^rA^T«H'lSt|'i.SS 
 
 HX64152170 
 RC887 .G91 1887 A practical treatise 
 
 RECAP 
 
 
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 Open Knowledge Commons 
 
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A PRACTICAL TREATISE 
 
 IMPOTENCE, STERILITY 
 
 ALLIED DISORDERS 
 
 MALE SEXUAL ORGANS, 
 
 BY 
 
 SAMUEL W. GROSS, A.M., M.D., LL.D., 
 
 PROFESSOR OF THE PRINCIPLES OF SURGERY AND CLINICAL SURGERY IN THE JEFFERSON MEDICAL 
 
 COLLEGE OF PHILADELPHIA; FORMERLY PRESIDENT OF THE PATHOLOGICAL SOCIETY OF 
 
 PHILADELPHIA; AUTHOR OF A PRACTICAL TREATISE ON TUMORS OF THE 
 
 MAMMARY GLAND ; FELLOW OF AND FORMERLY MUTTER LECTURER 
 
 ON SURGICAL PATHOLOGY IN THE COLLEGE OF PHYSICIANS 
 
 OF PHILADELPHIA; FELLOW OF THE AMERICAN 
 
 SURGICAL ASSOCIATION, ETC. ETC. 
 
 THIRD EDITION, THOROUGHLY REVISED. 
 
 WITH SIXTEEN ILLUSTRATIONS. 
 
 PHILADELPHIA: 
 
 LEA BROTHERS & CO. 
 
 1887. 
 
Entered according to Act of Congress, in the year 18S7, by 
 
 LEA BROTHERS & CO., 
 in the Office of the Librarian of Congress, at Washington. 
 
 DORNAN, PRINTER. 
 
PREFACE 
 
 The rapid exhaustion of two large editions of this work, the favorable 
 comments which it has received from the periodical press, its translation 
 into the Russian language, and the fact that it has been out of print for 
 several months, constitute valid evidence that it has filled the void for which 
 it was originally designed. 
 
 As was stated in the first edition, of the affections discussed in this brochure 
 at least two — Impotence and Spermatorrhoea — are commonly described as 
 functional diseases of the testicles ; while, according to my observations, 
 they usually depend upon reflex disturbances of the genitospinal centre, 
 and are almost invariably induced or maintained by appreciable lesions of 
 the prostatic portion of the uretura, which, as they may not be perceived 
 by the patient, are frequently overlooked by the physician. A more ex- 
 tended knowledge of these pathological facts, it is hoped, will afford a more 
 rational and simple basis for treatment. 
 
 My aim has been to supply in a compact form practical and strictly 
 scientific information, especially adapted to the wants of the general prac- 
 titioner, in regard to a class of common and grave disorders, upon the 
 correction of which so much of human happiness depends. In the chapter 
 on Sterility, the abnormal conditions of the semen and the causes which deprive 
 it of its fecundating properties are fully considered — a portion of the work 
 intended to supplement the subject of sterility in the female. From answers 
 to letters addressed to many of the most prominent writers in this country 
 on gynecology, I find that, with few exceptions, the woman alone com- 
 mands attention in unfruitful marriages. The importance of examining the 
 husband before subjecting the wife to operation will be best appreciated 
 when I state that he is, as a rule, at fault in at least one instance in 
 every six. 
 
 S. W. GROSS. 
 
 Philadelphia, 
 III2 Walnut Street, April, 1887. 
 
CONTENTS, 
 
 CHAPTER I. 
 
 IMPOTENCE. 
 
 Sect. I. — General observations — Mechanism of erection — Classi- 
 fication . ■ . . . . . . . , 17-20 
 
 Sect. II. — Atonic impotence. 
 
 A. Atonic impotence from hypersesthesia and inflammation 
 of the prostatic urethra — Etiology — Local effects of 
 masturbation — Masturbation a cause of stricture of the 
 urethra — General effects of masturbation — Classification 
 — Clinical history — Neurasthenia — Diagnosis — Prognosis 
 
 — Local treatment — General treatment . . . , 20-56 
 
 B. Atonic impotence without hyperaesthesia of the pros- 
 tatic urethra — Etiology — Treatment .... 56-57 
 
 Sect. III. — Psychical impotence. 
 
 Etiology — Prognosis — Treatment ..... 57-63 
 
 Sect. IV. — Symptomatic impotence. 
 
 From the prolonged use of cerebral sedatives and cerebral 
 excitants — From injuries of the brain and spinal cord — 
 Prognosis — Treatment ...... 63-66 
 
 Sect. V. — Organic impotence. 
 
 A, Impotence from abnormal conditions of the penis — 
 From malformations of the penis — From variations in 
 the size of the penis — From adhesion of the penis to the 
 
CONTENTS. 
 
 PAGE 
 
 scrotum — From distortion of the penis — From induration 
 of the corpora cavernosa — From gummata of the corpora 
 cavernosa — From calcification of the septum pectiniforme, 
 or corpora cavernosa — From retention of a ball in the 
 corpus cavernosum — From shortness of the frenum — 
 From varix of the dorsal vein of the penis . . . 66-74 
 
 B. Impotence from defects and disease of the testes — From 
 anorchidism — From crytorchidism — From loss of the 
 testes— From progressive atrophy of the testes — From 
 syphilitic orchitis — From tumors and tubercle . . 74-76 
 
 CHAPTER II. 
 
 STERILITY. 
 
 Sect. I. — General observations. 
 
 Composition of the semen — Functions of the prostatic fluid 
 — Spermatozoa — Spermatic crystals — Classification — 
 Relative frequency in the two sexes .... 77-84 
 
 Sect. II. — Azoospermism. 
 
 From bilateral anorchidism — From congenital bilateral 
 deficiency of the epididymis and vas deferens — From 
 failure of the testes to descend into the scrotum — From 
 affections of the testes — From bilateral atrophy of the 
 testes — From parenchymatous orchitis and total disor- 
 ganization of the substance of the testes — From syphilitic 
 orchitis — From bilateral obliteration of the epididymis 
 and vas deferens — From abnormal conditions of the 
 semen — Sexual excesses a cause of infertile semen — 
 Neurasthenia a cause of infertile semen — General diseases 
 a cause of infertile semen — Abnormal density of the 
 semen a cause of sterility — Purulent semen a cause of 
 sterility — Bloody semen a cause of sterility — Diagnosis 
 — Watery semen — Colloid semen — Catarrhal semen — 
 Prognosis — Treatment ....... 84-109 
 
CONTENTS. VU 
 
 PAGE 
 
 Sect. III. — Aspermatism. 
 
 A. Organic aspermatism — From seminal fistulse — From 
 congenital occlusion, and deviation of the ejaculatory 
 ducts — From stricture of the ejaculatory ducts, and devia- 
 tion of their orifices — From obstruction of the ejacula- 
 tory canals by sympexions — From stricture of the urethra 
 
 — From phimosis ........ 109-119 
 
 B. Atonic aspermatism — Etiology . . . . . 119 
 
 C. Anaesthetic aspermatism — Etiology . . . . 121 
 
 D. Psychical aspermatism — Etiology — Diagnosis of 
 aspermatism — Prognosis — Treatment . . . . 123 
 
 Sect. IA^. — Misemission. 
 
 From vices of conformation of the urethra — From mal- 
 position of the meatus — Treatment . . . . 128 
 
 CHAPTER III. . . 
 
 SPERMATORRHCEA. 
 
 Classification — Nocturnal pollutions — Diurnal pollutions — 
 Spermorrhagia — Clinical history — Etiology — Anatomical 
 characters — Diagnosis — Prognosis — Treatment . . 130 
 
 CHAPTER IV. 
 
 PROSTATORRHCEA. 
 
 Etiology — Clinical history — Prostatic crystals — Pathological 
 
 characters — Diagnosis — Prognosis — Treatment . . 160 
 
LIST OF ILLUSTRATIONS. 
 
 FIG. 
 
 
 
 
 PAGE 
 
 I. 
 
 Exploratory bulbous 
 
 bougie . 
 
 
 37 
 
 2. 
 
 Conical steel bougie 
 
 
 
 42 
 
 3- 
 
 Urethral dilator . 
 
 . 
 
 
 42 
 
 4- 
 
 Urethrotome 
 
 
 . 
 
 42 
 
 5- 
 
 Syringe and perforated bulbous explorer 
 
 
 .45 
 
 6. 
 
 Bulbous nozzle 
 
 . 
 
 . 
 
 46 
 
 7- 
 
 Catheter-syringe . 
 
 . 
 
 
 46 
 
 8. 
 
 Porte-caustique 
 
 
 
 47 
 
 9- 
 
 Cupped conical steel bougie . . 
 
 
 47 
 
 lO. 
 
 Porte- remede 
 
 
 
 47 
 
 II. 
 
 Psychrophor 
 
 
 
 54 
 
 12. 
 
 Spermatozoa 
 
 
 . 
 
 80 
 
 13- 
 
 Spermatic crystals 
 
 
 From Ultzmann 
 
 80 
 
 14. 
 
 Watery semen 
 
 
 . Ibid. 
 
 104 
 
 15- 
 
 Colloid semen 
 
 
 . Ibid. 
 
 105 
 
 16. 
 
 Prostatic crystals . 
 
 
 
 162 
 
IMPOTENCE, STERILITY, AND ALLIED DISORDERS 
 OF THE MALE SEXUAL ORGANS. 
 
 CHAPTER I. 
 
 IMPOTENCE. 
 
 Sect. I. General Observations. 
 
 Impotence, or inability to copulate or perform the sexual 
 act, is one of the most common of the derangements of the 
 generative functions, and is due either to deficiency or 
 absence of erection, or to congenital or acquired abnormal 
 conditions of the genital organs, which render intromission 
 of the penis impracticable. Hence, men who are impotent 
 are usually sterile, the power of procreating children being 
 dependent upon that of having connection ; but as sterility, 
 in the strict acceptation of the term, implies nonejaculation, 
 or emission of infertile semen, it will be discussed in a sepa- 
 rate chapter. 
 
 For a clear comprehension of the pathology of the most 
 frequent forms of impotence, a knowledge of the mechan- 
 ism of normal erection and of the nervous centres which 
 preside over it is essential. 
 
 Erection consists in augmentation of the volume, in stiff- 
 ness, and in rigidity of the penis, and is due to an increased 
 
 2 
 
18 IMPOTENCE. 
 
 flow of blood into that organ, as has been experimentally 
 demonstrated by Eckhard.' Loven,- who extended the 
 investigations of Eckhard, was, however, the first to show, 
 in opposition to former theories, that the essential factor in 
 the phenomenon is active dilatation of the arterioles of the 
 cavernous and spongy bodies, and not merely a stasis of 
 blood produced by constriction of the veins, although it is 
 certain that erection is strengthened by obstruction to the 
 outflow of the blood through the dorsal vein by the contrac- 
 tion of the anterior fibres of the accelerator urinae muscle 
 or the compressor venae dorsalis of Houston. 
 
 The nerves concerned in the production of erection in 
 the do^, and there is no reason to doubt their existence in 
 man, arise, according to Eckhard, by two roots, at the sacral 
 plexus from the first to the third sacral nerves. Electrical 
 stimulation of these, the erigent nerves, is followed by erec- 
 tion and ejaculation, while their division renders erection 
 and emission impossible. Eckhard, moreover, produced 
 erection by excitation of the lumbar, and lower and upper 
 segments of the cervical spinal cord, the pons, and the 
 crura cerebri, from which he inferred that the fibres of the 
 erigent nerv^es which convey the impressions for erection 
 arose in the cerebrum, and passed down through the crura 
 and the pons to the cord. Goltz,^ however, discovered 
 that, after the separation of the lumbar segment of the 
 cord from its upper portion, irritation of the glans penis 
 provoked a full erection, from which he concluded that the 
 lumbar cord constituted an independent reflex centre for 
 the genital functions ; and, what is important in the study 
 
 » 
 
 1 Beitrage zur Anat. und Phys., Bd. iii. p. 125, Bd. iv. p. 69, and Bd. vii. p. 67. 
 ^ Arbeiten aus der Phys. Anstatt zu Leipzig, 1866, p. i. 
 * Pfliiger's Archiv, Bd. viii. p. 460. 
 
MECHANISM OF ERECTION, 19 
 
 of psychical impotence, he demonstrated that this centre 
 could be acted upon inhibitorily from the brain. 
 
 From the preceding- considerations it is obvious that erec- 
 tions in the lower animals can be produced by stimulation 
 of the brain, the spinal cord, and the peripheral nerves ; and 
 ample observations, both in health and disease, demonstrate 
 that they originate in the same localities in man. The in- 
 fluence of certain emotional conditions of the mind over 
 erection is illustrated by its being induced by sexual desires, 
 or even by the sight or thought of certain women ; while it 
 may be arrested or prevented by mental preoccupation, or 
 by depressing emotions, as fear of inability to consummate 
 the venereal act, the loss of the object of one's affections, 
 modesty, disgust, or frigidity. Irritation of the cord, and 
 particularly of its cervical portion,' from disease, concussion, 
 effusion of blood, or fracture or dislocation of the vertebrae, 
 frequently occasions erections ; and these may constitute 
 the first sign of incipient ataxia,^ or general paralysis of 
 the insane, and other spinal affections. As illustrations of 
 erections from peripheral irritation, those arising from the 
 morning fulness of the bladder, from affections of the rec- 
 tum, and from inflammation of the prostatic urethra and of 
 the seminal vesicles may be mentioned. 
 
 The capacity for coition is most marked between the 
 ages of twenty and forty-five years ; after which it gradu- 
 ally declines, and usually ceases after the sixty-fifth year. 
 Sexual vigor is, moreover, greatly diminished by bodily 
 exertion, such as gymnastic exercises, and by close mental 
 occupation. Desire is also obtunded by the same causes. 
 
 ' OUivier, Traite des Maladies de la Moelle Epiniere, 3d ed., t. iii. p. 316. 
 ^ Trousseau, Clin. Med. de I'Hotel-Dieu de Paris, t. ii. p. 511 ; and Erb, 
 Ziemssen's Cyclopaedia, Amer. ed., vol. xiii. p. 545. 
 
20 ATONIC IMPOTENCE. 
 
 Impotence may arise from diminished or abolished reflex 
 excitabihty of the genito-spinal centre, or from disturbances 
 of the brain which restrain the action of that centre ; or 
 it may be symptomatic of the prolonged use of certain 
 remedies and beverages, or of various acute and chronic 
 diseases ; or it may depend upon congenital or acquired 
 defects of the genital organs. In accordance with its etiol- 
 ogy it may, therefore, be described as Atonic, Psychical, 
 Symptomatic, and Organic. Of two hundred and sixty-five 
 cases of which I have notes, two hundred and sixty were 
 atonic, two were psychical, one was symptomatic, and two 
 were organic. 
 
 Sect. II. Atonic Impotence. 
 
 When the lumbar reflex centre for erection fails wholly 
 or partially to respond to the ordinary stimuli the resulting 
 impotence may be termed atonic, in the sense that the 
 centre is deficient in activity, mobility, excitability, or toni- 
 city, through which the muscular walls of the arterioles and 
 the muscular fibres of the trabeculae of the erectile tissues 
 are prevented from relaxing and admitting the requisite 
 flow of blood into the penis, and through which the con- 
 tractility of the ischio-cavernous and bulbo-cavernous mus- 
 cles is impaired. 
 
 Atonic impotence depends either upon, or is maintained 
 by, inflammation and hyperaesthesia of the prostatic portion 
 of the urethra, or upon diminished or abolished reflex ex- 
 citability of the genito-spinal centre without the intervention 
 of those lesions. Of the two hundred and sixty cases that 
 
ETIOLOGY. 21 
 
 have come under my observation, two hundred and forty- 
 eight were of the former variety, and only twelve of the 
 latter variety. 
 
 A.— ATONIC IMPOTENCE FROM HYPERyESTHESIA AND INFLAM- 
 MATION OF THE PROSTATIC URETHRA. 
 
 Etiology. — From independent researches, which were 
 first published in 1877,' I long ago reached the conclu- 
 sion that impotence was generally induced by subacute or 
 chronic inflammation and morbid sensibility of the prostatic 
 urethra, which were frequently associated with stricture, 
 and which were usually due to masturbation, gonorrhoea, 
 sexual excesses, and constant excitement of the genital 
 organs without gratification of the passions. In subsequent 
 papers^ I called attention to the fact, previously noticed by 
 other writers, that inflammation of the prostatic urethra 
 bears the same relation to the spinal reflexes of the male 
 that inflammation of the uterus bears to allied disorders in 
 the female, and that it is a constant source of irritation of 
 the genital nerves which terminate in that locality. An 
 enfeebled state of the lumbar division of the cord and ex- 
 haustion of the cells that minister to its reflex functions are 
 thus finally brought about. 
 
 In sixty-three of the two hundred and forty-eight cases 
 the subjects had been confirmed masturbators, and had also 
 suffered from gonorrhoea, so that it is impossible to say upon 
 which of these factors the trouble depended. Of one hun- 
 dred and eighty-five patients, however, in whom the history 
 
 ^ Medical and Surgical Reporter, May 5, 1877, p. 391. 
 
 * Trans. Amer. Med. Assoc, vol. 28, p. 523 ; and Med. News and Library, 
 Sept. 1880, p. 513. 
 
22 ATONIC IMPOTENCE. 
 
 was clear, one hundred and thirty were masturbators, fifty- 
 one had had gonorrhoea, two had indulged in excessive 
 coition, one had received a blow on the perineum, and one, 
 who had never masturbated nor had gonorrhoea, had fondled 
 women for four years. Just how often prolonged and re- 
 peatedly ungratified sexual excitement produced by toying 
 with females, as in Case XXI., is to be considered a cause 
 of the morbid changfes which induce or maintain the affec- 
 tion I am unable to say, since young men addicted to this 
 habit indulge their propensities in various ways. 
 
 With reeard to masturbators who either never had sexual 
 intercourse, or had never contracted gonorrhoea, I have 
 made some notes that are interesting and practically impor- 
 tant. Thus, I find that one in every three has an elongated 
 prepuce ; one in every five has an inflamed meatus ; one in 
 every five has a contracted meatus ; one in every two 
 and a half has an exquisitely sensitive urethra ; that the 
 same proportion suffers from prostatic or abnormal seminal 
 discharges ; one in every eleven has an irritable testis ; and 
 that one in every ten has a small, and usually a pointed, 
 curved, and rigid penis. In the papers already referred to 
 I endeavored to show that confirmed masturbation is just as 
 sure to result in urethritis and the formation of a stricture 
 as is o-leet ; and that the failure to discover this lesion would 
 not have occurred to the majority of writers on this subject 
 if they had resorted to the bulbous bougie for exploring the 
 urethra. Of the one hundred and thirty masturbators 
 who suffered from atonic impotence, and of the one hun- 
 dred and fifty-three who had seminal incontinence, as will 
 be seen in the chapter on spermatorrhoea, or of two hun- 
 dred and eighty-three in all, only 35, or 12.3 per cent, were 
 free from stricture, so that a coarctation should always be 
 ooked for in this class of subjects. In rather more than 
 
ETIOLOGY. 23 
 
 one-half of the cases there is only one stricture, while in 
 the remainder two or more are present. In about three- 
 fourths of the entire number a contraction will be found 
 near the meatus. 
 
 As the knowledge of the connection between stricture 
 of the urethra from masturbation and impotence, prosta- 
 torrhoea, and seminal incontinence is of the utmost im- 
 portance in regard to the treatment of these affections, I 
 still further extended my investigations in this direction by 
 an examination of fifty-six onanists in the Insane Depart- 
 ment of the Philadelphia Hospital and the Pennsylvania 
 Hospital for the Insane. Of twenty-seven inmates whose 
 histories could be traced back, eighteen declared that they 
 never had gonorrhoea. These were either epileptics, who, 
 when their mental faculties are not enfeebled, are as capa- 
 ble of orivinp" sensible accounts of themselves as others not 
 
 o o 
 
 so affected, or the subjects of chronic insanity or dementia, 
 of whom it is characteristic that, if they remember anything 
 at all, they can recall even the most trifling incidents that 
 may have happened prior to the attack of insanity. In four 
 other instances it was improbable that the patients ever had 
 gonorrhoea, since they had been imbecile from childhood. 
 In the remaining five cases, the question of gonorrhoea 
 could not be entertained, because the subjects were ad- 
 mitted at too early an age, and had afterwards never left 
 the hospital. Their histories are briefly as follows : 
 
 Case I. An epileptic, aged twenty, admitted at the age of ten, 
 had a stricture at six inches, which was defined by a No. i8^ bul- 
 bous explorer. 
 
 '■ This and the succeeding measurements are in accordance with the French 
 catheter scale. The cahbre, therefore, represents the corresponding number 
 of millimetres in circumference, a millimetre being equal to about the one- 
 twenty-fifth of an inch. 
 
24 ATONIC IMPOTENCE. 
 
 Case II. An epileptic, aged twenty-three, had been in the house 
 twelve years, having been transferred from the Children's Asylum 
 at the age of eleven. A stricture, calibre 19, was detected at six 
 inches and a half from the meatus, which was contracted; there 
 was a gleety discharge ; and the penis was large. , 
 
 Case III. An epileptic, aged thirteen, an inmate for three months, 
 suffered from phimosis, with a stricture, calibre 17, at six inches and 
 a half, and very marked prostatic hyperaesthesia. 
 
 Case IV. An epileptic, aged nineteen, admitted at the age of 
 eleven, had a stricture, calibre 19, at six inches, with a very sensi- 
 tive urethra, and a gleety discharge. 
 
 Case V. An idiot, aged fifteen, an inmate for three years, had a 
 gleety discharge, and a stricture, calibre 18, at five inches and three- 
 quarters. 
 
 These five cases, occurring, as they did, in young sub- 
 jects, in whom the idea of gonorrhoea must be discarded, 
 sustain the view heretofore expressed that organic stricture 
 is a common lesion of masturbation. The coarctations 
 imparted the sensation of a firm, resisting obstacle upon 
 the withdrawal of the bulbous explorer, and were distinctly 
 recognized by my residents. Dr. Murray and Dr. Van 
 Valzah, by Dr. Dease, Dr. Heath, and Dr. Musser. 
 
 In addition to my personal observations on the connec- 
 tion between stricture and onanism, Otis' states that nine 
 per cent, of all cases are traceable to that practice. Ricord, 
 Phillips, Leroy, Henry Smith, Gouley, and S. D. Gross also 
 mention masturbation as a cause of stricture ; and my views 
 are, moreover, supported by the evidence of other authors, 
 who are more explicit in their statements than those just 
 
 ^ On Stricture of the Male Urethra. Pamphlet, New York, 1875. 
 
ETIOLOGY. 25 
 
 referred to. Thus, Black' reports a typical case, associated 
 with hyperaesthesia of the prostatic urethra, for which he 
 was consulted on account of fear of sexual incapacity. In 
 speaking of the etiology of stricture, Wade says : "I have 
 good reason to believe that the pernicious habit of self- 
 abuse is a much more frequent cause of stricture than is 
 generally supposed. In several instances of the kind, in 
 which there has been no sexual intercourse, the strictures, 
 which were at the bulb, proved more than usually refrac- 
 tory, from the extreme morbid sensitiveness of the entire 
 urethral canal." . . . "The complication of sperma- 
 torrhoea with stricture and a highly irritable state of the 
 urethra often proves very troublesome, and requires great 
 care and gentleness in its treatment. Such strictures are, 
 in fact, not infrequently caused by masturbation."^ Lizars 
 asserts that stricture "is also often produced by self-abuse, 
 since we find, in those affected with spermatorrhoea, that 
 there exists more or less stricture of the urethra, for 
 which it is necessary to dilate the canal before having re- 
 course to the porte-caustique."^ Lallemand^ refers to two 
 cases in masturbators who had never had sexual inter- 
 course, in one of which the stricture was very tight and 
 rebellious to treatment. Three-quarters of a century ago, 
 Sir Everard Home, in his work on the subject,^ devoted a 
 chapter to "Strictures brought on by Onanism," but he 
 classified them as spasmodic. In thus recognizing spasm 
 
 1 On the Functional Diseases of the Renal, Urinary, and Reproductive 
 Organs. Phila., 1872, p. 196. 
 
 ^ Stricture of the Urethra: Its Complications and Effects. 4th ed., pp. 21 
 and 318. 
 
 ^ Practical Observations on the Treatment of Stricture of the Urethra. 2d 
 ed., p. I. 
 
 *■ Des Pertes Seminales Involontaires, t. i. p. 479. 
 
 ^ Practical Observations on the Treatment, etc.. vol. ii. p. 243. 
 
26 ATONIC IMPOTENCE. 
 
 of the urethra as an effect of masturbation, he described the 
 condition which is the forerunner of permanent stricture, 
 since, as is well known, spasmodic contraction is a very 
 common cause of organic coarctation, and is, indeed, not 
 infrequently found in connection with it. 
 
 In addition to the foregoing lesions, masturbation may 
 be followed by other local affections, which are due mainly 
 to the extension of the morbid action from the inflamed 
 prostatic urethra. Among the more common of these are 
 irritability of the neck of the bladder, prostatorrhoea, noc- 
 turnal seminal discharges, and spermorrhagia. It may also 
 occasion spermatocystitis, funiculitis, epididymitis,' asper- 
 matism^ through obstruction of the epididymes or vasa 
 deferentia, wasting of the testes,^ and, as will be pointed out 
 in the next chapter, it is a fruitful source of azoospermism. 
 
 While in persons with an inherited predisposition to ner- 
 vous diseases, as insanity and epilepsy, there is no reason 
 to doubt that onanism may hasten their appearance, I be- 
 lieve that in the majority of cases it should be regarded as 
 an associated habit, or rather as the effect than as the cause 
 of these affections. From the constant occupation of the 
 mind with the local troubles which it induces, it certainly 
 does, however, give rise to a bad form of hypochondrism, 
 which is akin to insanity. Masturbation and sexual excesses 
 are among the most common of the causes of paralytic de- 
 mentia, and the disorder is supposed to extend upwards 
 from the cord to the brain. An examination of four cases 
 of this affection has convinced me that there is a source of 
 
 ^ See Case XV., p. 36. 
 
 ^ Liegeois, Medical Times and Gazette, 1869, vol. ii. p. 381 ; and Terrillon, 
 Annales de Dermatologie et de Syphiligraphie, ser. 2, t. i. p. 439. 
 
 ' Curling, Diseases of the Testes, 4th ed., p. 78 ; and Brodie, Lend. Med. 
 and Phys. Journ., vol. Ivi. p. 297. 
 
ETIOLOGY. 27 
 
 reflex irritability of the cord in the urethra. In one, in the 
 second stage, there was a stricture, calibre twenty-one, at 
 seven inches from the meatus. In another instance, in the 
 first stage, there was a large granular patch at six inches 
 and a half, and a gleety discharge. A. similar condition was 
 detected at six inches and a quarter, in a man in the second 
 stage ; while, in the fourth case, which was far advanced 
 in the third stage, there was also a granular patch at six 
 inches and a half, and the bougie brought away an abun- 
 dant brownish fluid from the prostatic urethra. In all, 
 hyperaesthesia was a marked symptom. Whether these 
 morbid states served as factors in the production of the 
 disease, or simply hastened and maintained the nervous 
 disturbance, I am unable to decide ; but, if the former view 
 be the correct one, functional conditions of the cord should 
 be prevented from passing into organic changes by curing 
 the peripheral sources of irritation in the first stage of the 
 affection, or when the peculiar gait and slight trouble in 
 speech are associated with extravagant ideas. I have never 
 known insanity, dementia, or phthisis to follow onanism, as 
 they are said to do by Krafl^t-Ebig, Emminghaus, Skae, 
 Ritchie, Esquirol, Pinel, Deslandes, Maudsley, Smith, Acton, 
 Bell, Ray, Spitzka, and other writers, nor have I ever met 
 with the distressing cases described by Lallemand ; and I 
 fully agree with Sir James Paget' in the statements that 
 " masturbation does neither more nor less harm than sexual 
 intercourse practised with the same frequency in the same 
 conditions of general health, and age, and circumstances," 
 and that the ills which result from it when indulged in by 
 young persons are due more to the "quantity, not the 
 method." Unfortunately, however, it is begun earlier in 
 
 ' Clinical Lectures and Essays, p. 284. 
 
28 ATONIC IMPOTENCE. 
 
 life' than coition ; and, as it does not require the cooperation 
 of the opposite sex, it can be practised to a greater extent, 
 and at all times, and even when erection is incomplete. 
 
 Of the remaining remote causes of atonic impotence, 
 namely, gonorrhoea, toying with females, and sexual ex- 
 cesses, which induce and keep up hypersesthesia and 
 inflammation of the prostatic urethra, it need only be said 
 that they are followed by precisely the same lesions as are 
 met with in masturbation. In his classical writingrs on Dis- 
 eases of the Spinal Cord, Erb" declares that sexual excesses 
 and irregularities occupy a prominent position in the pre- 
 disposition to, and production of, many spinal affections, 
 among which may be mentioned spinal irritation, neur- 
 asthenia, chronic meningitis and myelitis, softening, and 
 inflammation of the anterior horns, or poliomyelitis ; and 
 this view is held by many other distinguished authors, as 
 Rosenthal, Hammond, and Romberg. 
 
 Classification. — Atonic impotence varies in degree, and 
 may be divided into the following classes : 
 
 First. The erection is, as a rule, imperfect and of short 
 duration, and, in two-thirds of the cases, ejaculation is too 
 precipitate, but sexual desire remains, and intercourse is 
 possible, although incomplete. 
 
 Second. The erection is either so feeble that intromission 
 is impossible, or it is entirely absent. As in the preceding 
 form, desire is present. 
 
 ^ Fleischmann, in the Wiener med. Presse, 1878, p. 9, narrates a case in 
 which an infant began to masturbate at nine months of age, by crossing the 
 legs and setting up rocking motions of the pelvis and body ; and Barthez- 
 Rilliet, Marjolin, Von Bambecke, Jacobi, and Morton have recorded examples 
 in young children who were not sucklings. 
 
 ^ Loc. cit., p. 147. 
 
CLINICAL HISTORY. 29 
 
 Third. In the last phase of the affection, not only is there 
 loss of power of erection, but desire is completely abolished. 
 
 Of the relative frequency of these three varieties of im- 
 potence, an examination of the two hundred and forty-eight 
 cases previously alluded to shows that two hundred and ten 
 were examples of feeble erection and premature ejacula- 
 tion ; thirty-one were instances of loss of power of erection, 
 with retention of desire ; and seven were examples of fail- 
 ure of both erection and desire ; so that I have no hesita- 
 tion in declaring- that the first form is more common than 
 impotence from all other causes combined. 
 
 Clinical History. — As my readers will gain a better 
 insight into the peculiarities of the three varieties by a nar- 
 ration of cases than by a general and abstract description, 
 I append some typical examples. 
 
 Case VI. A grocer, twenty-two years of age, consulted me on 
 the 1 2th of October, 1876, on account of impaired erections and 
 premature ejaculation. He began to masturbate at the age of four- 
 teen, and continued the practice for three years. Its abandonment 
 was followed by nocturnal seminal emissions of an intermittent 
 character, that is to say, they recurred almost every night for a 
 fortnight, when there was an intermission of a week's duration. He 
 had been under treatment for two years before coming to me, the 
 effect of which was to improve his general health and materially 
 lessen the frequency of the nocturnal discharges. Up to one year 
 ago he had never had sexual intercourse. At the time he found 
 that erection was incomplete, the gland of the penis, in particular, 
 being soft and inelastic, and that ejaculation took place in a few 
 seconds. The same troubles had existed ever since. During the 
 past two months, nocturnal emissions had occurred from one to five 
 times a week, and he noticed that flakes of mucus, which he sup- 
 posed to be semen, were discharged in advance of the stream of 
 urine. He was easily fatigued, his hand was unsteady in writing. 
 
30 ATONIC IMPOTENCE, 
 
 he was habitually constipated, and he suffered from dull, heavy 
 pains in the groins and back. 
 
 Examination with the bulbous explorer disclosed slight tender- 
 ness of the urethra half an inch from the meatus, and decided ten- 
 derness at four inches and a half, which increased as the prostatic 
 urethra was reached. On withdrawing the instrument, a stricture, 
 calibre lo, was detected at five inches and a quarter from the 
 meatus. The bulb brought out a whitish fluid, which showed, 
 under the microscope, a large amount of pus and epithelium. The 
 urine was acid, and loaded with lithates, but the genital organs 
 were normal. 
 
 I prescribed a laxative pill, to be taken as often as it might be 
 required, warm hip-baths, and warm enemata night and morning, 
 and thirty grains of bromide of potassium every eight hours. The 
 diet was restricted to perfectly bland and digestible articles; sexual 
 intercourse and stimulating drinks were interdicted; and an injec- 
 tion of one drachm of Goulard's extract to ten ounces of water 
 was directed to be thrown into the urethra three times a day. 
 
 On the 14th I passed a No. 10 steel bougie, and continued its 
 introduction every second day until the 26th, when it was employed 
 once every twenty-four hours by the patient himself. At first it 
 was immediately withdrawn, but as the sensibility of the urethra 
 became obtunded, it was permitted to remain longer, but at no 
 time more than five minutes. The size was gradually increased, 
 until toward the close of the treatment it reached No. 27. During 
 the first week there were three nocturnal emissions; but from that 
 time until I discharged the patient, on the 3d of December, when 
 his sexual powers were entirely regained, there was only one. I 
 saw this man again early in January, 1877, on account of a chancre, 
 when he informed me that he had experienced no trouble whatever 
 in sexual congress. 
 
 Case VIL A mechanic, twenty- six years of age, states that he 
 has had intercourse with one woman three or four times every night 
 for the past eighteen months, and that he occasionally fulfilled en- 
 gagements of a similar nature with other females. He had never 
 masturbated much, nor had he ever contracted gonorrhoea. Lately 
 
CLINICAL HISTORY. 31 
 
 he has observed that his powers were growing feeble ; and at 
 present the erections are flabby, and the ejaculations, when pene- 
 tration is possible, are precipitate. He looks pale, is easily fatigued, 
 and suffers from pain in the back, and from frequent and painful 
 micturition. A No. 25 explorer detects a very sensitive urethra, 
 and a stricture seated at six inches from the meatus. The neck 
 of the bladder is so sensitive that it contracts when the instrument 
 comes in contact with it, so that its onward progress is momen- 
 tarily arrested. 
 
 Case VIII, A weaver, thirty-seven years of age, has had gonor- 
 rhoea three times, the last attack having occurred fourteen years 
 ago. For the past three years he has noticed that the erections 
 were becoming more and more feeble, until they frequently passed 
 of before intromission, and coition was always attended with hasty 
 emission. In addition to his sexual troubles, he complains of 
 numbness along the outer side of the left thigh, almost constant 
 dorsal pain, and a dull, heavy pain in the back of the head, the 
 left side of the neck, and the left shoulder, all of which localities 
 now and then suddenly become red and hot. The suffering is 
 aggravated by exercise and continuous work ; his sleep is unre- 
 freshing, and he has dyspeptic symptoms. He has two strictures, 
 the first of which, calibre 17, is located at three inches and a half, 
 and the second, calibre 15, is six inches from the meatus; and the 
 prostatic urethra is morbidly sensitive. 
 
 In the preceding illustrations of >the first variety of atonic 
 impotence, the exciting causes vv^ere chronic hyperaesthesia 
 and inflammation of the prostatic urethra, w^hich were pro- 
 duced, respectively, by masturbation, by sexual excesses, 
 and by gonorrhoea, and were maintained by one or more 
 strictures. One case was complicated by nocturnal emis- 
 sions, and another by inflammation of the neck of the 
 bladder ; and in all there were symptoms of neurasthenia. 
 
 In this form of the affection may be included the condition 
 known as irritable weakness, spasmodic spermatorrhoea, 
 
32 ATONIC IMPOTENCE. 
 
 prospermatism, or spermaspasmos, in which, the erection 
 being more or less complete, ejaculation occurs before 
 penetration, simultaneously with erection, or even before 
 erection. It is most common in men who are much excited 
 on entering upon sexual congress, in pronounced mastur- 
 bators who suffer from nocturnal pollutions, and in subjects 
 of ungratified desire from toying with women. In the lesser 
 grade of the trouble, the ejaculation is premature only on 
 the first attempt at intercourse, the succeeding ones being 
 properly completed. Some of these points are illustrated 
 by the following cases : 
 
 Case IX. A merchant, thirty-seven years of age, had masturbated 
 up to his eighteenth year, and has been in the habit of toying with 
 women ever since. At his first attempt at connection, which took 
 place when he was twenty-nine years old, he found that the erection 
 was imperfect, and that ejaculation occurred before intromission; 
 and he stated that these troubles still continued. There was a 
 stricture, calibre, i8, at six inches from the meatus, and the pros- 
 tatic urethra was exquisitely sensitive. 
 
 Case X. A clerk, thirty years of age, brought me a specimen of 
 urine for examination, which I found to contain an abundance of 
 motionless spermatozoa, oxalate of lime, and a few pus corpuscles 
 and epithelial cells. He never had gonorrhoea, but he had mas- 
 turbated from his sixteenth to his twenty-first year, on an average, 
 twice a day. There was a constant sticky feeling at the meatus, 
 and he informed me that for the past three years, whenever he 
 attempted sexual intercourse, he had an erection, with a simulta- 
 neous emission. The hands and feet were habitually cold, and he 
 had no knowledge of nocturnal emissions for five years. The ex- 
 . plorer detected a stricture, calibre 17, at six inches and a half from 
 the meatus, and there was marked hyperaesthesia of the prostatic, 
 urethra. 
 
CLINICAL HISTORY. 33 
 
 Case XI. A physician, thirty-four years of age, had masturbated 
 from his fifteenth to his seventeenth year, and had contracted gon- 
 orrhoea eleven years ago. For ten years he was unable to have 
 connection, in consequence of ejaculations at the moment of pene- 
 tration ; and for the past three years emission occurred before 
 erection, and he had nocturnal pollutions from two to three times 
 a week. The meatus would admit only a No. 17 explorer; but 
 after its enlargement, a stricture, calibre 25, was discovered at six 
 inches and one-eighth, and the prostatic urethra was very sensitive. 
 
 The subjoined illustrations are good examples of the 
 second variety of impotence, or of that in which desire is 
 retained, but in which the power of erection is lost, and 
 coition is impossible. 
 
 Case XII. A tavern-keeper, thirty-two years of age, of robust 
 frame, stated that he was engaged to be married in six weeks; that 
 he could not command an erection, although he had sexual desires; 
 that the presence of the object of his affections, and the most las- 
 civious books and pictures, which formerly brought on an erection, 
 had lost that effect ; and that the thought of his disability on his 
 wedding-night was constantly preying on his mind. This condi- 
 tion of affairs had existed for five months, during which time he had 
 nocturnal seminal emissions about twice a week. He was, more- 
 over, much alarmed at the presence of some shreds of purulent 
 mucus in his urine, which he thought was seminal fluid. He had 
 three attacks of gonorrhoea, the last of which occurred seven years 
 ago, since which period he has always had a slight gleety dis- 
 charge, and for the past few months a dribbling of a few drops of 
 urine in his clothes after the act of micturition was apparently 
 completed. He suffered from habitual constipation, but in other 
 respects he was the picture of health. 
 
 The bulbous explorer defined two strictures, calibre 23, located, 
 respectively, at six inches, and at six inches and a half, from the 
 external meatus, as well as marked hypersesthesia of the prostatic 
 urethra. 
 
 3 
 
34 ATONIC IMPOTENCE. 
 
 Case XIII. A mechanic, twenty-three years of age, at about his 
 sixteenth year, after having been in the habit of masturbating freely 
 for six or seven years, observed a urethral discharge. He had never 
 had sexual intercourse until he was twenty-one ; and, after a few 
 months of moderate indulgence, the discharge had increased, and 
 the erections had become more and more weak, until he was finally 
 unable to consummate the act, although the desire remained. He 
 is pale ; suffers much from pain in the back, the shoulders, the 
 anus, and the left temporo-maxillary articulation ; and is easily 
 fatigued. 
 
 Examination with a No. 25 explorer disclosed intense hyperaes- 
 thesia of the entire urethra, and particularly of its prostatic portion, 
 but there was no indication of a stricture. As soon as the instru- 
 ment entered the passage it occasioned tremor and retraction of 
 the testes, and when it reached the prostatic portion he shrank 
 from the excessive suffering which it awakened, and the muscles 
 of the lids, nose, and mouth twitched convulsively. On its with- 
 drawal, the bulb brought away a considerable prostatic discharge. 
 He afterwards rode to his house in the street cars, and about two 
 hours later, after urinating, he was seized with a curious crawling 
 sensation in his arms and legs, lost consciousness, and, when found 
 by his friends, was lying on the floor, and his face was livid. Three 
 days subsequently, he was placed upon thirty grains of bromide of 
 potassium, with five drops each of juice of belladonna and tincture 
 of gelsemium, every eight hours, and directed to take ten grains of 
 quinia one hour before his next visit, which occurred one week 
 ago. At that time a conical steel bougie was passed, and one-third 
 of a grain of morphia thrown under the skin. A slight epileptoid 
 paroxysm, as indicated by clonic spasms of the muscles of the 
 arms and eyelids, and a feeling as if he would become unconscious, 
 ensued; and these symptoms were followed by prostration and 
 numbness of both hands. 
 
 In the third phase, or as it is sometimes called the para- 
 lytic form, of the affection, erection and desire are completely 
 abolished, as is illustrated by the following instances : 
 
CLINICAL HISTORY. 35 
 
 Case XIV. A medical student, twenty-four years of age, had 
 masturbated excessively for six years, and for the past two years, 
 during which period he had discontinued the practice, had noc- 
 turnal seminal emissions, on an average, twice a week. When I 
 saw him he stated that he had lost all desire, and had been unable 
 to command an erection for three months. He was very watchful 
 of a gleety discharge, and brought with him, for my inspection, a 
 specimen of urine which contained little threads of mucus, which 
 he imagined to be semen. His general health was broken; his 
 expression was woe-begone ; he was gloomy, shy, and reserved, 
 and unable to fix his attention upon his studies, and easily fatigued. 
 He was constantly thinking of his previous bad habit and the noc- 
 turnal emissions, and was convinced that his condition was beyond 
 relief In a word, he was a victim of sexual hypochondrism. 
 
 The external genital organs, and the prostate and seminal vesi- 
 cles, as far as rectal touch enabled me to form an opinion, were 
 perfectly normal; but the urinary meatus was constantly moist, 
 and its lips were red and pouting. At five inches and three-quar- 
 ters from the meatus I detected a stricture, calibre 17, and also 
 found that the urethra behind it was extremely sensitive. Placing 
 a little of the fluid, which was withdrawn by the explorer, under 
 the microscope, I demonstrated to my patient that it was free from 
 spermatozoa, and I still further endeavored to gain his confidence 
 by assuring him that his disability was temporary, since, from its 
 dependence upon appreciable lesions, it could be cured. Under 
 appropriate treatment, in three weeks, the pollutions had decreased 
 in frequency, the prostatic discharge had lessened in quantity, the 
 hyperaesthesia had notably diminished, and he had begun to have 
 feeble erections. At the expiration of a month I divided the stric- 
 ture, and he went with me to the seashore. In three weeks, or 
 eleven weeks from the commencement of the treatment, he had 
 good erections, and his mental anxiety was calmed, but, unfortu- 
 nately, he desired to test his powers, and had an almost instan- 
 taneous ejaculation with cessation of erection. This act, which he 
 undertook entirely on his own responsibility, undid all the good I 
 had effected ; and it was only after the expiration of eight months 
 that he finally recovered under the employment of galvanism. 
 
86 ATONIC IMPOTENCE. 
 
 Case XV. A druggist, twenty-four years of age, came to me on 
 account of vesical irritability, under which he had labored for six 
 years. He has never had sexual intercourse, but had masturbated 
 from boyhood until his twentieth year, and desire and power of 
 erection had been abolished for nearly four years. The entire 
 urethra and neck of the bladder were excessively sensitive, and a 
 stricture, calibre 17, was detected at six inches and one-fifth from 
 the meatus, which measured thirty-three millimetres in circumfer- 
 ence. The epididymes, but especially the right, were enlarged 
 and indurated. 
 
 In the majority of cases of atonic impotence which I have 
 inserted for the purpose of illustrating the various phases 
 of the affection, in addition to the lesions of the urethra, it 
 will have been perceived that certain subjective symptoms 
 were present, which were indicative of spinal exhaustion, 
 the depressed form of spinal irritation, or neurasthenia. 
 Prominent among these signs are pain in the back, which 
 is increased by exercise, exposure to atmospheric vicissi- 
 tudes, and attempts at coition, and muscular weakness of 
 the limbs, so that the subjects are tired out by compara- 
 tively slight exertions and walking. These symptoms 
 point, to use a term introduced by Beard,' to myelasthenia 
 of the lumbar division of the cord. In a certain number ol 
 examples, as in Case VIII., there is dull, heavy pain in the 
 frontal region, the back of the head, the neck, and shoul- 
 ders, which now and then become flushed, si^ns which are 
 indicative of exhaustion of the upper portion of the cord. In 
 other instances, the symptoms are those of cerebrasthenia, 
 such as impairment of memory, mental debility, depression, 
 anxiety, or irritability, a feeling of fulness in the head, 
 asthenopia, and other disorders of the special senses ; all 
 
 ^ A Practical Treatise on Nervous Exhaustion, 2d ed., p. 106 ; and Medical 
 Record, 1879, vol. i. p. 184. 
 
DIAGNOSIS. 
 
 37 
 
 Fig. I. 
 
 of which are signs of enfeeblement of the functional power 
 of the brain, and which may be readily explained by the 
 commissural connections between the lumbar division of 
 the cord and the higher centres. In other cases, again, the 
 symptoms are variously interwoven ; and 
 in all troubled and un refreshing sleep, a 
 feelinor of heaviness on rising, coldness 
 of the hands and feet, poor appetite, 
 coated tongue, flatulence, a sense of 
 weight in the epigastrium after eating, 
 palpitation of the heart, sick headache, 
 vertigo, and constipation, are very com- 
 mon. In addition to the various phe- 
 nomena of neurasthenia and dyspepsia, 
 nocturnal emissions and prostatorrhoea 
 are frequently met with. 
 
 Diagnosis. — The diag-nosis of atonic 
 impotence is readily made from a con- 
 sideration of the preceding observations. 
 In all cases the urethra should be ex- 
 amined with the view of determining the 
 presence or absence of lesions which 
 induce or maintain the disorder. For 
 this purpose, the exploratory, or acorn- 
 headed, soft bougie, represented in Fig. 
 I, should be resorted to, as it is the only 
 instrument with which granular patches and strictures of 
 large calibre can be accurately defined, and with which 
 morbid discharges can be withdrawn for minute examina- 
 tion. One being selected which fills, without unpleasantly 
 stretching, the meatus, it is well oiled and inserted as far 
 as the bladder. If there be a coarctation, its introduction 
 
 Exploratory bulbous 
 bougie. 
 
88 ATONIC IMPOTENCE. 
 
 will be arrested, when smaller sizes are successively em- 
 ployed, until one will pass without difficulty. On its with- 
 drawal, the abrupt shoulder of the bulb coming in contact 
 with the posterior face of the obstruction imparts to the 
 touch a sensation as if it had jumped over a narrow band, 
 which is as perceptible to the patient as it is to the surgeon, 
 and is very different from the sensation conveyed by spasm. 
 In the latter, the instrument may be grasped for a time, 
 but the muscular contractions soon cease, or may be made 
 to cease by carrying the bulb several times through the 
 obstruction ; while a granular patch gives the impression 
 of a limited roughness of the canal. 
 
 Hyperaesthesia of the urethra is readily detected by the 
 ordinary metallic bougie, catheter, or sound ; and its exist- 
 ence should never be based upon the passage of the soft 
 explorer alone, as the insertion of that instrument is pro- 
 ductive of far more pain than the ordinary nickel-plated 
 bougie. If the surgeon should deem it desirable, he may 
 confirm his diagnosis by a resort to the endoscope, with 
 which Grunfeld' has discovered hypersemia and catarrhal 
 swelling of the verumontanum in cases of impotence, pros- 
 tatorrhoea, and spermatorrhoea. I myself never employ it, 
 nor do I think that any additional information is to be 
 gained from its use. 
 
 In the absence of proper instruments for exploring the 
 urethra, the general practitioner may suspect inflammation 
 and morbid sensibility if there be painful and frequent 
 micturition, painful ejaculation, a feeling of weight in the 
 anorectal region, a gleety discharge, prostatorrhoea, abnor- 
 mal nocturnal emissions, and sensibility of the prostate on 
 pressure with the finger in the rectum. 
 
 ^ Endoskopische Befunde bei Erkrankungen des Samenhiigels. Wien, 1880. 
 
PROGNOSIS. 39 
 
 Prognosis. — The milder forms of impotence are very 
 amenable to treatment, as is illustrated by the following 
 example : 
 
 Case XVI. A carriage-builder, twenty-three years of age, came 
 to me on the 8th of April, 1880, on account of a gleety discharge, 
 which kept the lips of the meatus glued together, and had existed 
 for two years and a half; of a discharge of prostatic fluid at stool; 
 and of nocturnal seminal emissions, which were often as frequent 
 as every night during a single week, now and then occurring to 
 the number of three in a night, and averaging three a week. The 
 erections were feeble, and ejaculation was premature. The bowels 
 were costive, but he had no signs of spinal exhaustion. Examina- 
 tion with a No. 17 explorer disclosed a stricture one-eighth of an 
 inch behind a contracted meatus, and a highly sensitive urethra, 
 especially in its membranous and prostatic divisions. On with- 
 drawing the instrument, a few drops of prostatic fluid came away. 
 I laid open the meatus along with the stricture, and directed a pill 
 composed of two grains of compound extract of colocynth and 
 half a grain of extract of nux vomica at bedtime, along with the 
 one-sixtieth of a grain of atropia in solution, and thirty grains of 
 bromide of potassium every eight hours. The incision was pre- 
 vented from closing by the passage of a No. 30 conical steel bougie, 
 which was carried through the entire urethra every other day. On 
 the 6th of May, the hypersesthesia had almost entirely disappeared ; 
 the gleet had ceased ; there was merely a slight prostatic discharge, 
 if the bowels were allowed to become constipated, but he had not 
 noticed it for several days ; there were nocturnal emissions on the 
 nights of April 17 and 18, and the erections were improving in vigor. 
 The treatment was continued, and a cure was effected in another 
 month. 
 
 This case is not a selected one ; and whenever a patient 
 presents himself who has erections and desire, even if he 
 has a prostatic discharge, or too frequent nocturnal pollu- 
 tions, or is suffering with both of these complications, the 
 
40 ATONIC IMPOTENCE. 
 
 surgeon will be perfectly justifiable in promising relief. In 
 the second variety of the affection, in which desire remains, 
 but in which the erections are so feeble that penetration is 
 impossible, or are entirely absent, it is not uncommon for 
 the man to have an erection and emission under the influ- 
 ence of a voluptuous dream, thereby showing that the 
 sexual instinct is not entirely lost. In such a case as this 
 the prognosis is also favorable, although the patient will 
 have to remain longer under treatment. When both desire 
 and erection are abolished, and the man is suffering from 
 hypochondrism, the outlook is bad, particularly if we cannot 
 gain his confidence, and he is not open to moral treatment. 
 In this class of cases, if there is neither hypochondrism nor 
 neurasthenia, the prognosis is good. In Case XII., which 
 was an example of the latter condition, I divided the stric- 
 tures on the nth of September, and placed the man upon 
 bromide of potassium and tincture of veratrum viride, a 
 laxative pill, as it might be required, warm sitz-baths, and' 
 a restricted diet, and enjoined abstinence from everything 
 which was calculated to excite the genital organs. He 
 married on the 6th of November, having in the meanwhile 
 passed a No. 32 conical steel bougie every twenty-four 
 hours until the tenderness of the prostatic urethra had dis- 
 appeared, and he wrote me five days subsequently that he 
 had had connection every night. I cautioned him against 
 committing such marital excess, lest sexual abuse might 
 cause a relapse. 
 
 The prognosis is not so good when the disorder arises 
 from excessive onanismi commenced early in life by ner- 
 vous, impressible boys. When impotence is developed 
 after the age of forty, the patient should be made to under- 
 stand that his pristine vigor can scarcely be expected to be 
 
TREATMENT. . 41 
 
 restored, since the power to copulate naturally diminishes 
 at that age. 
 
 Treatment. — In the management of atonic impotence, a 
 thorough examination of the genital and associated organs 
 should be made, with a view of getting rid of the causes 
 which produce and maintain it. If the patient has a redun- 
 dant prepuce, it should be removed ; if the meatus be 
 contracted, it should be enlarged ; while herpes of the 
 prepuce and glans, or balanitis, should be treated in the 
 usual way. All of these lesions are capable of setting up 
 hypersesthesia of the prostatic portion of the urethra, or 
 even of exciting reflex impotence without the intervention 
 of prostatic trouble, and their relief is quite sufficient in 
 mild cases to brino- about a cure. The same statement is 
 true of certain diseases of the bladder and rectum, so that 
 these viscera should not be overlooked. 
 
 Atonic impotence usually occurs in robust subjects, in 
 whom inflammation and morbid sensibility of the prostatic 
 portion of the urethra have set in before the signs of myel- 
 asthenia are pronounced, the usual symptom, according 
 to my experience, being pain in the back. Hence the 
 treatment, whether this be local or general, must be of a 
 sedative nature ; and the patient, at the outset, should be 
 impressed with the importance of avoiding all sources of 
 sexual excitement, such as masturbation, attempts at inter- 
 course, dalliance with women, and lascivious thoughts and 
 literature ; and if his sexual propensities are marked, they 
 should be kept under control by mental application and 
 gymnastic exercises. 
 
 Of the local iiieasui'-es to overcome hypersemia, inflamma- 
 tion, and hypersesthesia of the prostatic urethra, not one is 
 so universally applicable as the passage of the nickel-plated 
 
42 
 
 ATONIC IMPOTENCE. 
 
 conical steel bougie represented in Fig. 2. The size of the 
 instrument is to be gauged by that of the meatus, if it be 
 normal, or by that of the stricture, if one be present, and 
 
 Fig. 2. 
 
 Fig. 3. 
 
 Fig. d. 
 
 U 
 
 Conical steel bougie. 
 
