal desires, or lascivious ideas. Still, however, when
convalescence is advancing, very moderate sexual intercourse is ne-
cessary to relieve the overfilled seminal vesicles, and to prevent
them from again falling into a habit of involuntary contraction.

Fatigue is hurtful to patients whose pollutions arise from irrita-
tion, but moderate exercise is beneficial. Excessive mental exertion
is also to be avoided. In the milder cases of involuntary discharge,
caused by irritation, the introduction of a catheter may be sufficient,
as in cases of morbid sensibility, to modify the condition of the mu-
cous membrane.^ The remedy in the severer cases I have still to
consider, I mean cauterization of the mucous membrane of the pro-
static portion of the urethra, by means of the nitrate of silver.

Cauterization. — This operation is especially indicated in cases of
chronic inflammation, or irritation of the urethra : its results may
be considered certain when involuntary discharges follow a common
clap, or non-contagious gleet. I have also found it successful in
many cases where atony or relaxation seemed to predominate, and
in a few cases of marked nervous disorder, and congenital predis-
position. In the latter cases, however, the benefit derived from
cauterization has seldom proved permanent, though I believe that
bv changino; the condition of the tissues, the foundation has been
laid for the successful use of other means.

Before proceeding to cauterization it is indispensably necessary to
introduce a catheter, for the double purpose of taking the exact length
of the urethra, and of completely emptying the bladder. On slowly
withdrawing the instrument, during the escape of urine, the stream is

1 I have successfully treated a mild case in this manner. [II. J. M'D.]

320 TEEATMENT OF SPERMATOKRHCEA.

arrested as soon as the eyes of the catheter enter the canal, and re-
commences when they are again pushed into the bladder. The penis
being then moderately stretched, the thumb and forefinger should be
applied to the instrument at the point of the glans. When the cathe-
ter is withdrawn, the distance between the finger and thumb and its
eyes, gives the exact length of the urethra, and this must be imme-
diately marked on the porte-caustique, the eyes of the catheter being
applied to its olivary extremity, and the position of the fingers indi-
cated by fixing a little slider on the stem of the instrument. When
the porte-caustique has penetrated so far into the urethra, that this
slider touches the point of the glans — the penis being exactly in the
same state of elongation in which it was when the catheter was in-
troduced — it is clear that its olivary extremity will be in precisely
the spot previously occupied by the eyes of the catheter, when the
length of the canal was taken ; that is to say, at the commencement
of the neck of the bladder — a position which it is highly important
to the operator to be assured of.

The bladder must be completely emptied, in order that no urine
may penetrate into the tube of the porte-caustique, and that none
may enter the urethra during cauterization. When the caustic is
wetted by the urine, it acts much less energetically than if it were
dry, and its action extends to parts where it was not required. The
inflammation set up may, under these circumstances, be insufficient
to fulfil the desired object, although, at the same time, extremely
painful on account of its extent.

I need not describe the instrument I use for the purpose of cauter-
izing the urethra, as it is pretty well known to the profession. I
must, however, point out a few of the faults of those sold, by even
the best instrument makers, as my instrument. The enlargement
terminating the cuvette, is generally too round and too small. It
closes the end of the tube like a stopper, and hence it often happens
that the mucous membrane forcibly embracing the cuvette during
cauterization, becomes pinched on closing the instrument, and per-
haps portions of the membrane may be torn away on withdrawing it.
By giving the extremity of the instrument greater volume, and an
elongated olivary form, this accident is rendered quite impossible.

The diameter of this olivary body should considerably exceed that
of the tube of the instrument, because, although the operator may
judge when he is near the neck of the bladder, by the nearness of
the slider on the stem of the instrument to the point of the glans,
still it is proper that he should have a distinct sensation when the
neck of the bladder is reached. The passage of the enlarged ex-
tremity of the instrument through the sphincter of the bladder gives
this sensation very distinctly; then on gently withdrawing the in-
strument, a slight resistance is felt to the re-entrance of the bulb
into the urethra, and the operator may be certain that the cuvette
containing the caustic is in its proper position.

The cuvette and the stem which supports it, should be formed of a

CAUTERIZATION. 321

single piece of metal, because any soldering is soon destroyed by the
caustic. It is not, however, indispensable that the cuvette should be
made of platinum. I have used the same silver instrument for several
years, -without its being worn by the action of the caustic.

Very often the cavity in the cuvette intended to hold the caustic is
carefully polished ; when this is done, the caustic does not adhere
firmly to its sides, and there is danger of its escaping. The inner
surface of this cavity should, on the contrary, be as rough as possible.

The nitrate of silver must be melted into the cuvette by means of
a spirit lamp, so that it may present, when cold, a smooth and even
surface. So long as it continues rough, so as to project beyond the
level of the sides of the cuvette, the projecting portions are apt to be
broken oflf in closing the instrument, and to fall out when it is again
opened.

The patient should lie down during cauterization ; either standing
or sitting he is less fixed, and is more apt to move his pelvis suddenly
— an inconvenience which it is important to avoid ; the operator, too,
is less at his ease, and less certain as to his proceedings.

As the olivary extremity of the instrument approaches the neck of
the bladder, the irritability of the passage increases, and the patient's
agitation often becomes so great as to inconvenience the operator.
The instrument should now be allowed to pass on by its own gravity,
attention being paid to detect the moment when the olivary body
passes the neck of the bladder : as soon as this happens, the instru-
ment should be gently withdrawn — so as to bring its olivary extremity
slightly within the neck of the bladder — and firmly held in that situa-
tion, while the outer tube is a little drawn back, and the cuvette very
rapidly passed over the inferior surface of the prostate, by slightly
turning the stem attached to it; the instrument should then be in-
stantly closed and slowly withdrawn from the urethra.

In this manner the nitrate of silver reaches the prostate quite dry
in the situation where the ejaculatory ducts open. Their orifices
must, therefore, be cauterized sufficiently to produce a considerable
modification in the state of the tissues. No other parts are touched;
and hence the inflammation set up is at once both acute and cir-
cumscribed.

It must be remembered that cauterization is practised in these
cases, in order to bring on a lasting change in the condition of the
tissues, by means of active inflammation, and not for the purpose of
causing loss of substance ; and hence it is not necessary to produce
a slough. The action of the nitrate of silver should be just as rapid
as in cauterizing the conjunctiva in chronic inflammation, ulceration
of the cornea, &c. There is the same intention in both these diff'er-
ent cases, and the result obtained is of the same nature.

It is now twenty years since I first commenced the practice of cau-
terizing the prostate in cases of ancient gleet, which had resisted all
other kinds of treatment ; very soon afterwards, I applied the same
powerful means to the treatment of involuntary seminal discharges.

322 TEEATMENT OF SPERMATOKRHCEA.

Since that time I have performed the operation almost daily, and I
have never seen, in my own practice, any of the violent eifects, such
as retention of urine, hemorrhage, long-continued violent pain, nar-
rowing of the passage, &c., described by some operators as super-
vening. Indeed, I should almost doubt the accuracy of these de-
scriptions, had I not been consulted in one or two cases in which the
symptoms had been set up. Such ill effects result from the injurious
and absurd practice of some surgeons of cauterizing the urethra
during a fixed period of time, watch in hand. The time required to
glance at the second hand is more than sufiicient for appl3?ing the
caustic.

During the first days subsequent to cauterization, baths, enemata,
and diluents should be prescribed, with milk and vegetable diet, so
as to dilute the urine as much as possible. All fatigue should be
abstained from, and exposure to cold rigorously avoided. For two
or three days micturition is frequent, painful, and accompanied with
the escape of a few drops of blood. But these symptoms soon pass
off, provided no imprudence be committed, I have, however, known
the pain continue ten days or more, in patients who committed errors
of diet, or fatigued themselves too early, or who exposed themselves
to cold or damp.

These imprudences are not only injurious by hindering the rapid
termination of the inflammatory process ; they may also compromise
its results, which depend principally on the facility with which reso-
lution takes place. So long as the inflammatory stage continues, the
involuntary discharges are increased rather than diminished in fre-
quency, and sensible improvement only appears when resolution
takes place. It is seldom that we can judge of the amount of benefit
derived until the twelfth or fifteenth day, or sometimes longer, espe-
cially if a return of the inflammation should take place, when perhaps
the patient thinks himself freed from all restraint. He must be espe-
cially warned against indulging his sexual desires, although energetic
erections are sure to occur. Some unreflecting practitioners have
had recourse to a second cauterization, immediately that the severe
inflammatory symptoms of the first are dissipated, and sometimes
have performed the operation five or six times following, expecting
that the involuntary discharges would be arrested by such means.
Indeed, I have seen several patients who had been cauterized every
eight days, or even oftener, for a month or two, without other results
than obstinate irritation and stabbing pain in the neck of the blad-
der, with contraction of the urethra.

It must be remembered, that it is wholly for the consecutive re-
sults that cauterization is performed, and that these results depend
on a change which takes place in the condition of the tissues. The
curative action can, therefore, only show itself after the complete
resolution of the acute inflammation set up by the nitrate of silver.
This seldom takes place until the eighth day, and as many more
days are necessary before the required change is effected. I have

CAUTEKIZATION". 323

seen patients in whom a month and more has been required, because
the inflammation was prolonged by accidental causes. In such pa-
tients improvement commenced late, its progress was slow, and the
cure was not perfect until six weeks or two months after the opera-
tion.

In no case can we expect to find the curative effects of cauteriza-
tion manifested earlier than a fortnight at soonest, and a month must
be allowed to elapse before judging of them definitely. It is, there-
fore, absurd to attempt to set up, a second time, the inflammatory
process, before the first has had opportunity to produce its effects.
When cauterization is about to effect a cure, it soon becomes evident
by the rapid diminution of the involuntary discharges, and the steady
progress of the convalescence. It is sufficient afterwards to remove
the circumstances that might occasion a relapse, and all the functions
will soon be re-established. Exercise should be increased with the
return of strength, in order to confirm the recovery.

One operation suffices in such a case; indeed, the operation should
not be repeated, even although the patient, in hope of accelerating
his recovery, may be anxious for it. Hygienic care, travelling, and
sulphuretted waters will do the rest. A second cauterization should
only be practised when accidental causes have prevented the first
from producing its effects, and when a second application of the
caustic fails to complete the cure, it is probable that a third will have
no better success ; other means, therefore, should be had recourse to.

When cauterization only gives momentary relief too, it should
not be repeated, for a second and third would have no better
chances of success than the first. Further investigation into the
causes that keep up the pollutions, must be undertaken. Very
often, causes previously unsuspected are discovered, the proper
treatment for which, of course, must be employed.

In conclusion, I may simply record my opinion, that two-thirds of
the cases of spermatorrhoea would be beyond the reach of medical
assistance, were it not for the beneficial effects produced by the ap-
plication of nitrate of silver to the prostatic portion of the urethra.

Action of the Nitrate of Silver. — There is scarcely a tyro in surgery
who has not seen the nitrate of silver in substance, applied to fun-
gous, irritable, and bleeding ulcers ; and all well know, that the
pain caused by the application soon ceases; that the granulations
assume a more healthy aspect, and that the discharge becomes more
creamy and the sore shows a disposition to heal. It is not by de-
stroying the fungous and bleeding surface that this improvement is
effected, but by giving tone to the vessels of the part. In affections
of the skin, the nitrate also renders much service ; but it is in chronic
ophthalmia perhaps, that the rapidity of its effects is especially seen.
Before cauterization, the conjunctival mucous membrane is injected,
painful, thickened, fungoid, sometimes rough and granular. The
follicles of the lids furnish an abundant secretion of matter, and the
secretion of the lachrymal glands is much increased, and their pro-

324 TEEATMENT OF SPERM ATOERHCEA.

ducts modified, so that the discharge of tears over the cheek fre-
quently causes ulceration.

Immediately after the application of the nitrate of silver these
symptoms are exasperated; the tears especially, flow in much greater
abundance. But soon the pain lessens, and the lachrymal discharge
becomes arrested ; on the following day the injection of the eyes
becomes less evident, and for several days resolution continues its
progress, leaving the conjunctiva much paler than it was before.

The same results take place in ulcerations of the cornea.

In these cases, the nitrate of silver is merely drawn lightly and
rapidly over the diseased surface, its action not being sufficiently
continued to produce a slough.

Precisely the same phenomena occur in the prostatic portion of
the urethra, the action of the nitrate of silver being of limited dura-
tion.

In leucorrhoea too, which frequently depends on ulceration of the
neck of the uterus, cauterization with the nitrate of silver possesses
undoubted advantages over all other modes of treatment. The neck
of the uterus is red, fungoid, swollen, and more acutely sensitive
than natural ; there are often excoriations varying in extent, the
surfaces of which, when wiped with lint, generally bleed.

In leucorrhoea which owes its origin to a chronic inflammation,
sui generis^ of the lining of the vagina, attended by insupportable
pruritus, and accompanied with abundant thick, acrid, yellow dis-
charge, the nitrate of silver is often of much service. The mucous
membrane is not only red and injected, but frequently also, rough
and granular, and while general means are at the same time employed,
the application of the caustic affords a very speedy mode of relief
from many of the more distressing symptoms.

In cases of leucorrhoea too, which depend on lymphatic scrofulous
habit — in atonic cases in fact — the nitrate of silver will often arrest
the discharge, and thus remove a very serious cause of debilty, while
other means aVe taken for the permanent improvement of the system
generally.

Chronic Vesical Catarrli. — During more than fifteen years I have
employed cauterization with much success in cases of chronic inflam-
mation of the bladder. At first, like many other practitioners, I
dreaded the effects of such an agent on the mucous membrane, con-
stantly bathed by the urine, and I was frequently prevented from
having recourse to it by the terrible obstinacy of the disease. Since
that time, however, I have found cauterization cure nine-tenths of the
vesical catarrhs that have come under my care, many of which, too,
had resisted various scientific treatment for years. The cases which
cauterization failed in curing completely were much improved by it.
Cauterization should, however, only be used in uncomplicated cases :
where there is suspicion of suppuration in the kidnej^s, or of abscess
in the prostate, opening into the bladder, this treatment is contra-

CAUTERIZATION. 325

indicated. Generally a single cauterization suffices, but I have oc-
casionally been obliged to repeat the operation three or four times.

The bladder should be emptied as completely as possible, and the
same instrument should be used as in cauterizing the prostate, except
that it should be furnished with a convex cuvette. It is sufficient to
pass the caustic rapidly to the right and to the left, once only, to ob-
tain the desired result ; it is better to be obliged to repeat the opera-
tion than to excite too much inflammation.

After the operation, frequent baths must be used, with emollient
enemata, abundant diluents and rest. The inflammation passes off
very rapidly, and I have not met with one case in thirty, in which
abstraction of blood has been necessary.

When cauterization does not succeed in perfecting the cure, it in-
variably so alters the condition of the mucous membrane that the
means previously employed unsuccessfully may be used with every
prospect of success — I refer to the natural and artificial sulphuretted
waters, tar-water, and the turpentines — especially copaiba.

Deviation of the Orifices of the Ejaculatory Canals. — I have stated
that cauterization should be very rapid, and confined to the surface of
the prostate, in spermatorrhoea arising from irritation. There are,
however, cases in which involuntary discharges are complicated with
deviation of the orifices of the ejaculatory canals, and this deviation
requires a slight alteration in the mode of operating. It is no longer
necessary simply to modify the condition of the raucous membrane;
it is required to bring forward the verumontanura, which is turned
backwards. For this purpose it is necessary to produce a very small
slough in front of the orifices. Instead of the ordinary cuvette of the
porte-caustique, therefore, the instrument should be solid ; but about
fourteen lines from its olivary extremity, there should be a little ex-
cavation about large enough to hold a grain of linseed. This is to be
filled with the nitrate of silver in the same manner as before ; and
when the olivary extremity of the instrument is situated at the neck
of the bladder, the tube is to be drawn back, and the caustic al-
lowed to dissolve entirely, in front of the verumontanura. A little
slough results, and the cicatrix that succeeds it is generally sufficient
to draw forwards the orifices of the ejaculatory ducts.

326 TREATMENT OF SPERMATOREHCEA.

CHAPTER XVI.

TREATMENT OF S P E RM A T R R H (E A.

Convalescence.

In recent and simple cases of involuntary seminal discliarges,
re-establishment takes place promptly and rapidly; all the organs
successively resume their normal functions, without requiring any
further treatment on the part of the surgeon. But after severe
cases the progress from disease to health is never so simple or
rapid. The constitution, having been seriously weakened, requires
much time and attention for its repair. Beside this, habit, which
possesses considerable influence over all organs, tends unceasingly
to cause a relapse in cases of spermatorrhoea that have been of long
duration. It is, therefore, slowly and with prudence that the patient
should return to his ordinary diet and mode of life ; and there are
certain hygienic precautions which in some cases must be continued
long after the perfect re-establishment of health.

In proportion as the energy of the digestive organs returns,
more nourishing food is required, and the patients can no longer
bear the strict diet which was highly beneficial at first. The pa-
tients are also impelled by the desire of increasing their strength ;
but for this purpose it is better to permit an increased quantity of
light food, with greater frequency of meals, than to allow, too early,
a return to heavy diet that maj^ disorder the digestive organs, and
thus endanger a relapse. From vegetable diet, the patient should
proceed to fish and white meats, before having recourse to more
stimulating food.

Of course, exception must be made here, of those patients who
are troubled with ascarides, and in whom tonic and stimulating diet
is required on account of their pollutions arising from atony.

During convalescence from spermatorrhoea, arising from irritation,
a warm and damp climate agrees best, but on the other hand, when

CONVALESCENCE. 327

the disorder arises from atony or from lymphatic constitution, a dry
and pure air is required.

When the strength is so far re-established that the eifects of
cold are no longer to be dreaded, cold bathing is very useful pro-
vided the season be favorable : when reaction takes place vigor-
ously, the loss of the economy caused by it diminishes the secretion
of semen. At first the bath should consist of one plunge only, and
if the atmospheric temperature be low, two or three days should be
permitted to elapse between the baths. The length of time the pa-
tient continues in the water, should be very gradually and carefully
increased.

Exercise should be taken in proportion to the return of strength,
not only to increase the strength, but also in order that the products
of digestion may be as much as possible employed in the repair of
waste. This is the best means to prevent such materials from
proving an undue stimulus to the spermatic organs. Travelling is
highly useful after spermatorrhoea has been cured ; but in order that
the best results should be derived from it, the patient should travel
on foot. Carriage exercise favors constipation, and excites the geni-
tal organs, and horse exercise possesses both these inconveniences
in a still higher decree.

I have more than once stated that the seminal secretion is
never completely arrested in man except after long and severe ill-
nesses. The pollutions will therefore return, provided absolute con-
tinence be persevered in. Such pollutions may occur so rarely as
not to exert any injurious influence on the health ; but they may
increase by simple habit, or by the action of irresistible accidental
circumstances. In order that involuntary seminal discharges, there-
fore, should cease entirely, it becomes necessary that they should be
replaced by normal voluntary emissions. The regular exercise of
the organs, too, can alone restore to them their proper energy. This
is the case with all the organs of the body, and the generative are
by no means an exception to the general rule. In order, there-
fore, that the return to health may be durable, regular sexual intex'-
course must be established. The question now arises : when ought
such intercourse to be permitted ? The answer is : when continued
continence has become so painful as to bring on actual fatigue of
the generative organs, and when no further progress is observed in
the development of their energy. There is then danger that the
organs may lose power and fall into a state of debility from too long
inaction.

The surgeon is now consulted by the patient and his friends as
to the propriety of his marrying ; and this is one of the most
difficult questions to decide. Marriage ought not to be contracted
until the fullest proofs of a perfect and permanent return to health
has been given. The responsibility of sacrificing the happiness
of the female is to be considered seriously, as well as the possibility

328 TEEATMENT OF SPERMATOREHGEA.

of a relapse occurring to the patient, from comparatively unre-
strained indulgence during the first months of marriage. _ On this
subject, however, I think that no decided rules can be laid down ;
the matter must be left to the judgment of the surgeon, after he
has carefully considered all the circumstances affecting each par-
ticular case.

THE END.

ON DISEASES

OF THE

VESICULiE SEMINALES:

THEIE ASSOCIATED ORGANS,

WITH SPECIAL KEFEKENCE TO THE

MORBID SECRETIONS OF THE PROSTATIC AND
URETHRAL MUCOUS MEMBRANE.

HARRIS WILSON, M.D.

PEEFACE.

The reluctance shown by the medical profession to enter
upon the consideration of the affections described in the
following pages is gradually passing away; but the effect
of the want of attention to these important subjects by
those qualified to undertake their examination, which has
hitherto existed, is shown in the meagre information with
regard to the true nature and pathology of the diseases
which we at present possess.

Several of the works which have been written on the
subject are directed almost exclusively to the treatment of
the symptoms of the disease, without giving attention to
the condition of the structures whence those symptoms
proceed, and without considering the necessity of making
the functions of the affected organs a part of the investiga-
tion of their diseases.

The ground which I have selected has proved to be
unbroken in many points, more particularly in that having
reference to a system of classification. A method of
arranging the various and contradictory symptoms of sper-
matorrhoea has been much wanted, and that w^iioh I now
advance, if not entirely adopted, will, I hope, nevertheless,
lead to a better understanding of the subject.

If my views differ in some degree from the observations
of others, it is not that I have any intention of putting

332 PREFACE.

forward special theories; but that the facts and sugges-
tions expressed in these pages have risen forcibly and con-
vincingly to my mind, while contemplating the symptoms
presented by individual cases.

In submitting the following pages to publication, I have
been guided by the desire to enlarge our knowledge of the
different varieties of this distressing disease. AVhether
that object has been gained must be left to the judgment of
those into whose hands this treatise may fall, and who may
feel inclined to interpret the phenomena of spermatorrhoea
by the illustrations which it contains.

I have thouglit it undesirable to lengthen this work by
the publication of the cases, from which my opinions as to
the nature of spermatorrhoea have been deduced. But at
some future time, I may resolve to give those cases to the
profession, either in full or in abstract, founded on a careful
analysis, as may appear best suited to convey information,
when the opportunity and inducement occur.

55 Upper Charlotte Street,
FiTZROY Square.

January^ 1856.

TABLE OF CONTENTS.

CHAPTER I.

INTRODUCTORY REMARKS.

Relative dependence of the Pathological Phenomena — Method of examining

them ......

Plan proposed for investigating SpermatoiThoea

Causes of the Disease — Difficulties of Cure — Independence of Structures in

Yolved ......

Importance of this View of the Subject

Case in illustration — Removal of one Testicle — Return of the Malady

Failure of Cauterization — Removal of the other Testicle

Issues in the Perineum .....

Operation — Condition of Patient twelve months after Operation
Conclusions ... ....

Erection an evidence of the Pathological Condition of the Testicle
Necessity for Classification .....

337
337

338
338
339
339
339
340
340
341
341

CHAPTER II.

COMPOSITION OF THE SEMEN, FUNCTIONAL, CHEMICAL, AND
MICROSCOPICAL.

Source of the Component parts of the Semen . .

Relative proportions and variation ....

Chemical composition ......

Ducts of the Prostate Gland .....

Composition and purposes of the Prostatic Secretion .
Formation of Prostatic Calculi— Composition of Secretion of the
Seminales .......

Uses of the Secretion — Improbability of supposed accumulation of Scm

Distinguishing Characters of Vesicular Mucus

Fallacy of supposed accumulation shown by comparative analogy

VesiculiB
inal Fluid

341
342
342
343
343

343
344
344
345

334

CONTENTS.

Function of the Testicles — Limit of our knowledge relative to the ultimate

destination of the Semen— Spermatozoa .....
Difficulty of discovering them — Their resistance to destruction
Their physical characters — Nutrition derived from destruction of the Seminal

Fluid . . • • • ■ •

Jourdan's views on the nourishment of Human Parasites — Henle and Wagner's

observations— Propagation by gemmation .....
Donne on the Spermatozoa of the Dormouse — The Spermatophori
Koelliker's observations on the evolution of Spermatozoa — Their liability to

destruction — Earlier stages of the Spermatophori

345
345

346

346
347

347

CHAPTER III.

PATHOLOGY OF SPERMATORRHCEA.

Spermatorrhoea — Signification of the term ....
Necessity for Classification of the different manifestations of the disease

Primary division .......

Table of special Classification — Independence of healthy individual existence

on venereal influence ......

Vital energy necessary for secretion of Seminal Fluid ...
Lallemand's Classification founded on character of emissions — Nocturnal emis

sions ........

Diurnal emissions — Proposed third division ....

Laws governing Spermatozoa ......

Sthenic Spermatorrhoea of the Testicle .....

Asthenic Spermatorrhoea of the Testicle ....

Sthenic Spermatorrhoea of the Vesiculre Seminales

Asthenic Spermatorrhoea of the Vesiculre Seminales

Sthenic Spermatorrhoea of the Prostate Gland ....

Asthenic Spermatorrhoea of the Prostate Gland
Spermatorrhoea arising from conditions of the Urethra

348

349
349

349
350
350
350
351
351
352
353
354
354

CHAPTER IV

IM POTENCY.

Idiopathic Impotency Defined ....... 355

Incapacity without equivalent diseased action — Health independent of the

Function of Generation ....... 355

Impotency from imperfect Organic Development — Asthenic Impotency . 356

Principle of Treatment — Impotency remotely dependent on the nervous system,

immediately on the character of the Emissions .... 356

Imj^otency from high nervous Structural Excitement — From excitement caus-
ing Epileptic Spasm . . . . . . . 357

CONTENTS.

335

From Debility — From too precipitate or too tardy Emission
Impotency from conditions of the Urethra aflfecting the Emissions
Treatment .......

357
357
358

CHAPTER V.

CAUSES OF SPERMATORRHEA.

^Necessity for, and difBcuIty of, arriving at the true Causes of Spermatorrhoea
Constitutional Diseases which become causes — Influence on the Brain and

Nervous System .......

Division into three progressive stages .....

Indirect Sources of the Disease — Participation of other Systems of the Body

Congenital Debility — The Urethra an occasional cause .

Remote Causes existing in the Kidneys and Bladder — Irritation induced by

Diet and Medicines .......

Venereal Excesses . • .

Stricture of the Urethra — The Prostate Gland an occasional cause — Influence

of the Contractions of the Rectum ....

Condition of the Vesiculte and their Secretion ...

Simplest forms of Mechanical Irritation — Diarrhoea and Dysentery

Position of Testicles — Structural Irritation of the Vesiculse Seminales

Vesiculte Seminales the centre of diseased actions

Self-abuse and its Influences ......

Hufeland's narration of its evil effects .....

358

359
359
359

360
360

361
361
362
362
362
363
363

CHAPTER YL

SYMPTOMS OF SPERMATORRHCEA.

Necessity for an exact knowledge of exciting cause — Symptoms in a patient

afflicted with Spermatorrhoea
Constitutional and Local Efi"ects
Effects on the Brain
Hereditary tendency to Mental Derangement — Efi"ects on the Heart and Circu

lation ....

Effects on Digestion

Peculiarities of certain Local Symptoms
Symptom distinctive of A'"esicular and Prostatic Irritation — Progressive Local

Symptoms ....
Irritation of the Kidneys and Bladder .
Characters of the Urine in a well-marked case of Spermatorrhoea

366
367
368

368
368
368

369
370
370

836

CONTENTS.

CHAPTER VII.

TREATMENT OF SPERMATORRHCEA.

Objections to specifics in the Treatment of the Disease — Observation of Lalle-

mand ......... 370

Plan of Treatment . . . . . . . .371

Circumstances under wLicli Cauterization by nitrate of silver may be useful . 371
Lallemand's opinion of the specific action of caustic — Safer use of the solution

•with equivalent benefit — Mode of application of the solution . . 372
Mode of application of caustic important to its success — Introduction of the

Catheter ......... 372

Application of Cold — Cold as a Stimulant ..... 373

Use of Leeches, and local abstraction of Blood — Blisters to the Perineum —

Issue or Seton in the Perineum ...... 373

Use of Medicines internally — Ergot of Rye ..... 374

Camphor — Copaiba — Cantharides ....... 374

Sedatives for relieving pain — Hyoscyamus — Inunction of Veratrine and Bella-
donna ......... 374

Gallic Acid and Tannin — Acupuncture — Principle of Treatment . . 375
Necessity for modifying the Treatment of Constitutional Effects — Attention to

the circulating system necessary ...... 375

Abstraction of Blood — Sensibility of the Digestive System . . . 375
Remedial Indications — Regimen — Cod-liver oil , . . . .376

Necessity for ascertaining the primary cause of the Disease — Treatment of

Onanism ......... 377

Hufeland's plan of management in this Disorder .... 378

Conclusion ......... 380

ON SPEEMATOHEHffiA.

CHAPTER I.

IXTRODUCTORT KEMAEKS.

In mentally weighing the relative dependence of the various
pathological phenomena or symptoms, which attend upon a case
of spermatorrhoea, I have found it often diflScult to account satis-
factorily for the opposite cfmditions which presented themselves
during the progress of the disease. It frequently happened, that the
existing symptoms manifested but little proportion to the real and
assignable cause ; and that the cause, when discovered, might not
unreasonably be looked upon as insufficient for the production of so
extensive and so important a sequence of morbid symptoms.

With the view, therefore, of being able to comprehend fully the
series of unexpected effects of an ascertained cause which accompany
this disease, I have considered it expedient to examine, step by step,
the phenomena which present themselves during its gradual develop-
ment ; such phenomena being proved to depend on pathological
alterations in the structures involved in the production and continu-
ance of -the disease. These effects are usually presented to the
medical man only after a certain duration, and when in consequence
of their prolonged continuance they may be taken to have acquired
an existence separate from, and independent of, their original and
primary cause.

The plan I propose to follow in investigating the subject of sper-
matorrhoea, is, to take a short review of the functions belonging to
the generative system ; to compare these functions as they exist in
health with their state in disease ; to examine microscopically, the
physical condition of the secreted fluids ; and to ascertain as far as
possible the relative chemical dependencies of the generative secre-
tions. A rigorous adherence to this plan of weighing the observa-
tions furnished by the disease, will lead us, by degrees, to a complete
understanding of the intricate web of phenomena by which it is sur-
rounded, and elucidate with clearness its pathology, causes, and
symptoms. We shall thus be prepared to enter upon the difBculfc
field of treatment, with the assurance of correct views as a guide to
prospective success.

838 INTRODUCTORY REMARKS.

The disease depends for its more essential features, on the nature
of the secretion of the generative organs ; the relative amount of that
secretion ; its qualities ; and the state, whether of irritation or other-
wise, of the organs concerned in its production. We therefore per-
ceive clearly the importance of the symptoms we have to consider
and investigate.

The cure of spermatorrhoea is rendered difficult in proportion to
the number of the organs, or parts of organs, involved in disease.
Irregularities of secretion of the different organs, and excess in the
relative proportions of such secretions, constitute distinct forms of
spermatorrhoea, irrespective altogether of actual organic changes in
the structures themselves.

The semen in its healthy state is a compound fluid, and its com-
ponent parts bear a determinate proportion to each other. These
component parts are collected from different points to constitute a
mass, the varying qualities and bulk of which thus become the evi-
dence of the pathological conditions of the genital structures. Dis-
eases of these structures do not affect the general health in a like
degree, because the difference of thei'r influence in exhausting the
vital power is modified by the relative amount of excitement that
each structure exerts over the nervous system.

The importance of considering the subject in this way, struck me
forcibly, while studying the progress of spermatorrhoea in a case
where the removal of the most important of the organs of generation
— the testicles — failed in curing the disease. This circumstance first
led me to the supposition of the actual independence and separate
action of the different portions of the apparatus, and the investiga-
tions I have since made, with the view of elucidating this par-
ticular point, have fully confirmed me in the opinion. The case
throughout affords an illustration of the views I entertain, and tak-
ing it as my text, the confusion of having to refer to isolated -portions
of several other cases will be avoided. For this reason, therefore,
independent of the real interest attached to the case, 1 hope to be
excused for entering fully into its detail.

A gentleman of imaginative and excitable temperament, educated
for the medical profession, became the victim of self- abuse, brought
on by bad example at school. The practice was indulged in from
time to time until the age of twenty, and resulted in the pro-
duction of a permanent and continuous discharge of seminal fluid
from the urethra, attended with frequent spasmodic emissions.
While in this state, he fell into the hands of an irregular practi-
tioner, who, acting on the empirical and mischievous notion that
if one drug did not succeed another might, dosed him with every
possible kind of nostrum. The result of this course, as might be
expected, was a severe aggravation of the disease. He became the
patient successively of three or four medical men, without experi-
encing any relief, and then placed himself under the treatment
of an eminent surgeon, who advised exercise, to the neglect of all

INTEODUCTORY EEMARKS. 339

effective remedial treatment. Exercise as a curative medicine, proved
equally abortive, with ill-timed and ill-suited pharmaceutical reme-
dies, and he again sought surgical aid, this time selecting a gentle-
man of high standing in the profession, who recommended marriage
as the only panacea left.

Finding the methods of treatment hitherto suggested had inva-
riably a tendency to aggravate rather than to relieve his symptoms,
the idea of a complete eradication of his disease, by the removal of
the supposed source of the morbid phenomena — namely, the testi-
cles — occurred to his mind. After a good deal of persuasion, he
induced Sir Astley Cooper to undertake this operation, and the
left testicle was accordingly removed. The patient was, however,
deceived in his hope, and in a letter to me he says, " After the ces-
sation of the inflammatory action, the disease did not appear to be
in the least altered by the operation."

Being disappointed as to the result of this heroic method of treat-
ment, he submitted, under another surgeon, to the hardly less
severe operation of cauterization of the urethra ; this was repeated
several times. The employment of the caustic plan was not fol-
lowed by any useful results, nor by any alleviation of his symptoms.

Keeping his mind constantly directed to the subject, this gentle-
man became persuaded in the idea, that by sacrificing the remain-
ing testicle, he Avould certainly be relieved from a malady most irk-
some to him, and ill-requiting the advantages -of a questionable
virility. Much opposition was oifered to this proposal by the sur-
geon whom he consulted, but without changing his determination,
and his urgent request was complied with, under my observation,
in 1853. It was imagined that this operation must necessarily
prove successful, and for a few weeks, during the time that the
irritation occasioned by the wound remained, it appeared to be so.
After that time the spermatorrhoea reappeared, apparently with
the same degree of activity as before ; erections and emissions, both
nocturnal and diurnal, returned, but the ejected fluid was evidently
less in quantity, and altered in its quality. The patient's health
now became more impaired than it had heretofore been; he expe-
rienced great debility, suff'ered very much from depression of spirits,
and his mind lost its capability of concentration. He also began
to give up hope ; but always fertile in imagination, he conceived
the notion that the true seat of the disease must have been mis-
taken, and judging from certain sensations which he now experi-
enced that it was, to a great extent, if not entirely referable, not
to the testicles, as he had heretofore imagined, but to the prostate
gland.

On this supposition it was proposed to establish one or more issues
in the perineum ; a fold of skin, midway between the anus and
commencement of the scrotum, was pinched up, and transfixed by
a bistoury, and a piece of potassa fusa introduced into the wound,
and lodged beneath the skin. The effect of this proceeding was

340 INTKODUCTORY REMARKS.

Jlie formation of a slough, half an inch square, and about the same
in depth. The slough separated in ten or twelve days, discharged
freely for a time, and in a few weeks was completely healed. The
patient experienced so much benefit from this plan, that three
months later he was desirous of having the operation repeated.
An incision was made as before, but rather deeper, and posterior
to the former on the left side of the raphe. The local effect was
more extensive, but, as in the previous instance, no untoward symp-
toms resulted. A few weeks subsequently, a similar issue was
made, to the right of the raphe. The operations were almost pain-
less, being performed under the partial influence of chloroform.

It is now nearly twelve months since the last issue was entirely
healed, and the condition of the patient is thus far satisfactory.
He has gained flesh and strength ; he feels light and active; enjoj^s
exercise ; considers his mind better qualified for occupation than
has been the case for several years past ; has recovered the color
of his cheeks, and presents altogether a fresh and healthy appear-
ance. He still has .erections occasionally in the night, and some-
times in the morning. Distinct emissions continue to take place,
but at long intervals, the fluid being considerably less in quantity,
thin and transparent, and presenting no admixture of the usual
milky secretion of the prostate gland. During the whole of the
time subsequent to the formation of the first issue, he has pursued
no medical treatment, except that requisite to prepare him for the
operations ; therefore, to the latter alone must be attributed his
improvement.

This curious, and, in many points of view, very interesting case,
furnishes a means of distinguishing the separate functions of the
generative organs, of studying the influence of their morbid actions
on the general system, of diagnosing with a certain accuracy the
situation and degree of the irritation which accompanies the disease,
and the relative dependence oh each other of the various structures
involved. Whatever amount of excessive action may have disturbed
the functions of the genital organs, was not diminished by taking
away the supposed cause, but was rather concentrated with increased
intensity in the vesiculae seminales after the removal of the testicles.
And the disease, instead of being checked, became, as it were, per-
petuated by the continuance of the irritation; the vesiculse seminales
being, and becoming still more, a source of derivation of the con-
tinued and exhausting discharges. Judging from the results of the
removal of the testicles, it is evident, also, that they could not have
been the primary seat of the disease, and that the erections and
emissions arose, not from the presence of seminal fluid in them, but
from over activity in the vesiculte seminales, as is evidenced in the
return and continuance of the disease, after the cessation of the
counter-irritation following the operations.

Erection is shown by this case to be, not necessarily the result
of the presence of seminal fluid in the testicles, but to be even in-

COMPOSITION OF THE SEMEN. 841

dependent of those oro;nns. Congestion of the vessels of the penis,
and consequent erection, may arise from several different causes,
morbid or natural, and entirely independent of the functions of the
generative system. In eunuchs these phenomena are exemplifieil,
though the functional povrer of the testicles has never been present.
Erection, and a kind of modified emission, take place in them, in the
same manner as in the patient whose case I have just narrated.
Thevesiculse are subjected to the spasmodic contraction which ejects
their contents under the influence of excitement, and this, as in
the normal condition of the organs, is accompanied by a certain
amount of erection and sensation. The quality of virility is alone
lost. Questions- might arise, to which these known facts would
supply an answer of considerable importance ; for example, that the
existence of erection and emission is no proof that a disease affecting
the testicles is not therefore of a malignant character.

