8 P E RM AT ORRHCEA 
 
LIBRARY OF CONGRESS. 
 
 UNITED STATES OF '.ERICA. 
 
SPERMATORRHEA: 
 
 ITS CAUSES, 
 SYMPTOMS, RESULTS AND TREATMENT, 
 
 BY 
 
 ROBERTS BARTHOLOW, A.M., M.D., 
 
 Professor of the Theory and Practice of Medicine and of Clinical Medicine, in 
 
 the Medical College of Ohio ; Physician to the Hospital 
 
 of the Good Samaritan, etc., etc. 
 
 
 FOURTH EDITION, REVISED. 
 
 NEW YORK : 
 WILLIAM WOOD & CO., 27 GREAT JONES ST. 
 
 1879. 
 
 ALL EIGHTS RESERVED. 
 
 ^ io...l 
 

 
 Copyright 1879, 
 
 By William Wood & Company, 
 
 New York. 
 
 New York : J. J. Little & Co., Printers, 
 10 to 20 Astor Place. 
 
PREFACE TO THE FIRST EDITION. 
 
 A short essay on the Pathology and Treatment 
 of Spermatorrhoea, based upon a clinical lecture 
 delivered at St. John's Hospital; and published in 
 the Cincinnati Journal of Medicine, having met 
 with a very favorable reception from the profession, 
 it has seemed desirable to give the subject fuller 
 treatment from the same point of view. 
 
 There have been but few special treatises on this 
 disease of a reputable character. Tbe work of 
 Lallemand, Des pertes seminales involont aires, Paris 
 et Montpellier, 1837-41, is the source from which 
 subsequent writers have drawn their information. 
 A portion of this w r ork has been presented in 
 an English dress by two translators — Wood and 
 McDongall. Additions to the translation of the 
 last named have been made by Maris Wilson, and 
 in this form it is the principal authority now in 
 the hands of American physicians. The subject is 
 also discussed, necessarily in an incomplete manner, 
 in various works on the practice of medicine and 
 surgery. Besides these authorities, Mr. Acton has 
 lately addressed the general public in a work on 
 the reproductive organs, in which he discourses 
 more or less fully on Spermatorrhoea. 
 
 iii 
 
I think it is a reproach to our profession that 
 this subject has been permitted, in a measure by 
 our own indifference, to pass into the hands of the 
 unscrupulous pretenders, whose suggestive publi- 
 cations are amongst the crying evils of our time. 
 Because the subject is disagreeable, and to a certain 
 degree disreputable, competent physicians are loath 
 to be concerned with it. The same unnecessary 
 fastidiousness causes the treatment of this malady 
 to be avoided in private practice ; and the unfortu- 
 nate patients, thus precluded from obtaining intel- 
 ligent advice, fall into the hands of advertising 
 specialists, who excite their worst apprehensions 
 for a mercenary purpose. For this reason, and to 
 obviate the sad consequences which result from 
 spermatorrhoea, it is our duty to exert our best 
 efforts in behalf of those afflicted with this malady. 
 We should endeavor to attain to correct views of 
 its pathology, and apply our knowledge to its cure 
 — if for no other reason, for the good of our, species. 
 
 My little work will have done all that I can de- 
 sire for it, if it assist the practitioner in forming 
 correct view 7 s of the nature of spermatorrhoea, and 
 enable him to conduct cases of this disease to a 
 more successful issue than he has hitherto been 
 able to accomplish. 
 
PREFACE TO THE SECOND EDITION. 
 
 A second edition of this monograph having been 
 called for within less than a year after the publica- 
 tion of the first, is a gratifying evidence of the appre- 
 ciation of my labor by the medical profession. 
 
 In the present edition, some typographical errors, 
 overlooked in the first, have been corrected ; a table 
 of contents has been appended, and new matter has 
 been added at various places throughout the volume. 
 These improvements will, I trust, make the present 
 edition still more worthy of the favor so largely ac- 
 corded to the first. 
 
 v 
 
PREFACE TO THE THIRD EDITION. 
 
 I have to express my acknowledgments to the 
 medical profession for the very great favor with 
 which the two previous editions of this work have 
 been received. As it now appears in this edition, 
 the material has been rearranged, and in large parfc 
 rewritten. Some illustrations have been introduced, 
 and an appendix of formulae added. The value of 
 the book will, I trust, be considered to be enhanced 
 by these changes and additions. 
 
 More enlarged experience since the appearance of 
 the first edition has not caused me to amend any of 
 my views of the nature and true mode of treating 
 spermatorrhoea. I am, indeed, more than ever con- 
 firmed in the view that it is ^neurosis, and that the 
 treatment, to be successful, must be founded on this 
 
 pathological basis. 
 
 E. B. 
 
PREFACE TO THE FOURTH EDITION. 
 
 Ix the preface to the first edition of this mono- 
 graph, I haye stated the accident, so to speak, to 
 which it owes its origin. The hack article of the 
 Journal has expanded into the present volume, by 
 successive additions of material and by rewriting, 
 until now it has but little similitude to its pro- 
 genitor. The demand for new editions is a proof, 
 that the monograph fills a place in medical litera- 
 ture, although that place is, necessarily, an hum- 
 ble one. The original purpose of the author has 
 been maintained throughout — to place the subject 
 on a scientific basis, and to divorce it from char- 
 latanism. 
 
 Doubtless the success of this work as a business 
 venture would have been greater, if I had pan- 
 dered to a vicious popular taste, and whilst giving 
 it a quasi-scientific character, had really so writ- 
 ten it as to place it on a level with the lay under- 
 standing. 
 
 Besides the public expressions of approval in the 
 recognized organs of professional opinion, I have 
 
 vii 
 
Vlll PREFACE. 
 
 received many private assurances from my medical 
 friends and correspondents, that my little work 
 has accomplished good. This fact, alone, would 
 have justified me in undertaking the labor of re- 
 vision, so pressed am I on all sides by professional, 
 
 professorial, and literary work. 
 
 K. B. 
 
CONTENTS. 
 
 Introduction 1 
 
 I. True Spermatorrhea 5 
 
 Causes 5 
 
 Symptoms 29 
 
 I. Genital Form 87 
 
 II. Cerebral Form 44 
 
 III. Spinal Form 50 
 
 Results 56 
 
 II. Sperm atorrhcea as a Symptom 65 
 
 III. Imaginary Spermatorrhea 75 
 
 IV. Treatment 78 
 
 Formulae 124 
 
 rx 
 
SPERMATORRHEA : 
 
 ITS CAUSES, SYMPTOMS, EESULTS, AND 
 TREATMENT. 
 
 INTRODUCTION. 
 
 It seems to be necessary to define, at the out- 
 set, what is meant by Spermatorrhoea. The sense 
 in which this term is used not always being the 
 same, confusion has arisen as to its real patho- 
 logical import. By some, following in a literal 
 sense its etymological signification, this term is 
 restricted to that condition in which there is a 
 constant stillicidium of semen, without, of course, 
 the preHminary phenomena of erection and ejac- 
 ulation. If this definition be accepted, sper- 
 
 1 
 
2 SPERMATORRHEA. 
 
 matorrhcea can be admitted to exist but 
 rarely. 
 
 According to a more widely received view, 
 spermatorrhoea consists in the emission of semen 
 without copulation, or in involuntary seminal 
 losses of every kind. If the former definition 
 be defective by reason of too limited scope, the 
 latter is defective in a more injurious degree, 
 because it embraces a physiological as well as a 
 pathological state. 
 
 The term spermatorrhoea should be restricted 
 to that condition in which involuntary seminal 
 losses occur with sufficient frequency to produce 
 a definite morbid state. 
 
 It is very important to be accurate on this 
 point, for nothing is more common than mistaken 
 views in regard to the pathological importance of 
 occasional spermal losses. A physiological con- 
 dition is frequently confounded with the results 
 of disease. The prevalence of this error is due 
 chiefly to the false statements so persistently put 
 forth by advertising specialists in regard to the 
 evil consequences of nocturnal pollutions. I can- 
 not too strongly impress on my readers, that after 
 the period of puberty involuntary seminal losses 
 
NTKODUCTION. 6 
 
 occur in the continent with more or less fre- 
 quency, according to the activity of their sexual 
 organs. The young man who, ignorant of its 
 nature, happens to this accident for the first 
 time, is much concerned, especially if he have 
 read the impure publications on this topic now 
 so widely distributed. In such a case the in- 
 telligent and humane physician may render a 
 lasting service by an exact statement of the 
 importance of these physiological emissions. 
 
 Although many cases of so-called spermator- 
 rhoea are physiological in character, we should 
 not therefore assume that no morbid state is 
 produced by frequent involuntary losses. 
 
 Spermatorrhoea is also a symptom of lesion 
 of some part of the central nervous system. It 
 has, then, but little importance as compared 
 with the serious disease of which it is but an 
 indication. 
 
 It follows from the foregoing considerations, 
 in order to have a true comprehension of sper- 
 matorrhoea, it must be studied from several 
 points of view. I purpose, therefore, to treat 
 of the subject according to the following 
 scheme : 
 
SPERMATORRHOEA. 
 
 1. True Spermatorrhoea. 
 
 Its Causes. 
 
 Physical. 
 
 Moral. 
 Its Symptoms. 
 Its Results. 
 
 2. Spermatorrhoea as a Symptom. 
 
 3. False or Imaginary Spermatorrhoea. 
 
 4. Treatment. 
 
CAUSES. 5 
 
 I. 
 
 TRUE SPERMATORRHEA. 
 
 CAUSES. 
 
 Physical. — The vice of masturbation is un- 
 doubtedly the chief cause. The growth of the 
 sexual apparatus at the period of puberty is ac- 
 companied by abundant secretion of the semi- 
 nal fluid, which accumulates in the reservoirs. 
 The sexual instinct, then fully developed, ex- 
 erts a powerful influence over the mind, whilst 
 the reason is not in a sufficiently matured state 
 to correct the mirages of the imagination. ' An 
 accidental friction of the erect organ in these 
 moments of delirium makes the unfortunate 
 youth acquainted with a new and voluptuous 
 sensation.* Ignorant of the dreadful conse- 
 quences which must ensue from the repeated 
 perpetration of this act, the youth perseveres in 
 his secret pleasures until arrested by realizing 
 some of the sad effects upon the mind and body 
 which follow. 
 
 * Tissot. L'Onanisme. Dissertation sur Us Maladies pro- 
 duites par la Masturbation. Also, Fournier et Begin, Die- 
 tionnaire des Sciences Medicates, vol. xxxi., pp. 100-134. 
 
6 SPERMATORRHEA. 
 
 Although the practice of this vice is not con- 
 fined to boys of the nervous type, yet it finds 
 in them victims the most willing, and the least 
 able to resist the continually increasing de- 
 mands of the habit. Boys of vigorous consti- 
 tution, in whom the digestive and muscular 
 systems are well developed, are less under the 
 control of these erotic impulses, and are more 
 able to resist the inroads of the habit when 
 formed, because in them the exercises of youth 
 and the satisfaction of the appetite occupy their 
 minds. 
 
 A- premature and unnatural development of 
 the genital apparatus may give origin to the 
 vice of masturbation. Mr. South has related an 
 extraordinary case of premature puberty, in 
 which involuntary losses occurred : — 
 
 " When he was about four months old, the 
 hair on the pubes began to grow very thickly 
 and black, at which time the penis increased in 
 size, particularly the glans, so that it gradually 
 extended beyond the prepuce, till about fifteen 
 months, when it was entirely exposed ; the pubes 
 were then completely covered with black, curling 
 hair Soon after this, she (his mother) 
 
noticed that his linen was stained two or three 
 
 times in the week She also states 
 
 that since he has been in town (six weeks) the 
 emissions have been more frequent than for 
 some time previously." * Mr. South gives the 
 following measurements of the penis of this ex- 
 traordinary infant : leogth of penis when pendent 
 from the symphysis pubis, three inches ; length 
 of penis when erect, six inches. This is probably 
 the "most rare and curious " case of premature 
 puberty on record ; certainly it is the earliest 
 period at which spermatorrhoea has occurred. 
 Such an instance is wholly exceptional. Never- 
 theless, a premature development of the sexual 
 organs may constitute an occasional cause of self- 
 pollution — the more especially if such develop- 
 ment be not accompanied by corresponding 
 growth of the other organs and systems of the 
 body, and of the reason and moral control. 
 
 Independently, however, of a premature de- 
 velopment of the sexual apparatus, the vice of 
 masturbation may be contracted at a very tender 
 age, a very instructive example of which has been 
 
 *Medico-Cliirurgical Transactions, vol. xii., p. 7G. 
 
 2 
 
Q SPERMATORRHOEA. 
 
 narrated by Mr. Heckforcl. " I believe it is not 
 generally known," says Mr. Heckforcl, " that 
 this vice is practiced not only by adults of both 
 sexes, but also by young children, and even in- 
 fants in the cradle. The following notes, kindly 
 given me by Dr. Hughlings Jackson, are a suffi. 
 cient guaranty as to the correctness of this 
 assertion, at least as regards one case. . . . 
 The following is a narrative of Dr. Jackson : — 
 A woman came in the Hospital for Epilepsy and 
 Paralysis, on account of fits. She took the op- 
 portunity of asking my advice about her child. 
 The boy was fifteen months old ; he was delicate, 
 and had never been able to stand ; but the special 
 circumstance about which the mother wished to 
 hear my opinion was the peculiar position of 
 his legs. The right leg was almost always 
 placed high up over the other, and he kept it 
 moving in a sawing way towards the pelvis. The 
 penis was in the way of friction, and was quite 
 stiff when I examined it. He was much an- 
 noyed at my interference wdth the movements 
 of his leg, making resistance and crying. . . . 
 The boy had congenital phymosis, but he did 
 not cry when he made water. Mr. Hutchison 
 
CAUSES. 9 
 
 was kind enough, at my request, to circumcise 
 him. . . . After this the habit ceased, for a 
 time at least, and the child much improved in 
 health." * 
 
 I have had lately under observation a case, a 
 boy four years of age, who had practised the 
 habit for two years. He exposed the penis to 
 friction between the thigh and abdomen. His 
 mother informed me that he was much excited 
 during the act, and at its termination passed 
 into a nervous state, preceded by a shudder. 
 He had frequent epileptic convulsions. Circum- 
 cision, although it interrupted, did not cure the 
 habit, for the boy resumed it again after the 
 wound healed. Threats, punishment, and re- 
 straint were alike unavailing to prevent the per- 
 petration of the act. 
 
 A very influential cause in determining the 
 habit of onanism is a redundant prepuce. Around 
 the corona glandis, in the sulcus, are situated a 
 number of sebaceous glands, the secretion of 
 which, if allowed to accumulate, excites irrita- 
 tion and itching. Erection and the venereal 
 
 * London Hospital Reports, vol. ii., p. 58. 
 
10 SPEBMATOItEHCEA. 
 
 orgasm follow the friction which is innocently 
 used to allay the itching. Moreover, when the 
 glans is habitually covered, it becomes mor- 
 bidly excitable, and the least friction develops 
 the special sensibility of its nerves. The occur- 
 rence of herpetic eruptions is another impor- 
 tant factor. The itching demands relief, and an 
 innocent excitation develops into onanism. 
 
 According to Sinion* {de Metz) various causes 
 besides the foregoing increase the excitement 
 of the genitals at puberty, among which he enu- 
 merates prolonged sitting, as at school, which 
 fatigues the spinal column and causes an accu- 
 mulation of blood in the inferior parts of the 
 trunk. " For the same reason," says Simon, 
 " that clerks and persons who ride much on 
 horseback or in carriages are exposed to hemor- 
 rhoids, boys will experience excitement of the 
 genitals in consequence of engorgement of the 
 testes and spermatic cord." 
 
 Patients frequently refer the origin of the 
 habit of masturbation to the influence and exam- 
 ple of older boys. In public institutions, where 
 
 * Traite cVHygiene appliquee a V Education de la Jeunesse. 
 Paris, 1827, p. 164. 
 
CAUSES. 11 
 
 man}' boys of the more 'depraved sort are col- 
 lected together, this may sometimes occur ; and 
 even in the better class of boarding-schools a 
 bad boy, given to this vice, may induce others 
 to commence it : but generally speaking, the re- 
 mark of Quintilian is true : Non accipiunt e 
 scliolis mala ista, sed in scholas afferunt. The 
 masturbator takes into the school those organic 
 tendencies which lead to the perpetration of the 
 vice. Possessing the erotic temperament, slight 
 causes will suffice, at school or at home, to 
 awaken the special sensibility of the sexual 
 apparatus. 
 
 Under what circumstances soever the vice of 
 masturbation may be contracted, it is usually 
 continued, and with increasing frequency, until 
 weakness of the genital organs and various func- 
 tional derangements are produced. The habit 
 is discontinued, either because of some evident 
 ill consequence which alarms the patient, or he 
 is informed of the serious results which must 
 finally ensue from his violation of a natural law. 
 But the unfortunate victim finds that the cessa- 
 tion or diminution of the habit does not restore 
 him to the natural state. He cannot rid his im- 
 
12 SPEEMATOPJiHCEA. 
 
 agination of the erotic fancies which have so long 
 possessed it. During sleep lascivious dreams 
 beset him, accompanied by the venereal orgasm 
 and the seminal loss. During the day erotic 
 ideas constantly invade his mind, and partial 
 erections occur, followed by a tenacious dis- 
 charge which slowly escapes from the urethra. 
 