 Author's urethral dilator. 
 
 Author's urethrotome. 
 
 its circumference should be gradually increased up to that 
 of the full capacity of the urethra, as indicated by the ure- 
 thrameter. To effect this, however, the meatus will have 
 
TREATMENT. 43 
 
 to be enlarged as a preliminary measure ; or, instead of 
 this, my urethral dilator, represented in Fig. 3, which dis- 
 penses with the operation, may be employed, although it is 
 much less efficacious than the bougie. At first the bougie 
 should be at once withdrawn, and the intervals between 
 the insertions should be seventy-two hours. With the de- 
 crease of the sensibility it should be retained longer, and 
 the intervals of introduction be shortened until it is passed 
 daily. 
 
 If the case is complicated by an irritable or resilient 
 stricture, it should be subjected to internal division from 
 behind forward, as no progress can be made unless the 
 contraction is a simple one. For this purpose, I prefer the 
 instrument devised by myself several years ago, as I have 
 found from ample experience that its simplicity of construc- 
 tion and perfection of action leave nothing to be desired. 
 The essential part of the contrivance is its acorn-headed 
 distal extremity, through which the situation of the coarcta- 
 tion Is accurately determined. To use the exploratory 
 urethrotome, the stricture having been passed, and its pos- 
 terior face having been defined by the projecting shoulder 
 of the bulb, the bulb is carried at least half an inch toward 
 the bladder, as the object is to divide, along with the con 
 traction, the sound tissues to that extent behind and in front 
 of it ; then the blade is protruded, as in Fig. 4, and the 
 parts cut as the instrument is withdrawn, the penis being 
 put upon the stretch to render the urethra tense. In the 
 event of the tissues being thick or resistant, the section 
 may be materially aided by counterpressure with the fingers 
 of the left hand along the median line. The bulb is then 
 used as an explorer to detect any undivided bands, which, 
 if discovered, should be severed, since thorough section of 
 all narrowed points is essential to success. In regard to 
 
44 ATONICIMPOTENCE. 
 
 the subsequent treatment, I need only refer to my views 
 published elsewhere/ as its consideration would be out of 
 place here. 
 
 It now and then happens, as in Case XIII, ^ that the entire 
 urethra is so excessively sensitive that the introduction of 
 the bougie is followed by an epileptoid paroxysm, or that 
 the patient faints. Under the circumstances, it is more 
 judicious to desist from its use until the sensibility of the 
 passage has been obtunded by the injection, every eight 
 hours, of three grains of chloral, and ten grains of bromide 
 of potassium to the ounce of water, and by the internal 
 exhibition, at the same intervals, of thirty grains of the 
 bromide, ten drops of tincture of cannabis indica, and five 
 drops of tincture of gelsemium, and by sitz-baths of water 
 as warm as it can be borne. It will also be wise to throw 
 into the deep urethra, about ten minutes before inserting 
 the bougie, a drachm of a four per cent, solution of cocaine, 
 with the instrument dehneated in Fig. 5, the bulb being 
 passed just beyond the compressor urethrae muscle. 
 
 In many instances it will be found that the inflammation 
 and hyperaesthesia are finally reduced to a small and prob- 
 ably granular, patch, which proves rebellious to the bougie, 
 but which usually disappears under the application of as- 
 tringent remedies. Of these, I prefer a solution of nitrate 
 of silver, carried to the tender spot by a contrivance which 
 is essentially that of Felix Guyon,^ and which, as is shown 
 in Fig. 5, consists of a syringe of the capacity of rather less 
 than a drachm, and of an ordinary bulbous explorer per- 
 forated at the apex of the bulb. The syringe having been 
 
 ^ Gross on the Urinary Organs, 3d ed., p. 480; Med. Record, June 15, 1878, 
 p. 461 ; and Trans. Med. Soc. State of Penna., vol. xii. part i. p. 67. 
 ^ Bull. Gen. de Ther., 1867, p. 501. 
 
TREATMENT. 
 
 45 
 
 charo-ed with ithe solution, and its nozzle attached to the 
 explorer, pressure is made upon the piston, until a drop of 
 the fluid^appears at the small opening. Wiping this off, the 
 oiled instrument is then carried down until the bulb defines 
 
 Fig. 
 
 Syringe and perforated bulbous explorer. 
 
 the inflamed patch — and it does this with the greatest 
 accuracy — when it is slightly withdrawn, and a few drops 
 are deposited in the urethra. The bladder should be 
 evacuated before the application of the instrument, and the 
 
46 
 
 ATONIC IMPOTENCE, 
 
 patient should be kept in bed and use demulcent drinks for 
 a few hours subsequently. With these precautions, the 
 pain and desire to urinate will usually not last more than 
 
 Fic. 7. 
 
 Fig. 6. 
 
 Bulbous nozzle. 
 
 Dick's catheter-syringe. 
 
 thirty minutes, but there will be some scalding during the 
 next act of micturition. When I first adopted this practice, 
 about sixteen years ago, I employed ten grains of the salt 
 to the ounce of distilled water, at intervals of one week ; 
 
TREATMENT. 
 
 47 
 
 but from an extended experience, I now commonly use 
 thirty grains, and repeat the injection every four days. 
 
 As the soft, perforated, bulbous explorers are not easily 
 procured in this country, and as they are liable to wear out, 
 
 Fig. 8. 
 
 Fig. 9. 
 
 Fig. 10. 
 
 S. D. Gross's porte- 
 caustique 
 
 Cupped conical steel 
 bougie. 
 
 Harrison's porte- 
 remede. 
 
 I have had constructed a curved; :hard-rubber attachment 
 for the syringe, which is eight inches long, and which is 
 
48 ATONIC IMPOTENCE. 
 
 provided, as is shown in Fig. 6, with an acorn-shaped head 
 or bulb. This instrument is not quite so good in regard 
 to accuracy of definition of the inflamed patch as the pre- 
 ceding one, but, with that exception, it constitutes the best 
 of the contrivances for the purposes to which it is adapted. 
 
 In the absence of the foregoing instruments, Dick's 
 catheter-syringe, Fig. 7, may be employed ; or the cup 
 attached to the stylet of Gross's porte-caustique, Fig. 8, 
 may be charged with five grains of nitrate of silver to the 
 drachm of ointment of stramonium, which I regard as far 
 preferable to the fused salt, as the latter exerts a destructive 
 action on the mucous membrane unless the cauterization is 
 lightly performed. The glycerole of tannin, applied by 
 means of a sound. Fig. 9, having a cup at the convexity of 
 the curve, just anterior to the shaft, frequently answers a 
 good purpose. The depression filled with the solid mass is 
 kept in contact with the inflamed patch for a few minutes, 
 or until it is melted by the heat of the parts ; but this mode 
 of medication is open to the objection that some of the 
 liquefied paste is deposited along the whole length of the 
 urethra during- the withdrawal of the instrument. 
 
 Another excellent mode of applying astringents is by 
 the deposition of small soluble suppositories of cocoa butter 
 in the affected portion of the urethra by means of the 
 modified porte-remede of Harrison, of Liverpool, shown in 
 Fig. 10. The instrument consists of a metallic catheter, 
 open at the end for the receptiop of the suppository, which 
 is so shaped as to form a bulbous extremity for the instru- 
 ment. The exposed surface is hardened by a layer of 
 spermaceti, so as to prevent its becoming dissolved in 
 passing down the urethra. For ordinary use the supposi- 
 tory may contain a quarter of a grain of nitrate of silver, 
 or two grains of tannin, or half a grain of acetate of lead. 
 
TREATMENT. 49 
 
 When the affection proves to be more obstinate, I have 
 found that flying bHsters, made by penciUing cantharidal 
 collodion first on the one side of the perineal raphe, and, 
 after the surface has healed, on the opposite side, are of 
 the utmost value. The agent should be applied in the 
 morning, as it is liable to prevent sleep, and great care 
 should be taken to avoid vesication of the scrotum and 
 anus. 
 
 Of general remedies, the aphrodisiacs, as cantharides, 
 phosphorus, phosphide of zinc, strychnia, and damiana, are 
 to be studiously avoided, since the parts are to be kept 
 still further at rest by the administration of agents which 
 diminish the reflex excitability of the cord and suspend 
 sexual desires and the power of erection. Of the reme- 
 dies of this class, bromide of potassium is by far the best, 
 as it not only blunts the venereal appetite, but corrects the 
 acidity of the urine, and exerts an anaesthetic influence 
 upon the mucous membrane of the urethra. I am in the 
 habit of administering thirty grains of the salt every eight 
 hours, unless I find that it makes the patient drowsy during 
 the day, when I order a drachm to be taken at bedtime If 
 it is not well borne, as is indicated by physical and mental 
 languor, weakness of the heart, pallor, uncertain gait, acne, 
 and other signs of bromism, its use must be discontinued 
 for a time ; or its cumulative action must be prevented by 
 promoting its excretion by the urine by combining with it a 
 diurectic, as ten grains of nitrate or bitartrate of potassium, 
 as recommended by Rosenthal ;' this combination is far 
 better than that with Fowler's solution, which is devised by 
 Govvers and Bartholow.^ When the patient is anaemic, I 
 prefer to administer a drachm at night, and give him three 
 
 ' Wiener Klinik, May, 1880, p. 159. 
 ^ Materia Medica and Therapeutics, 3d ed., p. 406. 
 4 
 
50 ATONICIMPOTENCE. 
 
 grains of quinine along with twenty-five drops of the tinc- 
 ture of the chloride of iron three times during the day. 
 My own empirical observations in regard to the value of 
 quinine in decreasing the depression produced by the 
 bromides in asthenic subjects have been confirmed by Dr. 
 Landon Carter Gray,' who has shown that it not only 
 increases the sedative effects of the latter, but that it 
 diminishes or dispels bromism. 
 
 When the patient is robust and plethoric, I frequently 
 add to each dose of the bromide ten drops of the tincture 
 of veratrum viride or tincture of gelsemium ; or the 
 bromide may be given in half an ounce of the infusion of 
 digitalis ; and I have every reason to be pleased with the 
 action of the combinations. Instead of the bromide of 
 potassium, the monobromide of camphor may be employed 
 to the extent of about twelve grains in the twenty-four 
 hours, but its effects are not so striking as those of the 
 former remedy. 
 
 When the penis is cold and rigid, atropia is indicated to 
 overcome the contraction of the muscular fibres of the 
 trabeculae of the erectile bodies, and to induce the dilata- 
 tion of the arterioles and an increased flow of blood through 
 the organ ; and its good effects are also evinced by the 
 diminution of the number or the entire cessation of the 
 nocturnal emissions and prostatic discharges which fre- 
 quently complicate the affection. One-sixtieth of a grain 
 in solution should be administered on risino- ; and when its 
 peculiar action is denoted by dryness of the mouth, thirst, 
 dilatation of the pupils, and slight confusion of vision, that 
 quantity should be taken on retiring, so that the patient 
 may sleep through its disagreeable effects. 
 
 ' Archives of Medicine, October, 1880, p. 191. 
 
TREATMENT. 51 
 
 Of the remaining anaphrodisiacs, which have been 
 recommended in the management of impotence, camphor 
 and lupuhne cannot be rehed upon ; while arsenic evinces 
 its depressing action on the sexual functions only when 
 administered in such large doses as to occasion objection- 
 able disorders of the circulatory, digestive, and nervous 
 systems. 
 
 Among the accessory measures I know of "none that is 
 more grateful to the patient, and more relaxing and soothing 
 to the irritable organs, than a sitz-bath at a temperature of 
 about 95° F., taken for fifteen minutes every morning and 
 evening. In the absence of facilities for bathing, a sponge 
 dipped in water at a temperature of about ioo° F. may be 
 applied to the perineum and the back. Cold baths, which 
 are recommended by many authors, are to be studiously 
 avoided, as they aggravate the local troubles. 
 
 In a large proportion of cases the bowels are habitually 
 constipated. They should be kept in a soluble condition, 
 particular attention being paid to the rectum. For this 
 purpose, tepid water may be injected every morning, as it 
 has the additional advantage of soothing the hypersesthetic 
 prostatic urethra. If enemata do not answer the purpose, 
 and if there is atony of the muscular coat of the intestines, 
 a pill composed of one-twelfth of a grain of aloin, one-sixth 
 of a grain of extract of nux vomica, and one-fourth of a 
 grain of extract of hyoscyamus may be administered after 
 each meal; or a wineglass of Hunyadi or Friedrichshall 
 water, or two drachms of equal parts of Epsom and 
 Rochelle salt, may be ordered every morning. 
 
 Any special dyspeptic symptoms are to be met by 
 appropriate remedies. The diet should be nutritious 
 and digestible, but unstimulating; and coffee, malt, and 
 alcoholic Hquors must be eschewed, and the last daily 
 
52 A T O N I C I M P O T E N C E , 
 
 meal should be light. The patient should sleep on a hard 
 mattress, use only the lightest coverings, and empty his 
 bladder thoroughly on retiring, and early in the morning if 
 a more or less complete erection indicates fulness of that 
 viscus. He is, moreover, to be warned against horseback 
 exercise and driving over rough streets, and all other forms 
 of amusement which tend to produce hyperaemia of the 
 genitalia, as* well as against bodily and mental fatigue if the 
 signs of spinal and cerebral neurasthenia be marked. 
 
 Up to this point, the treatment, both local and general, 
 has been addressed to relieving the inflammation and hy- 
 peraesthesia of the prostatic portion of the urethra. When 
 this has been accomplished, abundant observation has • 
 convinced me that nothing more, as a rule, is required. 
 Cases, however, do occur in which, after the local lesions 
 have been cured, the irritability of the genital centre is still 
 so exhausted that the erections are not sufficiently vigorous, 
 and the ejaculations are premature. Under these circum- 
 stances, as well as in the rarer form of atonic impotence, 
 in which the prostatic urethra is devoid of lesions, but in 
 which a stricture, if one be present, will require preliminary 
 treatment, the object is to restore the sexual powers to 
 their normal condition by remedies which tone up the sys- 
 tem at large and excite the reflex activity of the genito- 
 spinal centre. An excellent combination is twenty-five 
 drops of the tincture of the chloride of iron, ten drops of 
 tincture of nux vomica, and two grains of quinia, to be 
 taken before meals in a wiheglassful of sweetened water, 
 which may be replaced by the syrup of the phosphate of 
 iron, quinia, and strA^chnia, in teaspoonful doses, or by the 
 following combination, which is probably more efficacious 
 than either of the preceding ones : 
 
TREATMENT. 53- 
 
 R. — Ouinise sulph., 
 
 Ferri sulph., aa ^ij ; 
 
 Zinci phosphidi, gr. ij ; 
 
 Strychnia sulph., gr. 2^. 
 M.— Ft. pil. no. xl. 
 S. — Two pills every eight hours. 
 
 The fluid extract of damiana, in doses of from two to 
 four drachms every eight hours, is said by Caldwell,' of 
 Baltimore, to be a capital tonic to the nervous centres 
 which preside over erection, and his observations are con- 
 firmed by Edwards,^ of Richmond. 
 
 Among the tonic agents cold sitz-baths and cold applica- 
 tions to the lumbar regfion for about ten minutes hold a 
 high position. At the commencement it will be wise to 
 employ water at a temperature of 60° F., and gradually to 
 lower the temperature until it is finally reduced to 46° F. 
 The efficiency of the remedy will be heightened by gently 
 projecting a stream of cold water against the perineum 
 and back ; and one of my patients informs me that he has 
 derived the best results from douches of moderate volume 
 after emerging from a Turkish bath. To promote reaction 
 and increase the flow of blood to the lower divisions of the 
 spinal cord and the genitalia, the parts should be briskly 
 rubbed after they are dry with a moderately coarse towel 
 or with a flesh-brush. 
 
 Cold may be applied directly to the prostatic portion of 
 the urethra by means of the cooling sound or psychrophor 
 of Winternitz,^ represented in Fig. 11, which is nothing 
 more than a double current eyeless catheter closed at its 
 beak. To the proximal extremities of this rubber tubes 
 are attached, through one of which the fluid flows into, and 
 
 ' Virginia Med. Journal, 1879, P- 444- ^ Ibid., p. 716. 
 
 3 Ziemssen's Hdbch. der AUg. Ther., Bd. 11, Theil 3, 1881, p. 238. 
 
54 
 
 ATONIC IMPOTENCE. 
 
 Fig. II. 
 
 through the other out of, the instrument. The former, pro- 
 vided with a stopcock, is connected with a rubber bag sus- 
 pended a few feet above the patient, while the latter is 
 
 received in an empty vessel placed at 
 the patient's feet. At the outset, the 
 temperature should be about 57° F., 
 and be gradually reduced to 52° F., 
 and the sittings be lengthened from 
 five to ten minutes. The device has 
 been found to be the most beneficial 
 when the ejaculations are too pre- 
 cipitate. 
 
 Galvanism very deservedly enjoys a 
 high reputation in the treatment of 
 impotence. Not only are the electro- 
 tonic effects of the constant current 
 valuable in increasing the excitability 
 of the genito-spinal centre, but gal- 
 vanization is far more serviceable in 
 restoring the tonicity of the arterioles 
 of the erectile tissues of the penis, 
 and in increasingf the amount of blood 
 flowing in them, than are the measures 
 to which I have just alluded. Although 
 the dose of the current cannot be ac- 
 curately prescribed by the number of 
 elements of the battery, the quantity 
 generated by from fifteen to twenty 
 cells will, as a rule, be found to answer the purpose. The 
 anode, or positive electrode, which should be of large size, 
 is placed over the lumbar spine, and the cathode carried 
 over the gland and back of the penis, the cords, testes, and 
 perineum. The sittings at first should be limited to two or 
 
 I 
 
 Winternitz's psychrophor. 
 
TREATMENT. 55 
 
 three minutes every forty-eight hours ; but they may soon 
 be lengthened to five minutes daily. In obstinate cases, 
 particularly if they are complicated by prostatic or seminal 
 discharges, an insulated catheter negative electrode may 
 be passed down to the prostatic urethra, while the anode 
 is applied to the back, groin, or perineum, or it may be 
 replaced by the rectal reophore. Great caution must, 
 however, be observed in the employment of the urethral 
 electrode, lest it awaken inflammation of the urethra, or 
 neuralgia of the testis or cord, or even induce suppuration 
 of the testis, as I have known to happen in one instance 
 from the use of too strong- a current. In all cases it will 
 be wise for the operator to begin with from three to five 
 cells, and to test the current by passing it through his own 
 temples, and cautiously to increase the number of elements 
 to fifteen,^ if pain is not excited. In the third or paralytic 
 variety of the affection, or in the other varieties, if galvanism 
 does not bring about the desired result, faradization of the 
 erector muscles of the penis and the accelerator muscle of 
 the urine is frequently highly serviceable. If this method 
 fails, the interrupted current may be passed through one 
 reophore in the urethra to the other, placed on the peri- 
 neum and the genitalia, or inserted in the rectum ; while 
 some cases will improve more rapidly if local faradization 
 and galvanization of the cord are employed on alternate 
 days. When the skin of the penis is deficient in sensibility, 
 the electrical brush is indicated. Central pfalvanization^ and 
 general faradization are beneficial when the symptoms are 
 those of cerebral and spinal exhaustion. 
 
 In addition to the foregoing measures, a change of air, 
 
 ' Althaus, Medical Electricity, 3d ed., p. 671. 
 
 ^ Beard and Rockwell, Med. and Surg. Uses of Electricity, 3d ed., p. 376. 
 
56 ATONIC IMPOTENCE. 
 
 travel, exercise, amusement, sea-bathing, good food, and a 
 glass of generous wine will do much to give' tone to the 
 parts, and the system at large. 
 
 The end having been accomplished, it remains to put the 
 patient on his guard against marital excess, for unless he 
 practises moderation he is liable to a relapse. In a large 
 proportion of cases the trouble is met with in young men 
 who are eneaeed to be married. Under these circum- 
 stances matrimony should not be delayed, as regular and 
 temperate intercourse tends to promote sexual quietude. 
 When marriage is not contemplated, the patient should lead 
 a continent life, and avoid all sources of sexual excitability. 
 
 B.— ATONIC IMPOTENCE WITHOUT HYPERESTHESIA OF THE 
 PROSTATIC URETHRA. 
 
 Imperfect or deficient erection may arise independently 
 of any lesion of the prostatic portion of the urethra in 
 persons of nervous or sensitive temperaments, a class of 
 subjects in whom diminished reflex excitability of the lumbar 
 genital centre appears to be induced before prostatic in- 
 flammation has had time to declare itself In the preceding 
 form of impotence the patients are, as a rule, robust and 
 strong, and inflammation and hyperaesthesia of the deep 
 urethra are set up before the functions of the genital centre 
 have been much impaired. 
 
 Of the twelve cases that have come under my notice, 
 eight were due to excessive masturbation, two to gonor- 
 rhoea and masturbation, and two to gonorrhoea alone. In 
 nine a stricture was detected, while three were free from 
 that complication, and the prostatic portion of the urethra 
 was not morbidly sensitive in a single one. In eight of the 
 
PSYCHICAL IMPOTENCE. 57 
 
 cases the erections were feeble, and the ejaculations were 
 precipitate ; and in four intercourse was impossible, 
 although desire was retained. 
 
 The treatment of this variety of atonic impotence is the 
 same as that directed for the preceding form after the 
 hyperaesthesia has been remedied. 
 
 Sect. III. Psychical Impotence, 
 
 Impotence from the restraining or inhibitory control of 
 the brain over the genito-spinal centre is infinitely less com- 
 mon than the preceding variety ; but that erection may fail 
 or cease under the influence of excitement, depressing or 
 other emotions, or mental preoccupation, is a fact with 
 which ever)^ one is familiar. Thus newly married men, who 
 were previously potent, and had never indulged in sexual 
 or unnatural excesses, are liable to be troubled in this 
 way, the undue stimulation of the passions at their first 
 efforts at coition having the effect of causing the erection 
 to cease before the act is completed, or of rendering it so 
 feeble that penetration is impossible, or of precipitating 
 emission, or of preventing erection altogether. Grimaud 
 de Caux^ relates the case of a mathematician in whom 
 erection failed before emission, because his thoughts wan- 
 dered toward the solution of an abstruse problem. Onimus 
 and Legros^ refer to a young man who remained impotent 
 
 ' Physiologic de I'Espece, p. 341. 
 
 '■^ Traite d'Electricile Medicale, p. 215. 
 
58 P S Y C H I C A L I M P O T E N C E . 
 
 for years after having been surprised at the moment of 
 connection by the husband ; and Roubaud' met with a man 
 who had been unable to command an erection during the 
 six months following a railway accident in which he was 
 terribly frightened. The death of a beloved child or wife, 
 as in the cases of Roubaud' and Ultzmann,-' may occasion 
 temporary impotence ; and the loss of a large sum of 
 moneys or the drawing of a prize in a lottery'^ may bring 
 about the same result. In other cases, the impotence is, in 
 regard to certain women, due to indifterence, repugnance, 
 or a suspicion of inhdelit}". 
 
 Impotence is very frequently entirely imaginar}^ or mental, 
 although it is based upon existing lesions. Thus too small 
 a penis, occasional nocturnal seminal losses, stricture of 
 the urethra, a tight prepuce, varicocele, a gleety discharge, 
 or irritability or neuralgia of the testis, not infrequently re- 
 strain erection through fear of inability to penetrate, or of 
 increasing the pollutions, or of impossibility of ejaculating, 
 or of aggravating the local troubles. The same statement 
 is true of moderate masturbators, who probably have nor- 
 mal nocturnal emissions which they assume to be or have 
 been informed are indicative of a diseased condition, and 
 who seem to regard impotence as a heritage of their vice. 
 In not one of these conditions is there any valid reason for 
 the trouble, but it has been ignorantly brought on by the 
 constant thought that impotence was the natural result of 
 the supposed infirmities. 
 
 I have alreadv alluded to the fact that vounsf husbands, 
 in their eagerness to consummate the rite, not infrequently 
 
 ^ Traite de I'lmpuissance et de la Sterilite, t. i. p. iS6. 
 
 ^ Op. cit., p. 433. 
 
 ^ Wiener Klinik, May and June, 1879, p. 131. 
 
 * Ibid. ^ Roubaud, op. rit., p. 186. 
 
ETIOLOGY. 59 
 
 fail ; and I fancy that there are few men who did not ejacu- 
 late prematurely when they had connection for the first 
 time. In such cases, the repetition of the act soon corrects 
 the trouble. Most writers on impotence, however, teach 
 that it is not uncommon for newly married men to be 
 baffled, simply because they are afraid that they cannot 
 accomplish the act properly, or because the mortification 
 which results from the unfortunate attempt gives rise to so 
 much distress and anxiety in regard to its recurrence that 
 the otherwise healthy subjects are really rendered impotent. 
 I am no believer in this doctrine, which is, as a rule, as false 
 in fact as it is pernicious in regard to the treatment which 
 such cases demand ; but I do believe that this condition 
 arises from overlooked lesions of the prostatic urethra which 
 were induced, as a rule, by masturbation. An examination 
 of the views of writers on this subject, as, for example, \'an 
 Buren and Keyes,' Curschmann,^ Rosenthal, -^ and Ultz- 
 mann,"* will show that nervous or psychical impotence is 
 usually met with in masturbators, subjects who are always 
 more or less timid as to their virile powers, and many of 
 whom are incapable of normal sexual excitement. Instead 
 of accepting the statements of these patients, that their 
 failure was due to normal impetuosit)', timidity, or want of 
 self-confidence, it will be wise for the surgeon to explore 
 the urethra, since, as I have already indicated, onanism is 
 the most fruitful source of inflammation and hypersesthesia 
 of the prostatic portion of the urethra, a view in which I 
 am sustained by Rosenthal, Ultzmann, Black,- Acton, '^ and 
 
 ' Genito-Urinary Diseases, with Sypliilis, p. 453. 
 
 ■' Ziemssen's CyclopEedia, vol. viii. p. 892. 
 
 ^ Wiener Klinik, IMay, 1880, p. 137. * Ibid., May and June, 1879, P- I3°- 
 
 ^ On the Functional Diseases of the Renal, Urinary, and Reproductive 
 Organs. Philada., 1S72, pp. 229 and 269. 
 
 ® The Functions and Disorders of the Reproductive Oreans. 2d Amer. 
 ed., pp. 91 and 240. 
 
60 PSYCHICAL IMPOTENCE. 
 
 nearly all surgical authors. Hence, the failure to copulate 
 in this class of patients is due to diminished reflex irrita- 
 bility of the centre for erection, although it is possible that 
 undue excitement or timidity may aggravate that condition 
 by exerting an inhibitory influence over the centre. Such 
 cases should, therefore, be relegated to the preceding or 
 atonic variety of impotence. 
 
 The only cases of psychical impotence that I have ever 
 met with are the following : 
 
 Case XVII. A widower, fifty^-two years of age, was engaged to 
 be married, and, despite the fact that he had erections in the pres- 
 ence of the object of his affection, he was so fearful that he would 
 disgrace himself on the night of his wedding, that he made the 
 experiment with another woman, and utterly failed. As a conse- 
 quence of this unfortunate test, he constantly brooded over his 
 imaginary trouble, for which he sought my opinion. I found that 
 his genital organs and prostatic urethra were perfectly normal, and 
 succeeded in obtaining his confidence by assuring him that I had 
 met with many cases of a similar nature, and that they had always 
 yielded readily to teaspoonful doses of fluid extract of damiana 
 taken every eight hours for three days before marriage. As a re- 
 sult of this ruse, he subsequently wrote me that the remedy had 
 acted like a charm. 
 
 Case XVIII. A clerk, twenty-six years of age, married two 
 days, on consummating his matrimonial engagement, had a feeble 
 erection with a precipitate emission. He never had gonorrhoea, 
 but masturbated at an early age, and, on ceasing the practice, was 
 troubled with nocturnal pollutions. The urethra and genital organs 
 were absolutely sound, and the difficulty arose simply from fear 
 that he could not accomplish the act properly. 
 
 The following would have been classified as cases of 
 psychical impotence by physicians who are not in the habit 
 of exploring the urethra in this and allied aflections : 
 
ETIOLOGY. 61 
 
 Case. XIX. A merchant, twenty-eight years of age, stated that 
 he was suffering from spermatorrhoea, which had so weakened his 
 powers that, on attempting intercourse four years previously, the 
 erection was so feeble that it passed off before the completion of 
 the act. He had not renewed the effort, as he was convinced that 
 he was permanently impotent. I found that the so-called sperma- 
 torrhoea consisted in an intermittent discharge of prostatic fluid at 
 stool, and in an occasional nocturnal emission. A stricture, 
 calibre 25, was detected at six inches from the meatus, the pros- 
 tatic urethra was excessively sensitive, and the man had almost 
 constant pain in the back. 
 
 Case XX. A lumberman, thirty years of age, consulted me 
 on account of impotence, which he ascribed to undue size of his 
 penis, as he found that on his first connection intromission was 
 difficult, and ejaculation was precipitate and painful ; and that on 
 several subsequent efforts the erections did not come up to the 
 proper standard. He had abstained from intercourse for about 
 thirty months, as he was convinced that the trouble arose from the 
 size of the organ, He suffered from pain in the back, and weak- 
 ness of vision, and informed me that he had masturbated from his 
 fifteenth to his twenty-seventh year. There was a stricture, calibre 
 18, at six inches and a quarter from the meatus, and the prostatic 
 urethra was morbidly sensitive. 
 
 Case XXI. A commercial traveller, thirty-six years of age, 
 complains that he has been married for four days, but that he has 
 been unable to consummate the rite, in consequence of the impos- 
 sibility of intromission from insufficient erections. He has never 
 had gonorrhoea, nor did he masturbate much in his youth ; but 
 during his engagement, which preceded his marriage by seven 
 months, his genitalia were kept in a constant state of excitement 
 by fondling the object of his affection, and he did not have illicit 
 intercourse to relieve his passions. The entire urethra was ex- 
 quisitely sensitive ; but there was no evidence of a coarctation. 
 
62 PSYCHICAL IMPOTENCE. 
 
 In the first two of the foregoing cases an inexperienced 
 observer might readily have assumed that the trouble de- 
 pended upon brooding over conditions which the patients 
 thought had prevented natural copulation ; and he might 
 have ascribed the failure of erections in the third case to 
 congenital deficiency, a variety of impotence which is de- 
 scribed by certain authors, when the causes are inexplicable. 
 In all of these examples, however, the failure of the first 
 attempts was due to debility of the genital centre, a lesion 
 of which the men were naturally entirely ignorant. 
 
 I have dwelt somewhat at length upon the erroneous 
 diagnosis which is usually made in cases of so-called psy- 
 chical or nervous impotence, in order that I might call atten- 
 tion prominently to the importance of examining the 
 urethra in all examples of impotence, since the prognosis 
 is far more favorable when the trouble depends upon hyper- 
 aesthesia of its prostatic portion than when that condition is 
 absent. Had this precaution been observed by many 
 writers on the subject, they would have been able to give a 
 less gloomy account of psychical impotence, and have said 
 less of the importance of gaining the patient's confidence, 
 and of the moral treatment adapted to each case. 
 
 Treatment. — In the management of psychical impotence 
 from undue sexual excitement or emotional causes, little 
 need be done, except to administer a placebo, with the 
 assurance that it will afford relief, since such cases usually 
 remedy themselves. In the case of Grimaud de Caux, the 
 wife resorted to the strategem of slightly intoxicating the 
 husband before connection, through which he was rendered 
 capable of procreating. 
 
 In the variety of mental impotence in which an existing 
 lesion has thoroughly impressed the patient with the belief 
 
SYMPTOMATIC IMPOTENCE. 63 
 
 that it is the source of his trouble, the treatment usually 
 advised, namely, to gain the man's confidence, is not easily 
 carried out. Such patients are very watchful of themselves 
 and of their physicians, and it is useless to try to convince 
 them that a varicocele, for example, is productive of no 
 harm, so far as the sexual functions are concerned, or that 
 the involuntary emissions are strictly within the limits of 
 health. Hence, it is far better to agree with them that 
 their imaginary infirmities demand treatment, to assure them 
 that they are capable of relief, and above all to institute the 
 treatment laid down in surgical works, as it will be found 
 that they are more or less familiar with the various maladies 
 of which they complain. A tight or redundant prepuce 
 should, therefore, be removed, and the introduction of 
 bougies, or local galvanization or faradization, or other 
 measures be resorted to, along with a bitter tonic, and a 
 systematic regulation of the diet, bathing, and exercise. 
 The mind is open to persuasion in this way, but not by 
 mere assurances, or by making light of the fancied dis- 
 order. If the subject is contemplating matrimony, he should 
 be advised to fulfil his engagement ; and a placebo, such as 
 a minute quantity of phosphorus, or a drachm of the tinc- 
 ture of damiana, of the presumed virtues of which he will 
 have some knowledge, should be administered at stated 
 intervals for a few days previously. 
 
 Sect. IV. Symptomatic Impotence. 
 
 Sexual power is now and then greatly impaired, if not 
 absolutely destroyed, by the prolonged use of certain cere- 
 bral sedatives, as opium, morphia, chloral, bromide of 
 
64 SYMPTOMATIC IMPOTENCE. 
 
 potassium, and alcohol, as well as of cerebral excitants, as 
 cannabis indica, and by the administration of or exposure 
 to arsenic, antimony, lead, sulphide of carbon, and iodine. 
 All of these agents are capable of exerting a harmful influ- 
 ence upon the entire organism, but particularly upon the 
 nervous system and the genital organs, when pushed to an 
 undue extent. 
 
 The anaphrodisiac action of chloral, of bromide of potas- 
 sium, and of spirituous and malt liquors is too well known 
 to require illustration. Rosenthal' has recorded two cases 
 of impotence and azoospermism from the hypodermic in- 
 jection of several grains of morphia daily ; and Siredey^ 
 states that the habitual use of hashish by the Orientals in- 
 duces absolute impotence early in life. Biett,^ Charcot,'^ 
 Rosenthal.^ Rayer,^ and Lewin'' have observed that sexual 
 vigor diminishes and finally ceases with the increase of the 
 dose of arsenic in the treatment of diseases of the skin ; 
 and Rosenthal observed the same effect in a merchant who 
 resided in a room covered with arsenical paper. Lohmerer' 
 witnessed impotence in four men who were exposed to the 
 fumes of antimony ; and the absorption of the vapor of 
 sulphide of carbon by workmen engaged in the manufacture 
 of vulcanized caoutchouc is said by Delpech'° to be followed 
 by loss of virility. Lead poisoning may cause temporary 
 impotence, as in the cases recorded by Siredey," Portal,'^ 
 Roubaud,'3 and Rosenthal ;"^ and Bartholow'^ thinks that 
 
 1 Wiener Klinik, May, 1880, p. 149. 
 
 ^ Diet, de Med. et de Chir. Prat., t. xviii. p. 456. ^ Ibid. 
 
 * Bull, de Ther., Jan. 1864, p. 529. '" Loc. cit., p. 151. 
 
 ^ Ibid. ^ Berl. klin. Wochenschrift, No. 17, 1884, p. 268. 
 
 ^ Ibid., p. 152. 9 Orfila, Traite de Toxicologic, t. i. p. 650. 
 
 1" Diet, de Med. et de Chir. Prat., t. xviii. p. 456. 
 
 '^ Ibid., p. 455. 12 Cours d'Anat. Med., t. v. p. 434. 
 
 '^ Op. eit., p. 303. '* Loe. cit., p. 153. 
 
 ^^ Materia Medica and Therapeutics, 3d ed., p. 189. 
 
PROGNOSIS AND TREATMENT. 65 
 
 the prolong-ed use of the iodides has resulted in permanent 
 loss of the sexual power. 
 
 Impotence is not an uncommon secondary effect of inju- 
 ries of the brain and spinal cord ; and it may also be symp- 
 tomatic of various functional disorders and of acute and 
 chronic affections, but particularly of the nervous, digestive, 
 and urinary systems, as brain worry, spinal irritation and 
 weakness, spinal meningitis and myelitis, locomotor ataxia, 
 progressive muscular atrophy, dyspepsia, saccharine dia- 
 betes, and albuminuria. I have myself met with a case in 
 a young man in which failure of erections was one of the 
 earliest signs of diabetes, although the quantity of sugar in 
 the urine was small, and the general powers of the system 
 were not reduced. The grade of impotence in that affec- 
 tion, as Seegen' has demonstrated, is not dependent upon 
 the amount of sugar excreted, as virility may not be im- 
 paired when the quantity is large. 
 
 In the preceding affections, the form of impotence gener- 
 ally met with is the so-called irritable weakness, or the 
 condition characterized by feeble erections and hasty ejacu- 
 lations, which is soon followed by complete loss of erections 
 with abolition of the sexual appetite. 
 
 Prognosis and Treatment. — When impotence arises 
 from the excessive use of remedial agents, from saturation 
 of the system with arsenic, lead, or other toxic substances, 
 and from certain chronic disorders, the power of erection 
 usually returns with the improvement in the sj^mptoms ; 
 but when it depends upon injuries of the cerebro-spinal 
 axis the outlook is unfavorable. When all signs of inflam- 
 mation have subsided after disease or injury of the cord, 
 
 ^ Der Diabetes Mellitus, p. 112. 
 5 
 
66 ORGANIC IMPOTENCE. 
 
 and, in other cases, if the erections are insufficient after 
 the cure of the original trouble, tonics, with a few drops of 
 tincture of cantharides, or minute doses of phosphide of 
 zinc, along with cold douches and galvanization of the 
 spinal cord and testes, are indicated. 
 
 Sect. V. Organic Impotence. 
 
 The power of sexual intercourse may be temporarily or 
 permanently abolished in consequence of certain congenital 
 or acquired malformations, injuries, or diseases of the ex- 
 ternal genital organs, through which penetration is rendered 
 impossible, or in which the loss of erection depends upon 
 arrested secretory activity of the testes. 
 
 A.— i:\IPOTENCE FROM ABNORMAL CONDITIONS OF THE PENIS. 
 
 «• The malformations of the penis which prevent coition 
 are complete absence, a rudimentary condition, or division 
 of the organ, of which vices of conformation, examples 
 have been recorded, respectively, by Goschler,' Fodere,^ and 
 Forster,^ A double penis, as in the case observed by Van 
 Buren and Keyes,'* may prevent intromission ; but in the 
 Portuguese, nineteen years of age, of whom Hart^ gives a 
 full account, there was considerable virile power, and the 
 left organ was used in coition. 
 
 * Prajer Vierteljahrschrift, 1859, ^^- ^''- P- 89. 
 2 Medecine Legale, t. i. p. 360. 
 
 ^ Klebs, Hdbch. der Path. Anat., p. 1132. * Op. cit., p. 5. 
 
 * Lancet, 1865, vol. ii. p. 124. 
 
ETIOLOGY. 
 
 67 
 
 ^- Variatio7ts in the size of the penis are causes of rela- 
 tive impotence. In the case of Roubaud,' in which the organ 
 was only two inches long and of the circumference of the 
 quill of the porcupine, its volume was increased and inter- 
 course rendered practicable by a mechanical contrivance ; 
 while in the case of Wilson,^ in which, at the age of twenty- 
 six, the penis and testes were scarcely larger than those of 
 a boy of eight years, the organs acquired the usual size in 
 twenty-four months after marriage. Nothing can be done 
 for the stunted penis which is associated with exstrophy of 
 the bladder. The organ may also be unfitted for use by 
 being partially or completely buried or concealed in a large 
 scrotal hernia, hydrocele, or elephantiasis of the scrotum, 
 from which it may be freed by appropriate operatfons, or by 
 the application of a truss if the hernia be reducible. Ex- 
 treme size of the penis may also involve relative incapacity 
 for intercourse ; and inordinate bulk from elephantiasis or 
 morbid growths of the prepuce, gland, or body of the organ, 
 or from urethral or preputial calculi, may prevent penetra- 
 tion. In these lesions the prognosis is usually favorable, 
 even if the operations for their relief necessitate the re- 
 moval of the entire gland. Loss of the penis through 
 disease or through design is irremediable. 
 
 y- Adhesion of the penis to the scrotum, the penis palme of 
 the French writers, in which the former is tied down by its 
 under surface to the latter, and is frequently incurvated, is 
 a rare cause of impotence, but is remediable. In the more 
 simple form of the affection liberation of the organ may be 
 effected by division of the web of skin. When, on the 
 other hand, the union is more considerable, and the penis 
 
 ^ Op. cit., t. i. p. i6o. 
 
 ' Lectures on the Urinary and Genital Organs, p. 424. 
 
ORGANIC IMPOTENCE. 
 
 is cur\^ed downwards, the combined operation of Weir' and 
 Bouisson^ holds forth excellent prospects for a good result, 
 and is described by the former surgeon in the following- 
 terms : "An incision was made on each side of the scrotum 
 sufficiently free from the body of the penis to afford skin 
 enough to cover the under surface when released, and the 
 flaps were dissected up to the penis. This constituted the 
 first step of the operation. The second consisted in sepa- 
 rating the urethra, with the corpus spongiosum, from the 
 corpora cavernosa as far back as the posterior margin of 
 the scrotum. This required but a few cuts of the scissors, 
 as the band was only about one inch and a half long, and 
 produced no effect upon the curvature of the penis. On 
 stretching out the curved organ, the septum between the 
 corpora cavernosa could be easily felt as a tense, thickened 
 band, and its division constituted the third step in the 
 operation. It was accomplished by a tenotomy knife, intro- 
 duced, however, not so far as described by Bouisson, and 
 cutting freely the septum in its lower part and half way 
 between the grlans and the scrotum. Immediatelv after this 
 section was made, the curve was readily abolished, and the 
 deformit}^ thoroughly overcome. The transverse incision 
 made involved, however, the tissues of both corpora caver- 
 nosa, and gave rise to persistent and troublesome oozing 
 of blood, only arrested by a ligature placed around an acu- 
 pressure needle. The skin flaps were then united by a 
 suture on the under surface of the penis, and the gaping 
 edges of the scrotal wound brought together without ten- 
 sion ; having, how^ever, first secured the mucous membrane 
 of the urethra by fine sutures to the integument at the 
 
 ^ New York Med. Journ., vol. xix. p. 281. 
 
 * De I'Hypospadias et de son Trait. Chir., t. ii. p. 536. 
 
ETIOLOGY. 69 
 
 posterior angle of the wound, that is to say, at the junction 
 of the scrotum with the perineum. The penis was laid 
 against the abdomen, without need of a retaining bandage, 
 and cold-water dressings were applied to the parts." 
 
 ^- Distortion of the penis may prevent copulation, and 
 may be due to congenital or acquired affections of the 
 corpus spongiosum or the corpora cavernosa. 
 
 I. The most common cause of unusual shape of the 
 male organ, according to my observation, is congenital short- 
 ness of the corpus spongiosum, which acts like the string of 
 a bow, and keeps the penis bent downwards toward the 
 perineum. In a few examples this is the only deformity ; 
 but in the majority there is a slight degree of hypospadias, 
 and the gland is somewhat flattened. I have myself met 
 with impotence from this cause in two instances, and have 
 seen at least a dozen additional cases in the practice of 
 S. D. Gross and Joseph Pancoast. 
 
 For the relief of this condition, the operation of cutting 
 a wedge out of the corpora cavernosa, which was devised 
 by Physick' and which has been successfully practised by 
 Gross, Pancoast, Furneaux Jordan,'' of Birmingham, and 
 myself, is attended with the most gratifying results. The 
 skin of the dorsum of the penis, behind the gland, having 
 been pinched up and divided transversely by transfixing its 
 base, a V-shaped portion, embracing about two-thirds of 
 the thickness of the corpora cavernosa, and of sufficient 
 length to remedy the deformity, is excised by carrying the 
 bistoury first from behind forwards, and then from before 
 backwards, the second incision being made about a quarter 
 
 ^ Gross's Surgery, 6th ed., vol. ii. p. 834, 
 ■^ Lancet, 1876, vol. i. p. 169. 
 
70 ORGANIC IMPOTENCE. 
 
 of an inch behind the head of the penis. The arteries, two 
 or three in number, having been secured by fine h'gatures, 
 the edges of the wound are approximated by three silver 
 sutures, one of which is carried through the cut surfaces of 
 the septum, and the other through the sides of the tunica 
 albuginea, the edges of the wound of the skin being 
 brought together separately. The penis is then supported 
 upon a splint and kept covered with cold water, and the 
 stitches are removed in eight or ten days. For some days 
 previous to the operation, full doses of bromide of potas- 
 sium should be administered, with the view to prevent 
 erections. 
 
 2. Vicious direction of the penis is generally due to the 
 formation of circitinscribed plates or hunps of indin^ation i7i 
 the erectile tissue and fibrous sheath of the corpora cavernosa, 
 an affection which was first described by La Peyronie,' and 
 subsequently by Boyer,^ Kirby,^ Johnson, "^ Galligo,^ Cru- 
 veilhier,^ S. D. Gross, ^ Hewett,^ Van Buren and Keyes,^ 
 Curling," Scholz," and other observers. The areas of in- 
 duration are usually single, and confined to one of the 
 cylinders, although, as in several examples recorded by Kirby 
 and Galligo, they may be multiple, and be scattered through- 
 out the organ ; and, as in a case observed by Curling, they 
 may be associated with a similar lesion of the corpus spon- 
 giosum. Their consistence varies, but it is usually hard 
 
 ^ Mem. de I'Acad. Roy. de Chir., 1S19, t. i. p. 316. 
 ^ Traiie des M.il. Chir., t. vi. p. 802. 
 ^ Dublm Med. Press, Oct. 3, 1849, p. 209. 
 * London LTncet, 1851. vol. ii. p. 481. 
 ^ Gaz. Med. de Paris, 1852, p. 440. 
 ^ Anat. Path., t. iii. p. 593. 
 ^ Op. cit., vol. ii. pp. 833 and 858. 
 ^ Ijritish Med. Journ., Feb. 1872, 
 
 ^ New York Med. Journ., vol. xix. p. 390, and op. cit., p. 24. 
 '" Op. cit., p. 462. '1 Schmidi's Jahrb., Bd. cii. p. 33. 
 
ETIOLOGY. 
 
 71 
 
 and cartilaginous. As the natural result of the obliteration 
 of the meshes of the erectile tissue, the organ, during erec- 
 tion, deviates toward the lesion, so that it may be drawn 
 upwards, downwards, or to either side, thereby materially 
 interfering with coidon, if not rendering that act impracti- 
 cable. In one case reported by Van Buren and Keyes, the 
 penis curved almost to a right angle, and in others it 
 assumed a spiral form. 
 
 The affection is almost always met with after middle life, 
 but its etiology is obscure. Of twenty-five examples which 
 I have coHated, in ten the cause could not be determined ; 
 in seven it was connected with the gouty diathesis ; in four 
 it resulted from injury during coition ; in three it was 
 ascribed to gonorrhoea ; and in one it arose from a violent 
 erection. Kirby, Curling, and Hewett believe that it is 
 connected with gout ; S. D. Gross has met with it most 
 frequently in men who have committed venereal excesses ; 
 VerneuiP states that sugar was present in the urine in nine 
 of the ten cases that he had met with ; while others think 
 that it usually arises from extension of gonorrhceal inflam- 
 mation. 
 
 Of the intimate nature of the lesion, nothing is accu- 
 rately known, as the condition has not been verified by 
 post-mortem inspection. Hewett supposes that the nodules 
 arise from clots of blood in the meshes of the corpora 
 cavernosa ; Van Buren and Keyes think that they depend 
 essentially upon chronic Inflammator}^ plastic obliteration of 
 the meshes ; and Klebs^ teaches that they are the result of 
 a combination of inflammation and thrombosis. 
 
 ^ Revue de Chirurgie, No. 12, 1884, p. 986. 
 * Hdbch. der Path. Anat., p. 11 52. 
 
72 ORGANIC IMPOTENCE. 
 
 £• Closely allied to the preceding affection is cicatricial 
 induration of the corpora cavernosa, the effect of injury, 
 abscess, or destructive inflammation. Thus, Curschmann' 
 relates a case of upward and lateral deviation of the penis 
 from an induration resulting from forcing the erect penis 
 downwards. Baudens' records an example of gunshot 
 wound of one corpus cavernosum, with lateral curvature. 
 Johnson^ met with an instance of distortion from abscess of 
 the right corpus cavernosum ; and he also describes a case 
 in which the glans penis came in contact with the left side 
 of the pubes from burrowing phagedaena. 
 
 ^- Giunmata of the corpora cavernosa, of which condition 
 Ricord'^ has given a good description, are not infrequently 
 attended with faulty curvature of the penis ; but, as they 
 do not evince any tendency to break down, they are indis- 
 tinguishable from the patches of induration resulting from 
 other causes. 
 
 'n- Calcification of the septnin pectiniforme, or the corpora 
 cavernosa, may give rise to impotence from upward or 
 downward curvature of the penis. In the case of a man, 
 fifty-two years of age, McClellan^ relieved the deformity by 
 removing a so-called ossified septum by an incision which 
 extended throughout the entire length of the organ ; and 
 Regnoli^ also restored the power of normal erection by 
 excising the ossified portion, which did not include the 
 entire thickness of the cylinders. 
 
 1 Loc. cit., p. 886. 
 
 Clinique des Plaies d'Armes a Feu, p. 408. 
 ^ Loc. cit., p. 574. 
 
 * Bumsteadand Taylor, Venereal Diseases, 4th ed., p. 639. 
 ^ Lancet, 1828, vol. i. p. 714. 
 ^ Petrequin, Brit, and For. Med. Rev,, vol.xx. p. 136. 
 
ETIOLOGY. 73 
 
 When distortion of the penis arises from gummata, the 
 prospect of rehef from the administration of iodide of 
 potassium and bichloride of mercury, and from friction 
 with mercurial ointment, is favorable. The induration 
 resulting from laceration, or so-called fracture, oi the 
 corpora cavernosa is irremediable. The prognosis in 
 circumscribed patches of these bodies is notoriously un- 
 favorable, as the only cure from general measures, of which 
 I have any knowledge, is that obtained by Scholz by the 
 application of tincture of iodine, plaster of vigo, and warm 
 douches ; althougfh Curling-' records a case in which the 
 hardness nearly disappeared, and in which the erections 
 were almost normal, by the internal administration of bin- 
 iodide of mercury, and by the local use of tincture of 
 iodine. In a case narrated by Friedberg,^ an induration 
 of the corpus cavernosum as large as a hazelnut was made 
 to disappear by inserting a seton under the skin, and per- 
 mitting- it to remain in contact with the tunica albuginea 
 for one month. Boyer and S. D. Gross recommend ex- 
 cision of the patches, a practice which I myself would follow 
 if they Avere single, and of moderate volume. When the 
 curvature depends upon calcification of the corpora caver- 
 nosa or its septum, the outlook is far better, since the 
 removal of the offending substance, as in cases of McClellan 
 and Regnoli, is followed by the most gratifying results. 
 After a shot wound of the right corpus cavernosum, which 
 terminated in a hard, depressed, and adherent cicatrix, 
 Baudens succeeded in effecting a cure by making two 
 incisions in the opposite cylinder, on a level with the 
 upper and lower extremities of the scar, and exciting 
 suppuration by the insertion of tents, through which 
 
 ^ Op. cit., p. 464. 2 Prajer Vierteljahrschrift, 1862, Bd. 1. p. 20. 
 
74 ORGANIC IMPOTENCE. 
 
 manoeuvre a compensating induration was obtained, 
 
 and the curvature was remedied. 
 
 e. The power of erection may be lost in consequence of 
 the permanent retention of a ball in the corpus cavernosiini, 
 of which curious condition I have recorded an example.' 
 The missile was encysted in the right cylinder, and its 
 point presented toward the pubes, from which it was 
 separated about one inch ; but the man refused to have it 
 removed. 
 
 I. Impotence may depend upon congenital or acquired 
 shortness of the frenuin, through which the head of the 
 penis is distorted ; and coition is abstained from on 
 account of the suffering with which the act is attended. 
 The proper remedy is division. 
 
 X. Finally, insufficient erections are occasioned by varix 
 of the dorsal vein of the penis. In a case of this descrip- 
 tion, Parona^ effected a rapid cure by the intravenous 
 injection of equal parts of chloral and water; and Bar- 
 tholow^ states that he has obtained excellent results from 
 the hypodermatic injection of ergotine in the immediate 
 vicinity of the enlarged and tortuous vein. 
 
 B.— IMTOTENXE FROM DEFECTS AND DISEASE OF THE TESTES. 
 
 o^- Congenital bilateral anorchidism, or absence of the 
 testes, of which condition examples are quoted in the 
 chapter on sterility, is necessarily attended with absolute 
 
 ' Med. and Surg. History of the War of the Rebellion, Part II., vol. ii. 
 
 P- 345- 
 
 ''■ Annales de Derm, et de la Syph,, t. i. p. 453. 
 ' Op. cit., p. 295. 
 
ETIOLOGY. (O 
 
 impotence. Cryptorchids, or persons in whom the organs 
 are retained in the abdomen or the groins, are on the 
 other hand generally potent, although they are only excep- 
 tionally fertile ; and arrest of development, as a rule, 
 diminishes virility. 
 
 /?• Loss of the testes from disease, self-mutilation, or sur- 
 gical interference is presumptive of inability to copulate, 
 although in exceptional cases the erections may continue 
 for a considerable time, as is exemplified in the following 
 instances. 
 
 Sir Astley Cooper removed the testis of a man two years 
 after the other had been excised. For the first twelve 
 months he had connections. At the end of two years the 
 erections were more rare and imperfect, and they usually 
 ceased under attempts at congress. Ten years subse- 
 quently he stated that he had had intercourse only once 
 during the previous year ; and twenty-eight years after the 
 operation the penis was shrivelled and wasted, and for 
 many years coition had been impossible. 
 
 M. Wilson' removed both testes for malignant disease, 
 and the man survived the operation two years. He had 
 occasional erections, and intercourse was attended with the 
 usual feeling and with the ejaculation of some fluid. 
 
 Professor Humphry' met with a man who had submitted 
 to castration on account of nervous troubles, but who was 
 able to have connection with an emission for more than a 
 year, although less frequently than before the mutilation. 
 
 Mr. Curling^ removed the right testis of an officer seven 
 years after the excision of the left testis by another sur- 
 
 ^ Lectures on the Urinary and Genital Organs, p. 133. 
 ^ Holmes's System of Surgery, 2d ed., vol. v. p. 160. 
 * Op. cit., 4th ed., pp. 307 and 450. 
 