It is with a conviction of the necessity for a more complete indi-
vidualization and classification of the symptoms of spermatorrhoea
that I have given my attention to the elucidation of the subject. I
have endeavored as far as possible to make out the relative depen-
dence of the numerous phenomena exhibited by the symptoms of
the disease, and to show that the mere cursory examination and
treatment of a few of its prominent symptoms will hardly be likely
to lead to an alleviation of the disease, and will do little towards
establishing a scientific foundation for supporting a correct principle
of cure.

CHAPTER II.

COMPOSITION OF THE SEMEN, FUNCTIONAL, CHEMICAL, AND
MICROSCOPICAL.

The seminal fluid, or semen, when poured out from the urethra, is
a semi-opaque, starch-like, compound fluid ; sometimes yellowish, like
cream, and at other times of a greenish-white tint. It is made up of
the secretions of the testicles, vesiculse seminales, prostate gland, and
Cowper's glands, and mucus of the urethra, the latter being, as a
component principle, merely accidental ; floating in it are also to be
found a greater or less number of epithelial scales. The chief
bulk of the seminal mass consists of transparent ovoid bodies, more
dense than the fluid that surrounds them. These bodies are the
production of the vesiculee seminales, receiving their form from the
sacculi of those organs, in which they are moulded during the
progress of gradual inspissation.

In a healthy condition the secretions derived from these separate
organs bear a relative proportion to each other ; that of the vesi-
cuke seminales amounting to about four-sevenths of the whole ; that
of the testicles and vasa deferentia to about one-seventh ; and the

312 COMPOSITION OF THE SEMEN.

remainder consisting of the products of the prostate fijland, Cow-
per's glands, and mucous membrane of the urethra. The average
quantity of semen expelled at each emission is about half an ounce,
but this quantity, as well as the relative proportions of its compo-
sition is not always the same ; both depend very much on the
perfection of healthy action of the various parts whence they are
derived.

I deduce these proportions, not only from the manifest differ-
ences of quantity in the component parts of the fluid, but also from
the diminution of the secretion occasioned by the removal of the
testicles, and destruction of the other organs. The proportions are
liable to variation from the circumstance, that irritation mny arise
in one or more of the structures without affecting the others ; and
as such irritation would cause an increased secretion of a particular
kind, it is evident that the composition of the fluid must undergo a
corresponding alteration. The quantity also varies considerably with
the constitution of the individual — in one being abundant, in others
below the average, though neither state is incompatible with vigorous
health. In certain diseased states, also, there is a largely increased
secretion, depending simply upon irritable action. On the other
hand, there may be a diminution of secretion, arising from an
atonic condition of the organs, and amounting to almost complete
suppression.

The chemical composition of the seminal fluid, as ascertained by
Vauquelin, consists, according to his latest analysis, of: —

Water 90 parts.

Mucus G "

Phosphate of lime ... 3 "

Phosphate of soda ... 1 "

100
When healthy semen is first emitted it has a neutral reaction,
which appears to be due to the presence of the prostatic fluid, holding
in suspension and solution a large quantity of the phosphates of lime
and soda. While the fluid continues warm, the salts are partially
retained in solution ; but on cooling, and with slight concentration,
crystals of the compound phosphate make their appearance, either
in the form of long, transparent, colorless prisms, thick in the
middle, and tapering slightly to either extremity, or springing in
abundance from a central point, and assuming the stellate form.
The milky appearance of the secretion arises from the presence of
minute granules, which float about in the fluid in vast numbers, and
remain suspended in it by virtue of its viscidity. Tliese granules
are more or less abundant in different states of health, and rela-
tively to the activity of function of the prostate gland, and consist
of phosphate of lime without any addition of the salt of soda, on
which the greater transparency and solubility of the crystals de-
pend. The purpose of this large production of the granular phos-

SECKETION OF THE VESICUL^ SEMINALES. 313

phate of lime is, I believe, to sustain the neutral reagency of the
fluid.

The ducts, or so-called cells of the prostate gland, being lined
by the genito-urinary mucous membrane, have been considered as
furnishing a secretion identical with that membrane, and therefore
unnecessary to fecundity. The unsoundness of this opinion is evi-
dent when applied to the other gUmds of the body, inasmuch as the
lining membranes of all glandular organs are simple inversions,
variously ramified, of the same mucous membrane, but the secretions
of the various glands differ very materially from those of the parent
and adjacent mucous membrane. Glands have a peculiar secretion
accommodated to their situation and purpose; and the purpose as-
signable to the secretion of the prostate gland, although not of an
essentially fecundating nature, is one, of effecting a condition
necessary to the fecundating action of the seminal fluid. The se-
cretion of the mucous membrane of the urethra is usually acid, but
at times an alkaline reagency predominates, arising from a peculiar
pathological condition of that membrane. When either the acid or
alkaline reaction is in excess, a deterioration of the qualities of the
fecundating fluid is likely to happen, which deterioration, by de-
stroying the spermatozoa, will at the same time very probably
destroy its fertilizing quality. Conditions of excessive acid and
alkaline secretion have been shown to be not uncommon in the
mucous membrane of the vagina and uterus, and to these conditions
sterility is no doubt often to be ascribed.

The mucus secreted by the prostate gland is charged with more
or less of the phosphates of lime and soda, and it is secreted and
poured out in a situation where the peculiar properties of its neu-
tralizing salts are likely to be made available for an immediate use.
I cannot, therefore, believe that this secretion is purposeless in
reference to fertilization, or that it merely supplies an additional
portion of mucus ; nor in that situation the salts are simply the
excretion of effete matter. For these reasons, then, it appears to
me, that the special office it has to perform is that of counteracting
the injurious effects likely to arise from the presence of the abnormal
acid and alkaline conditions of the secretion of that portion of the
mucous membrane appropriated for the reception and conveyance
of the seminal fluid. Thus, though not actually taking a primary
and direct part in the act of fecundation, it nevertheless serves a
secondary office so important, as to make that function depend very
materially on its presence.

In a diseased atonic state of the prostate gland, the action of the
organ is insufficient to expel the secreted salts, and thence arises
a tendency to the formation of calculi in its cellules, marking a
peculiar condition of the mucous membrane.

The secretion of the vesiculae seminales is mucilaginous and trans-
parent, containing ovoid bodies of pure condensed mucus, floating
in a small quantity of the same mucous substance in a more fluid

344: USES OF THE VESICULAE SECRETIOIS''.

state. When mingled with the mass of the semen, these bodies
float on account of their less specific gravity. Their state of con-
densation alters, however, when the secretion is allowed to stand
exposed to the air for a few hours ; the ovoid bodies slowly dissolve,
and the resulting fluid diff'uses itself equally through the mass of
the semen, the denser matters subsiding gradually to the bottom.

A consideration of function in relation with the fact of this gra-
dual solution ofiers an interesting suggestion. It would appear as
if the vesiculiB were intended to supply a fluid of light specific
gravity, by which the vitality and freedom of the spermatozoa may
be longer sustained in their altered situation, and their presence
rendered more effective in the process of impregnation. A con-
tinuous resolution of the condensed mucus is thus made to afford a
means of preserving, during a much longer time than would other-
wise be the case, a relative condition of media favorable, if not in-
deed necessary, to the proper accomplishment of impregnation.

It is a general belief that the fluid of the testicles is continually
secreted, and that when the tubuli become overcharged, the excess
is conveyed along the vas deferens, and, passing thence by a re-
trograde current into the vesicular seminalcs, remains accumulated
there until removed by emission. There can be no doubt that the
tubuli are capable of a certain degree of expansion, and that they
are able to accommodate themselves to the amount of secretion pro-
duced at any time during a healthy condition of the organs. There
does not appear to be a necessity for supposing an accumulation
of seminal fluid beyond an amount sufficient for the nutrition and
elimination of the spermatozoa. The circumstances favorable to
its production, and requiring its presence, are such as to cause an
amount of activity suflicient for the immediate secretion of as
much seminal fluid as is demanded for the occasion, in the same
way that obtains for the secretion of other glands. Again, the
secretions of the vesiculce and testicles arc materially different in
qualities and appearance, which could not be the case were they in-
termingled in the vesiculse seminales in the manner supposed.

The distinguishing character of the testicular fluid is the presence
of spermatozoa. A carefully conducted search has never enabled
me to detect spermatozoa in the vesicular mucus ; neither does the
latter present the milky appearance which the secretion of the
testicle possesses. I am satisfied, therefore, that the opinion of
the vesiculse being receptacles for a superabundant secretion from
the testicle is erroneous. The great nervous excitability of the
testicles, placed as they are under the immediate domination of the
brain, enables thera to effect their secretion at the instant required,
that is to say, immediately before, and during the act of coition,
and to produce their proper contribution of impregnating fluid.
The onl}' appearance of accumulation is that observed in the vesi-
culjB — namely, in the amount of condensation which takes place in
the mucus while it remains in them. This is certainly evident in an

SPEEMATIC ANIMALCULES. 34-5

alteration of density, but it results, not from excessive accumulation
of the secretion, but from the inspissation always going on by exos-
mosis of its more fluid portion.

It has also been supposed that there is a constant and natural
oozing away of the seminal fluid secreted in excess, but I consider
this idea quite as improbable as the former. In cases where this loss
of secretion has been observed, it has undoubtedly been the result
of morbid action. Again, the fallacy of supposing accumulation of
testicular fluid in the vesiculae is analogically demonstrated in the
instance of the elephant, and some other animals, by the separation
of the two sets of organs, which are placed in such difl"erent positions
that no communication whatever can subsist between them.

The function of the testicles is the secretion of a slightly opaque,
whitish mucus, which fills up the tubuli of the testis, the vasa eff'e-
rentia, epididymis and vas deferens, and is the actual fertilizing
fluid jjar excellence^ requiring only conveyance to the ovule of the
female ovarium to accomplish fecundation. Of the ultimate des-
tination of this fluid, and its mode of action, our knowledge is
limited to a few facts. We know, for example, that fecundation
cannot take place in the female without it, and judging from ana-
logy, probably without its actual contact with the ovum; that a
suspension of its production in the male causes an arrest in the ca-
pability of procreation, and that the removal of the testes efl'ectually
takes awa}'' that power. Beyond these known phenomena we enter
for our explanations upon the domain of metaphysics.

Floating in the mucus contained in the tubuli seminiferi are to
be found the spermatozoa. The spermatozoa are the distinguishing
element of this secretion, and determine its identity. They exist
in more or less abundance, and as on them depends the accomplish-
ment of fecundation, so they become the proof of the conditions of
health in the generative organs. They are not present in the semi-
nal tubes before puberty, and they diminish with the failing powers
of age, attending most intim.ately on the period of virility. Under
some forms of disease they also disappear, and their absence is
characterized by impotence.

If there be few of these animalcules existing in a large mass of
fluid submitted to microscopical examination, the demonstration of
their presence is difiicult, a circumstance which may probably have
led some observers to doubt their existence. But when brought
under the eye they are easily seen, and with a comparatively low
magnifying power. Donne, in speaking of some of their character-
istic peculiarities, has drawn a distinction between them and the
infusoria (sometimes found in the urine), on which he has based a
suggestion of importance, in relation with their discovery in that
fluid in cases of suspected spermatorrhoea. After remarking on
the facility with which the infusoria are destroyed, he mentions the
remarkable power of resistance to diff"erent sources of destruction
possessed by the spermatozoa, as is illustrated by the preservation

346 SPERMATIC ANIMALCULES.

of their foi-ro after boiling, and their remaining uninjured in putrid
urine for an indefinite length of time.

The internal structure of these beings has not yet been detected
on account of their minuteness, but their outline is well defined.
The form of the body is an oblong cylinder, swelling slightly in the
middle. From the anterior part of this body projects a slight emi-
nence, which appears from its situation to be the head. The tail
is of great length, being at least ten times that of the body, and
tapers to a very acute point, the place of its junction with the body
being well marked. Whilst swimming about in the fluid, which they
do with great vigor, the tail is thrown into the waves, and the
body is made to advance by a spiral motion. They turn readily
out of the way of any obstruction, but they have not the backward
motion of vibriones. The nature of the cause and existence of these
curious beings is involved in considerable mystery, and the mode
of their propagation in the seminal tubes is not easy to explain.
The source of their nourishment, for without nourishment they could
not live, raises a highly interesting question. That they have inde-
pendent existence there can be no doubt, and that their lives may
be sustained under suitable circumstances, away from the situation
of their first production, there is abundance of evidence. They
have been found alive in the uterus and Fallopian tubes twenty days
after ejection, and yet their nourishment must be derived from the
vital fluid, and probably therefore by its constant destruction.

Jourdan, speaking of the parasites of the human body, and the
spermatozoa have an existence analogous at least to that of such
parasites, says: "In fact, as infusory animalcules appear wherever
conditions favorable to their development are present, the same
takes place in living man. The most important of these conditions
seems to be a degree, however feeble, of decomposition, such as is
observed in a normal state in the excretions, or as a pathological
phenomenon in some of the liquids of the body." [Encyclopedie
Anatomique, tome ix. p. 395.)

Henlc conceives spermatozoa to be possessed of an extraordinary
amount of vitality, for he states that he has seen motion taking place
in tails separated and lying apart from their bodies. I have often
seen separated tails, but I never detected in them any appearance of
motion. AVagner noticed [Elements of Special Physiologij) " on
one or two occasions, the caudal end of the body to be double, bifid,
or forked, and once, too, the body appeared to be double, as in a
bicephalous monster." This latter occurrence I have also seen,
and I felt at the time inclined to refer it to that mode of propagation,
known as gemmation^ so general among the polypes and infusoria.
In the single instance in which I observed this phenomenon, the
two bodies were connected together at the seat of the junction of
the body and tail. The younger, which was slightly the smaller,
was joined to the elder by a very short footstalk, and appeared to
be ready to separate. To this circumstance, namely, generation

SPERMATIC ANIMALCULES. 347

hj geraraation, as well as the fact of finding separate tails, I am
inclined to refer for an explanation of the presence of several bodies
in the seminal fluid unfurnished with tails, but nevertheless endowed
with the power of motion. Most of the species of infusoria have the
remarkable power of propagation by gemmation, as well as by ova,
and I have an impression that the same happens with regard to the
spermatozoa. I am not, however, inclined to urge this idea very
strongly, merely on the strength of a single observation, though I
consider it sufficiently worthy of attention, to justify further exami-
nation into the question. Donne has given drawings in his Cours
de Microseopie of spermatozoa taken from the dormouse, from which
it would appear that reproduction by gemmation does actually take
place.

There are other bodies met with in the seminal fluid — namely, the
spermatophori. These are supposed to be the source whence the
spermatozoa are derived, and consist of compound cells of different
magnitude, containing within them a granular substance. Koelliker
pursued the subject of the evolution of the spermatozoa through
various gradations of the lower animals, extending his researches
upwards to man. He arrived at the conclusion that the spermato-
phori are the source whence the spermatozoa are evolved, and this
evolution he has detected in the human species.

Such an investigation, however, is surrounded with difficulties,
and with no small amount of uncertainty. Wagner demonstrated
the same evolution from the spermatophori of birds. By the aid
of analogy, and on such authority, therefore, we must consider the
evidence of this one mode of reproduction of the spermatozoa as de-
termined, but there is no reason for supposing that reproduction
by gemmation may not also occur. Indeed, where such constant
change in accumulation and diminution is taking place in the quan-
tity of the semen, and the spermatozoa are thus liable to destruc-
tion, it is natural to infer that the means of their reproduction
would be secured by every safeguard that nature could supply for
that purpose.

Besides the spermatic animalcules and spermatophori, there are
also found in the fluid of the testicle, minute glistening atoms, which
have been supposed to be the earlier stages of development of the
spermatophori.

From these observations we may conclude that much has already
been accomplished towards a knowledge of the development and
purposes of these remarkable animalcules. But there are still many
points requiring more accurate elucidation, particularly the question
of structure. Some physiologists of the present day doubt even the
separate vitality of the spermatozoa. The improvements of the
microscope, and the greater distribution of that instrument, with
the necessarily increased facilities of manipulation, will however
tend by degrees to put all doubt on the subject out of the question,
and clear up all our present difficulties in respect to this interesting
physiological inquiry.

848 PATHOLOGY OF SPERMATOEEHCEA.

CHAPTER III.

PATHOLOGY OF SPERMATORRHOEA.

The term spermatorrhcBa means simply an involuntary discharge
of seminal fluid. The disease intended to be represented is more
than this, since it is characterized by a series of consecutive symp-
toms, more or less important, developed in the constitution of the
sufferer, and of which an involuntary discharge of seminal fluid is
only one, but at the same time the chief of these symptoms. It is
seldom that the malady depends merely on the derangement of a
single organ ; the different portions of the genital apparatus parti-
cipate in a general irritation, and constitute essentially the disease,
lu a state of health the genital organs have a combined dependence
on each other, and when diseased, they. are capable of exercising a
separate influence in the aggravation of particular symptoms. An
observation of the results of disease on separate parts of the genital
system leads me to conclude, that the structure and functions of each
organ may be affected independently of the rest. When a single
organ alone is deranged, the disease presents the simplest form of
spermatorrhoea.

With a complication of independent actions, it is not surprising
that symptoms Avhich arise apparently from the same cause should
assume opposite forms in certain cases. Many interesting and re-
markable circumstances of this kind have occurred to me in prac-
tice, and the necessity for determining their relative influence, and
satisfactorily referring them to their proper origin, led me in the
first place to contrive some mode of classification. With this in-
tention, I constructed the following table, which has proved of es-
sential service to me in enabling me to refer to their proper source
many of the peculiar symptoms of spermatorrhoea.

A primary division of the disease may be made into the two forms
of Tonic and Atoxic, under the designation of Spermatorrhcea
Sthenica, and Spermatorrhcea Astuexica. Following the ar-
rangement of the table, it will be seen that the sthenic and asthenic
condition of the same organ occasions in it different modifications of
the disease, in proportion as the symptoms that result are varied b}'
the peculiar influence of structure and function.

SPERMATORRHCEA STHENICA.

[Spermatourucea Extoxica — Mason Good.]

STEUCTrRE. FC.VCTrOX.

m^,^^„ n ij- f Excessive secretion ; relative deficieucv

iESTES .... Orchitis < I. J.

\ of spermatozoa.

VESict7L.E Semi- 1

> Vesiculitis .... Excessive secretion ; -with inspissation.

PATHOLOGY OF SPERMATOKKKCEA. 349

Excessive secretion ; increased amount
of salts.
Urethra . . . Urethritis .... Excessive secretion of mucus.

r E
Prostate Glaxd . Prostatitis .... \ e i^

( of salts.

SPEFtMATORRHCEA ASTHENICA.
[Speematorrhcea ATO^"ICA — Mason Good.]

STRUCTURE. FUXCTIOX.

rr„„„ „ A, i r Impotence ; watery secretion; absence

Iestes .... Atrophy . . . . \ *^„ , •' '

•* -^ I Oi spermatozoa.

' > Irritability .... Watery secretion.

^AJj£S • • • • J

■D,„ /^ />, ■ T -J J- f Diminished secretion and salts; deposit

Prostate Glaxd . Chronic Irritation . \ n , ^■ > i-

( of calculi.

Urethra . . . Ulceratioyi .... Purulent discharge.

It cannot be admitted as a necessary law of healthy individual
existence, that the organs of generation should be brought into ex-
ercise. The functions of the body may be carried on perfectly well
without their employment. On the other hand, taking society as
at present constituted, and considering the large amount of nourish-
ment usually taken into the system, it must be allowed that the
moderate use of the generative organs is perfectly consistent with
the highest degree of health. By moderate use of this function,
and by the healthful activity which accompanies its exercise, the
general system is, to a certain extent, relieved and lightened, and
the tone both of mind and body improved. The too frequently re-
peated exercise of this function, on the other hand, is apt to occa-
sion an unhealthy state of excitement of the organs, which is prone
to terminate in disease. After a time the morbid excitement, as-
suming by continuance a chronic character, takes on an action inde-
pendent of its cause, progresses gradually, and occasions a constant
secretion of seminal fluid. The exhaustion proceeding from so ab-
normal and constant a drain upon the powers of the constitution,
quickly undermines the most vigorous strength, and establishes a
state of serious disease.

The secretion of the seminal fluid, destined for the important
purpose of preserving the species, demands for its perfection, if not
the highest at least a high standard of vital energy. Its excessive
loss, for the same reason, occasions an immediate and destructive
impression on the health. This symptom, therefore, as the most
obvious, and appai-ently the most dangerous, will naturally attract
the attention of the medical practitioner, and probably induce him to
direct the entire of his efforts to accomplish its removal. Lallemand
based his system of classification on the character of the emissions,
dividing them into nocturnal and diurnal. A careful consideration
of the importance of the symptoms he has attached to each division,
shows that the idea these terms convey does not clearly define his
meaning. His arrangement resolves itself more into a question of
degree, among a certain set of symptoms, controlled by peculiar cir-
cumstances, than of diff'erence in the pathological conditions of the
structure affected.

350 PATHOLOGY OF SPEEMATOERHCEA.

Emission is nothing more than the effect of some previous condition
of stimulus or excitement. The classification of the species of sper-
matorrhoea, by the variations of this one symptom, even though that
symptom be most important, must create uncertainty as to the part
of the apparatus to which the seat of the morbid action should be
assigned. Nocturnal emissions, arising from excessive activity of
the organs, are looked upon as showing the first stage of the dis-
ease. They are attended with all the evidences of the normal state,
by erection, and by venereal ecstasy. They are to be attributed
to the reaction on the brain of the local nervous excitability, oc-
curring either during partial sleep, or in active conditions of the
imagination. Diurnal emissions, on the contrary, are marked by
an absence of venereal desire and ecstasy, by an absence of sper-
matic fluid, and an equal absence of erection, and all sthenic condi-
tion.

A division has also been proposed, characterized by emissions
occurring in the same individual both by day and night. This can-
not, however, be received as a clearly separate state, but rather as
combining the different stages of the two former conditions, or, per-
haps, more correctly, the stage of diurnal emissions accompanied
by occasional erection of the penis. But these terms, nocturnal
and diurnal, evidently do not express the conditions of the affected
parts with sufficient precision. The structural and functional dif-
ferences are capable of more exact discrimination, and are suffi-
ciently distinct to enable us to estimate the symptoms separately,
as depending, for example, on affections of the testicles, vesiculse
seminales, prostate gland, or urethra.

Before proceeding to the separate consideration of these latter
forms of the disorder, it may however be well to remark, that the
laws by which the spermatozoa are governed differ altogether from
those affecting the structures or functions. The existence of these
animalcules is independent of the functional power, independent
even, as I have already pointed out, of the place of their produc-
tion ; and they may be present or absent, for reasons quite irrespec-
tive of the healthy condition and fertilizing quality of the semen.
So long therefore as disease of the testicle produces no essential
change in the quality of the secreted fluid which affords them nou-
rishment, the spermatozoa will continue to be reproduced at about
the same average rate. As, however, the quantity of the fluid may
be largely increased by excessive action, without any material
change in its character, so will it happen that the number of sper-
matozoa in relation to the bulk of the secretion may be diminished.

SPERMATORRHCEA STHENICA TESTICUL^.

Sthenic spermatorrhoea, arising from disease affecting the struc-
ture of the testicle, is attended with inflammatory symptoms more or
less acute. The testicles are swollen and painful on pressure, a

PATHOLOGY OF SPERMATOERHCEA. 351

sense of weight extends along the spermatic cord, accompanied
usually with pains in the loins, and with all those symptoms which
constitute an ordinary attack of inflammation of the testicle, or or-
chitis. It seldom happens, however, that orchitis, originating in
this way, is attended with resolution of substance and purulent de-
position, even although the early stages of the inflammatory action
be attended by a considerable amount of severity. The function of
the testicle is greatly stimulated by the excitement, and the secre-
tion of spermatic fluid is largely increased. The peculiar influence
of this excitement is shown by erection of the penis, and emissions,
and I have observed that so long as spermatic fluid, possessing a
fecundating power, is secreted by the testicles, its emission is con-
stantly attended by erection.

SPERMATOERHCEA ASTHENICA TESTICULiE.

When the sthenic state has existed for some little time, a material
change takes place in the symptoms, with respect to structure and
function. The activity that characterized the earlier stages of the
disease gives place to a condition of atony, and loss both of sub-
stance and power ensues. This is the spermatorrhoea asthenica.
The orchitis is relieved in proportion as the structural excitement
ceases, but function is sacrificed at the same time. The testicles
begin slowly to diminish in size as their structure is absorbed, and
they become flaccid and shrivelled. The spermatic secretion as-
sumes a watery character, gradually ceasing altogether, and the
spermatozoa disappear. This condition of the function of the tes-
ticle is quickly followed by complete impotence. Severe and dan-
gerous effects to the constitution naturally accompany these changes.
The brain and nervous system, on which the testicles depend for
their activity, are continually being exhausted by eff"orts for the re-
storation of the functional power of the latter, and the constitutional
symptoms assume characters of the highest degree of irritability.

SPERMATOERHCEA STHENICA VESICUL^.

The vesiculffi seminales are differently constituted, in reference
to their morbid phenomena, to the testicles. The results of exces-
sive action in them are the direct opposite to those produced by ir-
ritation of the testicles. They have no special function to perform
dependent upon nervous influence for its completion. Their secre-
tion is only an important accessory to that of the testicles. The
injurious eff"ects to the constitution, of diseases aff"ecting them, are
seldom first shown by impressions on the nervous system. Their
irritable activity increases with the continuance of excitement, and
instead of being relieved by the excited function, they acquire a
permanence of morbid action, by which the constitution is seriously
undermined.

The sthenic state of spermatorrhoea in relation with the vesicular

352 PATHOLOGY OF SPERMATOERHCEA.

seminales is attended with in3ammatoi\y action, as shown by the ex-
citement of those organs, though this inflammation does not rise to
any high degree of intensity. I have designated this state by the
term vesiculitis, meaning thereby, an inflammatory condition of the
structure of the vesicul^. It is attended by a sensation of dull pain
or aching at the back of the bladder, becoming more painful as the
latter organ is distended with urine. The eff'ect of inflammation
on the function of the vesiculas is an excessive increase in the quan-
tity of their secretion, which escapes under almost every sudden
contraction of the surrounding muscles.

The coats of the vosiculce are thin and fibrous, and admit of an
active exosmosis. Inflammation sometimes increases this exosmosis,
and by that means the fluid portion of the secretion is more rapidly
removed, the consequence being inspissation of their contents to a
degree amounting occasionally to almost complete solidification.
When this happens to any great extent, and the cellules of the vesi-
cula3 become much distended, their structure is liable to undergo
destructive absorption.

A less degree of inflammation often occurs, by which the secre-
tion, instead of preserving its pure, transparent condition, assumes
the appearance of pus.

SPERMATORRHEA ASTHENICA VESICUL^.

After inflammation of the vcsicula; has lasted for an uncertain
time, the active symptoms gradually cease, leaving behind an atonic
or asthenic condition. This condition is associated with irritability,
in a greater or less degree, and the functional result is the produc-
tion of a watery secretion, and a gradual diminution in the quan-
tity of that secretion. Impotence may arise from this cause, with-
out an actual deterioration of the fecundating fluid of the testicle,
although it is rare for one of these diseased states to happen inde-
pendently of the other.

When the vesiculse have become distended with secretion, either
naturally or under excitement, their evacuation may be attained by
the contraction of their coats, or by the mere physical eff'ect of exces-
sive distension, by pressure from repletion of the rectum, contraction
of the levatores ani muscles, or compression of the viscera of the pel-
vis, occasionedby the position of the body, as in sitting. These efl"ects,
it is evident, may take place independently of disease, and if rarely
called into exercise, we should hardly look for serious eff"ects from
them alone. On the other hand, if the evacuation take place fre-
quently, more or less serious effects will result from its repetition,
for we may be sure, whether the cause be morbid or otherwise, that
so unnatural a mode of evacuation could not take place without the
presence of a morbid cause. The simple emission of this fluid can
have little or no effect upon the constitution of the patient, but the
debility and exhaustion which succeed are occasioned by the often re-

PATHOLOGY OF SPEEMATOEEHCEA. 353

peated nervous excitations, or efforts which are rendered necessary
for the restoration of the lost secretion. It is therefore very unwise
to consider and to treat the mere injection as the actual disease.

The nervous phenomena here referred to are not those which ac-
company a state of healthy stimulus, but are the direct effect of
that morbid state termed irritability. A continuance of this morbid
condition would lay the foundation for the destruction of the organs
themselves, and so much of the general system as might be brought
by sympathy under the same morbid influence. The muscles in
these cases become wasted, the quantity of blood diminishes, it loses
its red globules, and the digestive organs and their secretory glands
undergo a gradual but total derangement. These conditions usually
come on slowly, and without the demonstration of any very sudden
symptoms. Should they continue long, the vital power will be ex-
hausted, and the constitution laid open to the invasion of still more
acute and serious disorders.

SPERMATORRHCEA STHENICA PROSTATA.

The prostate gland is liable to numerous and complex changes,
by which the symptoms affecting it, and depending peculiarly on
spermatorrhoea, are very apt to be obscured. Like the other asso-
ciated organs, however, it is subjected to sthenic and asthenic con-
ditions ; the first of which, exhibiting all the evidences of inflamma-
tion, I have named prostatis. The structural effects of the disease
are the same as those accompanying excitement of the prostate
gland, arising from other causes. In the active form of the disease
abscess of the prostate is liable to take place, and the presence of
that affection is evinced by a discharge of purulent mucus. The
functional activity of the organ is much increased under the in-
fluence of morbid irritation, and there is a copious production of
mucus containing a superabundance of phosphatic salts. The quan-
tity of these salts varies considerably under different circumstances,
independently of alterations in the more fluid portions of the secre-
tion ; and these variations generally indicate some peculiarity in
the progress of the disease, while the immediate effect of extreme
dilution of the prostatic mucus is that of rendering its neutralizing
power insufficient for the preservation of the fecundating fluid against
the destructive reagency of mucic and other acids present in the
urethra.

Concentration of the prostatic fluid may also take place to such
an extent as to permit the formation of crystals of phosphate of lime,
which give rise to much irritation, both in the gland itself, and to
the mucous membrane of the urethra in its passage along that canal.
To this circumstance, as it appears to me, some of the forms of blen-
norrhoea may be referred ; such as that which consists in a discharge
of thick greenish yellow mucus, and is independent of any impure
origin.

354 PATHOLOGY OF SPEKMATORRHCEA.

SPERMATORRHCEA ASTHENICA PROSTATJS.

In the asthenic morbid state of the prostate gland, the effect taking
place is an irritability, which may be termed chronic, as distinguish-
ing it from the active irritability accompanying the inflammatory
condition of prostatitis. The gland loses its power of producing
healthy mucus ; the secretion becomes watery and diminished in
quantity, and the salts remain behind in the ducts, and there aggre-
gate and form calculous concretions. Chronic irritability most
generally occasions enlargement of the gland, with the production
of impediments to the free passage of urine. The symptoms indi-
cative of disease of the prostate ghmd are commonly felt in the re-
gion of the neck of the bladder, and the lower part of the rectum.

SPERMATORRHCEA URETHRA.

The mucous membrane of the urethra must necessarily have a
place in any system of classification of the common phenomena of
spermatorrhoea. It may be, and undoubtedly is, difficult to point
out positive evidences of the presence of tiiis disease in the urethral
membrane, but we must not on that account be deterred from their
investigation and consideration. There are two important and dis-
tinctive states which constitute the foundation of a classification of
the diseases of this part — namely, urethritis, and ulceration of the
mucous membrane ; the former representing the sthenic, the latter
the asthenic condition. Urethritis is attended with more or less
generally a considerable discharge from the mucous membrane, and
all the symptoms of acute inflammation. From the inflamed mem-
brane irritation may be propagated throughout the whole of the
generative apparatus, producing peculiar effects in each separate
portion.

Ulceration of the mucous membrane of the urethra indicates a
condition of depressed nervous energy, in which most of the sur-
rounding organs participate, to the destruction of their natural
sensibility.

Ilaviuii thus examined the diseased conditions of the different
portions of the genital apparatus separately, I must remind the
reader that such states of complete isolation rarely or never occur in
practice. On the contrary, it constantly happens that the whole of
the associated organs, without exception, are involved in one con-
fused assemblage of symptoms, which will require much care to dis-
entangle and distinguish with accuracy. The due reference of each
symptom to its proper source, and a knowledge of the diseased alter-
ations of each portion of the genital system, constitute in reality the
pathology of spermatorrhoea.

IMPOTENCY. 355

CHAPTER IV.

IMPOTENCY.

The subject of impotency has been partially discussed when con-
sidering the condition of the testicles, under the head of asthenia of
those organs in my table of classification. That reference was more
particularly directed to functional incapacity, resulting from altera-
tion of structure of the testicles, and consequent change in the con-
stitution of the seminal fluid, such change being induced by sperma-
torrhosa.

Impotency, such as I am now about to direct attention to, has,
however, an existence altogether independent of the above disease.
It consists in an imperfect development of the generative power, or
its partial or complete abnegation ; the former succeeding to a de-
fective organization of the apparatus of generation, the latter to an
asthenic alteration in the condition of the same parts ; the result of
the presence of these conditions being an incapability of propagat-
ing the species. This definition of the term gives a wide scope for
the introduction of collateral causes, and points out many minute
circumstances capable of exciting the malady.

The most remarkable character connected with this disease is,
that the organs of generation are rendered unfit for the performance
of their natural functions without the exhibition of an amount of
diseased action equivalent to the incapacity which succeeds. This
character appears to be occasioned by certain imperfections and
gradual alterations in structure of the parts themselves, by which
the generative function becomes arrested.

The fact which I have mentioned in a former portion of this work,
of the independence of individual healthy existence of the function
of generation, is exemplified in the perfect state of health which
may coexist with an incapability of procreation. The active per-
formance of this function demands that an amount of nervous in-
fluence should always be in readiness for the purpose of properly
developing its eff'ects ; but this nervous influence may not be called
into action. The expenditure of this influence, on the other hand,
would occasion those inroads upon the constitution, which, in sper-
matorrhoea, arise from the frequent repetition of the nervous phe-
nomena.

Imperfect organic development, as occasioning impotency,
presents us with extreme conditions, though at the same time the
states of the disease are so definite, as almost always to enable us
to form an immediate and correct judgment as to the result. Thus,
when the defective organization is the consequence of an)putation,
or serious injury to the penis, of non-evolution of the testes, or of

856 IMPOTENCY.

defect in any other of the generative organs, the nature of the case
itself forbicis every chance of success. Other itnpediraents admit
of removal, such as phimosis, incurvation of the penis from short-
eninf^ of the fi-ffinum, and partial occlusion of the orifice of the
urethra. The knife or the caustic, under such circumstances, offers
ready means of relief.

Asthenic impotency shows itself by a deficiency of power in
the generative act, and assumes gradually a state of more or less
complete incapacity for reproduction. This disease is brought on
by several causes, one of the most influential of which is a natural
diminution of power, resulting from inactivity of the generative func-
tion. It results also from exhaustion of power, following excessive in-
dulgence in a life of debauchery ; and it may be the consequence of
paralysis of the nerves of the generative organs. When impotency
arises from causes of such powerful influence over the constitution,
the treatment naturally ofl"ers considerable diflficulties, but the case
is far from being incurable.

The same phenomena sometimes follow from blows on the loins,
and from other means of concussion to the spinal cord.

The principle of treatment in this affection is very obvious. The
disease is attended with considerable loss of power, and once esta-
blished, continues to exist for that reason ; to the restoration of this
lost power, all means should be made subservient. General and
local tonics, stimulants, and the cold bath, are the modes by which
this end may be accomplished ; and though they often require con-
siderable time, they will eventually be successful when properly di-
rected, and sufficiently persevered in.

There is a set of symptoms, however, which may as effectually
prevent the continuance of the species, and therefore cause impo-
tency, as those I have named, even though the functional power may
not be wanting. These symptoms depend remotehj on circumstances
principally affecting the nervous system, and admit of treatment
usually with a fair hope of success. The immediate effects are oc-
casioned by irregularities in the character of the actual emissions.

The first of these diseases is the consequence of high nervous ex-
citement, developing itself in the structural, instead of the functional
portion of the generative apparatus ; producing, in fact, a state of
priapism. It naturally happens from this condition of the parts,
that the nervous power, which ought to have been supplied for the
stimulation of function is absorbed in the production of structural ex-
citement, and the consequence is a deficiency in emission, and there-
fore, impotency. The mode of relief in a case of this kind, is to
reduce the tendency to excitement pervading the system through the
constitution; to regulate the diet; and relieve structural excitement,
by directing its activity to another channel, through the means of
increased muscular exertion. If, as sometimes happens, the excite-
ment occurs from some abnormal local cause, it may then become
necessary to apply local remedies for its relief.

IMPOTEXCY. 357

The venereal organism in persons of great nervous irritability is
liable to cause such commotion throughout the system, and to stretch
to so high a tension the excitement of the brain, as occasionally to
induce an epileptic spasm. At the moment of such a seizure, the
continuance of other excitations would cease, and with them natur-
ally the condition of excitement, on which the act of proper emission
depends. Under such circumstances impotency follows as a matter
of course. The frequent recurrence of epileptic attacks so caused,
would place the life of a patient affected wdth them in jeopardy, and
no doubt the opportunity for such recurrence should be avoided ; at
the same time I am forced to admit that occasional indulgence in the
practice is one of the readiest modes of subduing over-excited irrita-
bility of the nervous function. The treatment of this form of impo-
tency consists in reducing the irritation of the system by depletive
measures, such as aperients, and a strict regimen.