 It is probable, also, that spermatorrhoea may 
 result from excesses in natural coitus. Cases 
 apparently originating in this way have fallen 
 under my observation. The history of these 
 cases is as follows : After very free indulgence 
 symptoms have occurred indicating the neces- 
 sity for abstinence. This sudden and forced 
 continence puts the mind of the individual and 
 his genital apparatus in the same condition as 
 that which occurs after the habit of masturba- 
 tion ceases. We have on this point the high 
 authority of Sir James Paget : " Now I believe 
 you may teach positively, that masturbation 
 does neither more nor less harm than sexual in- 
 tercourse, practised with the same frequency, 
 in the same conditions of general health, and 
 age, and circumstances. Practised freely by 
 the very young, that is, at any time before or 
 
CAUSES. 13 
 
 at the beginning of puberty, masturbation is 
 very likely to produce exhaustion, effeminacy, 
 over-sensitiveness, and nervousness." — Clinical 
 Lecture. 
 
 The relation which spermatorrhoea bears to 
 certain structural alterations of the genito -urin- 
 ary organs requires to be carefully investigated. 
 Very contradictory opinions have been ex- 
 pressed on this point. 
 
 By surgeons it is regarded as an affection — an 
 inflammation or an irritation — of a part of the 
 genitourinary apparatus, and the surgical treat- 
 ment is based upon this pathological doctrine. 
 One of the most recent and able of surgical 
 authorities * treats of it under the heading of 
 " functional disorders of the testicle." The 
 modern surgical writers in general adopt this 
 view, especially those accessible to the Ameri- 
 can reader. t The work of Lallemand % is the 
 
 * Holmes's System of Surgery — Art. Diseases of the 
 Male Organs. Vol. iv., p. 539. Loudon. 1864. 
 
 f Gross's System of Surgery, p. 831-2, vol ii. Phila. : 
 1865. Erichsen's Surgery, p. 1224. A Practical Treatise 
 on the Disease of the Testis, etc., by Curling. Phila. Ed., 
 p. 326, et seq., etc., etc., etc. 
 
 \ Des Pertes Seminales Involontaires, op. cit. Also, 01- 
 
14 SPERMATORRHEA. 
 
 principal source of these pathological views. It 
 will be proper, therefore, to present an outline 
 of this author's doctrines before presenting our 
 own. 
 
 Views of M. Lallemand. — This author regards 
 the following as playing an important role in the 
 production of this disorder : Blenorrhagia and 
 stricture of the urethra, the former affecting the 
 prostatic part of the urethra and the orifices of 
 the seminal ducts, and the latter producing dila- 
 tation of the ducts by the efforts of micturition ; 
 gouty and rheumatic affections occurring in 
 these parts ; accumulation of sebaceous matter 
 under the prepuce, constituting a source of 
 irritation ; venereal excesses and masturbation, 
 which act principally by provoking inflammation 
 or irritation of the ducts ; prolonged erections 
 excited by erotic ideas or lascivious publica- 
 tions ; the use of diuretics, of ergot, of canthar- 
 ides, etc. ; the abuse of alcoholic drinks, of 
 coffee, and of tea ; constipation ; ascarides in 
 
 serrations sur les Maladies des Organes Genito- Urinaires. 
 Premiere Partie, p. 158, ei seg., 1825, by the same author. 
 The influence of a" hobby " is well seen in the growth of 
 M. Lallemand's opinions and practices during the fifteen 
 years' interval between these works. 
 
CAUSES. 15 
 
 the rectum ; hemorrhoids ; fissures of the anus ; 
 heating and irritation of the anal and perineal 
 regions by habitual sitting, or prolonged horse- 
 back riding. 
 
 The organic peculiarities which predispose to 
 spermatorrhoea are, according to this author — 
 excessive length of the prepuce ; hypospadias ; 
 extraordinary size of the meatus urethrae ; flac- 
 cidity of the corpora cavernosa ; smallness, tardy 
 descent and lack of firmness of the testes ; re- 
 laxation of the cord and of the scrotum ; vari- 
 cocele ; congenital induration of the prostate, 
 and great development of the pelvis with femi- 
 nine characters. 
 
 When the nocturnal pollutions are due to ex- 
 cesses, to abuse, to the presence of ascarides in 
 the rectum, they produce, according to Lalle- 
 mand, grave disorders in a short time after their 
 appearance. After a little, all the phenomena 
 of excitation which precede or accompany the 
 orgasm diminish, and finally completely disap- 
 pear ; the act of emission occurring without 
 erection, pleasure, or any particular sensation. 
 The semen loses little by little its color, its odor, 
 and its spermatozoa, and comes to resemble, 
 
16 SPERMATORRHEA. 
 
 more and more, either mucus or the prostatic 
 fluid. This progressive diminution in the exci- 
 tation of the genital organs, and this increasing 
 alteration in the sperm, correspond with a re- 
 markable augmentation in the gravity of the 
 general symptoms and in the difficulties in the 
 treatment. At the same time the vesiculae semi- 
 nales acquire the power of contracting under tbe 
 influence of a less energetic excitement. Then, 
 also, fullness of the bladder or rectum, a warm, 
 soft bed, lying on the back, warm drinks, exci- 
 tants, etc., provoke emissions more or less easily. 
 The effects are much more serious when to the 
 nocturnal are added diurnal pollutions. Some 
 patients suffer only from nocturnal pollutions, 
 but such cases are rare. 
 
 The diurnal pollutions, according to Lalle- 
 mand, are produced by all those causes which 
 increase constipation and favor the excitation 
 of the genital organs ; such as prolonged sitting, 
 the jolting of a carriage, riding on horseback, 
 etc. In some subjects the pollution does not 
 take place passively during the efforts of defeca- 
 tion, and by the simple effects of compression, 
 but by the proper action of the ejaculatory ap- 
 
CAUSES. 17 
 
 paratus. These cases are unusual. In all the 
 others the semen is emitted without the sensible 
 phenomena of ejaculation. The evil effects are 
 determined by the abundance of the loss ; but 
 some persons support the losses better than 
 others. 
 
 The varieties of nocturnal and diurnal pollu- 
 tions manifest themselves successively or simul- 
 taneously. The specific character is the sudden 
 expulsion of semen in notable quantities at vari- 
 able intervals. A symptom which has close 
 relation to spermatorrhoea, and which ordinarily 
 accompanies it, is impotence. In all cases of 
 nocturnal or diurnal pollutions, the first symp- 
 tom discovered is a notable diminution in the 
 energy and duration of the erections, and an 
 increased readiness of ejaculation. 
 
 M. Lallemand gives the following result of 
 his microscopic examinations of the excreted 
 matters in the different varieties of seminal loss : 
 " When the evacuations are rare and the semen 
 has preserved its distinctive characters, the ani- 
 malcules present nothing remarkable either in 
 respect to numbers or dimensions. But when 
 the spermatorrhoea has assumed sufficient im- 
 
18 SPERMATORRHOEA. 
 
 portance to influence the rest of the economy, 
 the semen becomes more liquid, and the animal- 
 cules are less developed and less vivacious, al- 
 though their number may not appear to be 
 diminished. When the erections commence to 
 diminish, the semen is more aqueous ; the di- 
 mensions of the spermatozoa are sometimes 
 one-fourth or one-third their normal size, their 
 caudal prolongation being distinguishable with 
 difficulty, with a power of 300 diameters." * 
 
 The central idea of M. Lallemand's theory of 
 the pathology of spermatorrhoea, is the produc- 
 tion, by various causes, of an irritation or inflam- 
 mation of the prostatic portion of the urethra and 
 of the seminal ducts. This view is not supported 
 by anatomical evidence. Although cadaveric 
 examinations, as is well said by M. Raige- 
 Delorme,f have resulted in the discovery of di- 
 verse alterations of the genital organs in cases in 
 which seminal losses icere presumed to have ex- 
 isted, these alterations were so connected with 
 important diseases of other parts of the genito- 
 urinary apparatus, that little reliance can be 
 
 * Op. tit., II., p. 404. 
 
 f Dictionnaire de Mklecine, vol. xxviii., p. 506. 
 
CAUSES. 19 
 
 placed in them as indicative of spermatorrhoea. 
 These alterations consisted in ulcerations of the 
 orifices of the ejaculatoiy ducts ; injection and 
 ulceration of various parts of these canals ; anal- 
 ogous alterations of the vesiculae seminales ; 
 purulent depots in the vesicles, in the vasa de- 
 ferentia, in the epididymis, in the body of High- 
 more, and in the testicle. It is impossible to as- 
 sociate these lesions with spermatorrhoea, since 
 in all the cases cited they were accompanied by 
 more or less grave alterations of the urinary pas- 
 sages. One cannot avoid the reflection in look- 
 ing over Lallemand's cases, published in his work 
 on the genito-urinary organs in 1825, and in his 
 work on seminal losses in 1839, that his cases as 
 well as his theory were constructed to justify his 
 practice. There is no proof that the anatomical 
 lesions described by this author were causative 
 of spermatorrhoea, or that they were even accom- 
 panied by it. On the other hand, the observa- 
 tions are numerous enough in which these altera- 
 tions occurred without the production of sper- 
 matorrhoea. The truth is, undoubtedly, that 
 there is no specific anatomical element in all 
 that Lallemand has submitted, to be associated 
 
20 SPERMATORRHOEA. 
 
 indissolubly with that disorder, and to which it 
 may be attributed. In support of our opinion, 
 we may cite the high authority of Mr. Thomp- 
 son,* who asserts that inordinate sexual in- 
 dulgence cannot have the effect to produce pro- 
 statitis unless gonorrhoea be already existing. 
 
 I may also refer, in opposition to the views of 
 Lallemand, to my personal observations. As 
 pathologist to the Cincinnati Hospital, and dur- 
 ing the time of my military experiences, I have 
 had numerous opportunities to ascertain — if it 
 exist — a causative relation between the lesions 
 of the generative apparatus and spermatorrhoea 
 described by Lallemand, but hitherto have failed 
 to observe this connection. To place this ques- 
 tion beyond controversy, I have lately made a 
 most careful dissection of the sexual apparatus 
 of a young man dead of a double pneumonia, 
 who was known to have practiced masturbation 
 in an extreme degree for many years. Besides 
 a catarrhal condition of the mucous membrane 
 of the seminal and prostatic ducts, and of the 
 vesicidce seminales, there was literally no lesion 
 
 * On Enlarged Prostate : Its Pathology and Treatment. 
 London, 1858, p. 195. 
 
CAUSES. 21 
 
 of these organs. I therefore reject this position 
 of Lallemand as untenable, and as leading to 
 improper methods of treatment. 
 
 The views of Lallemand in regard to the alter- 
 ations in the spermatozoicls, and their destruc- 
 tion in advanced cases of spermatorrhoea, are 
 hardly more tenable than his doctrine of the 
 structural alterations peculiar to this disease. 
 Liegeois, who has examined this question, re- 
 marks : " My own observations (six cases) are 
 not at all in accordance with the description 
 given by Lallemand. Azoospermia existed in 
 only one of my patients. The other five, though 
 the involuntary emissions were frequent, and 
 the virile faculties had materially diminished, 
 though the affection had lasted from two to 
 ten years, I have never found any change in 
 the aspect, the consistency, or the odor of the 
 seminal fluid, not even in the number or the 
 configuration of the spermatozoa." * This ac- 
 cords with my own observation. 
 
 Spermatorrhoea is, in the view of the author, a 
 
 * Tlie Seminal Secretion in Disease. Medical Times and 
 Gazette, Nov. 6, 1869. 
 
22 SPERMATORRHOEA. 
 
 neurosis. Although structural alterations may 
 be coincident, tliey are not causative. It is cer- 
 tainly true, however, that lesions of various parts 
 of the generative organs may increase that dis- 
 order of their nervous apparatus which finds ex- 
 pression in frequent involuntary seminal losses. 
 In order to a just comprehension of sperma- 
 torrhoea, our inquiry must start from the physi- 
 ology of the normal coitus. The seminal ejacu- 
 lation is a reflex act. The sensation excited by 
 the friction of the erect and turgid male organ is 
 transmitted to the cord, and the impression is 
 reflected over the testes, vesiculae seminales, ure- 
 thra, and appended muscular apparatus, produc- 
 ing the seminal ejaculation. The whole consti- 
 tutes the venereal orgasm.* It approximates 
 in many of its phenomena to epilepsy, and is 
 accompanied in some persons with an epilepti- 
 form seizure. This is more particularly exhibited 
 in the act of masturbation, in which the excita- 
 
 * Carpenter's Physiology, 5tlied., p. 794. Kirke's Physi- 
 ology, p. 411. On this point the reader may consult with 
 great advantage the elaborate work by Luys, entitled Re- 
 cherches surle Systeme Nerveux Cerebro-Sjrinal, sa Structure, 
 ses Fonctions, et ses Maladies. Paris, 1865, pp. 296 and 339. 
 
CAUSES. 23 
 
 tion of the genital organs is more intense, the 
 imagination more inflamed, and the orgasm more 
 profound. There is a great expenditure of ner- 
 vous force in a single act of coitus — much more 
 so in the unlawful excitation — manifested by the 
 languor, weakness, and mental feebleness which 
 occur for some time afterwards. Of course, 
 these effects will be experienced in a much 
 greater degree when the orgasm is frequently 
 repeated. 
 
 The generative apparatus of the male and 
 female has a very intimate relation with the ner- 
 vous system. It is the impression which the 
 individuals of each sex make upon the organs of 
 sense that excites those desires which have coi- 
 tus for their object. There is a corresponding 
 influence of the genital organs upon the nervous 
 centres ; for when semen accumulates in the 
 reservoirs, the organs of generation transmit an 
 influence to the cerebro-spinal centres, giving 
 rise to sexual desire. 
 
 " The glans penis," says Kobelt,* " is the prin- 
 cipal point of reunion of the sensitive nerves of 
 
 * Be Vappareil du sens genital. Strasbourg : 1851 ; quoted 
 by Luys. 
 
 3 
 
24 SPERMATORRHOEA. 
 
 the virile organ ; no other part which it regu- 
 lates can be compared with it in this respect. 
 In respect to richness in nerves, the glans penis 
 yields to no other part of the economy, not even 
 the organs of sense.'' According to Kobelt,* 
 the division of the dorsal nerve of the penis, in 
 the most powerful and erotic stallion, deprives 
 the animal of sexual desire as completely as 
 castration. 
 
 " Anatomically regarded," says Handfield 
 Jones. " it is very remarkable how closely the 
 different nervous centres, or parts of a nervous 
 centre, are connected by commissural fibres ; 
 and from a pathological point of view, the same 
 connection is very manifest. The general ex- 
 haustion induced by excess in venery ; the pro- 
 duction of neuralgia in weakly persons by bodily 
 exercise ; the effect of muscular exertion in caus- 
 ing drowsiness — are examples which show how 
 excessive consumption of nerve-force in one 
 part weakens it also in others," etc. 
 
 Experience has abundantly shown that the 
 lesions resulting from masturbation are those 
 
 * De I'appareil du sens genital. Op. cit. , as quoted by 
 Luys. 
 
CAUSES. 25 
 
 due to expenditure of nervous force and derange- 
 ment of the intimate and harmonious relation 
 existing between the sexual system and cerebro- 
 spinal centres, and not to a mere loss of seminal 
 fluid : for under no other circumstances is so 
 small a discharge from the body accompanied 
 by such serious results. This conclusion is 
 further strengthened by the more important ef- 
 fects which follow masturbation than sperma- 
 torrhoea, although the mere seminal loss in two 
 cases may be exactly equal. 
 
 A marked feebleness of the intellectual facul- 
 ties is observed after abuse ; other parts of the 
 nervous system also participate in the debility 
 of the encephalon. The organs of sense, espe- 
 cially that of vision, lose their sensibility to 
 their appropriate stimuli, and their functional 
 activity is lowered. 
 
 By masturbation, by excesses in venery, a 
 condition of hyperesthesia of the glans and 
 urethra is induced, and the reflex act of ejacu- 
 lation becomes abnormally excitable. Under 
 these circumstances erotic ideas are readily ex- 
 perienced, and so promptly does the reflex func- 
 tion of the cord respond, that the seminal loss 
 
26 SPERMATORRHOEA. 
 
 may occur without a decided venereal orgasm. 
 This is the essential pathological condition in 
 spermatorrhoea. By frequent involuntary losses 
 a habit is induced, and power diminishes. This 
 idea has been well expressed by Handfield 
 Jones : — 
 
 " It seems a well-established fact that the 
 nervous tissue, both in the centres and in the 
 peripheral extensions, becomes more excitable 
 and mobile in proportion as its power becomes 
 weaker. The motor nerve is more readily thrown 
 into action, though the impulse it communi- 
 cates is weak, and cannot be long sustained."* 
 
 The physiological origin of spermatorrhoea 
 .must not be overlooked. As I have already in- 
 dicated, adults in full health have emissions, 
 when continent, more or less frequently, accord- 
 ing to their sexual peculiarities. This sponta- 
 neous evacuation is an effort of nature, under 
 these circumstances, to supply the lack of use of 
 a physiological function. That such occasional 
 loss is physiological rather than pathological, 
 seems confirmed by the good effects which ensue 
 
 * Functional Nervous Diseases, op. cit., p. 48. 
 
CAUSES. 27 
 
 from it upon the mental and physical constitu- 
 tion of the individual. The inquietude of mind, 
 the headache, and the hebetude of body which 
 are experienced anterior to the evacuation be- 
 come relieved hereby ; the muscular movements 
 are then more easily executed; the headache 
 ceases, and the mental operations are more 
 rapid and clear. In some subjects, however, 
 these evacuations may become so frequent and 
 excessive as to constitute a pathological state. 
 This occurs in clergymen, in studious persons of 
 sedentary habits, and in those whose nervous 
 apparatus has been deranged by dyspepsia. 
 The excessive use of such stimulants as coffee 
 and tobacco by continent persons who have 
 weak digestion, slight muscular development, 
 and a preponderating nervous system, power- 
 fully contributes to the conversion of a physio- 
 logical into a pathological spermatorrhoea. 
 
 Moral. — Foremost amongst the moral causes 
 must be placed the indulgence in lascivious 
 thoughts, which acts by maintaining a state of 
 turgescence of the sexual apparatus. 
 