* ■ 
 
 76 ORGANIC IMPOTENCE. 
 
 geon. At the expiration of four years and a half from the 
 operation the officer informed Mr. CurHng that he had in- 
 tercourse with his wife about once a fortnight, but without 
 an ejaculation. 
 
 }'. Progressive atrophy of the testes is very liable to be 
 attended with impotence ; and Liegeois'. found that the 
 power of erection was diminished in four cases out of six 
 of atrophy of one organ. 
 
 ^' Bilateral syphilitic orchitis generally involves impo- 
 tence f while of forty-one examples of double epididymitis 
 analyzed by Liegeois^ and Gosselin* virility was diminished 
 in only eight. 
 
 f- Tiuiiors, as carcinoma, and sarcoma, and tiibercle, when 
 they completely destroy or disorganize the parenchyma of 
 the testes, are also attended with impotence ; but the state- 
 ment does not hold good when one organ alone is affected. 
 
 The power of erection after having been lost may usually 
 be restored, when it depends upon syphilitic orchitis, by 
 mercurial inunctions and the exhibition of iodide of potas- 
 sium and bichloride of mercury. Arrest of development of 
 the testes is sometimes overcome by the influence of sexual 
 desires, as in the interesting example recorded by Wilson,^ 
 in which, at the age of twenty-six, the glands were not 
 larger than those of a child, but in which they increased 
 almost to the volume of those of an adult man two years 
 after marriage. In all the remaining causes of impotence 
 from lesions of the testes the trouble is beyond relief. 
 
 i Annales de Derm, et de la Syph., t. i. p. 437, 
 
 ^ Liegeois, loc. cit., p. 431. ^ Ibid., p. 424. 
 
 * Archives Generales, ser. 5, t. ii. p. 267. ^ Op. cit., p. 424. 
 
CHAPTER II. 
 
 STERILITY. 
 
 Sect. I. General Observations. 
 
 The generative act on the part of the male impHes the 
 completion of sexual congress with an ejaculation of fertile 
 semen, and its deposition in the upper part of the vagina. 
 As we have already seen, the capacity for copulation de- 
 pends upon the perfect erection of the penis, the failure of 
 which renders the man sterile from impotence. Sterility, 
 on the other hand, not only does not include impotence, 
 but is met with in subjects who are vigorous in intercourse, 
 and who ejaculate a fluid which, in the absence of minute 
 examination, presents all the properties of normal semen. 
 Hence it is dififiicult for these subjects to realize that they 
 are the cause of barren marriages. 
 
 For the proper understanding of the alterations which 
 the semen undergoes in disease, I consider it requisite to 
 preface the consideration of sterility with a summary of the 
 most important attributes of the normal fluid. 
 
 Semen is the mixed product of the secretions of the 
 testes, vasa deferentia, seminal vesicles, sinus pocularis, 
 prostate, Cowper's glands, and the mucous follicles of the 
 urethra. The thick, white, pasty secretion of the semi- 
 niferous tubes consists mainly of spermatoblasts, or seminal 
 cells, out of which the spermatozoa, or fertilizing elements, 
 are developed ; but the spermatozoa first make their 
 appearance in the rete testis, and constitute at least nine- 
 
78 STERILITY. 
 
 tenths of the glutinous mass. In the epididymes and vasa 
 deferentia the zoosperms are perfectly motionless from the 
 density of the medium in which they are contained ; but 
 when they have reached the seminal vesicles they are in 
 active rhythmical, undulating motion. These facts are 
 noticed because some authors have erroneously based their 
 conclusions in regard to the productiveness of the semen 
 upon minute examination of the parenchyma of the testes 
 and the epididymes, or situations in which spermatozoa are 
 only forming, or in which they have as yet not acquired 
 mobility. 
 
 The fluid contained in the seminal vesicles is odorless, 
 viscous, and colorless, resembling fresh honey, heavier than 
 water, of neutral reaction, and does not coagulate. When, 
 however, it is incorporated with the secretions of the pros- 
 tatic and urethral glands, semen has an albuminous con- 
 sistence, a whitish or opalescent tint, and an alkaline 
 reaction, and it emits a peculiar faint odor which is not 
 unlike that of the raspings of fresh horn or bone. After 
 ejaculation it is transformed into a gelatinous mass, but 
 it becomes more fluid after exposure to the air for a few 
 minutes. 
 
 From the preceding considerations it is obvious that, 
 while the testes furnish the fecundating elements of the 
 semen, the secretions of the associated glands, and par- 
 ticularly the secretion of the prostate, not only render it 
 more thin and abundant, but also impart to it its color, 
 odor, alkalinity, and coagulability. The prostatic fluid, 
 moreover, has a more important function than that of 
 serving as a vehicle for the transmission of the sperma- 
 tozoa to the uterus, since Kraus' has shown that, in its 
 
 1 Medical Times and Gaz., 1871, vol. i. p. 170. 
 
COMPOSITION OF THE SEMEN. 79 
 
 absence, these bodies cannot live in the uterine mucus, 
 but that, with its aid, they often survive more than thirty- 
 six hours, or even for eight days and a half as has been 
 demonstrated by Percy,' of New York, 
 
 As early as 1856 Marris Wilson"" assigned the same 
 purpose to the secretion of the prostate, and regarded the 
 neutral phosphate of lime contained in that fluid as the ele- 
 ment upon which the vitality of the spermatozoa depends, 
 since it protects them against destruction by the too acid 
 or too alkaline conditions of the secretions of the passages 
 through which they have to pass in their progress to the 
 ovum. 
 
 If the ejaculated semen be permitted to stand in a test 
 tube for a few hours, it will separate into two layers, of 
 which the upper one, or the liquor seminis, is thin, whey- 
 like, and transparent, and contains a few epithelial cells 
 derived from the seminal passages and detritus, while the 
 lower one is thick, white, opaque, and consists of sperma- 
 tozoa. From the thickness of the sediment, and the 
 rapidity of its precipitation, Ultzmann^ states that a con- 
 clusion may be drawn in regard to the number of sperma- 
 tozoa in any given specimen, as will be pointed out in the 
 consideration of azoospermism from abnormal conditions 
 of the semen. 
 
 A drop of semen discloses under the microscope, as in 
 Fig. 1 2, the male elements of generation, or spermatozoa, 
 which are constituted by a pyriform, flattened head, an 
 intermediate portion, or the beginning of the tail, and a 
 long, tapering, filiform tail, which is in rapid undulating 
 motion, and which propels the head directly forwards. 
 
 ^ Sims, Uterine Surgery, p. 374. 
 
 ^ Lancet, 1856, vol. ii. p. 483. 
 
 ' Wiener Klinik, May and June, 1879, P- ^53- 
 
80 
 
 STERILITY. 
 
 These movements should continue at least twelve hours 
 after the fluid is ejaculated. If they are wanting, and the 
 spermatozoa are alive, as may happen when the semen is 
 
 Fig. 12. 
 
 Fig. 13. 
 
 Spermatozoa. 
 
 Spermatic crystals. 
 
 too thick, motion may be excited by the addition of weak 
 alkaline solutions ; but if they remain motionless under this 
 treatment, they are incapable of impregnating the ovum. 
 
 Minute examination of semen which has been allowed 
 to dry on an object glass, or of the lower layer which 
 forms after the secretion has stood for some time, shows, 
 on the second or third day, at first a few and later a 
 considerable number of transparent, variously modified 
 rhombic prisms with their bases in apposition ; the ends of 
 these occasionally terminate in fine points, but usually in 
 rhombi, as in Fig. 13. They were discovered by Van 
 Deen' and Boettcher,^ the latter of whom termed them 
 spermatic crystals, and regarded them as being composed 
 
 ^ Ctrbl. fiir die med. Wiss., 1864, p. 355. 
 ^ Virchow's Archiv, Bd. xxxii. p. 535. 
 
COMPOSITION OF THE SEMEN. 81 
 
 of albumen. Ultzmann, however, says that they consist of 
 phosphate of magnesium, while other observers regard 
 them as being composed of ammonio-magnesian phos- 
 phate, a view in which I coincide, and which is verified by 
 Fig. 1 6. Ultzmann' has directed attention to the fact, 
 which has been confirmed by Rosenthal's^ and my own 
 investigations, that the early and abundant formation of 
 these crystals denotes a diminution of the number of the 
 spermatozoa or their entire absence ; and Furbringer,^ from 
 an examination of the contents of the seminal vesicles and 
 the prostatic fluid of sixty-six bodies, and of the prostatic 
 secretion derived from twenty-one healthy persons, has 
 demonstrated that the crystals occur exclusively in the 
 latter, and that they indicate functional activity of the 
 glands of the prostate. That this view is correct is also 
 demonstrated by the early appearance of the crystals in 
 large numbers in the fluid ejaculated by azoospermous 
 subjects. 
 
 Semen begins to be secreted at the epoch of puberty, 
 and continues to be formed until an advanced age, al- 
 though the sexual power is usually lost after the sixty-fifth 
 year. Liegeois* examined the ejaculated fluid of eight 
 young persons, and found abundant spermatozoa in two 
 at fourteen years, in four at sixteen years, and in two at 
 eighteen years. Previous to th*e researches of Duplay^ in 
 1852, and of Dieu^ in 1867, the opinion was very general 
 that the semen of old persons was as infertile as was that 
 of impubic boys, although Wagner^ has noted the presence 
 
 ^ Loc. cit., p. 154. ^ Wiener Klinik, May, 1880, pp. 137, 139, and 149. 
 
 * Volkmann's Vortrage, No. 207, pp. 1848-185 1. 
 
 * Medical Times and Gazette, 1869, vol. ii. p. 247. 
 ^ Archives Generales, ser. 4, t. xxx. p. 385. 
 
 ® Journ. de I'Anat. et de Phys., 1867, p, 449. 
 
 ^ Histoire de la Generation, p. 31. 
 
 6 
 
82 STERILITY. 
 
 of spermatozoa in sexagenarians and septenarians, and 
 Curling"' and Casper^ had met with them, respectively, at 
 eighty-seven and ninet}^-six years. That old men in the 
 enjoyment of good health are as able to produce zoosperms 
 as younger men is shown by the investigations of Liegeois,^ 
 who discovered them in every examination, thirteen in 
 number, of the fluid emitted by that class of persons. 
 When death, however, occurs from decrepitude, or without 
 any organic lesions except those which are common to 
 advanced age, Dieu found that the fluid of the seminal 
 vesicles contained spermatozoa in only six, or twent)'-three 
 per cent., of twenty-three examinations. From these 
 observations we may conclude that the secretion of semen 
 continues to be formed in healthy old men, but that it is 
 very liable to cease in decrepitude. These facts and the 
 production of semen in disease will receive full attention in 
 the succeeding section. . 
 
 Classification. — Sterility includes, first, azoospermism, 
 or the condition in which either no semen whatsoever, or 
 unproductive semen, is secreted ; secondly, aspermatism, 
 in which spermatic fluid is not ejaculated ; and, thirdly, mis- 
 emission, or the failure to deposit fertile semen in the upper 
 portion of the vagina. In the first variety intercourse and 
 ejaculation are natural, but the essential anatomical ele- 
 ments are absent or dead, either because they are not 
 formed or are imprisoned behind an obstacle seated in the 
 epididymes or vasa deferentia, or because they are unable 
 to live in the medium in which they are suspended. In the 
 second variety the ability to copulate is unimpaired, but the 
 
 ^ Op. cit., p. 432. ^ Forensic Medicine, Syd. Soc. ed., 1864, p, 292. 
 
 ^ Loc. cit., p. 247. 
 
RELATIVE FREQUENCY. 83 
 
 power to ejaculate is prevented by an impediment situated 
 between the seminal vesicles and the urinary meatus. In 
 the third variety coition and emission are perfect ; but 
 fruitful semen fails to reach its proper destination, in conse- 
 quence of congenital deficiencies of the urethra, or of fistu- 
 lous openings in that canal resulting from inflammation, or 
 of abnormal positions of the meatus. 
 
 Relative Frequency, — It is not at all uncommon for 
 physicians to assume that a man who is potent, and who is 
 able to ejaculate, is capable of procreating. As a result of 
 the omission to examine the emitted fluid, and carefully to 
 explore the male organs, little is known of the relative fre- 
 quency of sterility in the two sexes ; and gynecologists, 
 with the exception of those mentioned below, do not appear 
 to have made any contributions to the solution of this im- 
 portant subject. I have been able to collect one hundred 
 and ninety-two cases in which examination of both the 
 husband and wife demonstrates that the former was at fault 
 in thirty-three, or in seventeen per cent. Of this number, 
 Manningham^ records one in thirty; Pajot' seven in eighty; 
 Mondot' one in ten ; Kehrer^ fourteen in forty ; Courty^ 
 one in ten ; Noeggerath* eight in fourteen ; and I myself 
 "have found that the male was deficient in one example in 
 eight. The cause of the sterility was azoospermism in 
 thirty-one, and aspermatism in two. These facts show that 
 the husband. is at fault in about one case out of every six; 
 and they convey information which should be carefully 
 
 1 Wiener Med. Blatter, 1879, PP" ^223 and 1271. 
 
 ^ Beitrage zur Klin, und E.xper. Geburtskunde und Gynakologie, Bd. ii. 
 p. 76. 
 
 ^ Wiener med. Presse, 1880, p. 252. 
 
 * Trans. Amer. Gynec. Soc, vol. i. p. 287. 
 
84 AZOOSPERMISM. 
 
 weighed before the practitioner even resorts to inspection 
 of the female organs of generation. 
 
 Sect. II. Azoospermism. 
 
 Azoospermism may be due, first, to congenital bilateral 
 anorchidism ; secondly, to congenital bilateral deficiencies 
 of the epididymis or vas deferens ; thirdly, to cryptorchid- 
 ism ; fourthly, to affections of the testes ; fifthly, to oblit- 
 eration or obstruction of the epididymes or vasa deferentia ; 
 and sixthly, to abnormal conditions of the semen. Hence, 
 the affection may be congenital or acquired, and absolute 
 or relative. 
 
 A.— BILATERAL ANORCHIDS. 
 
 Men born without testes are not only azoospermous, 
 but, from the fact that the accessory secreting organs are 
 rudimentary, they are unable to ejaculate a drop of any 
 kind of fluid. From a study of four cases, Godard' found 
 that persons in this condition resemble eunuchs mutilated 
 early in life. They have no venereal desire, and although 
 they may have, as an exception, erections, they are abso- 
 lutely impotent and sterile. It is important to bear in mind 
 that a distinction may be made between anorchids and 
 cryptorchids, when the testes are retained in the abdomen, 
 as the latter are apt at coition, and emit a fluid which is, 
 however, as a rule, devoid of spermatozoa. 
 
 ^ Note sur I'Absence Congeniale du Teslicule. Memoires de la Soc. de 
 Biologic, 1859, P- 3^^- 
 
ABNORMAL POSITION OF TESTES. 85 
 
 B.— CONGENITAL BILATERAL DEFICIENCY OF THE EPIDIDYMIS 
 AND YAS DEFERENS. 
 
 Double deficiencies of the excretory apparatus of the 
 testes prevent the ehmination of the secretion of the latter, 
 and render them useless. Rhodius^ met with an instance 
 of absence of the epididymes in an adult ; and John Hunter^ 
 dissected a body in which, while the testes were normal 
 and were contained in the scrotum, the epididymes and 
 vasa deferentia were deficient, and the seminal vesicles did 
 not communicate with the urethra. Although the state of 
 the genital functions in these cases must remain a matter 
 of conjecture, there is no reason for believing that a mere 
 deficiency of the excretory passages between the testes and 
 seminal vesicles engenders impotence and incapability of 
 ejaculation, provided the seminal vesicles, ejaculatory ducts, 
 and the prostate are normal, as, under these circumstances, 
 the condition would not be worse than that of imprison- 
 ment of the secretion of the testes by acquired obstruction 
 of the vasa deferentia. 
 
 C— FAILURE OF THE TESTES TO DESCEND INTO THE SCROTUM. 
 
 When the testes fail to descend into the scrotum, and 
 are retained in the abdomen or the groins, they are gen- 
 erally small and undeveloped, and now and then atrophied 
 through fibrous or fatty degeneration. As a result of 
 these malpositions and morbid changes, cryptorchids were, 
 up to a comparatively recent date, declared to be abso- 
 
 ^ Quoted by Godard in his Note sur I'Absence Congeniale du Canal Ex- 
 creteur et du Reservoir de la Semence, le Testicule Existant. Ibid., p. 335. 
 ^ Works by Palmer, vol. iv. p. 23. 
 
86 AZOOSPERMISM. 
 
 lutely sterile, although they were known to enjoy the 
 capacity for copulation and ejaculation. Opposed to this 
 opinion, which was maintained by Follin,' Gosselin,^ God- 
 ard,3 Liegeois,* and formerly by Curling,^ are the instances 
 recorded by Poland,^ Cock,^ Durham,^ and Debrou,^ of 
 married cryptorchids who had procreated children. It is 
 highly probable that fecundation in these cases was due to 
 another source, a supposition which is strengthened by the 
 fact that spermatozoa were not observed in the patient of 
 Debrou after death from strangulated hernia, and that the 
 ejaculated fluid does not appear to have been minutely 
 examined in the others ; and there is other evidence which 
 proves that the retained testes may perform their func- 
 tions. Thus, BeigeP° narrates the case of a man, two-and- 
 twenty years of age, whose testes were situated in the 
 groins, and whose emitted semen disclosed spermatozoa ; 
 and Vallette" found those bodies in the vasa deferentia of 
 an inguinal cryptorchid. 
 
 On the whole, the evidence in regard to cryptorchids 
 shows that while, as a rule, they are potent, and ejaculate a 
 fluid which is devoid of spermatozoa, exceptional instances 
 indicate that they may be fertile. This opinion is held by 
 Casper ;'^ but the question of fecundity should always be 
 determined by microscopical examination of the ejaculated 
 
 ^ Archives Generales, ser. 4, t. vi. p. 257. 
 
 ^ Ibid., ser. 4, t. ii. p. 268. 
 
 ^ Etudes sur la Monorchidie et la Cryptorchidie, p. 143. 
 
 * Medical Times and Gazette, 1869, vol. ii. p. 248. 
 
 ^ Brit, and For. Med.-Chir. Rev., April, 1864, p. 495 et seq. 
 
 ^ Guy's Hospital Reports, ser. 2, vol. i. p. 162. 
 
 '' Curling, op. cit., 4th ed., pp. 470 and 471. 
 
 8 Ibid. ' Ibid. 
 
 ^° Virchow's Archiv, Bd. xxxviii. p. 144. 
 
 " Pitha und Billroth's Handbuch, Bd. iii., Abth. ii., Lief. 7, p. 419. 
 " Forensic Medicine, Syd. Soc. ed., 1864, p. 256. 
 
AFFECTIONS OF THE TESTES. 87 
 
 semen of such persons when they are contemplating mat- 
 rimony. 
 
 D.— AFFECTIONS OF THE TESTES. 
 
 Disorders of the testes are Hable to be accompanied 
 with temporary or permanent absence of the spermatozoa. 
 In six cases of bilateral atrophy, Liegeois'^ found that these 
 bodies were greatly diminished ; and they are not formed 
 when the wasting is excessive. The only instances in 
 which the semen has been examined in the latter condition, 
 of which I have any knowledge, are three recorded by 
 Curling,^ and one by Laborde and Cousrem ;3 and sperma- 
 tozoa were absent in all. Simple parenchymatous orchitis, 
 and total disorganization of the substance of the testes, 
 from whatever cause they may arise, as well as fatty de- 
 generation of the secreting cells, a condition met with in 
 hard drinkers, are followed by absolute azoospermism. 
 Pardal destruction by malignant, tubercular,- cystic, and 
 other new formations, on the other hand, does not neces- 
 sarily occasion sterility. Syphilitic orchitis, when pro- 
 nounced, generally abolishes the functions of the organs, 
 but spermatozoa may return under proper treatment It 
 need scarcely be added that loss of the testes, as from 
 castration, renders the subject permanently azoospermous, 
 although he may for a certain time ejaculate the fluid of 
 the accessory glands, a phenomenon which is referred to 
 on page 75. 
 
 Godard^ has called attention to the sin ovular fact, which 
 he confirmed by examination of the ejaculated semen and 
 
 1 Loc. cit., p. 541. ^ Op. cit., pp. 69 and 83. 
 
 ^ Comptes Rendus de la Socieie de Biologic, 1859, P- ^4^- 
 * Ante. 
 
88 AZOOPERMISM. 
 
 of the contents of the seminal vesicles, that one tubercular 
 testis renders the subject absolutely sterile ; and, what is 
 more astonishing, he found that the azoospermism pre- 
 ceded the development of the tubercular affection from 
 one to two years. Hence, he utilizes this condition for the 
 differential diagnosis between unilateral tubercular orchitis 
 and ordinary orchitis, in the latter of which fertile semen is 
 secreted. 
 
 E.— BILATERAL OBLITERATION OF THE EPIDIDYMIS AND 
 VAS DEFERENS. 
 
 By far the most frequent and important of the causes of 
 azoospermism is bilateral obliteration of the epididymis 
 and vas deferens, through which the proper secretion of 
 the testes is confined, and is prevented from reaching the 
 vesiculae seminales and the urethra, and the ejaculated 
 fluid is of necessity deprived of spermatozoa. Obliteration 
 of the seminal passages, as Gosselin' first pointed out, 
 is usually due to gonorrhoea, when it is, with few excep- 
 tions, confined to the epididymes, the vasa deferentia alone 
 being rarely involved. I am not aware that it has ever 
 been traced to traumatic inflammation, as wounds and 
 contusions are generally limited to one side. Tubercular 
 deposits in the epididymes not uncommonly occasion 
 sterility; and a few examples are recorded of azoospermism 
 from bilateral sarcomatous or carcinomatous degeneration 
 of the epididymis. I have myself witnessed the same result 
 in a case of double syphilitic epididymitis, the indurations 
 having made their appearance on the seventy-second day 
 after the first observation of the initial lesion. 
 
 1 Archives Generales, ser. 4, t. xiv. p. 406, and t. xv. p. 40; and ser. 5, t. ii. 
 p. 257. 
 
OBLITERATION OF THE EXCRETORY PASSAGES. 89 
 
 A most important inquiry in connection with obliteration 
 of the excretory apparatus of the testes is, whetlier the 
 functional activity of the opposite gland is abrogated when 
 the lesion is confined to one side. Liegeois' found in thir- 
 teen examinations of the discharge of persons affected with 
 unilateral epididymitis that the number of spermatozoa was 
 greatly diminished; and he refers to three cases of Hirtz, 
 Duplay, and Gosselin, in which the spermatic fluid was 
 entirely devoid of those bodies. As the same occurrence 
 is witnessed in tubercular epididymitis of one side, Liogeois 
 believes, and Ultzmann^ agrees with him, that the testes are 
 so closely united by reflex ties that unilateral epididymitis 
 may abolish the functions of the opposite gland, and thereby 
 produce sterility. This conclusion is supported by five 
 cases of unilateral epididymitis in which spermatozoa were 
 entirely absent, recorded by Kehrer i^ but it is utterly at 
 variance with observations based upon analogous conditions. 
 Duplay, for example, has reported six instances of oblit- 
 eration of one vas deferens with spermatozoa in the epi- 
 didymis of the opposite side ; and Godard shows that 
 congenital absence of one excretory duct, or even of one 
 testis, exerts no effect upon the generative functions. 
 
 In bilateral gonorrhoeal epididymitis the inflammatory 
 new material may be seated in the interior of the canals, in 
 their walls, or in the interstitial connective tissue, and the 
 resulting obstruction or induration is very liable to be per- 
 manent and incurable, since, of eighty-three cases recorded 
 by Gosselin, Godard, and Liegeois,"* the spermatozoa re- 
 turned in only eight. The testes themselves continue to 
 secrete and preserve their normal volume and appearances, 
 
 1 Loc. cit., p. 541. 2 Wiener Klinik, 1879, p. 156. 
 
 ^ Op. cit., pp. 79 and 82. * Loc. cit., p. 380. 
 
90 AZOOSPERMISM. 
 
 and as the subjects ejaculate they are not aware that they 
 are sterile. Liegeois found in twenty-one instances that 
 impotence was present in eight ; but of twenty cases ob- 
 served by Gosselin all were thoroughly potent. The 
 former' states that the ejaculated fluid is rarely milky-white, 
 as in the normal condition, and that it possesses a yellowish 
 tint when leucocytes are present in large numbers ; while 
 Gosselin^ could not trace any variations from the natural 
 color, quantity, odor, and consistence. In a case of azoo- 
 spermism from double epididymitis, Nepveu^ detected in 
 the discharge hyaline cylinders which were casts of the 
 vasa deferentia, and which frequently attained a length of 
 from three to five centimetres. 
 
 F.— ABNORMAL CONDITIONS OF THE SEMEN. 
 
 The quality and composition of the ejaculated seminal 
 fluid are liable to be materially altered by sexual excesses, 
 by various exhausting diseases, and by inflammatory condi- 
 tions of the epididymes, vasa deferentia, seminal vesicles, 
 prostate, and urethra, which are entitled to a detailed ex- 
 amination. 
 
 «• Temporary, or physiological, absence of the sperma- 
 tozoa may be induced, in perfectly healthy men, by sexual 
 excesses, and the frequent repetition of the act of coition 
 renders the semen more and more watery and scanty, so 
 that it consists merely of the secretions of the accessory 
 glands. In the case of a medical student, recorded by 
 
 ^ Loc. cit., p. 511. 2 Archives Generales, ser. 5, t. ii. p. 267. 
 
 ^ Gazette Medicale de Paris, 1874, p. 32. 
 
ABNORMAL CONDITIONS OF THE SEMEN. 91 
 
 Liegeois/ who indulged in three or four connections daily 
 for ten successive days, repeated examinations of the emis- 
 sions demonstrated the complete absence of spermatozoa. 
 Some months later, after an abstinence of three weeks, 
 they were detected in large numbers. The case of Casper^ 
 is so interesting in this respect that it is quoted entire : "A 
 vigorous naturalist, sixty years of age, a married man, and 
 father of a large family, and accustomed to the use of the 
 microscope, whom I had interested in this question, exam- 
 ined with me for some time continuously his own semen 
 after coitus. Here we found the greatest variations, which 
 were accurately noted by both of us together. After coitus 
 on the third day, reckoning from the last performance of 
 the act, there was a large number of very small sperma- 
 tozoa ; after renewed coitus on the fourth day, few and 
 small ; after a pause of only two days, none ; after a pause 
 of only one day there was only a watery sperma, in which 
 no zoosperms were found. At another time, on the fifth 
 day after the last coitus, the zoosperms were very 
 numerous ; another time, after a pause of six days, they 
 were few, but large in size ; four months after the last ex- 
 amination, and seventy-two hours after the last act, the 
 zoosperms were comparatively very sm.all, and at another 
 time, on the third day after the last act, they were innumer- 
 able. Immediately after coitus, and before emptying the 
 bladder, the urethra was twice examined. Twenty-four 
 hours after the last act, a drop passed out of the urethra 
 exhibited numerous small zoosperms ; at another time, after 
 a three days' interval, there was not a single zoosperm." 
 The foregoing observations are corroborated by experi- 
 
 ' Loc. cit., p. 247. ^ Op. cit., p. 292. 
 
92 AZOOSPERMISM. 
 
 ments on animals. Thus, Plonnies,' by electrical irritation 
 of the spinal cord of dogs, has proved that the frequent 
 repetition of seminal evacuations results not only in a strik- 
 ing diminution in the quantity of semen and spermatozoa, 
 but frequently in the entire absence of the latter. Hence, 
 erection and ejaculation may be entirely normal, without 
 the semen containing fructifying elements. 
 
 Permanent absence of the spermatozoa is said to occur 
 now and then as an idiopathic affection. The only cases 
 bearing upon this point, of which I have any knowledge, 
 are those narrated by Hirtz."* Two young, robust, married, 
 but childless men, performed coition with unusual vigor. 
 The ejaculations were never followed by the sense of 
 fatigue so generally experienced after intercourse, and the 
 fluid was void of spermatozoa. While it is impossible to 
 explain these cases satisfactorily, I am inclined to believe 
 that the "unusual vigor" which they displayed points to 
 their having indulged too often in proportion to their 
 powers, and that they are to be classed among the cases of 
 azoospermism from sexual excesses. 
 
 ^- One of the most common causes of infertile semen is 
 nervous exhaustion or neurasthenia, attended with abnormal 
 seminal and prostatic discharges, and with various degrees 
 of impotence. This condition is usually brought about by 
 onanism, venereal excesses, or ungratified desires, and may 
 be regarded as an exaggerated or advanced stage of the 
 preceding variety of azoospermism. As a result of im- 
 paired nutrition, induced by perverted innervation, the 
 secretory activity of the testes is interfered with, and either 
 the evolution of the spermatozoa is arrested, or their num- 
 
 1 Inaug. Diss. Rostock, 1876. 
 
 * Gazette de Strasbourg, No. 5, 1861. 
 
ABNORMAL CONDITIONS OF THE SEMEN. 93 
 
 ber and their activity are diminished. In addition to this 
 factor, it is highly probable that the zoosperms are unable 
 to exist in the altered prostatic fluid, since the microscope 
 shows that they are motionless, and thereby confirms the 
 view of Kraus and Wilson, to which allusion has already 
 been made in the study of normal semen, that the vitality 
 of the spermatozoa is dependent upon the presence of the 
 healthy secretion of the prostate. 
 
 The investigations of Rosenthal,^ Ultzmann,^ and Cursch- 
 mann^ demonstrate that, when potence is as yet little 
 affected, and pollutions are merely beginning to overstep 
 the natural limits, the ejaculated fluid is unchanged. When 
 the pollutions are more frequent, and there are diurnal dis- 
 charges, the spermatozoa are smaller and more scanty ; 
 their movements are less active than in the normal condi- 
 tion, are liable to be abolished in less than an hour, and are 
 incapable of being reawakened by alkaline solutions. 
 Spermatic crystals, moreover, form more rapidly, and in 
 greater abundance than in health. In the worst cases, or 
 in those characterized by diurnal and nocturnal pollutions, 
 and by the presence of semen in the urine, the spermatozoa 
 are either entirely absent, or, if they are present, they are 
 motionless, stunted, or variously deformed. In these 
 advanced instances the semen is frequently seen to have 
 undergone fatty degeneration, as indicated by granular epi- 
 thelium, by molecular detritus, and even by oil globules in 
 the protoplasm of the altered spermatozoa. Spermatic 
 crystals are also abundant, and appear quickly. 
 
 These observations are in accord with those of Lalle- 
 
 ' Wiener Klinik, May, iS8o, p. 137. 
 ^ Wiener med. Presse, 1876, p. 599. 
 ^ Ziemssen's Cyclop£edia, Amer. ed., vol. viii. p. 852. 
 
94 AZOOSPERMISM. 
 
 mand ;' and I have been able to confirm them by the few- 
 examinations that I have made, to which I allude in the 
 succeeding- chapter, and of which the following case is a 
 good illustration : 
 
 Case XXII. A commercial traveller, forty-five years of age^_ 
 who had masturbated a great deal in his youth, and who had con- 
 tracted gonorrhoea twenty years before I saw him, states that 
 he has been constantly annoyed for the last two years by a dis- 
 charge which is increased by straining at stool, and by toying with 
 women without gratifying his passions, a practice in which he 
 indulged, as he feared to have sexual congress on account of feeble 
 erections. I detected a stricture, calibre 19, at five inches and a 
 half from the meatus, along with a granular patch immediately 
 behind the coarctation, and hyperaesthesia of the prostatic urethra. 
 On withdrawing the explorer, the bulb brought, away a consider- 
 able discharge, which, under the microscope, presented a few pus 
 corpuscles, granular epithelium, and detritus, and a few motionless 
 and deformed spermatozoa, several of which were occupied by fat 
 globules. On examining the slide a few hours subsequently, I 
 also discovered numerous spermatic crystals. 
 
 Fatty degeneration of the spermatozoa has also been 
 observed by Bianchi^ as rod-like bodies made up of shining^ 
 points, which disappeared on the addition of ether. 
 
 In a case of impotence from masturbation, complicated 
 by spermatorrhoea, Heitzman^ found that the heads of the 
 zoosperms were not much wider than the tails, and that 
 their movements were very feeble. 
 
 7. TJie relation of general diseases to anomalies of the semen 
 is a subject in regard to which widely different views are 
 
 1 Op. cit., 3d Amer. ed., Phila., 1858, p. 265. 
 ''■ Schmidt's Jahrbiicher, 1879, ^^- clxxxi. p. 38. 
 ^ New York Med. Journal, August, 1879, P- ^5^- 
 
ABNORMAL CONDITIONS OF THE SEMEN. 95 
 
 entertained. While there is no reason for beheving that 
 acute maladies impair the fertility of the semen of adults, 
 it is quite certain that both acute and chronic affections of 
 old age, and chronic diseases in the adult, not infrequently 
 lead to a suspension of the evolution of spermatozoa. 
 
 The investio-ations in this direction have been confined 
 almost exclusively to consumptives, in whom, as is well 
 known, the parenchyma of the testes is usually very moist, 
 pale, and ansemic, and in whom the epithelium of the tubules 
 has not uncommonly undergone fatty degeneration. The 
 frequency of azoospermism in phthisis, despite the changed 
 condition of the testes, has, however, been greatly exag- 
 gerated. Lewin,' Davy,^ Duplay,^ and Dieu'* examined the 
 secretions of the epididymes, vasa deferentia, and vesiculae 
 seminales of thirty-five persons dead of pulmonary tubercle, 
 and found spermatozoa in twenty-three, or 65.7 per cent.; 
 and in thirteen inspections of the fluid at the orifice of the 
 urethra, or pressed out of that passage, Lewin discovered 
 zoosperms in eight. Hence, the semen contained fertile 
 elements, and usually as numerous as in healthy persons, 
 in thirty-one, or 64.5 per cent., of forty-eight subjects dead 
 of phthisis ; and what is remarkable is the fact that they 
 were present in 62.5 per cent, of the semen of old persons, 
 arid in 65 per cent, of that of adults principally between 
 thirty and forty years of age. The accuracy of these in- 
 vestigations has recently been confirmed by Busch,^ who 
 detected spermatozoa in the fluids obtained from the testes, 
 epididymes, and vasa deferentia of twenty-eight, or 66.6 
 per cent., of forty-two phthisical subjects ; but it is to be 
 
 ^ Deutsche Klinik, 1861, p. 319. 
 ^ Edinb. Med, and Surg. Journ., July, 1839, p. i. 
 ^ Ante. * Ante. 
 
 ^ Ztbchr. f. Biol., Bd. xviii. p. 496. 
 
96 AZOOSPERMISM. 
 
 noted that they were abundant in only eight. From these 
 statements, it will be seen that the semen of consumptives 
 contains zoosperms far more frequently than certain writers 
 would lead us to believe. Godard was of the opinion that 
 spermatozoa were absent in persons who had become con- 
 sumptive at the age corresponding to the establishment 
 of the spermatic secretion ; but that they persisted when 
 tuberculosis began after that period. 
 
 That acute and chronic diseases do impair the fertility 
 of the semen of persons advanced in life is well shown by 
 the investigations of Duplay and Dieu, since of 156 in- 
 stances in which the fluid contained in the vasa deferentia 
 or vesiculse seminales of old men was examined, sperma- 
 tozoa were found in only one-half. Dividing the cases in 
 accordance with the periods of life — 
 
 Of 25 sexagenarians spermatozoa were discovered in 17, or 68 per cent. 
 " 76 septenarians " " " 40, " 59.2 " 
 
 " 51 octogenarians " " " 19, " 37.2 " 
 
 " 4 nonagenarians " " " o. 
 
 In none were they present after the age of eighty-six, and 
 they decreased pari passu with advancing years. 
 
 On analyzing the causes of death, I find that spermatozoa 
 were entirely absent in affections of the urinary organs ; 
 that they were present in only 38 per cent, of diseases of 
 the nervous system ; and that they were discovered, re- 
 spectively, in 68, 70, and 81 per cent, of disorders of the 
 lunors, the digestive organs, and the heart. Hence, we 
 may assume that while diseases of the kidney and brain 
 exert a most prejudicial influence upon the formation of 
 zoosperms, afl"ections of the other great systems interfere 
 with their development to only a slight extent. 
 
 Of the 76 cases in which spermatozoa were found, they 
 were abundant in 50, and fewer than usual in 26. They 
 
ABNORMAL CONDITIONS OF THE SEMEN. 97 
 
 were perfectly formed in 54; and in 22 their tails were 
 absent or shortened, and they varied in size. From these 
 facts we may infer that the inability of old men to procreate 
 arises more from impotence than from the composition of 
 their semen; and this view is supported by the fact, based 
 upon 51 examinations made by Duplay' of the testes of men 
 from sixty to eighty- six years, that the secreting- organs 
 are perfectly normal in structure, and only slightly dimin- 
 ished in size and weight. 
 
 The gross appearances of the seminal fluid of old men 
 are worthy of notice, since, in the absence of minute ex- 
 amination, they afford inferential aid in deciding the ques- 
 tion of the absence or presence of spermatozoa. When 
 the secretion is of a more or less transparent grayish tint, 
 thick, viscous, and abundant, it is almost always fertile ; but 
 when it is scanty, and either watery or gelatinous, sperma- 
 tozoa are almost always absent ; and a deep brown color, 
 which is due to broken-down blood and pigment, favors the 
 latter view. 
 
 Constitutional syphilis does not appear to exert much 
 influence upon the secretion of the testes, since Liegeois^ 
 and Bryson^ detected spermatozoa in the fluid ejaculated 
 by syphilitic subjects in sixteen cases out of twenty-one, and 
 Lewin" found them in three out of six examinations of the 
 contents of the excretory seminal apparatus of men dead 
 of that affection. 
 
 Under this head may be mentioned the altered composi- 
 tion of the semen produced by the excessive use of moi^phia, 
 to which attention has been called by Rosenthal. ^ A man 
 
 ^ Archives Generales, ser. 5, t. vi. pp. 136 and 439. 
 ^ Loc. cit., p. 380. 
 
 ^ New York Medical Abstract, July, 1882, p. 274. 
 * Loc. cit., p. 319. 
 
 ^ W^iener Klinik, May, 1880, p. 149. 
 7 
 
AZOOSPERMISM. 
 
 had injected under the skin, on account of cephalalgia and 
 insomnia, from nine to twelve grains of morphia daily for three 
 years. Paralysis of the bladder finally ensued ; and exami- 
 nation of the whitish fluid, which was occasionally forcibly 
 expelled with the last drops of urine, demonstrated sper- 
 matic crystals, but no spermatozoa. Under proper treat- 
 ment, at the expiration of a month, when the morphia had 
 disappeared from the urine, a specimen of the semen ejacu- 
 lated during coition was found to contain living zoosperms, 
 but they were not so abundant or so lively in their move- 
 ments as under normal circumstances. In a second case, 
 in which nearly eight grains of morphia had been injected 
 daily for one year, minute examination of a nocturnal pollu- 
 tion disclosed a few deformed and motionless spermatozoa, 
 which did not react on the addition of a weak alkaline 
 solution. 
 
 ^- Abnormal density of the semen may render it unfit for 
 fecundation. Beigeh narrates a case in' which the genital 
 organs were normal, but in which repeated examinations of 
 the ejaculated fluid showed that it was thicker and more 
 viscous than is usual, and that the spermatozoa were motion- 
 less and closely grouped side by side. The addition of a 
 few drops of tepid water put them in lively motion ; so that 
 the injecdon of a smah amount of lukewarm water into the 
 vagina, after coition, was advised, and the woman subse- 
 quently bore several children. 
 
 ^- Parnlent semen, which is met with principally in in- 
 flammation of the epididymes, vasa deferentia, seminal 
 vesicles, and prostate, may occasion the death of its essential 
 
 ' Krank. des Weibl. Geschlechts, Bd. ii. p. 791. 
 
ABNORMAL CONDITIONS OF THE SEMEN. 99 
 
 anatomical elements, as in the following case, which was 
 under my care in 1883 : 
 
 Case XXIII. A gentleman, thirty years of age, contracted 
 .gonorrhoea in 1870, or rather more than ten years before I saw him, 
 and at the end of six weeks was attacked by bilateral epididymitis, 
 v/hich confined him to his bed for a fortnight. Up to 1873 he had 
 always had an ejaculation on coition, but during the succeeding two 
 years he indulged so rarely that he does not remember whether he 
 had a discharge or not. He married in 1875, and although he has 
 always had good erections, intercourse was not completed with an 
 emission ; but by pressing along the course of the urethra, he 
 could force a drop of sticky fluid out of the meatus. Exploration 
 discovered a stricture, calibre 14, at five inches and three-quarters, 
 and great hyperaesthesia of the prostatic urethra. The seminal 
 vesicles and prostate were tender on pressure with the finger in 
 the rectum. Having detected these morbid conditions, I learned, 
 on further questioning, that intercourse was painful, and that there 
 was a constant feeling of dull, heavy pain in the rectum which was 
 increased at stool. On the 12th of January, 188 1, he brought me 
 the entire quantity of urine passed less than an hour after inter- 
 course. Examination of the sediment, as well as of the discharge 
 which I removed from the urethra with the bulbous explorer, dis- 
 closed rather abundant pus corpuscles and epithelial cells, with 
 some of the latter undergoing fatty degeneration, crystals of oxa- 
 late of lime, spermatic crystals, and a few stunted or tailless and 
 dead spermatozoa. The case was, therefore, one of sterility from 
 aspermatism dependent upon stricture of the urethra, and of azoo- 
 spermism from inflammation of the seminal vesicles. 
 
 Examples of symmetrical spermatocystitis, with complete 
 absence of spermatozoa, have been reported by Marce,' 
 Laborde,^ and Octave Guelliot ;3 and Heitzman'^has met with 
 
 1 Gazette des Hopitaux, 1854, p. 597. 
 
 ^ Gazette Medicale de Paris, 1859, P- 468- 
 
 ^ Des Vesicules Seminales, Paris, 1883, pp. 124 and 131. 
 
 * New York Med. Journ., August, 1879, P- ^5^- 
 
100 AZOOSPERMISM. 
 
 an instance of unilateral spermatocystitis In which those 
 
 elements were also destroyed. 
 
 Terillon,' in 1880, pointed out that the ejaculated fluid in 
 
 acute bilateral gonorrhoeal epididymitis is of a yellowish 
 
 tint vero-inor on screen, and that, while it contains abundant' 
 000' ' 
 
 pus corpuscles and a few large granular corpuscles, sper- 
 matozoa are nearly always absent. Thus of twelve cases 
 in which the semen was examined at from ten to ninety 
 days after the implication of the second testis, or on the 
 thirty-ninth day, on an average, there were no spermatozoa 
 in eiorht, a few livinof ones in three, and an abundance in 
 one. Even several years after the complete subsidence of 
 the acute symptoms, when the epididymes and vasa defer- 
 entia are normal in volume and consistence, though tender 
 on handling, the discharge may retain the same characters, 
 but in a less pronounced degree ; and Terillon illustrates 
 this important statement by a case in which yellowish azoo- 
 spermous semen, which contained relatively few pus cor- 
 puscles, continued to be emitted six years after the cessation 
 of the inflammation. The man had been married four 
 years, but had not procreated children. 
 
 In the preceding examples it has been seen that the 
 vitality and the changes in the form and dimensions of the 
 essential anatomical elements of the semen were associated 
 with purulent inflammation of the excretory passages of 
 that fluid, so that the inference is justifiable that pus is de- 
 structive of their evolution and life. This view is supported 
 by the researches of Levy' on the influence exerted upon 
 the viability of the spermatozoa by the perverted secretion 
 of the glands of the cervix in endometritis. Of fifty-seven 
 
 ^ Des Alterations du Sperme dans I'Epididymite Blennorrhagique. Annales 
 de Dermatologie et de Syphiligraphie, ser. 2, t. i. p. 439. 
 ■^ Aerztliches Intelligenzblatt, 1879, -^d. xxvi. pp. 3 and 12. 
 
ABNORMAL CONDITIONS OF THE SEMEN. 101 
 
 cases in which the secretion after coition contained an 
 abundance of pus corpuscles and epithehal cells, in not a 
 single one were many spermatozoa detected, and in none 
 did their movements, which were feeble from the first, con- 
 tinue for more than five hours ; whereas he frequently found 
 that they were vigorous in the cervical mucus of healthy 
 women for twenty-six hours after congress. 
 
 In none of these cases were the phenomena to be ascribed 
 to the reaction of the discharge. Sims' states that when 
 the cervical secretion is rich in epithelial cells it proves de- 
 structive of the spermatozoa ; and he ascribes this action 
 to its density and not to its chemical action. He,^ moreover, 
 thinks that catarrh of the prostate is as deleterious as is 
 uterine catarrh ; and there is, indeed, no reason why a 
 mucopurulent discharge of the urethra should not kill the 
 spermatozoa. Noeggerath^ believes that it acts as a poison ; 
 and in a letter which I received from him in 1S83, he says, 
 "the poison in the secretion is certainly not the pus cor- 
 puscle, but the micrococci which infest, not only the leuco- 
 cyte, but also the menstruum in which it is found ;." and he 
 refers me to a paper on the subject by Neisser, which, how- 
 ever, is not available. While these views are hypothetical, 
 they are worthy of further investigation, as they would seem 
 to be substantiated by a case of sterility from diabetes 
 mellitus recorded by Beigel,"* in which examination of the 
 semen contained in the urine disclosed, in addition to frag- 
 ments of spermatozoa, abundant micrococci and a few 
 cryptococci. 
 
 ^ Uterine Surgery, p. 390. 
 
 ^ New York Med. Journ., vol. viii. p. 407. 
 
 ^ Trans. Amer. Gynec. Soc, vol. i. p. 287. 
 
 * Krank, des Weibl. Geschlechts, Bd. ii. p. 791. 
 
102 AZOOSPERMISM. 
 
 ?• Bloody semen is an occasional cause of azoospermism, 
 the essential elements being, as a rule, diminished in num- 
 ber and frequently motionless or dead, and, in some cases, 
 entirely absent. When furnished by an inflamed prostatic 
 urethra, as in one of my patients suffering from bloody 
 ejaculations, no influence appears to be exerted upon the 
 number and movements of the spermatozoa, and Robin' 
 states that they live in blood for four or five hours. When, 
 however, the seminal vesicles are the seat of the hemor- 
 rhao-e, and the blood has been retained for some time in 
 those reservoirs, being intimately mixed with the semen, 
 the secretion is rust-colored, or of a dark brown or choco- 
 late tint, and the spermatozoa are either greatly reduced in 
 number or altogether wanting, as pointed out by Dieu. 
 These facts are illustrated by a case of chronic spermato- 
 cystitls recorded by Rapin,^ and by two cases of a similar 
 nature observed by Guelliot.^ When the bleeding is the 
 result of gonorrhoeal epididymitis, the effect produced upon 
 the fructifying elements is less marked than when it is in- 
 duced by inflammation of the seminal vesicles. Thus, in 
 three examples from the practice of Molliere,'^ the sper- 
 matozoa were dead in notable numbers, while in one instance 
 recorded by Fiirbringer^ they were numerous and in active 
 motion at the end of three days. From these considera- 
 tions it follows that azoospermism from sanguineous semen 
 is usually dependent upon hemorrhage connected with sper- 
 matocystitis. 
 
 ^ Diet. Encyclop. des Sciences Medicales, 3d ser., t. xi. p. 160. 
 
 2 These de Strasbourg, 1859, No. 491, Obs. II. 
 
 ^ Op. cit., pp. 208 and 221. 
 
 * Diet. Encyclop. des Sciences Medicales, 3d ser., t. xvi. p. 599. 
 
 ^ Volkmann's Vortrage, No. 207, p. 1847. 
 
DIAGNOSIS. 103 
 
 Diagnosis. — The discrimination between anorchids and 
 cryptorchids with the testes retained in the abdomen is 
 readily made, when it is remembered that the former are 
 impotent, while the latter complete the sexual act in the 
 usual manner. If spermatozoa have never appeared in the 
 discharge, the question of congenital absence of the epi- 
 didymes, or of want of union of the vasa deferentia with 
 the seminal vesicles or the epididymes, may be entertained. 
 
 In all other cases the diagnosis is to be established by 
 repeated examinations of the semen, since, as we have 
 already seen, that fluid is liable to undergo various changes 
 in sterility from sexual excesses, masturbation, ungratified 
 venereal desire, obstruction of the epididymes, prostatitis, 
 spermatocystitis, and epididymitis. Normal semen slowly 
 throws down a white sediment, which constitutes from one- 
 third to one-half of the discharge, while azoospermous 
 semen rapidly precipitates a slight sediment. Under ordi- 
 nary circumstances, the formation of spermatic crystals is 
 delayed until the second or third day after ejaculation, and 
 their number is small. In semen deprived of spermatozoa, 
 on the other hand, the crystals appear in half an hour ; or 
 somewhat later, if there are few spermatozoa. The earlier, 
 therefore, a sediment is deposited, and the more rapidly 
 and abundantly spermatic crystals form, the less fertile is 
 the discharge. 
 
 Ultzmann' describes the following varieties of semen in 
 which spermatozoa are not found, and his observations have 
 been confirmed by myself and other observers : 
 
 First, watery, transparent semen, which is normal in 
 quantity, and becomes gelatinous immediately after emis- 
 
 Wiener med. Presse, 1876, p. 599, and 1878, p. 78; and Wiener Klinik, 
 1879, P- 156. 
 
104 
 
 A Z O O S P E R BI I S M . 
 
 sion, as does the normal secretion. It, however, resumes 
 its fluid state when it is thoroughly cooled, and presents a 
 whey-like appearance. Its relatively slight sediment shows, 
 
 Fig. 14. 
 
 Watery semen. 
 
 under the microscope, as in Fig. 14, perfect spermatic crys- 
 tals, a few 'lymph corpuscles, cylinder epithelium, and an 
 abundance of fatty detritus. 
 
 Secondly, colloid sperm, Fig. 15, which differs from the 
 normal discharge only in the absence of spermatic crystals 
 and spermatozoa, and in the presence of abundant epithe- 
 lium which has undergone colloid degeneration, and of 
 laminated spherical masses of various dimensions. 
 
 Thirdly, catarrhal and purulent semen, which deposits a 
 tolerably abundant whitish or yellowish sediment, is of 
 normal consistence and quantity, and contains an abundance 
 of epithelium, leucocytes, and a few blood corpuscles, and 
 occasionally a few deformed and motionless spermatozoa. 
 
PROGNOSIS, 
 
 105 
 
 To these varieties I may add, fourthly, bloody semen, 
 which has a dark brown or chocolate tint, from the intimate 
 admixture of the two fluids in the seminal vesicles, and 
 
 Fig. 15. 
 
 iOO 
 
 Colloid semen. 
 
 which contains small clots, numerous normal and altered 
 red corpuscles, pigmented granules, and minute sympexions. 
 When the semen is discharged with the urine, it is to 
 be remembered that the movements of the spermatozoa 
 are arrested if the latter fluid is acid or ammoniacal ; 
 whereas they are not materially interfered with if the urine 
 is neutral or slightly alkaline. 
 
 Prognosis. — Azoospermism offers, in the large majority 
 of cases, little encouragement as regards the prospect of 
 permanent relief; and the prognosis depends upon its ex- 
 citing cause and the amenability of the cause to treatment. 
 
 In congenital absence of the testes or deficiency of their 
 
106 AZOOSPERMISM. 
 
 excretory passages, cryptorchidism, progressive atrophy, 
 parenchymatous inflammation, and total disorganization 
 from tubercle and morbid growths, as well as in tubercle, 
 sarcoma, and carcinoma of the epididymes, the absence of 
 spermatozoa is, with few exceptions, permanent and abso- 
 lute. In cases of arrest of development, the prognosis 
 should be guarded, since the testes may resume their pro- 
 per functions under amorous influences. Thus, in the 
 remarkable example recorded by Wilson,' the penis and 
 testicles of a man, twenty-six years of age, were not 
 larger than those of a boy of eight years of age. He 
 had never had sexual desires until he met his intended 
 wife ; and in two years after marriage he had become a 
 father, and the organs had increased nearly to the usual 
 size. The chances in favor of a return of the fecundating 
 elements are good when the affection arises from sexual 
 excesses, masturbation, or ungratified passion, overindul- 
 gence in morphia, and epididymitis from ordinary causes; 
 while they are not promising in cases of syphihtic epi- 
 didymitis and orchitis, and in gonorrhoea! epididymitis. 
 Liegeois^ examined the semen of twenty-eight persons 
 affected with bilateral epididymitis, and there were no 
 spermatozoa in twenty-one. Of the seven in which sper- 
 matozoa had returned, only two were of gonorrhoeal origin ; 
 so that the prognosis is far more favorable when the indur- 
 ation depends upon common causes than when it follows 
 blennorrhaeia. In the eonorrhceal cases with a return of 
 zoosperms, the induration lasted only ten days in one, and 
 in the other only one side was seriously affected ; while in 
 those in which the azoospermism was permanent, the 
 
 ^ Lect. on the Urin. and Gen. Organs, p. 424. 
 ^ Loc. cit., p. 380, 
 
TREATMENT. 107 
 
 inflammation had lasted from fifteen to sixty days. Hence, 
 the light cases are of far more favorable prognostic import 
 than the intense ones. Liegeois, moreover, found that the 
 induration persisted partially or completely in fifteen of the 
 twenty-one cases of absolute azoospermism ; but that the 
 epididymes seemed normal to the touch in six. Of the 
 seven in which the functions of the testes were reestab- 
 lished, five were free from induration ; and in two, which 
 were not of gonorrhoeal origin, the induration persisted ; 
 so that absence of swelling and hardness is not positively 
 indicative of a return of fertility. In such cases the canal 
 of the epididymis is strictured or obliterated. 
 
 As a prognostic aid, the ejaculated fluid should be 
 examined in all cases of bilateral epididymitis. If it pre- 
 sents the characters of watery or colloid sperm, the absence 
 of spermatozoa will, in all probability, be permanent. 
 
 Treatment. — The management of azoospermism is, as a 
 rule, most unsatisfactory. When it depends upon chronic 
 debilitating diseases and the excessive use of morphia, the 
 remedies are to be addressed to the primary affection and 
 to the breaking up of the habit. Abstinence is enjoined 
 when it is due to sexual excesses or masturbation ; and 
 moderation should be observed when the functions of the 
 testes are restored. 
 