At the same time let it be borne in mind, that due judgment must
be exercised to ascertain whether the excitement may not arise from
an entirely opposite cause — namely, from debility of constitution,
and an asthenic irritability of the generative organs inducing reac-
tion in the brain. In such a state the plan of treatment will consist
in supporting the constitution by tonic and stimulant medicines, and
reducing excessive local action by sedatives.

Two other circumstances, namely, that which arises from a too
precipitate emission, and that which arises from the opposite condi-
tion of a too tardy one, may become causes of impotency ; the former
from the emission occurring before the female orgasm, the latter
from its happening afterwards. The first of these states depends
upon a large amount of irritable excitement, so great occasionally as
to cause emission before the introduction of the penis into the vagina,
the second from deficient excitement. From the latter circumstance
it happens that no distinct emission does actually take place, but that
the seminal fluid gradually oozes away from the urethral orifice.
The nature of these cases so clearly indicates the method which
should be adopted in their treatment, that I shall be excused for not
dwelling upon them.

Another cause of impotency connected with imperfection in the
accomplishment of emission, is a condition of the urethra, by which
the seminal fluid i? prevented from issuing from its orifice, and is
made to pass backwards by a refluent action into the bladder, or in
some cases probably is not permitted to enter the urethra at all, on
account of the swelling of the ejaculatory and prostatic openings.
This state may arise from congestion of the mucous membrane of the
urethra, from irritability and spasm of the canal, or from stricture.
The treatment under these circumstances should be such as to remove
the diseased conditions of the urethra, and with them, the effects of
this form of impotency would also disappear.

I have thought it expedient to make my remarks on this subject
as concise as possible, and avoid repetition; 1 have therefore merely
2B

358 CAUSES OF SPERMATOEEH(EA.

taken a general view of the principles of treatment. Those ■which
apply to spermatorrhoea, and are more fully detailed in the chapter
on the treatment of that disease, Avill be found to be very generally
suitable to the phenomena of impotency.

CHAPTER V.

CAUSES OF SPERMATORRH(EA.

The knowledge of the precise cause of any given disease is of the
first importance to a proper understanding of its treatment and cure,
"Where the. phenomena presenting themselves are obscure, and difficult
to trace to their proper source, as in the case of spermatorrhoea, the
careful investigation of them, and of their mutual relations, becomes
an urnrent necessity. Inferences drawn from external appearances
are frequently the first and only guide to the cause of the disease.
As often happens, also, the indications of spermatorrhoea can only
be traced to their true head, through a set of symptoms, which, con-
sidered as independent diseases, would naturally be referred to a very
different origin and lead away the mind from the supposition that
disarrangement of the genital system was indeed their primary
origin. Increased difficulty also arises from the moral delicacy of the
subject, and from the disinclination that most patients suffering from
this distressing malady have to the investigation of a state of suffer-
ing, which, in their morbid fancy, is associated with degradation.

The diseases which it thus becomes necessary to look upon some-
times in the light of causes of spermatorrhoea occasionally assume
the characters of cerebral and nervous affections, of derangements
in the circulating and digestive systems, of congestions of various
organs, and excessive general and local debility. These constitutional
causes of the disease are numerous, and require judgment in their
diagnosis, from the difficulty of determining the relative proportion
of the symptoms assignable to a simple disarrangement of the func-
tion of any particular organ, and that due to primary disease of the
structure of tiie part.

The brain and nervous system are of all the organs of the body
the most susceptible of serious morbid changes originating in this
disease ; and upon them the first impression of disturbance is most
readily shown. The least dangerous but at the same time the most
persistent of these morbid conditions, is simple excitement of the
brain, developed by the most ordinary external circumstances, and
by the commonest occurrences of daily life. Excitement of this
kind increases in importance, in proportion as the mind is subjected
for a longer or shorter period to its influence. And although this
state must be considered more as a perversion of lieaUhy action
than one of actual disease, still it is better to endeavor to effect

CAUSES OF SPERMATORRHCEA. 359

its removal while in a recent stage, than to allow it to acquire a
firmer hold on the system. The symptoms now referred to depend
on congestion, which, if permitted to continue, will eventually in-
crease to a degree of extreme intensity, and assume all the characters
of threatened apoplexy. At other times the irregular distribution
of irritability will occasion serious inflammatory attacks, followed by
such an amount of exhaustion that the patient often sinks beneath
their violence ; and unless the symptoms be arrested before tliey
reach this degree of activity they are apt to proceed on to struc-
tural disorganization, and then admit of very feeble prospects of
relief.

The progress of these psychological conditions may therefore be
arranged into three stages: the first, and simplest, may be con-
sidered as merely a special tendency of the mind to erotic imagi-
nation while sleeping or waking, influencing directly the generative
system, the state of the brain being healthy ; the second embraces
the effects of congestion and inflammation, the brain being diseased;
while the third exhibits a state of paralysis, occasioned by structural
decay. Constitutional effects, therefore, in relation with the brain
may arise from any circumstance sufficiently powerful to excite
that organ into undue action ; from unchaste ideas created by the
perusal of licentious books ; from exciting passions ; from close appli-
cation to study ; from long continued attention to business. These
conditions affect the brain directly, and bear a sort of self-evidence
of their capability to produce diseased action in the genital system.
But there are other and more indirect sources whence the same
efiect is likely to arise, such as violent and excessive exercise, acci-
dental violence, or exposure to extremes of heat and cold. The
disease may in short be occasioned by anything that overstrains
the mind, or by which the bodily powers are weakened.

Such states of excitement can exist for a very short time indeed
without involving in a greater or less degree the other systems of
the body that depend for their performance on nervous activity.
One of the first among these to participate in the disorder is that
of digestion, and it soon beomes necessary to contend against the
long train of symptoms which accompany disorder of the assimi-
latincr functions. When disarrangement of the circulation, such
as is present with an apoplectic tendency, is added to these symp-
toms, it may easily be conceived that the difiiculty of diagnosis is
indeed seriously complicated.

Congenital debility is sometimes, though by no means frequently,
a cause of asthenic spermatorrhoea. When such is the case, the
malady is not very amenable to treatment, but it occasionally hap-
pens that a careful and judicious management is of essential bene-
fit, if not in entirely removing the symptoms, at least in modifying
them to a great extent, and thus irapioviug the condition of the
patient. Even those that are apparently the worst cases, sometimes
yield sufficiently to awaken hope and confidence in favor of the
steady pursuance of a proper course of treatment.

360 CAUSES OF SPERMATOEEHGEA.

The most frequent local causes of spermatorrhoea are to be found
in the urethra. Inflammation seated in its mucuous membrane,
hence communicated to the prostate gland, and giving more or less
evidence of its presence, usually precedes the same condition in the
vesiculce seminales and testes. Inflammatory attacks of this kind
are by no means unfrequent, and arise from various causes, among
•which exposure to cold is not uncommon. In that state the mem-
brane frequently takes on a disposition to active secretion, attended
with inflammation, showing itself in the form of urethral catarrh,
in the way that cold generally affects the raucous membrane; and
the inflammatory action spreads more or less rapidly to the other
contiguous structures. This condition is very different from the
urethritis and mucuous discharge, which arise as a consequence of
primary irritation of the seminal organs, occasioned by structural
disease, and independent of functional disorder.

The remote causes of spermatorrhoea sometimes take their rise
in irritation of the kidneys and bladder. The spread of inflamma-
tion from the urinary organs is direct, by virtue of the continuity
of the mucous membrane, extending along the surfaces of the semi-
nal secreting organs. The severity of the attack will be usually
found less in degree, and more easily treated, in proportion to the
remoteness of the local exciting cause.

xsext to inflammation of the kidneys and bladder, and proceeding
from actual structural disease, as a cause of spermatorrhoea, must
he arranged irritations excited in these organs, as well as in the
urethra, by the abuse of spirituous liquors, the ingestion of certain
articles of diet and particular medicines. Strong infusions of tea
and coffee, the local action of cantharides, nitrate of potass, and
camphor, naturally occur to the mind in considering a list of articles
likely to produce excitement of the genital organs, by their local as
well as by their constitutional influence on the system..

Venereal excesses are a fertile and common source of seminal
disease, but not exactly proportionate to the amount of their indul-
gence. It constantly happens that an excess which in some persons
would occasion only temporary derangement, would in others be
sufiicient to establish a permanent and exhausting discharge. Much
depends upon the natural excitability of the constitution, and much
also upon the predominant tendency to local irritations. If, com-
bined with such a constitutional susceptibility, an attack of go-
norrhoea should occur, symptoms of seminal disease more or less
complete, seldom fail to be produced. A subsidence of the active
symptoms of the disease may and usually does follow upon the dis-
appearance of the gonorrhoea, but this subsidence must not be mis-
taken for a proof of the complete restoration of the genital apparatus
to a state of health. The seminal disease requires only a certain
amount of irritation to recall it into a condition of activity. Some-
times, however, the apparent subsidence really indicates that the
disease is assuming gradually the passive or asthenic stage ; in other
words, is passing into a state of rebellious inveteracy.

CAUSES OF SPERMATORRHCEA. 361

A condition of the urethra occasioning stricture of the canal may
become an exciting cause of spermatorrhoea, and ^vhen the local in-
flammation attending it diminishes to the state usually understood
by the term atonic, the abrasion or ulceration Avhich succeeds then
continues to keep up the disease.

The prostate gland is also an occasional cause of spermatorrhoea,
either from inflammation primarily arising in the texture of the
gland itself, or from diseased action induced in it by irritation of
the urethra. It is probably not often a primary source of the dis-
ease, for reasons incident to its situation and function. When it
does become so, the effects produced on the gland are marked by
great permanence, and long after irritation of all the surrounding
organs has apparently ceased, the prostate seems to contain within
itself the elements for a recommencement of the spermatorrhoea.

A varicose state of the veins of the prostate is also conducive to
sustained irritation in the gland.

The rectum is subject to several diseases, both of a mechanical
and structural nature, and its proximity to the vesiculae seminales
naturally influences in a considerable degree the irritations which
affect those organs. The close vicinity of the intestine renders its
ordinary distension, and the contractions of the levatores ani mus-
cles, active in the production and continuance of the vesicular form
of spermatorrhoea, especially when the vesicular are more than
usually susceptible of irritation. This susceptibility excites the
function of secretion, and the pressure or muscular contractions
then cause an ejection from the urethra of a quantity of transparent
glairy mucus, immediately or soon after the passage of the feces.
The occurrence of this circumstance leads the patient to an attentive
examination of his state, and he discovers probably that it is almost
constant on going to stool. To the medical practitioner this occur-
rence will be the evidence of an undue excitement already com-
menced in the vesiculsB, which, without proper treatment, must end
in a permanently diseased action. If the vesicuise be examined by
the aid of the finger at this time, they will be found unusually tense,
and distended with secretion, and this condition is accompanied
with a sensation of dull, heavy aching pain. I have observed that
the fluid which is then emitted is generally thin and transparent.
It differs materially in its characters from urine, for which it is liable
to be mistaken, especially as there is frequently a spasmodic ex-
pulsion of the last few drops of urine from the bladder, immediately
after the passage of the feces. At the commencement of the dis-
ease, the fluid excreted during these muscular contractions contains
no spermatozoa, but after a time, when the testicles participate in
the excitement, the animalcules become numerous, and the evidence
of spermatorrhoea for that reason more distinct. When such effects
arise from simple mechanical disease of the rectum, they are gene-
rally temporary and removable, but occasionally sufficiently dis-
tressing and weakening to require careful and prolonged treatment
for preventing a relapse.

862 CAUSES OF SPERMATOERHCEA.

Amono- the simplest mechanical inducements of irritation are
collections of fecal matter in the rectum and ascarides. These,
however, present no great difficulty in their management. A vari-
cose state of the hpemorrhoidal .veins, by causing distension of the
structures around the rectum, may also have a large share in pro-
moting the conditions likely to occasion irritability of the vesiculae,
and therefore must be looked upon as a cause of spermatorrhoea.

Diarrhoea, acute and chronic, and dysentery, may also induce
excitement of the vesiculse. When the more important diseases of
the rectum become the excitants of spermatorrhoea, the treatment
is rendered particularly tedious and complicated, and the disease
will depend for its relief upon the progress of the exciting cause.
Those structural diseases of the rectum which may be admitted into
the list of causes of this disease are tumors, stricture, and scirrhus ;
and it will be understood at once that causes so persistent offer
almost insurmountable difficulties to successful treatment. Happily
these serious maladies, as causes of spermatorrhoea, are the excep-
tion and not the rule.

The position of the testicles renders them liable to accidental
violence, and they are apt, in consequence, to take on sometimes an
inflammatory action. Orchitis, or inflammation of the testicle,
arising from a blow, from sympathetic action, or from any other
cause, readily communicates its excitement to the neighboring
parts, and by the lining membrane of the vas deferens, directly to
the vesiculffi serainales. Should the inflammation assume a chronic
character and continue for any length of time, tliere is danger of
its exciting the structures permanently, and thus establishing sper-
matorrhoea.

In enumerating the list of causes of spermatorrhoea, structural
irritation of the vesicula3 seminales must not be omitted, but a purely
independent structural excitement is probably not often fixed iu
them. When such is the case, it arises in very few instances from
actual organic change. Functional excitement, on the contrary,
occurs more f?equently, and depends upon the general irritable con-
dition of the nervous system. It seldom demands much attention,
and will most probably cease entirely as the balance of nervous
energy becomes restored.

There is another point of view, however, from which the vcsiculte
seminales must be regarded in relation with spermatorrhoea, for
though not frequently subject to become the origin, they are un-
doubtedly the centre around which all the diseased actions of the
generative system are apt to congregate. Their structure and func-
tions are such as to render them not easily liable to disturbance ;
but for the same reason, when really excited into morbid action and
disarranged, it is very difficult to bring about a cessation of that
disturbance. When once sufficient irritation is established to oc-
casion spermatorrhoea, then the disease progresses independently of
the first exciting cause, kept up, indeed, by the participation of

CAUSES OF SPERMATOERHCEA. 363

the neighboring organs in the irritation. For this reason it is that
spermatorrhoea hardly ever admits of spontaneous recovery, when it
has been allowed to obtain and secure a firm hold upon the vesiculoj
seminales.

One of the most serious of all the causes of spermatorrhoea, and
one which includes in its terrible embrace both the physical power
of the constitution and the moral condition of the mind, is self-abuse.
This habit is usually contracted at an early age, most frequently
at school, and at a time when the moral power is insufficient to
oppose the contagion of bad example, or the force of violent and
precocious animal passions. Indulgence of this habit under these
circumstances ought not, in my opinion, to be classed in the list of
moral crimes, as too frequently happens, but rather in that of dis-
ease. The principal difficulty in the management and cure of this
fatal propensity is the incapability of making the patient, at an
early age, fully understand the injurious influence upon the con-
stitution or its after effects. It is not an easy matter to convince
him that he is pursuing a course that demands the very strictest
attention and counteraction to save him from the most evil conse-
quences to his health. To him the necessity for a strict resistance
is quite incomprehensible; he is practising, as he believes, a simple
sensual gratification merely, and if at any time it occurs to his mind,
that he is doing something which is wrong, the impression unfor-
tunately is so slight as scarcely to occasion him a moment's uneasi-
ness. He relies, perhaps, on his capability of giving up the habit
at a later age, before it becomes injurious to his health. In this
idea, however, he will find himself sadly mistaken. When the mind
has become morbidly directed to this subject, it is continually and
irresistibly seeking the means of reproducing its pleasurable sensa-
tions. There is no departure from the idea, every moment unoc-
cupied in bodily exertion is devoted to erotic fancies, and even sleep
is not exempt from the mental fascination. As the disease increases
in intensity, the mind wearies of any direction but the one, and
however much it may be distracted for a short time, wanders back
unconsciously to its morbid train of thought. The expenditure of
nervous energy thus carried on, rapidly wastes and enervates the
body, independently of the destruction of the function which sub-
sequently follows. It is not long under these circumstances before
permanent irritability becomes established, and the patient sinks
exhausted by all the fearful symptoms that accompany this terrible
condition of disease.

Hufeland, in his "Art of Prolonging Life," has so well and so
aptly described the effects of this habit, as influencing the duration
of life, and his description so perfectly agrees with my own obser-
vations, that I have considered it would add to the completeness of
my work to introduce his remarks on the subject in this place.

" Of all the means of hastening death, with which I am acquaint-
ed, there are none so highly destructive, and in which every baneful

064: CAUSES OF SPERMATORRHCEA.

property is so much united, as in these. None comprehend so per-
fectly all the four requisites for that purpose, which I have already
laid down ; and indeed these melancholy excesses may be considered
as the most highly concentrated process for shortening vital duration.
This I shall immediately prove.

" The first mean of shortening life was, lessening the vital power
itself. But what can more lessen the sum of the vital power within
us than wasting those juices which contain it in the most concen-
trated form, as well as the first vital spark for a new being, and the
most powerful balsam for our own blood ?

" The second manner of shortening life consists in lessening the
necessary solidity and elasticity of the vessels and organs. But it
is well known that nothing tends so much to relax, to soften, and to
corrupt, as this dissipation.

" The third manner, or more rapid consumption, can be promoted
by nothing so much as by a circumstance, which, as appears from
the example of all nature, is the highest degree of vital activity ; and
which, as before shown, is in many beings the conclusion of their
whole life.

" Lastly, proper restoration is thereby prevented in an uncommon
degree, because that rest and that equilibrium necessary for re-
pairing what has been lost are impeded, and the organs deprived of
the power requisite for the same purpose; but, in particular, because
these debaucheries have a peculiar weakening effect on the stomach
and the lungs, and thereby specifically desiccate the grand source
of our restoration.

" To this may be added the danger of imbibing, amid such irre-
gularities, that most dreadful of poisons, the venereal, against which
no one is secure who has illicit intercourse with the fair sex — a
poison which may not only shorten life, but render it also painful,
miserable, and loathsome, and of which I shall speak at more length
when I come to treat on Poisons.

'• I must here mention also several other concomitant circum-
stances which are connected with this dissipation, and among these
in particular, that of the mental faculties being weakened. It ap-
pears that between both these organs, that of the soul (the brain),
and those of generation, as well as between the two functions, that
of thinking and that of generating, the one spiritual, and the other
physical creation, there is a very intimate connection ; and that they
both re(iuire the noblest and most refined part of the vital power.
We find, therefore, that they both act alternately on each other,
and have a mutual and contrary effect. The more we strain the
mental faculties, the less vigorous will be our power of generation ;
the more we stimulate the generative power and waste its juices,
the more does the soul lose its faculty of thought, its energy, its
acuteness, and its memory. Nothing in the world can so much and
so irretrievably ruin the brightest mental talents as excess of this
kind.

CAUSES OF SPERIIATORRHCEA, 365

" It maj, perhaps, be here asked, what is meant by excess in
pliysical love ? My answer is, when either sex indulges that pas-
sion too early, before the body is completely formed — females
before the age of eighteen, and males before that of twenty ; when
this enjoyment is too often and too violently repeated, which may
be known by the following consequences: lassitude, dejection, and
loss of appetite ; when one, by a frequent change of object and cir-
cumstances, or by the artificial stimulus of spiceries, heating liquors,
and the like, excites new desires and the relaxed powers, or makes
that exertion during the time of digestion ; and, to include the
whole in a few words, when one enjoys physical love without mar-
riage ; for it is only under the matrimonial tie, which excludes the
stimulus of variety, and directs the physical propensity to a higher
moral object, that this passion can be physically refined, that is to
say, be rendered salutary and useful.

" Everything that has been here said is applicable, in an emi-
nent degree, to onanism also ; for that forced and unnatural vice
increases, in an extraordinary manner, the straining of the organs,
and the weakening connected with it ; and this is a new proof of
the principle I before laid down, that nature avenges nothing so
dreadfully as transgressions against herself. When transgressions
prove mortal, they are always crimes against nature. It is, indeed,
highly worthy of remark, that a dissipation which seems to be so
perfectly alike in all its parts should, however, be so different
in its consequences, according as it is confined to a natural or
unnatural method ; and as I am acquainted with judicious men who
cannot be fully convinced of this difference, I shall embrace the
present opportunity of showing how onanism, in either sex, does
infinitely more mischief than natural enjoyment. Horrid is the
impression stamped by nature on auch an oflFender ! He is like a
faded rose, a tree blasted in its bloom, a wandering skeleton. All
his fire and spirit are deadened by this detestable vice ; and nothing
remains but debility, languor, livid paleness, a withered body, and
a degraded soul. The eyes lose their lustre and strength ; the
pupils seem sunk ; the features are distorted and lengthened ; the
rosy complexion of youth vanishes, and the visage appears of a
pale-white leaden color. The whole body becomes afi:ected, and
sensible of the slightest impression ; the muscular power is lost ;
sleep brings with it no refreshment ; every movement is attended
with torture ; the legs can no longer support the body ; the hands
tremble ; aching pains arise in all the limbs ; the faculty of thought
is deranged, and cheerfulness is banished. The unhappy sufferer
speaks little, and as if it were only by force ; and all his former
liveliness of mind is depressed. A youth endowed by nature with
genius and talents becomes dull, or totally stupid ; the mind loses
all taste for virtuous and exalted ideas ; and the imagination is
altogether corrupted. The slightest circumstance respecting a
female is capable of exciting in him desire, shame, horror, and

366 CAUSES OF SPEKMATORKHCEA.

repentance ; and despair of his evils being cured renders his misery
complete. The whole life of such a man is a continued succession
of secret reproach ; painful sensations, arising from the conscious-
ness of having brought upon himself internal weakness ; irresolution
and disgust of life ; and it need excite no surprise that such an
unhappy wretch should at length become a self-murderer : for no
man is so much exposed to suicide as the onanist. The wasting of
that which gives life, excites disgust of life in the highest degree,
and that singular kind of self-murder par depit which is so peculiar
to the present age. Besides, the powers of digestion are destroyed;
the patient is tormented with flatulencies, and the cramp in the
stomach ; the blood becomes corrupted ; the breast is choked up
with phlegm ; and eruptions and ulcers in the skin, a desiccation and
wasting of the whole frame, epilepsy, asthma, slow fever, debility,
and premature death, are at length the consequences.

" There is another species of this vice which may be called moral
onanism ; it is possible without bodily pollution ; but it exhausts in
a dreadful manner also. I here allude to heatinfi: and fiUinir the
imagination with obscene and lascivious ideas, and a vicious and
habitual propensity to indulge in such thoughts. This evil may, at
length, become a real disease of the mind : the, imagination is then
totally corrupted, and governs the whole soul ; nothing is interesting
to men subject to it, but what relates to lewdness; the slightest;
impression of that kind excites in them a general fervor and irrita-
tion ; their whole existence is a continual fever, which weakens the
more, as it always stimulates without gratification. This state
may be found, above all, among voluptuaries who have abandoned
sensual enjoyment, but who endeavor, by such mental indulgence,
to make themselves amends, without reflecting that in its conse-
quences it is almost equally destructive ; also in religious celibacy,
where mental onanism can assume the mask of fervid devotion, and
conceal itself under the appearance of divine rapture and ecstasy ;
and, lastly, among idle persons of the other sex, who, by novels ami
the like means, have corrupted their imaginations, and excited in
them a propensity which is not unfrequently honored with the modish
name of sensibility; and who, under a stiff" and severe outside, indulge
often in the lewdest and most dissolute ideas.

" This may suffice on the melancholy consequences of such de-
baucheries, which tend not only to shorten but to embitter life."

CHAPTER VI.

SYMPTOMS OF SPERMATORRHCEA.

The symptoms which accompany spermatorrhoea are numerous,
and present appearances varying with the nature of the structures

SYMPTOMS OF SPERMATORRHCEA. 367

involved. These variable symptoms demand our careful considera-
tion and accurate judgment, for it is precisely in the states of irri-
table action, caused bj excessive or defective tonicity, that forms
of disease of a different nature simulate each other. Without an
exact knowledge of the exciting cause it is quite possible to mis-
take them, and to do a serious injury to the patient by mistaking
them, and adopting consequently a wrong mode of treatment.

A patient afflicted with sperraatorrhcea, which has endured for
some time, presents a melancholy and dejected appearance; he feels
a constant desire for change, as the mere result of restlessness, and
he exhibits a strong disinclination for exertion of every kind. The
idea of entering into and taking part in the intercourse of society is
in every way hateful to him. Seclusion, that he may dwell upon
his morbid fancies, is the one object of his care ; but this only serves
to create dissatisfaction and remorse. He is incapable of applying
his mind either to business or pleasure, and experiences a constant
and indefinable dread of something about to happen. Even in the
very commonest affairs of life he loses self-confidence. His temper
becomes irritable ; he has not unfrequently paroxysms of the most
ungovernable rage, occasionally without a shadow of reason. Con-
tradiction of his opinions, or a doubt of their irrefragibility, causes
him sudden attacks of angry violence. He suffers much from fa-
tigue and lassitude, aching in the loins, and general muscular de-
bility, especially of the lower limbs. The surface loses its healthy
color, the skin assumes a muddy appearance, the eyes become
dull and sunken, and surrounded by a dark halo ; his digestion soon
gets thoroughly out of order, the appetite assuming a remarkable
degree of capriciousness, selecting the most crude and indigestible
articles of diet, and rejecting tiie most simple and delicate food.

It is requisite to consider the symptoms of spermatorrhoea both
as to their constitutional or functional and their local effects on the
system. While a sthenic condition of the disease prevails, and is
attended with nocturnal emissions, if those emissions arise simply
from a plethoric condition of the seminal tubes, they occasion at
first no ill effects to the patient. When, however, the state of ex-
citement disappears, that of atony succeeds, and the disease then
gradually unfolds itself, altering in the first instance the functional
characters of the separate organs of the generative system, and
then extending its mischievous and dangerous influence more^ene-
rally through the constitution.

When a function so important as that of generation becomes ex-
cited into extreme and uncontrollable activity, it will not be matter
of surprise that the vital power should be drawn away from the
other equally necessary but less independent systems. The evil
consequences to the latter soon become manifest, and great organic
and constitutional disturbance folloAvs.

The function which suffers soonest from the drain on the system
is that of the brain and nerves, but it is not long before the heart

368 SYMPTOMS OF SPERMATORKHCEA.

and stomach sympathize in the derangement, and evince their parti-
cipation by several serious and ahirming symptoms.

The affections of the brain which make their appearance, and
result from the disturbance that has been set up in that organ are
indicated by giddiness and headache, the latter being principally
referable to the cerebellar region. The power of commanding
and controlling the ideas is lost, and much difficulty is experienced
in recalling the most familiar subjects of memory. There is also
considerable wakefulness, which terminates in general and extreme
physical exhaustion.

If there be hereditary tendency to mental derangement, it fre-
quentl}' happens that the cerebral excitement occasioned by sperma-
torhcEa is sufficient to cause its development. Even where there is
no such tendency, the overwhelming influence of long continued
cerebral excitement, combined with the disarrangement of the diges-
tive and secerning systems, is apt to induce hypochondriasis or some
form of monomania.

In conjunction with these indications of nervous irritability the
heart participates more or less quickly, furnishing 'unmistakable
signs of sympathetic irritation by frequent and long continued pal-
pitations. The circulation undergoes various changes, giving, in
the early conditions of the disease, evidences of congestion ; in the
advanced stages showing the effects of exhausting influences, as
fainting and general antemia. When the plethoric states predomi-
nate, the symptoms occasionally present a very severe character,
and assume so completely the appearance of apoplexy as to cause
anxiety for the life of the patient. Irritability of nervous power,
rather than fulness of blood, must however be referred to as occa-
sioning these results. The diagnosis, therefore, naturally offers
many difficulties, not merely on account of the peculiarities of the
disease itself, but also from the fact of the symptoms leading away
to all appearance from the actual cause.

Under circumstances of such constitutional disarrangement, it
cannot be supposed that digestion will be properly performed.
The digestive power becomes too feeble to assimihite sufficient nou-
rishment to preserve the strength and the bulk of the body, and a gra-
dual and progressive emaciation sets in. The epigastrium becomes
tender to the touch, and this symptom is accompanied with flatu-
lence, distension, and spermatic pains ; and all the complicated
phenomena of dyspepsia are very soon established. There is a
tendency besides to local congestion of the viscera of the abdomen,
and the action of the bowels is apt to become irregular, at one time
being obstinately constipated, at another thrown into a state of ex-
citement by a debilitating diarrhoea.

The local sjmiptoms of spermatorrhoea present many very apparent
anomalies having reference to the structural and functional pecu-
liarities of the several portions of the apparatus Avhich happens to
be affected. Neither must the effect of temperament be omitted :
for some of the more important symptoms of this disease depend

SYMPTOMS OF SPERMATOREHCEA. 369

probably as much upon tbe temperament of the individual, as upon
any other cause for their continuance. These symptoms also are
modified in their forms by the sthenic or asthenic condition of the
organs affected. One of the earliest symptoms of the complaint is
frequent erection with nocturnal emissions. This state so nearly
approaches to simple plethora, such as may exist in a healthy con-
dition of the organs, as scarcely to attract attention, except in so
far as by its constant repetition it leads on to the more decidedly
morbid stages.

Voluptuous ideas are constantly recurring in this excited condi-
tion of the organs, which no watchfulness or effort of the mind is
capable of banishing entirely, and emissions as constantly follow
after every such cerebral excitement, albeit slight in degree. When
this condition has become permanent, the patient is alarmed at
finding that his capabilities are inferior to his desires ; in fact that
there is an unaccountable debility of the genital organs at the
moment when he might have imagined his power to be greatest.
This frequently is the symptom which first arouses in his mind the
»idea that there must be some serious change taking place in his
constitution.

Along with symptoms of this kind there occurs one which I have
remarked to be very distinctive of vesicular and prostatic irritation,
and one which will be found present in almost every patient in
whom sthenic spermatorrhoea exists. It is that during coitus there
occurs a sensation of burning and smarting, as the semen escapes
into the urethra. This sensation, though a marked symptom of the
disease, is nevertheless favorable, when considered in relation to
treatment, as it is rarely experienced when the asthenic state has
become confirmed. It probably arises from an inflamed and sensi-
tive condition of that portion of the urethra situated around the
openings of the ducts, and its intensity is usually an evidence of
the actual amount of inflammation in the diseased organs.

After a continuance of the disease for some time, the emissions
not only increase in number during the night, but begin to make
their appearance also in the day, giving rise to the diurnal emis-
sions of Lallemand. The patient experiences a sensation of weight
and fulness in the rectum, with a tendency to bearing down at the
anus. There is a good deal of muscular contraction on the passage
of feces ; and during or immediately after these contractions, there
will be observed an occasional involuntary escape of seminal secre-
tion. This state of excitement gradually increases, until the pa-
tient rarely goes to stool without suffering a more or less abundant
emission, and as the disease progresses, the excitement of riding
or walking alone is sufficient to bring on the same occurrence. As
the disease advances further the erections cease ; though there still
exists an irritable condition of the vesicultB seminales, with atony
of the ejaculatory and prostatic duct. The consequences of this
atony is, that from the patent orifices ©f the ejaculatory ducts the
secretion of the seminal organs is constantly oozing. This loss

370 SYMPTOMS OF SPEKMATOREHCEA.

acts with fearful effect upon the constitution, the mental and bodily
powers diminish rapidly, and the most alarming exhaustion becomes
estnblished.

The list of local symptoms that attend on a confirmed case of
spermatorrhoea can hardly be complete without including within it
certain disarrangements that take place in the kidneys and bladder,
but which, though attendant upon the disease, may not perhaps be
considered as exclusively resulting from it. These ill effects do
however occur sufficiently often to render it necessary to include
them in the description of its symptoms. They consist of a general
excitement of the kidneys, causing them to pour out a considerable
quantity of thick, muddy, unhealthy urine ; and an irritability of
the bladder, including a frequent desire to micturate, accompanied
with heat and pain in the urethra. The frequent desire to pass
the urine becomes exceedingly troublesome, after the symptoms
have endured for a short time, especially during the night. Pa-
tients are accustomed to refer these attacks to exposure to cold.

In a well'maikcd case of spermatorrhoea, the urine submitted to
examination presented the following characters : Reaction neutral,*
appearance thick and muddy, specific gravity 1.23. Having been
allowed to stand for some time, a considerable flocculent mucous
deposit subsided to the bottom, carrying with it granular urate of
ammonia, with some crystals of uric acid. A film, which spread
over the surface of the fluid, contained stollne of the urate of am-
monia, with some dispersed crystals of triple phosphate, or ammo-
niophosphate of lime. The color of the urine, after deposition of
the sediment, was light brown. On the addition of nitric acid and
subsequent evaporation, a large quantity of nitrate of urea was ob-
tained. In other cases of spermatorrhoea in which I have made an
analysis of the urine, the contained salts consisted entirely of phos-
phates. The urine in most of these cases had a disagreeable odor,
and became rapidly putrid.

Symptoms such as these I have enumerated, are seldom met with
in practice separately, and it is not often that wc have to contend
with them in any large proportion. When, however, they do come
before us in large number, we must do our best to trace them to their
source, and determine, if possible, the causa causarum, for our
guidance to the attainment of cuie. On a correct diagnosis our
success in treatment must necessarily rest.

CHAPTER VII.

TREATMENT OF SPERMATORRHCEA.

The treatment of spermatorrhoea is deserving of our most careful
attention, and is in reality»the sole object to be accomplished by a

TREATMENT OF SPERMATORRHCEA. 371

Study of the phenomena of the disease. The scheme of chissification
proposed in the third chapter of this Essay sufficiently exposes the
error of attempting to treat the disease with specifics, since it wouhl
be more than absurd to attempt the removal of symptoms arisint^
from causes so diverse, by one uniform mode of treatment, however
great its excellencies.

The observation of Lalleraand, that "the discovery of the sus-
taining cause of spermatorrhoea is of more importance than the pri-
mary one with respect to treatment," deserves consideration in one
point of view, namely, in that which seeks to accomplish the purpose
of curing the disease without ascertaining the principles by which
the cure is to be eff"ected. The idea will, of course, bear greater
proportionate weight with those who consider spermatorrhoea as con-
sisting always of a more or less violent aff'ection of the entire of one
set of structures. It must, however, at the same time be admitted,
that a knowledge of the particular structure in which the immediate
symptoms originate, might furnish us with a very useful indication
as to the peculiar influence and direction of the sustaining cause.

A plan of treatment worthy of adoption should have a due regard
to the active or passive condition of the parts affected, not merely
so far as those conditions may be the evidences of disease, but also
in respect of their relation to the natural performance of their ac-
customed functions. In the one instance, the remedies employed
should be competent to subdue action ; in the other, they should be
calculated, eithjer by direct stimulation or counter-irritation, to pro-
mote a condition of reaction in the affected parts akin to a state of
health. Our chief endeavor should undoubtedly be, to remove the
cause of the morbid symptoms; but we must also consider that there
is usually a remote, as well as a sustaining cause, on which the per-
sistence of those symptoms may depend. The prognosis of sper-
matorrhoea is not easy. The development of the disease will be
rapid, and its duration long, in proportion to the amount of natural
constitutional excitement, and the tendency of the system to local
irritations. The results may depend materially on the natural powers
of the constitution.

I do not intend entering on the question of the applicability of
Lallemand's treatment of cauterization, to the various forms of the
disease, as arranged in my table under their proper heads. It
would appear, however, that in many of his cases the treatment
which he has pointed out as next to specific in theory, was frequently
unsuccessful in practice, and certainly does not favor the infalli-
bility of discovering and acting upon the sustaining cause alone.
The treatment by cauterization proves of the most essential service
where its employment produces the effect of a sufficiently extended
counter-irritation. It is particularly serviceable in subacute inflam-
mation of the vesicular seminales and testicle. It may be used also
with much advantage in those atonic states of the openings of the
prostatic and ejaculatory ducts, where there is a constant oozing

372 TEEATMENT OF SPEEMATOEKHCEA.

away of spermatic fluid. The effect in such cases is a certain degree
of inflammation, sometimes attended with an escape of blood; and
when this inflammation subsides, it frequently happens that the pri-
mary excitement of the organs is also subdued.

Lallemand has stated, that the application of nitrate of silver acts
only specifically when it is brought in substance into direct contact
with the openings of the prostatic and ejaculatory ducts, and that
the same benefit has not been obtained by its application in the
form of injection. The latter circumstance arises, I believe, merely
from the fact of its force being expended on the mucous membrane
of the urethra, and not being applied directly to the diseased spot.
A careful application of the solution immediately to the part aff"ected
may be made to produce an equivalent benefit, without risking
the serious effects which sometimes arise from the contact of the
solid caustic with the urethra. I am in the habit of applying a
strong solution of the nitrate to any single part of the canal by using
a curved glass syringe, a catheter in fact with an opening on the
back of the curve, near its extremity, the instrument having a small
globe of India rubber attached to its external end. Tiie opening
is made to pass over every part to which it is required to apply the
caustic solution, and a slight pressure kept up on the India rubber
globe always brings a fresh quantity of the solution to the opening.
Wherever the solution comes in contact with the mucous membrane
the nitrate will be almost immediately decomposed, and no longer
liable to produce irritation.

The mode of applying the caustic has certainly very much to do
■with its success, and is the reason probably that there have been so
many failures in its employment. When used too freely to the irri-
table mucous membrane in the neighborhood of the disease, it is
liable to occasion excessive action with severe pain, and sometimes
lays the foundation for ulceration. This might naturally be anti-
cipated from the known high degree of sensitiveness which renders
the membrane so liable to irritation. Such irritation is generally
an evidence of the degree of diseased activity in cases of sperma-
torrhoea. In whatever form, however, the nitrate is applied, the
object to accomplish, is just such an amount of action as to induce
counter-irritation, without occasioning abrasion and ulceration. On
the other hand, an insufficient application of the caustic simply
increases the existing inflammation, without efifecting any good
purpose.

The simple introduction of a catheter is also at times very
serviceable, apparently from producing, though to a less extent, a
certain amount of counter-irritation in the neighborhood of the
openings of the ducts. The pain occasioned by the introduction of
a catheter was taken by Lallemand as the test of the necessity for
the use of the caustic.