 During this condition of excitement semen is 
 abundantly secreted, and accumulating in the 
 
28 SPERMATORRHOEA. 
 
 vesiculce seminales, must find an outlet by the 
 nocturnal loss. Frequent repetition of this ex- 
 citement induces that condition of irritability of 
 the sexual organs, the essential cause of sper- 
 matorrhoea. Similar to this in all respects is 
 the effect of that venerea l excitement caused by 
 taking liberties with the opposite sex without 
 the gratification of desire. The intimate rela- 
 tion which exists between parties " engaged to 
 be married," if long continued, frequently pro- 
 duces the same condition of genital weakness. 
 
SYMPTOMS. 29 
 
 SYMPTOMS. 
 
 The signs and symptoms of spermatorrhoea 
 may be divided into the objective and subjective, 
 the objective being those which are recognized 
 by the physician ; the subjective those of which 
 the patient himself only is conscious. It is not 
 always possible to separate the symptoms due 
 to masturbation from those of spermatorrhoea. 
 There is a practical utility in placing them side 
 by side for the purpose of comparison. The two 
 conditions are so frequently united, and the 
 connection between them of cause and effect so 
 intimate, that the symptoms of both may be 
 comprehended in the experience of the same 
 individual. It is to be remarked that the vol- 
 untary seminal losses by unnatural means are 
 much more active in producing the various 
 secondary phenomena of this disorder, than the 
 involuntary. The former are manifested, also, 
 by more positive objective signs. 
 
 Objective Symptoms due to Masturbation. 
 — Objectively considered, the masturbator is 
 recognized by a marked facial expression, by a 
 
30 SPERMATORRHOEA. 
 
 characteristic mannerism, and by a peculiar 
 mental state. 
 
 The facial expression consists of a pale and 
 sallow tint of the skin, unusual development of 
 acne, especially on the forehead ; a dark circle 
 around the orbits ; dilated and sluggish pupils ; 
 lustreless eyes, and an oblique line extending 
 from the inner angle of the lids transversely 
 across the cheek to the lower margin of the 
 malar bone. The face has a haggard, troubled, 
 furtive expression. These signs of themselves 
 are by no means conclusive, for they may be 
 produced by other causes than masturbation. 
 This observation is especially true with respect 
 to acne. This eruption occurs at puberty, more 
 or less abundantly in different temperaments; 
 and hence it would be very unjust to accuse 
 young men of practising onanism in whom no 
 other evidence of the fact existed than the 
 presence of this eruption. 
 
 The manner of the masturbator is peculiar. 
 He is listless, shy, retiring, and easily con- 
 fused ; he avoids society, preferring solitude ; 
 there is a w T ant of steadiness and decision in 
 his locomotion ; his inferior extremities seem 
 
SYMPTOMS. 31 
 
 deficient in power, and all his movements be- 
 tray a mind ill at ease. 
 
 His mental operations are confused ; his 
 speech is embarrassed, awkward, and without 
 directness ; his memory is defective, and he is 
 absent-minded and given to reverie. If the 
 habit has long existed, and been excessively 
 frequent in repetition, epilepsy may be pro- 
 duced ; or serious mental disorder, as delu- 
 sional insanity, dementia, etc., may occur. 
 
 The state of the genital organs varies with 
 the length of time the habit has been indulged. 
 In some young subjects, there will be observed 
 an extraordinary development of the organs, 
 owing to premature excitement ; but the dis- 
 proportion is not maintained. With the prog- 
 ress of the habit the penis becomes relaxed, 
 the erections feeble: the corpora cavernosa 
 either atrophy, or their vessels lose their toni- 
 city, whereby an apparent diminution in bulk 
 takes place ; the corpus spongiosum and the 
 glans also shrink, so that the prepuce appears 
 unnaturally elongated. The testes may in- 
 crease in size, become tender and " irritable," 
 or they may undergo a certain degree of 
 
32 SPERMATORRHOEA. 
 
 atrophy; the latter is the more usual re- 
 sult. 
 
 The superficial veins of the penis, especially 
 the dorsal vein, dilate and become tortuous. 
 Their capacity is so much enlarged, that the 
 penis is emptied of blood with unnatural ra- 
 pidity ; hence the erections cannot be long 
 maintained. A considerable increase of capa- 
 city — how much the data do not warrant an 
 opinion — of the efferent vessels, notably the 
 dorsal, may prevent that degree of filling of 
 the veins necessary to constitute an erection. 
 
 Subjective Symptoms due to Masturbation. 
 — Pains in the lumbar region, a sense of weight 
 and aching in the loins, around the anus, and in 
 the testes, are experienced. The appetite is ca- 
 pricious, the digestion feeble, and the bowels 
 are constipated, or constipation alternates with 
 diarrhoea. 
 
 The mind is deficient in power of attention ; 
 the imagination is constantly pervaded with 
 vague erotic dreams, the moral sense is blunted, 
 and the perceptions are dull and confused. 
 Pains in the head, in the occipital and frontal 
 
SYMPTOMS. 33 
 
 regions, and a sense of fulness, and in serious 
 cases alarming vertigo ; pains in the course of 
 the principal nerves, and an extreme nervous 
 susceptibility are experienced. The organic ner- 
 vous system manifests a functional disturbance 
 in harmony with the disorder of the nervous 
 system of animal life. Gastralgia and abdomi- 
 nal pain and uneasiness are in some cases very 
 distressing symptoms. 
 
 The distinctiveness of the foregoing symptoms 
 will be determined by the extent and duration 
 of the habit, and by the constitutional peculi- 
 arities of the patient. The more highly devel- 
 oped the nervous system, and the more it pre- 
 ponderates in activity over the muscular and 
 digestive systems, the more serious the effects. 
 
 Objective Symptoms of Spekmatokkhom. — 
 These are in many respects similar to those due 
 to masturbation. The same cause, indeed, is in 
 operation, but is much less powerful. 
 
 The facial expression is not so marked. Acne 
 is not common. The discoloration of the eye- 
 lids is decided only in cases of very frequent 
 seminal loss. The face is usually pale, sallow, 
 
34 SPERMATORRHOEA. 
 
 and thin, anxious or sad in advanced cases. 
 The manner is more or less retiring, subdued, 
 and melancholy. Effeminacy, and sometimes 
 extreme pusillanimity, are observed. Society is 
 distasteful, or is absolutely avoided. Memory 
 and power of attention are defective, and the 
 patient is subject to fits of depression and mel- 
 ancholy, and is absorbed in the contemplation 
 of his infirmity. These mental effects are fre- 
 quently greatly disproportioned to the real im- 
 portance of the malady; they are increased by 
 popular works on this subject, for the perusal of 
 which these patients have a prodigious penchant. 
 They imagine themselves possessed of every in- 
 firmity portrayed in these works, and are not 
 unfrequently driven to the verge of insanity by 
 their apprehensions. Hypochondria is a very 
 constant mental symptom ; but true mental 
 alienation is not, by any means, so frequently 
 observed as in masturbation. 
 
 The gen tal organs are relaxed, the scrotum 
 pendent, the veins of the spermatic cord vari- 
 cose, the erections deficient in power and dura- 
 tion, and the seminal fluid is thin, watery ; the 
 spermatozoa are deficient in size and activity, 
 
SYMPTOMS. 35 
 
 and are imperfect in development. The urine 
 is pale, of low specific gravity, and loaded with 
 urates. An evident feebleness of the general 
 system exists, manifested by a quick, weak 
 pulse, cold hands and feet, hurried respiration, 
 and loss of flesh and muscular vigor. 
 
 Subjective Symptoms oe Spermatobkhcea. — 
 Weakness in the back and pain extending up- 
 wards to the scapula ; pain along the spermatic 
 cord, in the hips, around the anus, and pain in 
 micturition, are experienced by the patient. He 
 has a variable appetite, and ''suffers from dys- 
 pepsia, borborygmi, constipation, and diarrhoea. 
 He complains of weakness in the knees, with 
 pain and soreness of the calves, and loss of 
 power in the inferior extremities. His sensa- 
 tions in these parts may be perverted. He 
 has also headache, or a sense of fulness in the 
 head ; he can fix his mind on any subject with 
 difficulty ; his attention wanders, and he is given 
 to day-dreams and to erotic visions. 
 
 The importance of the foregoing symptoms 
 will be governed by the frequency of the spermal 
 
36 SPERMATORRHOEA. 
 
 losses. They are felt in the greatest intensity on 
 the morning succeeding the noctural emissions. 
 
 The essential symptom in spermatorrhoea is 
 the occurrence of seminal losses. Lallemand, 
 and succeeding writers following him, divide 
 these into nocturnal and diurnal pollutions. The 
 nocturnal occur at night in an erotic dream, 
 with a more or less decided venereal orgasm ; 
 and their importance, in a pathological point of 
 view, will be wholly determined by the frequency 
 of their occurrence, and the evident derange- 
 ments of the organism which precede or accom- 
 pany them. 
 
 The diurnal pollutions, according to Lalle- 
 mand, occur principally in micturition and defe- 
 cation; passively in some subjects, owing to a 
 superabundance of semen in the vesiculse se- 
 minales ; in others with a certain pleasure and 
 a definite ejaculation ; and in others, habitually, 
 without sensation, with a feeble or scarcely per- 
 ceptible ejaculatory effort. The first variety 
 can hardly be regarded as pathological. 
 
 It is peculiarly unfortunate that these views 
 of M. Lallemand, with reference to diurnal pol- 
 lutions, have obtained such general credence. 
 
SYMPTOMS. 37 
 
 The minds of patients become so impressed 
 with the conviction that every mucous flow 
 from the uretha is seminal, that it is difficult to 
 overcome it. They parade this symptom and 
 dwell upon it, believing that it has the patho- 
 logical significance which Lallemand and his 
 followers have ascribed to it. 
 
 The various symptoms of spermatorrhoea may 
 be comprehended in three groups : genital ; cer- 
 ebral; spinal. 
 
 In the first, or genital form or phase, which 
 is the most common, there are excessive sensi- 
 bility of the sexual apparatus, and greatly in- 
 creased reflex excitability of the cord. 
 
 In the cerebral form there are associated 
 with the preceding conditions certain disorders 
 of the mind — melancholia, delusional insanity, 
 and mania. 
 
 In the spinal form the functional derange- 
 ment of the cord is either excessive and pro- 
 nounced, or has resulted in organic lesion. 
 
 I. — GENITAL FORM. 
 
 The sexual organs are relaxed ; the testes 
 tender, painful, and sometimes wasted ; the 
 
38 SPERMATORRHOEA. 
 
 erections feeble and the seminal flow watery. 
 Slight causes — an erotic idea, gentle friction, a 
 voluptuous dream — will produce a feeble erec- 
 tion followed by a quick emission with but little 
 sensation. Whenever an erection and an emis- 
 sion occur, there is an evident orgasm, but not 
 nearly so pronounced as in the normal state. 
 After every erection without seminal loss, there 
 is a mucous flow from the urethra. A mixture 
 of this mucus with the semen produces the so- 
 called watery semen. The same mucous dis- 
 charge is not unfrequently observed after uri- 
 nation and defecation. It alarms the patient 
 because he has been led to believe that it is 
 seminal. These are the cases to which M. 
 Lallemand applies the term "diurnal pollu- 
 tion." If a proper examination of this fluid be 
 made, it will be found not to contain spermato- 
 zoa. It is a thick, transparent, albuminous fluid, 
 alkaline in reaction, and presents under the 
 microscope the cellular elements noted in Fig. 
 1. We need hardly remark that the presence 
 of spermatozoa (Fig. 2) is essential to prove 
 the existence of semen. No other test is at all 
 applicable to the determination of this ques- 
 
SYMPTOMS* 39 
 
 tion, than the microscopic. It cannot be de- 
 nied that spermatozoa may be found in the 
 urine or mucous secretion from the urethra, 
 if a nocturnal emission, or an emission pro- 
 duced by natural or unnatural means, have 
 recently occurred; but these fluids should be 
 examined, when this source of error may be 
 eliminated. We are glad to have an oppor- 
 tunity of quoting in support of our opinion so 
 able an observer as Prof. Flint,* who remarks 
 on this subject — "In the most of these cases 
 the fluid is either the liquor prostaticus or a 
 secretion from the vesicuke seminales. The 
 microscope affords the only mode of determin- 
 ing that the fluid is seminal. Were this mode 
 of examination generally adopted, cases of sper- 
 matorrhoea would be extremely rare." We quote 
 further some excellent remarks on this subject 
 from Hassell : f " Care must be taken not to 
 coufound the discharge of urethral gleet with 
 the seminal fluid ; the distinction is easy, since 
 the former is distinguished by the absence of 
 infusoria, by the presence of scaly epithelium, 
 
 * Practice of Medicine : H. C. Lea. Phila., 1866. 
 f The Urine in Health and Disease. London, 1863. 
 
 4 
 
40 SPERMATORRHOEA. 
 
 and by the escape being in general continuous. 
 Sometimes the gleet y discharge occurs only 
 after sexual excitement and lasts but for a 
 short time, when, of course, its character is 
 more apt to be mistaken. The prostatic fluid 
 might also be mistaken for semen ; in this the 
 spermatozoa would also be absent, and in addi- 
 tion, the microscope would reveal in it the 
 presence of the prostatic cylinders, and per- 
 haps, also, of the peculiar lamellated concre- 
 tions of phosphate of lime, which are found in 
 the prostate in such numbers. Like the mucus 
 from ordinary gleet, that from the prostate may 
 also be continuous, but more frequently it ap- 
 pears only after violent efforts at defecation, 
 when a small quantity of matter may be ex- 
 pressed, forming only a drop or two, of a thick, 
 stringy, and transparent fluid, which appears at 
 the orifice of the urethra." Dr. Chambers,* in 
 a lecture delivered at St. Mary's Hospital, ex- 
 pressed his conviction that this mucous flow 
 from the urethra has no more pathological sig- 
 
 * Lecture on Gonorrhoea and JmagiDary Spermatorrhoea, 
 delivered at St. Mary's Hospital, June 14, 1861. Lancet, 
 1861. 
 
SYMPTOMS. 41 
 
 nificance than the leucorrhoea of woman. He 
 further asserts that true spermatorrhoea is a 
 rare, almost unknown disease, but he evidently 
 here refers to that constant stillicidium of se- 
 men to which Lallemand gave the name diurnal 
 pollutions, and which many writers consider, but 
 erroneously, the true spermatorrhoea. Again, 
 Dunglison * says, " the presence of such a fluid 
 in these circumstances, by no means shows that 
 it is sperm. Indeed, it probably rarely is so, 
 and is nothing more than the mucous fluid from 
 the prostate or Cowper's glands." It seems a 
 labor of supererogation to multiply authorities 
 on this point. There can be no question that 
 this mucous fluid is derived from the prostate, 
 vesicuhe seminales, Cowper's glands, and from 
 the follicles of the urethra. The frequent ex- 
 citement accompanied by increased blood sup- 
 ply, to which these parts are subjected, must in- 
 duce a greater secretory activity in their glan- 
 dular appendages. Hence we should expect to 
 find blennorrhagia in cases of masturbation or 
 spermatorrhoea. The urethra is red, injected, 
 
 * Cyclopaedia of Practical Medicine. Am. Ed., Vol. II., 
 p. 212. 
 
42 SPERMATORRHOEA. 
 
 and exceedingly sensitive, and considerable irri- 
 tation is referred to the region of the neck of 
 the bladder and prostate gland. No other ana- 
 tomical lesions can, with propriety, be attributed 
 to spermatorrhoea. If any other be present, 
 they are merely accidental or accessory and not 
 essential. In this category may be placed those 
 lesions described by Lallemand: thickening 
 and stricture of the urethra, ulceration of the 
 seminal ducts, suppuration in the prostate, 
 etc. 
 
 The phenomena of the genital form will be 
 better exhibited by an illustrative case. 
 
 Case I. — This was a patient, aged 32, who had 
 practised masturbation with great frequency as a 
 youth, but on learning the evil consequences had 
 resolutely abandoned the habit. He afterwards 
 suffered from frequent nocturnal emissions, and 
 had, finally, such sensitiveness of the genital 
 organs, that the slightest excitement produced a 
 feeble erection and ejaculation. After micturi- 
 tion and defecation he had a thick, tenacious 
 discharge, which gave him great concern. He 
 had, also, considerable irritation of the bladder, 
 
SYMPTOMS. 43 
 
 pain and aching about the anus, in the back and 
 loins. He was pale and thin ; his appetite was 
 capricious, and he suffered much from constipa- 
 tion, pain in the abdomen, borborygmi, and 
 flatulence. His pulse was quick ; hands and 
 feet cool and damp. His special senses were 
 unimpaired ; he had no mental aberration in 
 any form ; he was despondent and brooded over 
 his sexual condition, fearing impotence. Al- 
 though more easily fatigued than usual, he was 
 still capable of very considerable exertion, His 
 sexual desire was not materially lessened, for 
 he had contracted a marriage engagement with 
 which he feared to comply. His fears had been 
 aroused by advertisements in the newspapers 
 and popular works on his malady, for the read- 
 ing of which he had the usual propensity. His 
 organs were not materially damaged. The pre- 
 puce was long and the penis lax; the left testis 
 was somewhat atrophied, owing, probably, to a 
 varicose condition of the veins of the cord on 
 that side. 
 
 The cases of the genital form of spermator- 
 rhoea vary very much in importance. They 
 
44 SPERMATORRHOEA. 
 
 occupy all possible intermediate gradations 
 between the pale and emaciated subject who 
 suffers from nightly pollutions and severe gas- 
 tric and cardiac symptoms, and the plethoric 
 subject whose weekly nocturnal loss is an ex- 
 pression of a necessity of his sexual nature. 
 