 In advancing atrophy of the testes, provided it is not a 
 symptom of lesions of the cerebro-spinal system, galvanism 
 holds forth some prospect of success. The positive pole 
 should be applied over the lumbar portion of the spinal 
 column, and the negative pole should be passed over the 
 affected organs, the precautions being taken to employ 
 weak currents and to limit the daily sittings to two or 
 three minutes. 
 
108 AZOOSPERMISM. 
 
 Azoospermism in cryptorchids may be prevented if the 
 subjects are seen sufficiently early in life, and if the testes 
 are retained' in the groins, by carrying out the suggestion 
 of Curling' to promote their descent into the scrotum by 
 gentle and repeated traction. In children the retained 
 organs enjoy great mobility ; and the manoeuvres might 
 succeed in adolescents and young adults, in whom the 
 testes are, however, usually fixed. Sir Astley Cooper 
 witnessed in " many cases " their descent from the thir- 
 teenth to the seventeenth year, and even as late as the 
 twenty-first year; and I myself have known it to occur still 
 later, as in the following example : 
 
 Case XXIV. In a widower, forty-six years of age, under my 
 care for impotence in 1883, the right testis remained in the inguinal 
 canal until six months after his marriage, at the age of twenty-four, 
 when it passed into the scrotum, and is now soft, tender, and of 
 about one-third the volume of its fellow. In its descent it was 
 accompanied by a portion of the intestine. 
 
 The arrest of the evolution of spermatozoa in syphilitic 
 orchitis may be anticipated, if the disease be recognized 
 within a few weeks, by the internal administration of iodide 
 of potassium and bichloride of mercury ; or the latter agent 
 may be replaced by mercurial inunctions, the testes in the 
 meanwhile being properly supported. Syphilitic epididy- 
 mitis, which I have occasionally met with as a secondary 
 symptom, readily yields to a mercurial course. 
 
 In bilateral epididymitis early and vigorous antiphlogistic 
 treatment will usually preserve the functions of the testes. 
 The means upon which I place the most reliance are strict 
 recumbency, light diet, a brisk purgative, the saline and 
 
 ^ Op. cit., p. 38. 
 
ASPERMATISM. 109 
 
 antimoriial mixture with a few drops of tincture of aconite 
 pushed to the extent of provoking- sHght nausea, and keep- 
 ing the parts well elevated and surrounded with absorbent 
 cotton, wet with a strong solution of acetate of lead and 
 laudanum. If, despite these measures, indurations remain 
 after the active symptoms have subsided, they may fre- 
 quently be made to disappear under the exhibition of 
 iodide of potassium and bichloride of mercury, along with 
 the local use of mercurial ointment, or oleate of mercury, 
 or an ointment composed of one drachm of iodoform, two 
 drachms of balsam of Peru, two drops of oil of gaultheria, 
 and five drachms of cosmoline. This treatment should be 
 steadily maintained, as the most chronic cases may ter- 
 minate favorably. Thus, Gosselin, Godard, and Curling 
 record a return of spermatozoa after eight, eighteen, and 
 twenty-four months ; and Godard even narrates an in- 
 stance of cure in which the indurations had lasted for ten 
 years. In all cases particular care should be observed to 
 guard against recurrence of the inflammation. 
 
 Finally, when the semen is too thick, as in the case of 
 Biegel, narrated on page 98, although nothing can be 
 done in the way of medication, so far as the man is con- 
 cerned, impregnation may be insured by the injection of a 
 small quantity of saccharine or alkaline tepid water into 
 the vagina after sexual congress. 
 
 Sect. III. Aspermatism. 
 
 Aspermatism is the variety of sterility in which sexual 
 intercourse is not finished with the ejaculation of semen, 
 either because that fluid does not enter the urethra, or 
 
110 ASPERMATISM. 
 
 because its forcible expulsion is prevented by some ob- 
 stacle in the urethra anterior to the prostate gland. The 
 term is, therefore, restricted to those cases in which the 
 lesions are seated between the seminal vesicles and the 
 urinary meatus. 
 
 Nonemission may be congenital or acquired, and per- 
 manent or temporary ; and it may depend, first, upon 
 seminal fistulae; secondly, upon obstruction of the ejacu- 
 latory ducts or the urethra ; thirdly, upon deficient excita- 
 bility of the spinal ejaculatory centre ; fourthly, upon 
 abolished sensibility of the nerves of the penis; and, fifthly, 
 upon the inhibitory action of the brain over the centre for 
 ejaculation. Hence, in accordance with its etiology, it may 
 be Organic, Atonic, Ansesthetic, and Psychical. 
 
 A.— ORGANIC ASPERMATISM. 
 
 The discharge of seminal fluid into the urethra may be 
 prevented, a, by seminal fistulae ; /?, by congenital vices ; 
 7, by inflammatory lesions of the ejaculatory ducts and the 
 prostate ; and, f>, by sympexions ; and the escape of semen 
 from the urethra may be due, e. to stricture of that pas- 
 sage, to a tight phimosis, or to induration of the corpora 
 cavernosa. 
 
 a. Seminal fistidcB, the result of wounds or pathological 
 lesions of the seminal vesicles and their excretory ducts^ 
 may constitute a cause of nonemission. Thus, Sabatier' 
 refers to a case of rectovesical lithotomy, followed by the 
 establishment of a flstulous tract between the two cavities,, 
 through which the semen was ejaculated into the rectum ; 
 
 1 Med. Oper., 1832, t. iv. p. 342. 
 
LESIONS OF THE EJACULATORY DUCTS. Ill 
 
 and in a case of a similar nature, from the practice of 
 Simonin/ there was no external escape of the semen in 
 masturbation, and it was mixed with the feces after coition. 
 Covillard^ has recorded a curious instance of the passage 
 of urinary calculi through fistulous openings in the peri- 
 neum and inner side of the thigh, in which the semen fol- 
 lowed the same routes. 
 
 (3. Congenital occbision^ absence, and deviation of the ejacu- 
 latory ducts have been rarely met with. Schmitt^ examined 
 a man, thirty-five years of age, who had never had an 
 emission either when awake or asleep, although his power 
 to cohabit was unimpaired. He had not suffered from 
 gonorrhoea, and his external organs were perfect ; but the 
 prostate could be felt through the rectum merely as a 
 small, flat body, and the seminal vesicles appeared to be 
 atrophied. Ultzmann^ records two cases of vigorous men, 
 in whom, as in the preceding instance, there was no history 
 of gonorrhoea, and who had never been able to ejaculate 
 during coition or under the influence of a dream, although 
 nothing abnormal could be discovered in regard to their 
 reproductive organs. Munroe' describes a similar condi- 
 tion of aflairs in a robust man, twenty-eight years of age. 
 Under no circumstances had there ever been an emission ; 
 but a drop or two of clear mucus could be pressed out of 
 the urethra after intercourse, and examination of the urine 
 passed soon afterwards disclosed abundant spermatozoa. 
 
 While in the case of Schmitt it is highly probable that 
 
 ^ Bull, et Mem. de la Soc. de Chir., 1880, t. vi. p. 166. 
 "^ Observations latrochirurgiques, 1839, Obs. 9. 
 
 * Wiirzburg med. Zeitschrift, 1862, Hd. iii. p. 361. 
 
 * Wiener Klinik, January, 1885, p. 5. 
 
 ^ Boston Med. and Surg. Journ., Feb. 21, 1867, p. 62. 
 
112 ASPERMATISM. 
 
 the atrophied prostate occluded the ejaculatory ducts, the 
 cause of the trouble in those of Ultzmann must remain a 
 matter of conjecture, although he ascribes it to congenital 
 absence of excitability of the reflex centre for ejaculation. 
 As the men, however, never emitted seminal fluid, we may 
 assume that the ducts were obliterated, or absent. That 
 the latter inference is not unfair is attested by a prepara- 
 tion' in the Hunterian Museum, in which the ducts are 
 wanting, and in which the remainder of the sexual organs 
 are completely developed, as well as by a case of a newly 
 born child, described by Rindfleisch,^ in which the ducts 
 were impermeable. In the case of Munroe there was 
 doubtless a congenital deviation of the orifices of the ducts, 
 so that the semen regurgitated into the bladder during 
 intercourse. 
 
 7. Acquired strichtre or obliteration of the ejaculatory 
 ducts and deviation of their orifices, the results of inflamma- 
 tion or injury, are among the most common causes of 
 organic aspermatism, although the evidence of their exist- 
 ence is based, for the most part, on the symptoms presented 
 during life. In his researches on the condition of the genital 
 oro-ans of old men dead of acute and chronic diseases, 
 Duplay^ made some interesting observations, which afford 
 post-mortem proof that the ejaculatory ducts undergo cer- 
 tain alterations which are capable of preventing ejaculation. 
 In one both ducts were entirely destroyed, and were sur- 
 rounded by tubercular matter from the neck of the seminal 
 vesicles to their entrance into the thickness of the pros- 
 
 * Klebs, Path. Anat., p. 781. 
 
 ^ Virchow's Archiv, Bd. 81, p. 521. 
 
 •'' Archives Generales, ser. 5, t. vi. pp. 437 and 438. 
 
CICATRICIAL OCCLUSION OF THE DUCTS. 113 
 
 tate ;' in one they were converted into small, impermeable 
 fibrous cords, and the man had had a catheter retained in 
 his bladder for a long time for retention of urine ; in one 
 the prostate was hypertrophied, and the ducts were nar- 
 rowed, but pervious to semen on pressing- the seminal 
 vesicles ; in one both ducts were strictured, and the orifice 
 of the right was completely obliterated, the prostate was 
 enlarged and indurated, and the verumontanum was hard 
 and of the size of a big pea ; and, in a fifth case, the orifices 
 of the canals were strictured, but pressure on the seminal 
 vesicles showed that they were open. Ample observation 
 has, moreover, demonstrated not only that the extension 
 of gonorrhoeal inflammation to the prostate obstructs its 
 ducts through inspissation of the catarrhal secretion of its 
 glands, and frequently brings about adhesion of the orifices 
 of the ejaculatory ducts,^ but that the latter may be occluded 
 by the secondary contraction or by the cicatrices which 
 result from abscess. 
 
 Cicatricial occlusion of the ducts from deeply seated 
 abscess has been observed by Kocher^ and Ultzmann ;'^ 
 and the following case from my own practice demonstrates 
 that the inability to ejaculate was due to suppuration of the 
 prostate and obliteration of the ejaculatory ducts : 
 
 Case XXV. A single gentleman, fifty years of age, contracted 
 gonorrhoea thirty years before he consulted me, and two years ago 
 suffered with symptoms of prostatic obstruction, which were fol- 
 lowed by suppuration of the gland, and spontaneous evacuation of 
 the abscess. Since that time sexual congress has been followed 
 by a somewhat painful sense of fulness in the region of the prostate 
 
 1 Ultzmann describes a similar case in a living subject. Loc. cit., p. 7. 
 ^ Compare with Kraus, Med. Times and Gaz., 1871, vol. i. p. 272. 
 ^ Pitha und BiUrotli's Hdbch., Bd. iii. Abth. 2, Lief. 7, p. 433. 
 * Loc. cit., p. 6. 
 
114 ASPERMATISM. 
 
 and the anus, and the act is not finished with an ejaculation of 
 semen. 
 
 On exploration of the urethra I detected a stricture, calibre 21, 
 at the bulbomembranous junction, a-long with marked tenderness 
 of its prostatic portion and the neck of the bladder. The finger 
 inserted into the rectum revealed decided diminution in the 
 volume of the prostate. 
 
 ♦ 
 Injur)^ of the canals in bilateral lithotomy, or even in the 
 lateral operation during the extraction of the calculus, is 
 liable to terminate in aspermatism. I have myself wit- 
 nessed sterility from this cause in tw^o examples, and Tee- 
 van has recorded four cases.' 
 
 La Peyronie'' describes the case of a man, the father of 
 three children, who, in consequence of a neglected gonor- 
 rhoea, lost the power to ejaculate, although semen oozed 
 away shortly after coition. On post-mortem examination 
 a cicatrix was discovered on the summit of the verumon- 
 tanum, which had so changed the direction of the orifices 
 of the ejaculatory ducts that they looked backwards toward 
 the bladder. Demeaux^ found in a man, twenty-three years 
 of age, after an abscess of the perineum from a fall, that 
 the urine passed after an aspermous coition contained nor- 
 mal spermatozoa ; and, as the urethra was not strictured, 
 but the perineum was diminished in size, and the prostate 
 was drawn down lower than usual, he properly inferred 
 that the ejaculatory ducts had been displaced. 
 
 ^- Aspermatism may arise, as Reliquef^ first pointed out, 
 from obsti^udion of the ejaculatoi^y canals by sympexions, or 
 
 ^ Trans. Clin. Soc. London, vol. vii. p. 179. 
 
 ''■ Mem. de I'Acad. Roy. de Chir., 1819, t. i. p. 316. 
 
 ^ Gaz. des Hopitaux, No. 21, i860. 
 
 * Ibid., 1879, PP- S91 ^^d 915. 
 
SYMPEXIONS. 115 
 
 concretions composed of spermatozoa, concrete mucus, epi- 
 thelial cells, and refracting granules, and formed in the 
 seminal vesicles. In the three cases narrated by Reliquet, 
 only one duct was involved, and he ascribes the loss, of 
 power to ejaculate to the compression exerted upon the 
 pervious duct by the distended one, and to the arrest of the 
 contraction of the former through the pain experienced at 
 the commencement of the expulsive act. In one example 
 the finger in the rectum detected a bosselation of the right 
 lobe of the prostate, near its middle, and showed the boss 
 to be continuous with the corresponding seminal vesicles ; 
 and in a second case, a small tumor, due to retention of the 
 semen, was discovered at the site of the ducts. Bergh,' of 
 Copenhagen, met with a similar condition in a man twenty- 
 nine years of age ; but the case differed from the cases of 
 Reliquet in that the nonejaculation was of an intermittent 
 character. The patient finished his first connection in the 
 usual manner, but afterwards there was merely a sensation 
 of distention ; although, on two occasions during sleep, 
 after dinner, there was an abundant discharge of semen. 
 Bergh advised coition with a condom, with a view to ex- 
 amine the fluid, if any should be evacuated. During the 
 act, the man felt as if something had torn, and there was a 
 seminal discharge, which was rich in spermatozoa and sym- 
 pexions. Subsequently there was sometimes an emission, 
 and at other times none. In an instance recorded by 
 De Blegny,^ the ducts were occluded with hard, spherical 
 concretions as large as peas ; and the verumontanum was 
 indurated, and of the volume of a small nut. The patient, 
 a widower, sixty years of age, and the father of several 
 
 1 Schmidt's Jahrbiicher, 1879, ^d. clxxxi. p. 36. 
 
 ^ Civiale, Traite Prat, sur les Maladies des Organes Genito-Urinaires, t. ii. 
 P- 234- 
 
116 ASPERMATISM. 
 
 children, contracted a second marriage, but was unable to 
 ejaculate. In this connection, it may be stated that Beck- 
 mann' discovered a concretion as large as a cherry in the 
 ejaculatory duct of an old man, the organic portion of 
 which was composed of spermatozoa, and the inorganic 
 portion principally of phosphate and carbonate of lime. 
 The possibilit}' of the formation of so large a concretion, 
 and of its effecting closure of the opposite duct, should be 
 remembered in framing a diagnosis. 
 
 «• The fourth division of organic aspermatism includes 
 those cases in which the semen is discharged into the ure- 
 thra, but its escape is prevented by some obstacle anterior 
 to the prostate gland. If the impediment to its evacuation 
 is seated in the posterior portion of the urethra, the greater 
 part will usually how back into the bladder, and minute 
 examination of the urine passed after coition will disclose 
 spermatozoa. When the obstacle, on the other hand, is 
 situated at the external orifice, the semen will dribble away 
 with the subsidence of the erection. 
 
 The most common cause of retention of the seminal 
 fluid is stricture of the ^tretJira, to which attention was first 
 called bv Petit ;^ and it is not difficult to conceive how an 
 opening, which, in the flaccid condition of the penis, admits 
 of the passage of urine, may, during erection, when the 
 normal calibre of the urethra is naturally diminished, 
 become so narrowed through spasm that the semen is con- 
 fined in the canal between the coarctation in front and the 
 turoid caput gallinaginis behind, so that its escape, either 
 forwards or backwards, is prevented until the penis becomes 
 
 ' A'irchow's Archiv, Bd. xv. p. 540. 
 
 - Mem. de I'Acad. Roy. de Chir., 1819, t. i. p. 323. 
 
STRICTURE OF THE URETHRA. 117 
 
 flaccid. At page 99, I have narrated the case of a man in 
 whom the stricture admitted a No. 14 bulbous explorer, 
 and in whom the parts behind the coarctation were very 
 sensitive ; and I have also met with four additional exam- 
 ples in which the contractions were not so small, and of 
 which the followino- are orood illustrations : 
 
 Case XXVI. A gentleman, twenty-eight years of age, had 
 masturbated excessively from his fourteenth to his twenty-second 
 year, and a few months subsequently, on his first sexual intercourse, 
 discovered that, although the act was completed with the usual 
 sensation and painful spasmodic ejaculatory movements, there was 
 no escape of semen until the erection subsided, when a few drops 
 could be pressed out of the urethra. Examination of the urine 
 passed after copulation disclosed abundant spermatozoa; and a 
 stricture, calibre 22, was discovered at one-third of an inch behind 
 the meatus; and a second, calibre 18, was found at five inches and 
 three-quarters from the external orifice. The prostatic urethra was 
 extremely sensitive, and he suffered from prostatic discharges at 
 stool. 
 
 Case XXVII. A merchant, thirty-eight years of age, who had 
 masturbated to some extent when a youth, and who had always in- 
 dulged excessively in venery, contracted gonorrhoea fifteen years 
 before I saw him, in 1885. During the past eight years, coition 
 was not terminated with an ejaculation, but the semen dribbled 
 away with the subsidence of the erection. There were marked 
 signs of myelasthenia, and strictures, calbre 27, were detected just 
 behind the meatus, and at two inches and a half and five inches 
 from the orifice. 
 
 In these cases, the fault is, in my opinion, to bejascribed 
 less to the organic contraction than to the spasm of the 
 muscular walls of the urethra beneath the sensitive mucous 
 membrane, through which the opening is temporarily 
 
118 ASPERMATISM. 
 
 occluded. Hence, such cases are analogfous to those of 
 stricture in which exposure to cold and wet, or acrid condi- 
 tions of the urine react on the inflamed mucous membrane, 
 and produce retention of urine from spasmodic contraction 
 of the muscular fibres of the urethra ; and it would prob- 
 ably be more correct to describe them as instances of re- 
 tention of semen from spasm. Since the stricture maintains 
 the inflammation upon which the spasm depends, it is, how- 
 ever, needless to remove the cases from this category. 
 
 Other examples of aspermatism from stricture are re- 
 corded by Curschmann,' Acton, ^ and Blackwood. ^ The 
 case of Hirtz"* terminated by a spontaneous cure during 
 coition, which was attended by violent pain, and followed 
 by severe hemorrhage. The man had had repeated attacks 
 of gonorrhoea, but never ejaculated, and spermatozoa were 
 detected in the urine. After the removal of the obstacle, 
 the nature of which is not clear, his wife gave birth to a 
 child. 
 
 The second impediment to the spasmodic, forcible dis- 
 charge of the semen is a tight phimosis, of which the fol- 
 lowing is an illustration : 
 
 Case XXVIII. A farmer, thirty-six years of age, and married 
 for fifteen years, consulted me in April, i8<So, on account of inability 
 to procreate children. The preputial orifice, which would only 
 admit a small probe, was seated upon the back of the head of the 
 penis, so that the meatus was completely hidden by the integu- 
 ments. He informed me not only that the urine, but that the semen, 
 when the penis became flaccid, converted the prepuce into a sac, 
 and that their egress had to be facilitated by manipulation. 
 
 ^ Loc. cit., p. 904. 2 Op. cit., 4th Amer. ed., p. 224, 
 
 ^ Proceedings of the Phila. Co. Med. Soc, vol. i. p. 4. 
 * Gazette de Strasbourg, No. 5, 1861. 
 
ATONIC ASPERMATISM. 119 
 
 In a similar instance, Blackwood' circumcised the patient 
 and relieved his trouble. In the case of Amussat,^ after a 
 barren marriage of five years' duration, the removal of a 
 very tight foreskin was crowned with success ; and Bergh,^ 
 in the case of a man twenty-one years of age, effected a 
 cure in three weeks by circumcision. 
 
 The third obstacle to the proper ejaculation of the urine 
 is induration of the corpora cavernosa, to which attention 
 was first directed a century and a quarter ago by La 
 Peyronie.'* As this lesion is fully considered on page 70, 
 it need not detain us in this connection. 
 
 B.— ATONIC ASPERMATISM. 
 
 In aspermatism from atony or loss of contractility of the 
 muscles of the seminal vesicles, ejaculatory ducts, prostate, 
 and urethra, although there is no obstacle to the ejacula- 
 tion or escape of the seminal fluid, there is never an 
 emission during Intercourse or when the patient is awake ; 
 but nocturnal pollutions under the influence of lascivious 
 dreams are not infrequent, and are accompanied with the 
 usual pleasurable feelings. Hence the sexual act is never 
 completed, and the subject has to abandon his efforts 
 merely from a sense of exhaustion. In organic asper- 
 matism, on the other hand, except when it depends upon 
 congenital lesions, coition is finished with a discharge 
 which is prevented from escaping ; or if the ejaculatory 
 ducts are closed or obstructed, the convulsive movements 
 are experienced with the ordinary sensations. 
 
 ^ Loc. cit., p. 5, 
 
 * Virchow-Hirsch's Jahresbericht, 1866, Bd. ii. p. 619, 
 
 ' Loc. cit., p. 37. * Mem. de I'Acad. Roy. de Chir., 1761, vol. i. p. 428. 
 
120 ASPERMATISM. 
 
 Roubaud^ attributes this form of aspermatism, which Is 
 termed idiopathic by Bergh/ paradoxical by Rheinstaedter,^ 
 and relative by other observers, to spasmodic contraction 
 of the ejaculatory ducts. This opinion cannot be enter- 
 tained, as the relaxation of the spasm should be followed 
 by the escape of semen, which never happens. Schulz,"* 
 Ultzmann, Rosenthal, Kocher, and other observers explain 
 it by the absence of excitability in the lumbar reflex ejacu- 
 latory centre during coition, a view in which I entirely 
 concur. In many examples, the general symptoms denote 
 neurasthenia, or the depressed form of spinal irritation, 
 which is presumed to be due to exhaustion of the lumbar 
 division of the spinal cord ; and from the fact that the 
 affection is most frequently met with in men who have 
 been addicted to masturbation or venereal excesses, or 
 who have suffered from repeated attacks of gonorrhoea, a 
 class of subjects in whom, as I have shown in the chapter 
 on Impotence, there are, as a rule, inflammation and hyper- 
 sesthesia of the prostatic portion of the urethra, I believe 
 that, with few exceptions, exploration with a sound or bul- 
 bous explorer will disclose lesions which maintain, and are 
 probably the cause of, the abolished excitability of the 
 reflex ejaculatory centre. In the majority of the cases of 
 aspermatism, other than of the organic variety, I find that 
 the urethra was not examined, and that hypersesthesia was 
 discovered in seven out of nine cases in which an instru- 
 ment was passed. Hence, exploration of the canal should 
 never be omitted, since upon its condition will depend the 
 employment of the proper measures for the relief of the 
 trouble. 
 
 ^ Op. cit., t. i. p. 248. ^ Loc. cit., p. 37. 
 
 ' Deutsche med. Wochenschrift, 1879, ^'^- ^6, p. 336. 
 * Ibid., 1862, pp. 769 and 787. 
 
ANESTHETIC ASPERMATISM. 121 
 
 These statements are corroborated by the following cases 
 from my private practice : 
 
 Case XXIX. A merchant, twenty-six years of age, had mas- 
 turbated from his thirteenth to his twentieth year, and erections 
 were provoked by merely looking at a woman, and by other slight 
 causes. At the age of twenty he had his first connection, but 
 failed to ejaculate ; and repeated subsequent efforts were attended 
 with the same result. His erections were normal, and he had a 
 nocturnal emission, with the usual sensations, about once every 
 two weeks. The entire urethra was hyperssthetic, and the pros- 
 tatic portion excessively so ; and there was a stricture, calibre 24, 
 at six inches from the meatus. 
 
 Case XXX. A clerk, thirty years of age, and married for two 
 years, never had an ejaculation during coition, although he pro- 
 longed the act until fatigue required him to desist, and he states 
 that ejaculation failed to occur during masturbation, which he 
 practised up to the age of fifteen. He had, however, a nocturnal 
 emission, which was attended with a pleasurable sensation, about 
 once a week. He suffered from pain in the back, a feeling of sore- 
 ness over the vertex, and palpitation of the heart ; was easily 
 fatigued, and his sleep was unrefreshing. The meatus was con- 
 tracted, and the entire urethra was very sensitive upon exploration. 
 The meatus was laid open on the loth of June, steel bougies were 
 passed at stated intervals, their size being gradually increased, and 
 bromide of potassium was exhibited internally. On the 27th of 
 August, sexual intercourse was completed with an emission ; the 
 symptoms of neurasthenia had disappeared in another month; and 
 from this time he had no further difficulty in intercourse. 
 
 C— ANESTHETIC ASPERMATISM. 
 
 The first link in the chain of the phenomena concerned 
 in the act of ejaculation is the conduction of the sensory 
 
122 ASPERMATISM. 
 
 Impressions excited by the friction of the penis against the 
 walls of the vagina to the lumbar division of the spinal 
 cord. If the sensory nerves fail to respond to the ordinary 
 stimulus, reflex contraction of the ejaculatory muscles is 
 prevented, and emission is rendered impossible. This 
 variety of aspermatism, which may be termed anaesthetic, is 
 not common, but the subjoined illustrations demonstrate 
 the possibility of its occurrence. 
 
 As the result of concussion of the spine, a soldier was 
 affected with insensibility of the prepuce, of the gland and 
 skin of the penis, and of the scrotum to such a degree that 
 pinching and pricking with pins were not perceived by him. 
 Abundant nocturnal pollutions occurred at long intervals ; 
 but he was unable to ejaculate on coition or masturbation, 
 the latter of which he resorted to with the vain hope of re- 
 lieving priapism, from which he often suffered, and which 
 constituted an obstacle to the discharge of the urine.' A 
 gentleman, aged twenty-eight years, with congenital absence 
 of the prepuce, was unable to complete sexual congress 
 with an emission, although he had an occasional nocturnal 
 pollution. Concluding that the trouble arose from a want 
 of excitability in the nerves of the gland of the penis. 
 Curling^ applied the acetum cantharidis, which left the part 
 in a very sensitive condition ; and the man subsequently 
 married, and seldom failed to finish intercourse in the 
 normal manner. 
 
 In the second case, under the charge of the same ob- 
 server,^ a gentleman, forty-four years of age, was unable to 
 ejaculate on account of insensibilit}^ of the gland and skin 
 of the penis. Nearly the entire back of the organ was 
 
 ^ Lallemand, op. cit., 3d Amer. ed., p. 211. 
 
 2 Op. cit., 4th ed., p. 483. ■'' Ibid., p. 485. 
 
PSYCHICAL ASPERMATISM. 123 
 
 covered by a large, indurated scar, and the prepuce had 
 disappeared, the lesions having been due to syphilis. 
 
 In a third case, under the charge of Curling,' the disten- 
 tion of the glans and the irritability of its sensitive nerves 
 were prevented by occlusion of the meshes of the corpus 
 spongiosum by inflammatory deposits, through which the 
 glans did not enter into perfect erection. 
 
 Nonemission may also be due to obtunded sensibility of 
 the prostatic portion of the urethra, which Van Buren and 
 Keyes^ regard as being the seat of pleasure in the act of 
 copulation. They record a case in which this condition was 
 found in a man, thirty-six years of age, who had never ex- 
 perienced an ejaculation during his nine years of married 
 life, although he had had nocturnal emissions. 
 
 D— PSYCHICAL ASPERMATISM. 
 
 That the reflex movements emanating from the lumbar 
 genital centre are amenable to the will is illustrated by the 
 fact that many men, to avoid impregnation, are able to 
 retard an emission until the penis is withdrawn from the 
 vagina ; and the restraining action of the cerebrum is also 
 proved by two curious cases of atonic aspermatism, recorded 
 by Roubaud^ and Hicquet,'*in which the ejaculation instantly 
 ceased if the patient awakened during a nocturnal pollution. 
 Other men, through disgust, suspicion of infidelity, or loss 
 of passion, are unable to complete sexual congress with 
 their wives, although they succeed perfectly with other 
 
 ^ Op. cit., 4th ed., p. 460. 
 
 ^ Genito-Urinary Diseases, with Syphilis, p. 466. 
 
 ^ Op. cit., p. 244. 
 
 * Bull, de I'Acad. Roy. de Med. de Belgique, ser. 2, t. iv. p. 482. 
 
124 ASPERMATISM. 
 
 women. Hence, aspermatism from the Inhibitory action of 
 the brain over the centre for ejaculation is temporary or 
 relative, emission being possible under some circumstances 
 and impossible under others ; and it is altogether indepen- 
 dent of organic lesions. 
 
 Diagnosis. — The determination of the particular form of 
 aspermatism is based upon the history of the case, upon 
 the thorouofh exploration of the external and internal 
 organs of generation, upon the examination of the urine, 
 and upon the conclusions drawn from the effects of the 
 remedies employed for its relief. As these points have 
 already been more or less fully considered, little need be 
 added in regard to them. 
 
 The existence of congenital absence or obliteration of 
 the ejaculatory ducts is rendered almost certain if there 
 has never been an emission under any circumstances 
 whatsoever, if the urine is devoid of spermatozoa, and if 
 there is no history of antecedent inflammation or injury. 
 When, on the other hand, the urine passed after coition 
 contains spermatozoa, and the other negative signs are 
 present, congenital deviation of the ducts with discharge 
 of the semen into the bladder Is a perfectly fair inference. 
 
 A history of deeply seated abscess of the perineum or 
 lithotomy points to cicatricial occlusion of the ducts; while 
 the detection of spermatozoa in the urine after sexual con- 
 gress In persons who have suffered from perineal abscess 
 or from neglected gonorrhoea shows that there is acquired 
 deviation of those canals. Obstruction of the ejaculatory 
 ducts by sympexlons gives rise to the affection termed 
 spermatic colic by Rellquet. There Is always reflex con- 
 traction or loss of dilatabllity of the bladder. .This makes 
 Itself known by difficult and very frequent urination, and 
 
DIAGNOSIS. 125 
 
 by the expulsion of the last drops, which are liable to be 
 bloody, being attended with lancinating- pains which extend 
 from the anus to the extremity of the penis. The subjects 
 refrain from intercourse because excessive sufferingr is 
 excited at the moment when ejaculation should occur; or 
 is even induced by venereal desires or by commencing 
 erection. Exploration through the rectum discloses a 
 small, circumscribed tumor in the region of the prostate; 
 and if the latter be compressed between the finger and a 
 sound in the urethra, either the swellino- will at once 
 disappear, and the instrument be covered with semisoft, 
 grayish masses looking like bits of vermicelli or grains of 
 boiled rice, or there will be an abundant discharge of semen, 
 which contains sympexions, at the ejaculation during the 
 first coition after the manipulations ; or spermatozoa and 
 seminal concretions will be passed at the succeeding act 
 of micturition. 
 
 In aspermatism from stricture of the urethra the patient 
 has nocturnal emissions, the usual convulsive movements 
 of ejaculation and pleasurable sensations are felt during 
 coition, and the urine passed after sexual congress contains 
 spermatozoa. The diagnosis is confirmed by the use of 
 the exploratory bougie, to which sufficient reference is 
 made on page 37. When the trouble arises from a tight 
 prepuce, its cause is obvious. 
 
 Atonic aspermatism is always to be suspected in persons 
 who have indulged excessively in venery or in masturba- 
 tion, or who have had gonorrhoea ; in those who suffer from 
 the ordinary symptoms of neurasthenia ; and in subjects 
 who ejaculate under the influence of a lascivious dream. 
 The diagnosis is confirmed by the existence of hyperaes- 
 thesia of the prostatic urethra. 
 
 The anaesthetic form of the affection is denoted by the 
 
126 ASPERMATISM. 
 
 loss of sensibility of the gland and skin of the prepuce and 
 penis ; and nonejaculation from emotional causes is readily- 
 determined by the history of the case. 
 
 Prognosis. — Aspermatism from spermatic fistulse and 
 congenital or acquired absence, obliteration, or deviation of 
 the ejaculatory ducts is permanent, and nothing is to be 
 expected from treatment. When the ducts are obstructed 
 by sympexions, or when the affection is referable to stric- 
 ture of the urethra or phimosis, a cure may be looked for. 
 The prognosis is good when the failure to ejaculate depends 
 upon hyperaesthesia of the prostatic portion of the urethra ; 
 but atonic aspermatism without morbid sensibility of that 
 division of the urethra calls for a certain amount of reserve 
 in the expression of an opinion ; and the same statement 
 holds good for the anaesthetic variety. The psychical formx 
 is temporary or relative, and capable of correction. 
 
 Treatment. — When the ejaculatory ducts are obstructed, 
 the plan proposed and successfully practised by Reliquet in 
 two cases is to be recommended. A sound having been 
 introduced into the bladder, the circumscribed swelling is 
 emptied by counterpressure with the finger in the rectum. 
 When the trouble depends upon stricture of the urethra, 
 dilatation or internal division should be resorted to ; and if 
 it arises from phimosis, circumcision will afford prompt 
 relief. 
 
 When the atonic variety of aspermatism is combined 
 with inflammation and hyperaesthesia of the prostatic ure- 
 thra, the measures should be directed to subduing the latter 
 before attempts are made to restore the contractility of the 
 muscles concerned in the act of ejaculation. Hence, the 
 treatment is essentially the same as that described in pages 
 
TREATMENT. 127 
 
 41-52, and its good effects are well illustrated by Case 
 XXX. 
 
 If, on the other hand, the prostatic portion of the urethra 
 is insensitive, a tonic course should be at once instituted. 
 The best prospects for relief are held out by quinine, iron, 
 and strychnia, internally, cold sitz-baths,' and galvanism,^ 
 the negative catheter pole being in contact with the veru- 
 montanum, while the anode is placed over the lumbar por- 
 tion of the spine or the perineum. Instead of continuous, 
 induced currents^ may be employed, as in the instance of 
 Hicquet,"^ in which a cure was effected in eight days after 
 the failure of the remedies advised by Roubaud.^ In the 
 case recorded by the latter author, under the idea that the 
 affection was due to spasm of. the ejaculatory ducts, normal 
 coition was restored, after a preliminary venesection, by a 
 pill composed of assafoetida, castoreum, extract of opium, 
 and extract of hemlock, and by sprinkling the vesicated 
 surface of the perineum with morphia. In another example 
 of atonic aspermatism Hicquet^ succeeded in curing his 
 patient in ten days by the internal exhibition of the alco- 
 holic extract of nux vomica, gradually increased from two 
 to six centigrammes a day. 
 
 In anaesthetic aspermatism, the passage of the faradic 
 brush over the penis, the anode being applied to the spine, 
 is indicated, with the view to restore the obtunded or 
 abolished sensibility of the nerves. In the event of the 
 failure of this measure, the gland of the penis may be blis- 
 tered with some prospect of success, as in an example from 
 the practice of Curling.^ 
 
 ' Consult page 53. ^ Consult page 54. 
 
 ^ Consult page 55. * Loc. cit., p. 482. 
 
 ^ Op. cit., p. 244. ^ Loc. cit., p. 492. 
 ■^ Op. cit., p. 483. 
 
128 MISEMISSION. 
 
 Aspermatism from disturbance of the brain, such as loss 
 of affection for or repugnance to a certain woman, is hope- 
 less, unless the subject undergoes a change of sentiment. 
 Being entirely emotional, nothing can be done for him in 
 the way of medication. 
 
 Sect. IV. Misemission. 
 
 In the preceding forms of sterility, no semen whatsoever, 
 or unproductive semen, is secreted ; or there is failure to 
 ejaculate. In the variety under consideration, fertile semen 
 is emitted, but it is not deposited in the upper portion of 
 the vagina ; so that it differs from aspermatism from me- 
 chanical obstruction in that the secretion has an outlet, and 
 does not regurgitate into the bladder, or slowly ooze from 
 the urethra when the erection has subsided. Hence, the 
 term misemission is employed in the sense that the ejacula- 
 tion has a faulty direction. 
 
 The most common causes of misemission are vices of con- 
 formation of the nretJn^a. Thus, hypospadias may destroy 
 the capacity for procreation, even when it is of light grade, 
 as in two cases recorded by Kirsch ;' but the deformity does 
 not usually involve sterility, unless the opening of the 
 urethra is situated at the penoscrotal junction or in the 
 perineum, and not even then, as, in excepdonal instances,^ 
 the posterior wall of the vagina may act by replacing the 
 deficient inferior wall of the urethra, thereby permitting 
 
 1 Wiener med. Presse, 1881, p. 214. 
 
 ^ Morgagni, Anat. Path., 1838, t. iii. p. 73 ; and Casper, op. cit., p. 251. 
 
MALPOSITION OF THE MEATUS. 129 
 
 the ejaculated semen to reach its destination. The same 
 statements are appHcable to epispadias, and to fistulous 
 openings in the urethra, the result of stricture or injury. 
 In all of these conditions the prognosis is unfavorable, and 
 the treatment is most unsatisfactory. If a plastic operation 
 be practised, the precaution should be taken to make a 
 perineal outlet for the urine. 
 
 Malposition of the meatus, through which the semen is 
 voided backward and downward, or to one side, is an occa- 
 sional cause of misemission, and is usually due to congenital 
 or acquired shortening of the frenum. Guerlain' has re- 
 ported the case of a man, thirty-five years of age, in which 
 the penis was almost completely rotated from left to right, 
 so that the dorsal surface reposed on the scrotum, and the 
 meatus was situated on the side of, and about five-tenths 
 of an inch behind, the extremity of the gland ; and Guillon' 
 met with a case in which the meatus opened on the side of 
 the gland, and in which the stream of urine described almost 
 a right angle with the penis. When the trouble arises from 
 shortening of the frenum, the proper remedy is division of 
 that structure. In the case of Guillon, excision of the 
 pouch-like walls of the meatus resulted in a cure. 
 
 1 Bull, de la Soc. Anat., ser. 2, t. iv. p. 87. 
 
 2 Gaz. Med. de Paris, 1843, P- 160. 
 
CHAPTER III 
 
 SPERMATORRHOEA. 
 
 In its restricted sense spermatorrhoea means a constant 
 escape of seminal fluid without erection or pleasurable 
 sensation ; but the term, in a sense which has prolonged 
 sanction, is employed in the following description of the 
 affection to designate all the varieties of involuntary seminal 
 losses which occur beyond the limits of health, and it is, 
 therefore, synonymous with seminal incontinence. Under 
 no circumstances should the affection be regarded merely 
 as a ''functional disorder of the testes," since, in the great 
 majority of instances, it is primarily dependent upon and 
 symptomatic of weakness or exhaustion along with in- 
 creased impressibility, mobility, or excitability of the genito- 
 spinal centre, phenomena usually induced and perpetuated 
 by hyperaesthesia of the nerves which supply the prostatic 
 portion of the urethra. 
 
 Classification. — Seminal incontinence includes three 
 conditions which may exist separately, or pass into one 
 another, or be combined in the advanced stage of the dis- 
 order. These conditions constitute the following varieties 
 of the disease : 
 
 First. Nocturnal emissions or pollutions, which occur 
 during sleep, and are generally attended with an erection, 
 pleasurable sensation, and an erotic dream. 
 
 Second. Diurnal pollutions, which take place when the 
 
NOCTURNAL POLLUTIONS. 131 
 
 subject is awake, are excited by slight mechanical or psy- 
 chical causes, and are usually accompanied with incomplete 
 erection and diminished sensation. 
 
 Third. Spermatorrhoea in the strict acceptation of the 
 term, or a slight continual flow of semen from the urethra, 
 without erection or specific sensation, without impure 
 thouofhts, or duringf urination or defecation. To avoid con- 
 fusion, I will employ the term spermorrhagia to indicate this 
 phase of the affection. 
 
 I. Nocturnal Pollutions. — Involuntary nocturnal semi- 
 nal discharges constitute the variety of the affection in 
 regard to which physicians are usually consulted, and about 
 which not a little ignorance prevails, as they are natural to 
 all men, and are most common after the epoch of puberty, 
 when the mind is more or less taken up with sexual matters. 
 Their frequency varies in accordance with a great many 
 circumstances, such as age, climate, habits, constitution, 
 temperament, diet, and predisposition, it having been ob- 
 served that they are very liable to occur in young men who 
 were affected in their childhood with nocturnal incontinence 
 of urine. Their frequency also varies greatly in the same 
 individual ; but it is impossible to determine the healthy 
 standard merely by the intervals of their repetition, since 
 what may be normal in one person may be morbid in 
 another. In a general way, I should say that in single men 
 who lead a continent life and possess a sound nervous sys- 
 tem, emissions at intervals of two weeks are indicative of 
 excellent health. In such persons they are merely reflex 
 signs of fulness or distention of the seminal passages, and 
 constitute an inconvenience of ungratifled sexual instinct. 
 Even if they occur several times a week, provided they are 
 not followed by symptoms of nervous disorder, they are 
 
132 SPERMA'J'ORRHCEA. 
 
 not at all inconsistent with temporary good health, as is 
 well exemplified by the following striking case, under my 
 care in 1882, and which I narrate in the patient's own 
 language : 
 
 Case XXXI. " I am a druggist, single, and twenty-seven years 
 of age. I commenced masturbating when I was sixteen, and con- 
 tinued the practice daily until I was twenty-one, when I quit it 
 for several months, and the nocturnal emissions began. From my 
 twenty-first to my twenty-sixth year, I masturbated three or four 
 times a month, and would stop it for a few weeks, and again resume 
 it, until one year ago, when I ceased it altogether. For the past 
 six years I have had from three to four emissions a week, at times 
 having two during one night. They were always accompanied by 
 a voluptuous dream. I have two or three erections daily, but no 
 emission during the day, and, for the past six months, I .have 
 noticed that a few drops of fluid would ooze out after each stool, 
 especially if I happened to strain. I have never had connection 
 with a female. I do not feel badly after having an emission, but 
 get up ready for my work. I have a good appetite, sleep well, am 
 strong, and my bowels are regular." I may add that this patient 
 had a sensitive prostatic urethra, and that I circumcised him, and 
 divided a stricture seated just behind the meatus. 
 
 Cases like the preceding are exceptional, but, as I have 
 already intimated, it is a question of individual tolerance 
 and constitution, or vulnerability of the nervous system. 
 Hence persons who consult the physician in regard to 
 involuntary nocturnal losses should be informed that they 
 are natural ; and they should be impressed with the fact 
 that the emissions need not awaken concern unless they 
 are accompanied with unpleasant effects, or they have 
 occurred frequently for several years, as in the latter condi- 
 tion it will only require a little longer time for general 
 symptoms to manifest themselves. 
 
NOCTURNAL POLLUTIONS. 133 
 
 Nocturnal pollutions are abnormal or pathological when 
 they are followed by headache, backache, slight enfeeble- 
 ment of the functional powers of the brain, mental depres- 
 sion, and bodily or mental languor or lassitude ; when they 
 occur in married or single men who indulge in regular in- 
 tercourse ; when they take place without erections or 
 dreams, and the patient is only made aware of them by 
 the stains on his linen ; when they attend or follow acute or 
 chronic diseases ; when they are associated with diurnal 
 pollutions or spermorrhagia ; and when they are compli- 
 cated by one of the varieties of impotence. 
 
 All of the preceding conditions are very liable to be 
 attended with one of the varieties of impotence, which, 
 indeed, may be the only indication that the emissions are 
 pathological or one of the effects of impairment of the 
 functions of the lumbar cord. In men of apparently the 
 same amount of vigor and resistance, and in whom the 
 pollutions occur with equal frequency, the associated symp- 
 toms of nervous exhaustion var}^ very much in degree, or 
 they may be entirely absent. Thus, in Case VI., page 29, 
 in which the emissions occurred from one to five times a 
 week, the signs of neurasthenia were pronounced ; while 
 in Case XVI., page 39, as in Case XXXI., which was char- 
 acterized by an excessive number of pollutions, there was 
 not the slightest evidence of spinal weakness. In Case XL, 
 page ;^T), there were no general symptoms whatsoever; 
 while in Case XIV., page 35, the patient was a hypochon- 
 driac. In both, the emissions took place at the same in- 
 tervals. In the first of the following examples, which illus- 
 trate the same point, the man was in robust health ; while 
 in the second, although the patient evinced no outward evi- 
 dence of impaired health, the signs of myelasthenia were 
 
184 SPERMATORRHOEA. 
 
 marked. They are selected because they present many 
 points in common. 
 
 Case XXXII. A student of law, aged twenty-one, had mastur- 
 bated from his eleventh to his eighteenth year, and has suffered 
 from nocturnal emissions for the past three years, on an average, 
 three times a week. For the past five months he has had irrita- 
 bility of the bladder, and feeble erections with premature ejacula- 
 tions, for which he sought my advice. The lips of the meatus 
 were red and pouting, and I detected a stricture, calibre 13, at five 
 inches and a half from the meatus, along with great sensitiveness 
 from that point as far as the neck of the bladder. 
 
 Case XXXIII. A bookkeeper, twenty-one years of age, has 
 had nocturnal pollutions, which were not always accompanied by 
 voluptuous dreams, three times a week, on an average, for four 
 years ; and he had masturbated from his tenth to his seventeenth 
 year. On the following morning he felt greatly prostrated ; and 
 he constantly suffered from pains in the back, anorectal region, 
 and top of the head, vertigo, muscular weakness of the limbs, and 
 mental lassitude and depression. The prostatic urethra was ex- 
 cessively sensitive, but there was no stricture, and he passed pros- 
 tatic fluid when the bowels were constipated. 
 
 2. Diurnal Pollutions. — Ejaculation of semen when 
 the patient is awake is always morbid, and indicates a 
 condition of irritable weakness of the genital organs and of 
 the reflex centres which preside over them. In the lesser 
 phase of this variety an emission is due to slight peripheral 
 irritation, provoked by friction of the clothing, crossing of 
 the legs repeated several times, horseback exercise, driving 
 over rough streets, or even shaving, or combing the hair,' 
 or shampooing the head f while in the more aggravated 
 
 ^ Townsend, Elements of the Therapeutics, vol. ii. p. 399. London, 1799. 
 ^ Flint, Principles and Practice of Medicine, 5th ed., p. 938. 
 
DIURNAL POLLUTIONS. 135 
 
 form the ejaculation is induced by psychical irritation, as 
 reading libidinous books, the sight of indecent pictures, 
 lascivious ideas, or simply looking at a female. In the 
 former of these conditions there is a tolerable erection, but 
 the sensation is diminished ; in the latter the erection is 
 flabby, or the penis is flaccid, and there is little or no pleasure. 
 In five cases under my care the diurnal pollutions were 
 due, respectively, to thinking of women in one, to thinking 
 of women and looking at indecent pictures in one, to driv- 
 ing, bathing, and impure thoughts in one, to horseback 
 exercise and driving in one, and in one, the history of which 
 is subjoined, to various causes. All of the subjects were 
 rnasturbators who never suffered from gonorrhoea ; all were 
 affected with neurasthenia ; and all had hypersesthesia of 
 the urethra and from one to three strictures. Of these five 
 cases, the following is noteworthy : 
 
 Case XXXIV. A farmer, forty- five years of age, masturbated 
 daily from his twelfth to his twentieth year, and less frequently to 
 the age of twenty-four. On ceasing the habit, he began to be 
 troubled with nocturnal emissions, which, up to the date of his 
 marriage, six years before he consulted me, averaged two a week, 
 but had decreased in frequency since that time. The erections 
 were always weak, and ejaculation premature, occurring frequently 
 before intromission. Of late years the penis has been so sensitive 
 that the mere friction of the clothing in walking was frequently 
 sufficient to cause an erection with simultaneous emission. He 
 suffered from pain and a feeling of weight in the perineum and 
 back, muscular weakness of the limbs, vertigo, disturbed sleep, 
 constipation, and an anxious frame of mind in regard to his con- 
 dition, which had been aggravated by his wife, an amorous woman, 
 who constantly toyed with his genital organs. An elongated pre- 
 puce had been removed, and the meatus enlarged eight years 
 before I saw him. 
 
 On examination, I discovered a small and rigid penis, which was 
 
136 SPERMATORRHOEA. 
 
 SO sensitive to the touch that the slightest manipulation preparatory 
 to exploring the urethra was followed by an erection and an emis- 
 sion mixed with blood, which contained only a few spermatozoa. 
 A stricture, calibre 20, was detected two inches from the meatus, 
 and the urethra was so excessively tender that the bougie, on 
 reaching its prostatic portion, produced lividity of the face and an 
 epileptoid convulsion. Emissions subsequently took place on the 
 passage of the bougie; but, at the end of three months, under ap- 
 propriate treatment and division of the stricture, they had dis- 
 appeared. 
 
 3. Spermorrhagia. — In the third variety of the affection, 
 semen is constantly discharged without the occurrence of 
 the orgasm ; and its passive loss, v^hich is associated with 
 dilatation of the orifices of the ejaculatory ducts from atony 
 of their muscular fibres, may be the only sign of seminal 
 incontinence. The existence of this condition is denied by 
 some writers, but its occurrence cannot be questioned ; and 
 Case XXIL, page 94, in which the fluid brought away by 
 the bulbous explorer contained motionless spermatozoa, 
 and in which the discharge was increased by straining at 
 stool, and by toying with women without gratifying the 
 passions, affords a capital illustration of it. 
 
 Under this category should be included the condition in 
 which the semen is unconsciously discharged in the acts of 
 urination and defecation ; and it likewise depends upon 
 irritable weakness of the seminal vesicles and dilatation with 
 atony of the ejaculatory ducts. While in the majority of 
 instances, the fluid pressed out of the urethra in these ways 
 is derived from the prostate, the microscope discloses that 
 it is spermatic in a certain proportion of cases. Some 
 authors are sceptical in regard to the passage of semen with 
 the urine ; but its occurrence is attested, apart from older 
 
SPERMORRH AGIA, 137 
 
 observations, by five case recorded by Beard,' by two under 
 the care of Fiirbringer," by two reported by Black, ^ by 
 Case X., at page 32, and by the following additional in- 
 stances from my private notes : 
 
 Case XXXV. A clerk, twenty-eight years of age, had mastur- 
 bated freely for ten years, and for the past two years had diffi- 
 culty in acquiring an erection, although he still has sexual desire. 
 He is greatly depressed, easily fatigued, incapable of prolonged 
 mental exertion, and has a woe-begone expression. There is a 
 constant slight discharge of a clear, viscous fluid which causes the 
 lips of the meatus to adhere during the night, and he is convinced 
 that the urine contained semen. I found, on examination, that the 
 urine was highly acid, and contained a few motionless spermatozoa, 
 pus corpuscles, and crystals of oxalate of lime. Strictures, calibre 
 22, were detected at one-eighth of an inch and five inches from the 
 meatus, and the prostatic urethra was highly sensitive. 
 
 Case XXXVI. A physician, twenty-four years of age, who 
 had masturbated from his eighth to his sixteenth year, and who 
 had never contracted gonorrhoea, consulted me concerning a dis- 
 charge which for one year had escaped from the urethra at stool 
 and at the end of micturition. Minute examination of the fluid 
 revealed abundant normal spermatozoa, and strictures, calibre 26, 
 were found at two inches and a half and five inches from the 
 meatus, and the prostatic urethra was extremely sensitive. He had 
 lost flesh and strength, was incapacitated for mental exertion, was 
 depressed and apathetic, and suffered from pain in the back, tin- 
 nitus, and constant twitching of the muscles. Nocturnal emissions 
 occurred, on an average, at intervals of eight days. 
 
 In two of my cases dead spermatozoa were detected in 
 the urine, thereby constituting a condition which may be 
 
 ' Medical Record, 1879, PP- 73' 74- ^^'^ 55^; and 1880, pp. 507 and 508. 
 ^ Volkmann's Vortrage, No. 207, 1881, pp. 1835 and 1856. 
 ^ London Lancet, 1882, vol. ii. pp. 618 and 655. 
 
138 SPERMATORRHCEA. 
 
 called azoospermorrhagia, or the passive loss of infertile 
 semen, while in the third case living" elements were numer- 
 ous in the fluid discharged durino^ defecation and micturition. 
 In these examples the orifices of the ejaculatory ducts were 
 open and atonic from the localization in the prostatic ure- 
 thra of inflammation induced by masturbation, and the 
 subjects were neurasthenic. 
 
 Fiirbringer' has recently called attention to the fact that 
 spermorrhagia, with precisely similar local lesions, is fre- 
 quently induced by chronic gonorrhoea, the semen being 
 expressed from the seminal vesicles by lifting weights, 
 coughing, and sneezing, as well as by straining at stool or 
 in passing water, or by any other cause which brings about 
 increased intraabdominal pressure. Excluding all cases in 
 which semen might be accidentally mixed with the urine, 
 Fiirbringer has found spermatozoa, sometimes in large 
 numbers, in the urine of twenty-five out of one hundred 
 and forty cases of chronic gonorrhoea. This "latent" or 
 false spermorrhagia has nothing in common with neuras- 
 thenic spermorrhagia, save the local lesions ; it is not com- 
 plicated by impotence or sterility, nor is it associated with 
 disorders of the general health. 
 
 Clinical History. — Any one of the three forms of 
 spermatorrhoea may exist separately, but they gradually 
 pass into each other, and are variously intermixed in the 
 advanced grade of the affection. When the case goes on 
 from bad to worse, it usually pursues the following course, 
 in consequence of the increase in the mobility of the ejacu- 
 latory centre, and of the advancing exhaustion of the entire 
 nervous system. At first, abnormal frequency of the noc- 
 
 ^ Deutsche medicinische Wochenschrift, No. 42, 1886, p. 730. 
 