The application of cold of a sufficient intensity and prolonged
duration is often of great advantage, and when the disease depends

TREATMENT OF SPERMATORRHCEA . 373

on irritation of the testicle, can easil}'' be managed. There is much
diiBculty in applying cold of a proper degree of intensity in irritation
of the vesiculaa, on account of the depth in the perineum at which
those organs are situated. Cold may also be used as a stimulant,
through its power of inducing reaction after a short application.
Thus, it is evident that cold may be made useful in two very diiierent
conditions of the organs, but a previous discrimination of the cause
of the disease is absolutely necessary for its eifective employment.
For this reason, cold baths and douches are sometimes efficacious in
affording relief, and at other times increase the disease materially.
The same observations are applicable to the use of hot and medi-
cated baths. It sometimes happens that the most desirable results
are produced by their use, while, on the other hand, it occasionally
chances that the symptoms are not only not improved, but arc
greatly aggravated.

Whenever there are evident proofs of local inflammation, benefit
is often obtained by the application of leeches, and also by cupping.
The good effects of the abstraction of blood are, however, too fre-
quently fugitive ; indeed, are generally so, unless followed up by an
active constitutional treatment.

Blisters to the perineum occasionally prove very serviceable, and
in proportion apparently to the intensity of the inflammation which
they excite, and the amount of serous effusion which follows their
application. The objection raised against them of inducing stran-
gury, can seldom be fairly made, when they are used with care, and
removed immediately after sufficient irritation has been effected to
cause a plentiful discharge of serum. A piece of muslin, interposed
between the surface of a blister and the skin, is generally all that is
necessary to prevent this accident from occurring.

When these remedies have failed to effect a cure, a still more
severe treatment may be employed for the purpose of accomplishing
this desirable object, namely, the insertion of an issue or seton in
the perineum. In the case related in the first chapter of this
treatise, this plan succeeded perfectly. The formation of an issue
by transfixing a fold of skin in the perineum by a bistoury, is not a
very painful operation, and is far from being difficult to perform.
It may, however, be considered as one of the most effectual means
of local' treatment, on account of the extensive and permanent
counter-irritation which is excited. This proceeding must not, how-
ever, be put in practice without great caution, and it is necessary to
determine correctly beforehand Avhether the condition of the parts
affected is asthenic or sthenic.

Previously to entering upon the general constitutional treatment
of spermatorrhoea it may be as well to examine into the effects of
certain medicines, which, taken internally, pass into the blood, and
appear to exert a kind of specific influence upon the urethra and its
surrounding structures. The applicability of the peculiar properties
of these medicines to different forms of the disease has naturally
24

374 TREATMENT OF SPEEM ATORRHCEA.

given them a right to be fully considered in any system of treatment
to be recommended for spermatorrhoea.

The ergot of rye, or spurred rye, has a remarkable influence on
the organs of generation, and renders valuable service in the treat-
ment of their diseases. Of all the classes of remedies having a
power of local determination to these organs it has certainly in my
hands appeared to effect the greatest amount of good. It must not,
however, be used indiscriminately and in every form of the disease,
but only in those states Avhich are associated with an asthenic
condition. In these cases it seems to have a specific action of its
own, in restoring permanently the functions of the generative system,
and in relieving the peculiar atony which, in the cases referred to,
pervades these structures. The forms in which I have been in the
habit of prescribing it are a spirituous extract made into pills, and
an infusion of the powdered grains with camphor. The former of
these two preparations is the most convenient, but I have not always
found it so eifective as the latter.

Camphor has a great efiect in subduing excitation of the urinary
organs, and occasionally proves of much service where the disease
is accompanied with irritation of the kidneys and bladder ; but, like
the ergot, it is a remedy which does not admit of indiscriminate use.
Copaiba, turpentine, and the oleo-resins, are other useful aids, but
their employment also requires limitation, and they are probably
most suitable where the disease has originated in syphilitic irritation
of the raucous membrane of the urethra.

Many objections have been raised against tlie use of cantharides
in this disease, some even contending that as an internal remedy it
should be totally abandoned ; but I do not give my assent to this
opinion without further consideration of the matter. In the atonic
forms of the disease its use is often advantageous, and it certainly
has a special influence over the bladder and urethra that no other
medicine possesses ; but like, and perhaps more than all other reme-
dies, it requires that the particular cases to which it is applicable
should be distinctly ascertained.

When, as sometimes happens, the inflammatory conditions of the
organs are attended with pain, especially when the exciting cause is
referable to the bladder, sedatives may be administered with advan-
tage. The best sedative for the purpose is hyoscyamus, because it
has no tendency to confine the bowels, and because its employment
is unattended with the excitement which follows the exhibition of
opium ; for this reason it is also preferable to most other narcotics.
The addition of a small quantity of ipecacuanha, by arresting in
some degreee the rapidity of the circulation, renders a smaller por-
tion of the sedative capable of producing the desired eff'ect.

Occasionally the pain increases to such an extent, and appears to
be so slightly controlled by constitutional means, as to require a
local application. Under these circumstances, the inunction of vera-
trine and belladonna to the perineum has often the eftect of subduing

TREATMENT OF SPERMATOREHCEA, 375

action and relieving pain, when other modes of treatment have proved
unavailing.

Gallic acid and tannin, on account of their power of arrestinrr ex-
cessive mucous secretion, are useful remedies in this disease, and
can be employed to produce their effects constitutionally or by local
application.

I must not pass over another local remedy, namely, acupuncture,
without a remark, since it has been highly extolled and recommended
by Lallemand for the relief of spermatorrhoea. I have had the
opportunity of applying it in two cases only, but in both v/ithout
success. Lallemand's plan consists in transfixing the prostate gland
with one or two fine long needles, the stimulus excited by their pre-
sence being intended to relieve the morbidly irritated portions of the
genital apparatus, as in other forms of counter-irritation.

From the list of remedies I have here detailed, the principle of
treatment will be distinctly perceived. There are, of course, prac-
tical suggestions that will arise, and present us with reasons for
modification, in every case, and by these v/e must be guided in our
selection of the most appropriate plan.

The same general observation bears a more important application
in the management of the constitutional evidences of the disease.
To the different kinds of spermatorrhoea, excitement of the brain and
nervous system contributes a very serious complication. Symptoms
of this nature require to be treated by the avoidance of all stimulat-
ing food, by following a cooling regimen, and paying careful atten-
tion to the bowels. When the nervous disorder arises from a reaction
of the excitement of the generative system on the brain, it will be
necessary to adopt local, in addition to constitutional, measures. A
morbid condition of the brain is sometimes established, which de-
pends for its continuance on the accumulation of a large amount of
nervous irritability. This may be relieved most effectually by in-
creased natural stimulus given to the mind, the direction of the
thoughts being turned into a train different from its ordinary course ;
or, better still, by the occupation of vital force in active muscular
exertion.

The circulating system in cases of spermatorrhoea demands much
attention, as many grave symptoms indicating serious disturbance
of the heart and large vessels are apt to arise. These attacks, though
depending essentially upon the progress and activity of the original
disease, nevertheless place the life of the patient in jeopardy by their
own peculiar violence. Symptoms of this kind appear to be of so
much vital importance, and it is so difficult to separate them from
the supposition of structural disease of the parts affected, that they
are very likely to deceive both patient and physician, as to the true
point whence they take their origin. If the patient should be of a
full plethoric habit, with a tendency to cerebral attacks, it will be
expedient to remove blood, in quantity proportioned to his general
powers or the activity of the disease. This, however, must be done

876 TREATMENT OF SPERMATORRHffiA.

■with caution, as the symptoms occasioned by irritable nervous action,
resulting from excitement of the genital organs, resemble, in a re-
markable degree, those produced by an entirely different cause. As
a general rule, instead of diminishing power by abstracting blood,
the opposite course must be pursued, of supporting the constitution,
and enabling it to meet the constant drain upon its vital resources.

The digestive function is extremely sensitive to exhausting influ-
ences existing in the system. In the early stages of spermatorrhoea,
when the symptoms indicate plethora of the testicles and vesiculiB
seminales, the unloading of these organs by emission of their secre-
tions tends to increase the appetite and promote activity in the per-
formance of digestion. If this mode of relief be too often repeated,
it induces an opposite efl'ect on the system, namely, irritability of the
stomach. This organ becomes incapable of retaining sufficient food
for the necessities of nutrition, and the power of assimilation is also
lessened. It then naturally follows that the strength and substance
of the body waste with rapidity.

The remedial indication, in such a condition as that I am now
describing, is to corroborate the constitution by tonic medicines,
such as quinine, gentian, the mineral acids, steel, and to these may
be added a regulated use of ordinary dietetic stimulants. A strict
regimen should be enforced, but with a reasonable amount of light
and digestible food. Care must, however, be taken to avoid the
use of spices, and of everything likely to irritate the stomach or
occasion indigestion. An excellent means of supporting the con-
stitution under the emaciation that usually follows an attack of this
disease is presented to us in a medico-alimentary substance, which
• has of late years come much into favor, namely, cod-liver oil.
Probably no dietetic preparation could be proposed more likely to
be serviceable in spermatorrhoea. The oil is not admitted into the
treatment with any supposed special medicinal quality, but offers
us a concentrated article of diet as a means of nourishment superior
to most others we are in the habit of using. It should be taken
directly after a meal, twice or thrice a day. In this way it will be
brought in contact with the absorbing and assimilating apparatus,
when in their most active conditions. It is readily absorbed into
the system, and rapidly supplies the wasting body with nourish-
ment.

The chief objection which may be raised against cod-liver oil is its
aptness to occasion nausea, a circumstance which arises partly from
the weakened powers of digestion, and partly from the large quantity
usually thought necessary to be administered. The objections to
this remedy are, in many instances, got over by a preparation which
I have found of great value, namely, the cod-liver oil of chocolate.
It is composed of the purest oil, carefully combined with chocolate
in its most agreeable shape. To cover the odor and taste of the oil
as completely as possible, various essential oils can be added to the
chocolate, by which means it becomes a pleasant article of diet.

TREATMENT OF SPERMATOKEHCEA. 377

Prepared in this -u-ay, the oil is much less likely to occasion nausea,
or otherwise to interfere with the delicate digestion that patients
suftering from spermatorrhoea are so liable to experience. The
division of the particles of the oil by chocolate, itself a highly
nourishing substance, renders the compound very easy of assimila-
tion by the system.

It will be gathered from the remarks I have thus made on the
constitutional effects of spermatorrhoea, that whatever be the method
of treatment which may appear most fit for adoption under particu-
lar circumstances, or whatever the urgency of the symptoms that
may arise, I consider the primary cause of the disease ought to be
sought after with diligence. In no complaint perhaps is it more
difficult to understand the complication of disease which is likely to
occur from the commingling of symptoms as they are derived from
their various sources.

The treatment of onanism demands more than common care, on
account of the serious injury it causes to the strength and constitu-
tion of the sufferer. It arises usually at an age and under circum-
stances in which it is unlocked for and unexpected ; and previous to
its discovery has often obtained a hold on the individual that renders
it more than usually rebellious to treatment. When the habit is
once contracted, there is every inducement in the sensations of the
patient to pursue it. This habit originates when the mind is not
sufficiently developed to comprehend its fatal tendency. When the
practice is discovered, the patient should be watched ; he should not
be left alone ; and all opportunity of solitary seclusion prohibited.
Careful attention must be paid to diet, and to the regulation of
general health. A proper amount of muscular exercise, verging
even on fatigue, is to be taken, and for this purpose gymnastic exer-
cises are the most appropriate. The mind should be directed to in-
teresting and absorbing occupation, as far away as possible from its
morbid feelings. It is a prevailing idea that the disease will prove
of easy self-correction when the mind begins to comprehend the
degradation of the habit ; and that as the child becomes older, he
will leave off the practice of his own accord. Nothing can be more
fallacious than this supposition, and the reverse is more generally
the case ; the demand for the peculiar excitement becomes more
urgent, and the moral disgrace lessens in his own eyes in proportion
as the practice acquires an ascendency over the mind. The endea-
vor to stay its progress cannot, therefore, be too prompt or too
energetic. With very inveterate cases, it will be found expedient to
blister the penis and neighboring surfaces, in a way to render the
continuation of the practice exceedingly painful. This plan is often
a means of entirely checking the disease, since it causes sufficient
pain and smarting to awaken the patient when he is unconsciously
pursuing the habit during sleep.

When spermatorrhoea arises from the habit of masturbation, of
which it is commonly the consequence, the most important thing to

378 TREATMENT OF SPERMATORRHCEA.

be accomplished is the removal of the cause. It is quite evident
that little can be attempted in the way of treatment until that has
been attained. To a certain extent it will be self-relieved more
especially in the advanced stages of atony, occasioned by the con-
stant practice of the habit. The system to be pursued, therefore,
for remedying the early stages of spermatorrhoea so contracted, is
precisely the same as that advised for counteracting the evil influ-
ences of masturbation.

Treating on this subject, Hufeland, to whom I have already had
occasion to refer, has laid down a set of rules so applicable to the
plan in view, that I feel no apology necessary for transcribing them.
Speaking of early life, and the evil habits sometimes acquired at
schools, he says : —

"To this period belongs also a very important point in regard to
physical education — the guarding against onanism; or, rather,
guarding against too early a propensity to amorous enjoyment.
As this evil is one of the most certain and most terrible of those
means which shorten and derange life, as has been already shown,
I consider it my duty to speak a little more expressly of the me-
thods that ought to be employed to counteract it. I am fully con-
vinced that this vice is exceedingly common and highly destructive
to human nature ; but that where it has once become habitual it is
very difficult to be eradicated. People also ought not to imagine
that the principal helps against it are to be found in nostrums and
specifics, which generally are employed too late ; but that the grand
object is to prevent onanism altogether, and that the whole art and
secret consists consequently in guarding against too early an ex-
pansion and excitement of the propensity to amorous indulgence.
This is properly the disease with which mankind are afflicted at
present, and of which onanism is now the consequence ; for this
disease may exist in the seventh or eighth year, before onanism
takes place. But it is necessary to pursue early measures for pre-
venting the latter, and to attend, in this respect, not to single points,
but to the whole education in general.

''According to my observations and experience, the following,
when properly employed, are the most certain means to subdue this
pestilence of youth.

" 1. One must beware, from the beginning, not to give a child
strong, stimulating, nutritive food. Many, indeed, when they in-
dulge their children very early with flesh, wine, coffee, and the like,
do not reflect that they are thereby laying a foundation for a ten-
dency to this vice. These stimulants, given so soon, hasten, as I
have already shown, expansion of the organs. It is, in particular,
hurtful to allow children at night, meat, hard eggs, spiceries, or
puffing things, such as potatoes, which, in this way, have a very
powerful effect.

"2. Washing with cold water daily, as already mentioned ; the
use of free air and light clothing, particularly of the private parts,

TREATMENT OF SPERMATORRHCEA. 379

are also of importance. Close warm breeches often tend to promote
this premature expansion ; and it is therefore a good rule to give
children, during their first years, a loose under-frock, and not to
suffer them to wear breeches till a more advanced period.

" 3. Do not permit them to sleep on feather beds, but on mat-
tresses ; do not let them retire to rest till they are heartily tired
with exercise, and cause them to get up early in the morning.
Lolling in bed in the morning, between sleeping and waking, par-
ticularly under warm bedclothes, is one of the greatest causes of
onanism, and ought never to be suffered.

" 4. Give them sufficient exercise daily, so that their natural
stock of vigor may, by muscular motion, be employed and exhausted ;
for, when a poor child is kept sitting the whole day, and its body
retained in a passive state, is it to be wondered at if its vigor, which
will and must have vent, should assume that unnatural direction ?
Let a child or youth daily exercise his vigor in the open air, by
running, jumping, &c., and I engage he will never fall into the
detestable vice of onanism. It is peculiar to a sedentary educa-
tion, in schools and other seminaries, where exercise is confined to
half hours.

" 5. Let not the powers of thought and sensation be strained too
early. The more these organs are refined and brought to perfec-
tion, the more tendency will the body have to onanism.
• " 6. One should be particularly cautious in regard to all dis-
course, writings, or circumstances which might tend to excite such
ideas, or turn the attention of children to certain parts. It will
be highly necessary to divert them from these by every means pos-
sible ; but not in a manner recommended by some, that is, making
these parts interesting to them by explaining their nature and use.
The more their attention is drawn to these, the sooner, without
doubt, can they be acted upon by any stimulus ; for internal atten-
tion to any point (internal contact) is as good a stimulus as external
contact ; and I agree, therefore, with the ancients, that the organs
of generation should not be mentioned to a child before the age of
fourteen. Of that for which nature has not as yet organs they
ought to have no idea, otherwise the idea may call forth the organs
before the proper time.

" One, also, must keep at a distance plays, romances, and poems,
which may have a tendency to excite such sensations. Nothing
should be allowed that may inflame the imagination of children, or
lead to lascivious ideas. Great mischief has been occasioned to
many by reading some of the old poets, or the study of mythology;
and for this reason, it would be much better to begin a child's
education with the study of nature, botany, zoology, economy, &c.
These subjects can awaken no unnatural propensity, but preserve
the thoughts pure, and therefore will act rather as an antidote to
anything of the kind.

" 7. One ought to watch, with the utmost care, over nursery-

380 TREATMENT OF SPERMATORRHCEA.

maids, domestics, and others, that they may not ignorantly foster
the first germ of this dissipation, as is too often the case. I have
met with some instances, where children became onanists merely
throuo-h the nursery-maids, who, when they cried and would not
sleep, knew no other method of soothing them than to sport Avith
their privities. The sleeping together of two ought also never to be
suffered.

" 8. If, however, notwithstanding all these precautions, this un-
happy propensity should be excited, one ought, above all things, to
inquire whether it may not be owing rather to disease than to
viciousness, to which hiost of those intrusted with the care of edu-
cation pay too little attention. All diseases, in particular, which
occasion great irritability in the abdomen, if they are combined
with an extraordinary sensibility of the nerves, may give rise to
this vice, as I know from experience. Of this nature arc worms,
the scrofula, and plethora of the lower belly, whether it be the con-
sequences of too heating food, or of too much sitting. When there
is any suspicion, therefore, of this being the case, one must always
begin by removing the bodily cause. Let the unnatural sensibility
of the nerves be subdued by strengthening medicines, and without
any other helps one may cure this propensity to onanism, or too
great irritability of the organs of generation."

Before concluding, I would remark, that in cases of spermator-
rhoea, from whatever cause arising, when by proper treatment th-e
patient has been restored to a state of health, no inconsiderable
amount of care is requisite for some time afterwards, for the purpose
of preserving him in a sound state. When once the important
functions of generation have suffered disarrangement, the liability
to a return of the disease is very great. However, with a judicious
plan of diet, exercise, pure air, and mental occupation, the disposi-
tion to disease will be finally subdued, and the patient may enjoy
the remainder of life free from every symptom, and even from a
dread of the return of so distressing a malady.

THE END.

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CONTENTS.

Introduction.

PART 1.— GoNORRHCEA AND ITS COMPLICATIONS.— CHAPTER I. Urethral Gonorrhoea in the Male.
II. Gleet III. Balanitis. JV. Phymosis. V. Paraphymosis. VI. Swelled Testicle. VII.
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X. Gonorrhipal Ophthalmia. XI. Gonorrhceal Rheumatism. XII. Vegetations. XIII. Stric-
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PART II. — The Chancroid and its Complications: Syphilis.— Chap. I. Introductory remark"?.
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Gummy Tumors. XI. Syphilitic Affections of Alucous Membranes. XII. Syphilitic Aft",;ctions
of the Eye. XIII. Syphilitic Aflections of the Ear. XIV. Syphilitic Orchitis. XV. Syphilitic
Afl^ections of the Muscles and Tendons. XVI. Syphilitic Aflections of the Nervous System.
XVII. Syphilitic Aflections of the Periosteum and Bones. XVIII. Congenital Syphilis.

BARCLAY (A. W.), M. D.,

Assistant Physician to St. George's Hospital, &c.

A MANUAL OF MEDICAL DIAGNOSIS ; being an Analysis of the Signs

and Symptoms of Disease. In one neat octavo volume, extra cloth, of 424 pages. $2 00. (LcUdy
issued.)

The task of composing such a work is neither an
easy nor a light one ; but Dr. Barclay has performed
it in a manner which meets our most unqualified
approbation. He is no mere theorist; he knows his
work thoroughly, and in attempting to perform it,
has not exceeded his powers. — British, Med. Journal,
Dec. 5, 1857.

We venture to predict that the work will be de-
servedly popular, and soon become, like Watson's
Practice, an indispensable necessity to the practi-
tioner. — JV. A. Med. Journal, April, 1858.

An inestimable work of reference for the young
practitioner and student. — Nashville M»d. Journal,
May, 1858.

We hope the volume will have an extensive cir-
culation, not among students of medicine only, but
practitioners also. They will never regret a faith-
ful study of its pages. — Cincinnati Lancet, Mar. '58.

An important acquisition to medical literiture.
It IS a work of high merit, both from the vast im-
por:ance of the subject upon which it treats, and
also from the real aDility displayed in its elabora-
tion. In conclusion, let us bespeak for this volume
that attention of every student of our art which it
so richly deserves — that place in every medical
library which it can so well adoru. — Peninsular
Medical Journal, Sept. 1858.

BARLOW (GEORGE H.), M. D.

Physician to Guy's Hospital, London, &c.

A MANUAL OF THE PRACTICE OF MEDICINE. With Additions by D.

F. CoNDiE, M.D., author of "A Practical Treatise on Diseases of Children," &c. lu one hand-
some octavo volume, leather, of over 600 pages. $2 75.

will be found hardly less useful to the experienced
physician. The American editor has added to the
work three chapters — on Cholera Infantum, Yellow
Fever, and Cerebro-spinal iMeningitis. Tliese addi-
tions, the two first of which are indispensable to a
work on practice destined for the profession in this
country, are executed with great judgment and fi-
delity, by Dr. Condie, who has also succeeded hap-
pily in imitating the conciseness and clearness of
style which are such agreeable characteristics of
the original book. — Boston Med. and Surg. Journal.

WerecommendDr. Barlow'sManualin the warm-
est manner as a most valuable vade-mecum. We
have had frequent occasion to consult it, and have
found it clear, concise, practical, and sound. It is
eminently a practical work, containing all that is
essential, and avoiding useless theoretical discus-
sion. The work supplies what has been for some
time wantingj a manual of practice based upon mo-
dern discoveries in pathology and rational views of
treatment of disease. It is especially intended for
the use of students and junior practitioners, but it

BARTLETT (ELISHA), M. D.
THE HISTORY, DIAGNOSIS, AND TREATMENT OF THE FEVERS

OF THE UNITED STATES. A new and revised edition. By Alonzo Clark, M. D., Prof,
of Pathology and Practical Medicine in the N. Y. College of Physicians and Surgeons, &c. In
one octavo volume, of six hundred pages, extra cloth. Price $3 00.

stood deservedly high since its first publication. It

It is a work of great practical value and interest,
containing much that is new relative to the several
diseases of which it treats, and, with the additions
of the editor, is fully up to the times. The distinct-
ive features of the different forms of fever are plainly
and forcibly portrayed, and the lines of demarcation
carefully and accurately drawn, and to the Ameri-
can practitioner is a more valuable and safe guide
than any work on fever extant. — Ohio Med. and
Surg Journal.

This excellent monograph on febrile disease, has

will be seen that it has now reached its fourth edi-
tion under the supervision of Prof. A. Clark, a gen-
tleman who, from the natur* of his studies and "pur-
suits, is well calculated to appreciate and discuss
the many intricate and diflicult questions in patho-
logy. His annotations add much to the interest of
the work, and have brought it well up to the condi-
tion of the science as it exists at the present uay
in regard to this class of diseases. — Southern Med.
and Surg. Journal.

BLANCHARD & LEA'S MEDICAL

BARWELL (RICHARD,) F* R. C. S.,

Assis'ant Surgeon Charing Cross Hospital, &c.

A TREATISE ON DISEASES OF THE JOINTS. Illustraterl with engrav-
ing's on wood. In one very handsome oclavo volume, of about 500 pages. {Nearly Ready.)
"A treatise on Diseases of the Joints equal to, or raiiier beyond the current knowledge of" Ihe
dav, lias long bt-en required — my professional brelhren must judge whether the ensuing pages may
supply ihe deficiency No auihor is fit lo estimate his own work at the moment ot its completion,
but it maybe permitted me to say thai the study of joint diseases has very much occupied my atten-
tion, eveii from my studentship, and that for the la~t six or eight years my devotion to that subject

has been almost uiiremitiing The real weight of my work has been at the bedside,

and the greatest labor devoted to interpreting symptoms and remedying their cause." — Author's
Preface.

At the outset we may state Miat Ihe work is
worthy of much praise, and hears evidence ol much
thoughtful uiid ciirefiil inquiry, and here and there
of no slight originality We have already carriid
U\U notice further th»n we iniended to do, hut not
tollieexlenl llie work detervcs. We cin only add,
that the perusal of it hag afforded us great pleasure.
The author has evidently worked very hard at his
subject, and his inveRiigfilionis into the Physiology
and P^tholi'gy of J 'inls have heen carried on in a
manner which entitles hinri to be listened lo wi'h
attention at.d respect. We must not omit to men-
tion tlie very admirable plates with which Ihe vo-
lume is enriched. We seldom meet with sucli sink-
ing and faithful deline iti"ns of di8(ase. — London
Meil. Times and Gazette, Feb. 9, IbGl.

We cannot take leave, however, of Mr. Barwell,
without cons ratulating him on Ihe Interesting
amount of information which he has compressed
into liis book. Tlie work appears lo us calculated

to be of much use to the practising surgeon who
may be in want ot a treatise on diseases of the jo;nts,
and a' the same time one which contains the latest
information on artiiular affections and the opera-
tions for their cure.— Dvblin Med. Press, Feb. 27,
IvSOl.

This volume will be welcomed, both by the pa-
thologist and the surgeon, as being the record of
mucn honest reseireh and careful investigation into
the nature and treatment of a most important class
of disorc'ers. We cannot conclude this notice of a
valuable and u?»ful book without calling attention
to the amount of broiUfi'le work it contains. In the
present day of universal book- making, it is no slight
matter for a volume to show laboriiius investiga-
tion, and at the same ti ne original thought, on th«
part of its au hor. whom ve may congratulate on
tlie successlul crapletion of his arduous task. —
London Lancet, March 9, ltd.

CARPENTER (WILLIAM B.), M. D., F. R. S., &c.,
Examiner in Physiology and Comparative Anatomy in the University of Loudon.

PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief applications to

Psychology, Pathology, Therapeutics, Hygiene, and Forensic Medicine. A new American, from
the last and revised London edition. With nearly three hundred illustrations. Edited, with addi-
tions, by Francis GrRNEY Smith, M. D., Professor of the Institutes of Medicine in the Pennsyl-
vania Medical College, iSrc. In one very large and beautiful octavo volume, ot about nine hundred
large pages, handsomely printed and strongly bound in leather, with raised bands. $4 25. '

In the preparation of this new edition, the auihor ha« spared no labor to render it, as heretofore,
a complete and lucid exposition of the most advanced condition of its important subject. The
amount of the additions required to effect this object thoroughly, joined to the former large size of
the volume, presenting objections ari^ing from the unwieldy bulk of the work, he has omitted all
those portions not bearing directly upon Human PiiYsioLOGy, designing to incorporate them in
his forthcoming Treatise on General Physiology. As a full and accurate text-book on the Phy-
siology of Man, the work in its present condition therefore presents even greater claims upon
the student and physician than those which have heretofore won for it the very wide and distin-
guished favor which it has so long enjoyed. The additions of Prof. Smith will be found to supply
whatever may have been wanting to the American student, while the introduction of many new
illustrations, and the most careful mechanical execution, render the volume cue of the most at-
tractive as yet issued.

For upwards of tliirteen years Dr. Carpenter'si To eulogize thisgreat'work would be superfluous,
work has been considered by the profession gene- We should observe, however, that in this edition
rally, both in this country and England, as the most the author has remodelled a large portion of the
valuable compendium on the Eul)ject of physiology former, and the editor has added much matter of in-
in our language. This distinction it owes to the high terest, especially in the form of illustrations. We
altainiiienls and unwearied industry of its accom- may confidently recommend it as the most complete
plished author. Thepresentedition (which. like the ] work on Human Physiology in our language. —
last American one, was prepared by the autlior him- Houtkern Mtd. mid Surg. Journal.

self), is the result of such extensive revision, tliat it
may alumst be cimsidered a new work. We need
hardly say, in cimcluding this brief notice, that while
the work is indispi nsalile to every student of medi-
cine in this country, it will amply repay the practi-
titmer for its perusal by the interest and value of its
contents. — Boston Med. and Surg. Journal.

This is a standard work — the text-book used by all
medical students who read the English language.
It has passed thr<mgh several editions in order to
keep pace w^ith the rapidly growing science of Phy-

The most complete work on the science in our
language. — Am. Med. Journal.

The most complete work now extant in our lan-
guage. — N. O. Med. Register.

The best text-book in the language on this ex-
tensive subject. — London Med. Times.

A complete cyclopaedia of this branch of Bcienco.
—N. Y. Med. Times.

The profession of this country, and perhaps also

of Europe, have anxiously and for some time awaited

Biology. Nothing need be said in its praise, for its i the announcement of this new edition of Carpenter's

merits are universally known ; we have ncithing to
say of its defects, for they only appear where the
science of which it treats is incomplete. — Western
Lancet.

The most complete exposition of physiology which
any language can at present give. — Brit, and For.
tled.-Chirurg. Beviete.

The greatest, the most reliable, and the best book
on the subject which we know of in the English
tangaage. — Stethoscopt.

Human Physiology. His former editions have for
many years been almost the only text-book on Phy-
siology in all our medical schools, and its circula-
tion among the profession has been unsurpassed by
any work in any department of medical science.

It is quite unnecessary for us to speak of this
work as its merits W(mld justify. The mere an-
nouncement of itsappearance will afford the highest
pleasure to every student of Physiology, while its
perusal will be of infinite service in advancing
physiological science. — Ohio Med. and Surg. Journ.

AND SCIENTIFIC PUBLICATIONS.

CARPENTER (WILLIAM B.), M. D., F. R. S.,
Examiner in Physiology and Comparative Anatomy in the University of London.

THE MICROSCOPE AND ITS REVELATIONS. With an Appendix con

taming the Applieations of the Microscope to Clinical Medicine, &c. By F. G. tiinxH M D
Illustrated by four hundred and thirty-four beautiful engravings on wood. In one large and ven
handsome octavo volume, of 724 pages, extra cloth, $4 00 ; leather, i4 50. '

Dr. Carpenter s position as a microscopist and physiologist, and his great experience as a teacher
eminently qualify him to produce v^^hat has long been wanted— a good text-book on the practical
use of the microscope. In the present volume his object has been, as stated in his Preface " to
combine, within a moderate compass, that information with regard to the use of his < tooN ' which
IS most essential to the working microscopist, with such an account of the objects be«t fitted for
his study, as might qualify him to comprehend what he observes, and might thus prepare him to
benefil science, whilst expanding and refreshing his own mind " That he has succeeded in accom-
plishing this, no one acquainted with his previous labors can doubt.

The great importance of the microscope as a means of diagnosis, and the number of microseo-
pists who are also physicians, have induced the American publishers, with the author's approval to
addan Appendix, carefully prepared by Professor Smith, on the applications of the instrument' to
clinical medicine, together with an account of American Microscopes, their modification* and
accessories. This portion of the work is illustrated with nearly one hundred wood-cuts and^ it is
hoped, will adapt the volume more particularly to the use of the American student. ' '

Those who are acquainted with Dr. Carpenter's [ medical work, the additions by Prof Smith eive it
previous v^ritings on Animal and Vegetable Physio- i a positive claim upon the profession, for which we
logy, will lully understand how vast a store of know- doubt not he will receive their sinrere thanks In
ledge he is able to bring to bear upon so comprehen- I deed, we know not where the student of medicine
give a subject as the revelations of the microscope j will find such a complete and satisfactory collection
and even those who have no previous acquaintance j of microscopic facts bearing upon physiolosry and
with the construction or uses of this instrument, , practical medicine as is contained in Prof Ssmith's
will find abundance of information conveyed in clear i appendix; and this of itself, it seems to us is fully
and simple language.— illed. Ti^nes and Gazette.] wortii the coat oC the volume.— Louisville'Medical

Although originally not intended as a strictly 1 R^^'^^i^w.

BY THB SAME AUTHOR.

ELEMENTS (OR MANUAL) OP PHYSIOLOGY, INCLUDING PHYSIO-

LOGICAL ANATOMY. Second American, from a new and revised London e<lition. With
one hundred and ninety illustrations. In one very handsome octavo volume, leather, dd 566
$3 00. ^^'

In publishing the first edition of this work, its title was altered from that of the London volume,
by the substitution of the word "Elements" for that of " Manual," and with the author's sanction
the title of "Elements" is still retained as being more expressive of the scope of the treatise.

To say that it is the best manual of Physiology
now before the public, would not do sufficient justice
to the author. — Buffalo Medical Journal.

In his former works it would seem that he had
exhausted the subject of Physiology. In the present,
he gives the essence, as it were, of the whole. — N. Y.
Journal of Medicine.

Those who have occasion for an elementary trea-
tise on Physiology, cannot do better than to possess
themselves of the manual of Dr. Carpenter.— iftfetiicai
Examiner.

The best and most complete expose of modera
Physiology, in one volume, extant in the English
language. — St. Louis Medical Journal.

BY THE SAME AUTHOR.

PRINCIPLES OP COMPARATIVE PHYSIOLOGY. New American, from

the Fourth and Revised London edition. In one large and handsome octavo volume, with over
three hundred beautiful illustrations, pp. 752. Extra cloth, $4 SO ; leather, raised bands, $5 20.

This book should not only be read but thoroughly
studied by every member of the profession. None
are too wise or old, to be benefited thereby. But
especially to the younger class would we cordially
commend it as best fitted of any work in the English
language to qualify them for the reception and com-
prehension of those truths which are daily being de-
veloped in physiology. — Medical Counsellor.

Without pretending to it, it is an encyclopedia of
the subject, accurate and complete in all respects —
a truthful reflection of the advanced state at which
the science hag now arrived. — Dublin Quarterly
Journal of Medical Science.

A truly magnificent work — in itself a perfect phy-
siological study. — Ranking's Abstract.

This work stands without its fellow. It is one
few men in Europe could have undertaken; it is one

no man, we believe, could have brought to so suc-
cessful an issue as Dr. Carpenter, ft required for
its production a physiologist at once deeply read in
the labors of others, capable of taking a general,
critical, and unprejudiced view of those labors, and
of combining the varied, heterogeneous materials at
his disposal, so as to form an harmonious whole.
We feel that this abstractcan give the reader a very
imperfect idea of the fulness of this work, and no
idea of its unity, of the admirable manner in which
material has been brought, from the most various
sources, to conduce to its completeness, of the lucid-
ity of the reasoning it contains, or of the clearness
of language in which the whole is clothed. Not the
profession only, but the scientific world at large,
must feel deeply indebted to Dr. Carpenter for this
great w^ork. It must, indeed, add largely even to
his nigh reputation. — Medical Tinus.

BY THE SAME AUTHOR. (Preparing.)

PRINCIPLES OP GENERAL PHYSIOLOGY, INCLUDING ORGANIC

CHEMISTRY AND HISTOLOGY. With a General Sketch of the Vegetable and Animal
Kingdom. In one large and very handsome octavo volume, with several hmidred illustrations.

BY THE SAME AUTHOR.

A PRIZE ESSAY ON THE USE OP ALCOHOLIC LIQUORS IN HEALTH

AND DISEASE. New edition, with a Preface by D. F. Condie, M. D., and explanations' of
scientific words. In one neat 12iuo. Tolume, extra cloth, pp. 178. 50 cents.

BLANCHAKD & LEA'S MEDICAL

CONDIE (D. F.), M. D., &c.
A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. Fifth

edition, revised and augmented. In one large volume, 8vo., leather, of over 750 pages. $3 25.

{Just Issued, 1859.)

In presenting a new and revised edition of this favorite work, the publishers have only to state
that the author has endeavored to render it in every respect "a complete and faithful exp)sition of
the pathology and therapeutics of the maladies incident to the earlier stages of existence — a full
and exact account of the diseases of infancy and childhood." To accomplish this he has subjected
the whole woik to a careful and thorough revision, rewriting a considerable portion, and adding
several new chapters. In this manner it is hoped that any deliciencies which may have previously
existed have been supplied, that the recent labors of practitioners and observers have been tho-
roughly incorporated, ai d that in every point the work will be found to maintain the high reputation
it has enjoyed as a complete and thoroughly practical book of reierence in infantile aflectious.

A few notices of previous editions are subjoined.

Dr. Condie's scholarship, acumen, industry, and
practical sense are manifested in this, as in all his
numerous contributions to science. — Dr. Holmes's
Report to the American Medical Association.

Taken as a whole, in our judgment, Dr. Condie*s
Treatise is the one from the perusal of w^hieh the
praetiticmer in this country will rise with the great-
est satisfaction. — Western Journal of Medicine and
Surgery.

One of the best works upon the Diseases of Chil-
dren in the English language. — Western Lancet.

We feel ussurad from actual experience that n<
physician's library can be ccimplete without a cop)
of this work. — A'. Y. .Tournnl of Medicine.

A veritable paediatric eneyclopsedui, and an honoi
to American medical literature. — Ohio Medical and
Surgical Journal.

We feel persuaded that the American medical pro
fesaion will soon regard it not only as a very good
but as the vbry best "Practical Treatise on tli»
Diseases of Children." — American Medical Journal

We pronounced the first edition to be the beat

work on the diseases of children in the English
language, and, notwithstanding all that has been
published, we still regard it in that light. — Medical
Examiner.

The value of works by native authors on the dis-
eases which the phvsician is called upon to combat,
will be appreciated by all ; an I the work of Dr Con-
die hasg>4ined for itself the character of a sale guide
lor students, and a useful work for consultation by
those engaged in practice. — N. Y. Med Times.