 II. — CEREBRAL EORM. 
 
 The most serious mental effects are produced 
 by masturbation. This vice, commenced at the 
 period of puberty, interferes seriously with the 
 development of the brain and the evolution of 
 the mental faculties. We have already seen 
 that this sad habit is contracted by those in 
 whom the nervous apparatus predominates in 
 activity over the muscular and digestive, and in 
 whom the imaginative faculties are more highly 
 cultivated than the reason and judgment. The 
 mental effects of spermatorrhoea are also marked 
 in those cases which we have denominated the 
 cerebral. 
 
 It is to be remarked that the mental pheno- 
 mena of spermatorrhoea are not always in pro- 
 portion to the seminal losses. In the cerebral 
 form in addition to those lesions of the sexual 
 
SYMPTOMS. 45 
 
 spinal system, of the digestive apparatus, and 
 of the circulation described under the genital 
 form, there are certain disorders of the mind. 
 That spermatorrhoea will produce in one class 
 of cases mental disorders, and not in another, 
 indicates either that some predisposition to 
 these disorders existed, or that the habit of self- 
 pollution was merely an expression of mental 
 alienation. The lascivious images which per- 
 vade the minds of boys possessed of the highly 
 developed nervous organization of masturbators 
 are those of delusional insanity. In one case 
 the spermatorrhoea is a symptom of mental dis- 
 order ; in the other, the spermatorrhoea is an ex- 
 citing cause — the predisposition already exist- 
 ing. 
 
 There is, however, a cerebral phase of sper- 
 matorrhoea which may be separated from the 
 two preceding classes. It is characterized by 
 indistinctness of vision, dilatation of the pupil, 
 amblyopia, diplopia ; diminution in the sensi- 
 tiveness of the auditory apparatus ; feebleness 
 of voice ; mental preoccupation, hebetude of 
 mind, confusion of ideas, and a profound melan- 
 choly. " Patients who have been laboring un- 
 
46 SPERMATORRHEA. 
 
 der spermatorrhoea for a series of years are 
 much more liable to hypochondriasis and cere- 
 bral affection than to tabes dorsalis," says 
 Romberg.* Not only do long-continued and 
 excessive seminal losses produce these cerebral 
 symptoms, but they may occur in those un- 
 happy individuals who have acquired very false 
 and highly-colored views of their condition from 
 popular works on the subject. The termina- 
 tion of such cases is in suicidal monomania, de- 
 lusional insanity, etc. 
 
 In that variety of the cerebral form in which 
 a decided predisposition must be admitted to 
 exist, to disorder of the intellectual faculties, 
 there are found various forms of mental aliena- 
 tion. The chronic form is the most common, 
 which corresponds to the melancholia of Pinel, 
 or the lypemania of Esquirol, terminating in 
 dementia. Several of the most characteristic 
 cases which have happened under my observa- 
 tion correspond to the delusional insanity of 
 Bucknill and Tuke.t Many writers are dis- 
 posed to underrate the importance of this ten- 
 
 * Vol. II., p. 400. 
 
 f Manual of Psychological Medicine. Pkila. Ed., p. 103. 
 
SYMPTOMS. 47 
 
 dene j in spermatorrhoea. To the influence of 
 quack advertisements and popular works, which 
 of course, greatly exaggerate the evils of this 
 disease, is ascribed the melancholy, the hypo- 
 chondriasis, and other mental disorders, which 
 occur in the course of it. The statistics of any 
 of our large insane asylums will illustrate the 
 influence of masturbation in the production 
 of mental alienation. We have already given 
 the opinion of Romberg on this point. Mr. 
 Holmes Coote, in a discussion which followed 
 Dr. Drysdale's paper on the " Medical Aspects 
 of Prostitution," read before the Harveian 
 Society of London, remarked that " he still 
 entertained the opinion that there were worse 
 evils appertaining to human weakness than 
 prostitution. He had opportunities of wit- 
 nessing the fact that among the young there 
 was no cause of insanity more common than in- 
 dulging in habits w T hich he would not further 
 particularize, but which were knowm to result 
 in the most complete bodily and mental pros- 
 tration." * Dr. John P. Gray, the distinguished 
 Superintendent of the State Asylum at Utica, 
 * British Medical Journal, Feb. 17, 1866. 
 
48 SPERMATORRHOEA. 
 
 New York, thus speaks * of the influence of 
 masturbation in the production of insanity : — 
 " The records of this institution show five hun- 
 dred and twenty-one cases admitted directly at- 
 tributable to this vice, and I am well convinced 
 that the number is greatly understated." • We 
 might add confirmatory testimony from a va- 
 riety of sources, but the foregoing is sufficient 
 for our purpose. 
 
 The cerebral form is exhibited in the follow- 
 ing typical cases : — 
 
 Case II. — Was a young man admitted to St. 
 John's' Hospital as a private patient ; set. 30 ; 
 five feet five inches high ; leuco-phlegmatic 
 temperament ; beard scanty ; hair thin. At 
 the time of admission he could not give a 
 rational account of himself. His eye was wild ; 
 pupil very much dilated; face pale, thin, and 
 haggard. He walked unsteadily because of 
 disturbance of cerebral circulation ; he was 
 " dizzy." At night he was given up to various 
 hallucinations ; he did not sleep, but spent the 
 
 * Twenty-fourth Annual Eeport. 1867. 
 
SYMPTOMS. 49 
 
 night in talking in a wild and incoherent man- 
 ner, in wandering about his room, and beating 
 upon the walls. Daring the clay he was quiet, 
 but his conversation was disconnected,, his 
 ideas wandering, and his speech confused. 
 His appetite was capricious, his bowels consti- 
 pated, and he had suffered greatly from bor- 
 borygmi and abdominal pain. From his brother 
 it was ascertained that he had been greatly ad- 
 dicted to natural and unnatural venereal ex- 
 citement, and had suffered lately from frequent 
 involuntary losses. The state of his genital 
 organs confirmed this. 
 
 Case III. — Was similar to the preceding — a 
 young man who had passed several years in 
 the military service, during which time he had 
 indulged very freely in the vice of masturba- 
 tion. He was led to St. John's Hospital by a 
 comrade ; he could not walk without support, 
 in consequence he said of "lightness of his 
 head." He had neither delirium nor hallucina- 
 tions, but he was reduced to a state of mental 
 feebleness bordering on dementia. He was 
 pale, thin, and had little appetite ; his vision 
 
50 SPERMATORRHEA. 
 
 was indistinct ; his pupils were dilated, and his 
 hearing was dull and indistinct. All of his 
 senses, indeed, were in a state of torpor. He 
 admitted a degree of self-abuse, extending over 
 several years, too revolting to be narrated, and 
 had lately, after discontinuing it, suffered from 
 a pitiable degree of seminal weakness.* 
 
 III. — SPINAL FORM. 
 
 Impairment of locomotion and spinal pa- 
 ralysis have long been associated with venereal 
 excesses. The progressive spinal paralysis, 
 the tabes dorsalis of the Germans, and the 
 ataxie locomotrice progressive of Duchenne, was 
 formerly confounded with the effects of mas- 
 turbation and excesses in venery. The differ- 
 ential diagnosis will be a subject for future con- 
 sideration. 
 
 In the spinal form of spermatorrhoea there 
 are weakness of inferior extremities, altered — 
 diminished or perverted — and referred sensa- 
 tions, incontinence of urine and faeces, and 
 
 * Both of these cases formed the subject of a Clinical 
 Lecture at St. John's Hospital, before the class of the 
 Medical College of Ohio. Session of 1865-1866. 
 
SYMPTOMS. 51 
 
 sometimes paraplegia. These symptoms are 
 additional to those described as pertaining to 
 the genital form ; they may also be superadded 
 to the cerebral. In the following typical case, 
 it will be seen that the spinal symptoms were 
 distinctive. 
 
 Case IV. — A travelling showman, set. 35, came 
 under my care, suffering from weakness, with 
 perverted sensations of both inferior extrem- 
 ities. He had an ill-conditioned ulcer on 
 the right leg ; slight pressure, as of riding on 
 horseback, induced intractable ulcerations of 
 buttocks and thighs. He had also, to a limited 
 extent, incontinence both of urine and faeces. 
 The sensibility of the skin, as to touch, pain, 
 pressure, and the electric current, was dimin- 
 ished. He had a sense of formication in his 
 legs and tingling in his feet. The tendo-achillis 
 of each side was a little shortened. He volun- 
 teered the information that earlier in life he 
 had been much addicted to onanism, and 
 that since the habit was discontinued he had 
 suffered from frequent nocturnal emissions. 
 His mental powers w 7 ere unimpaired. He had 
 
52 SPERMATORRHEA. 
 
 the unavoidable depression and anxiety arising 
 from his very miserable physical condition, and 
 nothing more. 
 
 In what does the spinal lesion consist in 
 these cases ? We have stated that the impor- 
 tant pathological condition in the genital form 
 of spermatorrhoea is a morbid excitability of 
 the reflex faculty, with anaemia, probably of 
 the cord. In the spinal form there is probably 
 some structural lesion inappreciable by our 
 ordinary means of investigation, a molecular 
 change, possibly, or the nervous phenomena 
 are of the reflex character. We have, however, 
 no anatomical facts on which to base the for- 
 mer opinion — our knowledge of these cases 
 being entirely clinical; but the symptoms and 
 the results of treatment seem to confirm our 
 view of the pathology. Schroeder van der 
 Kolk,* also, has made some observations which 
 tend to establish the same view. Says this 
 able observer : " Onanism is commonly consid- 
 ered, and often correctly, to be a cause of 
 epilepsy : but onanism and excitement of the 
 
 * On the Minute Structure and Functions of the Spinal 
 Cord and Medulla Oblongata. Syd. Soc. Translation, p. 268. 
 
SYMPTOMS. 53 
 
 sexual organs are, to a greater degree than is 
 usually supposed, the result of irritation and 
 congestion of the medulla oblongata. The 
 opinion formerly advanced by Gall, as to the 
 localization of the sexual impulse in the cere- 
 bellum, has been 'sufficiently refuted, and the 
 close relation between the medulla oblongata 
 and the action of the genital organs, is gener- 
 ally received by physiologists. Let it suffice 
 to call to mind the occurrence of erection and 
 emission in persons hanged, how the sexual 
 action is exalted in idiopathic mania with irri- 
 tation of the brain and medulla oblongata ; how 
 frequently, after injuries of the part, erection 
 and emission, or perhaps impotence is observed. 
 * x * * j n ^ e case f epilepsy I have 
 just recorded, this influence was very evident ; 
 the emissions disappeared for a time, when the 
 sensibility and over-irritation of the medulla 
 oblongata had again discharged themselves in 
 a fit. * * * It is but a short time since a 
 similar case occurred to me, of a young man 
 who was unable to continue his studies regu- 
 larly on account of epilepsy, apparently origi- 
 nating in onanism. A few days ago I received 
 
54 SPERMATORRHOEA. 
 
 a report, that for the last three months, after 
 an issue had been by my advice established in 
 the neck, neither the involuntary pollutions, 
 which in this case also were very frequent, nor 
 the epileptic attacks, which commonly returned 
 every two or three weeks, had again appeared, 
 while the patient's head had become much 
 clearer, and he was able to continue his studies." 
 
 On the other band, Gull relates* a case of 
 complete paraplegia, produced by sexual ex- 
 cess, in which no structural alteration of the 
 cord could be detected even by the most care- 
 ful microscopic examination. This case is justly 
 regarded as exceptional. 
 
 The state of the spinal cord in these cases 
 may be quite different — the opposite, indeed, of 
 that usually supposed to exist. The frequent and 
 excessive discharges of nervous force may ex- 
 haust the cells of the grey matter, and render 
 them incapable, for the time being, of func- 
 
 * Guy's Hospital Reports, 3d Series, Vol. IV., p. 175. 
 Gull's language is as follows : " But on the most careful 
 microscopical examination nothing abnormal was discov- 
 ered in the texture, either at these parts or in any other, 
 though the cord was submitted to repeated and searching 
 examination by the microscope." 
 
SYMPTOMS. 55 
 
 tional activity. Just as the electric eel is de- 
 prived of its power of resistance by exhausting 
 the stored-up force in its electric organ ; just 
 as a permanent magnet is deprived of its mag- 
 netic property by a powerful blow, so the spinal 
 cord may lose by over-stimulation its power 
 to functionate. In the condition supposed, the 
 change is not in the vascular supply, but in the 
 nerve cells. In that case, the minutest exam- 
 ination may fail to disclose any structural 
 alteration, as the closest inspection of the per- 
 manent magnet will fail to discover any differ- 
 ence in its appearance or quality. 
 5 
 
56 SPERMATOERHCEA. 
 
 RESULTS. 
 
 I have already sufficiently shown that various 
 forms of mental derangement may accompany 
 frequent involuntary losses. I need not waste 
 space by recapitulating the observations on this 
 topic. 
 
 An ordinary result of spermatorrhoea is weak- 
 ness of mind. The brain acts slowly and imper- 
 fectly, because a large part of the produced nerve 
 force is consumed in the frequently repeated 
 venereal orgasm. These patients are dull and 
 listless. To accomplish a given amount of in- 
 tellectual labor, they find that an unusual effort 
 is necessary. They are given to reverie, and to 
 vague and shadowy dreams in which erotic phan- 
 tasms play. They take little interest in business 
 and in the affairs of life, and to this cause is 
 to be attributed, in many instances, unexpected 
 failure in business and professional pursuits. 
 They are men of dreams instead of men of ideas 
 and action. This condition of the mental and 
 moral forces is a more frequent result of sper- 
 matorrhoea than mental derangement, properly 
 speaking. 
 
RESULTS. 57 
 
 I have not observed any disorder of the special 
 senses beyond the diminished sensibility due to 
 increased consumption of nerve force in the 
 sexual system. 
 
 The respiration becomes more or less irregular. 
 Frequent deep inspiration, sighing, and a dry 
 cough are often observed. Dryness of the fau- 
 ces, especially of the posterior wall of the pha- 
 rynx, and huskiness of voice also occur. I can- 
 not say that I have observed phthisis to be pro- 
 duced by spermatorrhoea, neither do I believe 
 that such result is probable ; but, on the other 
 hand, it is certainly true that if a tendency exist, 
 hereditary or acquired, to this disease, frequent 
 involuntary losses may promote its development, 
 as indeed any cause may, which lowers the vital 
 forces. 
 
 Irregular action of the heart is most common. 
 Pains are felt in the precordial region, the 
 rhythm of the heart's movement is altered, and a 
 subjective sense of fluttering is felt. These phe- 
 nomena are frequently accompanied by a sense 
 of constriction of the throat — a globus hysteri- 
 cus — a tendency to shed tears, and the emission 
 of a plentiful quantity of pale urine. 
 
58 ' SPERMATORRHEA. 
 
 The most serious results of spermatorrhoea are 
 those produced in the generative organs them- 
 selves. Amongst these are impotence, "irritable 
 testis," varicocele, and a state of hyperesthesia 
 of the spermatic plexus. Impotence should not 
 be confounded with loss of procreating power. 
 A man is said to be impotent when he is unable 
 to perform the act of coitus. Capacity for sexual 
 intercourse may exist without the power of pro- 
 creation. The practice of masturbation, or sper- 
 matorrhoea, more usually results in impotence 
 than in a mere loss of procreating power. 
 
 Long-continued excitation of the generative 
 organs, whether by natural or unnatural means, 
 so inflames the imagination and exalts the reflex 
 faculty that emission occurs before intromission 
 of the male organ can take place, or after very 
 imperfect coitus. The latter is the more usual 
 condition for which the physician is consulted. 
 Patients are peculiarly fearful and sensitive on 
 this point. The morbid apprehension under 
 which they labor, greatly increases their incom- 
 petence. In some instances, without being at all 
 seriously damaged in their sexual function, they 
 are rendered temporarily impotent by the mere 
 
KESULTS. 59 
 
 dread of failure. The London quack, Dr. Gra- 
 ham, understood the influence of the imagina- 
 tion upon the sexual congress. "Amongst the 
 furniture of the 'Temple of Health' was a ce- 
 lestial bed, provided with costly draperies, and 
 standing on glass legs. Married couples who 
 slept on this couch were sure of being blessed 
 with a beautiful progeny. For its use, one hun- 
 dred pounds per night were demanded, and nu- 
 merous persons of rank were foolish enough to 
 comply with the terms." * 
 
 The impotence of spermatorrhoea is not a per- 
 manent condition, unless serious cerebral or spi- 
 nal complications have occurred. Ordinarily, 
 the capacity for coitus returns with the cessation 
 of the seminal losses — the evidence of a healthy 
 functional state of the spinal cord. The loss of 
 procreating power is not a frequent accompani- 
 ment of seminal weakness ; the difficulty is in 
 the intromission of the organ. Every practical 
 physician is cognizant of instances of men whose 
 semen had fertilizing power, but who were 
 almost incapacitated for the sexual congress, 
 
 * A Book about Doctors. JeafEreson, p. 338. 
 
60 SPERMATORRHEA. 
 
 by reason of a great excitability of the reflex 
 faculty. 
 
 The same condition may exist as a result of 
 long continence in ardent temperaments. But 
 these cases only require a little time and famil- 
 iarity with the object of desire. 
 
 Excluding from consideration those organic 
 deficiencies which may produce impotence, "as 
 foreign to the purpose of this work, it will suffice 
 to allude to varicocele, and so-called " irritable 
 testes," when they are due to sexual abuses. 
 
 It is exceedingly doubtful whether varicocele 
 confined to the left testis ever results in impo- 
 tence. Some instances have occurred under my 
 observation in which this disease produced atro- 
 phy of this testis, accompanied by a painful state 
 of the right organ, and eventually resulting in 
 almost complete extinction of sexual desire. In 
 those exceptional and rare cases, where the vari- 
 cocele is double, and atrophy results, impotence 
 necessarily occurs. 
 