CLINICAL HISTORY. 139 
 
 turnal pollutions is associated with backache, headache, a 
 sense of painful muscular fatigue, and slight paresis of the 
 brain, as indicated by incapacity for any sustained mental 
 effort. With the increase in the number of the emissions, 
 the patient discovers that erections are becoming insuffi- 
 cient, and that ejaculation on coition is precipitate ; and the 
 general symptoms are aggravated by the addition of dul- 
 ness of perception, impairment of memory, vertigo, mental 
 dejection, weakness of vision, trembling of the limbs, palpi- 
 tation of the heart, shortness of breath, a sense of oppres- 
 sion in the chest, flatulence, constipation, and other dyspeptic 
 signs. Diurnal pollutions from slight mechanical or psy- 
 chical causes are now superadded, and the emissions occur 
 with little or no erection or pleasurable sensation, or even 
 when the penis is flaccid ; and intercourse is impracticable, 
 either from flabby erection or from anticipating ejaculation. 
 The general symptoms also are more serious. The patient 
 is liable to brood over his assumed lost virility, and the 
 mental depression verges upon or passes into a condition 
 of sexual hypochondrism. His gait is unsteady ; he is 
 subject to wandering neuralgic and rheumatoid pains ; the 
 hands and feet are habitually cold ; he passes restless or 
 sleepless nights ; shuns society ; fears to look one in the 
 face ; is utterly incapacitated for mental or physical exer- 
 tion ; and thinks of nothing but his sexual organs. With 
 the still further increase of the irritable weakness of the 
 genitalia and nervous system, the semen constantly oozes 
 out of the urethra, and its discharge is augmented during 
 defecation and micturition. The man is converted into a 
 confirmed hypochondriac, and if he comes from an insane 
 family, he lapses into insanity, not, however, because of the 
 seminal losses, but because of the disturbances of the 
 nervous system which lead to the emissions. A person 
 
140 SPERM ATORRHCEA. 
 
 who has inherited a tendency to insanity, epilepsy, ataxia, 
 or other nervous disorders, may, therefore, bring on those 
 affections, the first Hnk in the chain being functional troubles 
 of the nervous centres, which gradually pass into organic 
 disease, and are caused, according to my observations, in 
 rather more than nine-tenths of all cases, by masturbation. 
 
 Of the general symptoms which are associated with 
 abnormal seminal losses, and which indicate more or less 
 complete exhaustion of the brain and spinal cord, an 
 analysis of one hundred and seventy-five cases, of which I 
 have notes, indicates the following interesting facts in re- 
 gard to their importance and relative frequency. There 
 was an anxious or depressed condition of the mind in 
 seventy-two ; constant dwelling upon sexual matters in 
 seventy-two ; hypochondrism in fourteen ; mental dejec- 
 tion after intercourse or emission in sixty ; impairment of 
 memory in fifty-five ; incapacity for prolonged mental exer- 
 tion in sixty-eight ; headache in sixty-nine ; vertigo in 
 thirty; broken sleep in fifteen; insomnia in six; drowsiness 
 in eleven ; irascibility in two ; asthenopia, or muscae voli- 
 tantes, in thirty-one ; noises in the ears in twenty-six ; 
 muscular weakness of the limbs and fatigue in one hundred 
 and eighteen ; trembling of the limbs in ten ; temporary 
 reflex paraplegia in one ; pain in the back in ninety-five ; 
 oppressed breathing in seven ; pain in the chest in three ; 
 constipation in sixty-one; dyspepsia in forty; palpitation of 
 the heart in twenty-six ; subjective sensations of cold in 
 eleven, and of heat in four ; loss of flesh in nine ; and pallor 
 of the face in fifteen. 
 
 It will thus be perceived that constant occupation of the 
 mind with the sexual functions, mental dejection, impair- 
 ment of the memory, incapacity for mental work, headache, 
 vertigo, muscular weakness of the limbs, pain in the back, 
 
ETIOLOGY. 141 
 
 noises in the ears, and irritability of the eyes, constitute 
 the most common of the disturbances of the cerebrospinal 
 axis and of the special senses ; while, of the phenomena 
 referable to the circulatory, respiratory, digestive, vaso- 
 motor, and nutritive systems, palpitation of the heart, op- 
 pression of breathing-, constipation, indigestion, chilliness, 
 a feeling of elevated temperature, pallor, and emaciation, 
 are the most frequent. In six cases the presence of dark 
 spaces under the eyes formed the subject of grave appre- 
 hension. 
 
 A further analysis of the one hundred and seventy-five 
 cases shows that certain local sio-ns are connected with 
 seminal incontinence. There was feebleness of erection 
 with premature ejaculation in thirty-eight ; irritable weak- 
 ness in twenty-nine; total failure of erection in ten; elonga- 
 tion of the prepuce in thirty-nine; relaxation of the scrotum 
 in nineteen; irritable testis in nine; varicocele in six; 
 hemorrhoids in five ; coldness of the genitalia in eight ; a 
 feeling of heat in the genitalia in three ; painful ejaculation 
 on intercourse in three ; bloody ejaculation in one ; and 
 irritability of the bladder in eight. In fourteen examina- 
 tions of the semen furnished by patients suffering from 
 an aggravated form of the malady, I found that fluid to be 
 water}-, and that in four the spermatozoa were small, mo- 
 tionless, and variously deformed, and, therefore, incapable 
 of impregnating the ovum. As the changes which the 
 semen undergoes in spinal exhaustion have been so fully 
 considered in the section on azoospermism, they need only 
 be referred to in this connection. 
 
 Etiology. — Spermatorrhoea is not a distinct affection, 
 but one of many symptoms of general and local lesions, or 
 of both combined. In the vast majority of instances it 
 
142 SPERMATORRHCEA. 
 
 must be regarded as a motor neurosis, or a functional 
 derangement of the nervous S3^stem, which is indicated by 
 increased susceptibiHty of the brain and cord, or feebleness 
 of their powers of resistance to acts which in healthy per- 
 sons would not be productive of evil consequences. Like 
 other neuroses, it may be the result of congenital predis- 
 position, when it is liable to be observed in several mem- 
 bers of the same family through several generations. 
 Under these circumstances, the subject is of a nervous, 
 excitable, or irritable temperament ; and he probably suf- 
 fered during his infancy from nocturnal incontinence of 
 urine, as was first pointed out by Trousseau," of which the 
 following example is a marked illustration : 
 
 Case XXXVII. A physician, fifty years of age, consulted me, 
 March 14, 188 1, on account of nervous exhaustion, seminal losses, 
 and dread of impotence. Up to his tenth year he was troubled 
 with nocturnal enuresis. He was a close student at college ; and 
 at the age of eighteen began to have nocturnal emissions, and his 
 mind dwelt constantly on sexual ideas ; but he never masturbated. 
 Up to the time he saw me, or for thirty-two years, the emissions 
 varied from one to three a week ; but he did not evince any special 
 signs of neurasthenia for several years after their commencement, 
 when he observed that he was constantly drowsy, and that he was 
 very restless, particularly in crowded assemblies and at social enter- 
 tainments. He soon became easily fatigued, and was incapable of 
 bodily exertion, and his brain was unequal to prolonged work. 
 Three years ago he abandoned the practice of his profession, and 
 during a visit to Europe, in the summer of 1880, he had a mild 
 attack of reflex paraplegia, which followed a sudden rush of blood 
 to the head. He never had sexual intercourse. He has an erec- 
 tion nearly every morning, but the gland of the penis is rather 
 flabby, and he notices that the lips of the meatus are glued together 
 
 ' Op. cit., t. ii. p. 636. 
 
ETIOLOGY. 148 
 
 by a slight gleety discharge. The prepuce is somewhat long ; 
 there is a stricture, calibre 22, one-third of an inch behind the 
 meatus; the prostatic urethra is highly sensitive; there is a large 
 varicocele of the left side; and there is a tendency to irritability 
 of the bladder. 
 
 Among the predisposing- causes may be mentioned erotic 
 ideas. When constantly and involuntarily indulged in, 
 even when the patient does not practise natural or un- 
 natural acts, as in the preceding case, they constitute a 
 pov\^erful factor in the production of irritation of the genital 
 organs and of reflex impressibility of the centres which 
 preside over them. 
 
 Seminal incontinence is usually acquired, and is due in 
 the great majority of instances to masturbation. Thus of 
 the one hundred and seventy-five cases of which I have a 
 record, in only one was it the result of an inherited predis- 
 position. Of the remaining examples, in one hundred and 
 fifty-three it was traceable to onanism ; in seven it arose from 
 gonorrhoea ; in eleven it was met with in men who had 
 masturbated, suffered from gonorrhoea, and had indulged 
 their propensities in various ways ; in one it was due to 
 toying with women ; and in three the cause was obscure. 
 One hundred and fifty-four were single, eighteen were 
 married, and three were widowers. Twenty-two cases oc- 
 curred before the age of twenty ; one hundred and three 
 between twenty and thirty ; thirty-six between thirty and 
 forty ; and fourteen between forty and fifty-four. All of 
 the married men were given to sexual excesses ; and 
 although four stated that they were not addicted to mas- 
 turbation early in life, I believe that marital sexual excess 
 is generally the natural result of a previously vicious habit. 
 In only one case of this class did the emissions come on 
 
144 SPERMATORRHCEA. 
 
 subsequent to marriage. In the remaining seventeen, 
 they were present both before and after marriage. Of 
 the one hundred and fifty-three masturbators, all except 
 twenty-six had one or more strictures ; and the remaining 
 twenty-two patients were, with a single exception, affected 
 in the same way. In only eleven cases was decided hyper- 
 aesthesia of the urethra absent; so that this condition is 
 rather less frequent in case-s of spermatorrhoea than in 
 cases of impotence, in which, as has been pointed out on 
 page 2 1, it was wanting in twelve cases out of two hundred 
 and sixty. 
 
 Under the influence of erotic ideas, masturbation, sexual 
 excesses, or unsatisfied sexual excitement produced by toy- 
 ing with females, exaggerated irritability of the genital 
 organs is induced, and is soon followed by chronic or sub- 
 acute inflammation and hypersesthesia of the prostatic por- 
 tion of the urethra, which culminate, in bad cases, or in 
 those characterized by diurnal pollutions and spermor- 
 rhapfia, in dilatation and relaxation of the orifices of the 
 ejaculatory ducts. As the natural result of their constant 
 excitability, the nerves distributed to the prostatic urethra 
 are alive to the slightest impressions. This condition in- 
 duces increased mobility or irritability of the reflex cere- 
 bral and spinal genital centres, through which the motor 
 nerves which supply the ejaculatory apparatus are 
 thrown into action, and an emission follows. This, it 
 seems to me, is the rational explanation of seminal in- 
 continence. 
 
 Involuntary seminal losses are also met with during con- 
 valescence from or during the progress of certain acute and 
 chronic diseases which are characterized by disturbances, 
 or exhaustion, of the nervous system. Thus, it may be 
 
ETIOLOGY. 145 
 
 symptomatic of variola or phthisis,' typhus,^ progressive 
 muscular atrophy and commencing bulbar paralysis, ^ of 
 paraplegia,'* and of locomotor ataxia, ^ in the last of which 
 affections Hammond^ has recorded an example of eight 
 nocturnal pollutions in a night. Chronic alcoholism also 
 predisposes to their occurrence ; and MitchelP describes a 
 case in which they seemed to be due to the habitual use 
 of opium. I have myself met with a case in which the 
 emissions set in during an attack of typhoid fever ; but as 
 the man had a phimosis, and had been a masturbator, I am 
 inclined to believe that his illness served simply to increase 
 a preexisting weak condition of the spinal genital centre. 
 From the great rarity with which nocturnal emissions have 
 been observed in the diseases mentioned above, I have 
 no doubt that urethral lesions were present in the cases 
 here cited. 
 
 Of the local causes of spermatorrhoea, by far the most 
 common are hyperaesthesia and chronic inflammation of 
 the prostatic portion of the urethra, which are generally 
 induced by masturbation ; and these morbid conditions are 
 just as important in its production as they are in the causa- 
 tion of impotence. In the vast majority of cases they con- 
 stitute the original source of the trouble, and tend not only 
 to excite reflex emissions, but also to maintain the disorder 
 by keeping the mind occupied with sexual matters. Even 
 in cases in which the affection would seem to depend upon 
 
 ' Curschmann, loc. cit., p. 867. 
 '■^ Nowatschok, Wiener med. Presse, 1879, P- 1067. 
 ^ Stephanides, ibid., p. 9^13. 
 
 * Roberts, Canada Med. Record, vol. vii. p. 253. 
 
 '" Erb, op. cit., pp. 543 and 585; Trousseau, op. cit., p. 510; and Topinard, 
 De I'Ataxie Locomotrice, p. 171. 
 
 ^ Treatise on the Diseases of the Nervous System, 6th ed., p. 593. 
 ' Amer. Med. Monthly, vol. xv. p. 285. 
 
 10 
 
146 SPERMATORRHOEA. 
 
 Other local lesions, they are almost invariably present, so 
 that associated disorders of the penis, the urethra, or the 
 rectum merely act by intensifying them. In a few cases it 
 is true that the hyperaesthesia is not marked, and that other 
 abnormal states, as a congenital contraction of the meatus, 
 are sufficient to excite reflex contraction of the seminal 
 vesicles ; but in these instances it is scarcely possible that 
 local conditions would induce the trouble in persons who 
 were not predisposed to it. Hence, I think that no case 
 should be treated without a preliminary examination of the 
 urethra, which seems to be omitted by physicians in gen- 
 eral, and by many surgeons. 
 
 Of the local exciting causes phimosis, in the form of 
 redundancy of the prepuce, is probably one of the most 
 common, and acts as a source of reflex irritation by keeping 
 the gland moist, or by retaining the smegma. Not only is 
 the prepuce elongated, but in many cases it will be found 
 to constrict the gland when the penis is erect, a point which 
 should always be looked into, as it has an important bear- 
 ing upon the treatment. Herpes of the prepuce, which is 
 far less frequently met with than the preceding condition, 
 is another cause : so also is congenital shortness of the 
 frenum, as in a case recorded by Heulard Darcy.' 
 
 Of the conditions which relate to the urethra, the most 
 important are congenital narrowing of the meatus,^ which 
 I have seen in sixteen cases, and organic stricture, seated 
 near the orifice, of which I have met with many examples. 
 ZeissP has quite recently declared that spasmodic stricture 
 is a cause of very frequent pollutions. In a unique case 
 
 1 Virchow-Hirsch's Jahresbericht, 1866, Bd. ii. p. 169. 
 ''■ Hicquet, Canstatt's Jahresbericht, i860, Bd. iii. p. 225. 
 •'* Med. News and Library, January, 1881, p. 41. 
 
ETIOLOGY. 147 
 
 recorded by Genaudet,' the removal of a polyp from the 
 prostatic portion of the urethra was followed by the cessa- 
 tion of the nocturnal emissions. 
 
 Acute inflammation of the seminal vesicles is attended 
 with frequent and painful, and it may be with bloody, 
 pollutions. In an instance of chronic inflammation of these 
 bodies under my care, the discharge was usually of a 
 yellowish tint from the admixture of pus, and decidedly 
 bloody when the pollutions followed each other in quick 
 succession. In cases of this description the seminal losses 
 are due to hyperaesthesia of the mucous membrane of the 
 vesicles, so that the trouble is analogous to incontinence 
 of urine from morbid sensibility of the lining membrane 
 of the bladder. Liegeois^ states that epididymitis is a 
 fruitful source of nocturnal emissions. 
 
 Among other exciting causes of spermatorrhoea may 
 be mentioned diseases of the rectum and anus, as piles, 
 ascarides, fissures, pruritus, and painful eruptions; and 
 Perrin^ has recorded a case in which nocturnal pollutions 
 were induced by the cauterization of internal hemorrhoids. 
 As the rectum and anus are supplied by the same nerves 
 as are distributed to the genitalia, it is not surprising that 
 the reflex ejaculatory centre should respond to an impulse 
 transmitted from them. The same statement is true of 
 certain aflections of the bladder. Habitual constipation 
 may also excite emissions through the increased intra- 
 abdominal pressure exerted upon the seminal vesicles 
 during the evacuation of hardened feces ; but this is 
 observed only when the orifices of the ejaculatory ducts 
 are dilated and paralyzed. The fluid which escapes from 
 
 ^ Virchow-Hirsch's Jahresbericht, ut supra, p. 163. 
 
 ^ Loc. cit., p. 512. 
 
 ^ Canstatt's Jahresbericht, 1857, p. 301. 
 
148 SPERMATORRHCEA. 
 
 the urethra of heakhy men, under these circumstances, is 
 not seminal, but it is usually derived from the prostate. 
 
 Anatomical Characters. — The morbid appearances 
 which belong to spermatorrhoea in its early stage are utterly 
 unknown so far as their verification by post-mortem exami- 
 nation is concerned. That the exaltation of the sensibility 
 of the urethra depends upon subacute or chronic inflamma- 
 tion of its mucous membrane, particularly in the region of 
 the verumontanum, is rendered certain by the concomitant 
 local symptoms, by exploration with the endoscope and the 
 sound, aided by the finger in the rectum, and by the results 
 of treatment. In seven aggravated cases, of which two 
 are recorded by Lallemand,' one is narrated by Curling,^ 
 and four are collated by Kaula,^ there was a stricture in 
 four, injection of the mucous membrane of the deep por- 
 tion of the urethra in two, dilatation of the orifices of the 
 ejaculatory ducts in six, combined with excoriation in two, 
 ulceration in two, and enlargement of the canals themselves 
 in one, suppuration of the prostate in four, suppuration 
 of the seminal vesicles in three, and chronic inflammation 
 of those bodies in two. 
 
 So far as I am aware, there have been no examinations 
 of the nervous centres connected with the genital organs 
 in spermatorrhoea, so that it is impossible to say whether 
 they are the seat of structural lesions. In a case of para- 
 plegia induced by sexual excesses, however, Sir William 
 Gulk was unable to detect the slightest chang-e in the cord. 
 The common view, that the cells which minister to the 
 
 ' 0|). cit., Phila., 1858, pp. 37 and 42. 
 
 ^ Op. cit., 4th ed., p. 492. 
 
 ^ Dela Spermatorihee, These de Paris, 1846, pp. 167-173. 
 
 * Guy's Hosp. Reports, 1858, p. 175. 
 
DIAGNOSIS. 149 
 
 functions of the cord are completely exhausted is, therefore, 
 probably correct. 
 
 Diagnosis. — The only mode of determining whether the 
 fluid which constantly moistens the urethra, is discharged at 
 stool or with the urine, or is brought away by the bulb of 
 the explorer, is seminal in its character, is to examine it 
 under the microscope with a power of about four hundred 
 diameters, with the view of discovering spermatozoa. 
 Should they be found, there need be no doubt as to its true 
 nature ; but it must be remembered that their absence is 
 not an evidence that the case is not one of spermatorrhoea, 
 since, as I showed at page 90, the exhausted sexual appa- 
 ratus in aggravated examples furnishes a water)' fluid which 
 may be devoid of fertilizing elements. Under these cir- 
 cumstances the history of the case, and the associated 
 general symptoms are to be considered in framing the diag- 
 nosis ; and this is particularly true of the examples in which 
 a discharge is expressed at stool, and which in the majority 
 of instances is merely the secretion of the prostate gland. 
 Under the microscope the thin, more or less milky prostatic 
 fluid will be found to contain cylinder epithelium, number- 
 less colorless and refractino- oranules of lecithin, one-half 
 the diameter of a red blood-corpuscle, and minute concen- 
 tric amyloid concretions ; and spermatic cr)'stals will soon 
 make their appearance on the slide ; while the thin, trans- 
 parent, azoospermous semen contains cylinder epithelium, 
 and probably epithelium which has undergone fatty or col- 
 loid degeneration, a few lymph corpuscles, and abundance 
 of fatt)' detritus, and possibly a few small shining bodies 
 which are the remains of badly evolved spermatozoa. 
 
 In the absence of minute examination, the rule may be 
 framed that the dischargre which occurs durine defecation 
 
160 SPERMATORRHCEA. 
 
 in persons who are laboring merely under too frequent 
 nocturnal pollutions is an evidence of coexisting prostator- 
 rhoea ; while the flocculent sediment contained in the urine, 
 and the discharge at stool in persons who are suffering from 
 nocturnal and diurnal pollutions, and a slight continued 
 discharge from the urethra represent semen. In the last 
 case, the assumption that the orifices of the ejaculatory 
 ducts are relaxed will generally be correct, and it will be 
 strengthened if the patient is impotent. 
 
 Prognosis. — According to my experience, the prognosis 
 of seminal incontinence is far from being so unfavorable as 
 man)' writers would lead one to believe. In regard to in- 
 creased frequency of nocturnal emissions, the phase of the 
 affection about which the physician is most frequently con- 
 sulted, I have no hesitation in declaring that it yields readily 
 to treatment, particularly when it is caused or kept up by 
 appreciable local lesions, such as hyperaesthesia of the pros- 
 tatic urethra, stricture, or hemorrhoids. The subject of 
 Case XVI., page 39, is an excellent and not uncommon 
 illustration of the truth of this statement. The pollutions 
 had been excessive for two years, and were complicated by 
 prostatorrhoea and a mild grade of impotence. On the 8th 
 of April, I divided a stricture which was seated just behind 
 the meatus, and ordered thirty grains of bromide of potas- 
 sium to be taken at intervals of eight hours, along with 
 one-sixtieth of a grain of atropia at bedtime, and a laxative 
 pill as it might be required. 
 
 On the 6th of May, a No. 30 conical steel bougie having 
 been passed at stated intervals to overcome the morbid 
 sensitiveness of the prostatic urethra, the patient reported 
 that he had emissions on the nights of April 17 and 18 ; 
 and four weeks later he informed me that he had a pollu- 
 
PROGNOSIS. 151 
 
 tion on the 2 2d of May. Equally rapid and gratifying 
 results were obtained in the following example : 
 
 Case XXXVIII. A teacher, twenty-four years of age, had 
 masturbated up to five years ago. He then began to be troubled 
 with nocturnal emissions, which frequently occurred for five con- 
 secutive nights, when there would be an interval of freedom for 
 ten days. For the past two years the erections have been flabby, 
 and ejaculation has been premature; but with the exception of pain 
 in the back, there have been no other signs of spinal exhaustion. 
 The urethra has been very sensitive, but there has been no stric- 
 ture. The measures employed were the same as those resorted to 
 in the preceding case, with the addition of a hot sitz-bath at night. 
 He was ordered to be awakened early in the morning, with the 
 view to empty his bladder. The lumbar pain ceased after the 
 fourth insertion of the bougie ; and when I saw him, three weeks 
 subsequently, he told me that he had been entirely free from pollu- 
 tions. 
 
 Of the local lesions causative of nocturnal pollutions, by 
 far the most rebellious to treatment which I have encoun- 
 tered is chronic inflammation of the seminal vesicles, of 
 which the followinor is an instance : 
 
 o 
 
 Case XXXIX, A man, twenty-two years of age, contracted 
 gonorrhoea, which extended to the vesicles, where it set up acute 
 inflammation. When he came to me, the acute signs had subsided, 
 and for three months he had had painful pollutions, which fre- 
 quently occurred two or three times during the night, when they 
 left a yellowish-red stain upon his linen. There was a constant 
 sense of fulness and bearing-down pain in the rectum. The suffer- 
 ing was increased by urination, defecation, and erections. The 
 rectal touch disclosed two ovoidal, hot, and very tender bodies 
 in the region of the vesicles ; and there was a discharge of muco- 
 purulent fluid from the urethra. Under sedative measures, and the 
 local application of astringent solutions to the prostatic urethra. 
 
152 SPERM ATORRHCEA. 
 
 and of flying blisters to the perineum, I succeeded, after the ex- 
 piration of seven months, in reducing the number of pollutions to 
 one a week; and when I last saw him, three months afterwards, 
 he had not had an emission for thirty days. 
 
 With the above exception, when the pollutions are main- 
 tained by local lesions, and are associated with signs of 
 myelasthenia, the prognosis is good, but the patient will 
 have to remain longer under treatment than when signs of 
 nervous exhaustion are absent. The outlook is still favor- 
 able when symptoms of cerebrasthenia are present ; but it 
 is decidedly bad if the subject is a sexual hypochondriac. 
 Even when the emissions occur during the progress of acute 
 or chronic general affections, the prognosis is not dismal, 
 since I find that, in a case of progressive muscular atrophy 
 and commencing bulbar paralysis, Stephanides succeeded in 
 checking them by the internal exhibition of atropia, and 
 that Nowatschek was equally successful with the same 
 remedy in an example of an aggravated form of sperma- 
 torrhoea, the result of typhus. 
 
 The prognosis is far better when the usual local lesion, 
 namely, hypersesthesia of the prostatic urethra, has been 
 induced by gonorrhoea than when induced by masturbation ; 
 and it is also more favorable when the emissions occur in 
 mature years from sexual excesses than when they are due 
 early in life to onanism, especially if the youthful subjects 
 evince a tendency to inherited nervous disorders. 
 
 The outlook is favorable when the pollutions occur during 
 the day, or when the patient is awake, and when they are 
 excited by slight mechanical or psychical causes, as is illus- 
 trated by the following case ; 
 
 Case XL. A merchant, thirty-eight years of age, consulted 
 me on the i6th of October, 1883, on account of diurnal pollu- 
 
TREATMENT. 153 
 
 tions, of eighteen years' standing, induced by riding, by impure 
 thoughts, and even by bathing, and complicated by nocturnal 
 emissions. The urethra was hyperaesthetic, particularly in its 
 prostatic portion, the meatus was contracted, and a stricture was 
 detected immediately behind it. The stricture and meatus were 
 divided ; conical steel bougies of gradually increasing sizes were 
 methodically passed, and bromide of potassium, was administered 
 for five weeks, when it was followed by the fluid extract of ergot 
 for three weeks. The pollutions finally ceased, and the man mar- 
 ried three months after he first came under observation. 
 
 Treatment. — In all cases of involuntary seminal emis- 
 sions certain hygienic and moral rules must be observed. 
 The diet should be nutritious and digestible, the evening 
 meal in particular being light and dry, and all stimulating 
 articles of food, as well as spirituous and malt liquors, 
 should be avoided. Before retiring, the bladder is to be 
 thoroughly emptied, and the habit of sleeping on the side 
 upon a hair mattress without much covering should be 
 cultivated. As the morning fulness of the bladder has a 
 very decided tendency to induce erections, and as emissions 
 usually occur in the morning, the patient should set an 
 alarm clock one hour before the time at which he has usu- 
 ally observed that the pollutions take place, in order that 
 he may be awakened to relieve that viscus of its contents. 
 Horseback exercise and drivinof over rouo^h roads should 
 be interdicted. Masturbation, in which if the man be single 
 he still in all probability indulges, and sexual intercourse 
 must be abandoned, and the patient should be told that this 
 enforced rest of the organs will possibly result in temporary 
 increased frequency of the pollutions. Everything calcu- 
 lated to excite erotic thoughts and desire should be scrupu- 
 lously avoided. With this end in view, he should keep the 
 mind and body pleasantly occupied ; and if he happens to 
 
154 SPERMATORRHCEA. 
 
 belong to the class of society that has nothing to do, and if 
 he is still robust and vio-orous, he should have recourse to 
 gymnastic exercises, or to the close study of any subject 
 which he may most fancy. If, on the other hand, there are 
 commencing or marked signs of spinal exhaustion, mental 
 and physical moderation should be enjoined. 
 
 An essential part of the treatment is the removal of any 
 reflex or eccentric lesions or causes which predispose to the 
 occurrence of seminal losses, or even excite them in im- 
 pressible subjects. Hence, the external genitalia and the 
 anus and the rectum should be subjected to a careful ex- 
 amination. In many cases without the presence of a posi- 
 tive phimosis the redundant prepuce keeps the sensitive 
 gland of the penis constantly moist, and favors the collec- 
 tion of sebaceous matter. The latter condition is very 
 common amongf the lower classes, and whether circumcision 
 be resorted to or not, and I always advise it, the greatest 
 cleanliness should be enjoined. Herpes of the prepuce and 
 gland usually readily yields to attention to the bowels and 
 diet, and to dusting the parts with subnitrate of bismuth 
 and calomel, or to touching the excoriations, if they should 
 exist, with a five-grain solution of nitrate of silver, and 
 dressing them afterwards with scraped lint. If the meatus 
 be contracted, or if a stricture be seated behind that orifice, 
 it should be divided ; and a short frenum should be clipped 
 with the scissors. Internal oiles should be li^ated ; external 
 piles be opened ; rectal fissure be divided or lacerated by 
 overstretching the sphincter ; and pruritus be remedied by 
 cleanliness and the application of four grains of the bichlo- 
 ride of mercury to the ounce of water, or three grains of 
 the C3^anide of potassium to the ounce of balsam of Peru. 
 A varicocele, between which and spermatorrhoea, however, 
 I see no causal relation, should be properly suspended, or 
 
TREATMENT. 155 
 
 be subjected to subcutaneous ligation if it be large and 
 annoying. Habitual constipation, which is met with in one- 
 third of the cases, demands particular attention. If there 
 is atony of the intestines, the compound aloin pill, for which 
 the formula is given on page 51, will answer a good pur- 
 pose. In the majority of cases enemata of temperate water 
 will fulfil the indication ; or the patient may take two or 
 three drachms of equal parts of Rochelle and Epsom salt 
 in a tumbler of water before breakfast, or four ounces of 
 Hunyadi or Friedrichshall water, or of an artificial mineral 
 water composed of an ounce of sulphate of magnesium, a 
 drachm of bitartrate of potassium, and ten grains of sul- 
 phate of iron to a quart of water. This was a favorite 
 remedy of the late Professor Dunglison, and I can bear 
 testimony to its efficacy. 
 
 Of the exciting causes of abnormal seminal losses by far 
 the most constant and important are subacute or chronic 
 inflammation and hyperaesthesia of the prostatic portion of 
 the urethra and of the orifices of the ejaculatory ducts, con- 
 ditions which are frequently maintained and aggravated by 
 stricture of the passage anterior to them. Of the treat- 
 ment of stricture I can only refer to my views published 
 elsewhere,' as its consideration would be out of place here; 
 but I may add that, although the stricture may be palliated 
 by dilatation, and although the emissions may entirely 
 cease under the employment of that measure, the}' will be 
 sure to recur unless the bougie is methodically employed 
 duringr the remainder of life. 
 
 With regard to the inflammation and exaggerated sensi- 
 bility and irritability of the prostatic urethra, I need only 
 say that the general and local measures for their relief do 
 
 ^ Consult p. 43. 
 
156 SPERM ATORRHCEA. 
 
 not differ in any respect from those indicated in the chapter 
 on Impotence, pages 41-52. 
 
 In all cases of seminal incontinence, with rare exceptions, 
 the remedies at the outset should be directed to over- 
 coming the sensibility of the mucous membrane of the 
 urethra, of the ejaculatory ducts, and of the seminal vesi- 
 cles ; to subduing the irritability of the muscles concerned 
 in ejaculation ; and to diminishing the reflex excitability of 
 the genitospinal centre. Hence, they should be of a calm- 
 ing and sedative nature. By the ignorant and indiscrim- 
 inate employment of strychnia, cantharides, phosphorus, 
 damiana, and cold sitz-baths or affusions during the stage 
 of hyperaesthesia, much harm is done, and the therapeutics 
 of spermatorrhoea are brought into disrepute. Premising 
 the statement that the tonic should follow the sedative plan 
 of treatment, I will now give an oudine of my views as to 
 the best management of the varieties of the affection. 
 
 Under all circumstances, thirty grains of bromide of 
 potassium, along with about ten drops of the fluid extract 
 of gelsemium,' every eight hours, and one-sixtieth of a grain 
 of sulphate of atropia' on retiring, are worth all the other 
 internal remedies combined. In anaemic subjects, the bro- 
 mide may be administered at night, and quinine and iron 
 be exhibited during the day ; but if the bromide be badly 
 borne, it should be guarded in the manner which is indi- 
 cated on page 50, or it may be replaced by about the one- 
 seventieth of a grain of hydrobromate of hyoscine, or twenty 
 grains of chloral hydrate, on retiring. Not only does 
 atropia diminish the reflex mobility of the genitospinal 
 centre, but the researches of Keuchel, Heidenhain, and 
 
 1 Bartholow, op. cit., p. 415. ^ Consult page 50. 
 
TREATMENT. 157 
 
 Strieker and Spina,' show that it paralyzes the movements 
 of the cells of the acinous glands and checks their secre- 
 tion, so that it cannot be dispensed with. 
 
 Of the local remedies, the conical steel bougie^ occupies 
 the first rank ; but when the inflammation and tenderness 
 are reduced to a circumscribed area which, includes the 
 openings of the ejaculatory ducts, it should give way to the 
 application of nitrate of silver,^ a remedy which is usually 
 decried by physicians who appear to have no practical 
 experience with medication of the urethra, but which is 
 highly recommended by such men as Trousseau,"* Nie- 
 meyer,-' C. Handheld Jones, ^ and Rosenthal,^ and by the 
 most eminent surgeons. In addition to these measures, 
 the hot sitz-bath® is invaluable ; and Harrison^ advises 
 douching the lower part of the spine with water at the 
 temperature of 120° F. 
 
 Under this course of treatment, the majority of cases of 
 nocturnal pollutions recover ; but it may happen that the 
 reflex genital centre is still too impressible, in which case 
 galvanization, '° with the anode to the lumbar region and the 
 cathode to the perineum," will prove highly serviceable. 
 
 After the hyperaesthetic symptoms have subsided, if, from 
 the occurrence of diurnal pollutions and of spermorrhagia, 
 there is reason to suspect dilatation and atony of the m( ;uths 
 of the ejaculatory ducts, the continuous current, with the 
 negative reophore in the rectum, and the positive on the 
 
 ^ Rosenthal, Wiener Klinik, May, 1880, p. iGi. 
 
 ^ Consult page 41. '' Consult page 44. 
 
 * Op. cit., t. ii. p. 643. 
 
 ° Text-Book of Practical Medicine, New York, 1870, vol. ii. p. 100. 
 ® Functional Nervous Disorders, p. 733. 
 
 ^ Loc. cit., p. 162. ® Consult page 51. 
 
 ^ Op. cit., p. 62. '" Consult page 54. 
 
 " Benedikt, Elektrotherapie, p. 466. 
 
158 SPERM ATORRHCEA. 
 
 perineum or the lumbar vertebrae, affords the most strik- 
 ing results. This plan is recommended by Mobius ;' and 
 in one case I succeeded in affording relief in twenty days 
 by twelve sittings. Should galvanization prove inadequate, 
 the induced current may be passed through a negative 
 catheter electrode in the prostatic urethra to the anode 
 placed on the perineum or spine ; but this mode of appli- 
 cation requires great caution," and care should be taken to 
 employ a feeble power at the commencement. Hence I 
 prefer, with Ultzmann,^ Rosenthal,'* and Mobius, to replace 
 the urethral by the rectal reophore. In the absence of 
 electrical apparatus, the tonicity of the muscles of the ejacu- 
 latory ducts may be greatly improved and even restored 
 by the use of the psychrophor,^ by the application of nitrate 
 of silver, and by cold sitz-baths,'' and the dashing of cold 
 water against the perineum. In these cases of relaxation 
 and atony of the ducts, ergot, which, if I do not mistake, 
 was first employed by Mitchell,^ of New York, is also indi- 
 cated, half a drachm of the fluid extract being administered 
 in water after each meal ; and strychnia should also be 
 given in gradually increasing doses. Fifteen drops of a 
 mixture composed of six drachms of tincture of chloride of 
 iron and two drachms of tincture of cantharides will also 
 prove serviceable. With the curious device of Trousseau,^ 
 namely, an ivory or vulcanite plug inserted into the rectum, 
 I have had no experience, nor does it appear to have met 
 with favor. The same writer refers to Richard's good re- 
 sults from forcible dilatation of the anus ; and I can readily 
 imagine that it would be productive of benefit, if there was 
 
 1 Memorabilien, Heilbronn, 1879, 24, p. 545- 
 ■ '^ Consult page 55. ^ Wiener med. Presse, 1876, p. 641. 
 
 * Loc. cit.,.p. 162. ^ Consult page 53. 
 
 " Consult page 53. '^ Amer. Med. Monthly, April, 1861, p. 282. 
 
 ® Op. cit., t. ii. p. 645. 
 
TREATMENT. 159 
 
 spasm of the sphincter. Of the operation of castration, 
 which some patients demand, and which some surgeons are 
 weak enough to perform, I have only to say that I deem it 
 unscientific and barbarous. 
 
 When spermatorrhcea is incident to organic lesions of the 
 cerebrospinal axis, or to convalescence from debilitating 
 diseases, the treatment is that of the affection itself, with 
 the addition of atropia and of bromide of potassium, if the 
 latter remedy is not contraindicated. 
 
 To sum up the results of my experience in the manage- 
 ment of abnormal seminal losses, I may add that the steel 
 bougie, bromide of potassium, and atropia are especially 
 adapted to cases of nocturnal emissions, and that electricity, 
 ergot, and strychnia are the most reliable agents in diurnal 
 pollutions and spermorrhagia. 
 
 After recovery, moderation in sexual intercourse should 
 be enjoined if the patient is married ; matrimony should be 
 advised if his circumstances and inclinations warrant it ; 
 and continence in thought and in action should be observed 
 if he remains single. Under no consideration should mar- 
 riage be thought of until the urethral lesions have been 
 subdued, and the pollutions materially diminished in fre- 
 quency. I have met with many cases in which, acting upon 
 the advice of their physicians, patients have regretted such 
 an action, and their lives been rendered miserable from the 
 fact that not only did the emissions not cease, but the 
 sexual excitement to which they were subjected aggravated 
 the weakness of the genitospinal centre, through which 
 one of the varieties of impotence was superadded to the 
 original trouble. 
 
CHAPTER IV. 
 
 PROSTATORRHCEA. 
 
 Prostatorrhcea, an affection which was first described 
 by S. D. Gross/ signifies a discharge from the urethra of 
 the secretion of the prostate gland, especially after defeca- 
 tion and micturition. It may exist with or without inflam- 
 mation of the prostate, representing in the former event a 
 catarrh, and in the latter merely a hypersecretion of the 
 tubular glands of that organ, I believe that the malady is 
 generally due to passive congestion ; and I am certain that 
 it does not follow an attack of acute inflammation of the 
 prostate. 
 
 In the majority of examples prostatorrhcea is a complica- 
 tion of other disorders of the generative organs. Thus, of 
 seventy-nine cases of which I have notes, in only twenty- 
 one did it exist alone ; while it was associated with nocturnal 
 pollutions in five, of which Case XXXIII., p. 134, is an 
 illustration ; with emissions and various grades of impo- 
 tence in thirty-one, of which Case XVI., p. 39, is an instance ; 
 with impotence alone in twenty ; and with aspermatism in 
 two, as in Case XXX., p. 121, Hence my account is 
 limited to the disease in its pure form. 
 
 Etiology. — Of the twenty-one cases, two began at the 
 age of eighteen, thirteen between twenty and thirty, five 
 between thirty and forty years, and one at forty-six ; while 
 
 ^ North American Med.-Chir. Rev., July, i860, p. 693. 
 
ETIOLOGY. 161 
 
 eighteen of the subjects were single, and three were mar- 
 ried. In thirteen it was due to masturbation, in five to 
 the extension of gonorrhoea! inflammation, in one to mas- 
 turbation and gonorrhoea, and in two to onanism practised 
 early in life and to marital sexual excesses. In all there 
 was exaggerated sensibility of the prostatic portion of the 
 urethra, which was complicated by spasm of the compressor 
 urethrae muscles in two, and by stricture in nineteen. In 
 eight there was one coarctation, which was seated within 
 the first half an inch of the canal in six, and in the bulb in 
 two ; in ten two strictures were detected, of which the first 
 was near the meatus, and the second was in the bulbous 
 urethra in nine, and at the penoscrotal junction in one ; 
 and in one there were three strictures, which were seated, 
 respectively, just behind the meatus, at two inches and a 
 half from the meatus, and in the bulbous urethra. 
 
 These observations correspond with those of S. D. Gross, 
 who also states that the affection may be traced to disorders 
 of the rectum, and that intemperance in eating and drink- 
 ing, horseback exercise, drastic cathartics, cantharides, and 
 spirits of turpentine, or, in short, whatever is likely to pro- 
 duce a determination of blood to the pelvic organs, tends 
 to excite it. Ledwich' narrates a case in which it appears 
 to have been occasioned by riding for several consecutive 
 days in cold, damp weather ; and both he and Lee^ believe 
 that the strumous diathesis predisposes to its occurrence ; 
 and others trace it to sedentary, habits. While I cannot 
 deny the accuracy of these statements, I may be permitted 
 to express my conviction that none of the above-mentioned 
 causes are capable of lighting up the affection indepen- 
 dently of some preexisting lesion of the prostatic urethra. 
 
 ^ Dublin Quart. Journ. of Med. Sci., vol. x.xiv. p. 35. 
 '■^ St. George's Hosp. Reps., vol. vi. p. 26. 
 
 11 
 
162 
 
 PROSTATORRHGEA, 
 
 Clinical History. — The most prominent symptom of 
 the disease is the discharge of a thin, and, as a rule, more 
 or less milky, acid fluid from the meatus, which may be con- 
 stant in its appearance, but which is always expressed from 
 the urethra during straining at stool and during the forcible 
 expulsion of the last drops of urine, or even during sneez- 
 ing, coughing, or laughing. The quantity secreted may be 
 
 Fig. i6. 
 
 Prostatic crystals. 
 
 merely sufficient to induce an unpleasant sensation of wet- 
 ness in the urethra and to agglutinate the lips of its orifice ; 
 or it may amount to a drachm or more during the twenty- 
 four hours, and keep the linen stained. However this may 
 be, it is increased by riding, by driving, by alcoholic and malt 
 liquors, and by the contraction of the perineal and other 
 muscles during defecation and urination. Under the micro- 
 scope it will be found to consist of cylindrical epithelial 
 cells, countless refracting and colorless granules of lecithin, 
 and of minute, yellowish, concentric, amyloid concretions ; 
 and after it has slowly dried upon the slide crystals of phos- 
 phate of magnesium, as in Fig. 1 3, page 80, or of ammonio- 
 
CLINICAL HISTORY. 163 
 
 magnesian phosphate, as in Fig. i6 from one of my patients, 
 will make their appearance. These characters, along with 
 the absence of spermatozoa, serve to distinguish it from 
 semen and ordinary urethral discharges. When the secre- 
 tion depends upon chronic catarrhal inflammation of the 
 glands of the prostate, it is thicker, and contains, in addi- 
 tion to the foregoing morphological elements, pus and 
 mucous corpuscles, and filiform mucopurulent casts of the 
 follicles and ducts. 
 
 The escape of the fluid is occasionally attended with a 
 pleasurable feeling of titillation ; or there may be a drop- 
 ping sensation in the urethra, which is due to reflex con- 
 traction of the muscular substance of the prostate induced 
 by repletion of the glands with the secretion, and its con- 
 sequent discharge into the prostatic sinus; or there may be 
 a constant feelingf of moisture in the canal. All of these 
 abnormal sensations are increased by erections. 
 
 The only remaining local signs with which I have met 
 were frequent and urgent desire to relieve the bladder in 
 four ; occasional scalding during urination in two ; the loss 
 of a few drops of blood at the end of the act in two ; painful 
 ejaculation in one ; a sense of weight and fulness in the 
 rectum after stool in two ; and dull pains in the perineum, 
 which were increased by exercise, especially in warm 
 weather, in three. Hence, with the exception of pains 
 radiating from the pelvis through the hips and thighs, and 
 a constant sense of uneasiness about the loins, these symp- 
 toms agree with those portrayed by Adams,' who described 
 the affection as "Prostatitis from Onanism," and they are 
 confirmatory of the observations of S. D. Gross. 
 
 Prostatorrhoea differs widely from the affections which 
 
 ^ Anatomy and Diseases of the Prostate Gland, 1851, p. 48. 
 
164 PKOSTATORRHCEA. 
 
 have already been considered in the absence of signs which 
 point to nervous exhaustion, as I have met with them in 
 only one example, of which the following is a brief account : 
 
 Case XLI. A banker, thirty-two years of age, had masturbated 
 from his twelfth to his twenty-second year, when he married, and, 
 to avoid having children, indulged in incomplete connection. At 
 the expiration of six or eight months he began to be troubled with 
 intermittent prostatic discharges at stool, and to experience fatigue 
 on mental and physical exertion. When I saw him, ten years after 
 the appearance of these. symptoms, he was suffering from habitual 
 constipation, indigestion, acid eructations, furred tongue, bad taste 
 in the mouth, dizziness, muses volitantes, troubled and unrefresh- 
 ing sleep, impairment of memory, almost constant pain in the back 
 of the head, neck, and left shoulder, incapacity for mental exertion, 
 muscular weakness of the limbs, constant pain in the back, a sen- 
 sation of numbness along the outer side of the left thigh, and occa- 
 sional flushes of heat. The prostatic discharge had been habitual 
 for many years at the water-closet and during erections, and there 
 was a sense of fulness and weight in the rectum. The prostatic 
 urethra was morbidly sensitive, and the bulbous explorer defined 
 strictures at one-third of an inch from the meatus, calibre 22, and 
 at five inches and three-quarters, calibre i8. 
 
 Cases of a somewhat similar nature are narrated by 
 Ledwich ; but in these as well as in my own it should be 
 remarked that the signs of nervous exhaustion were de- 
 pendent upon natural and unnatural excesses, and were in 
 no wise connected with the diseased condition of the pros- 
 tate. In only two of the patients under my care were the 
 bowels habitually costive ; and in only one was there back- 
 ache. 
 
 Sixteen of the subjects consulted me under the fixed 
 impression that they were suffering from spermatic incon- 
 tinence, so that their minds dwelt constantly on the dis- 
 
PATHOLOGICAL CHARACTERS. 165 
 
 charge, and two were verging upan hypochondrism. I 
 was, however, fortunate enough to convince them that the 
 fluid was free from spermatozoa, and in this way succeeded 
 in eliminating an element which would otherwise have per- 
 petuated and aggravated the disease. 
 
 Pathological Characters. — In two patients, dead of 
 phthisis, Ledwich succeeded in obtaining port-mortem ex- 
 aminations, and describes the appearances in the following 
 terms : "The prostato-vesical plexus was full, and many of 
 its branches varicose ; the capsule of the prostate adhered 
 intimately to its surface, and, on slicing the gland, it seemed 
 soft, with large, open venous branches on the section, from 
 which blood exuded, whilst the whole o-land exhibited an 
 augmented volume ; the mucous membrane of its urethral 
 aspect was red, soft, thickened, and villous, whilst the ducts 
 could be distinguished with the unassisted eye, the uvula 
 and trigone vesicae were red and turgid, but the remainder 
 of the bladder was healthy." 
 
 These cases, and they are the only ones on record of 
 which I have any knowledge, demonstrate that the affection, 
 in some instances, is essentially a chronic inflammation of 
 the glandular apparatus of the prostate, with relaxation, 
 and consequent dilatation of, the muscular fibres which 
 surround the orifices of the ducts. Hence the discharge 
 may be readily accounted for by the contraction of the 
 muscular elements incited into action whenever the acini 
 and ducts become distended by the abnorma secretion, or 
 by the pressure exerted upon them during the first expulsive 
 efforts of defecation and urination. This view is moreover 
 confirmed by the subjective and objective symptoms, of 
 which the most characteristic is the morbid sensibility 
 evoked by the introduction of a sound. In a few cases the 
 
166 PROSTATORRHCEA. 
 
 urgent and frequent calls to empty the bladder, the scald- 
 ing during the act, and the passage of drops of blood at its 
 completion, point in the same direction, as does also the 
 tumid and tender condition of the prostate, as elicited by 
 rectal examination, with which I have met in two instances. 
 
 Diagnosis. — In the inflammatory form of the affection, if 
 the patient be requested to pass the first two or three 
 ounces of urine in a Mass, that fluid will be found to con- 
 tain delicate filiform shreds, which are sometimes more than 
 half an inch in length, and which are mucopurulent casts of 
 the follicles and ducts of the prostate. This highly charac- 
 teristic sio-n, when considered in connection with the local 
 siens and the minute examination of the discharo-e, the 
 composition of which has already been sufficiently con- 
 sidered, is quite sufficient to establish the true nature of 
 the trouble. In the simple variety of the disorder, the 
 thread-like casts are absent, so that the diagnosis will have 
 to be based on the microscopical appearances of the secre- 
 tion. 
 
 Prognosis. — Prostatorrhoea is a most obstinate affection, 
 unless it is subjected to early and persevering treatment. 
 Ordinarily the outlook, especially when the discharge is 
 comparatively recent, is most favorable, as the disease does 
 not evince any tendency to suppuration or other lesions of 
 the body of the organ. This statement is substantiated by 
 Case XVI., page 39, in which a discharge of two years' 
 duration entirely ceased under appropriate measures in 
 eight weeks. When mental disquietude and gloom are so 
 great that the patient cannot be convinced that his malady 
 is harmless, the prognosis is grave, and the management is 
 most unsatisfactory. 
 
TREATMENT. 167 
 
 Treatment. — When any lesion, as, for example, stricture, 
 phimosis, or internal piles, which tends to maintain the dis- 
 order has been relieved, the therapeutics of prostatorrhoea 
 are essentially those of impotence and spermatorrhoea, the 
 remedies being addressed to the relief of the morbid sensi- 
 bility of the prostatic sinuses, the atony of the ducts, and 
 the cessation of the discharge. To avoid needless repeti- 
 tion I will, therefore, merely indicate the measures which I 
 have found to yield the best results. 
 
 The bowels should be kept in a soluble condition, and 
 straining at the closet should be avoided. Driving, riding, 
 and much walking, if prolonged exercise excites pain in 
 the perineum, or aggravates it if it be present, alcoholic 
 and malt liquors, and sexual intercourse and unnatural 
 practices must he interdicted. If, however, the subject be 
 married, and if he finds that coition is not attended with 
 painful ejaculations, or that it does not increase the sensa- 
 tion of soreness in the perineum, it may be moderately 
 indulged in. In every instance, except two in which the 
 affection was respectively of six and ten years' duration, 
 the warm hip-bath,' the introduction of the bougie,' and the 
 exhibition of bromide of potassium^ and atropia,'^ combined 
 with tincture of hyoscyamus and bicarbonate of potassium 
 If there were vesical irritability and scalding on urination, 
 fulfilled the Indications. Rosenthal, ^ Indeed, speaks more 
 favorably of atropla in prostatic than In seminal discharges, 
 and my own experience fully confirms his views. In the 
 two exceptional cases, after the exaggerated sensibility of 
 the prostatic urethra had been allayed by the preceding 
 treatment, and the discharge was apparently kept up by an 
 
 ' Consult p. 51. ^ Consult p. 41. 
 
 ^ Consult p. 49. * Consult p. 50. 
 
 ^ Wiener Klinik, May, 1880, p_. 160. 
 
168 PROSTATORRHGEA. 
 
 atonic and dilated state of the orifices of the ducts, I stopped 
 the above-mentioned measures, but continued the atropia, 
 and finally succeeded in effecting a cure by the administra- 
 tion of the fiuid extract of ergot,' cold sitz-baths^ morning 
 and evening, the injection of thirty grains of nitrate of 
 silver to the ounce, ^ and the application of fiying blisters 
 to the perineum,'' which I consider indispensable, Winter- 
 nitz recommends the psychrophor' for this condition, and 
 Lederer^ also regards it with favor ; while Lee^ relies upon 
 the injection of a solution composed of from two to four 
 drachms of the liquor ferri persulphatis to eight ounces of 
 water ; and Ultzmann^ has obtained good results from the 
 induced current with one reophore in the rectum. I have 
 had no experience with these remedies, but think well of 
 the last, and would employ it if the case resisted the mea- 
 sures which I have indicated. 
 
 ^ Consult p. 158. ^ Consult p. 53. 
 
 ^ Consult p. 44. * Consult p. 49. 
 
 ° Consult p. 53. 
 
 ^ V/iener med. Presse, 1879, P-' 3°^- ^ Loc. cit., p. 34. 
 
 ^ Wiener Klinik, May and June, 1879, P- 164. 
 
I N D E X. 
 
 ACETATE of lead in the treatment 
 of azoospermism, 109 
 Ansesthetic aspermatism, 121 
 diagnosis of, 124 
 prognosis of, 126 
 treatment of, 127 
 Anorchidism, 84 
 
 Anus, affections of, as causes of sper- 
 matorrhoea, 147 
 Aspermatism, 109 
 anaesthetic, 121 
 atonic, 119 
 organic, no 
 psychical, 123 
 Atonic aspermatism, 119 
 diagnosis of, 124 
 prognosis of, 126 
 treatment of, 126 
 impotence, 20 
 
 classification of, 28 
 clinical history of, 39 
 diagnosis of, 37 
 etiology of, 21 
 prognosis of, 39 
 treatment of, 41 
 Atropia in treatment of impotence, 50 
 of prostatorrhoea, 167 
 of spermatorrhoea, 156 
 Azoospermism, 84 
 diagnosis of, 103 
 from abnormal states of semen, 
 
 90 
 from affections of testes, 87 
 from anorchidism, 84 
 from cryptorchidism, 86 
 from defects of epididymes, 85 
 from defects of vasa deferentia, 85 
 from neurasthenia, 92 
 
 Azoospermism — 
 
 from obliteration of epididvmes, 
 88 
 I from obliteration of vasa defer- 
 
 entia, 88 
 1 from sexual excesses, 90 
 
 I prognosis of, 105 
 
 ' treatment of, 107 
 
 BICHLORIDE of mercury in treat- 
 ment of azoospermism, 109 
 Bromide of potassium in treatment of 
 impotence, 49 
 of prostatorrhoea, 167 
 of spermatorrhoea, 156 
 
 CANTHARIDES in the treatment of 
 spermatorrhoea, 158 
 Catheter-syringe, 46 
 Cerebrasthenia, 37 
 
 Conical bougie in treatment of impo- 
 tence, 41 
 of prostatorrhoea, 167 
 of spermatorrhoea, 157 
 Constipation a cause of spermatorrhcea, 
 
 147 
 Cryptorchidism, 86 
 Crystals, prostatic, 164 
 
 spermatic, 80 
 Cupped bougie, 48 
 
 DAMIANA in treatment of impo- 
 tence, 53 
 I Diurnal pollutions, 134 
 12 
 
170 
 
 INDEX. 
 