This IS the fourth edition of this deservedly popu-
lar treatise. During the interval since the last edi-
tion, it has been subjected to a thorough revision
by the author; and all new observations in the
pathology and therapeutics of children have been
included in the present volume. As we said bi fore,
we uo not know of a better book on diseases of chil-
dren, and to a l.irge part o( its recommendations we
yield un unhesitatiog concurrence. — Buffalo Med.
Tournal.

Perhaps the most full and complete work now be-

In the department of int'antile therapeutics, the ore the profession of the United States; indeed, we
work of Dr. Conuie is considered one or the best nay say in the English language. It is vastly supe-
wliich has been published in the English language, "ior to moslof itspredecessors. — Transylvania Med .
— The Stethoscope, Ijournal

CHRISTISON (ROBERT), M. D., V. P. R. S. E., Ac.

A DISPENSATORY; or, Commentary on the Pharmacopoeias of Great Britain

and the United States; comprising the Natural History, Description, Chemistry, Pharmacy, Ac-
tionsj, Uses, and Uoses of the Articles of the Materia Medica. Second edition, revised and im-
proved, with a Supplement containing the most important New Remedies. With copious Addi-
tions, and two hundred and thirteen large wood-engravings. By R. Eglesfeld Griffith, M. D.
In one very large and handsome octavo volume, leather, raised bands, of over 1000 pages. $3 50.

COOPER (BRANSBY B.), F. R. S.

LECTURES ON THE PRINCIPLES AND PRACTICE OF SURGERY.

in one very large octavo volume, extra cloth, of 750 pages. $3 00.

COOPER ON DISLOCATIONS AND FRAC-
TURES OF THE JOINTS —Edited by Bransbt
B. Cooper, F. R. S., ice. With additional Ob-
servations by Prof. J. C. Warren. A new Ame-
rican editiim. In one handsome octavo volume,
e.xtra cloth, of about 501) pages, with numerous
illustrations on wood. S3 '25.

COOPER ON THE ANATOMY AND DISEASES
OF THE BREAST, with twenty-five .Miscellane-
ous and Surgical Papers. One large volume, im-
perial bvo., extra cloth, with 25a figures, on 36
plates «-2 50.

COOPER ON THE STRUCTURE AND DIS-
EASES OF THE TESTIS, AND ON THE
TH\ MUS (iLA.ND. One vol. imperial tvo., ex-
tra cloth, with 177 figures on 29 plates. €2 00.

COPLAND ON THE CAUSES, NATURE, AND
TREAT.MENT OF PALSY AND APOPLEXY.
In one volume, royal 12mo,, extra cloth, pp. 326.
60 cents.

CLYAIER ON FEVERS; THEIR DIAGNOSIS,
PATHOLOGY, AND TREATMENT In one

octavo volume, leather, of 600 pages. $1 50.

COLO.MBAT DE L'lSERE ON THE DISEASES
OF FEMALES, and on the special Hygiene of
their Sex. Translated, with many Notes and Ad-
ditions, by C. D. Meigs, M.D. Secimd edition,
revised and improved In one large volume, oc-
tavo, leather, with numerous wood-cuts. pp. 720.
m SO.

CARSON (JOSEPH), M. D.,

Professor of Materia Medica and Pharmacy in the University of Pennsylvania.

SYNOPSIS OF THE COURSE OF LECTURES ON MATERIA MEDICA

AND PHARiVIACY, delivered in the University of Pennsylvania Second and revised edi-
tion, lu one very neat octavo volume, extra ciolh, of 208 pages. $1 50.

CURLING (T. BJ, F. R.S,,

Surgeon to the London Hospital, President of the Hunterian Society, 4.C.

A PRACTICAL TREATISE ON DISEASES OF THE TESTIS, SPERMA-

TIC CORD, AND SCROTUM. Second American, troin the second and enlarged English edi-
tion. In one handsome octavo volume, extra cloth, with numerous lilusiraiions. pp. 4:;iO. $2 00.

AND SCIENTIFIC PUBLICATIONS.

CHURCHILL (FLEETWOOD), M. D., M. R. I. A.
ON THE THEORY AND PRACTICE OF MIDWIFERY. A new American

from the fourth revised and enlarged London edition. With Notes and Additions, by D Francis
UoNDiE, Nl. D., author oi a "Practical Treatise on the Diseases of Children," &c. With 194
illustrations In one very handsome octavo volume, leather, of nearly 700 large na<'es $3 50
(Now Ready, October, 1860.) - f o -w .

This work has been so long an established favorite, both as a fext-biok for the learner and as a
reliable aid in consul'aiion tor the practitioner, thul in presenting a new edition it is only necessary
to call attention to the very extended improvements which it has received. Having had the benefit
of two revisions by the amhor since the last American reprint, it has been materially enlarsed, and
Dr. Churchill's well-known conscientious industry is a guarantee that everv portion has been tho-
roughly brought up with the latest results of European investigation in all departments of the sci-
ence and art of obstetrics. The recent date of the last Dublin edition has not left much of novelty
for the American editor to introduce, but he has endeavored to insert whalevir has since appeared,
together Vi^iih such matters as his experience has shown him would be desirable for the Amsrican
student, including a large number of illustrations. Wiih the sanction of the author he has added
in the form of an appendix, some chapters from a little "Manual for jNIidwive- and Nurses," re-
cently is-ued by Dr. Churchill, believing that the details there presented can hardly fail to prove of
advantage to the junior practitioner. Tne result of all these additions is that the work now con-
tains fully one-half more matter than the last American edition, with nearly one-half more illus-
trations, so that n >twithstanding the use of a smaller type, the volume contains almost two hundred
pages more than before.

No effort has been spared to secure an improvement in the mechanical execution of the work
equal to that which the text has received, and the volume is confidently presented as one of the
handsomest that has thus far been laid before the American profession; while the very low price
at which it is offered should secure for it a place in every lecture-room and on every office table.

A better book in which to learn these important
points we have not met than Dr. Churchill's. Every
page of it is full of instruction ; the opinion of all
writers of authority is given on questions of ditfi-
culty, as well as the directions and advice of the
learned autaor himself, to which he adds the result
of statiBtical inquiry, putting statistics in their pio
per place and giving them tlieir due weight, and no
more. We have never read a bonk more free from
professinnal jealousy than Dr. Churchill's. It ap-
pears to be written with the true design of a book on
medicine, viz : to give all that is known on the sub-
ject of which he treats, both theoretically and prac-
tically, and to advance such opinions of nis own as
he believes will benefit mtdical science, and insure
the safety of the patient. We have said enough to
convey to the profession that this book of Dr. Cnur-
cnill's is admirably suited for a book of reference
for the practitioner, as well as a text-book for the
student, and we hope it may be extensively pur-
chased amongst our readers. To them we most
stronsly recommend it. — Dublin Medical Press,
June '20, IS60.

To bestow praise on a book that has received such
marked approbation would be superfluous. We need
only say, therefore, that if the first edition was
thought worthy of a favorable reception by the
medical public, we can confidently affirm that this
will be found much more so. The lecturer, the
practitioner, and the student, may all have recourse
to its pages, and derive from their perusal much in-
terest and instruction in everything relating to theo-
retical and practical midwifery. — Dublin Quarterly
Journal of Medical Science.

A work of very great merit, and such as we can
confidently recommend to the study of every obste-
tric practitioner. — London Medical Gazette.

This is certainly the most perfect system extant.
It is the best adapted for the purposes of a text-
book, and that which he whose necessities confine
him to one book, should select in prel'erence to all
others. — Southern Medical and Surgical Journal.

BY THE SAME AUTHOR

The most popular work on midwifery ever issued
'rom the American press. — Charleston Med. Journal.

Were we reduced to the necessity of having but
me work on midwifery, and permitted to choose,
ve M^ould unhesitatingly take Churchill. — Western
Med. and Surg. Journal.

It is impossible to conceive a more useful and
ilegant manual than Dr. Churchill's Practit:e of
Vlidwifery. — Provincial Medical Journal.

Certainly, in our opinion, the very best work on
he subject which exists. — N. Y. Annalist.

No work holds a higher position, or is more de-
serving of being placed in the hands of the tyro,
the advanced student, or the practitioner. — Medical
Examiner.

Previous editions, under the editorial supervision
of Prof R. M. Huston, have been received with
marked favor, and they deserved it; but this, i;e-
printed from a very late Dublin edition, carefuMy
revised and brought up by the author to the present
time, does present an unusually accurate and able
exposition of every important particular embraced
in the department of midwifery. * * The clearness,
directness, and precision of its teachings, together
with the great amount of statistical research whieh
its text exhibits, have served to place it already in
the foremost rank of works in this department of re-
medial science. — N. O. Med. and Surg. Journal.

In our opinion, it forms one n{ the best if not the
very best text-book and epitome of obstetric science
which w^e at present possess in the Hnglish lan-
guage. — Monthly Journal of Medical Science.

The clearness and precision of style in which it is
written, and the greatamount(>f statistical research
which it contains, have served to phn-e it in the first
rank of works in this departmentof medical science.
— N. Y. Journal of Medicine.

Few treatises will be found better adapted as a
text-book for the student, or as a manual for the
frequent consultati<m of the young practitioner. —
American Medical Journal.

(Lately Published.)

ON THE DISEASES OF INFANTS AND CHILDREN. Second American

Edition, revised and enlarged by the author. Edited, with Notes, by W. V. Keating, M. D. In
one large and handsome volume, extra cloth, of over 700 pages. $3 00, or in leather, $3 '25.
In preparing this work a second time for the American profession, the author has spared no
labor in giving it a very thorough revision, introducing several new chapters, and rewriting others,
while every portion of the volume has been subjected to a severe scrutiny. The etforis of the
American editor have been directed to supplying such information relative to matters peculiar
to this country as might have escaped l»he attention of the author, and the whole may, there-
fore, be safely pronounced one of the most complete works on the subject accessible to the Ame-
rican Profession. By an alteration in the size of the page, these very extensive additions have
been accommodated without unduly increasing the size of the work.

BY THE SAME AUTHOR.

ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PE-

CULIAR TO WOMEN. Selected from the writingsof British Authors previous to the close o(
the Eighteenth Century. In one neat octavo volume, extra cloth, of about 450 pages. $2 50.

10 BLANCHARD & LEA'S MEDICAL

CHURCHILL (FLEETWOOD), M. D., M . R. I. A., ice.
ON THE DISEASES OP WOMEN; including those of Pregnancy and Child-
bed. A new American edition, revised by the Author. With Notes and Additions, by D Fran-
cis CoNDiE, M. D., author ol "A Practical Treatise on the Diseases of Children." With nume-
rous illustrations. In one large and handsome octavo volume, leather, of 768 pages. $3 00.
This edition of Dr. Churchill's very popular treatise may almost be termed a new work, so
thoroughly has he revised it in every portion. It will be found greatly enlarged, and completely
brought up to the mo'rt recent condition ol the subject, while the very liandfome series of illustra-
tions introduced, representing such pathological conditions as can be accurately portrayed, present
a novel feature, and afford valuable assistance to the young practitioner. Such additions as ap-
peared desirable for the American student have been made by the editor. Dr. Condie, while a
marked improvement in the mechanical execution keeps pace with the advance in all other respects
which the volume has undergone, while the price has been kept at the former very moderate rate.
It comprises, unquestionably, one of the most ex- } extent that Dr. Churchill does. His, indeed, is the
act and comprehensive exposititms of the present j only thoroueh treatise we know of ctn the subject;
stateof medical knowledge in respect to the diseases J and it may be commended to practitioners and stu-

of women that has yet been published. — Am. Joum
Med. Sciences.

This work is the most reliable which we possess
on this subject; and is deservedly popular with the
profession. — Charleston Med. Journal, July, 1S37.

We know of no author who deserves that appro-
bation, on "the diseases of females," to the same

dents as a masterpiece in its particular department.
— Tkt Western Journal of Medicine and Surgery.

As a comprehensive manual for students, or a
work of reference for practitioners, it surpasses any
other that has ever issued on the same subject from
the British press. — Dublin Quart. Journal.

DICKSON (S. H.), M. D.,

Professor of Practice of Medicine in the Jefferson Medical College, Philadelphia.

ELEMENTS OF MEDICINE; a Compendious View of Pathology and Thera-

peutics, or the History and Treatment of Diseases. Second edition, revi.>ed. In one large and
handsome octavo volume, of 750 pages, leather. $3 70. {Just Issued.)

The steady demand which has so soon exhausted the first edition of this work, sufficiently shows
that the author was not mistaken in suppo-;ing that a volume of this characier was needeii — an
elemeniary manual of practice, which should present the leading principles of medicine with the
practical results, in a condensed and perspicuous manner. Disencumbered of unnecessary detail
and fruitless speculations, it embodies what is most requisite for the student to learn, and at the
same time what the active practitioner wants when obliged, m the daily calls of his profession, to
refresh his memory on special points. The clear and attractive style of the author renders the
whole ea-y of comprehension, while his long experience gives to his teachings an authority every-
where acknowledged. Few physicians, indeed, have had wider opportunities (or observation and
experience, and few, perhaps, have used them to lielter purpose. As the result of a long life de-
voied to study and practice, the present edition, revised and brought up to the date of puhlicalion,
will doubtless maintain the reputation already acquired as a condensed and convenieut American
text-book on the Practice of Medicine.

DRUITT (ROBERT), M.R.C.S., &.C.
THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. A new

and revi^ed American from the eighth enlarged and improved London edition. Illustrated with
four hundred and thirty-tsvo wood-ensrravings In one very handsomely prmted octavo volume,
leather, of nearly 700 laige pages. $3 50. {Noiv Ready, October, 1660.)

A work which like Druitt's Surgery has for so many years mninlalned the position of a lead-
ing favorite with all classes of the profession, needs no special recommendation to attract attention
to a revi.-ed edition. It is only necessary to slate that the author has spared no pains to keep the
work up to its well earned reputation of presenting in a small and convenient compass the latest
condition of every deparlinent ol surgery, considered both as a science and as an art; and that the
services of a competent American editor have been employed to introduce whatever novelties may
have escapfd the author's attention, or may prove ol service to the American practitioner. As
several editions have appeared in London since the issue of the last American reprint, the volume
has had the benefit of rei>eatcd revisions by the author, resulting in a very tnorough alteration and
improvement. The extent of these additions may be estimated from the fact that it now contains
about one-third more matter than the previous American edition, and that notwithstanding the
adoption of a smaller type, the pages iiave been increased by about one hundred, while nearly two
hundred and fifty wood-cuts have been added to the former list of illustrations.

A marked i.nprovement will also be perceived in the mechanical and artisiical execution of the
work, which, primed in the best style, on new type, and fine paper, leaves little to be desired as
regards external finish; while at the very low price affixed it will be found one of the cheapest
Volumes accessible to the profession.

This popular volume, now a most comprehensive nothing of real practical importance has been omit-
work on surgery, has undergone many corrections, ted; it presents a faithful epitome of every thine; re-
im pro Yemenis, and additions, and the principles and la ting t > surgery up to the present hour. It is de-
the practice of the art have been brought down to servedlv a popular manual, bolh with the student
the latest record and observation. Of the r)perations and practitioner. — London Lancet, Nov. 19, 1859.
in snigtry iiisimpossiblelofpeakloohii«hiy. The' t , . ,_ ■ i. • /• .• j

descriptions are so clear and concise, and the illus- ' , In closing this brief notice, we recommend as cor-
t.ations so a-eurate and numerous, that the student , diallv as ever this most utelul and compreheiiSive
can have no ditf.culty, with instrument in hand, and hand-bo,.k. It must prove a vast assittance, not
bcok by his side, over the dead body, in obtaining- ' ""'>' '" '^e student of surgery, but also to the busy
a proper knowledge and sufficient tact in this mueh ' practitioner whi may not have the leisure tod'-vote
Beglected oepartmentof medical education.— /;r,<Ks/i himself to the study of more lengthy yolunies.-
and Foreign Medico-Chirurg. Review, Jan. ISCO j London Med. Times and Gazette, Oi;t 22, 1M9.

In the present edition the author has entirelv re- j In a word, this eighth edition of Dr. Druitt's
■written many of the chapters, and has incorpi.rat-d ] Manual of Surgery is all that the surgical student
the various improvements and additions in modern or practitioner could desire. — Dublin Quarterly
surgery. On carefully going over it, we find that | Journal of Med. Sciences, Nov. 1859.

AND SCIENTIFIC PUBLICATIONS.

DALTON, JR. (J. C), M . D.

Professor of Physiology in tlie College of Physicians, New York.

A TREATISE OX HUMAN PHYSIOLOGY, designed for the use of Students

and Practitioners of Medicine. Second edition, revise-! and enlarged, willi two bundled and
seventy-one illustrations on wood. In one very beaniifnl oclavo volume, of 700 na-^e- extra
cloth, $4 00 ; leather, raised bands, $4 50. {No^u Ready, March, J861.) y a ■,

The general fiivor which has so soon exhausted an edition of this work has afforded the author
an opportunity in its revision of supplying the dehciencies which existed in the former volume
This has caused the insertion of two new .-hapters— one on the Special Senses, the other on Im-
bibition, Exhalation, and the Functions of the Lymphatic System— besides numerous a-lditions of
smaller amount scattered through the work, and a general revision deM^ned lo brina- it lhorou<'hlv
up to the present condition of the science wilh legdid to all points wnich may be""considered as
definilely settled. A number of new illustrations has been introduced, and the Work, it is hoped
in its improved form, may continue to command the confidence of those for whose' use it is in-
tended.

It will be seen, therefore, that Dr. Dalton's best i own original views an'i experiments together with
ftr.rts have been directed towams perfeciing his ; a desirelo supply whit he coi.sidereu some defirien-
work. The additioriS are marked b> the same fta- ■ ■ -

tures which characterize the remainder of the vol-
ume, and render it by far the most desirsble text-
book on physiology to place in ihe hands of the
student which, so far as we are aware, exists

the English language, or perhaps in any other. AVe
iherefiire have no hesitation in recommending Dr.
Dalton's book for the classes for which it is intend-
ed, satisfied as we are that it is better acapted lo
their use than any other work of the kind to which
they have access. — American Journal of the Med.
Sciences, April, 1861.

It is, therefore, no disparagemert to the many
books upon piiysiology, most excellent in their day.

cies in the fiist coition, hav< aiready made the pre-
sent one a ntctssity, and it will no douht he even
more eagerly soii!.lu far than the first. That it is
not merely a reprint, will he s-tn from the author'*
statement of the foi owing priuci|)>il Jidditions and
altera'ions which he has made. The present, liKe
the first edition, is printe'l in ihe highest style of Ihe
pr'nter's art, and the illustiations are truly admira-
hle tor their clparness in expressing exactly what
their author intended.— i;os(o» Medical and Surgi-
cal Journal, March 28, IfcGt.

It is unnecessary to eive a detail of the additions ;
suifice It to say, tliat they wre nuinf-rons acid import-
ant, and such as will render llie worK still m.ire

to say that Dalton's is the only one that gives us the j valuable and acceptable to the profession as a learn-
Bcience as it was known to the best philosophers I ed and original treatiseon this all-i,nportant brHnch
throughout the world, at the beginning of the cur- [ of medicine. All that was said in comintndaiion
rent year. It states in comprehensive but concise I of the getting up of the firstedition, and the superior
diction, the facts established by experiment, or | style of the illustratiims. apply with equal f'nce to
other method of demonstration, and details, in an tins. No better work on physiology cin be (jJaceU
understandable manner, how it is done, but abstains : in the hand of the student. — St. Louis Medical and
Irom thediscussion of unsettled or theoreticalp lints. 1 Surgical Journal, j\Iay, ISGl.

Herein it is unique; and these characteristics x,n \ These additions, wh.le tes ifying to the learning
oer It a text-bo(,k wi hout a riv,il, for those who g^j industry of the author, render the b..oK exceed-
desire to study physiological science as it is known I i,,g,y ^s^fui ^s the most complete expose of a scj-

to its most successful cultivators. And it is physi-
ol igy thus presented that lies at the toundation of
correct pathological knowledge; and this in turn is
the basis of rational therapeutics; so that pathjlo-
py, in fact, becomes of prime importance in the
proper discharge of our every-day practical duties.
— Cincinnati Lancet, May, IbGl.

Dr. Dalton needs no word of praise from us. He

ence, of which Dr.Dilton is doubtless the ablest
re^)refentative on this side of the Atlantic. — iYew
Orleans Med Times, May, 1861.

A sf cond edition of this deservedly popular work
having been called for in the short space of two
years, the author has su|>| lied deficiencies, whicii
existed in the former volums, and has thus more
completely fulfilled his design of prescn ing ti> the
is universally recognizeu as among the first, if not I profession a reliable and precise text book, and <me
the verv fiist, of American pliysiologists now living, j which we consider the best outline tm the subiect
The first edition of his admirable work appeared but of which it treats, in any language. — N. Atnerican
two years since, and the advance of science, his I Medico-Ckirurg. Review, May, ItGl.

DUNGLISON, FORBES, TWEEDIE, AND CONOLLY.
THE CYCLOPEDIA OF PRACTICAL MEDICINE: comprising Treatises on

the Nature and Treatment of Diseases, Materia Medica, and Therapeutics, Diseases of Women
and Children, Medical Jurisprudence, &;c. &c. In four large super-royal octavo volumes, of
3254 double-columned pages, strongly and handsomely bound, with raised bands. $12 00.
*^* This work contains no less than four hundred and eighteen distinct treatises, contributed by
sixty-eight distinguished physicians, rendering it a complete library of reference for the country
practitioner.

I The editors are practitioners of established repu-
tatum, and the list of contributors embraces many
of the most eminent professors and teachers of Lon-
don, Edinburgh, Dublin, and Glasgow. It is, in-
deed, the great merit oi this work that theprincipal
articles have been furnished by practitioners who

The most complete work on Practical Medicine
extant; or, at' least, in our language.— £M//a/o
Medical and Surgical Journal.

For reference, it is above all price to every prac-
titioner. — Western Lancet.

One of the most valuable medical publications of | '"^ve not only devotee especial atlenti.m to the dis-

the day — as a work of reference it is invaluable. —
Western, Journal oj Medicine and Surgery.

It has been to us, both as learner and teacher, a
work for ready and frequent reference, <me in which
modern English medicine is exhibited in the most
advantageous light. — Medical Examiner .

eases about which the> have written, but have
also enjoyed opportunities for an extensive practi-
cal acquaintance with them and whose reputation
carries the assurance of their competency justly lo
appreciate the opinions ol others, while it stamps
their own doctrines witl high and just authority. —
American Medical Journal.

DEWEES'S COMPREHENSIVE SYSTEM OF
MIDWIFERY. Illustrated by occasional cases
and many engravings. Twelfth edition, with the
author's last improvements and corrections In
oneoctavovolume, extracloth, of 600 pages. S3 20.

AND MEDICAL TREATMENT OF CHILD-
REN. The last edition In one volume, octavo,
extra cloth, ai8 pages. $'2 SO
DEWEEl!;'S TREATISE ON THE DISEASES
OF FEMALES. Teiilh edition. In one volume,

DEWEES'S TREATISE ON THE PHYSICAL I octavo extra cloth, 532 pages, with plates. 83 00

BLANCHARD & LEA'S MEDICAL

DUNGLISON (ROBLEY), M.D.,

ProfessoT of Institutes of Medicine in the Jefferson Medical College, Philadelphia.

NEW AND ENLARGED EDITION.

MEDICAL LEXICON; a Dictionary of Medical Science, containing a concise

Explanation ofthe various Subjects and Terms of Anatomy, Physiology, Pathology, Hygiene,
Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Jurisprudence, Dentistry,
&:c. Notices of Climate and of Mineral Waters; Formulae for Oflicinal, Empirical, and Dietetic
Preparations, ifec. With French and other Synonymes. Revised and very greatly enlarged.
In one very large and handsome octavo volume, of 992 double-columned pages, in small type ;
strongly bound in leather, with raised bands. Price $4 00.

Especial care has been devoted in the preparation of this edition to render it in every respect
worthy a continuance of the very remarkable favor which it has hitherto enjoyed. The rapid
sale of Fifteen large editions, and the constantly increasing demand, show that it is regarded by
the profession as the standard authority. Stimulated by this tact, the author has endeavored in the
present revision to introduce whatever might be necessary " to make it a satisfactory and desira-
ble — if not indispensable — lexicon, in which the sludent may search without disappointment for
every term that has been legitimated in the nomenclature of the science." To accomplish this,
large additions have been found requisite, and the extent of the author's labors may be estimated
from the fact that about Six Thousand subjects and terms have been introduced throughout, ren-
dering the whole number of definitions about Sixty Thousand, to accommodate which, the num-
ber of pages has been increased by nearly a himdred, notwithstanding an enlargement in the size
of thepaffe. The medical press, both in this country and in England, has pronounced the work in-
dispensable to all medical students and practitioners, and the present improved edition will not lose
that enviable reputation.

The publishers have endeavored to render the mechanical execution worthy of a volume of such
universal use in daily reference. The greatest care hns been exercised to obtain the typographical
accuracy so necesi-ary in a work of the kind. By the small but exceedingly clear type employed,
an immense amount oJ matter is condensed in its thousand ample pages, while the binding will be
lound strong and durable. With all these improvements and enlargements, the pricehas been kept
at the former very moderate rate, placing it within the reach of all.

This work, the appearance of the fifteenth edition
of which, it has become our duty and pleasure to
announce, is perhaps the most stupendous monument
of lahor and erudition in medical literature. One
w^ould hardly suppose after constant use of the pre-
ceding editions, wliere we have never failed to find
a sufficiently full explanation of ever> medical term,
that in tliis edition ^^ about six thousand subjects
and terms have been added,^^ with a careful revision
and correction of the entire work. It is only neces-
sary to announce the advent of this edition to m:ike
it occupy the place of the preceding one on the table
of every medical man, as it is without doubt the best
and most comprehensive work of the kind which has
ever appeared. — Buffalo Med.Journ., Jan. 1858.

The work is a monument of patient research,
skilful judgment, and vast physical labor, that will
perpetuate the name of the author more effectually
than any possible device of stone or metal. Dr.
Dunglison deserves the thanks not only ofthe Ame-
rican professiwn, but of the whole medical world. —
North Am. Medico-Chir. Reviexo, Jan. Ifc58.

A Medical Dictionary better adapted for the wants
of the profession than any other with wiiich we are
acquainted, and of a character which places it far
above comparison and competition. — Am,. Journ.
Med. Sciences, Jan. 1858.

We need only say, that the addition of 6,000 new
terms, with tlieir accompanying definitions, may be
said to constitute a new work, by itself. We have
examined the Dictionary attentively, and are most
happy to pronounce it unrivalled of its kind. The
erudition displayed, and the extraordinary industry
which must have been demanded, in its preparation
and perfection, redound to the lasting credit of its
author, and have furnished us with a volume indis-
pensable at the present day, to all who would find
themselves au niveau with the highest standards of
medical information. — Boston Medical and Surgical
Journal, Dec. 31, la57.

Good lexicons and encyclopedic works generally,
are the most labor-saving contrivances which lite-
rary men enjoy; and the labor which is required to
produce them in the perfect manner of this example
is something appalling to contemplate. The author

tells us in his preface that he has added about six
thousand terms and subjects to this edition, which,
before, was considered universally as the best work
of the kind in any language. — Silliman's Journal,
March, lb58.

He has razed his gigantic structure to the founda-
tions, and remodelled and reconstructed the entire
pile. No less than six thousand additional subjects
and terms are illustrated and analyzed in this new
edition, swelling the grand aggregate to beyond
sixty thousand ! Thus is placed before the profes-
sion a complete and thorough exponent of medical
terminology, without rival or possibility of rivalry.
— Nashville Journ. of Med. and Surg., Jan. 1858.

It is universally acknowledged, we believe, that
this work is incomparably the best and most com-
plete Medical Lexicon in the English language.
The amount of labor which thedislinp[uislied author
has bestowed upon it is truly wonderful, and the
learning and research displayed in its preparation
are equally remarkable. Comment and commenda-
tion are unnecessary, as no one at the pr<»sent day
thinks of purchasing any other Medical Dictionary
than this. — St. Louis Med. and Surg. Journ., Jan.
1858.

It is the foundation stone of a good medical libra-
ry, and should always be included in the first list of
books purchased by the medical student. — Am. Med.
Monthly, Jan. 1S58.

A very perfect work of the kind, undoubtedly the
most perfect in the English language. — Med. and
Surg. Reporter, Jan. 1868.

It is now emphatically the Medical Dictionary of
the English language, and for it there is no substi-
tute.— jV. H. Med. Journ., Jan. 1858.

It is scarcely necessary to remark that any medi-
cal library wanting a copy of Dunslison's Lexicon
must be imperfect. — Cin. Lancet, Jan. 1858.

We have ever considered it thebestauthority pub-
lished, and the present edition we may safely say has
no equal in the world. — Peninsular Med. Journal,
Jan. 1858.

The most complete authority on the subject to be
foundin any language. — Va.Med. Journal, Feb. '58.

BY THE SAME AUTHOK.

THE PRACTICE OF MEDICINE. A Treatise on Special Pathology and The-
rapeutics. Third Edition. In two large octavo volumes, leather, of 1,500 pages. $6 25.

AND SCIENTIFIC PUBLICATIONS.

DUNGLISON (ROBLEY), M.D.,

Professor of Institutes of Medicine in tlie Jefferson Medical College, Philadelphia.

HUMAN PHYSIOLOGY. Eighth edition. Thoroughly revised and exten-

sively modified and enlarged, with five hundred and thirty-two illustrations. In two laro-e and
handsomely printed octavo volumes, leather, of about 1500 pages. $7 00. °

In revising this work for its eighth appearance, the author has spared no labor to render it worthy
a continuance of the very great favor which has been extended to it by the profession. The whole
contents have been rearranged, and to a great extent remodelled ; the investigations which of late
years have been so numerous and so important, have been carefully examined and incorpjraled
and the work in every respect has been brought up to a level with the present slate of the subject!
The object of the author has been to render it a concise but comprehensive treatise, containing- the
whole body of physiological science, to which the student and man of science can at all times "refer
with the certainty of finding whatever they are in search of, fully presented in all its aspects; and
on no former edition has the author bestowed more labor to secure this result.

We believe that it can truly be said, no more com-
plete repertory of facts upon the subject treated,
can anywhere be found. The author lias, moreover,
that enviable tact at description and that facility
and ease of expression which render him peculiarly
acceptable to the casual, or the studious reader.
This faculty, so requisite in setting forth many
graver and less attractive subjects, lends additional
charms to one always fascinating. — Boston Med.
and Surg. Journal.

The most complete and satisfactory system of
Physiol()gy in the English language. — Amer. Med.
Journal .

The best work of the kind in the English lan-
guage. — Sillitnan^s Journal.

The present edition the author has made a pel feet
mirror of the science as it is at tlie present hour.
As a work upon physiology proper, the science of
the functions performed by the body, the student will
find it all he wiaiiea.—Naskville Journ. of Med.

That he has succeeded, most admirably succeeded
in his purpose, is apparent from tlie appearance of
an eighth edition. It is now the great encyclopoedia
on the subject, and worthy of a place in every phy-
sician's library. — Western Lancet.

BY THE SAME AUTHOR. {A new edition.')

GENERAL THERAPEUTICS AND MATERIA MEDICA; adapted for a

Medical Text-book. With Indexes of Remedies and of Diseases and their Remedies. Sixth
Edition, revised and improved. With one hundred and ninety-three illustrations. In two large
and handsomely printed octavo vols., leather, of about 1100 pages. $6 00.

In announcing a new edition of Dr. Dunglison's
General Tlierapeutics and Materia Medica, we have
no words of commendation to bestow upon a work
whose merits have been heretofore so often and so
justly extolled. It must not be supposed, however,
that the present is a mere reprint of the previous
edition; the character of the author for laborious
research, judicious analysis, and clearness of ex-
pression, is fully sustained by the numerous addi-
tions he h;is made to the work, and tne careful re-
vision to which he has subjected the whole. — JV. A.
Medico-Chir. Review, Jan. 1658.

The work will, we have little doubt, be bought
and read by the majority of medical students^ its
size, arrangement, and reliability recommend it to
all; no one, we venture to predict, will study it
without profit, and there are few to whom it will
not be in some measure useful as a work of refer-
ence. The young practitioner, more especially, will
find the copious indexes appended to this edi;ion of
great assistance in the selrction and preparation of
suitable formulee. — Charleston Med. Journ. and Re-
view, Jan. 1858.

BY THE SAME AUTHOR, {A new Edition.)

NEW REMEDIES, WITH FORMULAE FOR THEIR PREPARATION AND

ADMINISTRATION. Seventh edition, with extensive Additions. In one very large octavo
volume, leather, of 770 pages. $3 75.

Another edition of the " New Remedies" having been called for, the author has endeavored to
add everything of moment that has appeared since the publication of the last edition.

The articles treated of in the former editions will be found to have undergone considerable ex-
pansion in this, in order that the author might be enabled to introduce, as far as practicable, the
results of the subsequent experience of others, as well as of his own observation and reflection ;
and to make the work still more deserving of the extended circulation with which the preceding
editions have been favored by the profession. By an enlargement of the page, the numerous addi-
tions have been incorporated without greatly increasing the bulk of the volume. — Preface.

One of the most useful of the author's works. —
Southern Medical and Surgical Journal,

This elaborate and useful volume should be
found in every medical library, for as a book of re-
ference, for physicians, it is unsurpassed by any
other work in existence, and the double index for
diseases and for remedies, will be found greatly to
enhance its value. — New York Med. Gazettt.

The great learning of the author, and his remark-
able industry in pushing his researches into every
source whence information is derivable, have enabled
him to throw together an extensive mass of facte
and statements, accompanied by full reference to
authorities; which last fe.iture renders the work
practically valuable to investicfators who desire t«
examine the original papers. — Tke American Journal
of P harmacy .

ELLIS (BENJAMIN), M.D.
THE MEDICAL FORMULARY : being a Collection of Prescriptions, derived

from the writings and practice of many of the most eminent physicians of America ami Europe.
Together with the usual Dietetic Preparations and Antidotes for Poisons. To whicli i» added
an Appendix, on the Endermic use of Medicines, and on the use of Ellier and Chloroform. The
whole accompanied with a few brief Pharmaceutic and Medical Observations. Tenth edition,
revised and much extended by Robert P. Thomas, M. D., Professor of Materia Medica in the
Philadelphia College of Pharmacy. In one neat octavo volume, extra cloth, of '.^96 pages. $1 75.

BLANCHARD & LEA'S MEDICAL

ERICHSEN (JOHN),

Professor of Surgery in University College, London, 4;C.

THE SCIENCE AND ART OF SURGERl^; being a Treatise on SimaiCAL

Injuries, Diseases, and Operations. New and improved American, from the second enlarged

and carefully revised London edition. Illustrated with over four hundred engravings on wood.

In one large and handsome octavo volume, of one thousand closely printed pages, leather,

raised bands. $4 50. [Just Issued.)

The very distinguished favor with which this work has been received on both sides of the Atlan-
tic has stimulated the author to render it even more worthy of the position which it has so rapidly
attained as a standard authority. Every portion has been carefully revised, numerous additions
have been made, and the most watchful care has been exercised to render it a complete exponent
of the most advanced condition of surgical science. In this manner the work has been enlarged by
about a hundred pages, while the series of engravings has been increased by more than a hundred,
rendering it one of the most thoroughly illustrated volumes before the profession. The additions of
the author having rendered unnecessary most of the notes of the former American editor, but little
has been added in this country; some few notes and occasional illustrations have, however, been
introduced to elucidate American modes of practice.

It is, in our humhle judgment, decidedly the best j step of the operation, and not deserting him until the

book of the kind in the English language. Strange
that just such l)ooks are notoflener produced by pub
lie teachers of surgery in this country and Great
Britain Indeed, it Is a matter of great astonishment
but no less true than astonishing, thai of the many
works on surgery repullished in this country within
the last fifteen or twenty years as text-hooks for
medical studeius, this i.* the only one that even ap-
proximates to the fulfilment of the peculiar wants of
young men just entering upon ttip «tudy of this branch
of the profession. — Western Jour .of Med. ami Surgery.

Its value is greatly enhanced by a very copious
well-arransed index. We regard this as one of the
most valuable contributions to morlern surgery. To
one entering his novitiate of practice, we regard it
the most serviceable guide wlilcli he can consult. He
will find a t'ulness of detail leadinghim ihroLgh every

final issue of the case is decided. — Sethoscope.

Embracing, as will be perceived, ttie whole surgi-
cal domain, and each division of itself almost com-
plete and perfect, each chapierfull and explicit, each
subject faithfully exhibited, we can only express oui
estimate of it in the aggregate. We consider it an
excellent contribution to surgery, as probably the
best single volume now extant on the subject, and
with greai pleasure we add it to our text-books. —
Nashville Journal of Medicine and Surgery.

Prof Erichsen's work, for its size, has not been
surpassed; his nine hundred and eight pages, pro-
fusely illustrated, are rich in physiological, patholo-
gical, and operative suggestions, doctrines, details,
and processes; and will prove a reliable resource
for information, both in physician and surceon, in the
hour of peril. — N. 0. Med. and Surg. Journal.

FLINT (AUSTIN), M. D.,

Professor of the Theory and Practice of Medicine in the University of Louisville, &.C.

PHYSTCAL EXPLORATION AND DIAGNOSIS OF DISEASES AFFECT-
ING THE RESPlK.-\TORY ORGANS. In one large and handsome octavo volume, extra
cloth, 6.36 pages.

$3 00.
We regard it, in point both of irrangement and of
the marked abllitv of its treatment of the subiccts,
as destined to take the first rank in works of this
class. So far as our inl'ormation extends, it has at
present no equal. To the practitioner, as well as
the student, it will be invaluable in clearing up the
diagnosis of doubtful eases, and in shedihnp light
upon difficult phenomena. — Buffalo Med. Journal.