 To the increased activity of the testes in secret- 
 ing semen, has been attributed the varicose con- 
 dition of the spermatic veins in spermatorrhoea. 
 This view is hardly tenable. As the varicocele 
 
EESULTS. 61 
 
 occurs on the left side almost invariably, in con- 
 sequence of an anatomical peculiarity, and as it 
 is not a constant nor even a frequent complica- 
 tion, we may consider its presence, in general, as 
 accidental. Opposed to this view, we should not 
 omit mention of Mr. Hutchison's* opinion, that 
 varicocele is of spinal origin. Dr. Hughlings 
 Jackson t has reported a case which seems to 
 confirm this opinion of Mr. Hutchison. 
 
 The relation of " irritable testis " to impotence 
 is much more immediate. By this term, Sir 
 Astley Cooper,J to whom we are indebted for 
 the most of our information on this subject, in- 
 tended to express a state of hyperesthesia of the 
 spermatic plexus. One or both testes are pain- 
 ful, sometimes exquisitely so, tender to the touch, 
 and occasionally swollen. The epididymis and 
 spermatic cord also become so painful that the 
 weight of the testes gives intolerable pain ; and 
 pain is experienced in the back and loins. Not- 
 withstanding these symptoms, the testes are not 
 
 * London Hospital Reports, vol. i., p. 77. 
 f Lancet, March 31, 1866. 
 
 \ Observations on the Structure and Diseases of the Tes- 
 tis. — Chapter iv. London: 1830. 
 
62 SPERMATORRHEA. 
 
 hot and inflamed; the swelling is paroxysmal, 
 and is not accompanied by fever. The general 
 health is much impaired, partly in consequence 
 of the suffering endured, and partly by reason of 
 the disturbance of the nervous and digestive sys- 
 tems. The patient has a poor appetite ; he suf- 
 fers from indigestion ; he is hysterical and de- 
 spondent, and is unable to sleep. Impotence 
 is a usual attendant on this state. Tenereal ex- 
 cesses, masturbation, and spermatorrhoea, are the 
 causes. At least we have frequently obseiwed 
 it to accompany spermatorrhoea, and in this case 
 it proved the most troublesome and distress- 
 ing symptom. The following case very well 
 illustrates the signs and symptoms of this mal- 
 ady occurring in connection with seminal trou- 
 ble. 
 
 Case V. — An Israelite, a?t. 25, was admitted 
 to St. John's Hospital, under the following cir- 
 cumstances : He had been married a week, but 
 proved unable to consummate the sexual act, in 
 consequence of which he was placed by bis 
 Meads in a hospital to undergo treatment. He 
 presented these symptoms: He .was pale and 
 
RESULTS. 63 
 
 sallow ; his tongue coated ; his appetite was 
 poor ; lie had much abdominal pain, especially 
 about the umbilicus, and he was constipated. 
 The testes were very tender, constantly painful, 
 especially when pendent, and the cord was also 
 painful. The testes were subject to periodical 
 attacks of enlargement, which lasted a few days 
 and then subsided, there being, however, no 
 redness nor increased heat, but only increased 
 tenderness. He experienced various nervous 
 symptoms ; among others he had a well-marked 
 globus hystericus, and he shed tears on the least 
 provocation. He admitted to very great sexual 
 indulgences for several years, which were fol- 
 lowed by spermatorrhoea. Since the occur- 
 rence of irritability of the testes, he had been 
 entirely without sexual desire. He admitted 
 that he had not been able to effect the sexual 
 congress since his marriage.* 
 
 Even when it does not result in impotence, 
 hyperaesthesia of the spermatic plexus produces 
 
 * This patient left the hospital after a stay of four weeks. 
 He visited me recently, to assure me that he was restored 
 to sexual soundness. 
 
64 SPERMATORRHOEA. 
 
 distressing nervous symptoms of an hysterical 
 character. The various pelvic pains, occurring 
 in spermatorrhoea, and referred to the prostate, 
 neck of the bladder, rectum, perineum, and 
 testes, are probably due to the same cause. 
 
SPEEMATOKRHCEA AS A SYMPTOM. 65 
 
 II. 
 
 SPERMATORRHEA AS A SYMPTOM. 
 
 Various disorders of the nervous system, ac- 
 companied by frequent spermal losses, were, 
 formerly, confounded with the results of sem- 
 inal weakness. This was especially the case 
 with the disease known as tabes dorsalis, which 
 in the time of Hippocrates was assumed to be 
 caused by venereal excesses. In the work De 
 Morbis* occurs the following passage : 
 
 Tabes dorsalis a spinali medulla oritur, max- 
 ime vero recentes sponsos et libidinosos corripit. 
 Febris sunt expertes, bene comedunt, et colliquan- 
 tur. Quod si ita affectum perconteris, dicet, sibi 
 videri ex superioribus partibus a capite velut for- 
 micas in spinam descendere ; quumque urinam 
 aut stercus recldit, ipse semen genitale copiosum 
 et liquidum prodit ; necque genitura intus concipi- 
 tur et inter dormiendum cum uxore dormiat, nee 
 ne semen prof undat, etc. (Lib. ii., cap. 19.) 
 
 * Dr. Adams, the learned author of the Sydenham Soci- 
 ety's edition of the works of Hippocrates, thinks the book 
 De Morbis emanated from the Cnidian school. 
 
66 SPERMATORRHOEA. 
 
 Celsus also alludes to similar effects produced 
 by nimia profusio seminis which tabe hominem 
 consumat* 
 
 Under the "same designation similar effects 
 have, since the time of Hippocrates, been as- 
 cribed to masturbation and venereal excesses 
 by various German, French, and English writ- 
 ers. By Romberg, t however, the term " tabes 
 dorsalis" is restricted to a nervous disease, 
 identical with the progressive locomotor ataxia 
 of Duchenne. On the other hand, so recent an 
 authority as Dr. MeryonJ adheres to the an- 
 cient idea of tabes dorsalis, defining it as a 
 "tractable form of paralysis, not unfrequently 
 seen in youth and early manhood, which may 
 be traced to the vicious and enervating habit 
 of masturbation." 
 
 In progressive locomotor ataxia there occurs 
 a peculiar degeneration of the posterior columns 
 of the cord : a gelatiniform degeneration of the 
 
 * De Medicina, lib. iv. , p. 187. Edit. Milligan, Edinburgh : 
 1831. 
 
 f A Manual of the Nervous Diseases of Man. Edition of 
 Syd. Society, translated by Sieveking, vol. ii., p. 395. 
 
 \ Practical and Pathological Eesearches on the Various 
 Forms of Paralysis, p. 44. London : 1864. 
 
SPERMATORRHEA AS A SYMPTOM. 67 
 
 nerve fibres and a hyperplasia of the interven- 
 ing connective tissue. " Progressive abolition 
 of co-ordination of movements and apparent 
 paralysis, contrasting with integrity of the mus- 
 cular force, are the fundamental characteris- 
 tics," says Duchenne,* of this disease. Accord- 
 ing to this author, it is divisible as respects its 
 symptomatology into three periods : 
 
 " 1. Characterized by three symptoms — paios, 
 ocular troubles, and anaphrodisia ; 2d, by dis- 
 orders of motility and of sensibility in the infe- 
 rior extremities ; 3d, the extension of the same 
 symptoms to the upper extremities." Before 
 anaphrodisia and the disorders of voluntary 
 movement, symptoms referable to the genera- 
 tive organs are present. These symptoms are 
 satyriasis and spermatorrhoea. In fi.Ye cases 
 of progressive locomotor ataxia, of which I 
 have preserved full notes, more or less decided 
 increase of the sexual appetite occurred in the 
 inception of the disorder. Involuntary seminal 
 losses are observed at the same time, and they 
 attract the attention of the patient more than 
 
 * De FElectrisation Localisee, etc. Deux. ed. Paris : 
 1861, p. 547. 
 
68 SPERMATORRHOEA. 
 
 any other symptom then present. It is in con- 
 sequence of this fact that progressive locomotor 
 ataxia was so long confounded with the results 
 of excesses in venery. Trousseau* has espe- 
 cially called attention to these sexual symptoms 
 which attend upon the first stage of this singu- 
 lar affection. 
 
 In some observations on this topic, Topi- 
 nardf thus speaks of the symptoms in progres- 
 sive locomotor ataxia, belonging to the gene- 
 rative organs : 
 
 " Four symptoms present themselves : sper- 
 matorrhoea, satyriasis, anaphrodisia, and impo- 
 tence. The first occurs amongst the most 
 remote antecedents of the first period, through- 
 out which it continues. The nocturnal pollu- 
 tions, at first accompanied by erections and a 
 sensation of pleasure, at last become passive. 
 After the spermatorrhoea, or without having 
 been preceded by it, there occur, after some 
 
 * Clinique Medicale de l'Hotel Dieu de Paris. Tome 
 Deux., p. 534, et seq. 
 
 f De l'Ataxie Locomotrice et en particulier de la Maladie 
 appelee Ataxie Locomotrice Progressive. Paris, 1864, p. 
 171. 
 
SPERMATORRHOEA AS A SYMPTOM. 69 
 
 months or years, progressive diminution of 
 desire, difficulty in procuring satisfaction, and 
 at last absolute impotence." 
 
 Eisenmann reports a case (Topinard), in 
 which priapism existed thirty years. " During 
 thirty years of his life, priapism had tormented 
 this patient, and was only calmed by continual- 
 ly increasing and enormous doses of opium." 
 
 In order to exhibit the relation of the genital 
 symptoms to the other phenomena in cases of 
 progressive locomotor ataxia, I subjoin an 
 analysis of the symptoms of the first period in 
 the five cases of which I have preserved notes : 
 
 The disease commenced in No. 1, at 35. He 
 is 5 feet 6 in. in height ; has a light complexion, 
 light auburn hair, blue eyes, and the lymphatic 
 temperament. The first symptoms manifested 
 themselves in No. 2, at 40 years of age ; he is 
 now 65. He is 5 feet 8 in. in height, of nervous 
 temperament ; has blue eyes, and his hair, now 
 gray, was originally auburn. No. 3 experienced 
 the first symptoms at 43 ; he is now 46. He 
 has also a fair complexion, blue eyes, and light 
 auburn hair. No. 4 was 42 years of age when 
 he began to experience the pains ; he is now 45. 
 
70 SPERMATORRHOEA. 
 
 He is 5 feet 10 in. in height, and has a dark 
 complexion, dark eyes, and black hair. No. 5 
 experienced his first symptoms at 37, ten years 
 ago. He has reddish hair and beard, blue 
 eyes, and a strongly marked nervous tempera- 
 ment. 
 
 No. 1 had satyriasis, spermatorrhoea, tingling 
 and numbness of the feet and legs, and amau- 
 rosis and double vision. The satyriasis was 
 soon succeeded by anaphrodisia and impotence. 
 The dimness of vision and the double vision 
 suddenly disappeared at the commencement of 
 the second period. He did not experience 
 those peculiar pains so commonly present in this 
 disease. The whole duration of the first period, 
 commencing with the satyriasis, was only three 
 months. The symptoms of the first period in 
 No. 2 were similar in character, but extended 
 over a much longer period. The state of the 
 sexual appetite in the beginning could not be 
 accurately ascertained, but anaphrodisia soon 
 occurred, and absolute impotence was the final 
 result. Yiolent pains, supposed to be rheu- 
 matic, preceded the other symptoms. These 
 pains are localized in the inferior extremities, 
 
SPERMATORRHOEA AS A SYMPTOM. 71 
 
 and especially in the left hip, so that disease of 
 this articulation was suspected. No derange- 
 ment of vision occurred at any period. No. 3 
 experienced, for more than a year, sharp pains 
 in the extremities, and also deep-seated pains 
 in the trunk, before the ataxia manifested itself. 
 These pains, being sudden in onset, fugitive in 
 character, and irregular in their recurrence, 
 were supposed to be neuralgia. A decided de- 
 crease in sexual desire, and imperfect sexual 
 congress were observed, but complete anaphro- 
 disia did not occur. Dimness of sight, but no 
 other ocular trouble, has thus far been present 
 in this case. In No. 4, two years of neuralgic 
 pains preceded the other symptoms. The pains 
 had the two characters so frequently noticed in 
 this disease : the first, deep-seated, dull, and 
 heavy, pretty nearly constant ; the second, 
 sharp and sudden, temporary. The dull and 
 heavy pains experienced in the lumbar region, 
 in the thighs, and in certain parts of the 
 trunk, preceded the others, which attacked the 
 legs and thighs. No ocular derangemeut oc- 
 curred, in this case. Spermatorrhoea, anaphro- 
 disia, and impotence, however, were experienced 
 
72 SPERMATORRHEA. 
 
 early. No. 5 began to have pains in the lum- 
 bar region in 1857, and soon after severe at- 
 tacks of neuralgia along the course of the 
 sciatic. These were succeeded by sharp, sud- 
 den, and fugitive pains in both inferior extrem- 
 ities. 
 
 The patient compares these pains to electric 
 shocks. Anaphrodisia and spermatorrhoea did 
 not occur until two years after the pains had 
 been experienced. He admits that at the pres- 
 ent time he is completely impotent. Derange- 
 ments of vision manifested themselves in two 
 years after the commencement of his malady. 
 These consisted in amblyopia and double vision. 
 They disappeared suddenly — in a night, he says 
 — after continuing for several months. 
 
 After the first period has passed there can be 
 no difficulty in coming to a conclusion as to the 
 relation of the spermatorrhoea to the other phe- 
 nomena. 
 
 Various other affections of the nervous system 
 are accompanied by involuntary seminal losses. 
 Diseases of the medulla, cerebellum and pons, of 
 the spinal cord, epilepsy, chronic mania, may 
 have this as a more or less pronounced symptom. 
 
SPERMATORRHOEA AS A SYMPTOM. 73 
 
 In the early stage of diabetes, before impotence 
 results, spermatorrhoea is sometimes present. 
 
 In all cases in which the involuntary loss is a 
 symptom merely, it is of little consequence from 
 the therapeutical point of view ; the centric 
 lesion, of which it is a sign, is the point of 
 importance to which our attention should be 
 directed. 
 
 That the spermatorrhoea is a symptom merely, 
 should be easily determined by reference to the 
 accompanying lesions. There will be present 
 evidences of degenerative changes in the great 
 vessels, in the fundus oculi, in the organs of special 
 sense, and in the cerebro-spinal centres. As a 
 rule, spermatorrhoea as a substantive affection 
 occurs in the young, in men at the most vigorous 
 period of life, and is a result of the abuse of 
 the sexual organs. On the other hand, sperma- 
 torrhoea as a symptom appears after the middle 
 period of life, during the decline of sexual 
 activity, and coincidentally with symptoms 
 indicating lesions of the cerebro-spinal appara- 
 tus. "When spermatorrhoea is a symptom, the 
 important centric lesions on which it depends, 
 soon manifest themselves by other and more 
 
74 SPERMATORRHOEA. 
 
 characteristic signs ; whereas when spermator- 
 rhoea is a disease, the case remains in very much 
 the same state months, even years. Attention 
 to these points can hardly fail to conduct the 
 examination to a correct conclusion. 
 
IMAGINARY SPERMATORRHEA. 75 
 
 III. 
 
 IMAGINARY SPERMATORRHEA. 
 
 It is important to bear in mind that involun- 
 tary seminal losses, to constitute a disease, should 
 occur with sufficient frequency to produce defi- 
 nite symptoms. Many patients who come to a 
 physician for advice and treatment for this affec- 
 tion, are not really suffering from the seminal 
 losses, but from an imaginary ailment. Ex- 
 periencing an occasional seminal loss, and igno- 
 rant in regard to the physiological condition, 
 they imagine themselves the subjects of sperma- 
 torrhoea. Brooding over their presumed "weak- 
 ness," they fall into a hypochondriacal state, and 
 soon experience the whole train of wretched 
 symptoms depicted in popular works on the 
 subject. Every subjective sensation, no matter 
 what its origin, is referred to the debilitating 
 effects of the spermal losses. As an evidence of 
 the attention which these patients give to their 
 sensations, and of their mental and moral 
 peculiarities, I subjoin a written statement 
 handed to me by one of them, on presenting 
 himself at my consultation-rooms : 
 
76 SPERMATORRHEA. 
 
 " Kinging in my ears occasionally. 
 
 "Fullness and weight in stomach at all times. 
 
 " Considerable wind in the stomach. 
 
 " Want of strength in thighs and groins. 
 
 "Dull, heavy feeling in back of head at night 
 and after dinner. 
 
 " Drowsiness after supper, so that I cannot 
 read. 
 
 " Great want of clearness and want of strength 
 of vision. 
 
 " Weakness of voice, and sometimes thickness 
 of speech. 
 
 " Very sensitive to the least rudeness, and very 
 apt to become nervous and low-spirited from 
 being harassed or worried in any way. 
 
 " Heart palpitates somewhat violently at times. 
 
 " Digestion is very imperfect. 
 
 " Dryness of the scalp. 
 
 " Have been very subject to having boils on 
 my legs, which always were of a dry nature. 
 
 "Apt to have pimples on forehead and neck." 
 
 All of these symptoms he referred to seminal 
 emissions, occurring at intervals of three weeks. 
 His health was robust, and he was actively en- 
 gaged in business ; but the corners of his mouth 
 
IMAGINARY SPERMATORRHOEA. 77 
 
 were depressed, and his countenance had an air 
 of deep dejection. 
 
 Cases of this kind are very numerous, and 
 difficult to manage. No explanation or demon- 
 stration satisfies them. One apprehension al- 
 layed, they quickly take up another, returning at 
 last to the sexual disorder. They exhibit a real 
 pleasure in dwelling upon this infirmity, and in 
 talking with endless iteration over all the dis- 
 gusting details connected with it. 
 
 Certain masturbators, struggling to free them- 
 selves from the trammels of the vice, but too 
 weak of will to resist it wholly, please themselves 
 with the delusion that the act is involuntary, 
 because it is indulged in during the dreamy con- 
 sciousness of the half-waking state. They con- 
 sult the physician under the guise of having 
 involuntary evacuations. 
 