 Ducts, ejaculatory, absence of, iil 
 deviation of, in 
 occlusion of, 1 1 1 
 
 ELECTRICITY in treatment of im- 
 potence, 54 
 of prostatorrhoea, i68 
 of spermatorrhoea, 157 
 Epididymes, deficiency of, 85 
 
 obliteration of, 88 
 Epididymitis, gonorrhoea!, 89, 100 
 Erection, mechanism of, 17 
 Ergot in treatment of prostatorrhoea, 
 168 
 of spermatorrhoea, 158 
 Exhaustion, spinal, 36 
 
 a cause of azoospermism, 92 
 Exploratory bougie, 37 
 
 FARADISM in treatment of impo- 
 tence, 55 
 of prostatorrhoea, 168 
 of spermatorrhoea, 157 
 
 GALVANISM in treatment of azoo- 
 spermism, 107 
 of impotence, 54 
 of spermatorrhoea, 157 
 Gelsemium in treatment of impotence, 
 50 
 of spermatorrhoea, 156 
 Genitospinal centre, 18 
 
 diminished excitability of, 20 
 
 mcreased excitability of, 130 
 
 Glycerole of tannin in treatment of 
 
 impotence, 48 
 Gonorrhoea, a cause of impotence, 28 
 of prostatorrhoea, 163 
 of spermatorrhoea, 145 
 Gonorrhceal epididymitis, 89, 100 
 
 HERPES, a cause of spermatorrhoea, 
 146 
 Hyperassthesia of the urethra, a cause j 
 of impotence, 21 
 of prostatorrhoea, 161 
 of spermatorrhoea, 145 
 
 IMPOTENCE, 17 
 1 atonic, 20 
 organic, 66 
 paralytic, 34 
 psychical, 57 
 symptomatic, 63 
 Iodide of potassium in treatment of 
 
 azoospermism, 109 
 Iodoform in treatment of azoosperm- 
 ism, 109 
 Iron in treatment of impotence, 50, 52 
 of prostatorrhoea, 168 
 of spermatorrhoea, 156, 158 
 Irritable weakness, 31 
 Irritation, spinal, 36 
 
 LAXATIVES in treatment of impo- 
 tence, 51 
 of prostatorrhoea, 167 
 of spermatorrhoea, 155 
 
 MASTURBATION, effects of, 22 
 hypersesthesia of urethra from, 
 21 
 nervous disorders from, 26 
 prostatorrhoea from, 161 
 spermatorrhoea from, 143 
 stricture of urethra from, 23 
 Meatus, stricture of, a cause of sper- 
 matorrhoea, 146 
 Misemission, 128 
 Monobromide of camphor in treatment 
 
 of impotence, 50 
 "Morphism, a cause of azoospermism, 
 
 97 
 Myelasthenia, 36 
 
 NEURASTHENIA, a cause of azoo- 
 spermism, 92 
 of impotence, 36 
 of prostatorrhoea, 164 
 of spermatorrhoea, 142 
 Nitrate of silver in treatment of impo- 
 tence, 44 
 of prostatorrhoea, 168 
 of spermatorrhoea, 157 
 Nocturnal pollutions, 131 
 
IN DEX. 
 
 171 
 
 ORGANIC aspermatism, no 
 diagnosis of, 124 
 prognosis of, 126 
 treatment of, 126 
 Organic impotence, 66 
 
 PENIS, lesions of, causes of impo- 
 tence, 66 
 Phimosis, a cause of aspermatism, 118 
 
 of spermatorrhoea, 146 
 Phthisis, a cause of azoosperism, 95 
 Pollutions, diurnal, 134 
 
 nocturnal, 131 
 Porte-caustique, 47 
 Porte-remede, 47 
 Prospermatism, 32 
 Prostatic crystals, 164 
 fluid, uses of, 79 
 Prostatorrhoea, 160 
 
 clinical history of, 162 
 diagnosis of, 166 
 etiology of, 160 
 pathological characters of, 165 
 prognosis of, Ib6 
 treatment of, 167 
 Psychical aspermatism, 123 
 prognosis of, 126 
 treatment of, 128 
 impotence. 57 
 
 treatment of, 62 
 Psychrophor in treatment of impo- 
 tence, 53 
 of prostatorrhoea, 168 
 of spermatorrhoea, 158 
 Purulent semen, 98 
 
 Q 
 
 UININE in treatment of impotence, 
 
 50.53 
 of spermatorrhoea, 156 
 
 RECTUM, affections of, causes of 
 prostatorrhoea, 161 
 of spermatorrhoea, 147 
 
 SEMEN, abnormal conditions of, 90- 
 102 
 bloody, 102 
 colloid, 104 
 
 Semen — 
 
 composition of, ']'] 
 purulent, 98, 104 
 watery, 104 
 Sexual excesses, causes of azoosperm- 
 ism, 90 
 of impotence, 28 
 of prostatorrhoea, 161 
 of spermatorrhcea, 143 
 Sitz-bath, warm, in treatment of im- 
 potence, 51 
 of prostatorrhoea, 167 
 of spermatorrhoea, 157 
 cold, in treatment of impotence, 
 
 53 
 of prostatorrhoea, 168 
 of spermatorrhcea, 158 
 Spinal exhaustion, 36 
 
 a cause of azoospermism, 92 
 of impotence, 36 
 of prostatorrhoea, 164 
 of spermatorrhoea, 142 
 Spermaspasmos, 31 
 Spermatic crystals, 80 
 
 colic, 124 
 Spermatocystitis, a cause of azoosper- 
 matism, 99 
 of spermatorrhcea, 147 
 Spermatozoa, 79 
 absence of, 90 
 infertile, 92-97 
 Spermatorrhcea, 130 
 
 anatomical characters of, 148 
 classification of, 130 
 clinical history of, 138 
 diagnosis of, 149 
 etiology of, 141 
 prognosis of, 150 
 spasmodic, 31 
 treatment of, 153 
 Spermorrhagia, 136 
 Sterility, •]'] 
 
 classification of, 82 
 from aspermatism, 109 
 from azoospermism, 84 
 from misemission, 128 
 relative frequency of, 83 
 Stricture of ejaculatory ducts, in 
 
 of urethra from masturbation, 23 
 a cause of aspermatism, 116 
 of prostatorrhoea, 161 
 of spermatorrhcea, 144 
 Strychnia in treatment of impotence, 
 52 
 
172 
 
 INDEX. 
 
 Strychnia in treatment of spermator- 
 
 rhcEa, 158 
 Sympexions, 114 
 
 diagnosis of, 124 
 treatment of, 126 
 Symptomatic impotence, 63 
 prognosis of, 65 
 treatment of, 65 
 Sypliilis, a cause of azoospermism, 97 
 
 TESTES, absence of, 84 
 atrophy of, 87 
 lesions of, in azoospermism, 
 
 Testes, lesions of — 
 
 in impotence, 74 
 retained, 85 
 
 LTRETHRA, hypersesthesia of, 21 
 J stricture of, 23 
 Urethral dilator, 42 
 Urethrotome, 42 ' 
 
 VASA deferentia, deficiency of, 85 
 obliteration of, 88 
 Veratrum viride in treatment of im- 
 potence, 50 
 Vesication in impotence, 49 
 in prostatorrhoea, 168 
 
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 Empirical and Dietetic Preparations, with the Accentuation and Etymology of the Terms, 
 and the French and other Synonymes, so as to constitute a French as well as an English 
 Medical Lexicon. Edited by Kichabd J. Dxhstglison, M. D. In one very large and 
 handsome royal octavo volume oi 1139 pages. Cloth, $6.50 ; leather, raised bands, $7.60 ; 
 very handsome half Kussia, raised bands, $8. 
 
 The object of the author, from the outset, has not been to make the work a mere lexi- 
 con or dictionary of terms, but to afford under each word a condensed view of its various 
 medical relations, and thus to render the work an epitome of the existing condition of 
 medical science. Starting with this view, the immense demand which has existed for the 
 work has enabled him, in repeated revisions, to augment its completeness and usefulness, 
 until at length it has attained the position of a recognized and standard authority wherever 
 the language is spoken. Special pains have been taken in the preparation of the present 
 edition to .maintain this enviable reputation. The additions to the vocabulary are more 
 numerous than in any previous revision, and particular attention has been bestowed on the 
 accentuation, which will be found marked on every word. The typographical arrangement 
 has been greatly improved, rendering reference much more easy, and every care has been 
 taken with the mechanical execution. The volume now contains the matter of at least 
 four ordinary octavos. 
 
 About the first book purchased by the medical 
 student is the Medical Dictionary. The lexicon 
 explanatory of technical terms is simply a sine qua 
 non. In a science so extensive and with such col- 
 laterals as medicine, it is as much a necessity also 
 to the practising physician. To meet the wants of 
 students and most physicians the dictionary must 
 be condensed while comprehensive, and practical 
 while perspicacious. It was because Dunglison's 
 met these indications that it became at once the 
 dictionary of general use wherever medicine was 
 studied in the English language. In no former 
 revision have the alterations and additions been 
 so great. The chief terms have been set in black 
 letter, while the derivatives follow in small caps; 
 an arrangement which greatly facilitates reference. 
 — Cincinnati Lancet and Clinic, Jan. 10, 1874. 
 
 A book of which every American ought to be 
 proud. When the learned author of the work 
 
 passed away, probably all of us feared lest the book 
 should not maintain its place in the advancing 
 science whose terms it defines. Fortunately, Dr. 
 Richard J. Dunglison, having assisted his father in 
 the revision of several editions of the work, and 
 having been, therefore, trained in the methods 
 and imbued with the spirit of the book, has been 
 able to edit it as a work of the kind should be 
 edited — to carry it on steadily, without jar or inter- 
 ruption, along the grooves of thought it has trav- 
 elled during its lifetime. To show the magnitude 
 of the task which Dr. Dunglison has assumed and 
 carried through, it is only necessary to state that 
 more than six thousand new subjects have been 
 added in the present edition. — Philadelphia Medical 
 Times, Jan. 3, 1874. 
 
 It has the rare merit that it certainly has no rival 
 in the English language for accuracy and extent of 
 references. — London Medical Gazette. 
 
 HOBLYW, MICMABD jD., M, D. 
 
 A Dictionary of the Terms Used in Medicine and the Collateral 
 Sciences. Kevised, with numerous additions, by Isaac Hays, M. D., late editor of 
 The American Journal of the Medical Sciences. In one large royal 12mo. volume of 520 
 double-columned pages. Cloth, $1.50 ; leather, $2.00. 
 
 It is the best book of definitions we have, and ought always to be upon the student's table. — Southern- 
 Medical and Surgical Journal. 
 
 STVDBNTS' SBMIES OF MAJSITALS, 
 
 A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine 
 and Surgery, written by eminent Teachers or Examiners, and issued in pocket-size 
 12mo. volumes of 300-540 pages, richly illustrated and at a low price. The following vol- 
 umes are now ready : Treves' Manual of Surgery, by various writers, in three volumes ; 
 Bell's Comparative Physiology and Anatomy, GtOTTLd's Surgical Diagnosis, Robertson's 
 Physiological Physics, Bruce's Materia Medica and Therapeutics, Povs^er's Human Physi- 
 ology, Clarke and Lockwood's Dissectors' Manual, Ealfe's Clinical Chemistry, Treves*^ 
 Surgical Applied Anatomy, Pepper's Surgical Pathology, and Klein's Elements of Histology 
 The following are in press : Bellamy's Operative Surgery, Pepper's Forensic Medidr^ 
 and CuRNOw's Medical Applied Anatomy. For separate notices see index on last page. 
 
 SERIES OF CLINICAL MANUALS, 
 
 In arranging for this Series it has been the design of the publishers to provide the 
 profession with a collection of authoritative monographs on important clinical subjects 
 in a cheap and portable form. The volumes will contain about 550 pages and will be 
 freely illustrated by chromo-lithographs and woodcuts. The following volumes are 
 now ready: Marsh on the Joints, Owen on Surgical Diseases of Children, Morris on 
 Surgical Diseases of the Kidney, Pick on Fractures and Dislocations, Butlin on the Tongue, 
 Treves on Intestinal Obstruction, and Savage on Insanity and Allied Neuroses. The 
 following will be ready shortly : Hutchinson on Syphilis. The following are in active 
 preparation : Carter & Frost's Ophthalmic Surgery, Bryant on the Breast, Broadbent 
 on the Pulse, Lucas on Diseases of the Urethra, and Ball on the Rectum and Anus. For 
 separate notices see index on last page. 
 
Lea Brothers & Co.'s Publications — Anatomy. 5 
 
 GMAT, SBWBY, F. B. S., 
 
 Lecturer on Anatomy at St. Qeorge^s Hospital, London. 
 
 Anatomy, Descriptive and Surgical. The Drawings by H. V. Caktee, M. D., 
 and Dr. Westmacott. The dissections jointly by the Author and Dr. Carter. With 
 an Introduction on General Anatomy and Development by T. Holmes, M. A., Surgeon to 
 St. George's Hospital. Edited by T. Pickering Pick, F. E. C. S., Surgeon to and Lecturer 
 on Anatomy at St. George's Hospital, London, Examiner in Anatomy, Eoyal College of 
 Surgeons of England. A new American from the tenth enlarged and improved London 
 edition. To which is added the second American from the latest English edition of 
 Landmarks, Medical and Sxikgical, by Luther Holden, F. E. C. S., author of 
 " Human Osteology," " A Manual of Dissections," etc. In one imperial octavo volume 
 of 1023 pages, with 564 large and elaborate engravings on wood. Cloth, $6.00 ; leather, 
 $7.00 ; very handsome half Eussia, raised bands, $7.50. 
 
 This work covers a more extended range of subjects than is customary in the ordinary 
 text-books, giving not only the details necessary for the student, but also the application to 
 those details to the practice of medicine and surgery. It thus forms both a guide for the 
 learner and an admirable work of reference for the active practitioner. The engravings 
 form a special feature in the work, many of them being the size of nature, nearly all 
 original, and having the names of the various parts printed on the body of the cut, in 
 place of figures of reference with descriptions at the foot. They thus form a complete and 
 splendid series, which will greatly assist the student in forming a clear idea of Anatomy, 
 and will also serve to refresh the memory of those who may find in the exigencies of 
 practice the necessity of recalling the details of the dissecting-room. Combining, as it 
 does, a complete Atlas of Anatomy with a thorough treatise on systematic, descriptive 
 and applied Anatomy, the work will be found of great service to all physicians who receive 
 students in their offices, relieving both preceptor and pupil of much labor in laying the 
 groundwork of a thorough medical education. 
 
 Landmarks, Medical and Surgical, by the distinguished Anatomist, Mr. Luther Holden, 
 has been appended to the present edition as it was to the previous one. This work gives 
 in a clear, condensed and systematic way all the information by which the practitioner can 
 determine from the external surface of the body the position of internal parts. Thus 
 complete, the work, it is believed, will furnish all the assistance that can be rendered by 
 type and illustration in anatomical study. 
 
 There is probably no work used so universally 
 by physicians and medical students as this one. 
 It is deserving of the confidence that they repose 
 in it. If the present edition is compared with that 
 issued two years ago, one will readily see how 
 much it has been improved in that time. Many 
 pages have been added to the text, especially in 
 those parts that treat of histology, and many new 
 cuts have been introduced and old ones modified. 
 — Journal of the American Medical Association, Sept. 
 1, 1883. 
 
 This well-known work comes to us as the latest 
 American from the tenth English edition. As its 
 title indicates, it has passed tnrough many hands 
 and has received many additions and revisions. 
 The work is not susceptible of more improvement. 
 Taking it all in all, its size, manner of make-up, 
 its character and illustrations, its general accur- 
 acy of description, its practical aim, and its per- 
 spicuity of style, it is the Anatomy best adapted to 
 the wants of the student and practitioner. — Medical 
 Record, Sept. 15, 1883. 
 
 Also for sale separate — 
 HOLD JEW, LVTHMM, F. M. O. S., 
 
 Surgeon to St. Bartholomew's and the Foundling Hospitals, London. 
 Landmarks, Medical and Surgical. Second American from the latest revised 
 English edition, with additions by W. W. Keen, M. D., Professor of Artistic Anatomy in 
 the Pennsylvania Academy of the Fine Arts, formerly Lecturer on Anatomy in the Phila- 
 delphia School of Anatomy. In one handsome 12mo. volume of 148 pages. Cloth, $1.00. 
 
 This little book is all that can be desired within 
 its scope, and its contents will be found simply in- 
 valuable to the young surgeon or physician, since 
 they bring before him such data as he requires at 
 every examination of a patient. It is written in 
 language so clear and concise that one ought 
 almost to learn it by heart. It teaches diagnosis by 
 external examination, ocular and palpable, of the 
 body, with such anatomical and physiological facts 
 as directly bear on the subject. It is eminently 
 the student's and young practitioner's book. — Phy- 
 sician and Surgeon, Nov. 1881. 
 
 The study of these Landmarks by both physi- 
 
 cians and surgeons is much to be encouraged. It 
 inevitably leads to a progressive education of both 
 the eye and the touch, by which the recognition of 
 disease or the localization of injuries is vastly as- 
 sisted. One thoroughly familiar with the facts here 
 taught is capable of a degree of accuracy and a 
 confidence of certainty which is otherwise unat- 
 tainable. We cordially recommend the Landmarks 
 to the attention of every physician who has not 
 yet provided himself with a copy of this useful, 
 practical guide to the correct placing of all the 
 anatomical parts and organs. — Canada Medical and 
 Surgical Journal, Dec. 1881. 
 
 WILSOJSr, FMASMUS, F. It. S. 
 
 A System of Human Anatomy, General and Special. Edited by W. H. 
 GoBRECHT, M. D., Professor of General and Surgical Anatomy in the Medical College of 
 Ohio. In one large and handsome octavo volume of 616 pages, with 397 illustrations. 
 Cloth, $4.00; leather, $5.00. 
 
 CLFZAWD, JOHJSr,M.iy,,F.It.S., 
 
 Professor of Anatomy and Physiology in Queen's College, Oalway. 
 
 A Directory for tlie Dissection of the Human Body. In one 12mo. 
 volume of 178 pages. Cloth, $1.25. 
 
G 
 
 Lea Brothers & Co.'s Publications — Anatomy. 
 
 ALLJEW, SAMBISOJ!^, M. J)., 
 
 Professor 0/ Physiology in the University of Pennsylvania. 
 
 A System of Human Anatomy, Including Its Medical and Surgical 
 Relations. For the use of Practitioners and Students of Medicine. With an Intro- 
 ductory Section on Histology. By E. O. Shakespeaee, M. D., Ophthalmologist to 
 the Philadelphia Hospital. Comprising 813 double-columned quarto pages, with 380 
 illustrations on 109 full page lithographic plates, many of which are in colors, and 241 
 engravings in the text. In six Sections, each in a portfolio. Section I, Histology. 
 Section II. Bones and Joints. Section III. Muscles and Fascia. Section IV. 
 Artekies, Veins and Lymphatics. Section V. Nervous System. Section VI. 
 Organs of Sense, of Digestion and Genito-Urinary Organs, Embryology, 
 Development, Teratology, Superficial Anatomy, Post-Mortem Examinations, 
 AND General and Clinical Indexes. Price per Section, $8.50 ; also bound in one 
 volume, cloth, $23.00 ; very handsome half Russia, raised baiids and open back, $25.00. 
 For sale by subscription only. Apply to the Publishers. 
 
 Extract from Introduction. 
 
 It is the design of this book to present the facts of human anatomy in the manner best 
 suited to the requirements of the student and the practitioner of medicine. The author 
 believes that such a book is needed, inasmuch as no treatise, as far as he knows, contains, in 
 addition to the text descriptive of the subject, a systematic presentation of such anatomical 
 facts as can be applied to practice. 
 
 A book which will be at once accurate in statement and concise in terms ; which wiU be 
 an acceptable expression of the present state of the science of anatomy ; which will exclude 
 nothing that can be made applicable to the medical art, and which will thus embrace all 
 of surgical importance, while omitting nothing of value to clinical medicine, — would appear 
 to have an excuse for existence in a country where most surgeons are general practitioners, 
 and where there are few general practitioners who have no interest in surgery. 
 
 It is to be considered a study of applied anatomy 
 in its widest sense — a systematic presentation of 
 such anatomical facts as can be applied to the 
 practice of medicine as well as of surgery. Our 
 author is concise, accurate and practical in his 
 statements, and succeeds admirably in infusing 
 an interest into the study of what is generally con- 
 sidered a dry subject. The department of Histol- 
 ogy is treated in a masterly manner, and the 
 ground is travelled over by one thoroughly famil- 
 iar with it. The illustrations are made with great 
 
 care, and are simply superb. There is as much 
 of practical application of anatomical points to 
 the every-day wants of the medical clinician as 
 to those of the operating surgeon. In fact, few 
 general practitioners will read the work without a 
 feeling of surprised gratification that so many 
 points, concerning which they may never have 
 thought before are so well presented for their con- 
 sideration. It is a work which is destined to be 
 the best of its kind in any language. — Medical 
 Record, Nov. 25, 1882. 
 
 CLAItKE,W,B,,F.M.C.S. & LOCKWOOI>>C.B.,F,B.C.S, 
 
 Demonstrators of Anatomy at St. Bartholomew's Hospital Medical School, London. 
 The Dissector's Manual. In one pocket-size 12mo. volume of 396 pages, with 
 49 illustrations. Limp cloth, red edges, $1.50. See Students^ Series of Manuals, page 4. 
 
 This is a very excellent manual for the use of the 
 student who desires to learn anatomy. The meth- 
 ods of demonstration seem to us very satisfactory. 
 There are many woodcuts which, for the most 
 
 part, are good and instructive. The book is neat 
 and convenient. We are glad to recommend it. — 
 Boston Medical and Surgical Journal, Jan. 17, 1884. 
 
 THIEVES, FBBDEMICK, F. M. C, So, 
 
 Senior Demonstrator of Anatomy and Assistant Surgeon at the London Hospital. 
 
 Surgical Applied Anatomy. In one pocket-size 12mo. volume of 540 pages, 
 with 61 illustrations. Limp cloth, red edges, $2.00. See Students^ Series of Manuals, 
 page 4. 
 
 He has produced a work which will command a 
 larger circle of readers than the class for which it 
 was written. This union of a thorough, practical 
 acquaintance with these fundamental branches. 
 
 quickened by daily use as a teacher and practi- 
 tioner, has enabled our author to prepare a work 
 which it would be a most difficult task to excel. — 
 The American Practitioner Feb. 1884. 
 
 Preparing. 
 
 CJJItNOW, JOSJSr, M. D., F, M. C. F,, 
 
 Professor of Anatomy at King's College, Physician at King's College Hospital. 
 Medical Applied Anatomy. In one pocket-size 12mo. volume. 
 See Students' Series of Manuals, page 4. 
 
 BELLA3IY, EDWABD, F. M. C. S., 
 
 Senior Assistant-Surgeon to the Charing- Cross Hospital, London. 
 
 The Student's Guide to Surgical Anatomy : Being a Description of the 
 most Important Surgical Regions of the Human Body, and intended as an Introduction to 
 operative Surgery. In one 12mo. volume of 300 pages, with 50 illustrations. Cloth, $2.25. 
 
 HARTSHORNE'S HANDBOOK OF ANATOMY 
 AND PHYSIOLOGY. Second edition, revised. 
 In one royal 12nio. volume of 310 pages, with 220 
 vroodcuts. Cloth, $1.75. 
 
 HORNER'S SPECIAL ANATOMY AND HISTOL- 
 OGY. Eighth edition, extensively revised and 
 modified. In two octavo volumes of 1007 pagea, 
 with 320 woodcuts. Cloth, $6.00. 
 
Lea Brothers & Co.'s Publications — Pliysics, Physiol., Anat. 7 
 DRAPER, JOHN C, M, D., LL, D., 
 
 Professor of Chemistry in the University of the City of New York. 
 
 Medical Physics. A Text-book for Students and Practitioners of Medicine. In 
 one octavo volume of 734 pages, with 376 woodcuts, mostly original. Cloth, $4. 
 
 From the Preface. 
 
 The fact that a knowledge of Physics is indispensable to a thorough understanding of 
 Medicine has not been as fully realized in this country as in Europe, where the admirable 
 works of Desplats and Gariel, of Robertson and of numerous German writers constitute a 
 branch of educational literature to which we can show no parallel. A full appreciation 
 of this the author trusts will be sufficient justification for placing in book form the sub- 
 stance of his lectures on this department of science, delivered during many years at the 
 University of the City of New York. 
 
 Broadly speaking, this work aims to impart a knowledge of the relations existing 
 between Physics and Medicine in their latest state of development, and to embody in the 
 pursuit of this object whatever experience the author has gained during a long period of 
 teaching this special branch of applied science. 
 
 This elegant and useful work bears ample testi- 
 mony to the learning and good judgment of the 
 author. He has fitted his work admirably to the 
 exigencies of the situation by presenting the 
 reader with brief, clear and simple statements of 
 such propositions as he is by necessity required to 
 master. The subject matter is well arranged, 
 liberally illustrated and carefully iadexed. That 
 it will take rank at once among the text-books is 
 certain, and it is to be hoped that it will find a 
 place upon the shelf of the practical physician, 
 where, as a book of reference, it will be found 
 useful and agreeable. — Louisville Medical News, 
 September 26, 1885. 
 
 Certainly we have no text-book as full as the ex- 
 cellent one he has prepared. It begins with a 
 statement of the properties of matter and energy. 
 After these the special departments of physics are 
 
 explained, acoustics, optics, heat, electricity and 
 magnetism, closing with a section on electro- 
 biology. The applications of all these to physiology 
 and medicine are kept constantly in view. The 
 text is amply illustrated and the many difficult 
 points of the subject are brought forward with re- 
 markable clearness and ability. — Medical and Surg- 
 ical Reporter, July 18, 1885. 
 
 That this work will greatly facilitate the study 
 of medical physics is apparent upon even a mere 
 cursory examination. It is marked by that scien- 
 tific accuracy which always characterizes Dr. 
 Draper's writings. Its peculiar value lies in the 
 fact that it is written from the standpoint of the 
 medical man. Hence much is omitted that ap- 
 pears in a mere treatise on physical science, while 
 much is inserted of peculiar value to the physi- 
 cian. — Medical Record, August 22, 1885. 
 
 MOBEBTSOJSr, J, McGBEGOB, M. A., M. B,, 
 
 Muirhead Demonstrator of Physiology, University of Glasgow. 
 Physiological Physics. In one 12mo. volume of 537 pages, with 219 illustra- 
 tions. Limp cloth, |2.00. See Students' Series of Manuals, page 4. 
 
 raents. It will be found of great value to the 
 
 The title of this work sufficiently explains the 
 nature of its contents. It is designed as a man- 
 ual for the student of medicine, an auxiliary to 
 his text-book in physiology, and it woul d be particu- 
 larly useful as a guide to his laboratory experi- 
 
 practitioner. It is a carefully prepared book of 
 reference, concise and accurate, and as such we 
 heartily recommend it. — Journal of the American 
 Medical Association, Dec. 6, 1884. 
 
 n ALTON, jOHJsr a, m, d., 
 
 Professor Emeritus of Physiology in the College of Physicians and Surgeons, New York. 
 
 Doctrines of the Circulation of the Blood. A History of Physiological 
 Opinion and Discovery in regard to the Circulation of the Blood. In one handsome 
 12mo. volume of 293 pages. Cloth, $2. 
 
 Dr. Dalton's work is the fruit of the deep research I revolutionized the theories of teachers, than the 
 of a cultured mind, and to the busy practitioner it discovery of the circulation of the blood. This 
 cannot fail to be a source of instruction. It will explains the extraordinary interest it has to all 
 inspire him with a feeling of gratitute and admir- j medical historians. The volume before us is one 
 ation for those plodding workers of olden times, i of three or four which have been written within a 
 
 who laid the foundation of the mignificent temple 
 of medical science as it now stanc s. — New Orleans 
 Medical and Surgical Journal, Aug I 885. 
 
 In the progress of physiologii s, study no fact 
 was of greater moment, none rr ore completely 
 
 few years by American physicians. It is in several 
 respects the most complete. The volume, though 
 small in size, is one of the most creditable con- 
 tributions from an American pen to medical history 
 that has appeared. — Med. & Surg. Rep., Dec. 6, 1884. 
 
 BELL, F, JEFFREY, M. A,, 
 
 Professor of Comparative Anatomy at King's College, London. 
 
 Comparative Physiology and Anatomy. In one 12mo. volume of 561 pages, 
 with 229 illustrations. Limp cloth, $2.00. See Students' Series of Manuals, page 4. 
 
 The manual is preeminently a student's book — 1 it the best work in existence in the English 
 clear and simple in language and arrangement. ' language to place in the hands of the medical 
 It is well and abundantly illustrated, and is read- ' student. — Bristol Medico- Chirurgical Journal, Mar., 
 able and interesting. On the whole we consider | 1886. 
 
 ELLIS, GEORGE VINER, 
 
 Emeritus Professor of Anatomy in University College, London. 
 Demonstrations of Anatomy. Being a Guide to the Knowledge of the 
 Human Body by Dissection. From the eighth and revised London edition. In one very 
 handsome octavo volume of 716 pages, with 249 illustrations. Cloth, $4.25 ; leather, $5.25. 
 
 ROBERTS, JOHN B,, A. M,, M. D., 
 
 Prof, of Applied Anat. and Oper. Surg, in Phila. Polyclinic and Coll. for Ghraduates in Medicine. 
 The Compend of Anatomy. For use in the dissecting-room and in preparing 
 for examinations. In one 16mo. volume of 196 pages. Limp cloth, 75 cents. 
 
8 Lea Brothers & Co.'s Publications — Physiology, Chemistry. 
 
 I>AZTOW, JOSW C, M. D., 
 
 Professor of Physiology in the College of Physicians and Surgeons, New York, etc. 
 
 A Treatise on Human Physiology. Designed for the use of Students and 
 Practitioners of Medicine. Seventh edition, thoroughly revised and rewritten. In one 
 very handsomeoctavo vokime of 722 pages, with 252 beautiful engravings on wood. Cloth, 
 $5.00 ; leather, $6.00 ; very handsome half Russia, raised bands, $6.50. 
 
 This edition of Dr. Dalton's well-known work 
 bears evidence of having been thoroughly and 
 carefully revised. From the first appearance of 
 the book it has been a favorite, owing as well to 
 the author's renown as an oral teacher as to the 
 charm of simplicity with which, as a writer, he 
 always succeeds in investing even intricate sub- 
 jects It must be gratifying to him to observe the 
 frequency with which his work,written for students 
 and practitioners, is quoted by other writers on 
 physiology. This fact attests its value, and, in 
 great measure, its originality. It now needs no 
 such seal of approbation, however, for the thou- 
 sands who have studied it in its various editions 
 have never been in any doubt as to its sterling 
 worth. — N. Y. Medical Journal and Obstetrical Re- 
 view, Oct. 1882. 
 
 Professor Dalton's well-known and deservedly- 
 appreciated work has long passed the stage at 
 which it could be reviewed in the ordinary sense. 
 The work is eminently one for the medical prac- 
 titioner, since it treats most fully of those branches 
 
 of physiology which have a direct bearing on the 
 diagnosis and treatment of disease. The work is 
 one which we can highly recommend to all our 
 readers. — Dublin Journal of Medical Science, Feb.'83. 
 
 Certainly no physiological work as ever issued 
 from the press that presented its subject-matter in 
 a clearer and more attractive light. Almost every 
 page bears evidence of the exhaustive revision 
 that has taken place. The material is placed in a 
 more compact form, yet its delightful charm is re- 
 tained, and no subject is thrown into obscurity. 
 Altogether this edition is far in advance of any 
 previous one, and will tend to keep the profession 
 posted as to the most recent additions to our 
 physiological knowledge. — Michigan Medical News, 
 April, 1882. 
 
 One can scarcely open a college catalogue that 
 does not have mention of Dalton's Physiology as 
 the recommended text or consultation-book. For 
 American students we would unreservedly recom- 
 mendDr. Dalton's work. — Va. Med. Monthly, July, ^&'i. 
 
 FOSTER, MICHAEL, M, 2>., F, JR, S., 
 
 Prelector in Physiology and Fellow of Trinity College, Cambridge, England. * 
 
 Text-Book of Physiology. Third American from the fourth English edition, 
 with notes and additions by E. T. Reichert, M. D., Professor of Physiology in the Uni- 
 versity of Pennsylvania. In one handsome royal 12mo. volume of 908 pages, with 271 
 illustrations. Cloth, $3.25 ; leather, $3.75. 
 
 will be found to be much increased. — Cincinnati 
 Medical News, July 1885. 
 
 For several years Foster's Physiology has occu- 
 pied a peculiar and quite enviable position among 
 the textbooks on this most important branch of 
 medicine. In the highest sense scientific, it 
 should nevertheless be the constant companion 
 of every student of medicine. To the student 
 who is not engaged in special physiological study 
 it should be the most constant book of reference, 
 while to him who is specially engaged in physio- 
 logical work it is an absolute necessity. — Journal 
 of the American Medical Association,k\i.gVisi 29,1885. 
 
 Dr. Foster's work upon physiology is so well- 
 known as a text-book in this country, that it needs 
 but little to be said in regard to it. There is 
 scarcely a medical college in the United States 
 where it is not in the hands of the students. The 
 author, more than any other writer with whom 
 we are acquainted, seems to understand what 
 portions of the science are essential for students 
 to know and what may be passed over by them as 
 not important. From the beginning to the end, 
 physiology is taught in a systematic manner. To 
 this third American edition numerous additions, 
 corrections and alterations have been made, so 
 that in its present form the usefulness of the book 
 
 POWEM, HENItT, M, B,, F. M, C, S., 
 
 Examiner in Physiology, Royal College of Surgeons of England. 
 Human Physiology. In one handsome pocket-size 12mo. volume of 396 
 with 47 illustrations. Cloth, $1.50. See Students' Series of Manuals, page 3. 
 
 The prominent character of this work is that of I to every one of our readers. — The American Jowr- 
 judicious condensation, in which an able and sue- | nal of the Medical Sciences, October, 1884. 
 
 cessful effort appears to have been made by its 
 accomplished author to teach the greatest number 
 of facts in the fewest possible words. The result 
 is a specimen of concentrated intellectual pabu- 
 lum seldom surpassed, which ought to be care- 
 fully ingested and digested by every practitioner 
 who desires to keep himself well informed upon 
 this most progressive of the medical sciences. 
 The volume is one which we cordially recommend 
 
 This little work is deserving of the highest 
 praise, and we can hardly conceive how the main 
 facts of this science could have been more clearly 
 or concisely stated. The price of the work is such 
 as to placeit within the reach of all, while the ex- 
 cellence of its text will certainly secure for it most 
 favorable commendation — Cincinnati Lancet and 
 Clinic, Feb. 16, 1884. 
 
 SIMON, W,, Ph. n., M. D., 
 
 Professor of Chemistry and Toxicology in the College of Physicians and Surgeons, Baltimore, and 
 Professor of Chemistry in the Maryland College of Pharmacy. 
 Manual of Chemistry. A Guide to Lectures and Laboratory work for Beginners 
 in Chemistry. A Text-book, specially adapted for Students of Pharmacy and Medicine, 
 In one 8vo. vol. of 410 pp., with 16 woodcuts and 7 plates, mostly of actual deposits, 
 with colors illustrating 56 of the most important chemical reactions. Cloth, $3.00 ; also 
 without plates, cloth, $2.50. 
 ~" ■ ' " ■■ ' - -■ - ... p]ates, beautifully executed, illustrating precipi- 
 
 tates of variotis reactions, form a novel and valu- 
 able feature of the book, and cannot fail to be ap- 
 preciated by both student and teacher as a help 
 over the hard places of the science. — Maryland 
 Medical Journal, Nov. 22, 1884. 
 
 This book supplies a want long felt by students 
 of medicine and pharmacy, and is a concise but 
 thorough treatise on the subject. The long expe- 
 rience of the author as a teacher in schools of 
 medicine and pharmacy is conspicuous in the 
 perfect adaptation of the work to the special needs 
 of the student of these branches. The colored 
 
 Wohler's Outlines of Organic Chemistry. Edited by Fittig. 
 by Ira Eemsen, M. D., Ph. D. In one 12mo. volume of 550 pages. Cloth, $J 
 
 Translated 
 
 LEHMANN'S MANUAL OF CHEMICAL PHYS- 
 IOLOGY. In one octavo volume of 327 pages, 
 with 41 illustrations. Cloth, $2.25. 
 
 CARPENTER'S HUMAN PHYSIOLOGY. Edited 
 by Henry Powt.e. In one octavo volume. 
 
 CARPENTER'S PRIZE ESSAY ON THE USE AND 
 Abuse of Alcoholic Liquors in Health and Dis- 
 ease. With explanations of scientific words. Small 
 12mo. 178 pages. Cloth, 60 cents. 
 
 GALLOWAY'S QUALITATIVE ANALYSIS. 
 
Lea Brothers & Co.'s Publications — Chemistry. 
 
 9 
 
 FOWNES, GBOMGE, Ph, 2>. 
 
 A Manual of Elementary Chemistry; Theoretical and Practical. Em- 
 bodying Watts' Physical Inorganic Chemistry. New American edition. In one large 
 royal 12mo. volume of 1061 pages, with 168 illustrations on wood and a colored plate. 
 Cloth, $2.75 ; leather, $3.25. 
 
 Fownes' Chemistry has been a standard text- 
 book upon chemistry for many years. Its merits 
 are very fully known by chemists and physicians 
 everywhere in this country and in England. As 
 the science has advanced by the making of new 
 discoveries, the work has been revised so as to 
 keep it abreast of the times. It has steadily 
 maintained its position as a text book with medi- 
 cal students. In this work are treated fully: Heat, 
 ' Light and Electricity, including Magnetism. The 
 influence exerted by these forces in chemical 
 action upon health and disease, etc., is of the most 
 important kind, and should be familiar to every 
 medical practitioner. We can commend the 
 work as one of the very best text-books upon 
 
 chemistry extant. — Cincinnati Medical News, Oc- 
 tober, 1885. 
 
 Of all the works on chemistry intended for the 
 use of medical students, Fownes' Chemistry is 
 perhaps the most widely used. Its popularity is 
 based upon its excellence. This last edition con- 
 tains all of the material found in the previous, 
 and it is also enriched by the addition of Watts' 
 Physical and Inorganic Chemistry. All of the mat- 
 ter is brought to the present standpoint of chemi- 
 cal knowledge. We may safely predict for this 
 work a continuance of the fame and favor it enjoys 
 among medical students. — New Orleans Medical 
 and Surgical Journal, March, 1886. 
 
 FItANKLAND,B.,I>. aZ.,F.B.S.,&JAPI*,F.M.,F,I. C, 
 
 Professor of Chemistry in the Normal School 
 of Science, London. 
 
 Assist. Prof, of Chemistry in the Normal 
 School of Science, London. 
 
 Inorganic Chemistry. In one handsome octavo volume of 677 pages with 51 
 woodcuts and 2 plates. Cloth, $3.75 ; leather, $4.75. 
 
 This excellent treatise will not fail to take its 
 place as one of the very best on the subject of 
 which it treats. We have been much pleased 
 with the comprehensive and lucid manner in 
 which the difficulties of chemical notation and 
 nomenclature have been cleared up by the writers. 
 It shows on every jjage that the problem of 
 rendering the obscurities of this science easy 
 of comprehension has long and successfully 
 engaged the attention of the authors. — Medical 
 and Swgical Reporter, October 31, 1885. 
 
 This work should supersede other works of its 
 class in the medical colleges. Itis certainly better 
 adapted than any work upon chemistry, with which 
 we are acquainted, to impart that clear and full 
 knowledge of the science which students of med- 
 icine should have. Physicians who feel that their 
 chemical knowledge is behind the times, would 
 do well to devote some of their leisure time to the 
 study of this work. The descriptions and-demon- 
 strations are made so plain that there is no diffi- 
 culty in understanding them. — Cincinnati Medical 
 News, January, 1886. 
 
 ATTFIELJy, JOSJV, I'll. D., 
 
 Professor of Practical Chemistry to the Pharmaceutical Society of Chreat Britain, etc. 
 
 Chemistry, General, Medical and Pharmaceutical ; Including the Chem- 
 istry of the U. S. Pharmacopoeia. A Manual of the General Principles of the Science, 
 and their Application to Medicine and Pharmacy. A new American, from the tenth 
 English edition, specially revised by the Author. In one handsome royal 12mo. volume 
 of 728 pages, with 87 illustrations. Cloth, $2.50 ; leather, $3.00. 
 
 A text-book which passes through ten editions 
 in sixteen years must have good qualities. This 
 remark is certainly applicable to Attfleld's Chem- 
 istry, a book which is so well known that it is 
 hardly necessary to do more than note the appear- 
 ance of this new and improved edition. It seems, 
 however, desirable to point out that feature of the 
 book which, in all probability, has made it so 
 popular. There can be little doubt that it is its 
 thoroughly practical character, the expression 
 being used in its best sense. The author under- 
 stands what the student ought to learn, and is able 
 
 to put himself in the student's place and to appre^- 
 ciate his state of mind. — American Chemical Jov/r- 
 nal, April, 1884. 
 
 It is a book on which too much praise cannot be 
 bestowed. As a text-book for medical schools it 
 is unsurpassable in the present state of chemical 
 science, and having been prepared with a special 
 view towards medicine and pharmacy, it is alike 
 indispensable to all persons engaged in those de- 
 partments of science. It includes the whole 
 chemistry of the last Pharmacopoaia. — Pacific Medi- 
 cal and Surgical Journal, Jan. 1884. 
 
 BJLOXAM, CSAMLES L,, 
 
 Professor of Chemistry in King's College, London. 
 Chemistry, Inorganic and Organic. New American from the fifth Lon- 
 don edition, thoroughly revised and much improved. In one very handsome octavo 
 volume of 727 pages, with 292 illustrations. Cloth, $3.75 ; leather, $4.75. 
 
 Comment from us on this standard work is al- 
 most superfluous. It differs widely in scope and 
 aim from that of Attfield, and in its way is equally 
 beyond criticism. It adopts the most direct meth- 
 ods in stating the principles, hypotheses and facts 
 of the science. Its language is so terse and lucid, 
 and its arrangement or matter so logical in se- 
 quence that the student never has occasion to 
 
 complain that chemistry is a hard study. Much 
 attention is paid to experimental illustrations of 
 chemical principles and phenomena, and the 
 mode of conducting these experiments. The book 
 maintains the position it has always held as one of 
 the best manuals of general chemistry in the Eng- 
 lish language. — Detroit Lancet, Feb. 1884. 
 
 F^MSEW, IRA, M, n., Fh, D., 
 
 Professor of Chemistry in the Johns Hopkins University, Baltimore. 
 Principles of Theoretical Chemistry, with special reference to the Constitu- 
 tion of Chemical Compounds. Second and revised edition. In one handsome royal 12mo. 
 vt)lume of 240 pages. Cloth, $1.75. 
 
 That in so few years a second edition has been 
 called for indicates that many chemical teachers 
 have been found ready to endorse its plan and to 
 adopt its methods. In this edition a considerable 
 proportion of the book has been rewritten, much 
 
 new matter has been added and the whole has been 
 brought up to date. We earnestly commend this 
 book to every student of chemistry. — Amerirm 
 Journal of Science, March, 1884. 
 
10 
 
 Lea Brothers & Co.'s Publications — Chemistry. 
 
 CMAHLESf T. CBANSTOV^, M. !>., F, C. S., M, S., 
 
 Formerly Asst. Prof, and Denionst. of Chemistry and Chemical Physics, Queen's College, Belfast. 
 
 The Elements of Physiological and Pathological Chemistry. A 
 
 Handbook for Medical Students and Practitioners. Containing a general account of 
 Nutrition, Foods and Digestion, and the Cliemistry of the Tissues, Organs, Secretions and 
 Excretions of the Body in Health and in Disease. Together with the methods for pre- 
 paring or separating their chief constituents, as also for their examination in detail, and 
 an outline syllabus of a practical course of instruction for students. In one handsome octavo 
 volume of 463 pages, with 38 woodcuts and 1 colored plate. Cloth, $3.50. 
 
 The work is thoroughly trustworthy, and in- 
 formed throughout by a genuine scientific spirit. 
 The author deals with the chemistry of the diges- 
 tive secretions in a systematic manner, which 
 leaves nothing to be desired, and in reality sup- 
 plies a want in English literature. The book ap- 
 pears to us to be at once full and systematic, and 
 to show a just appreciation of the relative import- 
 ance of the various subjects dealt with.— ^ritis/j 
 Medical Journal, November 29, 1884^ 
 
 Dr. Charles' manual admirably fulfils its inten- 
 tion of giving his readers on the one hand a sum- 
 mary, comprehensive but remarkably compact, of 
 the mass of facts in the sciences which have be- 
 come indispensable, to the physician; and, on the 
 other hand, of a system of practical directions so 
 minute that analj^ses often considered formidable 
 may be pursued by any intelligent person. — 
 Archives of Medicine, Dec. 1884. 
 
 BLOFFMAJn^, F,, A.M„ Bh.D.f & FOWFM F,B,, FJi.D., 
 
 Public Analyst to the State of New York. Prof, of Anal. Chem. in the Phil. Coll. of Pharmacy. 
 
 A Manual of Chemical Analysis, as applied to the Examination of Medicinal 
 Chemicals and their Preparations. Being a Guide for the Determination of their Identity 
 and Quality, and for the Detection of Impurities and Adulterations. For the use of 
 Pharmacists, Physicians, Druggists and Manufacturing Chemists, and Pharmaceutical and 
 Medical Students. Third edition, entirely rewritten and much enlarged. In one very 
 handsome octavo volume of 621 pages, with 179 illustrations. Cloth, $4.25. 
 
 We congratulate the author on the appearance 
 of the third edition of this work, published for the 
 first time in this country also. It is admirable and 
 the information it undertakes to supply is both 
 extensive and trustworthy. The selection of pro- 
 cesses for determining the purity of the substan- 
 ces of which it treats is excellent and the descrip- 
 
 tion of them singularly explicit. Moreover, it is 
 exceptionally free from typographical errors. We 
 have no hesitation in recommending it to those 
 who are engaged either in the manufacture or the 
 testing of medicinal chemicals. — London Pharma- 
 ceutical Journal and Transactions, 1883. 
 
 CLOWES, FJRANK, D. Sc, Loudon, 
 
 Senior Scieiice- Master at the High School, Newcastle-under-Lyme, etc. 
 
 An Elementary Treatise on Practical Chemistry and Qualitative 
 Inorganic Analysis. Specially adapted for use in the Laboratories of Schools and 
 Colleo-es and by Beginners. Third American from the fourth and revised English edition. 
 In one very handsome royal 12mo. volume of 387 pages, with 55 illustrations. Cloth, 
 $2.50. 
 
 The style is clear, the language terse and vigor- 
 ous. Beginning with a list of apparatus necessary 
 for chemical work, he gradually unfolds the sub- 
 ject from its simpler to its more complex divisions. 
 It is the most readable book of the kind we have 
 yet seen, and is without doubt a systematic, 
 intelligible and fully equipped laboratory guide 
 
 and text book. — Medical Record, July 18, 1885. 
 
 We may simply repeat the favorable opinion 
 which we expressed after the examination of the 
 previous edition of this work. It is practical in its 
 aims, and accurate and concise in its statements. 
 — American Journal of Pharmacy, August, 1885. 
 
 BALFF, CSABLFS M,, M. jD., F, M. C F., 
 
 Assistant Physician at the London Hospital. 
 Clinical Chemistry. In one pocket-size 12mo. volume of 314 pages, with 16 
 
 illustrations. Limp cloth, red edges, $1.50. 
 This is one of the most instructive little works 
 that we have met with in a long time. The author 
 is a physician and physiologist, as well as a chem- 
 ist, consequently the book is unqualifiedly prac- 
 tical, telling the physician just wnat he ougnt to 
 know, of the applications of chemistry in medi- 
 
 See Students' Series of Manuals, page 4. 
 cine. Dr. Ralfe is thoroughly acquainted with the 
 latest contributions to his science, and it is quite 
 refreshing to find the subject dealt with so clearly 
 and simply, yet in such evident harmony with the 
 modern scientific methods and spirit. — Medical 
 Record, February 2, 1884. 
 
 CLASSEN, ALEXAJfL>EIt, 
 
 Professor in the Royal Polytechnic School, Aix-lorChapelle. 
 
 Elementary Quantitative Analysis. Translated, with notes and additions, by 
 Edgak F. Smith. Ph. D., Assistant Professor of Chemistry in the Towne Scientific School, 
 University of Penna, In one 12mo. volume of 324 pages, with 36 illust. Cloth, $2.00. 
 
 and then advancing to the analysis of minerals and 
 such products as are met with in applied chemis- 
 try. It is an indispensable book for students in 
 
 It is probably the best manual of an elementary 
 nature extant insomuch as its methods are the 
 best. It teaches by examples, commencing with 
 single determinations, followed by separations, 
 
 chemistry. — Boston Journal of Chemistry, OctH878. 
 
 GBEENE, WILLIAM S., M, D., 
 
 Demonstrator of Chemistry in the Medical Department of the University of Pennsylvania. 
 A Manual of Medical Chemistry. For the use of Students. Based upon Bow- 
 man's Medical Chemistry. In one 12mo. volume of 310 pages, with 74 illus. Cloth, $1,75. 
 
 It is a concise manual of three hundred pages, 
 giving an excellent summary of the best methods 
 of analyzing the liquids and solids of the body, both 
 for the estimation of their normal constituents and 
 
 the recognition of compounds due to pathological 
 conditions. The detection of poisons is treated 
 with sufficient fulness for the purpose of the stu- 
 dent or practitioner. — Boston Jl. of Chem. June.'SO. 
 
Lea Brothers & Co.'s Publications — Pharm., Mat. Med., Therap. 11 
 
 BBVNTON, T, LAUDBB, M.D,, D.Sc, F.M.S,, F.M.C.JP., 
 
 Lecturer on Materia Medica and Therapeutics at St. Bartholomew's Hospital, London, etc. 
 
 A Text-book of Pharmacology, Therapeutics 'and Materia Medica ; 
 
 Including the Pharmacy, the Physiological Action and the Therapeutical Uses of Drugs. 
 In one handsome octavo volume of 1033 pages, with 188 illustrations. Cloth, |5.50 ; 
 
 leather, $6.50. Just ready. 
 
 It is a scientific treatise worthy to be ranlsed with 
 the highest productions in physiology, either in 
 our own or any other language. Everything is 
 practical, the dry, hard facts of physiology being 
 pressed into service and applied to the treatment 
 of the commonest complaints. The information 
 is so systematically arranged that it is available 
 for immediate use. The index is so carefully 
 compiled that a reference to any special point is 
 at once obtainable. Dr. Brunton is never satisfied 
 with vague generalities, but gives clear and pre- 
 cise directions for prescribing the various drugs 
 and preparations. We congratulate students on 
 being at last placed in possession of a scientific 
 treatise of enormous practical importance. — The 
 London Lancet, June 27, 1885. 
 
 Of all the numerous publications of this year 
 
 upon the subject of Pharmacology the compre- 
 hensive work of Brunton is clearly the most 
 important, and is beyond question the foremost 
 English handbook of Materia Medica and Thera- 
 peutics since the appearance of Pereira's Elem enta 
 of Materia Medica in 1842. It is original both in 
 the arrangement of the subjects and in the mode 
 of' treatment, and develops in a comprehensive 
 manner the foundation principles of the science 
 of Pharmacology without leaving the needs of the 
 practitioner out of sight for an instant. In fact, 
 the author has written a book which deserves to 
 be known far beyond the boundaries of England, 
 and can serve as a model for the pharmacological 
 works of the continent on account of its happy 
 combination of theory with practice. — Virchow's 
 Jahresbericht, Berlin, 1886. 
 
 BAItMISH, BJDWAMJD, 
 
 Late Professor of the Theory and Practice of Pharmacy in the Philadelphia College of Pharmacy. 
 A Treatise on Pharmacy : designed as a Text-book for the Student, and as a 
 Guide for the Physician and Pharmaceutist. With many Formulae and Prescriptions. 
 Fifth edition, thoroughly revised, by Thomas S. WrEGAND, Ph. Gr. In one handsome 
 octavo volume of 1093 pages, with 256 illustrations. Cloth, $5 ; leather, $6. 
 
 No thoroughgoing pharmacist will fail to possess 
 himself of so useful a guide to practice, and no 
 physician who properly estimates the value of an 
 accurate knowledge of the remedial agents em- 
 ployed by him in daily practice, so far as their 
 
 miscibility, compatibility and mosteffeetive meth- 
 ods of combination are concerned, can afford to 
 leave this work out of the list of their works of 
 reference. The country practitioner, who must 
 always be in a measure his own pharmacist, will 
 find it indispensable. — Louisville Medical News, 
 March 29, 1884. 
 
 This well-knovni work presents itself now based 
 upon the recently revised new Pharmacopoeia. 
 
 Each page bears evidence of the care bestowed 
 upon it, and conveys valuable information from 
 the rich store of the editor's experience. In fact, 
 all that relates to practical pharmacy — apparatus, 
 processes and dispensing — has been arranged and 
 described with clearness in its various aspects, so 
 as to afford aid and advice alike to the student and 
 to the practical pharmacist. The work is judi- 
 ciously illustrated with good woodcuts — American 
 Journal of^ Pharmacy, January, 1884. 
 
 There is nothing to equal Parrish's Pharmacy 
 in this or any other language. — London Pharma,- 
 ceutical Journal. 
 
 MBBMAJn^, Dr, i.. 
 
 Professor of Physiology in the University of Zurich. 
 Experimental Pharmacology. A Handbook of Methods for Determining the 
 Physiological Actions of Drugs. Translated, with the Author's permission, and with 
 extensive additions, by Egbert Meade Smith, M. D., Demonstrator of Physiology in the 
 University of Pennsylvania. In one handsome 12mo. volume of 199 pages, with 32 
 illustrations. Cloth, $1.50. 
 
 MAISCS, JOJSNM., JPJiar, ^ 
 
 Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. 
 
 A Manual of Organic Materia Medica; Being a Guide to Materia Medica of 
 the Vegetable and Animal Kingdoms. For the use of Students, Druggists, Pharmacists 
 and Physicians. Second edition. In one handsome royal 12mo. volume of 526 pages, 
 with 242 illustrations. Cloth, $3.00. 
 