A work of original observation of the highest merit.
We recommend the treatise to every one who wishes
to become a correct auscultator. Based to a very
large extent upon cases numerically examined, it
carries the evidtnce of careful study and discrimina-
tion ui'on every pane. It does credit to ttie author,
and through him, to the profession in this country.
It is, what we cannot call every book upon auscul-
tation, a readable book. — Am. Jour. Med. Sciences.

BY THE SAME ATTTHOR. (NoW Ready.)

A PRACTICAL TREATISE ON THE DIAGNOSIS, PATHOLOGY, AND

TREATMENT OF DIJ^EASES OF THE HEART. In one neat octavo volume, of about
500 pages, extra cloth. $ I Tfx

We do no* know that Dr. Flint has written any-
thing which is not first rate ; but this, his latest con-
tribution to medical literature, in our opini(m, sur-
passes all the others. The work is mo.st comprehen-
sive in its scope, and most sound in the views it enun-
ciatrs. The descriptions are clear and methodical;
the statements are substantiated by facts, aid are
made with such simplicity and sincerity, that witti-

diseasps of the chest. VVe have adopted his work
upim the heart as a fcxt-book, believing it to be
more valuable for that purpose than any work of the
kind that has yet appeared. — Kashville Med.Journ.,
Dec. 1S.59.

With more than pleasure do we hail the advent of
this work, for it fills a wide gap on the list c f text-
books for our scliools, and is, lor the practitioner.

out them they would carry convic'ion. The style | ,|,e n.„st valu;.ble practical work of its kind.— A'. O
is admirably clear, direct, and free from dryness | jyjfcl^ J\'ewt Nov. 1859

With Dr. Walshe's excellent treaiise before us, we
have no hesitation in saj in? that Dr. Flint's book is
the best work (m the heart in the English language.
— Boston Med. and Surg. Journal., Dec. 15, ls59.

We have thus endeavored to present our readers
w^ith a fair analysis ot this remarkable work. Pre-
ferring to employ the very words of thedistinguished
autiior, wherever it was possible, we have essayed
to condense into the briefest spacea general view of
his observations and suggestions, and to direct the
attenti<m of our brethren to the abounding stores of
valuable matter here collected and arraiiged for their
use and instruction. No mediea' library will here
after be considered complete without ttiis volume;
and we trusf it will promptly find its way info the
hands of every Ame'ican student and physician. —
N Am. Med. Chir. Review, Jan 1860.

This last work of Prof. Flint will add much to
his previous well-earned celebrity, as a writer ot
great forceand beauty, and, wiih his previous work,
places him at the head of American writers upon

In regard to the merits of the work, we have no
hesi'utHm in pronouncing it full, accurate, and ju-
dicious. Considering the pres'nt state of science,
such a work was much needed. Jt should be in the
hands of every practitioner. — Chicago Med. Journal.
April, 1860.

But these are verv trivial spots, and in nowise
prevent us from declaring our most hearty approval
of the author's ability, industry, and conscientious-
ness. — Dublin Quarterly Journal of Med. Sciences,
Feo. 1860.

He has labored on wi'h the same industry and care,
and his place among the Jirst authors of our country
is bec<Mning fully esiabliohed. To this end, the work
whose title is given above, contributes in no small
degree. Our spa :e will not admit of »n extended
analysis, nnd we will close this urief no'ice by
commending it without reserve to every class of
readers in the profession. — Peninsular Med. Journ.,
Feb. 1800.

AND SCIENTIFIC PUBLICATIONS.

FOWNES (GEORGE), PH. D., &c.
A MANUAL OF ELEMENTARY CHEMISTRY; Theoretical and Practical.

From the seventh revised and correeted Lond.m edition. With one hundred and ninety-<even
illustrations. Edited by Robert Bridges, M. D. In one large royal 12mo. volume of tiOO
pages. In leather, $1 65; extra cloth, $1 50. (Just Issued.) '

The death of the author having placed the editorial care of this work in the practised hands of
Drs. Bence Jones and A. W. Hoffman, everything- has been done in its revision which experience
could suggest to keep it on a level with the rapid advance of chemical science. The additions
requisite to this purpose have neces^ilated an enlargement of the page, notwithstanding which the
work has been increased by about fifty pages. At the same time every care has been used to
maintain its distinctive character as a condensed manual for the student, divested of all unneces.sary
detail or mere theoretical speculation. The additions have, of course, been mainly in the depart-
ment of Organic Chemistry, which has made such rapid progress within the last kw years, but
yet equal attention has been bestowed on the other branches of the subject— Chemical Physics and
inorganic Chemistry— to present all investigations and discoveries of importance, and to keep up
the reputation of the volume as a complete manual of the whole .science, admirably adapted for the
learner. By the use of a small but exceedingly clear type the matter of a large octavo is compressed
within the convenient and portable limits of a modera"le sized duod>>cimo, and at the very low price
affixed, It is offered as one of the cheapest volumes before the profession.

Dr Fownes' excellent work has been universally
recognized everywhere in liis own and this founlry,
as the best elementary treatise on chemiscry in the

English tongue, and is very gerierallv adopted, we
believe, as the standard text hook in alli ur colleges,
both literiiry and scientific. — Charleston M.ed Journ.
and Review, Sept. 1859.

A standard manual, which has long enjoyed the
reputation of embodying much knowledge in a small
space. The author liasachieved the difficult task of
condensation with masterly tact. His book is con-
cise without being dry, and brief witliout being too
dogmatical or general . — Virginia Med. and Surgical
Journal.

The work of Dr. Fownes has long been before
the public, and its merits have been fully appreci-
ated as the best text-book on chemistry now io
existence. We do not, of course, place it in a rank
superior to the works of Brunde, Graham, Turner,
Gregory, or Gmelin, but we say that, as a work
for students, it is preferable to any of them. — Lon-
don Journal of Medicine.

A work well adapted to the wants of the student
It is an excellent exposition of the chief doctrines
and facts of modern chemistry. The size of the work,
and still more the condensed yet perspicuous style
in which it is written, absolve it from the charges
very properly urged against most manuals termed
popular. — Edinburgh Journal of Medical Scienct.

fiske fund prize essays —the ef-
fp:cts of climate on tuberculous

DISEASE. By Edwin Lee, M.R.C S.London,
and THK INFLUKNCK oF PREGNANCY ON
THE DEVELOi'AIENT OF TUBERCLES By

Edward Wareisn, M. D , of Edenton, N. C. To-
gether in one neat 8vo volume, extra cloth. S^I 00.
FRICK OxN RENAL AFFKCTIONS; their Diag-
nosis and Pathology. With illustrations. One
volume, royal l'2mo., extra cloth. 75 cents.

FERGUSSON (WILLIAM), F. R. S.,

Professor of Surgery in Kine's Collesre, London, &c.

A SYSTEM OF PRACTICAL SURGERY. Fourth American, from the third

and enlarged London edition. In one large and beautifully printed octavo volume, of about 700
pages, with 393 handsome illustrations, leather. $3 00.

GRAHAM (THOMAS), F. R. S.
THE ELEMENTS OF INORGANIC CHEMISTRY, including the Applica-

tions of the Science in the Arts. New and much enlarged edition, by He.\ry Watts and Robert
Bridges, M. D. Complete in one large and handsome octavo volume, of over 800 very large
pages, with two hundred and thirty-two wood-cuts, extra cloth. $4 00.
,^*^ Part II., completing the work from p. 431 to end, with Index, Title Matter, &c., may be

had separate, cloth backs and paper sides. Price $2 50.

From Prof. E. N. Horsford, Harvard College. \ afford to be without this edition of Prof. Graham's
It has, in its earlier and less perfect editions, been j Elements.— SJi/i»ian'* Journal, March, 18.53.

familiar to me, and the excellence of its plan and i p^g^^ p^„f Woicott Gihbs, N. Y. Free Academy.

the clearness and eompletentss of its discussions, _,, , . , ■ l, • ,, . j

have long been my admiration. . The vvork is an admirable one in all respects, and

I its republicatKm here cannot fill to exert a positive
No reader of English works on this science can . influence upon the progress of science in this country.

GRIFFITH (ROBERT E.), M. D., &.c.
A UNIVERSAL FORMULARY, containing the methods of Preparing and Ad-

ministering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceu.
lists. Second Edition, thoroughly revised, with numerous additions, by Robert P. Thomas,
M. D., Professor of Materia Medica in the Philadelphia College of Pharmacy. In one large and
handsome octavo volume, extra cloth, of 650 pages, double columns. $3 00; or in sheep, $3 25.

It was a work requiring much perseverance, and
when published was looked upon as by far the best
work of its kind that had issued from the American
press. Prof Thomas has certainly "improved." as
well as added lolhis Formulary, and has rendered il
additionally deserving of llie coiifidence of pharma-
ceutists and physicians.— j4ot. Journal of Pharmacy.

We are happy to announce a new and improved
edition of this, one of the most valuable and useful
works that have emanated from an American pen.
It would do credit to any country, and will be found
of daily usefulness to practitioners of medicine; il is
better adapted 10 their purposes than the dispensaio
ries. — Southern Med. and Surg. Journal.

It is one of the most useful books a country practi-
tioner can possibly have. — Medical Chronicle.

This is a work of six hundred and fifty one pageu,
■mhracing all on tlie sulijeci of preparine and admi-
lusiering medicines that can be desired by the phygi-
''Jan and pharmaceutist. — Western Lancet.

The amouniof useful, every-day matter. for a prac
licing physician, is really immense.— Bo.«/o»i Med.
and Surg. Journal.

This edition has been greatly improved by the re-
vision and ample adilitions of Dr Tlionri* and is
now, we believe, one of the most po'iijileit- works
of its kind ill any language. Tht addllioii'' amount
to about seventy pages, and no effori ha- ln-rn spared
to include in them all the rcenl improveiiifiiis K
work of this kind appears lo us indispeii-able lo ihe
physician, and there is none .ve can more cordially
recommend.— iV. Y. Journal of Medicine.

BLANCHARD & LEA'S MEDICAL

GROSS (SAMUEL D.), M. D.,

Professor of Surgery in the Jefferson Medical College of Philadelphia, &c.

Just Issued.

A SYSTEM OF SURGERY : Pathological, Diagnostic, Therapeutic, and Opera-

xive. Illustrated by Nine Hcnpred and Thirtv-six Engravings. In two large and beautifully

printed octavo volumes, of nearly tv/enty-four liundred pages; strongly bound in leather, with

raised bands. Price $12.

From the Author's Preface.

" Th,e object of this work is to furnish a systematic and comprehensive-treatise on the science and
practice of surgery, considered in the broadest sense; one that shall serve the practitioner as a
faithful and available guide in his daily routine of duty. . . . My aim has been to embrace the
whole domain of surgery, and to allot to every subject its legitimate claim to notice in the great
family of external diseases and accidents. How far this object has been accomplished, it is not for
me to determine. It may safely be afi'irmed, however, that there is no topic, properly appertaining
to surgery, that will not be found to be discussed, to a greater or less extent, in these volumes."

Has Dr. Gross satisfactorily fulfilled this object? I style of publication, that we can honestly recom-

A careful perusal of his volumes enables us to give
an answer in the affirtiia tive. Not only has he given
to the reader an elaborate and well-wriiten account
of his o^n vast experience, but he has not failed to
embody in his pages the opinions and practice of
surgeons in this and other countries of Europe. The
result has been a work of such completeness, that it
has no superior m the systematic treatises on sur-
gery which have emanated from English or Conti-
nental authors. It has been justly objected that
these have been far from cotnplele in many essential
particulars, many of them having been deficient in
some of the most important points whi-jh should
characterize such works Some of them have been
elaborate — too elaborate— wiih respect to certain
diseases, while they have merely glanced at, or
given an unsatistactory account of, others equally
important to the surgeon. Dr. Gross has avoided
this error, and has produced the most complete work
that has yet issued from the press on the science and
practice of surgery. It is not, strictly speaking, a
Dicth nary of Surgery, but it gives to the reader all
the information that he may require forhis treatinent
i»f surgical diseases. Having said so much, it might

mend it as the best work of the kind to be taken
home by the young practitioner. — Am. Med. Journ.
The treatise of Prof. Gross is not, therefore, a
mere text-book for undergraduates, but a systema-
tic record of more than thirty years' experience,
reading, and reflection by a man of observation,
sound judgment, and lare practical fact, and as sucli
deserves to tahe rank w^ith the renowned produc-
tions of a similar character, by Vidal and Boyer, of
France, or those of Chelius, Blasius, and Langen-
beck, of Germany. Hence, we do not hesitate to
express the opinion that it will speedily take the
same elevated position in regard to surgery that lias
been given by common consent to the masterly work
of Pertira in Materia Medi -a, or to Toud and Bow-
man in Physiology. — A'. O. Med. and Surg. Journal.

At present, however, our object is not to review
the work (this we purpose doing hereaiter), but
simply to announce its appearance, that in the
meantime our readers may procure and examine it
for themselves. But even this much we cannot do
without expressing the opinion that, in putting forth
these two volumes, Dr. Gross has reared for hirn-

Of Dr. Gross's treatise on Surgery we can say
no more than that it is the most elaborate and com-
plete work on this branch of the I eating art which
has ever been published in any country. A sys-
tematic work, it admits of no analvtical review

appear superfluous to add another w ird ; but it is self a lasting monument to his skill as a surgeon,
only due to Dr. Grois to state that he has embraced «n<l '" "'^ industry and learning as an author.— S<.
the opportunity of transferring to his pages a vast | l-oui$ Med. and Surg. Journal.
number o( engravings from English and other au- l With pleasure we record the completion of this
ttiors, illustrative oi the pathology and treatment of long-anticiptted work. The reputation which the
surgical diseases. To these are added several hun- | author has for many years sustained, both as a sur-
dred original wood-cuts. The work altogether com- j geon and as a writer, had prepared us to expect a
mentis itself to the attention of British surgeons, i treatise of great excellence and originality ; but we
from whom it cannot fail to meet with extensive ctmfess we were by no means prepared lor the work
patronage. — London Lancet, Sept. 1, 18C0. which is before us — the most complete treatise upon

surgery ever published, either in this or any othtr

country, and we might, perhaps, safely say, the

I most original. Thert is no subject belonging pro-

I pcrly to surgery which has not received from the

j author a due share of attention. Dr. Grof s has sup-

,,,,,,.! plied a want in surgical literature which has long

but, did^ our spacj permit, we sh.-uld^ gladly gye . ,,^g„ f^n ^y practitioners; he has furnished us with

"""""" "" "■" ~" ts

the
-, , , ^ ., , „ ■ I ...... ^ ,....^.., , „„ „„rgeons, we are most sincerely

Quarterly Journal of Med. Science. thankful to him for his extraord nary labors in our

The work is so superior to its predecessors in behalf. — N. Y. Monthly Review and Buffalo Med.
matter and extent, as well as in illustrations and Journal.

BY THE SAME AUTHOR.

ELEMENTS OF PATHOLOGICAL ANATOMY. Third edition, thoroughly

revised and greatly improved. In one large and very handsome octavo volume, with ab>iut three
hundred and fifty beautiful illustrations, of which a large number are from original drawings.
Price in extra cloth, H 75; leather, raised bands, %") 25. {Lately Puhlished.)
The very rapid advances in the Science of Pathological Anatomy during the last few years have
rendered essential a thorough modification of this work, with a view of making it a correct expo-
nent of the present state of the subject. The very careful manner in which this task has been
executed, and the amount of alteration which it has undergone, have enabled the author to say that
" with the many changes and improvements now introduced, the work may be regarded almost as
a new treatise," while the efforts of the author have been seconded as regards the mechanical
execution of the volume, rendering it one of the handsomest productions of the American press.
We most sincerely congratulate the author on the We have been favorably impressed with the gene-

^..v, v.... ..... c|,..v,>, ,........», ..V, „.......« p. ,...., g..^ . ueen lelt by practitioners; ne lias turnished us witi

some extracts from it, loenable our readers to judge ■ ^ complete practical treatise upon surgery in all it
of the classical siyle of the author, and the exhaust- ! departments As Aneric ins, we are proud of th
ing way in which eacli subject is treated.-DMfriin achievement; as surgeons, we are most sincere!-

successful manner in which he has accomplished his
proposed object. His book is most admirably cal
culated to fill up a blank which has long been felt to

ral manner in which Dr. Gross has executed his task
of alTordinK a comprehensive digest of the present
state of the literature of Pathological Anatomy, and

exist in this department of medical literature, and j have much pleasure in recommending his work to
as such must become very widely circulated amongst I our readers, as we believe one well deserving of
all classes of the profession. — Dublin QuarJer/y j diliL-ent perusal and careful study. — Montreal Med.
Journ. of Med. Science, Nov. 1857. I Chron., Sept. 1857.

BY THE SAME AUTHOR.

A PRACTICAL TREATISE ON FOREIGN BODIES IN THE AIR-PAS-

SAGES. In one handsome octavo volume, extra cloth, with illustrations, pp. 468. $2 75.

AND SCIENTIFIC PU BL.TC ATIONS.

GROSS (SAMUEL D.), M. D..
Professor of Surgery in the Jefferson Medical College of Philadelphia, &c.

A PRACTICAL TREATISE ON THE DISEASES, INJURIES, AND

MALFORMATIONS OF THE URINARY BLADDER, THE PROSTATE GLAND, AND
THE URETHRA. Second Edition, revised and muoh enlarged, wilh one hundred and eighty-
four illustrations. In one large and very handsome octavo volume, of over nine hundred pages.
In leather, raised bands, $5 2-5 ; extra cloth, $4 75.
Philos'iphical in 'ts desig^n, methodical in its ar-

rausement, ample and sound in its practical details,

it may in truth be saiO to leave scarcely anything to

be desired on so important a subject. — Boston Med.

and Snrg Journal.

Whoever will peruse the vast amount of valuable
practical information it contains, will, we think,

agree with us, that there is no work in the English
language which can make any just pretensions to
be its equal. — N. Y. .Journal of Medicine.

A volume replete with truths and principles of the
atmost value in the investigation of these diseases.—
American MedicalJournal .

GRAY (HENRY), F. R. S.,

Lecturer on Anatomy at St. George's Hospital, London, &<».

ANATOMY, DESCRIPTIVE AND SURGICAL. The Drawings by H. V.

Carter, M. D., late Demonstrator on Anatomy at St. George's Hospital ; the Dissections jointly
by the Author and Dr. Carter. In one magnificent imperial octavo volume, of nearly SOb
pages, with 363 large and elaborate engravings on wood. Price in extra cloth, $6 25; leather
raised bands, $7 00. {Just Issued.)

The author has endeavored m this work to cover a more extended range of subjects than is
customary in the ordinary text-books, by giving not only the details necessary for the student, but
also 'he application of those details in the practice of medicine and surgery, thus rendering it both
a guide for the learner, and an admirable work of reti^rence tor the active practitioner. The
engravings form a special feature in the work, many of them being the size of nature, nearly all
original, and havingthe names ot the various parts printed on the body of the cut, in place of figures
of reterence with descriptions at the foot. They thus form a complete and splendid series, which
will greatly assist the student i.i obtaining a clear idea of Anatomy, and will also serve to refresh
the memory of those who may hiid in the exigencies of practice the necessity of recalling the details
of the dissecting room ; while combining, as it does, a complete Atlas of Anatomy, with a thorough
treatise on systematic, descriptive, and applied Anatomy, the work will be found of essential use
to all physicians who receive students in their othces, relieving both preceptor and pupil of much
labor in laying the groundwork of a thorough medical education.

The work before us is one entitled to the highest
praise, f nd we accordingly welcome it as a valu-
able addition to medical literature. Intermediate
in fulness of detail between the treatises of S lar
pey and of Wilson, its characteristic merit lies in
the number and excellence of the engravings it
contains. Most of these are original, of much
larger than ordinary size, and admiral) y executed.
The various parts are also lettered after the plan
adopted in Holden's Osteology. It would be aiffi-
cnlt to over-estimate the advantages olfertd by this
mode of pictorial illusiration. Bones, ligaments,
muscles, bloodvessels, and nerves are each in turn
fiffured, and marked with their appropriate names ;
thus enabling the student to C( mprehend, at a glance,
what would otnerwise often be ignored, or at any
rate, acquired only by prolonged and irksome ap-
plicatiim. In conclusion, we heartily commend the
work of Mr. Gray to the attention of the meuical
profession, feeling certain that it should be regarded
as one of the most valuable contributions ever made
to educational literature. — N. Y. Monthly Review.
Dec. 1859.

In ^his view, we regard the work of Mr. Gray as
far belter adapted to the wants of the profession,
and especially of the student, than any treatise on
anatomy yet published in this country. It is destined.
we believe, to supersede \\\ others, both as a manual
of dissections, and a standard of reference to the
student of general or relative anatomy. — N. Y.
Journal of Medicine, Nov. 18.59.

This is by all comparison the most excellent work
on Anatomy extant. It is just the thing that has
be<n long desired by the professi<m. With such a
guide as this, the student of anatomy, the practi-
tioner of medicine, and the surgical devotee have
all a newer, clearer, and more radiant light thrown
np(m the intricacies and mysteries of this wonder-
ful science, and are thus enabled to accomplish re-
sults which hitherto seemed possible only to the
specialist. The plates, which are copied irom re-
cent dissections, are so well executed, that the most
superficial observer cannot fail to perceive the posi-
tions, relations, and distinctive features of the vari-
ous parts, and to take in more of anatomy at a glance,
than by many long hours of diligent study over the
most erudite treatise, or, perhaps, at the dissecting
table itself. — Med. Journ. of N. Carolina, Oct. 1859.

For this truly admirtible work the profession is
indebted to the distinguished author of " Gray on
the Spleen." The vacancy it fills has been long felt

to exist in this eoun'ry. Mr. Gray writes through-
out with both branches of his subject in view. His
description of each particular part is followed by a
notice of its relations to tie parts with which it is
connected, and this, too, sufficiently ample for all
the purposes of the operative surgeon. After de-
scribing the bones and muscles, he gives a concise
statement of the fractures to which the hone§ of
the extremities are most liable, together with the
amount and ciirection of the displacement tj which
the fragments are subjected by muscular actiim.
The section on arteries is remarkably full and ac-
curate. Not only is the surgical anatomv given to
eviry important vessel, with directiims for its liga-
tion, but at tlie end of the description of each arte-
rial trunk vve have a useful summary of the irregu-
larities which may occur in its origin, course, and
termination. — N. A. Med. Ckir. Review, Mar. 1659.

Mr. Gray's book, in excellency of arrangement
and comnleteness of execution, exceeds any work
on anatomy hitherto published in the English lan-
guage, affording a complete view of the structure of
the human bodv, with especial reference to practical
surgery. Thus the volume constitutes a perfect book
of reference for the practitioner, demanding a place
in even the most limited library of the physician or
surgeon, and a work of necessity for the student to
fix in his mind what he has learned by the dissecting
knife from the book of nature. — Tke Duhlin Quar-
terly Journal of Med. Sciences, Nov. lb'58.

In our judgment, the mode of illustration adopted
in the present volume cannot but present many ad-
vantages to the studentof anatomy. To the zealous
disciple of Vesalius, earnestly desirous of real im-
provement, the book will certainly be of immense
value ; but, at the same time, we must also confess
that to those simplv desirous of "cramming" it
will be an undoubted podsend. The peculiar value
of Mr. Gray's mode of illustration is nowhere more
markedly evident than in the chapter on osteology,
!ind especially in those portions which treat of the
bones of the head and of Ihjir development. The
study of these parts is thus made one of comparative
CHse, if not of positive pleasure; an<l those bugbears
of the student, the temporal and sphenoid bones, are
shorn of half their terrors. It is, in our estimation,
an admirable and complete text-book for the student,
and a useful work of reference for the practitioner;
its pictorial character forming a novel element, to
which we have already sufficiently alluded. — Am.
Journ. Med. Sci., July, 1859.

BLANCHARD & LEA'S MEDICAL

GIBSON'S INSTITUTES AND PRACTICE OF
SURGERY. Eighth edition, improved aiid al-
tered. With thirty-four plates. In tvvohandsome
octavo volumes, contain in°r about 1,000 pages,
leather, raised bandi. $6 50.

GARDNER'S MEDICAL CHEMISTRY, for the
use of Students and the Prc-fi'ssion. In one royal
12mo. vol., cloth, pp. ;jfl6, with woodcuts. SI.

GLUGE'S ATLAS OF PATHOLOGICAL HIS-
TOLOGY. Trui.slated, with Notes and Addi-

tions, by Joseph Letdy, M. D. In one volume,
very large imperial quarto, extra cloth, wit i 320
copper- plate figures, plain and colored, $5 00.

HUGHES' INTRODUCTION TO THE PRAC-
TICE OF AUSCULTAI'lON AN1» OTHER
MODES OF PHYSICAL DIAGNOSIS IN DIS-
EASES OF THE LUNGS AND HEART. Se-
cond edition 1 vol. royal 12mo., sx. cloth, pp.
304. $1 00.

HAMILTON (FRANK H.), M. D.,

Professor of Surgery in the Long Island College Hospital.

A PRACTICAL TREATISE ON FRACTURES AND DISLOCATIONS. Tn

one larse and handsome octavo volume, of over 750 page.*, with 289 illustrations. $4 25. [Now
Ready, January, 1S60.)

Among the many good workers at surgery of vsrhom
America may now boast rot the least is Frank Ilast-
ingii Hamilton; and the volume before us is(we say
it with a pang of wounded patriotism) the best and
handiest book on the subject in the Erglish lan-
guage. It is in vain to attempt a review of it;
nearly as vain to seek for any sins, either of com-
mission or omission. We have seen no work on
practical surgery which we would sooner recom-
mend to our brother surgeons, especially those of
'' the services," c r those whose practice lies in dis-
tricts where a man has necessarily to rely on his
own unaided reEources. The practitioner will find
in It directions for nearly every possible accident,
easily found and compreliended ; and much pleasant
tending for him to muse over in the after confidera-
tion of his cases. — Edinburgh Med. Jovrn Feb. 1601.

This is a valuable contribution to the surgery of
most important affections, and is the more welcome,
inasmuch as at the present time we do not pDssess
a single complete treatife on Fractures and Dislo-
cations in the English language. It has remained for
our American brother to produce a complete treatise
upon the subject, and bring together in a convenient
form tliose alterations and improvements that have
been made from time tolime in tlie treatment of these
affections. One great and valuable feature in the
work before us is the fact that it comprises all the
improvements introduced into the practice of both
Eng;lish and American surgery, and though far from
omitting mention of our continental nei^hjiors, the
author by no means tncourages the notion— but too
prevalent in some quarters— that nothing is good
unless imported from France or Germany. Tne
latter half of the work is devoted to the considera-
tion of the various dislocations and their appropri-
ate treatment, and its merit is fully equal to that of
the preceding portion.— 2'Ae London Z-oncer,May 5, \
1860. ) ^ '

It is emphatically the book upon the subjects of
which it treats, and we cannot doubt that it will
Continue so to be for an indefinite period of time.
When we say, however, that we believe it will at
once take ils place as the best book for consultation
by the practitioner; and that it will form the most
complete, available, and reliable guide in emergen-
cies of every nature connected with its subjects; and
also that the student of surgery may make it his text-
book wi'h entire confidence, and with pleasure also,
from Us agreeable and easy sty le— we think our own

opinion may be gathered as to its value. — Tioston
Medical and Surgical Journal, March 1, 1860.

The work is concise, judicious, and accurate, and
adapted to the wants of the student, practiticner,
and investigator, honorable to the author and to the
profession. — Chicago Med. Journal, March, 18G0.

We regard this work as an honor not only to its
author, but to the profession of our country. Were
we to review it thoroughly, we could not convey to
the mind of ihe reader more forcibly our honest
opinion expressed in the few words — we think it the
best book ol ils kind extant. Every man interested
in surgery will 80(m have this work on his desk.
He who does not, will be the loser. — New Orleans
Medical News, March, l&CO.

Now that it is before us, we feel bound to say that
much as was expected from it, and onerous as was
the undertaking, it has surpassed expectation, and
achieved more than was pledged in its behalf; for
its title does not express in full the richcess of its
contents. On the whole, we are prouder of this
work than of any which lias for years emanated
from the American medical press; its sale will cer-
tainly be very large in this country, and we antici-
pate its eliciting much attention in Europe. — Nash-
ville Medical Record, Mar. 1860.

Every surgeon, young and old, should possess
himself of it, and give it a careful perusal, in doing
which he will be richly repaid. — St. Louis Med.
and Surg. Journal, March, 1860.

Dr. Hamilton is fortunate in having succeeded in
filling the void, so long felt, with what cannot fail
to be at once accepted as a model monograph in some
respects, and a work of classicil authority. We
sincerely congratulate the profession of the United
States on the appearance of such a publication from
one of their number. We have reason to be proud
of it as an original work, both in a literary and s-i-
entific point of view, and to esteem it as a valuable
guide in a most difficult and important branch of
study and practice. On every account, therefore,
we hope that it may soon be widely known abroad
as an evideoce of genuine progress on this side of
the Atlantic, and further, that it may be si ill more
widely known at home as an authoritative teacher
from which every one may profitably learn, and as
aff.)rdingan example of honest, well-directed, and
untiring industry in autliorship which every surgeon
may eiuulate.- Am. Med. Journal, April, 1800,

HOBLYN (RICHARD D.), M. D.
A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE

COLLATERAL SCIENCES. A new American edition. Revit^ed, with numerous Additions,
by Isaac Hays, M. D., editor of the '< American Journal of the iVledieal Sciences." In one large
royal 12mo. volume, leather, of over 500 double columned pages. $1 50.

To both practitioner and student, we recommend use; embracingevery department of medical science
this dictionary as being convenient in size, accurate i down to the very latest date. — Western Lancet.
in definition, and sufficiently full and complete for 1 Hoblyn's Dictionary has long been a favorite with
ordinary consultation.-C/iaW«<onMed. Joum. ^^ ^^jg j^e best book of definitions we have, and

We know of no dictionary better arranged and i ought always to be upon the student's table. —
adapted. It is not encumbered with the obsolete terms Southern Med. and Surg . Journal .
of a bygone age, but it contains all that are now in I

HOLLAND'S MEDICAL NOTES AND RE- i
FLECTIONS. From the thiid London edition.
In ote handsome octavo volume, extra ciolh. ¥3.

HORNER'S SPECIAL ANATOMY AND HIS-

TOLOGY. Eighth edition. Extensively revised
and iiioditied. In two large octavo voli'.ines, ex-
tra cloth, of more than 1000 pages, with over 300
illustrations. $6 00.

AND SCIENTIFIC PUBLICATIONS.

HODGE (HUGH L.), M. D.,
Professor of Midwifery and the Diseases of Women and Ctiildren in the University of Pennsylvania, &c.

ON DISEASES PECULIAR TO WOMEN, including Displacements of the
TJlerus. With original illustrations. In one beautifully printed octavo volume, of nearly 500
pages, extra cloth. $3 25. {Now Ready.)

We will say at once that the work fulfils its object
capitally well ; and we will moreover venture the
asatrti(iii that it will inaugurate an imnroved prac-
tice thrnughoul this whole country. The secrets of
the author's success are so clearly revealed that the
attentive student cannot fail to insure a goodly por-
tion of similar success in his own practice. It is a
credit to all medical literature; and we add, that
the physician who does not place it in his library,
and who does not faithfully con its pages, will lose
a vast deal of knowledge that would be most useful
to himself and beneficial to his patients. It is a
prnctiral work nf the highest order of merit; and it
w^ill.take rank as such immefiiatelv. — Maryland and
Virginia Medical Journal, Feb. 1861.

This contribution towards the elucidation of the
pathology and treatment of some of the diseases
peculiar to women, cannot fail to meet with a favor-
able reception from the medical profession. The
character of the particular maladies of which the
■work before us treats; their frequency, variety, and
obseuiity ; the amount of malaise and even of actual
suffering by which they are invariably attended;
their obstinacy, the difficulty with which they are
overcome, and their dispositicm again and again to
lec'ir — these, taken in connection with the entire
competency of the author to render a correct ac-
count of their nature, their causes, and their appro-

priate management— his ample experience, his ma-
tured judgment, and his peifect conscientiousness

invest this puhlication with an interest and value to
which few of the medical treatises of a recent date
can lay a stronger, if, perchance, an equal claim. —
Atn. Journ. M^^d. Sciences, Jan. 1S61.

Indeed, although no part of the volume isnotemi-
nently rieserving'of perusal and study, we think that
the nine cliapttrs devoted to this subject, are espe-
cially so, and wt know of no more valuable mono-
graph upon the symptom?, prognosis, and manage-
ment of these annoying maladies than is constituted
by this part of the woik. We cannot but regard it
as one of the most original and m ist practical worKs
of the day ; one which every accoucheur and physi-
ciaa should most carefully re id; for we are per-
suaded that he will arise from its perusal with new
ideas, which will induct him into a more rational
practice in regard to many a suffering femile, who
may have placed tier health in his hunds.— British
America7i Journal, Feb. 1661.

Of the many excellences of the work we will not
speak at length. We advise all who would acquire
a knowledge of the proper management of the mala-
dies of which it treats, to study it with care. The
secf nd part is of itself a most valuable contributi(m
to the practice of our arc. — Am. Med. Monthly and
New York Review. Feb. ISGl.

The illustrations, which are all original, are drawn to a uniform scale of one-half the natural size.

HABERSHON (S. O.), M. D.,

Assistant Physician to and Lecturer on Materia Medica and Therapeutics at Guy's Hospital, &c.

PATHOLOGICAL AND PRACTICAL OBSERVATIONS ON DISEASES

OF THE ALIMENTARY CANAL, (ESOPHAGUS, STOMACH, U^CUM, AND INTES-
TINES. With illustrations on wood. In one handsome octavo volume of 312 pages, extra
cloth $1 75. {Now Ready.)

JONES (T. WHARTON), F. R, S.,

Professor of Ophthalmic Medicine and Surgery in University College, London, &c.

THE PRINCIPLES AND PRACTICE OP OPHTHALMIC MEDICINE

AND SURGERY. With one hundred and ten illustrations. Second American from the second
and revised London edition, with additions by Edward Hartshokne, M. D., Surgeon to Wills'
Hospital, &c. In one large, handsome royal 12mo. volume, extra cloth, ol 500 pages. $1 50.

JONES(G. HANDFIELD), F.R.S., & EDWARD H. SIEVEKING, M.D.,

Assistant Physicians and Lecturers in St. Mary's Hospital, London.

A MANUAL OF PATHOLOGICAL ANATOMY. First American Edition,

Revised. With three hundred and ninety-seven handsome wood engravings. In one large and
beautiful octavo volume of nearly 750 pages, leather. $3 75.

As a concise text-book, containing, in a condensed | obliged to glean from a great number of monographs'
form, a complete outline of what is known in the and the field was so extensive that but few cultivated

domain of Pathological Anatomy, it is perhaps the
best work in the English language. Its great merit
consists in its completeness and brevity, and in this
respect it supplies a great desideratum in our lite-
rature. Heretofore the student of pathology was

it with any desree of success. As a simple work
of reference, therefore, it is of great value to the
student of pathological anatomy, and should be in
every physician's library. — Western Lancet.

KIRKES (WILLIAM SENHOUSE), M. D.,

Demonstrator of Morbid Anatomy at St. Bartholomew's Hospital, &c.

A MANUAL OF PHYSIOLOGY. A new American, from the third and

improved London edition. With two hundred illustrations. In one large and handsome royal
12mo. volume, leather, pp. 586. $2 00. (Lately Publ is ked.)

This is a new and very much improved edition of
Dr. Kirkes' well-known Handbook of Physiology.
It combines conciseness with completeness, and is,
therefore, admirably adapted for consultation by the
busy practitioner. — Dublin Quarterly Journal.

One of the very best handbooks of Physiology we
possess — presenting just such an outline of the sci-
ence as the student requires during his attendance
upon a course of lectures, or for reference whilst
preparing for examination. — Am. Medical Journal.

Its excellence is in its compactness, its clearness,

and its carefully cited authorities. It is the most
convenient of text-books. These gentlemen, Messrs.
Kirkes and Pa^et, have the gift of telling us what
we want to know, without'thinkiiig it necesjary
to tell us all they know. — Boston Med and Surg.
Journal.

For the student beginning this study, and the
practitioner who has but leisure to refresh his
memory, this book is invaluable, as it contains all
that it is important to know. — Charleston Med.
Journal.

20 BLANCHARD & LEA'S MEDICAL

KNAPP'S TECHNOLOGY ; or, Chemistry applied
to the Arts and to Manufactures. Edited by Dr.
Ronalds, Dr. Richardson, and Prof. W. R.
Johnson. In two handsomf 8vo. vols., withabout
500 wood- engravings. $6 00.

LAYCOCK'S LECTURES ON THE PRINCI-
PLES AND METHODS OF MEDICAL OU-
SERVATION AND RESEARCH. For the Use
of Advanced Students and Junior Pruclitumf rs.
In one royal 12mo. volume, extra cloth. Price SI.

LALLEMAND AND WILSON.
A PRACTICAL TREATISE ON THE CAUSES, SYMPTOMS, AND

TREATMENT OF SPERMATORRHCEA. By M. Lali.e.mand. Translated and edited by

Henry J McDougall. Third American edition. To which is added ON DISEASES

OF THE VESICUL^ SEMINALES; and their associated organs. With special reler-
ence to the Morbid Secretions of the Prostatic and Urethral Mucous Membrane. By Marris
Wilson, M.D. In one neat octavo volume, of about 400 pp., extra cloth. $2 00. (Juat Issued.)

LA ROCHE (R.), M. D., &c.
YELLOW FEVER, considered in its Historical, Pathological, Etiological, and

Therapeutical Relations. Including a Sketch of the Disease as it has occurred in Philadelphia
from 1699 to 1854, with an examination of the connections between it and the fevers known under
the same name in other parts of temperate as well as in tropical regions. In two large and
handsome octavo volumes of nearly 1500 pages, extra cloth. $7 00.

From Professor S. H. Dickson, Charleston, S. C, I nant and unmanageable disease of modern times,

September 18, 185.5. has for several years been prevailing in our country

A monument of intelligent and well applied re- to a greater extent than ever before; that it is no

search, almost without example. It is, indeed, in longer confined to either large or small cities, but

itself, a large library, and is destined to corrstitute
the special resort as a book of reference, in the
subject of which it treats, to all future time.