78 SPERMATORRHEA. 
 
 IV. 
 
 TREATMENT. 
 
 A correct view of the pathology of sperma- 
 torrhoea is necessary to its successful curative 
 treatment. 
 
 If spermatorrhoea be a purely local disease — an 
 inflammation and ulceration of the prostatic por- 
 tion of the urethra — local treatment only will be 
 required. If, however, the essential condition 
 consists of an increased reflex excitability of the 
 spinal cord, due to frequent peripheral irrita- 
 tion seated in the urethra, then the local must be 
 regarded as accessory to the general treatment. 
 The relative importance of these two views as to 
 the causation of the disease, should be definitely 
 ascertained. A particular plan of treatment is 
 followed by the adherents of each view. A wise 
 therapeutist will not reject whatever is beneficial 
 in either plan. 
 
 The local treatment consists in the applica- 
 tion of the porte caustique to the prostatic portion 
 of the urethra ; the use of injections of the nitrate 
 of silver, sulphate of copper, acetate of lead, etc. ; 
 
TREATMENT. 79 
 
 certain mechanical expedients ; the internal ad- 
 ministration of copaiba, cubebs, and other reme- 
 dies of this class ; cold hip -bathing, and injec- 
 tions of cold water into the rectum, etc. The 
 most important of these measures is the use of 
 the porte caustique. This instrument has been 
 largely employed since its introduction for this 
 purpose. Few practical surgeons at the present 
 day will assent to the dictum of Lallemand, that 
 " two-thirds of the cases of spermatorrhoea would 
 be beyond the reach of medical assistance, if it 
 were not for the good effects produced by the ap- 
 plication of the nitrate of silver to the prostatic 
 portion of the urethra." 
 
 It is very desirable, however, to ascertain its 
 real importance and the limits of its applica- 
 tion. 
 
 The Porte Caustique. — This instrument, which 
 is so closely associated with the name of Lalle- 
 mand, had an existence long anterior to his 
 employment of it. Ambrose Pare devised an 
 instrument for cauterizing the urethra, which is 
 the progenitor of the modern instruments for 
 this purpose. It consisted of a silver canula 
 and a stylet of the same metal, having at its 
 
80 SPERMATORRHOEA. 
 
 extremity a tampon of linen which was dusted 
 with powdered caustic. Loizeau is said to have 
 cured King Henry IV. of France of an induration 
 of the urethra (organic stricture) with a similar 
 instrument. Wiseman of England, and after- 
 wards Hunter, employed the nitrate of silver in 
 a porte caustique, but the latter substituted a 
 caustique holder for the linen tampon. Sir 
 Everard Home * was a warm advocate for the 
 proceeding of Hunter. The instrument of Du- 
 camp was the more immediate progenitor of 
 Lallemand's. It was a porte caustique com- 
 posed of a gum elastic canula the stylet being 
 an ordinary bougie, and of a caustic holder of 
 platinum which was attached to the bougie. 
 Amussat t in 1824 also invented a porte caus- 
 tique, the canula being of silver, and the stylet, 
 of the same metal, contained at its extremity a 
 platinum point for lodging the caustic. About 
 the same time Lallemand proposed his instru- 
 
 * Practical Observations on the Treatment of Strictures 
 of the Urethra and Esophagus. Second Edition. London : 
 1797. P. 116, et seq. 
 
 f Legons du Amussat, sur les retentions d' urine, etc. 
 Paris : 1831, p. 115, et seq., from which many of these par- 
 ticulars have been obtained. 
 
TREATMENT. 81 
 
 mcnt, and a discussion arose as to the value 
 of each instrument respectively. Differing in 
 merely mechanical arrangements, the object to 
 be attained in the use of them was essentially 
 the same. The application of the caustic was 
 employed in cases of thickening of the canal, 
 ulceration and stricture due to chronic inflam- 
 mation. We find in Lallemand's treatise on the 
 disease of the genito-urinary organs,* the germ 
 of those ideas put forth in full maturity fifteen 
 years later in his work Des pertes seminales in- 
 voluntaires. After a discussion of the changes 
 produced by blennorrhagia, he proceeds as 
 follows : 
 
 " It may be easily conceived that irritation 
 of the mucous membrane of the prostatic por- 
 tion may extend itself to the ejaculatory canals, 
 the vesiculse seminales, etc. ; and the proof is, 
 the engorgement of the testicle which so fre- 
 quently accompanies stricture. The results of 
 this irritation of the seminal reservoirs and 
 ejaculatory ducts are, that the act of coitus is 
 promptly followed by the ejaculation ; that the 
 
 * Observations sur les Maladies des Organes Oeniio- 
 urinaires, Premiere Partie. Paris : 1825, p. 158. 
 
82 SPERMATORRHOEA. 
 
 patients have frequent nocturnal pollutions, 
 and that in some cases the voluptuous sensa- 
 tion is accompanied by a more or less acute 
 pain. Still further, the irritation augmenting, 
 the seminal emission takes place with an in- 
 complete erection, or is expelled with the last 
 
 drops of urine 
 
 Governed by analogy and by direct experiences, 
 I have not hesitated to apply to these parts the 
 nitrate of silver ; the mucous membrane takes 
 on a new action ; a benign inflammation sup- 
 plants the chronic inflammation ; tone is re- 
 stored to the tissues, and the mucous secretion 
 progressively diminishes." The original idea 
 of Lallemand, following Pare, Hunter, Ducamp, 
 and others, was the treatment of these chronic 
 inflammatory affections of the urethra resulting 
 in stricture, ulceration, and abscess. The ex- 
 tension of the method of cauterization to the 
 treatment of spermatorrhoea was an after- 
 thought. Very diverse views have obtained 
 since as to the utility of the porte caustique. It 
 has not, in general, produced that favorable 
 impression upon these cases claimed for it by 
 its advocates. Not only does it often fail to 
 
TREATMENT. 83 
 
 cure the patient, but the application of the 
 caustic is frequently followed by most serious 
 consequences.* In all cases it produces great 
 irritation, frequently strangury and bloody 
 mine, and sometimes severe urethritis and cys- 
 titis. Too long contact of the caustic may in- 
 duce induration and organic stricture, a very 
 serious complication of the case. Notwith- 
 standing these sometimes unfortunate results, 
 some surgeons adhere to it, and a few claim all 
 that Ducamp, or Amussat, or Hunter, or Home, 
 did in former times. Mr. Acton, for instance, 
 is a zealous partisan of the porte caustique, 
 contending [p. 225] that, as far as his own ex- 
 perience is concerned, it " fully bears out " the 
 statement of Lallemand as to the infrequency 
 of any ill consequences arising from its use. 
 "We should not, therefore, reject this practice of 
 cauterization entirely. Under what circum- 
 stances may we resort to it? There appear to 
 be two classes of cases in which it is indicated : 
 1st. Those in which chronic inflammatory 
 
 * Thompson, On Enlarged Prostate : Its Pathology and 
 Treatment, etc. Op. cit. 
 
84 SPERMATORRHOEA. 
 
 changes exist as a complication of spermator- 
 rhoea. 
 
 2d. Those in which the moral effect of the 
 application is desirable. 
 
 We have already, we think, conclusively es- 
 tablished that the lesions of the prostatic por- 
 tion of the urethra, described by Lallemand as 
 constant to spermatorrhoea, are only accidental. 
 The\^ are produced by inflammation arising in 
 the course of gonorrhoea, as appears evident 
 enough indeed, on the perusal of the cases 
 given by Lallemand in his treatise on diseases 
 of the urinary organs. At all events, it is not 
 at all common to find such changes in the 
 urethra of patients suffering from seminal 
 weakness in this country. A hypersesthetic 
 state of the canal, especially of the prostatic 
 part, is, on the other hand, a most usual condi- 
 tion. 
 
 Eomburg * has very well indicated the cases 
 of the second class to which the use of the 
 porte caustique is adapted : " Spermatorrhoea, 
 to which not unfrequently hypochondriasis is 
 
 * Manual of the Xervous Diseases of Man. Op. cit. Vol. 
 i., p. 188. 
 
TREATMENT. 85 
 
 to be attributed, requires special attention, and 
 if all other remedies fail, we must have re- 
 course to cauterization of the urethra, which 
 has a moral as well as a physical effect by 
 withdrawing the patient's attention from his 
 malady." It is not improbable that to this 
 " moral effect " is to be attributed much of 
 whatever good is accomplished by the use of 
 the porte caustique. 
 
 We would limit the application of caustic, 
 then, to those conditions of inflammation, ulcer- 
 ation, and hyperesthesia of the prostatic por- 
 tion of the urethra, which proved refractory to 
 other less painful and dangerous methods. For 
 the moral effect, we would limit it to those ob- 
 stinate cases accompanied with severe hypo- 
 chondria, in which the fancy of the patient 
 referred all the suffering to the region of the 
 prostate, and to the cases of youths who perse- 
 vered in the vice of masturbation. 
 
 The use of the porte caustique is not attended 
 with difficulty. Certain precautions, however, 
 are requisite to avoid injury to the parts. In 
 the first place, it is necessary to ascertain the 
 length of the canal, which may be done by in- 
 
86 SPERMATORRHOEA. 
 
 troducing the catheter and observing the mo- 
 ment it enters the bladder. The length of the 
 urethra from the meatus to the bladder is then 
 marked on the canula. The curette is now 
 charged with melted nitrate of silver and placed 
 in the canula, which is oiled and introduced the 
 desired length. The operator, however, will 
 perceive when he enters the sphincter of the 
 bladder bj the sensation of the passage of the 
 enlarged extremity of the instrument. Now 
 when this enlarged extremity is withdrawn 
 through the sphincter the sensation will be 
 quite distinct, and the operator will know that 
 he is in the prostatic part. It is only necessary 
 to withdraw the outer canula half an inch and 
 rotate rapidly the curette, withdrawing it quick- 
 ly into the canula. Before the operation is per- 
 formed the patient should empty the bladder, 
 and he should not make water for some hours 
 afterwards. The recumbent position should be 
 enjoined, diluents and alkalies prescribed, and 
 a moderate diet directed. Should there be 
 much pain, opiates, morphia, or chlorodyne may 
 be prescribed, or an anodyne suppository, or 
 an enema of starch and laudanum may be in- 
 
TEEATMENT. 87 
 
 troduced. For several clays afterwards consider- 
 able irritation is experienced, even when most 
 care has been exercised. 
 
 Injections. — If cauterization be desirable, it 
 may be accomplished by injection. This is cer- 
 tainly as effectual and much safer than the pre- 
 ceding operation. A special instrument, such as 
 Mr. Acton's glass syringe, may be employed, or 
 the universal syringe (Fig. 3), which may be 
 fitted to a silver catheter, will suffice for the 
 purpose. The catheter must be introduced into 
 the bladder, and then withdrawn into the pros- 
 tatic portion of the urethra. The solution of 
 nitrate of silver, of sulphate of copper, of ace- 
 tate of lead, or, preferably, of tanno-glycerine 
 (3 j. — I j.), may now be injected and allowed to 
 apply itself thoroughly to the mucous surface. 
 Not more than 3 j of the solution should be 
 used at a time, and too great force should be 
 avoided lest the fluid be thrown into the blad- 
 der. The strength of the nitrate of silver solu- 
 tion should not exceed gr. x. — f j. Before the 
 injection is made the patient should be required 
 to empty the bladder, and should avoid emission 
 of urine after as long as possible. Injections 
 7 
 
SPERMATORRHOEA. 
 
TREATMENT. 89 
 
 by an ordinary penis syringe are sometimes 
 recommended, but they are entirely futile. It 
 is difficult, if not impossible, to make efficient 
 application in tins way to the prostatic part of 
 the urethra. 
 
 A great many instruments have been devised 
 for making application to the prostatic part of 
 the urethra. It would be a waste of space to 
 mention them all. The universal syringe and 
 catheter answer most purposes. I have had 
 constructed, in ' imitation of many that have 
 been devised, a syringe which is very useful for 
 this purpose. It consists of an ordinary hard- 
 rubber syringe, having a nozzle the diameter of 
 a No. 6 catheter, and seven inches in length. 
 The nozzle terminates by an olive-shaped blind 
 extremit} T , behind which are a number of orifices 
 for the escape of fluid. (Fig. 4.) The injected 
 fluid flows from within outward, and is pre- 
 vented by the bulb in front from escaping into 
 the bladder. 
 
 Catheterism is beneficial in that state of hy- 
 peresthesia of the prostatic part of the urethra 
 which is so commonly present in cases of sper- 
 matorrhoea. The mere stretching of the canal 
 
90 SPERMATORRHOEA. 
 
 by a full-sized bougie or catheter has the ef- 
 fect to diminish the excessive sensibility of the 
 parts, and the moral effect of the introduction 
 of the instrument is not inconsiderable. 
 
 The application of cold by means of a con- 
 tinuous flow of hydrant water, is an expedient 
 which sometimes allays irritation of the prosta- 
 tic part most admirably. The apparatus re- 
 quired, consists of a double canula curved in 
 catheter-shape, and having orifices of entrance 
 and exit at the external extremity, the internal 
 or bladder extremity being closed ; rubber tub- 
 ing of sufficient length. A tube is attached to 
 the water tap and to one orifice of the canula 
 which is so introduced that it reaches to and 
 through, the prostatic part. Another tube com- 
 municates with a receiving vessel. When water 
 is turned on a continuous stream flows through 
 the canula. Instead of communicating with the 
 hydrant, the supply of water may be by gravity. 
 
 Circumcision. — When the prepuce is long the 
 glans penis is kept moist and the epithelial layer 
 becomes exceedingly delicate and susceptible. 
 The abundant sensitive nerves of the glans are 
 thus placed in the most favorable condition for 
 
TKEATMENT. 91 
 
 the reception of impressions; an irritation ex- 
 perienced there is promptly, and with height- 
 ened impulse, conveyed to the cord, and hence, 
 in the act of coitus, the emission takes place 
 too quickly. So too, in sleep, the venereal im- 
 pulse takes its origin, frequently, in these nerves 
 thus endowed with an exaggerated sensibility. 
 For these reasons, the operation of circumci- 
 sion is frequently necessary in the treatment of 
 spermatorrhoea. It would, probably, be well 
 for society if the Jewish rite were made univer- 
 sal. It is a well-known fact, that, although the 
 Jews suffer from gonorrhoea, they are rarely 
 affected with syphilis. My observation justifies 
 me in asserting that it is uncommon to meet a 
 Jew afflicted with " seminal weakness." The 
 freedom with which they expose themselves 
 to contagion, and their great sexual activity, 
 would, certainly, favor the occurrence of these 
 disorders, if circumcision did not prove a pro- 
 tection. A knowledge of this hygienic fact, 
 probably, existed at a very remote period of 
 antiquity, for, according to Herodotus,* the 
 
 * Vol. ii., chap. 37, p. 53. 
 
92 SPERMATORRHEA. 
 
 Egyptian priests " practised circumcision for 
 cleanliness, considering it better to be cleanly 
 than comely." The editor of Herodotus in a 
 foot-note expresses the belief that " this insti- 
 tution reaches to the most remote antiquity ; we 
 find it existing more than 2,400 years before 
 our era, and there is no reason to doubt that it 
 dated still earlier." At first confined to the 
 priests, it afterwards extended through all ranks 
 of society, as the benefits of the practice be- 
 came known. In all probability the Jews ob- 
 tained it from the Egyptians. 
 
 Other instrumental methods. — We may classify 
 under this head various mechanical appliances 
 to prevent involuntary seminal discharges. A 
 useful expedient of this kind is a leather ring 
 armed with metallic points large enough to be 
 worn without discomfort until erection occurs, 
 when the pricking will arouse the patient. This 
 instrument may be employed by those who 
 have decided erections and the emission with a 
 distinct orgasm. Trousseau * recommends the 
 introduction of a pear-shaped cylinder of wood 
 
 * Clinique Medicale de V 'Hotel Dieu, etc., op. cit., vol. ii., 
 p. 646-8. 
 
TREATMENT. 93 
 
 into the rectum to compress the prostate and 
 seminal ducts. This barbarous contrivance, as 
 it seems to me, cannot prevent venereal excite- 
 ment and erection, although it may prevent 
 emission, or force the semen backward into the 
 bladder. Trousseau, however, speaks warmly 
 in its praise, and adduces evidences of the good 
 effects of the practice. Any theoretical objec- 
 tion which we may entertain must yield to the 
 demonstrations of clinical observation. Accord- 
 ingly, I will, when a suitable case presents it- 
 self, give this method of treatment a fair trial. 
 Meanwhile, having no experience of its use to 
 narrate, we propose to put our readers in pos- 
 session of the experience of M. Trousseau. 
 He observes that this apparatus has been of 
 real service, and that more than one case, re- 
 bellious under all methods of treatment, yielded 
 completely and promptly to this means. He 
 alludes especially to the rapid return of the 
 virile power in the cases treated in this way. 
 
 In the same category may be classed the 
 method of acupuncture. This consists in pass- 
 ing long needles into the prostate, vesiculae 
 seminales, and sometimes into the testes and 
 
94 SPERMATORRHEA. 
 
 vasa deferentia. Lallemand thinks it unfortu- 
 nate that acupuncture has fallen into disuse ! 
 We can hardly join in his regrets. A general 
 objection may be urged against all of those 
 mechanical appliances that they fix the atten- 
 tion of the patient upon his infirmity, thereby 
 retarding recovery. 
 
 Another remedy, proposed in Trousseau's 
 clinical lecture on spermatorrhoea, is forced dila- 
 tation of the anus. This practice was recom- 
 mended to him by Dr. Adolphe Kichard, who 
 operated on a case in Trousseau's presence, 
 with a most fortunate result. Four months 
 afterwards Dr. Eichard received a letter from 
 the young man announcing that the good effects 
 continued. The frequent passage of rectal bou- 
 gies, increased to the utmost capacity of the 
 anus, is, sometimes, very beneficial. 
 