 This work contains the substance, — the practical 
 "kernel of the nut" picked out, so that the stu- 
 dent has no superfluous labor. He can confidently 
 accept what this work places before him, without 
 any fear that the gist of the matter is not in it. 
 Another merit is that the drugs are placed before 
 him in such a manner as to simplify very much 
 the study of them, enabling the mind to grasp 
 them more readily. The illustrations are most 
 
 excellent, being very true to nature, and are alone 
 worth the price of the book to the student. To the 
 practical physician and pharmacist it is a valuable 
 work for handy reference and for keeping fresh 
 in the memory the knowledge of materia medica 
 and botany already acquired. We can and do 
 heartily recommend it. — Medical and Surgical Re- 
 porter, Feb. 14, 1885. 
 
 BJRTTCE, J, MIICMELL, M, J>,, F. It, C, P., 
 
 Physician and Lecturer on Materia Medica and Therapeutics at Charing Cross Hospital, London. 
 Materia Medica and Therapeutics. An Introduction to Kational Treat- 
 ment. Fourth edition. In one pocket-size 12mo, volume of 591 pages. Limp cloth, 
 $1.50. See Students' Series of Manuals, page 4. 
 
 GRIFFITH:, BOBFMT EGLESFIELD, M, D. 
 
 _ A Universal Formulary, containing the Methods of Preparing and Adminis- 
 tering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceut- 
 ists. Third edition, thoroughly revised, with numerous additions, by John M. Maisch, 
 Phar. D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacv. 
 In one octavo volume of 775 pages, with 38 illustrations. Cloth, $4.50 ; leather, $5.50. 
 
12 Lea Brothers & Co.'s Publications — Mat. Med., Tlierap. 
 
 STILLE, A., M, !>., ZZ, D., & MAISCH, J. M., Thar, I),, 
 
 Prof essor Emeritus of the Theory and Prac- 
 tice of Medicine and of Clinical Medicine 
 in the University of Pennsylvania. 
 
 Prof, of Mat. Med. and Botany in Phila. 
 College of Pharmacy, See' y to the Ameri- 
 can Pharmaceutical Association. 
 
 NEW EDITION.-JUST READY. 
 
 The National Dispensatory. 
 
 CONTAINING THE NATURAL HISTORY, CHEMISTRY, PHARMACY, ACTIONS AND USES OF 
 
 MEDICINES INCLUDING THOSE RECOGNIZED IN THE PHARMACOP(EIAS OF THE 
 
 UNITED STATES, GREAT BRITAIN AND GERMANY, WITH NUMEROUS 
 
 REFERENCES TO THE FRENCH CODEX. 
 
 Fourth edition, revised to October, 1886, and covering the new British Pharmacopcda. 
 
 In one magnificent imperial octavo volume of 1794 pages, with 311 elaborate 
 engravings. Price in cloth, $7.25 ; leather, raised bands, $8.00; very handsome half 
 Eussia, raised bands and open back , $9.00. 
 
 %* This work will be furnished with Patent Beady Reference Thumb-letter Index for $1.00 
 in addition to the price in any style of binding. 
 
 In this new edition of The National Dispensatory, all important changes in the 
 recent British Pharmacopoeia have been incorporated throughout the volume, while in 
 the Addenda will be found, grouped in a convenient section of 24 pages, all therapeutical 
 novelties which have been established in professional favor since the publication of the 
 third edition two years ago. Detailed information is thus given of the following among 
 the many drugs treated : Antipyrin, Cocaine Hydrochlorate, Cascara Sagrada, Fabiana, 
 Franciscea, various new Glycerins, Gymnocladus, Hydroquinon, Hypnone, lodol, Jaca- 
 randa. Lanolin, Menthol, Phormium, Sulphophenol, Thallin and Urethan. In this 
 edition, as^ always before, The National Dispensatory may be said to be the represent- 
 ative of the most recent state of American, English, German and French Pharmacology, 
 Therapeutics and Materia Medica. 
 
 Thif, the most comprehensive of the several 
 commentaries on the Pharmacopoeias of the United 
 States, Great Britain and Germany which has yet 
 appeared, has by this last revision been brought 
 fully up to the existing knovcledge upon the sub- 
 ject treated. Its references to the British Phar- 
 macopceia have been amended for the late and 
 much-changed new edition of that work; an "ad- 
 denda" of twenty-five pages has been appended, 
 treating of the latest and most important addi- 
 tions to the materia medica. This work should 
 be in the hands of every physician and pharma- 
 cist. — Boston Medical and Surgical Journal, Feb. 10, 
 1887. 
 
 The previous editions of The National Dispensa- 
 tory have from time to time been brought before 
 our readers, and that in 1884 left apparently little 
 to be desired, as the authors had entirely remod- 
 elled their work, and also brought its contents up 
 to the latest possible period. The publication of 
 the revised British Pharmacopoeia has, however, 
 necessitated another edition, embracing the nu- 
 
 merous changes therein embodied, and the oppor- 
 tunity has thus been afforded of supplying 
 information on the unoflScinal additions which 
 have, during the past two years, been made to the 
 materia medica. — Canadian Pharmaceutical Jour- 
 nal, Feb. 1887. 
 
 This, the most comprehensive and exhaustive 
 commentary on the Pharmacopoeias of the United 
 States, Great Britain and Germany which has yet 
 appeared, might with great propriety have been 
 called the International Dispensatory. By this 
 last revision it has been brought fully up to the 
 limit of existing knowledge upon the subject 
 treated. The references to the British Pharma- 
 copoeia have been changed to correspond with the 
 latest and greatly altered edition of that work. 
 Besides other features of improvement, the most 
 recent advances have been embraced in the shape 
 of ''Addenda" of all new and important articles. 
 No pharmacist will be without this work, and no 
 physician will be without it. — The American Prac- 
 titioner and News, February 19, 1887. 
 
 FAMQVSABSOW, BOBERT, M. !>., 
 
 Lecturer on Materia Medica at St. Mary's Hospital Medical School. 
 
 A Guide to Therapeutics and Materia Medica. Third American edition, 
 specially revised by the Author. Enlarged and adapted to the U. S. Pharmacopoeia by 
 Frank Woodbury, M. D. In one handsome 12mo. volume of 524 pages. Cloth, $2.25. 
 
 Dr. Farquharson's Therapeutics is constructed 
 upon a plan which brings before the reader all the 
 essential points with reference to the properties of 
 drugs. It impresses these upon him in such a way 
 as to enable him to take a clear view of the actions 
 ol medicines and the disordered conditions in 
 which they must prove useful. The double-col- 
 
 umned pages — one side containing the recognized 
 physiological action of the medicine, and the other 
 the disease in which observers (who are nearly al- 
 ways mentioned) have obtained from it good re- 
 sults — make a very good arrangement. The early 
 chapter containing rules for prescribing is excel- 
 lent. — Canada Med. and Surg. Journal, Dec. 1882. 
 
 EBES, MOBEBT T., M. D., 
 
 Jackson Professor of Clinical Medicine in Harvard University, Medical Department. 
 
 A Text-Book of Materia Medica and Therapeutics. In one octavo volume 
 of about 600 pages, with illu&trations. Preparing. 
 
 STIZZE, AZFBEZ^, M. B., ZZ, !>., 
 
 Professor of Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna. 
 Therapeutics and Materia Medica. A Systematic Treatise on the Action and 
 Uses of Medicinal Agents, including their Description and History. Fourth edition, 
 revised and enlarged. In two large and handsome octavo volumes, containing 1936 pages. 
 Cloth, $10.00 ; leather, $12.00 ; very handsome half Eussia, raised bands, $13.00. 
 
Lea Brothers & Co.'s Publications — Pathol., Histol. 
 
 13 
 
 COATS, JOSBJPMf M. JD., F. F. F, S., 
 
 Pathologist to the Glasgow Western Infirmary. 
 A Treatise on Pathology. In one very handsome octavo volume of 829 pages, 
 with 339 beautiful illustrations. Cloth, |5.50 ; leather, $6.50. 
 
 The work before us treats the subject of Path- 
 ology more extensively than it is usually treated 
 In similar works. Medical students as well as 
 physicians, who desire a work for study or refer- 
 ence, that treats the subjects in the various de- 
 partments in a very thorough manner, but without 
 prolixity, will certainly give this one the prefer- 
 ence to any with which we are acquainted. It sets 
 forth the most recent discoveries, exhibits, in an 
 interesting manner, the changes from a normal 
 condition eflFected in structures by disease, and 
 points out the characteristics of various morbid 
 agencies, so that they can be easily recognized. But, 
 not limited to morbid anatomy.it explains fully how 
 the functions of organs are disturbed by abnormal 
 conditions. There is nothing belonging to its de- 
 
 partment of medicine that is not as fully elucidated 
 as our present knowledge will admit. — Cincinnati 
 Medical News, Oct. 1883. ' 
 
 One of the best features of this reatise consists 
 in the judicious admixture of foreign observation 
 with private experience. Thus the subject is 
 presented in a harmonious manner, facilitating 
 the study of single topics and making the entire 
 volume profitable and pleasant reading. The 
 author includes in his descriptions, general 
 pathology as well as the special pathological histol- 
 ogy of the different systems and organs. He has 
 succeeded in offering to students and practition- 
 ers a thoroughly acceptable work. — Medical Record, 
 Dec. 22, 1883. 
 
 GMFFJ^, T, ELENRY, M, I),, 
 
 Lecturer on Pathology and Morbid Anatomy at Charing-Cross Hospital Medical School, London. 
 
 Pathology and. Morbid Anatomy. Fifth American from the sixth revised 
 and enlarged English edition. In one very handsome octavo volume of 482 pages, with 
 150 line engravings. Cloth, $2.50. 
 
 The fact that this well-known treatise has so 
 rapidly reached its sixth edition is a strong evi- 
 dence of its popularity. The author is to be con- 
 gratulated upon the thoroughness with which he 
 has prepared this work. It is thoroughly abreast 
 with all the most recent advances in pathology. 
 No work in the English language is so admirably 
 adapted to the wants of the student and practi- 
 tioner as this, and we would recommend it most 
 earnestly to every one. — Nashville Journal of Medi- 
 cine and Surgery, Nov. 1884. 
 
 An extended review of such a well-known book 
 is unnecessary. We had already regarded the 
 book as a model of its kind, and the author's as- 
 surance that he believes the present edition to be 
 fully up to date will be received as sufficient 
 proof that nothing of importance has been omitted. 
 The book has been most carefully revised, and 
 bears upon every page the marks of the care and 
 accuracy that have won for it an international 
 reputation. — New York Medical and Surgical Jour- 
 nal, July 18, 1885. 
 
 WOODHEAD, G. SIMS, M. J>., F. R. C, F. E., 
 
 Demonstrator of Pathology in the University of Edinburgh. 
 Practical Pathology. A Manual for Students and Practitioners. In one beau- 
 tifdl octavo volume of 497 pages, with 136 exquisitely colored illustrations. Cloth, $6.00. 
 
 It forms a real guide for the student and practi- themselves with this manual. The numerous 
 tioner who is thoroughly In earnest in his en- drawings are not fancied pictures, or merely 
 deavor to see for himself and do for himself. To schematic diagrams, but they represent faithfully 
 the laboratory student it will be a helpful com- the actual images seen under the microscope, 
 panion, and all those who may wish to familiarize The author merits all praise for having produced 
 themselves with modern methods of examining a valuable work. — Medical Record, May 31, 1884. 
 morbid tissues are strongly urged to provide 
 
 SCHAFER, EI>WARD A., F. R, S., 
 
 Assistant Professor of Physiology in University College, London, 
 The Essentials of Histology, in one octavo volume of 246 'pages, with 
 
 281 illustrations. Cloth, $2.25. 
 
 This short volume might be called a companion 
 book to Green's Pathology, and fills the same place 
 in histology the latter occupies in pathology. This 
 book is so short, clear and satisfactory, as to invite 
 perusal, and repay any time spent in doing so. We 
 think the book deserving of the highest praise. 
 — New Orleans Med. and Surg. Journal, Dec. 1885. 
 
 This admirable work is a cheering example of 
 
 well-won success, earned by the faithful and dili- 
 gent pursuit of excellence in presentation of this 
 essential foundation of all true medical science. 
 Since this new work of Professor Sctiafer's will 
 doubtless be speedily placed upon the list of text- 
 books required in every medical college, we feel 
 that it needs no further recommendation at our 
 hands. — Am. Jour, of the Med. Sciences, Jan. 1886. 
 
 KLEIJSr, E., M. D., F, R. S., 
 
 Joint Lecturer on General Anat. and Phys. in the Med. School of St. Bartholomew'' s Hosp., London. 
 Elements of Histology. In one pocket-size 12mo. volume of 360 pages, with 181 
 illus. Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 4. 
 
 This little volume, originally intended by its 
 able author as a manual for medical students, 
 contains much valuable information, systematic- 
 ally arranged, that will be acceptable to the 
 general practitioner. It gives a graphic and lucid 
 description of every tissue and organ in the hu- 
 
 man body; and, while small in size, it is full to 
 overflowing with important facts in regard to these 
 multiform and complex structures. We know of 
 no book of its size that will prove of greater va'ue 
 to medical students and practitioners of medi- 
 cine. — The Southern Practitioner, Nov. 1883. 
 
 FEFFER, A, J., M, B., M, S., F, R. C. S,, 
 
 Surgeon and Lecturer at St. Mary's Hospital, London. 
 Surgical Pathology. In one pocket-size 12mo. volume of 511 pages, with 81 
 illustrations. Limp cloth, red edges, $2.00. See Students' Series of Manuals, page 4. 
 
 It is not pretentious, but it will serve exceed 
 ingly well as a book of reference. It embodies a 
 great deal of matter, extending over the whole 
 field of surgical pathology. Its form is practical, 
 its language is clear, and the information set 
 forth is well-arranged, well-indexed and well- 
 
 illustrated. The student will find in it nothing 
 that is unnecessary. The list of subjects covers 
 the whole range of surgery. The book supplies a 
 very manifest want and should meet with suc- 
 cess. — New York Medical Journal, May 31, 1884. 
 
 Cornil and Ranvier's Pathological Histology. — Translated by E. O. 
 Shakespeaee, M. D., and J. Henry C. Simes, M. D. Octavo, 800 pp., 360 illustrations. 
 
14 
 
 Lea Brothers & Co.'s Publications — ^Practice of Med. 
 
 FLINT, AVSTIJS^, M. J>., 
 
 Prof, of the Principles and Practice of Med. and of Clin. Med. in Bellevue Hospital Medical College, N. T. 
 
 A Treatise on the Principles and Practice of Medicine. Designed for 
 the use of Students and Practitioners of Medicine. New (sixth) edition, thoroughly re- 
 vised and rewritten by the Author, assisted by William H. Welch, M. D., Professor of 
 Pathology, Johns Ho'pkins University, Baltimore, and Austin Flint, Je., M. D., Professor 
 of Physiology, Bellevue Hospital Medical College, N. Y. In one very handsome octavo 
 volume of about 1170 pages, with illustrations. Cloth, |5.50; leather, ^6.50; very 
 handsome half Eussia, raised bands, $7.00. 
 
 No text-book on the principles and practice of 
 medicine has ever met in this country with such 
 general approval by medical students and practi- 
 tioners as the vpork of Professor Flint. In all the 
 medical colleges of the United States it is the fa- 
 vorite work upon Practice; and, as we have stated 
 before in alluding to it, there is no other medical 
 work that can be so generally found in the libra- 
 ries of physicians. Jn every state and territory 
 of this.vast country the book that will be most likely 
 to be found in the ofifice of a medical man, whether 
 in city, town, village, or at some cross-roads, is 
 Flint's Practice. We make this statement to a 
 considerable extent from personal observation, and 
 it is the testimony also of others. An examina- 
 tion shows that very cons-iderable changes have 
 been made in the sixth edition. The work may un- 
 doubtedly be regarded as fairly representing the 
 present state of the science of medicine, and as 
 
 reflecting the views of those who exemplify in 
 their practice the present stage of progress of med- 
 ical art. — Cincinnati Medical Keics, Oct. 1886. 
 
 He was a born teacher, a teacher by the bedside, 
 a teacher in the lecture-room, a teacher to the in- 
 dividual pupil, and a teacher to thousands of stu- 
 dents. He was a constiant teacher with his pen. 
 He lived to collect, to analyze, and so to formulate 
 new ideas, which were freely given to the pro- 
 fession of his choice. This" volume, more per- 
 fectly than any previous edition, gathers up and 
 completes an account of all those matters which 
 may fairly be discussed in a work on the practice 
 of medicine. It is a work of which any American 
 physician can well be proud, when he compares 
 it with the best that has been done in a similar way 
 by any writer in any country or any age. — The 
 American Lancet, Nov. 1886. 
 
 JBLAMTSSOBNE, JEBNRT, M, !>., LL, D., 
 
 Lately Professor of Hygiene in the University of Pennsylvania. 
 
 Essentials of the Principles and Practice of Medicine. A Handbook 
 for Students and Practitioners. Fifth edition, thoroughly revised and rewritten. In one 
 royal 12mo. volume of 669 pages, with 144 illustrations. Cloth, $2.75 ; half bound, $3.00. 
 
 Within the compass of 600 pages it treats of the 
 history of medicine, general pathology, general 
 symptomatology, and physical diagnosis (including 
 laryngoscope, ophthalmoscope, etc.), general ther- 
 apeutics, nosology, and special pathology and prac- 
 tice. There is a wonderful amount of information 
 contained in this work, and it is one of the best 
 of its kind that we have seen. — Glasgow Medical 
 Journal, Nov. 1882. 
 
 An indispensable book. No work ever exhibited 
 a better average of actual practical treatment than 
 
 this one; and probably not one writer in our day 
 had a better opportunity than Dr. Hartshorne for 
 condensing all the views of eminent practitioners 
 into a 12mo. The numerous illustrations will be 
 very useful to students especially. These essen- 
 tials, as the name suggests, are not intended to 
 supersede the text-books of Flint and Bartholow, 
 but they are the most valuable in affording the 
 means to see at a glance the whole literature of any 
 disease, and the most valuable treatment. — Chicago 
 Medical Journal and Examiner, April, 1882. 
 
 BRISTOWB, JOMN SYEM, 31. !>., F. B. C. F., 
 
 Physician and Joint Lecturer on Medicine at St. Thomas^ Hospital, London. 
 
 A Treatise on the Practice of Medicine. Second American edition, revised 
 by the Author. Edited, with additions, by James H. Hutchinson, M.D., physician to the 
 Pennsylvania Hospital. In one handsome octavo volume of 1085 pages, with illustrations. 
 Cloth, $5.00 ; leather, $6.00 ; very handsome half Russia, raised bands, $6.50. 
 
 The book is a model of conciseness, and com- 
 bines, as successfully as one could conceive it to 
 be possible, an encyclopaedic character with the 
 smallest dimensions. It differs from other admi- 
 rable text-books in the completeness with which 
 it covers the whole field of medicine. — Michigan 
 Med'cal News, May 10, 1880. 
 
 His accuracy in the portraiture of disease, his 
 care in stating subtle points of diagnosis, and the 
 faithfully given pathology of abnormal processes 
 have seldom been surpassed. He embraces many 
 diseases not usually considered to belong to theory 
 
 and practice, as skin diseases, syphilis and insan- 
 ity, but they will not be objected to by readers, aa 
 he has studied them conscientiously, and drawn 
 from the life. — Medical and Surgical Reporter, De- 
 cember 20, 1879. 
 
 The reader will find every conceivable subject 
 connected with the practice of medicine ably pre- 
 sented, in a style at once clear, interesting and 
 concise. The additions made by Dr. Hutchinson 
 are appropriate and practical, and greatly add to 
 its usefulness to American readers. — Buffalo Med- 
 ical and Surgical Journal, March, 1880. 
 
 WATSOW, SIB TSOMAS, M. D,, 
 
 Late Physician in Ordinary to the Queen. 
 
 Lectures on the Principles and Practice of Physic. A new American 
 from the fifth English edition. Edited, with additions, and 190 illustrations, by Henry 
 Hartshorne, A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. 
 In two large octavo volumes of 1840 pages. Cloth, $9.00 ; leather, $11.00. 
 
 LECTURES ON THE STUDY OF FEVER. By 
 A. Hudson, M. D., M. R. I. A. In one octavo 
 volume of 308 pages. Cloth, 82.50. 
 
 STOKES' LECTURES ON FEVER. Edited by 
 John William Moore, M. D., F. K. Q. C. P. In 
 one octavo volume of 280 pages. Cloth, 82.00. 
 
 A TREATISE ON FEVER. By Robeht D. Lyons, 
 K. C. C. InoneSvo. vol. of354pp. Cloth, 82.25. 
 
 LA ROCHE ON YELLOW FEVER, considered in 
 its Historical, Pathological, Etiological and 
 Therapeutical Relations. In two large and hand- 
 some octavo volumes of 1468 pp. Cloth, 87.00. 
 
 A CENTURY OV AMERICAN MEDICINE, 1776—1876. By Dra. E. H. Clabkb, H. J. 
 BiQELOw, S. D. Gross, T. G. Thomas, and J. S. Billings. In one 12mo. volume of 370 pages. Cloth, 82.25. 
 
Lea Brothers & Co.'s Publications — System of Med. 
 
 15 
 
 For Sale by Subscription Only. 
 
 A System of Practical Medicine. 
 
 BY AMERICAN AUTHORS. 
 
 Edited by WILLIAM PEPPER, M. D., LL. D., 
 
 PROVOST AND PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE AND OF 
 CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANTAj 
 
 Assisted by Louis Starr, M. D., Clinical Professor of the Diseases of Children in the 
 Hospital of the University of Pennsylvania. 
 
 The complete work, in five volumes, containing 5573 pages, with 198 illustrations, is just ready. 
 Price per volume, cloth, $5 ; leather, $Q ; half Russia, raised bands and open back, $7. 
 
 In this great work American medicine is for the first time reflected by its worthiest 
 teachers, and presented in the full development of the practical utility which is its pre- 
 eminent characteristic. The most able men — from the East and the West, from the 
 North and the South, from all the prominent centres of education, and from all the 
 hospitals which aiford special opportunities for study and practice — have united in 
 generous rivalry to bring together this vast aggregate of specialized experience. 
 
 The distinguished editor has so apportioned the work that to each author has been 
 assigned the subject which he is peculiarly fitted to discuss, and in which his views 
 will be accepted as the latest expression of scientific and practical knowledge. The 
 practitioner will therefore find these volumes a complete, authoritative and unfailing work 
 of reference, to which he may at all times turn with full certainty of finding what he needs 
 in its most recent aspect, whether he seeks information on the general principles of medi- 
 cine, or minute guidance in the treatment of special disease. So wide is the scope of the 
 work that, with the exception of midwifery and matters strictly surgical, it embraces the 
 ■whole domain of medicine, including the departments for which the physician is accustomed 
 to rely on special treatises, such as diseases of women and children, of the genito-urinary 
 organs, of the skin, of the nerves, hygiene and sanitary science, and medical ophthalmology 
 and otology. Moreover, authors have inserted the formulas which they have found most 
 efficient in the treatment of the various aflTections. It may thus be truly regarded as a 
 Complete Library of Practical Medicine, and the general practitioner possessing it 
 may feel secure that he will require little else in the daily round of professional duties. 
 
 In spite of every effort to condense the vast amount of practical information fur- 
 nished, it has been impossible to present it in less than 5 large octavo volumes, containing 
 about 5600 beautifully printed pages, and embodying the matter of about 15 ordinary 
 octavos. Illustrations are introduced wherever requisite to elucidate the text. 
 
 A detailed prospectus of the work will be sent to any address on application to the 
 pMishers. 
 
 These two volumes bring this admirable work 
 to a close, and fully sustain the high standard 
 reached by the earlier volumes; we have only 
 therefore to echo the eulogium pronounced upon 
 them. We would warmly congratulate the editor 
 and his collaborators at the conclusion of their 
 laborious task on the admirable manner in which, 
 from first to last, they have performed their several 
 duties. They have succeeded in producing a 
 work which will long remain a standard work of 
 reference, to which practitioners will look for 
 
 fuidanee, and authors will resort to for facts. 
 'rom a literary point of view, the work is without 
 any serious blemish, and in respect of production, 
 it has the beautiful finish that Americans always 
 give their works. — Edinburgh Medical Journal, Jan. 
 1887. 
 
 * * Thegreatestdistinctively American work on 
 the practice of medicine, and, indeed, the super- 
 lative adjective would not be inappropriate were 
 even all other productions placed in comparison. 
 An examination of the five volumes is sufficient 
 to convince one of the magnitude of the enter- 
 prise, and of the success which has attended its 
 fulfilment.— TAe Medical Age, July 26, 1886. 
 
 Convenience and good order, witn easy refer- 
 ence, are no less characteristic than the almost 
 uniform excellence of the matter. — New York 
 Medical Journal, June 19, 1886. 
 
 We consider it one of the grandest works on 
 Practical Medicine in the EngUsh language. It is 
 a work of which the profession of this country can 
 feel proud. Written exclusively by American 
 physicians who are acquainted with all the varie- 
 ties of climate in the United States, the character 
 of the soil, the manners and customs of the peo- 
 
 ple, etc., it is peculiarly adapted to the wants 
 of American practitioners of medicine, and it 
 seems to us that every one of them would desire 
 to have it. It has been truly called a "Complete 
 Library of Practical Medicine," and the general 
 practitioner will require little else in his round 
 of professional duties. — Cincinnati Medical News, 
 March, 1886. 
 
 Each of the volumes is provided with a most 
 copious index, and the work altogether promises 
 to be one which will add much to the medical 
 literature of the present century, and reflect great 
 credit upon the scholarship and practical acumen 
 of its authors. — The London Lancet, Oct. 3, 1885. 
 
 The feeling of proud satisfaction with which the 
 American profession seps this, its representative 
 system of practical medicine issued to the medi- 
 cal world, is fully justified by the character of the 
 work. The entire caste of the system is in keep- 
 ing with the best thoughts of the leaders and fol- 
 lowers of our home school of medicine, and the 
 combination of the scientific study of disease and 
 the practical application of exact and experimen- 
 tal knowledge to the treatment of human mal- 
 adies, makes every one of us share in the pride 
 that has welcomed Dr. Pepper's labors. Sheared 
 of the prolixity that wearies the readers of the 
 German school, the articles glean these same 
 fields for all that is valuable. It is the outcome 
 of American brains, and is marked throughout 
 by much of the sturdy independence of thought 
 and originality that is a national characteristic. 
 Yet nowhere is there lack of study of the most 
 advanced views of the day. — North Carolina Medi- 
 cal Journal, Sept. 1886, 
 
16 Lea Brothers & Co.'s Publications — Clinical Med., etc. 
 
 BJEYNOLnS, J, BVSSBLL, M, JD., 
 
 Professor of the Principles and Practice of Medicine in University College, London. 
 A System of Medicine. Witli notes and additions by Hexe,"X Hartshoene, 
 A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. In three large 
 and handsome octavo volumes, containing 3056 double-columned pages, with 317 illustra- 
 tions. Price per volume, cloth, $5.00 ; sheep, $6.00 ; very handsome half Russia, raised bands, 
 $6.50. Per set, cloth, $15; leather, $18; half Russia, $19.50. Sold only by subscription. 
 For conciseness and comprehensiveness in the | this index can fully appreciate. — Michigan Medical 
 treatment of all the subjects embraced under the ' Neivs, June 10, 1880. 
 
 head of "Practice of Bledicine," there is no work There is no medical work which we have in 
 in the English language, or in any other language, ] times past more frequently and fully consulted 
 for that matter, which equals, much less excels, | when perplexed by doubts as to treatment, or by 
 
 Reynolds' System. Each volume contains a com- 
 plete index — a feature which those who may have 
 encyclopaedic works on medicine not containing 
 
 having unusual or apparently inexplicable symp- 
 toms presented to us than Reynolds' System at 
 Medicine. — Am. Journ. of Med. Sci., January, 1880. 
 
 STILZE, ALFItBD, M. D,, LL, D., 
 
 Professor Emeritus of the Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna, 
 Cholera : Its Origin, History, Causation, Symptoms, Lesions, Prevention and Treat- 
 ment. In one handsome 12mo. volume of 163 pages, with a chart. Cloth, $1.25. Just ready. 
 This timely little work is full of the learning 
 
 and good judgment which marks all that comes 
 from the pen of its distinguished author. What 
 he has to say on treatment is characterized by 
 his usual caution and his well-known preference 
 
 for a rational system. Altogether, the monograph 
 is one that will have an excellent influence on the 
 professional mind. — Medical and Surgical Reporter, 
 August 1, 1885. 
 
 FIWLAYSOJS^, JA3IBS, M. !>., Editor, 
 
 Physician and Lecturer on Clinical Medicine in the Olasgow Western Infirmary, etc 
 Clinical Diagnosis. A Handbook for Students and Practitioners of Medicine, 
 With Chajsters by Prof. Gairdner on the Physiognomy of Disease ; Prof. Stephenson on 
 Diseases of the Female Organs; Dr. Robertson on Insanity; Dr. Gemmell on Physical 
 Diagnosis ; Dr. Coats on Laryngoscopy and Post-Mortem Examinations, and by the Editor 
 on Case-taking, Family History and Symptoms of Disorder in the Various Systems. New 
 edition. In one handsome 12mo. volume of 682 pages, with 158 illustrations. Cloth, 
 $2.50. Just ready. 
 
 We are pleased to see a second edition of this 
 admirable book, which occupies a position in 
 medical literature that previous to the first ap- 
 pearance of this work was unoccupied. It is 
 
 tions maintain its present standard of excellence! 
 It is a book which will greatly aid the work of 
 the clinical teacher, and should be thoroughly 
 digested by every student of medicine. The 
 
 essentially a practical treatise on medical diagno- j general practitioner will find many practical hints 
 sis, in which every sign and symptom of disease I in its pages, while a careful study of the work 
 is carefully analyzed, and their relative signifi- j will save him from many pitfalls in diagnosis, 
 cance in the ditferent affections in which they j The book, therefore, in our opinion, commends 
 occur pointed out. From their synthesis the stu- i itself to a wide field of readers, and we sincerely 
 dent can accurately determine the disease with j wish it the great success which it so richly merits, 
 which he has to deal. The book has no competi- — Liverpool Medico-Chirurgical Journal, Jan. 1887. 
 tor, nor is it likely to have as long as future edi- | 
 
 FOTSEMGILLf J. M,, M. D., Edin,, M. M, C. JP,, Lond., 
 
 Physician to the City of London Hospital for Diseases of the Chest. 
 
 The Practitioner's Handbook of Treatment ; Or, The Principles of Thera- 
 peutics. New edition. In one octavo volume of about 700 pages. Cloth, $3.75. Shortly. 
 
 BMOADBEWT, W. BC., M. B., F, B. C. B., 
 
 Physician to and Lecturer on Medicine at St. Mary's Hospital. 
 The Pulse. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 4. 
 
 FENWICK, SAJKUEB, M, D., 
 
 Assistant Physician to the London Hospital. 
 
 The Student's Guide to Medical Diagnosis. From the third revised and 
 enlarged English edition. In one very handsome royal 12mo. volume of 328 pages, with 
 87 illustrations on wood. Cloth, $2.25. 
 
 HABEBSSOW, S. O., 31, B., 
 
 Senior Physician to and late Led. on Principles and Practice of Med. at Ghiy's Hospital, London. 
 
 On the Diseases of the Abdomen ; Comprising those of the Stomach, and 
 other parts of the Alimentary Canal, (Esophagus, Caecum, Intestines and Peritoneum. Second 
 American from third enlarged and revised English edition. In one handsome octavo 
 volume of 554 pages, with illustrations. Cloth, $3.50. 
 
 TAJn^EM, THOMAS BCAWKES, M, B. 
 
 A Manual of Clinical Medicine and Physical Diagnosis. Third American 
 from the second -London edition. Revised and enlarged by TrLBimY Fox, M. D. 
 In one small 12mo. volume of 362 pages, with illustrations. Cloth, $1.50. 
 
Lea Brothers & Co.'s Publications — Hygiene, Electr., Pract. 17 
 
 BICSARJDSON, B. W., M,A,, M,D., T.L. J>., F.It.S., F.S.A. 
 
 Fellow of the Royal College ol Physicinw., Jonaon. 
 
 Preventive Medicine. In one octavo volume ot 729 pages. 
 $5; very handsone halt ±i .ssia, raised bands, %b.b^ . 
 
 Cloth, |4; leather, 
 
 Pr. Richar'asop ha:- ... .:.'<^,.;f- > in producing a 
 work which is elevated in conception, comprehen- 
 sive in scope, scientific in character, systematic in 
 arrangement, and wliich is written in a clear, con- 
 cise and pleasant manner. He evinces the happy 
 faculty of extracting the pith of what is known on 
 the subject, and of presenting it in a most simple, 
 intelligent and practical form. There is perhaps 
 no similar work written for the general public 
 thatcontains such acomplete, reliable and instruc- 
 tive collection of data upon the diseases common 
 to the race, their origins, causes, and the measures 
 for their prevention. The descriptions of diseases 
 are clear, chaste and scholarly; the discussion of 
 the question of disease is comprehensive, masterly 
 and fully abreast with the latest and best knowl- 
 edge on the subject, and the preventive measures 
 advised are accurate, explicit and reliable. — The 
 American Journal of the Medical Sciences, April, 1884. 
 
 It excels any other book which has fallen under 
 
 ou\ observation on the subject of which it treats. 
 It comprehends the nature, causes and preven- 
 tion of disease from a strictly scientific stand- 
 point. The American publishers have done the 
 medical profes.'ion a valuable service in laying it 
 before them. It contains much with which every 
 physician should be familiar. There is no other 
 work in the language in which the information 
 here presented can be found so systematically 
 arranged and intelligently presented.— TAe Sani- 
 taria-n, March, 1884. 
 
 This is a book that will surely find a place on the 
 table of every progressive physician. To the 
 medical profession, whose duty is'quite as much to 
 prevent as to cure disease, the book will be a boon. 
 — Boston Medical and Surgical Journal, Mar. 6, 1884. 
 
 The treatise contains a vast amount of solid, valu- 
 able hygienic miormaXiou.— Medical and Surgical 
 Reporter, Feb. 23, 1884. 
 
 JEEAMTSHOItNE, MENHY, M. D., LL, D., 
 
 Formerly Professor of Hygiene in the University of Pennsylvania, and Professor of Physiology and 
 Diseases of Children in the Woman's Medical College of Pennsylvania. 
 
 A Household Manual of Medicine, Surgery, Nursing and Hygiene: 
 
 For Daily Use in the Preservation of Health and Care of the Sick and Injured, with an 
 Introductory Outline of Anatomy and Physiology. In one very handsome royal octavo 
 volume of 946 pages, with 8 plates and 283 engravings. Cloth, §4.00 ; very handsome 
 half Morocco, $5.00. 
 
 BABTSOZOW, BOBEBTS, A. M., M, 2>., ii. JD,, 
 
 Prof, of Materia Medica and General Therapeutics in the Jefferson Med. Coll. of Phila., etc. 
 
 Medical Electricity. A Practical Treatise on the Applications of Electricity 
 to Medicine and Surgery. New (third) edition. In one very handsome octavo volume of 
 300 pages, with about 125 illustrations. Shortly. 
 
 A notice of the previous edition is appended. 
 
 A most excellent work, addressed by a practi- 
 tioner to his fellow-practitioners, and therefore 
 thoroughly practical. The work now before us 
 has the exceptional merit of clearly pointing out 
 where the benefits to be derived from electricity 
 must come. It contains all and everything that 
 the practitioner needs in order to understand in- 
 telligently the nature and laws of the agent he is 
 making use of, and for its proper application in 
 
 practice. In a condensed, practical form, it pre- 
 sents to the physician all that he would wish to 
 remember after perusing a whole library on medical 
 electricity, including the results of the latest in- 
 vestigations. It is the book for the practitioner, 
 and tne necessity for a second edition proves that 
 it has been appreciated by the profession.— Pfej/s^ 
 dan and Surgeon, Dec. 1882. 
 
 TSB TBAB-BOOK OF TBBATMENT FOB 1886. 
 
 A Comprehensive and Critical Review for Practitioners of Medi- 
 cine. In one 12mo. volume of 309 pages, bound in limp cloth, $1.25. Just ready. 
 
 This work presents not only a complete classified account of all the more important 
 • advances made in the treatment of disease during the year ending September 30, 1886, 
 but also a critical estimate of the same by competent authorities. Each department of 
 practice is fully and concisely treated, and into the consideration of each subject enter 
 such allusions to recent pathological and clinical work as bear directly upon treatment, 
 
 4e.*4{. For special commutations with periodicals see page 3. 
 
 TME TEAB-BOOK OF TBEATMENT FOB 1885, 
 
 Similar to that of 1886 above. 12mo., 320 pages. Limp cloth, §1.25. 
 
 SCSBEIBEB, BB. JOSEFS, 
 
 A Manual of Treatment by Massage and Methodical Muscle Ex- 
 ercise. Translated by Walter Mendelson, M. D., of New York. In one handsome 
 octavo volume of about 300 pages, with about 125 fine engravings. In press. 
 
 8TURGES' INTRODUCTION TO THE STUDY 
 OF CLINICAL MEDICINE. Being a Guide to 
 the Investigation of Disease. In one handsome 
 12mo. volume of 127 pages. Cloth, 81.25. 
 
 DAVIS' CLINICAL LECTURES ON VARIOUS 
 IMPORTANT DISEASES. By N. S. Davis, 
 M. D. Edited by Frank H. Davis, M. D. Second 
 edition. 12mo. 287 pages. Cloth, 81.75. 
 
 TODD'S CLINICAL LECTURES ON CERTAIN 
 ACUTE DISEASES. In one octavo volume of 
 320 pages. Cloth, $2.50. 
 
 PAVT'S TREATISE ON THE FUNCTION OF DI- 
 GESTION; its Disorders and their Treatment. 
 From the second London edition. In one octavo 
 volume of 238 pages. Cloth, 82.00. 
 
 BARLOW'S MANUAL OF THE PRACTICE OF 
 MEDICINE. With additions by D. F. Condie, 
 M. D. 1 vol. 8vo., pp. 603. Cloth, 82.50. 
 
 CHAMBERS' MANUAL OF DIET AND REGIMEN 
 IN HEALTH AND SICKNESS. In one hand- 
 some octavo volume of 302 pp. Cloth, 82.75. 
 
 HOLLAND'S MEDICAL NOTES AND HEFLEC- 
 TIONS. 1 vol. 8vo., pp. 493. Cloth, 83.50. 
 
18 Lea Brothers & Co.'s Publications — Throat, livings. Heart. 
 FLINT, AUSTIN, M. D., 
 
 Professor of the Principles and Practice of Medicine in Bellevue Hospital Medical College, N. T. 
 
 A. Manual of Auscultation and Percussion ; Of the Physical Diagnosis of 
 Diseases of the Lungs and Heart, and of Thoracic Aneurism. Fourth edition. In one 
 handsome royal 12mo. volume of 278 pages, with 14 illustrations. Cloth, $1.75. Just ready. 
 
 The student needs a first-class text-book in 
 which the subject is fally esDlained for him to 
 study. Dr. Flint's work is just such a book. It 
 contains the substance of the lessons which the 
 author has for many years given in connection 
 with practical instruction m auscultation and 
 
 percussion to private classes, composed of medical 
 students and practitioners. The fact that within 
 a little more than two years a large edition of this 
 manual has been exhausted, is proof of the favor 
 with which it has been regarded by the medical 
 profession. — Cincinnati Medical News, Feb. 1886. 
 
 BY THE SAME A UTHOR. 
 
 Physical Exploration of the Lungs by Means of Auscultation and 
 Percussion. Three lectures delivered before the Philadelphia County Medical Society, 
 1882-83. In one handsome small 12mo. volume of 83 pages. Cloth, $1.00. 
 
 A Practical Treatise on the Physical Exploration of the Chest and 
 the Diagnosis of Diseases Affecting the Respiratory Organs. Second and 
 revised edition. In one handsome octavo volume of 591 pages. Cloth, $4.50. 
 
 Phthisis: Its Morbid Anatomy, Etiology, Symptomatic Events and 
 Complications, Fatality and Prognosis, Treatment and Physical Diag- 
 nosis ; In a series of Clinical Studies. In one handsome octavo volume of 442 pages. 
 Cloth, $3.50. 
 
 A Practical Treatise on the Diagnosis, Pathology and Treatment of 
 Diseases of the Heart. Second revised and enlarged edition. In one octavo volume 
 of 550 pages, with a plate. Cloth, $4. 
 
 Essays on Conservative Medicine and Kindred Topics. In one very hand- 
 some royal 12mo. volume of 210 pages. Cloth, $1.38. 
 
 BBOWNE, LBNNOX, F. H. C. S,, Fdin., 
 
 Senior Surgeon to the Central London Throat and Ear Hospital, etc. 
 The Throat and its Diseases. Second American from the second English edi- 
 tion, thoroughly revised. With 200 engravings and 120 illustrations in colors. In one 
 very handsome imperial octavo volume of about 350 pages. Shortly. 
 
 GHOSSf S, D.f iHf.D., IL.D.f D.C.i. Oxon,, LL.I). Cantab. 
 
 A Practical Treatise on Foreign Bodies in the Air-passages. In one 
 
 octavo volume of 452 pages, with 59 illustrations. Cloth, $2.75. 
 
 COHEN, J. SOUS, M. D., 
 
 Lecturer on Laryngoscopy and Diseases of the Throat and Chest in the Jefferson Medical College. 
 
 Diseases of the Throat and Nasal Passages. A Guide to the Diagnosis and 
 Treatment of Affections of the Pharynx, QEsophagus, Trachea, Larynx and Nares. Third 
 edition, thoroughly revised and rewritten, with a large number of new illustrations. In 
 one very handsome octavo volume. Preparing. 
 
 SFIZFB, CABL, M, I)., 
 
 Lecturer on Laryngoscopy in the University of Pennsylvania. 
 
 A Handbook of Diagnosis and Treatment of Diseases of the Throat, 
 Nose and Naso-Pharynx. Second edition. In one handsome royal 12mo. volume 
 of 294 pages, with 77 illustrations. Cloth, $1.75. 
 
 and there are a valuable bibliography and a good 
 index of the whole. For any one who wishes to 
 make himself familiar with the practical manage- 
 
 It is one of the best of the practical text-books 
 on this subject with which we are acquainted. The 
 present edition has been increased in size, but its 
 eminently practical character has been main- 
 tained. Many new illustrations have also been 
 introduced, a case-record sheet has been added, 
 
 ment of cases of throat and nose disesise, the book 
 will be found of great value. — New York Medical 
 Journal, June 9, 1883. 
 
 FULLER ON DISEASES OF THE LQNGS AND 
 AIR-PASSAGES. Their Pathology, Physical Di- 
 agnosis, Symptoms and Treatment. From the 
 second and revised English edition. In one 
 octavo volume of 475 pages. Cloth, $3.50. 
 
 BLADE ON DIPHTHERIA; its Nature and Treat> 
 ment, with an account of the History of its Pre- 
 valence in various Countries. Second and revised 
 edition. In one 12mo. vol., pp. 158. Cloth, 81.25. 
 
 WALSHE ON THE DISEASES OF THE HEART 
 AND GREAT VESSELS. Third American edi- 
 
 SMITH ON CONSUMPTION ; its Early and Reme- 
 diable Stages. 1 vol. 8vo., pp. 253. Cloth, 82.25. 
 
 LA ROCHE ON PNEUMONIA. 1 vol. 8vo. of 490 
 pages. Cloth, S3.00. 
 
 WILLIAMS ON PULMONARY CONSUMPTION; 
 its Nature, Varieties and Treatment. With an 
 analysis of one thousand cases to exemplify its 
 duration. In one 8vo. vol. of 303 pp. Cloth, 82.50. 
 
 JONES' CLINICAL OBSERVATIONS ON FUNC- 
 TIONAL NERVOUS DISORDERS. Second Am- 
 erican edition. In one handsome octavo volume 
 
 tion. In 1 vol. 8vo., 416 pp. Cloth, 83.00. I of 340 pages. Cloth, $3.25. 
 
Lea Brothers & Co.'s Publications — Nerv. andMent. Dis., etc. 19 
 
 MOSS, JAMES, M.n., F.M.C.P,, ZZ.D., 
 
 Senior Assistant Physician to the Manchester Royal Infirmary. 
 
 A Handbook on Diseases of the Nervous System. In one octavo 
 volume of 725 pages, with 184 illustrations. Cloth, $4.50 ; leather, $5.50. 
 .This admirable worli is intended for students of I the department of medicine of which it treats. 
 
 medicine and for such medical men as have no time 
 for lengthy treatises. In the present instance the 
 duty of arranging the vast store of material at the 
 disposal of the author, and of abridging the de- 
 scription of the different aspects of nervous dis- 
 eases, has been performed with singular skill, and 
 the result is a concise and philosophical guide to 
 
 Dr. Boss holds such a high scientific position that 
 any writings which bear his name are naturally 
 expected to have the impress of a powerful intel- 
 lect. In every part this handbook merits the 
 highest praise, and will no doubt be found of the 
 greatest value to the student as well as to the prac- 
 titioner. — Edinburgh Medical Journal, Jan. 1887. 
 
 MITCHELL, S. WEIM, M, !>., 
 
 Physician to Orthopmdic Hospital and the Infirmary for Diseases of the Nervous System, Phila., etc. 
 
 Lectures on Diseases of the Nervous System; Especially in Women. 
 Second edition. In one 12mo. volume of 288 pages. Cloth, |1.75. 
 
 No work in our language develops or displays 
 more features of that many-sided affection, hys- 
 teria, or gives clearer directions for its differen- 
 tiation, or sounder suggestions relative to its 
 
 general management and treatment. The book 
 is particularly valuable in that it represents in 
 the main the author's own clinical studies, which 
 have been so extensive and fruitful as to give his 
 
 teachings the stamp of authority all over the 
 realm of medicine. The work, although written 
 by a specialist, has no exclusive character, and 
 the general practitioner above all others will find 
 its perusal profitable, since it deals with diseases 
 which he frequently encounters and must essay 
 to treat. — American Practitioner, August, 1885. 
 
 HAMILTON, ALLAJS^ McLANE, M, D., 
 
 Attending Physician at the Hospital for Epileptics and Paralytics, BlackwelVs Island, N. T. 
 Nervous Diseases ; Their Description and Treatment. Second edition, thoroughly 
 revised and rewritten. In one octavo volume of 598 pages, with 72 illustrations. Cloth, $4. 
 When the first edition of this good book appeared | characterized this hookas the best of its kind in 
 
 we gave it our emphatic endorsement, and the i 
 present edition enhances our appreciation of the j 
 book and its author as a safe guide to students of I 
 clinical neurology. One of the best and most I 
 critical of English neurological journals, £ram, has 1 
 
 any language, which is a handsome endorsement 
 from an exalted source. The improvements in the 
 new edition, and the additions to it, will justify its 
 purchase even by those who possess the old. — 
 Alienist and Neurologist, April, 1882. 
 
 TUKE, DAJVIEL HACK, M, J),, 
 
 Joint Author of The Manual of Psychological Medicine, etc. 
 
 Illustrations of the Influence of the Mind upon the Body in Health 
 and Disease. Designed to elucidate the Action of the Imagination. New edition. 
 Thoroughly revised and rewritten. In one handsome octavo volume of 467 pages, with 
 two colored plates. Cloth, $3.00. 
 
 method of interpretation. Guided by an enlight- 
 ened deduction, the author has reclaimed for 
 science a most interesting domain in psychology, 
 previously abandoned to charlatans and empirics. 
 This book, well conceived and well written, must 
 commend itself to every thoughtful understand- 
 ing. — New York Medical Journal, September 6, 1884. 
 
 It is impossible to peruse these interesting chap- 
 ters without being convinced of the author's per- 
 fect sincerity, impartiality, and thorough mental 
 grasp. Dr. Take has exhibited the requisite 
 amount of scientific address on all occasions, and 
 the more intricate the phenomenathe more firmly 
 has he adhered to a physiological and rational 
 
 CLOUSTOJ^, THOMAS S., M. I),, F, B, C. I*,, i. B, C. S,, 
 
 Lecturer on Mental Diseases in the University of Edinburgh. 
 
 Clinical Lectures on Mental Diseases. With an Appendix, containing an 
 Abstract of the Statutes of the United States and of the Several States and Territories re- 
 lating to the Custody of the Insane. By Charles F. Folsom, M. D., Assistant Professor 
 of Mental Diseases, Med. Dep. of JEIarvard Univ. In one handsome octavo volume of 541 
 pages, with eight lithographic plates, four of which are beautifully colored. Cloth, $4. 
 
 The practitioner as well as the student will ac- 
 cept the plain, practical teaching of the author as a 
 forward step in the literature of insanity. It is 
 refreshing to find a physician of Dr. Clouston's 
 
 experience and high" reputation giving the bed- 
 side notes upon which his experience has been 
 founded and his mature judgment established. 
 Such clinical observations cannot but be useful to 
 
 the general practitioner in guiding him to a diag- 
 nosis and indicating the treatment, especially in 
 many obscure and doubtful cases of mental dis- 
 ease. To the American reader Dr. Folsom's Ap- 
 pendix adds greatly to the value of the work, and 
 will make it a desirable addition to every library. 
 — American Psychological Journal, July, 1884. 
 
 S^'Dr. Folsom's Abstract may also be obtained separately in one octavo volume of 
 108 pages. Cloth, $1.50. 
 
 SAVAGE, GEOMGE H., M. I>,, 
 
 Lecturer on Mental Diseases at Cfuy's Hospital, London. 
 
 Insanity and Allied Neuroses, Practical and Clinical. In one 12mo. vol. 
 of 551 pages, with 18 illus. Cloth, $2.00. See Series of Clinical Manuals, page 4. 
 
 JPLATFAIB, W. S., M. H., F, M, O. 1*., 
 
 The Systematic Treatment of Nerve Prostration and Hysteria. In 
 
 one handsome small 12mo. volume of 97 pages. Cloth, $1.00. 
 
 Blandford on Insanity and its Treatment: Lectures on the Treatment, 
 
 Medical and Legal, of Insane Patients. In one very handsome octavo volume. 
 
20 
 
 Lea Brothers & Co.'s Publications — Surgery. 
 
 ASSBUJRST, JOSN, Jr., M. !>., 
 
 Professor of Clinical Surgery, Univ. of Penna., Surgeon to the Episcopal Hospital, Philadelphia. 
 
 The Prinoiples and Practice of Surgery. New (fourth) edition, enlarged 
 and revised. In one large and handsonae octavo volume of 1114 pages, with 597 illustra- 
 tions. Cloth, $6 ; leather, $7 ; half Eussia, §7.50. 
 
 Every advance in surgery worth notice, chroni- 
 cled in recent literature, has been suitably recog- 
 nized and noted in its proper place. Suffice it to 
 sa}'', we regard Ashhurst's Surgery, as now pre 
 
 As with Erichsen so with Ashhurst, its position 
 in professional fairor is established, and one has 
 now but to notice the changes, if any, in theory 
 and practice, that are apparent in the present 
 as compared with the preceding edition, published 
 three years ago. The work has been brought well 
 up to date, and is larger and better illustrated than 
 before, and its author may rest assured that it will 
 certainly have a "continuance of the favor with 
 which it has heretofore been received."— T/i.e 
 American Journal of the Medical Sciences, Jan. 1886. 
 
 sented in the fourth edition, as tiie best single 
 volume on surgery published in the English lan- 
 guage, valuable alike to the student and the prac- 
 titioner, to the one as a text-book, to the other as 
 a manual of practical surgery. With pleasure we 
 give this volume our endorsement in full. — New 
 Orleans Medical and Surgical Journal, Jan., 1886. 
 
 GBOSSf S. n,, M. JD.f LL. jD., JD, C, L. Oxon., LL, D. 
 Cantab. f 
 
 Emeritus Professor of Surgery in the Jefferson Medical College of Philadelphia. 
 A System of Surgery: Pathological, Diagnostic, Therapeutic and Operative. 
 Sixth edition, thoroughly revised and greatly improved. In two large and beautifully- 
 printed imperial octavo volumes containing 2382 pages, illustrated by 1623 engravings. 
 Strongly bound in leather, raised bands, $15 ; half Russia, raised bands, $16. 
 
 Dr. Gross' System of Surgery has long been the | His System of Surgery, which, since its first edi- 
 standard work on that subject for students and 
 practitioners. — London Lancet, May 10, 188-1. 
 
 The work as a whole needs no commendation. 
 Many years ago it earned for itself the enviable 
 reputation of the leading American work on sur- 
 gery, and it is still capable of maintaining that 
 standard. A considerable amount of new material 
 has been introduced, and altogether the distin- 
 
 fuished author has reason to be satisfied that he 
 as placed the work fully abreast of the state of 
 our knowledge.— ilfed. Record, Nov. 18, 1882. 
 
 tion in 1859, has been a standard work in this 
 country as well as in America, in "the whole 
 domain of surgery," tells how earnest and labori- 
 ous and wise a surgeon he was, how thoroughly 
 he appreciated the work done by men in other 
 countries, and how much he contributed to pro- 
 mote the science and practice of surgery in his 
 own. There has been no man to whom America 
 is so much indebted in this respect as the Nestor 
 of surgery. — British Medical Journal, May 10, 1884. 
 
 GOULD, A. FBAMCE, M. S., M. B,, F. M, C. S,, 
 
 Assistant Surgeon to Middlesex Hospital. 
 
 Elements of Surgical Diagnosis. In one pocket-size 12mo. volume of 589 
 
 pages. Cloth, $2.00. See Students' Series of Manuals, page 4. 
 
 This book will be found to be a most useful 
 guide for the hard-worked practitioner. Mr. 
 Gould's style is eminently clear and precise, and 
 we can cordially recommend the manual as being 
 the outcome of the efforts of an honest and thor- 
 oughly practical surgeon.— TAe Medical News, Jan. 
 24, 1885. 
 
 This is a capital little book, written by a prac- 
 tical man on a very practical subject. The topics 
 are very systematically and succinctly arranged, 
 are tersely presented, and the points of diagnosis 
 very intelligently discussed. It will be found to 
 be of the greatest amount of help both to teacher 
 and stwie-'-it.— Medical Record, Feb, 28, 1885. 
 