We have not time at present, engaged as we are,
by da^' and by night, in the work of combating this
very disease, now prevailing in our city, to do more
than give this cursory notice of what we consider
as undoubtedly the most able and erudite medical
publication our country has yet produced. But in
view of the startling fact, that this, the most malig-

penetrates country villages, plantations, and farm-
houses; that it is treated with scarcely better suc-
cess now than thirty or forty years ago; that there
is vast mischief done by ignorant pretenders to know-
ledge in regard to the disease, and in view of the pro-
bability that a majority of southern physiciiins will
be called upon to treat the disease, we trust that this
able and comprehensive treatise will he very gene-
rally read in the south. — Memphis Med. Hecorder.

BY THE same AUTHOR.

PNEUMONIA ; its Supposed Connection, Pathological and Etiological, with Au-
tumnal Fevers, including an Inquiry into the Existence and Morbid Agency of Malaria. In one
handsome octavo volume, extra cloth, of 500 pages. $3 00.

LAWRENCE (W.), F. R. S., 8cc.
A TREATISE ON DISEASES OF THE EYE. A new edition, edited,

with numerous additions, and 243 illustrations, by Isaac Hays. M. D., Surgeon to Will's Hospi-
tal, &c. In one very large and handsome octavo volume, of 950 pages, strongly bound in leather
with raised bands. $5 00.

LUDLOW (J. L.), M. D.
A MANUAL OF EXAMINATIONS upon Anatomy, Physiology, Surgery,

Practice of Medicine, Obstetrics, Materia Medica, Chemistry, Pharmacy, and Therapeutics. To
which is added a Medical Formulary. Third edition, thoroughly revised and greatly extended
and enlarged. With 370 illustrations. In one handsome royal 12rao. volume, leather, o) 816
large pages. $2 50.
We know of no better companion for the student I crammed into his head by the various professors to

during the hours spent in the lecture room, or to re- whom he is compelled to listen. — Western Lancet,

fresh, at a glance, his memory of the various topics | May, 1857.

LEHMANN (C. G.)

PHYSIOLOGICAL CHExMISTRY. Translated from the second edition by
George E. Day, M. D., F. R. S., &:c., edited by R. E. Rogers, M. D., Profe.>^sor of Chemistry
in the Medical Department of the University of Pennsylvania, with illustrations selected from
Funke's Atlas of Physiological Chemistry, and an Appendix ol plates. Complete in two large
and handsome octavo volumes, extra cloth, containing 1200 pages, with nearly two hundred illus-
trations. $6 00.
The work of Lehmann stands unrivalled as the I The most important contribution as yet made to

most comprehensive book of reference and informa- | Physitdogical Chemistry. — Am. Journal Med. Sci-

tion extant on every branch of the subject on which tnces, Jan. 1856.

it treats. — Edinburgh Journal of Medical Science. \

BY THE SAME AUTHOR. {Lately Published.)

MANUAL OF CHEMICAL PHYSIOLOGY. Translated from the German,

with Notes and Additions, by J. Cheston Morris, M. D., with an Ir^roductory Essay on Vital
Force, by Professor Samuel Jackson, M. D., of the University of Penn.-ylvania. With illus-
trations on wood. In one very handsome octavo volume, extra cloth, of 336 pages. $2 25.

FroKi Prof. J'adsoti's Introductory Essay,
In adopting the handbook of Dr. Lehmann as a manual ot Organic Chemistry for the use of the
students of the University, and in recommending his original work of Physiological Chemistry
for their inore mature studies, the high value of his researches, and the great weigtil of his autho-
rity in that important department of medical science are fully recognized.

AND SCIENTIFIC PUBLICATIONS.

LYONS (ROBERT D.), K. C. C,

Late Pathologist in-chief to the British Army in the Crimea, &c.

A TREATISE ON FEVER; or. selections from a course of Lectures on Fever.
Being part of a course of Theory and Practice of Medicine. la one neat octavo volume, of 3(32
pages, extra cloth; $2 00. {^Now Ready.)

From the Author'' s Preface.

"lam induced to publish this work on Fever with a view to bring within the reach of the
student and junior practitioner, in a convenient form, the more recent results of inquiries into the
Pathology and Therapeutics of this formidable class of di>eases.

" Tlie works of the great writers on Fever are so numerous, and in the present day are scattered
in so many languages, that they are diHicult of access, not only to students but also to practitioners.
I shall deem myself fortunate if I can in any measure supply the want which is felt in this respect.

We have great pleasure in recommending Dr.
Lyons' work on ¥tvt.r to the attention of the pro-
fession. It is a work whieh cannot fail to enhance
the author's previous well-earned reputation, as a
diligent, careful, and accurate observer. — British.
Mf.ri. .Tournal, March 2, 1861.

Taken as a whole we can recommend it in the
highest terms as well worthy the careful perusal
and study of every student and practitioner of medi-

cine. We consider the work a most valuable addi-
tion to medical literature, and one destined to wield
no little influence over the mini of the profession. —
Med and Swf. Report- r, May 4, 1861.

This is an admirable work upon the most remark-
able and most important class of diseases to which
mankind are lialjle. — Mtd. Journ. of N. Carolina,
Mdy, 1861.

MEIGS (CHARLES D.), M.D.,

Professor of Obstetrics, &c. in the Jefferson Medical College, Philadelphia.

OBSTETRICS : THE SCIENCE AND THE ART. Third edition, revised

and improved. With one hundred and twenty-nine illustrations. In one beautifully printed octavo
volume, leather, of seven hundred and fifty-two large pages. $3 75.

The best American work on Midwifery that is
accessible to the student and practitioner — JV. W.
Med. and Surg. Journal, Jan. 1S57.

This is a standard work by a great American Ob-
stetrician. It is the third and last edition, and, in
the larguage of the preface, the author has "br<mght
the subject up to the latest dates of real improve-
ment in our art and Science." — Nashville Journ. of
Med. and Surg., May, 1857.

Though the work has received only five pages of
enlargement, its chapters throughout wear the im-
press of careful revision. Expunging and rewriting,
remodelling its sentences, with occasional new ma-
terial, all evince a lively desire that it shall deserve
to be regarded as improved in manner as well as
matter. In the matter, every stroke of the pen has
increased the value of the book, both in expungings
and additions — Western Lancet, Jan. 1857.

BY THE SAME AUTHOR. (JliSt Issued.)

WOMAN: HER DISEASES AND THEIR REMEDIES. A Series of Lec-
tures to his Class. Fourth and Improved edition. In one large and beautifully printed octava
volume, leather, of over 700 pages.

$3 60,

In other respects, in our estimation, too much can-
not be said in praise of this work. Ic a'jounds with
beautiful passages, and for conciseness, for origin-
ality, and for all that is commendable in a work on
the diseases of females, it is not excelled, and pro-
b ibly not equalled in the English language. On the
whole, we know of no worK on the diseases of wo-
men which we can so cordially commend to the
student hnd practitioner as the one before us. — Ohio
Med. and Sttrg. Journal.

The body of the book is worthy of attentive con-
sideration, and is evidently the production of a
clever, thoughtful, and sagacious physician. Dr.
Meigs's letters on the diseases of the external or-
gans, contain many interesting and rare cases, and
many instructive observations. We take our leave
of Dr. Meigs, w^ith a high ojunion of his talents and
originality.— r/ie British and Foreign Medico-Chi-
rurgical Review.

Every chapter is replete with practical instruc-
tion, and bears the ir.ipress of being the coniijosition
of an acute and experienced mind. There is a terse-
ness, and at the same time an accuracy in his de-
scription o( symptoms, and in the rules for diagnosis,

which cannot fail to recommend the volume to the
attention of the reader. — Ranking^s Abstract.

It contains a vast amount of practical knowledge.
tiy one who has accurately observed and retained
the experience of many years. — Dub'.in Quarterly
Journal.

Full of important matter, conveyed in a ready and
agreeaole manner.— Sr Lewis Med. and Surg. Jour.

There is an off-hand fervor, a glow, and a warm-
heartedness infecting; the effirt of Dr. Meigs, which
is entirely captivating, and which absolutely hur-
ries the reader through from beginning to end. Be-
sides, the book teems with solid instruction, and
it shows the very highest evidence of ability, viz.,
the clearness with which the information is pre-
3ented. We know of no better test of one's under-
standing a subject than the evidence of the power
of lucidly explaining it. The most elementary, as
well as the obscurest subjects, under the pencil of
Prof. Meigs, are isolated and made to stand out in
such bold relief, as to produce distinct impressions
upim the mind and memory of the reader. — Th*
Charleston Med. Journal.

BY THE SAME AtTTHOR.

ON THE NATURE, SIGNS, AND TREATMENT OF CHILDBED

FEVER. In a Series of Letters addressed to the Students of his Class. In one handsome
octavo volume, extra cloth, ol 365 pages. $2 50.

lectable book. * * * This treatise upon child-

The instructive and interesting author (if this
work, whose previous labors have placed his coun-
trymen under deep and abiding obligations, again
challenges their admiration in the fresh and vigor-
ous, attractive and racy pages before us. It is a de-

bed fevers will have an extensive sale, being des-
tined, as it deserves, to find a place in the library
of every practitioner who scorns to lag in the rear. —
Nashville Journal of Mediiini and Surgery.

BY THE SAME AUTHOR; WITH COLORED PLATES.

A TREATISE ON ACUTE AND CHRONIC DISEASES OF THE NECK

OF THE UTERUS. With numerous plates, drawn and colored from nature in the highest
style ol art. In one handsome octavo volume, extra cloth. $4 50.

BLANCHARD & LEA'S MEDICAL

MACLISE (JOSEPH), SURGEON.
SURGICAL ANATOMY. Forming one volume, very large imperial quarto.

With f^ixty-eight large and splendid Plates, drawn in the best style and beautifully colored. Con-
taining one hundred and ninety Figures, many of them the size of life. Together with copious
and explanatory letter-press. Strongly and handsomely bound in extra cloth, being one of the
cheapest and best executed Surgical works as yet issued in this country. $11 00.
*^* The size of this work prevents its transmission through the post-orfice as a whole, but those

who desire to have copies forwarded by mail, can receive them in five parts, done up in stout

wrappers. Price $9 00.

One of the greatest artistic triumphs of the age
in Surgical Anatomy. — British American Medical
Journal.

No practitioner whose means -will admit should
fail to possess it. — Ranking^s Abstriet.

Too much cannot be said in its praise; indeed,
we have not language to do it justice. — Ohio Medi-
cal and Surgical Journal.

The most accurately engraved and beautifully
colored plates we have ever seen in an American
book — one of the best and cheapest surgical works
ever published. — Buffalo Medical Journal.

It is very rare that so elegantly printed, bo well
illustrated, and so useful a work, is offered at so
moderate a price. — Charleston Medical Journal.

Its plates can boast a superiority which places
them almost beyond the reach of competition. — Medi-
cal Examiner.

Country practitioners will find these plates of im-
mense value. — N. Y. Medical Gazette.

A work which has no parallel in point of accu-
racy and cheapness in the English language. — N. Y.
Journal of Medicine.

We are extremely gratified to announce to the
profession the completion of this truly magnificent
work, which, as a whole, certainly stands unri-
valled, both for accuracy of drawing, beauty of
coloring, and all the requisite explanations of the
subject in hand. — Th€ Nevt Orleans Medical and
Surgical Journal.

This is by far the ablest work on Surgical Ana-
tomy that has come under our observation. Wo
know of no other work that would justify a stu-
dent, in any degree, for neglect of actual dissec-
tiim. In those sudden emergencies that so often
arise, and which require tlieinstantaneouscommand
of minute anatomical knowledge, a work of this kind
keeps the detiiils of the dissecting-room perpetually
fresh in the memory. — The Western Journal of Medi-
cine and Surgery.

MILLER (HENRY), M. D.,

Professor of Obstetrics and Diseases of Women and Cliililren in the University of Louisville.

PRINCIPLES AND PRACTICE OF OBSTETRICS, &c.; including the Treat-

ment of Chronic Inflammation of the Cervix and Body of the Uterus considered as a frequent
cause of Abortion. With about one hundred illustrations on wood. In one very handsome oc-
tavo volume, of over 600 pages. {Lately Fubtixhed.) $3 75.
We congratulate the author that the task is done. \ tion to which its merits justly entitle it. The style

\y r. n..r>n'i..>tiil.itA liiii-i tli.it \^t. li'ic?.Tiir*it, tit tliM tTi«.r1i- ) ic ciif.ti tli-it tti»/l«'a^rinti(ineurA i>1.inr fin/1 /irir* li ciiK-

We congratulate him that he has given to the medi
cal public a work which will secure for hiin a high
and permanent position among the standard autho-
rities on the principles and practice of obstetrics.
Congratulations are not less due to the medical pro-
fession of this country, on the acquisition of a trea-
tise embodying the results of the studies, reflections,
anil experience of Prof. Miller. Few men, if any,
in this country, are more competent than he to write
on thisdepartrnentof medicine. Engaged for thirty-
five years in an extended practice of olistetrics, for
many years a teacher of tins branch of instruction
in one of the largest of our institutions, a diligent
student as well as a careful ol)8erver, an original and
independent thinker, wedded to no hobbies, ever
ready to consider without prejudice new views, and
to adopt innovations if they are really improvements,
and withal a clear, agreeable writer, a practical
treatise from his pen could not fail to possess great
value. — Buffalo Med Journal.

In fact, this volume must take its place among the
Btandurti systematic treatises on obstetrics ; a posi-

is such that the descriptionsare clear, and each sub-
ject is discussed and elu'idated with due regard to
its practical bearings, which cannot fail to make it
acceptable and valuable to both students and prac-
titioners. We cannot, however, close this brief
notice without congratulating the author and the
profession on the production of such an excellent
treatise. The author is a western man of whom we
feel proud, and we cannot but think that his book
will find many readers and warm admirers wherever
obstetrics is taught and studied as a science and an
art. — The Cincinnati Lancet and Observer.

A most respectable and valuable addition to our
home medical literature, and one reflecting credit
alike on the author and the institution townich he
is attached. The student will find in this work a
most useful guide to his studies; the country prac-
titioner, rusty in his reading, can obtain from its
pages a fair resume of the modern literature of the
science; and we hope to see this American produc-
tion generally consulted by the profession. — Ya.
Med. Journal.

MACKENZIE (WJ, M.D.,

Surgeon Oculist in Scotland in ordinary to Her Majesty, &c. &c.

A PRACTICAL TREATISE ON DISEASES AND INJURIES OF THE

EYE. To which is prefixed an Anatomical Introduction explanatory of a Horizontal Section of
the Human Eyeball, by Thomas Wharton Jones, F. R. S. From the Fourth Revised and En-
larged London Edition. With Notes and Additions by Addinell Hewson, M. D., Surgeon to
Wills Ho>pital, t^c. &c. In one very large and handsome octavo volume, leather, raised bands, with
plates and numerous wood-cuts. $5 25.

The treatise of Dr. Mackenzie indisputably holds
the first place, and forms, in respect of learning and
research, an Encyclopaedia unequalled in extent by
any other work of the kind, either English or foreign.
— Dixon on Diseases of the Eye.

Few modern books on any department of medicine
or surgery have met with such extended circulation,
or have procured for their authors a like amount of
European celebrity. The immense research which
it displayed, the thorough acquaintance with the
•ubject, practically as well as theoretically, and the

able manner in which the author's stores of learning
and experience were rendered availablefor general
use, at once procured for the first edition, as well on
the continent as in this country, that high position
as a standard work which each successive edition
has more firmly established. We consider it tlie
duty of every one who has the love of his profession
and the welfare of his patient at heart, to make him-
self familiar with this the most complete work in
the English language upon the diseases of the eye.
— Med. Times and Gazette.

MAVNE'S DISPENSATORY AND THERA-
PEUTICAL REMEMBRANCER. With every
Practical Formula contained in the three British
PharmacopcEias. Edited, with the addition of the
Formulae of the U. S. Pharmacopoeia, by R. E.
Griffith, AI.D 1 12mo. vol. ex.cl.,300pp. 73c.

MALGAIGNE'S OPERATIVE SURGERY, based
on Normal and Pathological Anatomy. Trans-
lated I'rom the French by Frederick Brittan,
A. B.,M.D. With numerous illustrations on wood.
In one handsome octavo volume, extra cloth, of
nearly sLs hundred pages. $2 23.

AND SCIENTIFIC PUBLICATIONS.

MILLER (JAMES), F. R. S. E.,

Professor of Surgery in the University of Edinburgh, &c.

PRINCIPLES OF SURGERY. Fourth American, from the third and revised

Edinburgh edition. In one large and very beautiful volume, leather, of 700 pages, with two

hundred and forty illustrations on wood. i3 75.

The work of Mr. Miller is too well and too favor-
ably known among us, as one of our best text-books,
to render any further notice of it necessary than the
announcement of a new edition, the fourth in our
country, a proof of its extensive circulation among
us. As a concise and reliable expositi(m of the sci-
ence of modern surgery, it stands deservedly high —
we know not its superior. — Boston Med. and Surg.
Journal.

The work takes rank with Watson's Practice of
Physic; it certainly does not fall behind that great
work in soundness of principle or depth of reason-
ing and research. No physician who values his re-
putation, or seeks the interests of his clients, can
acquit himself before his God and the world without
making himself familiar with the sound and philo-
sophical views developed in the forejoing book. —
New Orleans Med. and Surg. Journal.

BY THE SAME AUTHOR. {^Just Issued.)

THE PRACTICE OF SURGERY. Fourth American from the last Edin-
burgh edition. Revised by the American editor. Illustrated by three hundred and sixty-four
engravings on wood. In one large octavo volume, leather, of nearly 700 pages. $.3 75.

No encomium of ours could add to the popularity
of Miller's Surgery. Its reputation in this country
is unsurpassed by that of any other work, and, when
taken in connection with the author's Principles of
Surgery, constitutes a whole, without reference to
which no conscientious surgeon would be willing to
practice his art. — Southern Med. and Surg. Journal.

It is seldom that two volumes have ever made so
profound an impression in so short a time as the
" Principles" and the " Practice" of Surgery by
Mr. Miller — or so richly merited the reputation they
have acquired. The author is an eminently sensi-
ble, practical, and well-informed man, who knows
exactly what he is talking about and exactly how to
talk it. — Kentucky Medical Recorder.

By the almost unanimous voice of the profession,

his works, both on the principles and practice of
surgery have been assigned the highest rank. If we
were limited to but one work on surgery, that one
should be Miller's, as we regard it as superior to all
others. — St. Louis Med. and Surg. Journal.

The author has in this and his " Principles," pre-
sented to the profession oneof the most completeand
reliable systems of Surgery extant. His style of
writing is original, impressive, and engaging, ener-
getic, concise, and lucid. Few have the faculty of
condensing so much in small space, and at the same
time so persistently holding theattention. Whether
as a text-book for students or a book of reference
for practitioners, it cannot be too strongly recom-
mended. — Southern Journal of Med. and Physical
Sciences.

MORLAND (W. W.), M. D,,

Fellow of the Massachusetts Medical Society, &c.

DISEASES OF THE URINARY ORGANS; a Compendium of their Diagnosis,

Pathology, and Treatment. With illustrations. In one large and handsome octavo volume, of
about 600 pages, extra cloth. (Just Issued.) $3 50.

Taken as a whole, we can recommend Dr. Mor-
lard's compendium ag a very desirable addition to
the library of every medical or surgical practi-
tioner. — Brit, and For. Med.-Chir. Rev., April, 1S59.

Every medical practitioner whose attention has
been to any extent attracted towards tlie class of
diseases to wliich this treatise relates, must have
often and sorely experienced the want of some full,
yet concise recent compendium to which he could
refer. This desideratum has been supplied by L)r.
Morland, and it lias been ably done. He has placed
before us a full, judicious, and reliable digest.
Each subject is treated with sufficient minuteness,

yet IB a succinct, narrational style, such as to render
the work one of great interest, and one which will
prove in the highest degree useful to the general
practitioner. To the members of the profession in the
country it will be peculiarly valuable, on account
of the characteristics which we have mentioned,
and the one broad aim of practical utility which is
kept in view, and which shines out upon every page,
together with the skill which is evinced in the com-
bination of this grand requisite with tiie utmost
brevity which a just treatment of the subjects would
admit. — N. Y. Journ. of Medicine, Nov. 1658.

MONTGOMERY (W. F.), M. D., M. R. I. A., «tc.,

Professor of Midwifery in the King and Queen's College of Physicians in Ireland, &;c.

AN EXPOSITION OF THE SIGNS AND SYMPTOMS OF PREGNANCY.

With some other Papers on Subjects connected with Midwifery. From the second and enlarged
English edition. Wiih two exf|U!site colored plates, and numerous wood-cuts. In one very
handsome octavo volume, extra cloth, of nearly 600 pages. {Lately Published.) $3 75.

has been weighed and reweighed through years of
preparation; that this is of all others the book of
Obstetric Law, on each of its several topics ; on all

A book unusually rich in practical suggestions. —
Am Journal Med. Sciences, Jan. 1857.

These several subjects so interesting in them-
selves, and so important, every one of theui, to the
most delicate and precious of social relations, con-
trolling often the honor and domestic peace of a
family, the legitimacy of offspring, or the life of its
parent, are all treateil with an elegance of diction,
fulness of illustrations, aeuteness and justice of rea-
soning, unparalleled in obstetrics, and unsurpassed in
medicine. The reader's interest can never flng, so
fresh, and vigorous, and classical is our autiior's
style; and one forgets, in the renewed charm of
every page, that it, and every line, and every word

points connected with pregnancy, to be everywhere
received as a manual of special jurisprudence, at
once announcing fact, affording argument, establish-
ing precedent, and governing alike the juryman, ad-
vocate, and judge. It is not merely in its legal re-
lations that we find this work so interesting. Hardly
a page but that has its hints or facts important to
the general practitioner; and not a chapter without
especial matter for the anatomist, physiologist, or
pathologist. — iV. A. Med.-Chir. Eevieio, March,
1857.

MOHR (FRANCIS), PH. D., AND REDWOOD (TH EOPH I LUS).
PRACTICx\L PHARMACY. Comprising the Arrangements, Apparatus, and

JVIanipulations of the Pharmaceutical Shop and Laboratory. Edited, with extensive Additions,
by Prof William Procter, of the Philadelphia College of Pharmacy. In one handsomely
prmted octavo volume, extra cloth, of 570 pages, with over 500 engravings on wood. $2 75.

BLANCHARD & LEA'S MEDICAL

NEILL (JOHN), M. D.,

Surgeon to the Pennsylvania Hospital, &c.; and

FRANCIS GURNEY SMITH, M.D.,

Professor of Institutes of Medicine in tlie Pennsylvania Medical

College.

AN ANALYTICAL COMPENDIUM OF THE VARIOUS BRANCHES

OF MEDICAL SCIENCE; for the U^e and Examination of Students. A new edition, revised
and improved. In one very large and handsomely printed royal r2mo. volume, of al>uut one
thousand pages, with 374 wood-cuts. Strongly bound in leather, with raised bands. $3 00.
The very flattering reception which has been a(;corded to this work, and the high estimate placed
upon it by the profession, as evinced by the constant and increasing demand which has rapidly ex-
hausted two large editions, have stimulated the authors to render the volume in its present revision
more worthy of the success which has attended it. It has accordingly been thoroughly examined,
and such errors as had on former occasions escaped observation have been corrected, and whatever
additions were necessary to maintain it on a level with the advance of science have been introduced.
The extended series ot' illustrations has been still further increased and much improved, while, by
a slia-ht enlargement of the page, these various additions have been incorporated without increasing
the bulk of the volume.

The work is, therefore, again presentedaseminently worthy of the favor with which it has hitherto
been received. As a book for daily reference by the student requiring a guide to his more elaborate
text-books, as a manual for preceptors desiring to stimulate their students by frequent and accurate
examination, or as a source from which the practitioners of older date may easily and cheaply acquire
a knowledge of the changes and improvement in professional science, its reputation is permanently
established.

The best work of the kind with which we are
acquainted. — Med. ExaTniner.

Having made free use of this volume in our ex-
aminations of pupils, we can speak from experi-
ence in recommending it ns an admirahle compend
for 8tu<lents, and as especially useful to precepture
who examine their pupils. It will save the teacher
much labor by enabling him readily to recall all of
the points upon winch his pupils should be ex-
amined. A work of this sort should be in the iiands
of every one who takes pupils into his offi<'e with a
viewof examining them ; and this is unquestionably
the best of its class. — Transylvania Med. Journal

In the rapid course of lectures, where work for

the students is heavy, and review necessary for an
examination, a compend is not only valuable, but
it is almost a sine qua non. The one before us is,
in most of the divisions, the most unexceptionable
of all books of the kind that we know of. The
newest and soundest doctrines and the latest im-
provements and discoveries are explicitly, though
cimcisely, laid before the stuilent. Tiiere is a class
to whom we very sincerely commend this cheap book
as worth its weight in silver — that class is the gradu-
ates in medicine of more than ten years' stamling,
who have not studied medicine since. Tliey will
perhaps find out from it that the science is not exactly
now what it was when they left it off. — The Stetho-
scopt.

NELIGAN (J. MOORE), M. D., M . R. I. A., &.C.

[A splendid work. Just Issued.)

ATLAS OF CUTANEOUS DISEASES. la one beautiful quarto volume, extra

cloth, with splendid colored plates, presenting nearly one hundred elaborate representations ol

disease. $4 50.

This beautiful volume is intended as a complete and accurate representation of all the varieties
of Diseases of the Skin. While it can lie consulted in conjunction with any work on Practice, it has
especial reference to the author's " Treatise on Diseases of the Skin," so favorably received by the
profession some years since. The publishers feel justified in saying that few more beautifully exe-
cuted plates have ever been presented to the profession of this country.

Neligan's Atlas of Cutaneous Diseases supplies a I give, at a couji d^aeil, the remarkable peculiarities
long existent desideratum much felt by the largest of each inilividual variety. And while thus tlie dis-
class 'if our profession. It presents, in quarto size, ease is rendered more definable, there is yet no loss
16 plates, each containing from 3 to 6 figures, ana j of proportion incurred by the necessary concentra-
forining in all a total of 90 ili8lin''t representations j tion. Each figure is highly colored, anil so truthful
of the different species of skin affections, grouped h:i8 ihe artist tieen ihatthe mostfastid ous oliserver
together in genera or families. The illustrations [ could not justly lake exception to the correctness of
have been taken from nature, and have leen copied the executiim of the pictures under his scrutiny. —
with such fidelity that they present a striking picture | Montreal Med. Chronicle.
of life; in which the reduced scale aptly serves to I

BY THE SAME AUTHOR.

A PRACTICAL TREATISE ON DISEASES OF THE SKIN. Third

American edition. In one neat royal 12mo. volume, extra cloth, of -334 pages. $1 00.

The two volumes will be sent by mail on receipt of Five Dollars.

OWEN ON THE DIFFERENT FORMS OF
THE SKELKTON, AND OF THE TEETH.

One vol. royal 12mo., extra cloth with numerous
illustrations. $1 25.

PIRRIE (WILLIAM), F. R. S. E.,

Professor of Surgery in the University of Aberdeen.

THE PRINCIPLES AND PRACTICE OF SURGERY. Edited by John

Neill, M. D., Professor of Surgery in the Penna. Medical College, Surgeon tothe Pennsylvania
Hospital, &c. In one very handsome octavo volume, leather, ol 780 pages, with 316 illustrations.
$3 75.

We know of no other surgical work of a reason-
able size, wherein there is so much theory and prac-
tice, or where subjects are more soundly or clearly
taught. — Tke Stethoscope.

Prof. Pirrie, in the work before us, has elabo-

rately discussed the principles of surgery, and a
safe and effectual practice predicated upr)n them.
Perhaps no work upon this subject heretofore issued
is so full upon the science of the art of surgery. —
Is'ashville Journal of Medicine and Surgery,

AND SCIENTIFIC PUBLICATIONS.

PARRISH (EDWARD),

Lecturer on Practical Pharmacy and Materia Medica in the Pennsylvania Academy of Medicine Ac

AN INTRODUCTION TO PRACTICAL PHARMACY. Designed as a Text-
Book for the Student, and as a Guide for the Physician and Pharmaceutist. With many For-
mulse and Prescriptions. Second edition, greatly eularsed and improved. In one handsome
octavo volume of 720 pages, with several hundred Illustrations, extra cloth. $3 50. (Ju/i
Issiced.) ^

Duiiijg the short time in which this work ha? been before the profession, it has been received
with veiy great favor, and in assuming the position of a standard authority, it has filled a vacancy
which had been severely felt. Stimulated by this encouragement, the author, in availing himself
of the opportunity of revision, has spared no pains to render it more vi^oithy of the confidence be-
stowed upon it, and his assiduous labors have made it ra.her a new book ihan a newedilion, many
portion> having been rewritten, and much new and important matter added. These alterations and
improvements have been rendered necessary by the rapid progress made by pharmaceutical science
during the last few years, and by the additional experience obtained in the practical use of the
volume as a text-book and work of reference. To accommodate these improvements, the size of
the page has been materially enlarged, and the number of pages considerably increased, presentin<^
in all nearly oiu-half more matter tlian the last edition. The work is therefore now presented as a
complete exponent of the subject in its most advanced condition. From the most ordinary matters
in the dispensing office, to the most complicated details of the vegetable alkaloids, it is hoped that
everything requisite to the pracli^lng physician, and to the apothecary, will be found fully and
clearly set forth, and that the new matier alone will be worih more than the very moderate cost of
the work to those who have been consulting the previous edition.

That Edward Parrish, in writing a boolc upon
practical Pharmacy sonit few years ago — one emi-
nently original Hiid unique — did the medical and
pharmaceutical professions a grea^ and v.ilualile ser-
vice, no one, we think, wlio has had access to its
pages will deny ; doubly welcome, then, is this new
edition, containing the Hdded results of his recent
and rich experience as an observer, teacher, and
practic .1 (n'crator in ihf pharmaceutical laboratory
The excellent plan of the first is more thoroughly,
and in detail, carried out in this edition. — Peninsular
Med Journal, Jan. 18G0.

Of course, all apothi caries who have not already
a copy of the first edition will procure (me of this;
it is, ilierefore, to physicians residing in the country
and in small towns, who cannot avail themselves of
the skill of an educated pharmaceutist, that wt
would espi daily commend this work. In it they

will find all that they desire to know, and should
know, but very little of which they do really <now
in reference to this impoilant c<Mlateral branch of
their profession; for it is a well estahlislied fact,
lliat, in the ei u''ation oi physicians, while the sci-
ente of medicine is generally well taught, very
little attention is paid to the art of preparing them
for use, and we know not how tnis defect can be so
well remedied as by procuring and consulting Dr.
Pa rrish's excellent work. — St. Louis Med. Journal
Jan 1860.

We know of no work on the subject which would
be more indispensable to the phjsician or stu'lent
desiring information on the subject of which it treats.
VViih Griffith's " Medicil Formulary" and this, the
practising physician would be supplied with nearly
or quite all the most ujeful infor nation on the sub-
ject. — Charleston Med. Jour, and Review, Jan. ISOO

PEASLEE (E. R.), M. D.,

Professor of Physiology and General Pathology in the New York Medical College.

HUMAN HISTOLOGtY, in its relations to Anatomy, Physiology, and Pathology;
for the use of Medical Students. With four hundred and thirty- four illustrations. In one hand-
some octavo volume, of over 600 pages. (Lately Published.') $3 75.

We would recommend it to the medical student
and practitioner, as containing a summary of all that
is known of the important subjects which it treats;
of all that is contained in the great works of Simon
and Lehmann, and the organic chemists in general.
Master this one volume, we would say to the mtdical
student and practitioner — master this book and you
know all that is known of the great fundamental
principles of medicine, and we liave eo hesitation
in saying that it is aa honor to the American medi-
cal professiim that one of its members should have
produced it. — St. Louis Med. and Surg. Journal,
March, 1«58.

It embraces a library upon the topics discussed
within Itself, and is just whatthe teaclierand learner
need. Another advantage, by no means to be over-
looked, everything of real value in the wide range
which it embraces, is with great skill compressed
into an octavo volume of but little more than six
hundred pages. We have not only the whole sub-
ject of Histology, interesting in itself, ably and fully
discussed, but what is ol infinitely greater interest
to the student, because of greater practical value,
are its relations to Anatomy, Physiology, and Pa-
thology, which are here fully and satisfactorily set
ioxth.— JSashiiille Journ. of Med. and Surgery, Dec.
1857.

PEREIRA (JONATHAN), M . D., F. R. S., AND L. S.
THE ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS.

Third American edition, enlarged and improved by the author; incUiding Notices of most of the
Medicinal Substances in use in the civilized world, and forming an Encyclopnedia of Materia
Medica. Edited, with Additions, by Joseph Cakson, M. U., Professor of Materia Medica and
Pharmacy in the University of Peniisylvania. In two very large octavo volumes of 2100 pages,
on small type, with about 500 illustrations on stone and wood, strongly bound iu leather, with
raised bands. $y 00.
**jt Vol. II. will no longer be sold separate.

PARKER (LANGSTON),

Surgeon to the Queen's Hospital, Birmingham.

THE MODERN TREATMENT OF SYPHILITIC DISEASES, BOTH PRI-

MARY AND ^CONUARY; comprisingtheTreatment of Constitutional and Confirmed Syphi-
lis by a safe and successful method. With numerous Cases, Formulae, and Clinical Observa-
tions. From the Third and entirely rewritten London edition. In one neat octavo volume,
extra cloth, of 316 pages. $175.

ROYLE'S MATERIA MEDICA AND THERAPEUTICS; including the

Preparations of the Pharmacopoeias of London, Edinburgh, Dublin, and of the United States.
With many new medicines. Edited by Joseph Carson, M. D. ^With ninety-eight illustrations.
In one large octavo volume, extra cloth, of about 700 pages. $•" 00.

BLANCHARD & LEA'S MEDICAL

RAMSBOTHAM (FRANCIS H.), M.D.
THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND

SURGERY, in reference to the Process of Parturition. A new and enlarged edition, thoroughly
revii^ed by the Author. With Additions by W. V. Keating, M. D., Professor of Obstetrics, &:c., in
the Jefferson ^ledical College, Philadelphia. In one large and handsome imperial octavo volume,
of 650 pages, strongly bound in leather, with raised bands; vf'ilh sixty four beautiful Plates, and
numerous Wood-cuts in the text, containing in all nearly 200 large and beautiful figures. $-5 00.

From Prof. Hodge, of the University of Pa.
To the American public, it is most valuable, from its intrinsic undoubted excellence, and as being
the best authorized exponent of British Midwifery. Its circulation will, 1 trust, be extensive throughout
our country.

It is unnecessary to say anything in regard to the | truly elegant style in which they have brought it

out, excelling tliemselves in its production, espe-
cially in its plates. It is dedicated to Prof. iMeigs,
and has the emphatic endorsement of Prof. Hodge,
as the best exponent of British Midwifery. We
knuw of no text-book which deserves in all respects
to be more highly recommended to students, and we
could wish to see it in the handsof every practitioner,
for they will find it invaluable for reference. — Med.
Gazette.

utility of this work. It is already appreciated in our
country for the value of the matter, the clearness of
its style, and the fulness of its illustrations. To the
physician's library it is indispensable, while to the
student as a text-book, from which to extract the
material for laying the foundation of an education on
obstetrical science, it has no superior. — Ohio Med.
and Surg. Journal.
The publishers have secured its success by the

RICORD (P.), M. D.
A TREATISE ON THE VENEREAL DISEASE. By John Hunter, F. R. S.

With copious Additions, by Ph. Ricord, M. D. Translated and Edited, with Notes, by Freema?j
J. BuMSTEAD. iVl. D., Lecturer on Venereal at the College of Physicians and Surgeons, New York.
Second edition, revised, containing a risumi of Ricokd's Recent Lectures on Chancre. Tn
one handsome octavo volume, extra cloth, of 550 pages, with eight plates. $3 25. (Just hsiied.)
In revising this work, the editor has endeavored to introduce whatever matter of interest the re-
cent investigations of syphilographers have added to our knowledge of the subject. The principal
source from which this has been derived is the volume of "Lectures on Chancre," published a lew
months since by M. Rioord, which affords a large amount of new and instructive material on many
controverted points. In the previous edition, M. Ricord's additions amounted to nearly one-third
of the whole, and with the matter now introduced, the work may be considered to present his views
and experience more thoroughly and completely than any other.

secretaries, sometimes accredited and sometimes not.
In the notes to Hunter, the master subsuiutes him-
self forhis interpreters, and give? hisorigiiial llioughis
to the world in a lucid and perfectly iiitelligi hie man-

Every one will recognize the attractiveness and
ralue which this work derives from thus presenting
the opinions of these two masters side by side. But.
it must be admitted, what has made the fortune of
the book, is the fact that it coiuains the "most com-
plete embodimeiil of the veritable doctrines of the
HOpiial du Midi," which has ever been made public.
The doctrinal ideas of Al. Ricord. ideas which, if not
universally adopted. are incontestably dominant, have
heretofore only been interpreted by more or less.>.kilfu I

uer. In conclusion we can say that this is incon-
testably the best treatise on syphilis wiih which we
are acquainted, and, as we do iiol often employ the
phrase, we may he excused for expressing ilie hope
that it may find a place in the library of every phy-
sician. — Virginia Med. and Surg. Journal.

BY THE SAME AUTHOR.

RICORD'S LETTERS ON SYPHILIS. Translated by W. P. Lattimore, M. D.

In one neat octavo volume, of 270 pages, extra cloth. %i 00.

SLADE (O. D.), M. D.
DIPHTHERIA ; its Nature and Treatment, with an Account of the History of its

Prevalence in various countries. Being the Dissertation to which the Fiske Fund Prize was
awarded, July 11, IS60. In one small octavo volume, extra cloth; 75 cents. (Now Reaily, 1801.)