 Since the last edition of this monograph, I 
 have had excellent results from stretching the 
 sphincter ani. The method as pursued by me 
 consists in the introduction of a bi-valve rectal 
 speculum, and then working the screw until the 
 blades are sufficiently separated. This opera- 
 tion causes considerable pain, and may rupture 
 
TREATMENT. 95 
 
 the sphincters if incautiously carried too far. 
 The methodus medendi is not known, nor the 
 class of cases to which this method is adapted ; 
 but it has seemed most useful in the cases of 
 simple spermatorrhoea. 
 
 The internal medicines intended to act locally 
 are chiefly copaiba and cubebs. They need 
 only be mentioned to be condemned, for the 
 irritation which they produce in the mucous 
 membrane of the stomach and kidney will more 
 than counterbalance any possible good which 
 they can accomplish in the urethra. Enemas 
 of cold water and other medicaments and sup- 
 positories are capable of much more useful re- 
 sults. We have found urethral suppositories, 
 especially, of great utility in those cases of so- 
 called " diurnal pollutions," which consist essen- 
 tially of urethral leucorrhcea. 
 
 The medical treatment has consisted in the 
 main in efforts to improve the general health 
 by appropriate tonics, as iron, quinine, strych- 
 nia, sea-bathing, douches, etc. ; by suitable di- 
 etetics ; by improved hygiene, etc. Conjoined 
 with these measures anaphrodisiacs are em- 
 ployed as they seem to be indicated. 
 
96 speematoeehcea. 
 
 Remedies employed in the Treatment of - 
 Speematoeehcea. — It will be convenient to dis- 
 cuss under this head the actions and uses of 
 the most approved remedies. 
 
 Anaphrodisiacs. — One of the oldest of these 
 remedies is camphor. Camphora per naves cas- 
 trat odore mares, was an aphorism of the school 
 of Salernum. It is not, however, a very valu- 
 able remedy. To produce the desired anaphro- 
 disiac effect large doses are necessary ; it fre- 
 quently fails, and its action upon the stomach 
 is unpleasant, giving rise to a sense of heat and 
 burning, and followed by disagreeable eructa- 
 tions. 
 
 Lupulin is much employed by many distin- 
 guished therapeutists. Thus it is a favorite 
 remedy with Lebert,* who gives it in combina- 
 tion with camphor. It has considerable efficacy 
 as an anaphrodisiac, but, like camphor, it is 
 uncertain. Belladonna, or better its alkaloid, 
 atropia, is much more efficient than camphor. 
 Our indigenous remedy, gelsemium, is still more 
 powerful in its action on the sexual organs. 
 
 * Op. cit. , vol. ii.,p. 587. 
 
TREATMENT. 97 
 
 The fluid extract of either of these agents may 
 be combined with other anaphrodisiacs, or they 
 may be given alone. The tincture of belladon- 
 na and the tincture of gelsemium may be pre- 
 scribed with advantage together. 
 
 The most important agent of this class, the 
 most efficient and certain, and the least dis- 
 tressing in its immediate and remote effects, 
 when freely administered, is the bromide of 
 potassium. The anaphrodisiac property of this 
 drug is now almost universally acknowledged, 
 but the conditions of its success and failure 
 have not been as definitely determined as is 
 desirable. There are yet seme sceptics who 
 disbelieve in this property of the bromide of 
 potassium. One of the most recent and preten- 
 tious of them is Dr. S. W. Duckworth Wil- 
 liams.* The cases submitted by him in proof 
 of his "views serve very well to illustrate the 
 conditions under which the bromide of potas- 
 sium fails, to produce its characteristic effects. 
 We accordingly reproduce them in Dr. Wil- 
 
 ! * On the Efficacy of the Bromide of Potassium in Epilepsy 
 and certain Psychical Affections. Churchill, London, I860 
 (Pamphlet.) 
 
98 SPERMATORRHEA. 
 
 Harris's words, as they are very suitable to our 
 purpose. " Dr. Crichton Browne, in a pamphlet 
 on 'The Action of the Bromide of Potassium 
 upon the Nervous System,' published since I 
 commenced writing these remarks, is very much 
 inclined to allow it strong anaphrodisiac pro- 
 perties, although I cannot quite perceive on 
 what data. He owns that he had had no op- 
 portunity of trying the bromide of potassium 
 in simple nymphomania, although he used it 
 without effect in one patient who was in a state 
 of mania, following upon melancholia, and in 
 whom there was presumed to be excitement of 
 the sexual feelings, on account of the extra- 
 ordinary obscenity of language which she used. 
 Now, I have tried it in every variety of uterine 
 affection that has come within my reach, in- 
 cluding nymphomania, satyriasis, menorrhagia, 
 amenorrhoea, dysmenorrhcea, etc., etc., but with- 
 out perceiving the least benefit accrue. . . . 
 I had under treatment at one time two cases 
 that seemed especially well adapted for favor- 
 ing the anaphrodisiac properties of this medi- 
 cine. They were both strong, healthy girls, the 
 one a lady, the other a domestic servant. Both 
 
TREATMENT. 99 
 
 were admitted into the asylum at Northampton, 
 suffering from simple mania without any posi- 
 tive delusion. They were lively, excitable, rest- 
 less, and extremely volatile, often able to com- 
 mand their faculties sufficiently to converse 
 calmly and rationally for a few minutes on any 
 ordinary subject, but liable at any moment to 
 burst out laughing or into a fit of tears without 
 any visible cause, or to begin to rave and 
 scream, or swear ; both were fine, handsome, 
 fully developed young women ; both were most 
 indecent in language, voice, and gesture, and 
 both openly practised self -pollution. The bro- 
 mide of potassium was given to them in doses 
 of gr. v. bis die in a little pure water, and in- 
 creased up to gr. xx., and although both were 
 much affected by its use, and both became pale 
 and thin, and reduced, and their circulation 
 powerfully controlled (indeed, in one case the 
 pulsations were reduced from 90 to 60 beats 
 in a minute), nevertheless they persisted in their 
 bad habits, and their sensuality became, if pos- 
 sible, more confirmed. The administration of 
 the medicine was persisted in for nearly twelve 
 months in both cases. 
 
100 SPERMATORRHEA. 
 
 " Another case in which I tried it was that of 
 a married lady, nearly 40 years of age, in a state 
 of chronic mania, and at the same time I made 
 some observations as to the influence of the 
 bromide on the heart's action. This lady was 
 extremely amative, fell in love with every per- 
 son of the opposite sex she encountered, and 
 was in the habit of writing the most obscene 
 letters to all her male acquaintances. Her 
 pulse was habitually about 90 — tolerably strong 
 and full. Being of a strong constitution, I com- 
 menced by giving gr. xv. his die. About an 
 hour after the third dose her pulse was 76 ; two 
 hours from that time it had almost regained its 
 accustomed frequency, but in an hour's time 
 from the fourth dose it was reduced to 70, and 
 on one occasion during the first week it was 
 nearly as low as 60. Combined with this de- 
 crease in the circulation there was, as might be 
 expected, marked languor and ennui almost 
 amounting to debility, and she seemed inclined 
 to maintain the recumbent position constantly ; 
 but I cannot say that her lascivious wishes or 
 ideas were in the least disturbed, or that her 
 advances were marked by more delicacy; au 
 
TREATMENT. 101 
 
 oontraire, I am not quite sure that she was not 
 worse." 
 
 The experience of Dr. "Williams, which seems 
 so entirely opposed to that of other observers, 
 is easily interpreted by a knowledge of the con- 
 ditions which retard or altogether prevent the 
 action of the bromide of potassium. In some 
 investigations, published recently,* I attempted 
 to define these conditions. My conclusions 
 were embodied in the following : 
 
 " Its physiological effects are not very de- 
 cided, and are readily modified by any local 
 disturbance. 
 
 "Its therapeutical action is still more decid- 
 edly influenced by local morbid processes. 
 
 "It is indicated where a sedative to the 
 nervous system is required, e. g.— in insomnia ; 
 too great reflex excitability ; nervous and spas- 
 modic affections of the larynx and bronchi; 
 sexual excitement, and in an irritable state of 
 the sexual organs. 
 
 " It icill he effectual in the foregoing conditions, 
 in proportion to the degree in tuhich structural 
 
 * Experimental Investigations into the Actions and Uses 
 of the Bromide of Potassium. Cincinnati Lancet and Ob- 
 server, 1865. 
 
102 SPERMATORRHOEA. 
 
 lesions are absent, or in otlver ivords, in propor- 
 tion to the degree in ivhich these morbid states are 
 functional rather than organic" 
 
 These conclusions, the result of observation 
 and experiment, afford us a satisfactory solution 
 of the cause of failure in the use of the bromide 
 of potassium in cases such as those described 
 by Dr. "Williams. The cases of sexual excite- 
 ment in mania are due, as is shown by Schroe- 
 der van der Kolk, to structural alteration in the 
 medulla oblongata, the centre, according to this 
 author, of the sexual impulse. The bromide 
 of potassium can have no influence over these 
 structural alterations, and hence cannot control 
 the manifestations of sexual excitement which 
 depend upon them. 
 
 Aphrodisiacs. — These are indicated under cer- 
 tain circumstances. The tincture of cantha- 
 rides is sometimes beneficial in cases of great 
 atony and relaxation — those characterized by 
 profuse mucous discharge, so-called diurnal 
 pollutions, very feeble power of erection, and 
 absence of sexual desire. It is contra-indicated 
 where much hyperesthesia of the prostatic 
 portion of the urethra exists. To prevent its 
 
TREATMENT. 103 
 
 irritant effects, or at least to reduce them to 
 the minimum, opium, or cannabis indica, Or 
 chlorodyne, may be advantageously combined 
 with it. The red or amorphous phosphorus, or 
 phosphide of zinc, may be given in the same 
 class of cases as suggested for the tincture of 
 cantharides. Nux vomica is adapted to those 
 cases in which it is desired to restore the func- 
 tional activity of the sexual organs, after the 
 state of quiescence induced by the prolonged 
 administration of anaphrodisiacs. Cimicifuga 
 (actea racemosa) has seemed to me to pos- 
 sess considerable aphrodisiac power, and has 
 proved useful in cases of long-standing sper- 
 matorrhoea accompanied by nervousness and 
 anxiety, and diminished sexual desire. 
 
 Jaborandi, or its alkaloid, pilocarpin, is an 
 efficient aphrodisiac, and is indicated in cases 
 characterized by debility. I have found it more 
 efficient than any of the agents referred to — 
 more efficient than phosphorus. The dose, 
 which is generally sufficient, is thirty minims of 
 the fluid extract morning and evening. From 
 one-fifteenth to one-eighth of a grain of muriate 
 of pilocarpin may be given. 
 
104 SPERMATORRHOEA. 
 
 Galvanism, especially the induction current, 
 and static electricity, are often decidedly aphro- 
 disiac, and are probably applicable to more 
 numerous cases than any other remedy of the 
 class. 
 
 Duchenne * (de Boulogne) operates in the fol- 
 lowing manner : One rheophore properly insu- 
 lated is introduced into the rectum, and placed 
 in contact with the has fond of the bladder ; 
 the other is passed to the prostatic part of the 
 urethra. In this way a current can be made to 
 traverse the vesiculce seminales and ejaculatory 
 apparatus. Benedikt f applies " the copper 
 pole to the lumbar vertebrae, and passes the zinc 
 pole along the spermatic cords, over the differ- 
 ent zones, transversely, of the penis, and along 
 the perineal region antero-posteriorly. . . Be- 
 side this, usually three times in two weeks, the 
 copper pole is applied by means of a catheter- 
 shaped rheophore to the orifices of the ejacula- 
 tory ducts, and the zinc pole is passed along 
 the spermatic cords." 
 
 Ergot has been much extolled in those cases 
 
 * De rfilectrisation Localisee. Paris, 1861, p. 97. 
 f Elektrotherapie. Wien, 1868, p. 446. 
 
TREATMENT. 105 
 
 in which emission takes place quickly with feeble 
 erections. 
 
 Tonics. — Iron, quinine, the vegetable bitters, 
 the mineral acids, are indicated in anaemic cases. 
 The hygienica, air, exercise, bathing, travel, etc., 
 are valuable adjuncts to the remedial measures. 
 
 The Therapeutical Management oe Sper- 
 matorrhoea comprehends — 
 
 First, the treatment of the causes. 
 Second, the treatment of the malady. 
 
 The Treatment of the Causes. — We have al- 
 ready expressed the opinion that venereal ex- 
 cesses, and especially masturbation, are the 
 causes of spermatorrhoea, in a vast major- 
 ity of cases as they occur in this country. 
 Hence it is important to recognize this vice at 
 an early period, to prevent the immediate and 
 remote consequences of its continued perpetra- 
 tion. 
 
 We have already seen that this vice is con- 
 tracted chiefly by boys in whom the nervous 
 preponderates over the muscular and digestive 
 systems, and that certain moral and social 
 
106 SPEItMATOBRHCEA. 
 
 circumstances, and organic peculiarities, in- 
 crease the tendency to it. These influences 
 must, as far as possible, be repressed. Of 
 course, it is not within the power of the 
 physician to alter those inherent mental and 
 physical defects which exercise such a bane- 
 ful influence ; but much may be done to 
 diminish the activity of the nervous sys- 
 tem, and to restore the balance between it and 
 the other systems. Therefore, to the physical 
 culture of boys possessing these inherited pe- 
 culiarities too great importance cannot be at- 
 tached. The development of the muscular and 
 digestive systems should be promoted by every 
 agency. Open air exercise, constant physi- 
 cal employment, avoidance of confinement and 
 idleness, cold bathing, etc., are the means ne- 
 cessary for this purpose. Lebert * places chief 
 reliance upon these hygienic means in all cases 
 of masturbation and spermatorrhoea. The prin- 
 cipal organic peculiarity promotive of this vice, 
 is phymosis. "Where this condition exists, the 
 operation of circumcision is proper. A long 
 
 * Op. cit., p. 784, vol. ii. 
 
TBEATMENT. 107 
 
 and contracted prepuce hinders the develop- 
 ment of the penis, and by retaining the mois- 
 ture and secretions of the part, increases the 
 sensibility of the glans. 
 
 Ignorance of the character and tendency of 
 the habit favors the perpetration of mastur- 
 bation. Parents and public teachers have a 
 sad duty to perform in this connection which 
 they naturally shrink from. In a large major- 
 ity of cases the habit would be discontinued, if 
 the dreadful consequences of it were plainly set 
 forth to the unfortunate victims. This becomes 
 especially necessary in boarding schools and 
 in other public institutions where numbers of 
 boys are congregated. 
 
 It is also very important to prevent sugges- 
 tive novels, and books of every description hav- 
 ing a tendency to excite erotic ideas, falling 
 into the hands of these youths. 
 
 As a general rule it is sufficient in cases of 
 masturbation to set forth clearly the dangers of 
 the practice ; to institute a thorough system of 
 physical culture ; to reduce the mental work; 
 to keep the body occupied ; to correct, if possi- 
 ble, any organic imperfection which may be 
 
108 SPERMATORRHOEA. 
 
 remedied (phymosis), in order to effect a cure. 
 In some inveterate cases this may not be suffi- 
 cient. The habit may be so confirmed, the in- 
 stincts so low, and the moral obliquity so great, 
 that no means other than physical restraint will 
 prevent the perpetration of the act. The me- 
 chanical appliances may be assisted by ana- 
 phrodisiacs. 
 
 Mr. Heckford * has recently published a 
 paper showing the great value of "circumcision 
 as a remedial measure in certain forms of epi- 
 lepsy, chorea, etc." In the very instructive 
 cases given by Mr. Heckford, the convulsive 
 affections depended upon masturbation. 
 
 As the operation of circumcision is easily 
 performed, and is without danger to life, it 
 should not be omitted from the treatment in 
 two classes of cases: 1. Those in which the 
 habit of masturbation is due to the hyperes- 
 thesia of the glans produced by an elongated 
 prepuce and the irritation of the retained seba- 
 ceous matter ; and 2. In those cases in which 
 the same cause (a peripheral irritation) in- 
 
 * London Hospital Reports, 1865, vol. ii., p. 62. Already 
 quoted. 
 
TREATMENT. 109 
 
 duces the venereal orgasm and involuntary dis- 
 charge. 
 
 Although we do not deny the possibility of it, 
 we regard it as rather improbable that a mere 
 peripheral irritation, such as an irritable or in- 
 flamed state of the prostatic portion of the 
 urethra, or a balanitis, will of itself produce 
 the reflex phenomena of spermatorrhoea. Such 
 irritation, however, will undoubtedly increase 
 the morbid excitability of the reflex faculty, if 
 it have already been aroused by such causes as 
 masturbation and venereal excesses. 
 
 Ceasing an ill habit may suffice in many cases 
 to cure these local irritations. The operation 
 of circumcision should be performed when the 
 prepuce is long, the glans moist, and epithelium 
 very sensitive. The frequent application of 
 cold water to the glans, when in this condition, 
 is of great service. The tanno-glycerine (3i. — §i.) 
 may also be applied daily to the glans with ad- 
 vantage. Similar measures" may be adopted for 
 an irritation in the prostatic part of the urethra : 
 daily injections of cold water ; the injection 
 through a silver catheter in the manner already 
 recommended, of the tanno-glycerine, or of a 
 
110 SPERMATOEItHCEA. 
 
 solution of nitrate of silver. But the irritable 
 state of the prostatic portion is more properly 
 an effect rather than a cause of spermator- 
 rhoea ; accordingly, we postpone the further con- 
 sideration of it until we come to treat of the 
 therapeutic measures proper to the malady it- 
 self. 
 
 Remedial Management. — Remedies should be 
 employed with reference to the pathological 
 states of the several phases of spermatorrhoea. 
 