ROKITANSKY (CARL), M.D.,

Curator of the Imperial Pathological Museum, and Professor at the University of Vienna, &c.

A MANUAL OF PATHOLOGICAL

bound in two. extra cloth, of about 1200 pages.

KING, C. H. Moore, and G. E. Day. $5 50.

The profession is too well acquainted with the re-
putation of Rokitansky's work to need our assur-
ance that this is one of the most profound, thorough,
and valuable books ever issued from tne meilical
press. It is iui generis, and has no standard of com-
parison. It is only necessary to announce that it is
issued in a form as cheap as is compatible with its
size and preservation, and its sale follows as a
matter of course. No library can be called com-
plete without it. — Buffalo Med. Journal.

An attempt to give our readers any adequate idea
of the vast amount of instruction accumulated in
these volumes, would be feeble and hopeless. The
effort of the distinguished author to concentrate
in a small space his great fund of knowledge, has

ANATOMY. Four volumes, octavo,

Translated by W. E. Swaine, Edward Sieve-
so charged his text with valuable truths, that any
attempt of a reviewer to epitomize is at once para-
lyzed, and must end in a failure. — Western Lancet.
As this is the highest source of knowledge upon
the important subject of which it treats, no real
student can afford to be without it. The American
publishers have entitled themselves to the thanks of
the profession of their country, for this timeous and
beautiful edition. — Nashville Journal of Meilicine.

As a book of reference, therefore, this work niust
prove of inestimable value, and we cannot too highly
recommend it to the profession. — Charleston Med.
Journal and Kevieu).

This book is a necessity to every practitioner. —
Am. Med. Monthly.

RIGBY (EDWARD), M.D.,

Senior Physician to the General Lying-in Hospital, kc.

A SYSTEM OF MIDWIFERY. With Notes and Additional lUustrations.

Second American Edition. One volume octavo, extra cloth, 422 pages. $2 50.
BY THE same AUTHOR. (Lately Published.)

ON THE CONSTITUTIONAL TREATMENT OF FEMALE DISEASES.

In one neat royal 12mo. volume, extra cloth, of about 250 pages. $1 00.

AND SCIENTIFIC PUBLICATIONS.

STILLE (ALFRED), M.D.
THERAPEUTICS AND MATERIA MEDIC A; a Systematic Treatise on the

Action and Uses of Medicinal Ag-ents, including their Description and History. In two lar"-e
and handsome octavo volumes, ot 17S9 pages. {Just Issued, i860.) $8 00. °

This work is designed especially for the student and practitioner of medicine, and treats the various
articles of the Materia Medica from the point of view of the bedside, and not of the shop or o( the
leciure-room. While thus endeavoring to give all practical information likely to be useful with
respect to the employment of special remedies in special allections, and the results to be amicipated
/rom their administration, a copious Index of Diseases and their Remedies renders the work emi-
nently fitted for reference by showing at a glance ihe different means which have been emploved,
and enabling the practitioner to extend his resources in difficult cases with all that tiie experience
of the profession has suggested.

Rarely, indped, have we had submitted to us a
work on medicine so ponderous in its dimensions
as that now before us, and yet so fascinating in its
contents. It is, therefore, with a peculiar gratiti-
Crttion that we recognize in Dr. Siille the posses-
sion of many of those more distinguished qualifica-
tions which entitle him to approbation, and which
justify him in coming before his medical bretliren
iis an instructor. A comprehensive knowledge,
tested by a sound and penetrating judgment, joined
to a love of progress — which a discriminating spirit
of inquiry has tempered so as to accept nothing new
because it is new, and abandon nothing old because
it is old, but whicti estimates either accort ing to its
relations to a just logic and experience — m;inifeFts
itself everywhere, and gives to the guidance of tlie
author all iie assurance of safety which ihe diffi-
culties of his subject can allow. In conclusion, we
earnestlv advise our readers to ascertain for them-
selves, by a study of Dr. StiUe's volumes, the great
value and interest of the stores of knowledge they
present. We have pleasure in referring raiher to
the ample treasury of undoubted truths, the real and
jissured conquest of medicine, accumulated by Dr.
Stille in his pages ; and commend the sum of his la-
bt)rs to the attention of our readers, as alike honor-
able to our science, and creditable to the zeal, the
candor, and the judgment of him who has garnered
the whole so carefully. — Edinburgh Med. Journal.

Our expectations of the value of this work were
based on the well-known reputation and character
of the author as a man of scholarly attainments, an
elegant writer, a candid inquirer after truth, and a
philosophical thinker ; we knew that the task would
be conscientiously performed, and that itvf, if any,
among the distinguished medical teachers in this
country are better qualified than he to prepare a
systen atic treatise on therapeutics in accordance
with the present requirements of medical science.
Our preliminary examination of the work has satis-

fied us that we were not mistaken in our anticipi-
lions.—Ntiv Orleans Medical News, March, IsGO.

The most recent authority is the one last men-
tioned, Stille. His great work on '' Materia Medi-
ca and Therapeutics," published last year, in two
octavo volumes, of some sixteen hundred pages,
while it embodies the results of the l^bor of others
up to the time of pul)lication, is enriched with a
great amount of original observation and research.
We would draw attention, by the way, to the very
c<mvenient mode in which the Inrhx is arranged in
this work. There is firstan " Index of Remedies ;"
next an "Index of Diseases and their Remedies."
Such an arrangement of the Indices, in our oninion,
greatly enhances the practical value of books of ihis
kind. In tedious, obstinate cases of disease, where
we have to try ime remedy after another until our
stock is pretty nearly exhausted, and we are almost
driven to our wit's end, such an inde.x as the second
of the two just mentKmed, is precisely what we
want. — London Med. Times and Gazette, April, 1*-C1.

AVe think this work will do much to obviate the
reluctance to a thorough investigation of this branch
of scientific study, for in the wide range of medical
literature treasured in the English tongue, we shall
hardly find a work written in a style more clear and
simple. Conveying forcibly the facts taught, and yet
free from turgidity and redundancy. There is a fas-
cination in its pages that will insure to it a wide
popularity and attentive perusal, and a deiriee of
usefulness not often attained through the influence
of a single work. The author has much enhanced
the practical utility of his book by passing briefly
over the physical, botani !al, aiid comuiereial history
of medicines, and directing attentnm chiefly to their
physiological action, and their applicati<m for the
amelioration or cure of disease. He i^n ires hypothe-
sis and theory which are so alluring to many medical
writers, and so liable to lead them astray, and con-
fines himself to such facts as have been tried in the
crucible of experience. — Chicago Medical Journal.

SMITH (HENRY H.), M.D.

MINOR SURGERY; or, Hints on the Every-day Duties of the Surgeon. With

247 illustrations. Third edition. 1 vol. royal 12mo., pp. 456. In leather, $2 25; cloth, $2 00.

BY THE SAME AUTHOR, AND

HORNER (WILLIAM E.), M.D.,

Late Professor of Anatomy in the University of Pennsylvania.

AN ANATOMICAL ATLAS, illustrative of the Structure of the Human Body.

In one volume, large imperial octavo, extra cloth, with about six hundred and fifty beautilul
figures. $3 00.

These figures are well selected, and present a

complete and accurate representation of that won-
derful fabric, the human body. The plan of this
Atlas, which renders it so peculiarly convenient
for the student, and its superb artistical execution,
have been already pointed out. We must ccmgratu-

late the student upon the completion of thisAtlas'
as it is the most convenient work of the kind that
has yet appeared ; and we must add, the very beau-
tiful manner in which it is "got up" is so creditable
to the country as to be flattering to our national
pride. — American Mtdizal Journal.

SHARPEY (WILLIAM), M.D., JONES QUAIN, M. D., AND

RICHARD QUAIN, F. R. S., &.C.

HUMAN ANATOMY. Revised, with Notes and Additions, by Joseph Letdy,

M. D., Professor of Anatomy in the University of Pennsylvania. Complete in two large octavo
volumes, leather, of about thirteen hundred pages. Beautifully illustrated with over five hundred
engravings on wood. $6 00.

SIMPSON (J. Y. , M. D.,

Professor of Midwifery, &c., in the University of Edinburgh, &c.

CLINICAL LECTURES ON THE DISEASES OF FEMALES. With numc-

rous illustrations.

This valuable series of practical Lectures is now appearing in the "Medical News and
Library" for 1S60 and 1861, and can thus be had without cost by subscribers to the "American
Journal of the Medical Sciences." See p. 2.

28 BLANCHARD & LEA'S MEDICAL

SARGENT (F. W.), M. D.
ON BANDAGING AND OTHER OPERATIONS OF MINOR SURGERY.

Second edition, enlarged. One handsome royal 12mo. vol., of nearly 400 pages, wilb 182 wood-
cuts. Extra cloth, $1 40; leather, $1 50.

A work that has been bo long and favorably known
to the profession ns Dr. Sargent's Minor Surgery,
needs no commendation from us. We would remark,
however, in this connection, that minor surgery sel-
dom gets that attention in our schools that its im-
portance deserves. Our larger works are also very
defective in their teaching on these small practical
points. This little book will supply the void which
all must feel who have not studied its pages. — West-
ern Lancet.

Sargent's Minor Surgery has always been popular,
and deservedly so. It furnishesthatknowledgeof the
most frequently requisite performances of surgical
art which cannot be entirely understood by attend-
ing clinical lectures. The art of bandaging, which
is regularly taught in Europe, is very frequently
overlooked by teachers in this country ; the student
and junior practitioner, therefore, may often require
tha.t knowledge which this little volume so tersely
and happily supplies. — Charleston Med. Journ. and
Review.

SMITH (W. TYLER), M. D.,

Physician Accoucheur to St. Mary's Hospital, &c.

ON PARTURITION, AND THE PRINCIPLES AND PRACTICE OF

OBSTETKIGS. In one royal 12mo. volume, extra cloth, of'400 pages. $1 25.

BY THE SAME AUTHOR.

A PRACTICAL TREATISE ON THE PATHOLOGY AND TREATMENT

OF LEUCORKHCEA. With numerous illustrations. In one very handsome octavo volume,
extra cloth, ol about 250 pages. $1 50.

SOLLY ON THE HUMAN BRAIN; its Structure. | handsome octavo volume, extra cloth, of over 650
Physiology, and Diseases. Fro.-n the Second ana pages, with about one hundred wood-cuts. $3 25.
much enlarged L<mdon editnm. In one octave gij^iON-!* GENERAL PATHOLOGY, as eonduc-
volume. extra cloth, of 500 pages, with 120 wood- j^e to the Establishn.cut of Raticmal Principles
cuts. $'2 00. for the prevention aiio Cure of Uisease. In one

SKEY'S OPERATIVE SURGERY. In one very ' octavo volume, extra clolh, of 212 pages. $125.

TANNER (T. H.), M. D.,

Physician to the Hospital for Women, &c.

A MANUAL OF CLINICAL MEDICINE AND PHYSICAL DIAGNOSIS.

To which is added The Code of Ethics of the American Medical Association. Second
American Edition. In one neat volume, small r2mo., extra cloth, 87^ cents.

TAYLOR (ALFRED S.), M. D., F. R. S.,

Lectureron Medical Jurisprudence and Chemistry in Guy's Hospital.

MEDICAL JURISPRUDENCE. Fifth American, from the seventh improved

an(* enlarged London edition. With Notes and References to American Decisions, by Edward
Hartshorne, M. D. In one large octavo volume, leather, of over 700 pages. {Nearly Ready.)
This .standard work having had the advantage of two revii-ions at the hands oflhe auihor since
the appearance of the last American edition, will be found thoroughly revi>ed and brought up com-
pletely to the present *taie of the science. As a work of auihomy, it must therefore mainiaiii iis
position, both as a text-book for the student, and a compendious treatise to which the practitioner
can at all times refer in cases of doubt or dilficully.

No work upon the subject can be put into the > American and British legal medicine. It should be
bands of students either of law or medicine which in the possession of every physiciHn, as the subject
will engage them more closely or profitably; and is ore of great and increasing importunee to the
none could be oflered to the busy practitioner of public as well as to the profession.— 6«. i-o«t« Aferf.
either calling, for the purpose of casual or hasty and Surg. Journal.
reference, that would be more likely toafford the aid , , , t^ r„ , , •

desired. We therefore recommend it as the best and , T"'? "^Z^^ ^' ^J- Baylor's la generally acknow-

Med

fest manual for daily \xst.—Amtritan Journal oj lodged to be one of the ablest extant on the subject
edical Sciences. of medical jurisprudence, it is certainly one ol the

, . ._ . »k»i. »k....„i.,.^« most attractive books that we have met with : sup-

It IS not excess of praise to say that the volume , g„ ^„p,, ,,„jj, j„ interest and instruct, that

before us IS the very best treatise extant on Medical ^e do not hesitate to athrm that after having once

Jurisprudence. In saying this, we do not wish to commenced Us perusal, few could be prevailed upon

It is at once comprehensive and eminently prac- subjects never before published. — Charleston Med.
tical, and by universal consent etands at the head of Journal and Rtvietv.

BY THE SAME AUTHOR. {New Edition, ju.$t issited.)

ON POISONS, IN RELATION TO MEDICAL J URISPRUDENCE AND

MEDICINE. Second American, from a second and revised London edition. In one large

octavo volume, ol 755 pages, leather. $3 50.

Since the first appearance ol this work, the rapid advance of Chemistry has introduced into
use many new sub:stances which may become fatal through accident or design — while at the
same time it hav likewise designated new and more exact modes of counteracting or delecting those
previously treated of. Mr. Taylor's position as the leading medical jurist of England, has during
this periocl conferred on him extraordinary advantages in acquiring experience cii these subjects,
nearly all cases of mor»ent being referred to him for examination, as an expert whose testimony
is generally accepted as final. The results of his labors, therefore, as gathered together in this
volume, carefully weighed and sifted, and presented in the clear and inlelligible style for which
he IS noted, may be received a-s an acknowledged authority, and as a guide to be lollowed with
mpiicit confidence.

AND SCIENTIFIC PUBLICATIONS.

20^

TODD (ROBERT BENTLEY), M . D., F. R. S.,

Professor of Physiology in King's College, London; and
WILLIAM BOWMAN, F. R. S.,

Demonstrator of Anatomy in King's College, London.

THE PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. With

about three hundred large and beautiful illustrations on wood. Complete in one large octavo

volume, of 950 pages, leather. Price $4 50.

B^ Gentlemen v*rho have received portions of this work, as published in the " Medical News
AND Library," can now complete their copies, if immediate application be made. It will be fur-
nished as follows, free by mail, in paper covers, with cloth backs.

Parts I., II., III. (pp. 25 to 552), $2 50.

Part IV. (pp. 553 to end, with Title, Preface, Contents, fee), $2 00.

Or, Part IV., Section II. (pp. 725 to end, with Title, Preface, Contents, &c.), $1 25.

A magnificent contribution to British medicine,
and the American physician who shall fail to peruse
it, wili have failed to read one of the most instruc-
tive books of the nineleenlh century. — N. O. Med
and Surg. Journal, Sept. 1857.

It is more concise than Carpenter's Principles, and
more modern than the accessible edition of Mailer's
Elements; its details are brief, but sufficiett; its
descripl ions vivid ; its illustrations exact and copi-
ous; and its language terse and perspicuous. —
Charleston Med. Journal, July, 1S57.

We know of no work on the subject of physiology

so well adapted to the wants of the medical student.
Its completion has been thus long delayed, that the
authors might secure accuracy by personal observa-
tion. — St. Louis Med. and Surg. Journal, Sept. '57.

Our notice, though it conveys but a very feeble
and imperfect idea of the magnitude and importance
of the work now under consideration, already tran-
scends our limits ; and, with the indulgence of our
readers, and the hope that they will peruse the book
for themselves, as we feel we can with confidence
recommend it, we leave it in their hands. — The
Northwestern Med. and Surg. Journal.

TODD (R. B.) M. D., F. R. S., &c.
CLINICAL LECTURES ON CERTAIN DISEASES OF THE URINARY

ORGANS AND ON DROPSIES. In one octavo volume, 284 pages. $1 50.
BY THE SAME AUTHOR. {Nov> Ready.)

CLINICAL LECTURES ON CERTAIN ACUTE DISEASES. In one neat

octavo volume, of 320 pages, extra cloth.

75.

TOYNBEE (JOSEPH), F. R. S,,

Aural Surgeon to, and Lecturer on Surgery at, St. Mary's Hospital.

A PRACTICAL TREATISE ON DISEASES OF THE EAR; their Diag-

nosis, Pathology, and Treatment. Illustrated with one hundred engravings on wood. In one

very handsome octavo volume, extra clolh, $3 00. {Just Issued.)

The work, as was stated at the outset of our no- | ment, and with a sincere and unbiassed judgment,

tice, is a model of its kind, and every page and para-
graph ot it are worthy of the most thorough study.
Considered all in all — as an original work, well
written, philosophically elaborated, and happily il-
lustrated with cases and drawings — it is by far the

when we affirm Ihac as a treatise on Aural Surgery,
it is without a rivi>l in our language or any otiier. —
Charleston Med. Joiirii. and Keview, Sept. tSGO.

The work of Mr. Toynbee is undoubtedly, upon
the whole, the most valuable production of tiie kind

ablest monograph that has ever appeared on the i ,„ ^ny language. The author has long Deen known
anatomy and diseases of the ear, and one of the most ! (jy jjjg numerous monographs upon subjects con

valuable contributions to the art and science of sur
gery in the nineteenth century. — N. Arner. Medico-
Chirurg Review, Sept. 186U.

To recommend such a work, even after the mere
hint we have given of its original excellence and
value, would be a work of supererogation. We are
speaking within the limits of modest acknovvledg-

nected with diseases of the ear, and is now regarded
as the highest authority on most points in his de-
partment of science. Mr. Toynbee's work, as we
have already said, is undoubtedly the most reliable
guide for the study of the diseases of the tar in any
language, and should be in the library of every phy-
sician.— 6' /ticag^o Med. Journal, Jul) , WGU.

WILLIAMS (C. J. B.), M.D., F. R. S.,

Professor of Clinical Medicine in University College, London, &c.

PRINCIPLES OP MEDICINE. An Elementaiy View of the Causes, Nature,

Treatment, Diagnosis, and Prognosis of Disease; with brief remarks on Hygienics, or the pre-
servation of health. A newAmerican, from the third and revised London edition. In one octavo
volume, leather, ol about 500 pages. $2 50. {Just Issued.)

We find that the deeply-interesting matter and
style of this book have so far fascinated us, that we
have unconsciously hung upon its pages, not too
long, indeed, for our own profit, but longer than re-
viewers can be permitted to indulge. We leave the
further analysis to the student and practitioner. Our
judgment of the work has already been sufficiently

expressed. It is a judgment of almost unqualified
praise. — London Lancet,

A text-book to which no other in our language is
comparable. — Charleston Medical Journal.

No work has ever achieved or maintained a more
deserved reputation.— Va. Med. and Surg. Journal.

WHAT TO OBSERVE
AT THE BEDSIDE AND AFTER DEATH, IN MEDICAL CASES.

Publishedundertheauthority of the London Society for Medical Observation. A new American,

from the second and revised Londoi. edition. In one very handsome volume, royal 12mo., extra

clolh. $1 00.

To the observer who prefers accuracy to blunders ) One of the finest aids to a young practitioner wo
aad precision to carelessness, this little book is ;n-
Taiuable.— iV. H. Journal of Medicin*.

have ever a€,ea.—Ptnins\ilaT Journal of Mtditin*.

BLANCHARD & LEA'S MEDICAL

New and much enlarged edition — (Just Issued.)

WATSON (THOMAS), M.D., &.C.,

Late Physician to tlie Middlesex Hospital, &c.

LECTURES ON THE PRINCIPLES AND PRACTICE OP PHYSIC.

Delivered at King's Colleffe, London. A new American, from the last revised and enlarged

English edition, with Additions, by D. Francis Condie, M.D., author of "A Practical Treatise

on the Diseases of Children," i:c. Wilh one hundred and eighty.five illustrations on wood. In

one very large and hand>ome volume, imperial octavo, of over 1200 closely printed pages in

small type ; the whole strongly bound in leather, with raided bands. Price $4 25.

That the high reputation of this work might be fully maintained, the author has subjected it to a

thorough revision; every portion has been examined wilh the aid of the most recent researches

in pathology, and the results of modern investigations in both theoretical and practical subjects

have been carefully weighed and embodied throughout its pages. The watchful scrutiny of the

editor has likewise introduced whatever possesses immediate importance to the American physician

in relation to diseases incident to our climate which are little known in England, as well as those

points in which experience here has led to different modes of practice ; and he has also added largely

to the series of illustrations, believing that in this manner valuable assistance may be conveyed lo

the student in elucidating the text. The work will, therefore, be found thoroughly on a level with

the most advanced state of medical science on both sides of the Atlantic.

The additions which the work has received are shown by the tact that notwithstanding an en-
largement in the size of the page, more than two hundred additional pages have been necessary
to accommodate the two large volumes of the London edition (which sells at ten dollars), within
the compass of a single volume, and in its present form it contains the matter of at least three
ordinary octavos. Believing it to be a work which should lie on the table of every physician, and
be in the hands of every student, the publishers have put it at a price within the reach of all, making
it one of the cheapest books as yet presented to the American profession, while at the same time
the beauty of its mechanical execution renders it an exceedingly attractive volume.

The fourth edition now appears, so carefully re- 1 The lecturer's skill, his wisdom, his learning, are
vised, as to add considerably to the value of a book equalled by the ease of his graceful diction, his elo-
already acknowledged, wherever the English Ian- quence, and the far higher qualities of candor, of
guage is read, to be beyond all eomparisdn the best courtesyj of modesty, and of generous appreciation
systematic work on the Principles and Practice of ^ of merit \n others. Alay he long remain to instruct
Physic in the whole range of medical literature. | us, and to enjoy, in the glorious sunset of his de-
Every lecture contains proof of the extreme anxiety I dining years, the honors, the confidence and love
of the author to keep pace with ihe advancing know- gained during his useful life.— iV. A. Med.-Chir.
ledge of the day, and to bring the results of the Review.
labors, not only of physicians, but of chemists and

histologists, before his readers, wherever they can
be turned to useful account. And this is done wilh
Buch a cordial appreciation of the merit due to the
industrious observer, such a generous desire to en-
courage younger and rising men, and such a candid
acknowledgment of his own obligations to them,
that one scarcely knows whether to admire most the
pure, simple, forcible English — the vast amount of
uset'ul practical information condensed into the
Lectures— or the manly, kind-hearted, unassuming
character of Ihe lecturer shining through his work.
— London Med. Times and Gazette.

Thus these admirable volumes come before the
profession in their fourth edition, abounding in those I third edition, which has been severely I'elt for the

Watson's unrivalled, perhaps unapproachable
work on Practice — the copious additions made to
^vhich (the fourth edition) have given it all the no-
velty and much of the interest of a new book. —
Charleston Med. Journal.

Lecturers, practitioners, and students of medicine
will equally iiail the reappearance of the work of
Dr. Watson in the form of a new — a fourth — edition.
We merely do justice to our own feelings, and, we
are sure, of the whole profession, if we tliank him
for having, in the trouble and turmoil of a large
practice, made leisure to supply the hialus caused
by the exhaustion of the publisher's stock of the

distinguished attributes of moderation, judgment,

erudite cultivation, clearness, and eloquence, with

Which they were from the first invested, but yet

richer than bel"ore in the results of more prolonged

observation, and in the able appreciati(m of the

latest advances in pathology and medicine by one

of the most proi'ound medical thinkers of the day. — j Medico-Chi.r. Heview.

London Lancet. \

last three years. For Dr. Watson has not merely
caused the lectures to be reprinted, but scattered
through the whole work wc find additions or altera-
tions which prove that the author has in every way
sought to bring up his teaching to the level of the
most recent acquisitions in science. — Brit, and For.

WALSHE (W. H.), M. D.,

Professor of the Principles and Practice of Medicine in University College, London, &;c.

A PRACTICAL TREATISE ON DISEASES OF THE LUNGS; including

the Principles of Physical Diagnosis. A new American, from the third revised and much en-
larged Lone on edition. In one vol. octavo, of 4b8 pages. (Just Issued, June, 18Q^.) §2 "25.

The present edition has been carefully revised and much enlarged, and may be said in the main
to be rewritten. Descriptions of several diseases, previously omitted, are now introduced; the
causes and mode of production of Ibe more important alfectioiis, so far as they possess direct prac-
tical significance, are succinctly inquired into; an effort has been made to bring the description ol
anatomical characters to the level of the wants of the practical physician ; and the diagnosis and
prognosis of each complaint are more completely considered. The sections on Treat.me.\t and
the Appendix (concerning the inlluence of climate on pulmonary disorders), have, eepeciully, been
largely extended. — Aiithor''s Preface.

^*^ To be followed by a similar volume on Diseases of the Heart and Aorta.

WILSON (ERASMUS), F. R. S.,

Lecturer on Anatomy, London.

THE DISSECTOR'S MANUAL; or, Practical and Surgical Anatomy. Third

American, from the last revised and enlarged English edition. Modified and rearranged, by
William Hunt, M. D., Demonstrator of Anatomy in the University ol Pennsylvania. In one
large and handsome royal 12mo. volume, leather, of 582 pages, with 154 illustrations. $2 00.

AND SCIENTIFIC PUBLICATIONS.

New and much enlarged edition— (Just Issued.)
WILSON (ERASMUS), F. R. S.

A SYSTEM OF HUMAN ANATOMY, General and Special. A new and re-
vised American, from the last and enlarged Engli.-h Edition. Edited by W. H Gobrecht M D
Profe>sor of Anatomy in the Pennsylvania Medical College, &c. Illustrated with three hundred
and ninety-seven engravmgs on wood. In one large and exquisitely printed octavo volume of
over 600 large pages; leatiier. $3 25. '

The publishers trust that the well earned reputation so long enjoyed by this work will be more
than maintained by the present edition. Besides a very thorough revision by the author it ha^been
most carefully exammed by the editor, and the efforts of both have been directed to introducino-
everything which increa'^ed experience in its use has suggested as desirable to render it a complete
text-book for those seeking to obtain or to renew an acquaintance with Human Anatomy. The
amount of additions which it has thus received may be estimated .("rom the fact that the present
edition contains over one-fourth more matter than the last, rendering a smaller type and an enlar°-ed
page requisite to keep the volume within a convenient size. The author has not only thus added
largely to the work, but he has also made alterations throughout, wherever there appeared the
opportunity of improving the arrangement or style, so as to present every fact in its most appro-
priate manner, and to render the whole as clear and intelligible as possible. The editor has
exercised the utmost caution to obtain entire accuracy in the text, and has Largely increased the
number of illustrations, of which there are about one hundred and fifty more in this edition than
in the last, thus bringing distinctly before the eye of the student everything of interest or importance.

It may be recommended to the student as no less
distinguished by its accuracy and clearness of de-
scription th;m by its typographical elegance. The
wooii-cuts are exquisite. — Brit, and For. Medical
Review.

An elegant edition of one of the most useful and
accurate systems of anatomicat science which has
been issued from the press The illustrations are
really beautiful. In its style the \v()rk is extremely
concise and intelligible. No one can possibly take
up this volume without being struck with the great

BY THE SAME AUTHOR.

beauty of its mechanical execution, and the clear-
ness of the descriptions which it contains is equally
evident. Let students, by all means examine tiie
claims of this work on their notice, before they pur-
chase a text-book of the vitally impcirtant science

which this volume &o fully and easily unfolds.

Lancet.

We regard it as the best system now extant for
students. — Wester7i Lancet.

It therefore receives our highest commendation.

Southern Med. and Surg. Journal.

{Just Issued.)

ON DISEASES OF THE SKIN. Fourth and enlarged American, from the last

and improved London edition. In one large octavo volume, of 650 pages, extra cloth, $2 75.

The writings of Wilson, upondiseases of the skin,
are by far the most scientifie and practical that
have ever been presented to the medical world on
this subject. Thepresentedition isa great improve

inent on all its predecessors. To dwell upon all the
great merits and high claims of the work before us,
seriatim, would indeed be an agreeable service ; it
v/ould be a mental homage which we could freely
offer, but we should thus occupy an undue amount
of space in this Journal. We will, howtver, look

at some of the more salient points with which it
abounds, and wh ich make ii incoinpurH uiy su perior in
excellence to all other treatises on thesubject of der-
matology. No mere speculative views are allowed
a place in this volume, which, without a doubt, will,
for a very long period, be acknowledged as the chief
standard work on deiinatohigy. The principles of
an enlightened and rational therapeia are introduced
on every appropriate occasion. — Am. Jour. Med.
Science, Oct. 1857.

ALSO, NOW READY,

A SERIES OF PLATES ILLUSTRATING WILSON ON DISEASES OP

THE SKIN ; consisting of nineteen beautifully executed plates, of which twelve are exquisitely
colored, presenting the Normal Anatomy and Pathology of' the Skin, and containing accurate re-
presentations of about one hundred varieties of disease, most of them the size of nature. Price
in cloth $4 25.

In beauty of drawing and accuracy and finish of coloring these plates will be found equal to
anything of the kind as yet issued in this country.

The plates by which this edition is accompanied
leave nothing to be desired, so far as excellence of
delineation and perfect accuracy of illustration are
concerned. — Medico-C hirurgical Review.

Of these plates it is impossible to speak toohighl}'.
The representations of the various forms of cutane-
Dus disease are singularly accurate, and the color-
ing exceeds almost anything we have met with in
point of delicacy and &ms,h.— British and Foreign
Medical Review.

We have already expressed our high appreciation
of Mr. Wilson's treatise on Diseases of the Skin.
The plates are comprised in a separate volume,
which we counsel all those who possess the text to
purchase. It is a beautiful specimen of color print-
ing, and the representations of the various forms of
skin disease are as faithful as is possible in plates
of the size. — Boston Med. and Surg. Journal, April
8, 1858.

BY THE SAME AUTHOR.

ON CONSTITUTIONAL AND HEREDITARY SYPHILIS, AND ON

SYPHILITIC ERUPTIONS. In one small octavo volume, extra cloth, beautifully printed, with
four exquisite colored plates, presenting more than thirty varieties of syphilitic eruptions. $2 25,

BY THE SAME AUTHOR.

HEALTHY SKIN; A Popular Treatise on the Skin and Hair, their Preserva-
tion and Management. Second American, from the fourth London edition. One neat volume,
royal 12mo.5 extra cloth, of about 300 pages, with numerous illustrations. $1 00 ; paper cover,
75 cents.

WHITEHEAD ON THE CAUSES AND TREAT-
MENT OF AliORTION AND STERILITY.

Second American Edition. In one volume, octa-
vo extra cloth, pp. 308. 51 75.

BLANCHARD & LEA'S MEDICAL PUBLICATIONS.

WINSLOW (FORBES), M.D., D. C. L., &.c.
ON OBSCURE DISEASES OF THE BRATN AND DISORDERS OF THE

MIND; their incipient Symptom-^, Pal holugy,
handsome octavo volume, of nearly 600 pages
We close this brief and necessarily very imperfect
notice (if Dr. Wmslow's j real and classieal work,
by expressing our conviction that it is long since so
important and beautifully written a volume liiis is-
sued from the British medical pre^s.—JJvblin Med.
rress, July 25, ISGU.

We honestly believe this to b" the best book of the
eeviSot.—Ranhitig^i Abstract, July, 1^60.

It cairiedusback to our old days of novel reading,
it kept us from cur dirncr, from our bni-iness, ■ind
from our »luml)ers; in short, we luid it down only
when we had got to the end of the last paragmph,
and cvn then turned bacK to the repe usal ol several
passages which we h id inarkrd as rtqiiiring fur her
study We hnve fuiKd entirely in tlie above notice
to give an adequate sicknowledginent of the profit
and pleiisure witn which a'c liav-e pcrufced the above
WorK. We can only say to our readers, study it

Diagnosis, Trealmeni, and Prophylaxis. In one
{Just Issued.) $3 00.

yourselves; and we extend the invitation to unpro-
fessional as well as professional men, believing that
it contains matter deeply interesting not to physi-
cians alone, but to all who appreciate the trutii that;
" The proper siudy of mnnkind is man." — Nashville
Mfdical Record, July. 1^60.

The latter portion of Dr. Winslow's work is ex-
clusively deviited to the consideration of Cerebral
PatholoKy. It completely exhausts the subject, in
the s irae manner as the previous seventeen chapters
relating to morbid psy.;hical phenomena lelt nothing
unnoticed in refereiice to ihe menial symptoms pre-
monitory of Cerebral diseaie It is impossible to
overrate the benefits likely to result from a general
perusal of Dr. Winslow's valuajle and deeply in-
teresting work — London Lancet, June 23, If-GO.

It contains an immense mafs of information. —
Brit, anil For. Mtd.-Ch.ir. Review, Oct. ItOO,

WEST (CHARLES), M. D.,

Accoucheur to and Lecturer on Midwifery at St. Bartholomew's Hospital, Physician to the Hospital for

Sick Children, dec.

LECTURES ON THE DISEASES OF WOMEN. Second American, from the

second London edition. In one liaiid<onie octavo volume, extra cloth, ol about 500 pages;

price iiji".^ 50. (Now Ready, July, lb6l.)
*,t* Gentlemen who received the first portion, as issued in the "Medical News and Library," can

now compete their copies by procuring Part II, being page 309 to end, with Index, Title matter,

&c., 8vo., cloth, price $1.

proverb, along a royal road to learning. His work
IS one whicii will not satisfy the extreme on either
Bide, but It is one thai will please the great mujuriiy
who arc seeking Irulh and one Ihat will convince
the student Ihat he has commuted hiiiiselt to a can-
did, bfiie, and valuable guide. W k anticipate with
pleasure tlie appeiirance of the sectmd part of the
work, which, if it tquals this part, will complete
one ol our very best volumes upon iliseases of fe-
males — iV. A. Med -Ckirurg. Review, July, 1^5ti.

Happy in his simplicity of manner, und moderate
in hig expression of opinion, the author is a sound
reasoner and a good piuctitioner, and his hook is
worthy <il the hanusome ga'b in whicli it has ap-
peared from the press of the Philadelphia publishers.
— Virginia Med. Journal.

We must take leave of Dr. West's very useful
work, Willi our cominenduiKm ot tlie eleurness of
its style, and the uu ustry and sobriety of judgment
of whicii II gives evidence. — London Med Times
and Uazetle.

We must now conclude this hastily written sketch
with the confident assurance to our rcadeis that the
work will well repay perusal. The conscientious,
painstaking, prac'ical phytician isapparent on everj
page. — A'. Y. Journal of Medicine, March, ls5S.

We know of no treatise of the kind so complete
an'l yet so compact.— CAtcago Med. Journal, Janu-
ary, 1»58.

A fairer, more honest, more earnest, and more re-
liable investigator of the many diseases of women
and chilcren is not to be found in any country.—
Southern Med. and Surg. Journal, January IHoS.

We gladly recommend his Lectures us in the high-
est degree instructive to all who are interested in
obstetric practice. — London Lancet.

We have to say of it, briefly and decidedly, that
it is the best work on the subject in any language;
and that it stamps Dr. West as tlie/ac(7e princept
of British obstetric authors. — Edinb. Med. Journ.

As a writer, Dr. West stands, in our opinion, sec-
ond only to Watson, the " Macaulay of .Medicine;"
he possesses tiiat happy faculty of clothing instruc

Sound judgment and good sense pervade every
tion in easy garments'; CJinbining pleasure with | chapLer oi the uin.k. From its perusal we liave de-
profil, he leads his pupils, lu siuie of the ancient. I rived unmixed latist'action. — JJubiin Quart. Juurn.

BY THE SAME AUTHOR. (Just Issued.)

LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD.

Third American, from the fourth enlarged and improved London edition
octavo volume, extra cloth, ol' about six hundred and lil'ty pages. $•? 75.
The three former editions of the work now before

us have placed tlie author in tne loremost ruuk cf

those ph> sicians who have cevoted special attention

to tne uiseabes of early life We attempt no ana-

1) SIS of tills editiiin, but may refer the reader to some

of the ciiaplers to wnich the largest aduitions have

been made — those un Diphtheria, Disorderj of the

In one handsome

diseases it omits to notice altogether. But those
who know anything of the present condition of
ptediairics win readily admit Uiat it would lie next
to impiissiole to elfect more, or elfect it better, tiian
ibe accoucheur of St. Bartholomew's has done in a
single voiume. The lecture (XVI.) upon Disorcirs
f the .Miiid in chiloren is an admirable specimen of

Mind, and Idiocy, for instance — as a prooi that Ihe the value oi the later information ctmvejed in the

work IS really a new edition; not a mere repriut.
In its prei ent shape it will be lound of ihe greatest
possible service in the evcry-day practice ol nine-
tenlhs of the profession. — Med. Times and Gazette,
London, Dec. lU, 18j9.

All things consid; red this book of Dr. West is
by far the best treatise in our language upon such
modifi jatiuns of morbid action and diseise as are
witntbsed when we have to deal with infancy and
childhood. It IS true that it confines itself to such
disorders as come wi-hin the province of the phy-
sician, and even with res^ject to tnese it is unequal
as regards minuteness of consideration, and some

Lectures of iir. Charles West. — London Lancet,
Oct. 22, IS59.

Since the appearance of the first edition, about
eleven years ago, the experience of the author has
Uoubbd; so that, whereas the leclures at lii st were
founded on six hundred observations, and one hun-
dred and eigiiiy dissections made among neaily four-
teen thousand children, they now embody the results
of nine hundred observations, and two liundr'-d and
eighty-eight post- iiiorlem examinations male among
nearly thirty thousand children, who, durii.g the
past twiily years, have been under his care. —
British Med. Journal, Oct. 1, 18oU.

BY THE SAME AtJTHOR.

AN ENQUIRY INTO THE PATHOLOGICAL IMPORTANCE OF ULCER-

ATION UF THE OS UTERI. la one neat octavo volume, extra cloth, fl 00.

UNIVERSITY OF CALIFORNIA LIBRARY

Los Angeles
This book is DUE on the last date stamped below.

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