 In the genital form there are associated with 
 the peripheral irritation increased reflex excita- 
 bility and derangement of the primary assimi- 
 lation. There may be a condition of plethora, 
 or more or less emaciation ; much more usually 
 the latter : the therapeutical methods are indi- 
 cated in this brief pathological summary. In 
 those rather exceptional cases, in which the 
 spermatorrhoea is the result of plethora and 
 forced continence, it may only be necessary to 
 impart to the patient correct views of the im- 
 portance of the losses, which, influenced by cur- 
 rent publications, he will be very apt to exag- 
 gerate. If his vessels are full, his bowels are 
 constipated, and his digestion active, he will be 
 
TREATMENT. Ill 
 
 benefited, if somewhat reduced by saline cathar- 
 tics, by liquor potassce, by a less liberal diet, by 
 abundant exercise, and b} T diminishing the num- 
 ber of hours devoted to sleep. Many cases of 
 so-called idiopathic spermatorrhoea occur in 
 studious persons of sedentary habits, whose 
 nervous system has been rendered unduly ex- 
 citable by prolonged mental work with enfeebled 
 digestive powers. These are relieved by mental 
 rest, by* some physical employment, and by at- 
 tention to the state of the digestive organs. 
 
 Activity of the sexual system may be asso- 
 ciated with this excitable state of the nervous 
 system in studious persons ; when, of course, 
 the anaphrodisiac remedies will be required. 
 It has happened to me to meet cases of this 
 character in clergymen who led a life of celibacy. 
 A judicious employment of the hygienic means 
 together with the medical, and especially a can- 
 did statement of the real importance of the in- 
 firmity, will be followed by most satisfactory 
 results. 
 
 A vast majority of the patients who pre- 
 sent themselves for treatment do not belong to 
 either of the foregoing classes. They are those 
 
112 SPERMATORRHOEA. 
 
 in whom seminal weakness has been induced 
 by masturbation, or by prolonged excesses in 
 venery. They have frequent nocturnal emis- 
 sions. The reflex excitability of the cord is so 
 much increased, that the feeblest irritation pro- 
 cures a prompt emission with little of venereal 
 orgasm, and the frequent discharges of nervous 
 force affect the supply to all the organs — whence 
 come palpitation, indigestion, constipation, irri- 
 table bladder, pain in the back, mental feeble- 
 ness, and debility. The peripheral irritation and 
 the reflex excitability must be diminished. These 
 important objects may be accomplished by 
 means partly hygienical and partly medicinal. 
 
 The patient should cease his excesses, what- 
 ever they may have been, and avoid all sources 
 of excitement, whether the reading improper 
 publications, suggestive novels or works upon 
 his own malady, or the society of women of 
 easy virtue. The liberties between the sexes 
 permitted by custom in many places and in 
 certain circles of society without extending so far 
 as the gratification of desire, are so very iojuri- 
 ousto young men with " seminal weakness," that 
 they should be absolutely interdicted. The 
 
TREATMENT. 113 
 
 inind of tlie patient should be freed, as far as 
 possible, from any association with his disagree- 
 able infirmity. Hence constant and agreeable 
 employment, physical rather than mental, or an 
 association of the two, is especially desirable. 
 The bromide of potassium will powerfully con- 
 tribute to the success of these measures. Forty 
 to sixty grains may be given every night until 
 sexual desire is entirely suspended. This reme- 
 dy has a decided power to allay urethral irrita- 
 tion, as we have found, not only in the cases for 
 which it is now recommended, but in gonor- 
 rhoea after the acute stage has subsided, and in 
 gleet. We observe that Mr. Hutchison* has 
 committed himself to the same opinion. In 
 that very distressing complication of sperma- 
 torrhoea — hyperesthesia of the spermatic plexus 
 — the bromide of potassium is, also, very effec- 
 tive. If decided anaamia exist in these cases of 
 the genital form, iron and quinia may be given 
 during the day, conjoined with lupulin, should 
 it be desirable to increase the anaphrodisia. 
 "We have seen that dilatation of the inter- 
 
 * London Hospital Reports, vol. ii., p. 340. 
 
114 SPERMATORRHOEA. 
 
 rachidian vessels probably exists in advanced 
 cases. This view seems confirmed by the fact 
 that the involuntary emissions occur much more 
 certainly when the patient is lying on his back 
 — a position favoring congestion of the cord. 
 Hence management of the position in bed is not 
 to be neglected. The patient should lie upon 
 his side, and if unable to continue in this posi- 
 tion when asleep, should adopt some mechani- 
 cal appliances to compel it. Tying the hand 
 to the bed-post so that the position of the back 
 cannot readily be assumed may suffice in some 
 instances. Or, Lallemand's contrivance may 
 be adopted : this consists of a thin sheet of lead 
 to which a piece of wood is fastened, attached 
 by a girdle to the loins. Or, Mr. Acton's expe- 
 dient, which is nothing more than a towel tied 
 about the waist with a large knot behind. Or, 
 lastly, the leather ring armed with metallic 
 points, which will arouse the patient when 
 erection occurs. 
 
 The principal remedial agent for inducing 
 contraction of the inter-rachiclian vessels is 
 ergot. The drug should be fresh, or carefully 
 prepared ergotin or fluid extract should be 
 
TREATMENT. 115 
 
 used. Gelsemimn may be used for the same 
 purpose. It is probably more effective even 
 thau ergot. Cold to the spiue, not too pro- 
 longed, or alternate hot and cold douches, may 
 be usefully conjoined with the ergot. It should 
 be remembered, however, that cold to the spine 
 is a powerful aphrodisiac. 
 
 If the patient experience the tenacious dis- 
 charge from the urethra, consisting of the se- 
 cretion from the prostate, Cowper's glands, and 
 follicles of the mucous membrane, he will un- 
 doubtedly believe himself to have ' ; diurnal pol- 
 lutions," and will be correspondingly alarmed. 
 If the discharge do not cease during the course 
 of treatment just recommended, it will be ne- 
 cessary to adopt some special means to ar- 
 rest it. These special means consist in the 
 local application in the manner already indi- 
 cated of tanno-glycerine, of solutions of nitrate 
 of silver, or the use of the povte caustique. "We 
 should not forget, however, that caustic appli- 
 cations are considered by Henry Thompson* 
 as a cause of prostatitis. 
 
 * On Enlarged Prostate : Its Pathology and Treatment, 
 Loudon, 1858, p. 195, op. cit. 
 
116 SPERMATORRHEA. 
 
 Our duty is not ended in a case of sperma- 
 torrhoea, with the production of a state of ana- 
 phrodisia and the curing of irritation in the 
 urethra. We must restore the patient to the 
 proper performance of his sexual functions, 
 and this must be accomplished in such a way 
 that he will not lapse into his former infirmity. 
 The bromide of potassium and the ergot must 
 be suspended, and tonics and special excitants 
 must be employed. Extract of nux vomica or 
 strychnia with iron, is a useful combination 
 under these circumstances. Cimicifuga and 
 gelsemium are also indicated, if there be any 
 decided nervous phenomena present as a com- 
 plication. Galvanism should not be neglected. 
 In these cases, Duchenne's method should be 
 practised : i. e., one rheophore in the rectum ; 
 the other passed into the prostatic part of the 
 urethra. Benedikt reports great success by his 
 mode of applying the currents. Sometimes 
 static electricity is of great service. The pa- 
 tient is placed on an insulated stool, in commu- 
 nication with the prime conductor, and sparks 
 are drawn from the genitals. 
 
 During the whole period occupied by this 
 
TREATMENT. 117 
 
 treatment certain accessories must not be dis- 
 regarded. Simple but nutritious food must be 
 taken; the supper should be light, and eaten 
 four or five hours before retiring, and alcoholic 
 stimulants should be avoided. The habitual use 
 of tea, coffee, and tobacco should be discour- 
 aged. Fluids and articles of food having a 
 diuretic action should be sparingly used, since 
 erections occur when the bladder becomes full. 
 Laxatives are indicated if constipation exist, 
 but not otherwise. 
 
 In that phase of spermatorrhoea which we 
 have denominated the cerebral, in addition to 
 the derangement of the sexual-spinal system 
 there exists some form of cerebral disorder. If 
 the sexual troubles are mere symptoms of mental 
 derangement, the treatment of them is merged 
 into that for insanity. If, on the other hand, 
 the mental derangement is the result of seminal 
 losses or abuse, the treatment of it becomes as- 
 sociated necessarily with that for the cause. 
 The cases given in the extract from Dr. Wil- 
 liams's pamphlet belong to the first class ; the 
 typical cases presented under the head of the 
 cerebral form are instances of the second. The 
 
118 SPERMATORRHEA. 
 
 first are not amenable to the action of anaphro- 
 disiacs, whilst the second are. Usually the 
 mental derangement has proceeded no further 
 than hypochondria, melancholia, or trembling 
 delirium (delusional insanity) corresponding to 
 delirium tremens of alcoholismus. In all of the 
 psychical affections of spermatorrhoea the bro- 
 mide of potassium is very efficacious. Ergot 
 should be administered in conjunction with it, 
 and counter-irritants (firing, setons, blisters,) 
 should be applied to the nape of the neck, on 
 Schroeder van der Kolk's plan, and also as 
 recommended by Romberg. 
 
 The early recognition of mental disorders 
 arising from abuse is very important. With the 
 anaphrodisiacs — bromide of potassium, lupulin, 
 and camphor — and moral agencies, should be 
 conjoined the operation of circumcision. Physi- 
 cal constraint may also be resorted to, but this 
 is a temporary expedient which more usually 
 fails than succeeds. Division of the vasa de- 
 fer entia in inveterate cases has been recom- 
 mended, and we have seen it performed in an 
 inveterate case. Nothing but a failure in the 
 means already proposed will justify the perform- 
 
TREATMENT. 119 
 
 ance of this operation, as in its practical re- 
 sults it is equivalent to castration. The opera- 
 tion is readily enough performed. The duct 
 can be easily felt and separated from the rest 
 of the spermatic cord, when it may be divided 
 by the subcutaneous section. 
 
 In the spinal form of spermatorrhoea the 
 treatment will be influenced by the condition of 
 the cord. If the loss of power, the altered and 
 referred sensations, the paraplegia, be merely 
 functional derangements, or due to a " dynamic 
 alteration," strychnia, cimicifuga, faradization, 
 douches, hot and cold, to the spinal column, 
 will be indicated. Bromide of potassium is 
 hurtful in the paraplegia of sexual excess. It 
 is, however, especially applicable to the treat- 
 ment of the epilepsy and chorea of spermator- 
 rhoea. The striking results obtained by Mr. 
 Heckford, and my own observations, warrant 
 me in strongly urging the operation of circum- 
 cision, in those convulsive disorders due to 
 masturbation. In the typical cases of the spinal 
 form narrated under that head, I found the ex- 
 tract of belladonna of signal advantage. 
 
 Treatment of Impotence. — The temporary im- 
 9 
 
120 SPERMATORRHOEA. 
 
 potence of spermatorrhoea requires time and 
 familiarity with the object of desire. If it con- 
 sist of nothing more than such a degree of ex- 
 citability of the reflex faculty, that intromission 
 cannot be accomplished, or that the seminal 
 discharge takes place after very imperfect coi- 
 tus, then the treatment recommended for the 
 genital form of spermatorrhoea may be pur- 
 sued. 
 
 In the impotence dependent upon spermator- 
 rhoea of long standing, hot and cold douches to 
 the spine, galvanism or static electricity, and a 
 properly conducted system of physical training 
 and exercise, are the most appropriate measures. 
 Special excitants may be employed in conjunc- 
 tion with these means : strychnia, phosphide of 
 zinc, cannabis indica, cantharides, etc. ; but 
 these remedies will not be successful unless the 
 general health has been restored by proper hy- 
 giene and suitable haematinics. "When the im- 
 potence depends upon " irritable testis," a judi- 
 cious course of bromide of potassium should 
 precede the use of the other measures. Some 
 of these cases may be very quickly cured by an 
 induction current passed through an insulated 
 
TREATMENT. 121 
 
 metallic sound introduced into the bladder. 
 The occasional passage of a full-sized catheter, 
 I have found in not a few instances, to produce 
 energetic erections. 
 
 The question of the propriety of marriage 
 often involves considerations of great delicacy. 
 Many cases are undoubtedly curable in this 
 way. Marriage will always have a fortunate 
 result in the cases of spermatorrhoea of physio- 
 logical origin. In true spermatorrhoea, marriage 
 may be enjoined when the genital apparatus is 
 not so impaired in function as to prevent intro- 
 mission. Regular intercourse, not too frequent- 
 ly repeated, will prove of signal advantage in 
 these cases. At first sexual contact may be un- 
 satisfactory in consequence of the greatly in- 
 creased reflex excitability of the ejaculatory 
 apparatus ; but power increases by judicious 
 use of the organs. 
 
 Singular as the opinion may appear, I cannot 
 refrain from stating that marriage has resulted 
 unhappily more frequently in cases of imagi- 
 nary spermatorrhoea than in the other forms 
 described. When the supposed existence of 
 this trouble becomes a predominant idea, and 
 
122 SPERMATORRHEA. 
 
 moral and medicinal treatment cannot destroy 
 or weaken it, marriage will only confirm the 
 delusion, for the first attempts proving failures, 
 the patient will give himself up to the most ab- 
 solute conviction of incompetence. 
 
FORMULA. 123 
 
 FOBMULM 
 
 INJECTIONS. 
 
 Argenti Nitrat., gr. x. 
 Aquae Distil., 5 j. 
 Solve. 
 
 3. 
 
 Zinc. Sulphat., gr. xij. 
 Morphiae Sulphat., gr. iv. 
 Atropiae Sulphat., gr. ss. 
 Aquae Distil., § j. 
 M. 
 
 Acidi Tannici, 3 j. 
 Glycerini, f j. 
 M. 
 
 #.; 
 
 Acid. Tannici, 3 j. 
 Tinct. Iodinii, 3 ss. 
 Glycerini, I j. 
 M. 
 
124 SPERMATORRHEA. 
 
 Bismuthi Subnitrat., 3 ij. 
 Ext. Hydrastis FL, 3 j. 
 Mucil. Acacise, 3 vij. 
 AquaB, ij. 
 M. 
 
 Ext. Hydrastis EL, gj. 
 S. 10 drops injected through, the 
 urethral tube into the pros- 
 tatic part. 
 
 Anaphrodisiacs. 
 
 Lupulin., gr. vj. 
 Pulv. Camphorse, gr. iij. 
 Ext. Belladonna, gr. j. 
 ft. pil. no. vi. 
 S. One 3 times a day. 
 
 Atropise Sulphat., gr. ss. 
 
 Aquae Distil., § ss. 
 M. 
 S. 3 to 5 drops 3 times a day. 
 
FORMULA. 125 
 
 9- . 
 
 Tinct. Gelseroii, 3 j. 
 
 Tinct. Belladonnas, 3 ij. 
 M. 
 S. 15 drops 3 times a day. 
 
 Tinct. Gelsemii, 3j. 
 
 Tinct. Cimicifugae, 3 vij. 
 M. 
 
 S. 30 drops to a teaspoonful 3 times 
 a day. 
 
 9. 
 
 Potassii Bromidi, § j. 
 ft. pulv. no. viii. 
 S. One dissolved in water every 
 night. 
 
 9- 
 
 Potassii Bromidi, 1 j. 
 
 Ext. GelsemiiFL, 3ij. 
 
 Syrp. Simpl. 3 vj. 
 
 Aquae Cinnamomi, § iij. 
 M. 
 S. A teaspoonful 3 times a day. 
 
126 SPERMATORRH(EA. 
 
 Potassii Bromidi, I j. 
 
 Ext. Belladonnae, Fl. 
 
 Ext. Gelsemii Fl., aa 3 ij. 
 
 Syrp. Simpl., I iss. 
 
 Aquae Menth. P., £ ij. 
 M. 
 S. A teaspoonful 3 times a day. 
 
 Aphrodisiacs. 
 
 Tinct. Cantharidis, 3 j. 
 
 Tinct. Cannabis Ind. 
 
 Sol. Morphias Bi-mec, aa 3 ij. 
 M. 
 S. 15 drops 3 times a day. 
 
 Pilocarpin. Muriai, gr. iij. 
 
 Aquae Distil., | j. 
 M. 
 S. 10 to 20 minims twice a day. 
 
 Zinci Pkosphidi, gr. iij. 
 Conserv. Rosae, 3 ss. 
 ft. pil. no. xxx. 
 S. One night and morning. 
 
FORMULAE. 127 
 
 Tinct. Nucis Vom., 3 j. 
 
 Tinct. Actese Baa, 3 iij. 
 M. 
 S. 20 drops 3 times a day. 
 
 Syrp. Ferri, Quiniae, et Strychnia? 
 Phos., I ij. 
 S. A teaspoonful 3 times a day. 
 
 Auri Terchloridi, gr. j. 
 Ext. Nucis Yom., gr. v. 
 ft. pil. no. xx. 
 S. One 3 times a day. 
 
 Ext. Jaborandi EL, I ij. 
 S. Half a teaspoonful twice a day. 
 
 Urethral Suppositories . 
 
 Iodoformi, 
 
 Acid. Tannici, aa gr. vj. 
 01. Theobrom., q. s., 
 ft, supposit. ureth. no. vi. 
 
128 SPEEMATOEEHCEA. 
 
 Acid. Tannici, gr. vj. 
 Ex. Belladonnas, gr. j. 
 01. Theobroni., q. s. 
 
 ft. supposit. ureth. no. vi. 
 
 Plumb i Acetat., gr. xij. 
 Morphias Acetat., gr. j. 
 01. Theobrom., q. s. 
 
 ft. supposit. ureth. no. vi. 
 
 ?• 
 
 Morphias Sulph., gr. iij. 
 Zinci Sulph., gr. yj. 
 01. Theobroni., q. s. 
 
 ft. supposit. ureth. no. yi. 
 
 THE END. 
 
LIBRARY OF CONGRESS 
 
 021 062 608 6