 GIBWET, V, J»., M, J>., 
 
 Surgeon to the Orthopaedic Hospital, New York, etc. 
 Ortiiopsedic Surgery. For the use of Practitioners and Students, 
 some octavo volume, profusely illustrated. Preparing. 
 
 In one hand- 
 
 DBUITTf MOBBHTf M. M. O. S,, etc. 
 
 The Principles and Practice of Modern Surgery. From the eighth 
 
 London edition. In one 8vo. volume of 687 pages, with 432 illus. Cloth, $4 ; leather, $5. 
 
 BOBEBTS, JOSJS^ B,, A, M., M. D., 
 
 Lecturer on Anatomy and on Operative Surgery at the Philadelphia School of Anatomy. 
 
 The Principles and Practice of Modern Surgery. For the use of Students 
 and Practitioners of Medicine and Surgery. In one very handsome octavo volume of about 
 500 pages, with many illustrations. Preparing. 
 
 BELLAMY, EDWABD, F. B. C. S., 
 
 Surgeon and Lecturer on Surgery at Charing Cross Hospital, London. 
 Operative Surgery. Shortly. See Students' Series of Manuals, page 4. 
 
 PIRRIE'S PRINCIPLES AND PRACTICE OF 
 SURGERY. Edited by John Neill, M. D. In 
 one 8vo. vol. of 784 pp. with 316 illus. Cloth, 83.75. 
 
 MILLER'S PRACTICE OF SURGERY. Fourth 
 and revised American from the last Edinburgh 
 edition. In one large 8vo. vol. of 682 pages, with 
 364 illustrations. Cloth, $3.75. 
 
 SKEY'S OPERATIVE SURGERY. In one vol. 8vo. 
 of 661 pages; with 81 woodcuts. Cloth, 83.25. 
 
 MILLERS PRINCIPLES OF SURGERY. Fourth 
 Americaen from the third Edinburgh edition. In 
 one 8vo. vol. of 638 pages, with 340 illustrations. 
 Cloth, 83.75. 
 
Lea Brothers & Co.'s Publications — Surgery. 
 
 21' 
 
 MMICHSBN, JOSJV E., F, Jt. S,, F. B. C. S., 
 
 Professor of Surgery in University College, London, etc. 
 
 The Science and Art of Surgery ; Being a Treatise on Surgical Injuries, Dis- 
 eases and Operations. From the eighth and enlarged English edition. In two large and 
 beautiful octavo volumes of 2316 pages, illustrated with 984 engravings on wood. 
 Cloth, $9; leather, raised bands, $11 ; half Eussia, raised bands, $12. 
 
 In noticing the eighth edition of this well- 
 known work, it would appear superfluous to say- 
 more than that it has, like its predecessors, been 
 brought fully up to the times, and is in conse- 
 quence one of the best treatises upon surgery that 
 has ever been penned by one man. We nave al- 
 ways regarded "The Science and Art of Surgery" 
 as one of the best surgical text-books in the 
 English language, and this eighth edition only 
 confirms our previous opinion. We take great 
 pleasure in cordially commending it to our read- 
 ers.— TAeilfedJcai News, April 11, 1885. 
 
 After being before the profession for thirty 
 
 years and maintaining during that period a re- 
 putation as a leading work on surgery, there is not 
 much to be said in the way of comment or criti- 
 cism. That it still holds its own goes without say- 
 ing. The author infuses into it his large experi- 
 ence and ripe judgment. Wedded to no school, 
 committed to no theory, biassed by no hobby, he 
 imparts an honest personality in his observations, 
 and his teachings are the rulings of an impartial 
 judge. Such men are always safe guides, and their 
 works stand the tests of time and experience. 
 Such an author is Erichsen, and such a work is his 
 Surgery.— Medical Record, Feb. 21, 1885. 
 
 BBTAJSTT, THOMAS f F. M. C. S,, 
 
 Surgeon and Lecturer on Surgery at Gruy's Hospital, London. 
 The Practice of Surgery. Fourth American from the fourth and revised Eng- 
 lish edition. In one large and very handsome imperial octavo volume of 1040 pages, with 
 727 illustrations. Cloth, $6.50 ; leather, $7.50 ; half Russia, $8.00. 
 
 The fourth edition of this work is fully abreast | books for the medical student. Almost every 
 
 of the times. The author handles his subjects 
 with that degree of judgment and skill which is 
 attained by years of patient toil and varied ex- 
 perience. The present edition is a thorough re- 1 
 vision of those which preceded it, with much new 
 matter added. His diction is so graceful and 
 logical, and his explanations are so lucid, as to 
 place the work among the highest order of text- i 
 
 topic in surgery is presented in such a form as to 
 enable the busy practitioner to review any subject 
 in every-day practice in a short time. No time is 
 lost with useless theories or superfluous verbiage. 
 In short, the work is eminently clear, logical and 
 practical. — Chicago Medical Journal arid Examiner, 
 April, 1886. 
 
 By the same Author. 
 Diseases of the Breast. In one 12mo. .volume. Preparing. See Series of Clinical 
 Manuals, page 4. 
 
 TMFVFS, FMFBFMICK, F, M. C. S,, 
 
 Hunterian Professor at the Royal College of Surgeons of England. 
 A Manual of Surgery. In Treatises by Various Authors. In three 12mo. 
 volumes, containing 1866 pages, with 213 engravings. Price per volume, cloth, $2. See 
 Students' Series of Manuals, page 4. 
 
 We have here the opinions of thirty-three 
 authors, in an eneyclopEedic form for easy and 
 ready reference. The three volumes embrace 
 every variety of surgical affections likely to be 
 met with, the paragraphs are short and pithy, and 
 the salient points and the beginnings of new sub- 
 jects are always prmted in extra-heavy type, so 
 that a person may find whatever information he 
 may be in need of at a moment's glance. The 
 authors have confined themselves to stating only 
 what is really important to know, free from all 
 difi'useness and unnecessary adornment. — Cincin- 
 nati Lancet-Clinic, August 21, 1886. 
 
 in the choice, arrangement and logical sequence of 
 the subjects. Every topic, as far as observed, is 
 treated with a fulness of essential detail, which is 
 somewhat surprising in view of the necessary 
 limitations of space. Another characteristic of the 
 work is the well-nigh universal acceptance of mod- 
 ern and progressive views of pathology and treat- 
 ment. The entire work is conceived and executed 
 in a scientific spirit. It is conservative without 
 bigotry and contains the bone and marrow of mod- 
 ern surgery. Taking the manual in its entirety, 
 it unquestionably fills a place in the surgeon's 
 library which would otherwise be untenanted. — 
 
 The hand of Mr. Treves is evident throughout | Annals of Surgery, Oct. 1886. 
 
 BUTLIJV, MENHY T,, F, It, C. S., 
 
 Assistant Surgeon to St. Bartholomew's Hospital, London. 
 
 Diseases of the Tongue. In one 12mo. volume of 456 pages, with 8 colored 
 plates and 3 woodcuts. Cloth, $3.50. See Series of Clinical Manuals, page 4. 
 
 Twenty-four excellent colored lithographs, illus- 
 trating the diseased condition of the organ have 
 been added, which much increase the value of 
 the book. Mr. Butlin has written a work of great 
 merit, and the book is a valuable addition to sur- 
 gical literature. — New York Medical Journal, July 
 17, 1886. 
 
 The language of the text is clear and concise. 
 
 The author has aimed to state facts rather than to 
 express opinions, and has compressed within the 
 compass of this small volume the pathology, etiol- 
 ogy, etc., of diseases of the tongue that are incon- 
 veniently scattered through general works on sur- 
 gery and the practice of medicine. The physician 
 and surgeon will appreciate its value as an aid and 
 guide. — Physician and Surgeon, Sept. 1886. 
 
 TMEVFS, FMFDFRICK, F. M. C. S., 
 
 Surgeon to and Lecturer on Surgery at the London Hospital. 
 
 Intestinal Obstruction. In one pocket-size 12mo. volume of 522 pages, with 60 
 
 illustrations. Limp cloth, blue edges, $2.00 
 
 A standard work on a subject that has not been 
 80 comprehensively treated by any contemporary 
 English writer. Its completeness renders a full 
 review difficult, since every chapter deserves mi- 
 nute attention, and it is impossible to do thorough 
 
 See Series of Clinical Manuals, page 4. 
 justice to the author in a few paragraphs. Intes- 
 tinal Obstruction is a work that will prove of 
 equal value to the practitioner, the student, the 
 pathologist, the physician and the operating sur- 
 geon. — British Medical Journal, Jan. 31, 1885. 
 
 BALL, CMABLFS B., M. Ch,, Dub,, F, M. C. S. E., 
 
 Surgeon and Teacher at Sir P. Dun's Hospital, Dublin. 
 
 Diseases of the Rectum and Anus. In one 12mo. volume of 550 pages. 
 Preparing. See Series of Clinical Manuals, page 4. 
 
22 Lea Brothers & Co.'s Publications — Surgery* Frac, Disloc. 
 SOLMES, TIMOTHY, M, A., 
 
 Surgeon and Lecturer on Surgery at St. George's Hospital, London. 
 
 A System of Surgery ; Theoretical and Practical. IN TKEATISES BY 
 VAEIOUS AUTHORS. American edition, thoroughly revised and re-edited 
 by John H. Packard, M. D., Surgeon to the Episcopal and St. Joseph's Hospitals, 
 Philadelphia, assisted by a corps of thirty-three of the most eminent American surgeons. 
 In three large and very handsome imperial octavo volumes containing 3137 double- 
 columned pages, with 979 illustrations on wood and 13 lithographic plates, beautifully 
 colored. Price per set, cloth, $18.00; leather, f 21.00; half Russia, |22.50. Sold only by 
 subscription. 
 
 HAMILTON, FBAWK H,, M. D., LI, jD., 
 
 Surgeon to Bellevue Hospital, New York. 
 
 A Practical Treatise on Fractures and Dislocations. Seventh edition 
 thoroughly revised and much improved. In one very handsome octavo volume of 998 
 pages, with 379 illustrations. Cloth, |5.50 ; leather, |6.50 ; very handsome half Russia, 
 open back, $7.00 
 
 It is about twenty-five years ago since the first 
 edition of this great work appeared. The edition 
 now issued is the seventh, and this fact alone is 
 enough to testify to the excellence of it in all par- 
 ticulars. Books upon special subjects do not 
 usually command extended sale, but this one is 
 without a rival in any language. It is essentially 
 a practical treatise, and it gathers within its covers 
 almost everything valuable that has been written 
 about fractures and dislocations. The principles 
 and methods of treatment are very fully given. 
 The book is so well known that it does not require 
 
 any lengthened review. We can only say that it 
 is still unapproached as a treatise, and that it is a 
 proof of the zeal and industry and great ability of 
 its distinguished author. — The Dublin Journal of 
 Medical Science, Feb. 1886. 
 
 His famous treatise on Fractures and Disloca- 
 tions, published first in 1860, is justly regarded as 
 the best book on that subject in existence. It has 
 now run through seven editions, and has been 
 translated into French and German. — Medical 
 Record, Aug. U, 1886. 
 
 SMITH, STEPHEN, M. H., 
 
 Visiting Surgeon to Bellevue and St. Vincent's Hospitals, N. Y. 
 
 The Principles and Practice of Operative Surgery. New (second) and 
 thoroughly revised edition. In one very handsome octavo volume of 892 pages, with 
 1005 illustrations. Cloth, $4.00; leather, $5.00. Just ready. 
 
 EXTRACT FROM THE PREFACE TO THE SECOND EDITION. 
 
 This work was first published in 1879, and although there have been repeated large 
 issues since that date, there has been no change whatever in the text until the present, 
 which must therefore be regarded as the second and only revised edition. To make the 
 work a proper exponent of the present state of Operative Surgery has required a complete 
 revision of nearly the entire text. This has been carefully performed, and the author has 
 the satisfaction of believing that the work now embraces the latest advances in the field 
 of new operations, and that the details of the most approved antiseptic methods have 
 been placed in such a light that they may be easily mastered and utilized by every 
 practitioner. 
 
 STIMSON, LEWIS A,, B. A,, M. I),, 
 
 Professor of Pathological Anatomy at the University of the City of New York, Surgeon and Curator 
 to Bellevue Hospital, Surgeon to the Presbyterian Hospital, New York, etc. 
 A Manual of Operative Surgery. New (second) edition. In one very hand- 
 some royal 12mo. volume of 503 pages, with 342 illustrations. Cloth, $2.50. Just ready. 
 
 etfected in operative methods and procedures by 
 the antiseptic system, and has added an account 
 of many new operations and variations in the 
 
 There is always room for a good book, so that 
 while many works on operative surgery must be 
 considered superfluous, that of Dr. Stimson has 
 held its own. The author knows the difficult art 
 of condensation. Thus the manual serves as a 
 work of reference, and at the same time as a 
 handy guide. It teaches what it professes, the 
 steps of operations. In this edition Dr. Stimson 
 has sought to indicate the changes that have been 
 
 steps of older operations. We do not desire to 
 extol this manual above many excellent standard 
 British publications of the same class, siill we be- 
 lieve that it contains much that is worthy of imi- 
 tation. — British Medical Journal, Jan. 22, 1887. 
 
 By the same Author. 
 A Practical Treatise on Fractures. In one very handsome octavo volume of 
 
 598 pages, with 360 beautiful illustrations. Cloth, $4.75 ; leather, $5.75. 
 
 The author has given to the medical profession 
 in this treatise on fractures what is likely to be- 
 come a standard work on thesubject. Itis certainly 
 not surpassed by any work written in the English, 
 or, for that matter, any other language. The au- 
 thor tells us in a short, concise and comprehensive 
 manner, all that is known about his subject. There 
 is nothing scanty or superficial about it, as in most 
 other treatises ; on the contrary, everything is thor- 
 
 ough. The chapters on repair of fractures and their 
 treatment show him not only to be a profound stu- 
 dent, but likewise a practical surgeon and patholo- 
 gist. His mode of treatment of the different fract- 
 ures is eminently sound and practical. We consider 
 this work one of the best on fractures ; and it will 
 be welcomed not onlv as a text-book, but also by 
 the surgeon in full practice.— iV^. O. Medical and 
 Surgical Journal, March, 1883. 
 
 MARSH, HOWARD, F, R, C. S,, 
 
 Senior Assistant Surgeon to and Lecturer on Anatomy at St. Bartholomew's Hospital, London. 
 Diseases of the Joints. In one 12mo. volume of 468 pages, with 64 woodcuts 
 and a colored plate. Cloth, $2.00. Just ready. See Series of Clinical Manuals, page 4. 
 
 FICK, T, PICKERING, F, R. C, S., 
 
 Surgeon to and Lecturer on Surgery at St. George's Hospital, London. 
 
 Fractures and Dislocations. In one 12mo, volume of 530 pages, with 93 
 illustrations. Limp cloth, 2.00. See Series of Clinical Manuals, page 4. 
 
Lea Brothers & Co.'s Publications — Otol., Ophthal. 
 
 23 
 
 BVUNETT, CSARLES S,, A, M., M, D., 
 
 Professor of Otology in the Philadelphia Polyclinic ; President of the American Otological Society. 
 
 The Ear, Its Anatomy, Physiology and Diseases. A Practical Treatise 
 for the use of Medical Students and Practitioners. New (second) edition. In one handsome 
 octavo volume of 580 pages, with 107 illustrations. Cloth, $4.00 ; leather, $5.00. 
 
 We note with pleasure the appearance of a second 
 edition of this valuable work. When it first came 
 out it was accepted by the profession as one of 
 the standard works on modern aural surgery in 
 the English language; and in his second edition 
 Dr. Burnett has fully maintained his reputation, 
 for the book is replete with valuable information 
 and suggestions. The revision has been carefully 
 
 carried out, and much new matter added. Dr. 
 Burnett's work must be regarded as a very valua- 
 ble contribution to aural surgery, not only on 
 account of its comprehensiveness, but because it 
 contains the results of the careful personal observa- 
 tion and experience of this eminent aural surgeon. 
 — London Lancet, Feb. 21, 1885. 
 
 JPOLITZER, AID AM, 
 
 Imperial- Royal Prof, of Aural Therap. in the Univ. of Vienna. 
 
 A Text-Book of the Ear and its Diseases. 
 quest, by James Pattekson Cassells, M. D., M. E. C. S. 
 
 ume of 800 pages, with 257 original illustrations. Cloth, $5.50. 
 
 Translated, at the Author's re- 
 in one handsome octavo vol- 
 
 The work itself we do not hesitate to pronounce 
 the best upon the subject of aural diseases which 
 has ever appeared, systematic without being too 
 diffuse on obsolete subjects, and eminently prac- 
 tical in every sense. The anatomical descriptions 
 of each separate division of the ear are admirable, 
 and profusely illustrated by woodcuts. They are 
 followed immediately by the physiology of the 
 
 section, and this again by the pathological physi- 
 ology, an arrangement which serves to keep up the 
 interest of the student by showing the direct ap- 
 plication of what has preceded to the study of dis- 
 ease. The whole work can be recommended as a 
 reliable guide to the student, and an efficient aid 
 to the practitioner in his treatment. — Boston Med- 
 ical and Surgical Journal, June 7, 1883. 
 
 JULEB, HEJSTtT E., E. M. C, S., 
 
 Senior AssH Surgeon, Royal Westminster Ophthalmic Hosp. ; late Clinical AssH, Moorjields, London. 
 
 A Handbook of Ophthalmic Science and Practice. In one handsome 
 octavo volume of 460 pages, with 125 woodcuts, 27 colored plates, selections from the 
 Test-types of Jaeger and Snellen, and Holmgren's Color-blindness Test. Cloth, $4.50 ; 
 leather, $5.50. 
 
 This work is distinguished by the great num- 
 ber of colored plates which appear in it for illus- 
 trating various pathological conditions. They are 
 very beautiful in appearance, and have been 
 executed with great care as to accuracy. An ex- 
 amination of the work shows it to be one of high 
 standing, one that will be regarded as an authority 
 among ophthalmologists. The treatment recom- 
 mended is such as the author has learned from 
 actual experience to be the best. — Cincinnati Medi- 
 cal News, Dee. 1884. 
 
 It presents to the student concise descriptions 
 
 and typical illustrations of all important eye 
 affections, placed in juxtaposition, so as to be 
 
 f rasped at a glance. Beyond a doubt it is the 
 est illustrated handbook of ophthalmic science 
 which has ever appeared. Then, what is still 
 better, these illustrations are nearly all original. 
 We have examined this entire work with great 
 care, and it represents the commonly accepted 
 views of advanced ophthalmologists. We can most 
 heartily commend this book to all medical stu- 
 dents, practitioners and specialists. — Detroit 
 Lancet, Jan. 1885. 
 
 CABTEB, M, BMUDENELL, & EJROST, W, ADAMS, 
 
 F, M. C. S., F, M. a S., 
 
 Ophthalmic Surgeon to and Lecturer on Oph- Assistant Ophthalmic Surgeon to and Joint 
 
 thalmic Surgery at St. George's Hospital, Lecturer on Ophthalmic Surgery at St. 
 
 London. George's Hospital, London. 
 
 Ophthalmic Surgery. In one 12mo. volume of about 400 pages. Preparing. 
 See Series of Clinical Manuals, page 4. 
 
 WORJRIS, WM, F., M. D., and OLIVER, CSAS. A., M. D, 
 
 Clin. Prof, of Ophthalmology in Univ. of Pa,. 
 
 A Text-Book of Ophthalmology. In one octavo volume of about 500 pages, 
 
 with illustrations. Preparing. 
 
 WELL^, J. SOELBEBG, F, It, C, S,, 
 
 Professor of Ophthalmology in King's College Hospital, London, etc. 
 
 A Treatise on Diseases of the Eye. New (fifth) American from the third 
 London edition. Thoroughly revised, with copious additions, by L. Webster Fox, M. D. 
 In one large octavo volume of about 850 pages, with about 275 illustrations on wood, six 
 colored plates, and selections from the Test-types of Jaeger and Snellen. Preparing. 
 
 NETTLESMIF, EDWAMD, F, It, C, S., 
 
 Ophthalmic Surg, and Lect. on Ophth. Surg, at St. Thomas' Hospital, London. 
 
 The Student's Guide to Diseases of the Eye. Second edition. With a chap- 
 ter on the Detection of Color-Blindness, by William Thomson, M. D., Ophthalmologist 
 to the Jefferson Medical College. In one royal 12mo. volume of 416 pages, with 138 
 illustrations. Cloth, $2.00. 
 
 BMOWNE, EnGAB A,, 
 
 Surgeon to the Liverpool Eye and Ear Infirmary and to the Dispensary for Skin Diseases. 
 How to Use the Ophthalmoscope. Being Elementary Instructions in Oph- 
 thalmoscopy, arranged for the use of Students. In one small royal 12mo. volume of 116 
 pages, with 35 illustrations. Cloth, $1.00. 
 
 LAURENCE AND MOON'S HANDY BOOK OF 
 OPHTHALMIC SURGERY, for the use of Prac- 
 titioners. Second edition. In one octavo vol- 
 ume of 227 pages, with 65 Illust. Cloth, $2.75. 
 
 LAWSON ON INJURIES TO THE EYE, ORBIT 
 AND EYELIDS: Their Immediate and Remote 
 Effects. 8 TO., 404 pp., 92 illus. Cloth, 83.50. 
 
24 Lea Brothers & Co.'s Publications — Urin. Dis., Dentistry, etc. 
 HOBJEBTS, WILLIAM, M, J)., 
 
 Lecturer on Medicine in the Manchester School of Medicine, etc. 
 
 A Practical Treatise on Urinary and Henal Diseases, including Uri- 
 nary Deposits. Fourth American from the fourth London edition. In one hand- 
 some octavo volume of 609 pages, with 81 illustrations. Cloth, $3.50. 
 
 The previous editions of this book have made it ! The peculiar value and finish of the book are in 
 so familiar to and so highly esteemed by the med- ' 
 ical public, that little more is necessary than a 
 mere announcement of the appearance of this, 
 their successor. But it is pleasant to be able to 
 say that, good as those vpere, this is still better. 
 In fact, we think it may be said to be the best book 
 in print on the subject of which it treats. — The 
 American Journal of the Medical Sciences. — Jan. 1886. 
 
 a measure derived from its resolute maintenance 
 of a clinical and practical character. It is an un- 
 rivalled exposition of everything which relates 
 directly or indirectly to the diagnosis, prognosis 
 and treatment of urinary diseases, and possesses 
 a completeness not found elsewhere in our lan- 
 guage in its account of the different affections. — 
 The Manchester Medical Chronicle, July, 1885. 
 
 BUnDT, CMABLES TF., M. />. 
 
 Bright's Diseas%and Allied Disorders. In one octavo volume of 288 pages, 
 with illustrations. Cloth, $2. Just ready. 
 
 The object of this work is to "furnish a system- 
 atic, practical and concise description of the 
 pathology and treatment of the chief organic 
 diseases of the kidney associated with albuminu- 
 ria, which shall represent the most recent ad- 
 vances in our knowledge on these subjects ; " and 
 this definition of the object is a fair description of 
 the book. The work is a useful one, giving in a 
 
 short space the theories, facts and treatments, and 
 going more fully into their later developments. 
 On treatment the writer is particularly strong, 
 steering clear of generalities, and seldom omit- 
 ting, what text-books usually do, the unimportant 
 items which are all important to the general prac- 
 titioner. — The Manchester Medical Chronicle, Oct., 
 1886. 
 
 MOMMIS, MBNRY, M. B,, F, B. C. S,, 
 
 Surgeon to and Lecturer on Surgery at Middlesex Hospital, London. 
 
 Surgical Diseases of the Kidney. In one 12mo. volume of 554 pages, with 40 
 woodcuts, and 6 colored plates. Limp cloth, |2.25. See Series of Clinical Manuals, page 4. 
 
 In this manual we have a distinct addition to 
 surgical literature, which gives information not 
 elsewhere to be met with in a single work. Such 
 a book was distinctly required, and Mr. Morris 
 has very diligently and ably performed the task 
 
 he took in hand. It is a full and trustworthy 
 book of reference, both for students and prac- 
 titioners in search of guidance. The illustrations 
 in the text and the chromo-lithographs are beau- 
 tifully executed. — The London Laneet,Feh. 26, 1886. 
 
 LUCAS, CLBMENT, M. B., B. S., I, B, C, S., 
 
 Senior Assistant Surgeon to Ouifs Hospital, London. 
 Diseases of the Urethra. In one 12mo. volume. Preparing. See S&ries 
 of Clinical Manuals, page 4. 
 
 TSOMBSOJV, SIB SBNBY, 
 
 Surgeon and Professor of Clinical Surgery to University College Hospital, London. 
 
 Lectures on Diseases of the Urinary Organs. Second American from the 
 third English edition. In one 8vo. volume of 203 pp., with 25 illustrations. Cloth, $2.25. 
 
 By the Same Author. 
 On the Pathology and Treatment of Stricture of the Urethra and 
 Urinary Fistulse. From the third English edition. In one octavo volume of 359 
 pages, with 47 cuts and 3 plates. Cloth, $3.50. 
 
 THB AMBBICAJSr SYSTEM OF BENTISTBY, 
 
 In Treatises by Various Authors. Edited by Wilbur F. Litch, M. D,, 
 D. D. S., Professor of Prosthetic Dentistry, Materia Medica and Therapeutics in the 
 Pennsylvania College of Dental Surgery. In three very handsome octavo volumes of 
 about 1000 pages each, richly illustrated. Per volume, cloth, |6 ; leather, $7 ; half 
 Morocco, gilt top, $8. Volume I., containing 1015 pages, with 6 plates and €37 woodcuts, 
 just ready. For sale by subscription only. 
 
 As an eneyclopsedia of Dentistry it has no su- 
 perior. It should form a part of every dentist's 
 library, as the information it contains is of the 
 greatest value to all engaged in the practice of 
 dentistry. — American Journal of Dental Science, 
 September, 1886. 
 
 A grand system, big enough and good enough 
 and handsome enough for a monument (which 
 
 doubtless it is), to mark an epoch in the history of 
 dentistry. Dentists will be satisfied with it and 
 proud of it — they must. It is sure to be precisely 
 what the student needs to put him and keep him 
 in the ri^ht track, while the profession at large 
 will receive incalculable benefit from it. — Odonto- 
 graphic Journal, Jan. 1887. 
 
 COLEMAJf, A,, L, B. C, JP., F. B. C, S., Exam. i. D, S., 
 
 Senior Dent. Surg, and Lect. on Dent. Surg, at St. Bartholomew's Hasp, and the Dent. Hosp., London. 
 
 A Manual of Dental Surgery and Pathology. Thoroughly revised and 
 adapted to the use of American Students, by Thomas C. SteI/Lwagen, M. A., M. D., 
 D. D. S., Prof, of Physiology at the Philadelphia Dental College. In one handsome octavo 
 volume of 412 pages, with 331 illustrations. Cloth, $3.25. 
 
 ESMABCS, Dr. FBIEDBICBT, 
 
 Professor of Surgery at the University of Kiel, etc. 
 
 Early Aid in injuries and Accidents. Five Ambulance Lectures. Trans- 
 lated by H. R. H. Pkincess Christian. In one handsome small 12mo. volume of lO^ 
 pages, with 24 illustrations. Cloth, 75 cents. 
 
 BASHAM on renal diseases : A Clinical I one 12mo. vol. of 304 pages, with 21 lUustrationB, 
 Guide to their Diagnosis and Treatment. In | Cloth, $2.00. 
 
Lea Brothers & Co.'s Publications — Venereal, Impotence. 
 
 25 
 
 BJJMSTEAn, F. J., 
 
 M. JD., LL. D., 
 
 Late Professor of Venereal Diseases 
 at the College of Physicians and 
 Surgeons, New York, etc. 
 
 and TAYJLOIt, JR. W., 
 
 A. M., M. JD., 
 
 Surgeon to Charity Hospital, New York, Prof, of 
 Venereal and Skin Diseases in the University of 
 Vermont, Pres. of the Am. Dermatological Ass'n. 
 
 The Pathology and Treatment of Venereal Diseases. Including the 
 results of recent investigations upon the subject. Fifth edition, revised and largely re- 
 written, by Dr. Taylor. In one large and handsome octavo volume of 898 pages with 
 139 illustrations, and thirteen chromo-lithographic figures. Cloth, $4.75 ; leather, $5.75 ; 
 very handsome half Eussia, $6.25. 
 
 It is a splendid record of honest labor, wide 
 research, just comparison, careful scrutiny and 
 original experience, which will always be held as 
 a high credit to American medical literature. This 
 is not only the best work in the English language 
 upon the subjects of which it treats, but also one 
 wnich has no equa. in other tongues for its clear, 
 comprehensive and practical handling of its 
 themes. — American Journal of the Medical Sciences, 
 Jan, 1884. 
 
 It is certainly the best single treatise on vene- 
 real in our own, and probably the best in any lan- 
 guage. — Boston Medical and Surgical Journal, April 
 3, 1884. 
 
 The character of this standard work is so well 
 known that it would be superfluous here to pass in 
 review its general or special points of excellence. 
 The verdict of the profession has been passed; it 
 has been accepted as the most thorough and com- 
 plete exposition of th* pathology and treatment of 
 venereal diseases in the language. Admirable as a 
 model of clear description, an exponent of sound 
 pathological doctrine, and a guide for rational and 
 successful treatment, it is an ornament to the medi- 
 cal literature of this country. The additions made 
 to the present edition are eminently judicious, 
 from the standpoint of practical utility. — Journal of 
 Cutaneous and Venereal Diseases, Jan. 1884. 
 
 COMJSl^L, v., 
 
 Professor to the Faculty of Medicine of Paris, and Physician to the Lour cine Hospital. 
 
 Syphilis, its Morbid Anatomy, Diagnosis and Treatment. Specially 
 revised by the Author, and translated with notes and additions by J. Heney C. Simes, 
 M. D., Demonstrator of Pathological Histology in the University of Pennsylvania, and 
 J. WrLLiAM White, M. D., Lecturer on Venereal Diseases and Demonstrator of Surgery 
 in the University of Pennsylvania. In one handsome octavo volume of 461 pages, with 
 84 very beautiful illustrations. Cloth, $3.75. 
 
 The anatomical and histological characters of the ' the whole volume is the clinical experience of the 
 hard and soft sore are admirably described. The ' author or the wide acquaintance of the translators 
 multiform cutaneous manifestations of the disease i with medical literature more evident. The anat- 
 are dealt with histologically in a masterly way, as j omy, the histology, the pathology and the clinical 
 we should indeed expect them to be, and the j features of syphilis are represented in this work in 
 accompanying illustrations are executed carefully | their best, most practical and most instructive 
 and well. The various nervous lesions which are , form, and no one will rise from its perusal without 
 the recognized outcome of the syphilitic dj^scrasia ; the feeling that his grasp of the wide and impor- 
 are treated with care and consideration. Syphilitic . tant subject on which it treats is a stronger and 
 epilepsy, paralysis, cerebral syphilis and locomotor ! surer one. — The London Practitioner, Jan. 1882. 
 ataxia are subjects full of interest; and nowhere in I 
 
 JETUTCSINSOW, JOJS^ATMAN, F. B. S., F. B. C. S., 
 
 Consulting Surgeon to the London Hospital. 
 Syphilis. In one 12mo. volume. Shortly. See Series of Clinical Manuals, page 4. 
 
 GMOSS, SAMUFL W,, A, M., M. D., 
 
 Professor of the Principles of Surgery and of Clinical Surgery in the Jefferson Medical College of Phila. 
 
 A Practical Treatise on Impotence, Sterility, and Allied i)isorders 
 of the Male Sexual Organs. Third edition, thoroughly revised. In one very hand- 
 some octavo volume of about 175 pages, with about 20 illustrations. In press. 
 
 A notice of the previous edition is appended. 
 _ The author of this monograph is a man of posi- ! book shows that he has not neglected to compare 
 tive convictions and vigorous style. This is iusti- ; his own views with those of other authors. The 
 fied by his experience and by his study, which has ' result is a work which can be safely recommended 
 gone hand in hand with his experience. In regard to both physicians and surgeons as a guide in the 
 to the various organic and functional disorders of treatment of the disturbances it refers to. It is 
 the male generative apparatus, he has had ex- , the best treatise on the subject with which we are 
 ceptional opportunities for observation, and his ! acquainted.— TAe Medical Neios, Sept. 1, 1883. 
 
 GROSS, S. D., M. !>., ii. J>., D. C, X., etc. 
 
 A Practical Treatise on the Diseases, Injuries and Malformations 
 of the Urinary Bladder, the Prostate Gland and the Urethra. Third 
 edition, thoroughly revised by SAMXXEii W. Gnoss, M. D. In one octavo volume of 574 
 pages, with 170 illustrations. Cloth, $4.50. 
 
 CTJLLFMIEIt, A,, <& BUMSTFAD, F. J., M.I>., LL.D., 
 
 Surgeon to the Hdpital du Midi. Late Professor of Venereal Diseases in the College of Physicians 
 
 and Surgeons, New York. 
 
 An Atlas of Venereal Diseases. Translated and edited by Freeman J. Btjm- 
 STEAD, M. D. In one imperial 4to. volume of 328 pages, double-columns, with 26 plates, 
 containing about 150 figures, beautifully colored, many of them the size of life. Strongly 
 bound in cloth, $17.00. A specimen of the plates and text sent by mail, on receipt of 25 cts. 
 
 HILL ON SYPHILIS AND LOCAL CONTAGIOUS 
 
 DISORDERS. In one 8vo vol. of 479 p. Cloth, 83.25. 
 
 LEE'S LECTURES ON SYPHILIS AND SOME 
 
 FORMS OF LOCAL DISEASE AFFECTING 
 PRINCIPALLY THE ORGANS OF GENERA- 
 TION. In one 8vo. vol. of 246 pages. Cloth, S2.25. 
 
26 Lea Brothers & Co.'s Publications — Diseases of Skin. 
 
 STDJE, J, WBVIWS, A. M., M. !>., 
 
 Professor of Dermatology and Venereal Diseases in Bush Medical College, Chicago. 
 
 A Practical Treatise on Diseases of the Skin. For the use of Students and 
 Practitioners. In one handsome octavo volume of 570 pages, with 66 beautiful and elab- 
 orate illustrations. Cloth, 54.25 ; leather, §5.25. 
 
 The author has given the student and practi- 
 tioner a work admirably adapted to the wants of 
 each. We can heartily commend the book as a 
 valuable addition to our literature and a reliable 
 guide to students and practitioners in their studies 
 
 Professor Hyde has long been known as one of 
 the most intelligent and enthusiastic representa- 
 tives of dermatology in the west. His numerous 
 contributions to t^e literature of this specialty 
 have gained for him a favorable recognition as a 
 
 and practice. — Am. Journ. of Med. Set., July, 18S3. careful, conscientious and original observer. The 
 The aim of the author has been to present to his remarkable advances made in our knowledge of 
 readers a work not only expounding the most diseases of the skin, especially from the stand- 
 modern conceptions of his subiect, but presenting point of pathological liistology and improved 
 what is of standard value. He has more especially methods of treatment, necessitate a revision of 
 devoted its pages to the treatment of disease, and the older text-books at short intervals in order to 
 by his detailed descriptions of therapeutic meas- bring them up to the standard demanded by the 
 ures has adapted them to the needs of the physi- march of science. This last contribution of Dr. 
 cian in active practice. In dealing with these Hyde is an effort in this direction. He has at- 
 questions the author leaves nothing to the pre- tempted, as he informs us, the task of presenting 
 sumed knowledge of the reader, but enters thor- ' in a condensed form the results of the latest ob- 
 oughly into the most minute description, so that servation and experience. A careful examination 
 one is not only told what should be done under ! of the work convinces us that he has accomplished 
 given conditions but how to do it as well. It is his task with painstaking fidelity and with acred- 
 therefore in the best sense "a practical treatise." | itable result. — Journal of Cutaneous and Venereal 
 That it is comprehensive, a glance at the index I Diseases, June, 1883. 
 will show. — Mbryland Medical Journal, July 7, 1883. | 
 
 AJ^DEMSOW, T. M'CALL, M, D,, 
 
 Professor of Clinical Medicine in the University of Glasgow. 
 
 A Text-Book of Skin Diseases. With Special Reference to Diag- 
 nosis and Treatment. In one octavo volume, with two chromo-lithographs, a steel 
 plate and numerous illustrations. Shortly. 
 
 FOX, T., M.n,, F,It, C. jP., and FOX, T, C, B,A,, M,It. C.S,, 
 
 Physician to the Department for Skin Diseases, Physician for Diseases of the Skin to the 
 
 University College Hospital, London. Westminster Hospital, London. 
 
 An Epitome of Skin Diseases. With Pormulse. For Students and Prac- 
 titioners. Third edition, revised and enlarged. In one very handsome 12mo. volume 
 of 238 pages. Cloth, $1.25. 
 
 The third edition of this convenient handbook ' manual to lie upon the table for instant reference, 
 calls for notice owing to the revision and expansion ; Its alphabetical arrangement is suited to this use, 
 which it has undergone. The arrangement of skin j for all one has to know is the name of the disease, 
 diseases in alphabetical order, which is the method - and here are its description and the appropriate 
 of classification adopted in this work, becomes a ; treatment at hand and ready for instant applica- 
 positive advantage to the student. The book is i tion. The present edition has been very carefully 
 one which we can strongly recommend, not only ! revised and a number of new diseases are de- 
 to students but also to practitioners who require a ' scribed, while most of the recent additions to 
 compendious summary of the present state of ! dermal therapeutics find mention, and the formu- 
 dermatology. — British Medical Journal, July 2, 1883. i lary at the end of the book has been considerably 
 
 We cordially recommend Fox's ^pitome'to those j augmented. — The Medical News, December, 1883. 
 whose time is limited and who wish a handy j 
 
 MORMIS, 3IALCOLM, F. B. C. S., 
 
 Joint Lecturer on Dermatology at St. Mary''s Hospital Medical School, London. 
 Skin Diseases ; Including their Definitions, Symptoms, Diagnosis, Prognosis, Mor- 
 bid Anatomy and Treatment. A Manual for Students and Practitioners. In one 12mo. 
 volume of 316 pages, with illustrations. Cloth, $1.75. 
 
 To physicians who would like to know something for clearness of expression and methodical ar- 
 about skin diseases, so that when a patient pre- rangement is better adapted to promote a rational 
 sents himself for relief they can make a correct ; conception of dermatology — a branch confessedly 
 diagnosis and prescribe a rational treatment, we : difficult and perplexing to the beginner. — St. Louis 
 unhesitatingly recommend this little book of Dr. : Courier of Medicine, April, 1880. 
 Morris. The afiFections of the skin are described j The writer has certainly given in a small compass 
 in a terse, lucid manner, and their several charac- , a large amount of well-compiled information, and 
 teristics so plamly set forth that diagnosis will be : his little book compares favorably with any other 
 easy. /I he treatment m each case is such as the | which has emanated from England, while in many 
 experience of the most eminent dermatologists ad- i points he has emancipated himself from the st-ah- 
 •viaes.— Cincinnati Medical ]\ews, April, 1880. ! tornly adhered to errors of others of his country- 
 
 This is emphatically a learner's book ; for we men. There is certainly excellent material in the 
 can safely say, that in the whole range of medical book which will well repay perusal. — Boston Med. 
 literature there is no book of a like scope which and Surg. Journ., March, 1880. 
 
 WILSOJV, FMASMUS, F. M. S. 
 
 The Student's Book of Cutaneous Medicine and Diseases of the Skin. 
 In one handsome small octavo volume of 535 pages. Cloth, $3.50. 
 
 HILLIER, TJBCOMAS, 31. D., 
 
 Physician to the Skin Department of University College, London. 
 Handbook of Skin Diseases; for Students and Practitioners. Second Ameri- 
 can edition. In one 12mo. volume of 353 pages, with plates. Cloth, $2.25. 
 
Lea Brothers & Co.'s Publications — Dis. of Women. 
 
 27 
 
 AJ^ AMBMICAJS^ SYSTEM OF GTJ^^COLOGT, 
 
 A System of Gynseeclogy, in Treatises by Various Authors. Edited 
 by Matthew D. Mann, M. D., Professor of Obstetrics and Gynaecology in the Uni- 
 versity of Buffalo, ISl". Y. In two handsome octavo volumes, richly illustrated. In active 
 preparation. 
 
 LIST OF CONTRIBUTORS. 
 
 WILLIAM H. BAKER, M. D., 
 FORDYCE BARKER, M. D., 
 ROBERT BATTEY, M. D., 
 SAMUEL C. BUSEY, M. D., 
 HENRY C. COE, M. D., 
 E. C. DUDLEY, M. D., 
 GEORGE J. ENGELMANN, M. D., 
 HENRY F. GARRIGUES, M. D., 
 WILLIAM GOODELL, M. D., 
 EGBERT H. GRANDIN, M. D., 
 SAMUEL W. GROSS, M. D., 
 JAMES B. HUNTER, M. D., 
 A. REEVES JACKSON, M. D., 
 EDWARD W. JENKS, M. D., 
 
 WILLIAM T. LUSK, M. D., 
 
 MATTHEW D. MANN, M. D., 
 
 ROBERT B. MAURY, M. D., 
 
 PAUL F. MUNDE, M. D., 
 
 C. D. PALMER, M. D., 
 
 WILLIAM M. POLK, M. D., 
 
 THADDEUS A. REAMY, M. D., 
 
 A. D. ROCKWELL, M. D., 
 
 ALEX. J. C. SKENE, M. D., 
 
 R. STANSBURY SUTTON, A. M., M. D. 
 
 T. GAILLARD THOMAS, M. D., 
 
 ELY VAN DE WARKER, M. D., 
 
 W. GILL WYLIE, M. D. 
 
 TSOMAS, T. GAILLARD, M, 2>., 
 
 Professor of Diseases of Women in the College of PhysU:iam and Surgeons, N. Y. 
 
 A Practical Treatise on the Diseases of Women. Fifth edition, thoroughly 
 revised and rewritten. In one large and handsome octavo volume of 810 pages, with 266 
 illustrations. Cloth, $5.00 ; leather, $6.00 ; very handsome half Kussia, raised bands, $6.50. 
 
 The words which follow " fifth edition" are in vious one. As a book of reference for the busy 
 this case no mere formal announcement. The practitioner it is unequalled.— Boston Medical and 
 alterations and additions which have been made are Surgical Journal, April 7, 1S80. 
 
 both numerous and important. The attraction! It has been enlarged and carefully revised. It is 
 and the permanent character of this book lie in a condensed encyclopaedia of gynecological medi- 
 the clearness and truth of the clinical descriptions cine. The style of arrangement, the masterly 
 of diseases; the fertility of the author in thera- manner in which each subject is treated, and the 
 peutic resources and the fulness with which the honest convictions derived from probably the 
 details of treatment are described; the definite largest clinical experience in that specialty of any 
 character of the teaching; and last, but not least, in this country, all serve to commend it in the 
 the evident candor which pervades it. We would highest terms to the practitioner. — Nashville Jour. 
 also particularize the fulness with which the his- of Med. and Surg., Jan. 1881. 
 
 tory of the subject is gone into, which makes the That the previous editions of the treatise of Dr. 
 book additionally interesting and gives it value as Thomas were thought worthy of translation into 
 a work of reference. — London Medical Times and German, French, Italian and Spanish, is enough 
 Gazette, July 30, 1881. to give it the stamp of genuine merit. At home it 
 
 The determination of the author to keep his has made its way into the library of every obstet- 
 book foremost in the rank of works on gynaecology rieian and gynaeologist as a safe guide to practice, 
 is most gratifying. Recognizing the fact that this No small number of additions have been made to 
 can only be accomplished by frequent and thor- the present edition to make it correspond to re- 
 ough revision, he has spared no pains to make the cent improvements in treatment. — Pacific Medical 
 present edition more desirable even than the pre- I arid Surgical Journal, Jan. 1881. 
 
 EDIS, ATiTTTUn W,, M. D., Land., F.B. C.F., M.M, C.S,, 
 
 Assist. Obstetric Physician to Middlesex Hospital, late Physician to British Lying-in Hospital. 
 The Diseases of Women. Including their Pathology, Causation, Symptoms, 
 Diagnosis and Treatment. A Manual for Students and Practitioners. In one handsome 
 octavo volume of 576 pages, with 148 illustrations. Cloth, $3.00 ; leather, $4.00. 
 
 It is a pleasure to read a book so thoroughly i The greatest pains have been taken with the 
 good as this one. The special qualities which are sections relating to treatment. A liberal selection 
 conspicuous are thoroughness in covering the of remedies is given for each morbid condition, 
 whole ground, clearness of description and con- the strength, mode of application and other details 
 ciseness of statement. Another marked feature of being fully explained. The descriptions of gynse- 
 the book is the attention paid to the details of cological manipulations and operations are full, 
 many minor surgical operations and procedures, clear and practical. Much care has also been be- 
 as, for instance, the use of tents, application of stowed on the parts of the book which deal with 
 leeches, and use of hot water injections. These ■. diagnosis — we note especially the pages dealing 
 are among the more common methods of treat- ' with the difl'erentiation, one from another, of the 
 ment, and yet very little is said about them in | different kinds of abdominal tumors. The prac- 
 many of the text-books. The book is one to be titioner will therefore find in this book the kind 
 warmly recommended especially to students and ! of knowledge he most needs in his daily work, and 
 general practitioners, who need a concise Vjut com- : he will be pleased with the clearness and fulness 
 pleteresume of the whole subject. Specialists, too, I of the information there given. — The Practitioner, 
 will find many useful hints in its pages. — Boston i Feb. 1882. 
 Med. and Surg. Journ., March 2, 1882. ' 
 
 BABJSTFS, ItOBEMT, M. !>., F. M. C. JP., 
 
 Obstetric Physician to St. Th.amns'' Hospital, London, etc. ^^ 
 
 A Clinical Exposition of the Medical and Surgical Diseases of Women. 
 
 In one handsome octavo volume, with numerous illustrations. New edition. Preparing. 
 
 WEST, CMAMLES, M. B. 
 
 Lectures on the Diseases of Women. Third American from the third Lon- 
 don edition. In one octavo volume of 543 pages. Cloth, $3.75 ; leather, $4.75. 
 
28 
 
 Lea Brothers & Co.'s Publications — Dis. of Women, Midwfy. 
 
 BMMBT, TMOMAS ADDIS, M, JD., LL, D,, 
 
 Surgeon to the Woman's Hospital, New York, etc. 
 
 The Principles and Practice of Gynaecology ; For the use of Students and 
 Practitioners of Medicine. New (third) edition, thoroughly revised. In one large and very 
 handsome octavo volume of 880 pages, with 150 illustrations. Cloth, $5 ; leather, $6 ; 
 very handsome half Russia, raised bands, $6.50. 
 
 once a credit to its author and to American med- 
 ical literature. We repeat that it is a book to be 
 
 We are in doubt whether to congratulate the 
 author more than the profession upon the appear- 
 ance of the third edition of this well-known work. 
 Embodying, as it does, the life-long experience of 
 one who has conspicuously distinguished himself 
 as a bold and successful operator, and who has 
 devoted so much attention to the specialty, we 
 feel sure the profession will not fail to appreciate 
 the privilege thus offered them of perusing the 
 views and practice of the author. His earnestness 
 of purpose and conscientiousness are manifest. 
 He gives not only his individual experience but 
 endeavors to represent the actual state of gynas- 
 cological science and art. — British Medical Jour- 
 nal, May 16, 1885. 
 
 No jot or tittle of the high praise bestowed upon 
 the first edition is abated. It is still a book of 
 marked personality, one based upon large clinical 
 experience, containing large and valuable ad- 
 ditions to our knowledge, evidently written not 
 only with honesty of purpose, but with a conscien- 
 tious sense of responsibility, and a book that is at 
 
 studied, and one that is indispensable to every 
 practitioner giving any attention to gynaecology. — 
 American Journal of the Medical Sciences, April, 1885. 
 The time has passed when Emmet's Oyncecology 
 was to be regarded as a book for a single country 
 or for a single generation. It has always been his 
 aim to popularize gynsecology, to bring it within 
 easy reach of the general practitioner. The orig- 
 inality of the ideas, asidd from the perfect con- 
 fidence which we feel in the author's statements, 
 compels our admiration and respect. We may 
 well take an honest pride in Dr. Emmet's work 
 and feel that his book can hold its own against the 
 criticism of two continents. It represents all that 
 is most earnest and most thoughtful in American 
 gynasoology. Emmet's work will continue to 
 reflect the individuality, the sterling integrity and 
 the kindly heart of its honored author long after 
 smaller books have been forgotten. — American 
 Journal of Obstetrics, May, 1885. 
 
 DUJSrCAJSr, J. MATTSEWS, M.D., LL, D., I, B. S. B., etc. 
 
 Clinical Lectures on the Diseases of Women; Delivered in Saint Bar- 
 tholomew's Hospital. In one handsome octavo volume of 175 pages. Cloth, $1.50. 
 
 They are in every way worthy of their author ; 
 indeed, we look upon them as among the most 
 valuable of his contributions. They are all upon 
 matters of great interest to the general practitioner. 
 Some of them deal with subjects that are not, as a 
 
 rule, adequately handled in the text-books; others 
 of them, while bearing upon topics that are usually 
 treated of at length in such works, 3'et bear such a 
 stamp of individuality that they deserve to be 
 widely read.— iV^. Y. Medical Journal, March, 1880. 
 
 MAY, CSAMLBS S,, M. D. 
 
 Late House Surgeon to Mount Sinai Hospital, New York. 
 
 A Manual of the Diseases of Women. Being a concise and systematic expo- 
 sition of the theory and practice of gynsecologv. In one 12mo. volume of 342 pages; 
 Cloth, 11.75. 
 
 Medical students will find this work adapted to 
 their wants. Also practitioners of medicine will 
 find it exceedingly convenient to consult for the 
 purpose of refreshing their minds upon the lead- 
 ing points of a gynsecologica! subject. By syste- 
 matic condensation, the omission of disputed ques- 
 
 tions, and the presentation only of accepted views, 
 it constitutes a very satisfactory exposition of the 
 leading principles of gynaecology as they are UHf 
 derstood at the present time. — Cincinnati Medical 
 
 News, Nov. 1885. 
 
 HODGB, BUGHL., M. D., 
 
 Emeritus Professor of Obstetrics, etc., in the University of Pennsylvania. 
 
 On Diseases Peculiar to Women; Including Displacements of the Uterus. 
 Second edition, revised and enlarged. In one beautifully printed octavo volume of 519 
 pages, with original illustrations. Cloth, $4.50. 
 
 By the Same Author. 
 
 The Principles and Practice of Obstetrics. Illustrated with large litho- 
 graphic plates containing 159 figures from original photographs, and with numerous wood- 
 cuts. In one large quarto volume of 542 double-columned pages. Strongly bound in 
 cloth, $14.00. Specimens of the plates and letter-press will be forwarded to any address, 
 free by mail, on receipt of six cents in postage stamps. 
 
 MAMSBOTMAM, FMAH^CIS H,, M, J). 
 
 The Principles and Practice of Obstetric Medicine and Surgery; 
 
 In reference to the Process of Parturition. A new and enlarged edition, thoroughly revised 
 by the Author. With additions by W. V. Keating, M. D., Professor of Obstetrics, etc., 
 in the Jefferson Medical College of Philadelphia. In one large and handsome imperial 
 octavo volume of 640 pages, with 64 full-page plates and 43 woodcuts in the text, contain- 
 ing in all nearly 200 beautiful figures. Strongly bound in leather, with raised bands, $7. 
 
 WINCKBL, F. 
 
 A Complete Treatise on the Pathology and Treatment of Childbed, 
 
 For Students and Practitioners. Translated, with the consent of the Author, from the 
 second German edition, by J, R. Chadwick, M. D. Octavo 484 pages. Cloth, $4.00. 
 
 ASHWELL'S PRACTICAL TREATISE ON THE 
 DISEASES PECULIAR TO WOMEN. Third 
 American from the third and revised London 
 edition. In one 8vo. vol., pp. 520. Cloth, 83.50. 
 
 CHURCHILL ON THE PUERPERAL FEVER 
 
 AND OTHER DISEASES PECULIAR TO WO- 
 MEN. In one 8vo. vol. of 464 pages. Cloth, $2.50. 
 MEIGS ON THE NATURE, SIGNS AND TREAT- 
 MENT OF CHILDBED FEVER. In one 870. 
 volume of 346 pages. Cloth, $2.00. 
 
Lea Brothers & Co.'s Publications — Midwifery. 
 
 29 
 
 PAMVIN, THEOPSILVS, M. 2>., ii. J>., 
 
 Prof, of Obstetrics and the Diseases of Women and Children m Jefferson Med. Coll., Philg,. 
 
 The Science and Art of Obstetrics. In one handsome 8vo. volume of 697 
 pages, with 214 engravings and a colored plate. Cloth, $4.25 ; leather, |5.25. Just ready. 
 " " ■ ■ " This treatise, by the professor of the branch in 
 
 the Jefferson Medical College of Philadelphia, has 
 been the result of years of careful study directed 
 to the presentation of the suVJect in the most 
 complete manner consistent with the limits of a 
 manual r f itistruction. Dr. Parvin's well-known 
 literary ability gives him unusual advantages for 
 precisely such an undertaking, and he is to be 
 congratulated on the success with which he has 
 accomplished ii.— Medical and Surgical Reporter, 
 January 29, 1887. 
 
 The author has had the experience of an exten- 
 sive obstetric practice of upward of thirty -four 
 years, nearly two-thirds of which time he has been 
 a medical teacher, and consequently he has embod- 
 ied in his work a large amount of valuable infor- 
 mation derived from personal observation and 
 reflection. The student and physician, therefore, 
 who study this work can feel that the information 
 contained in it comes from the author as his own 
 knowledge, and can be accepted as having been 
 verified by him. — Cincinnati Medical News, Decem- 
 ber, 1886. 
 
 BARNES, ItOBBMT, M. IP,, and FANCOVBT, M. D., 
 
 Phys. to the General Lying-in Bosp., Land. Obstetric Phys. to St. Thomas' Eosp., Land 
 
 A System of Obstetric Medicine and Surgery, Theoretical and Clin- 
 ical. For the Student and the Practitioner. The Section on Embryology contributed by 
 Prof. Milnes Marshall. In one handsome octavo volume of 872 pages, with 231 illus- 
 trations. Cloth, %b ; leather, $6. 
 
 This system will be eagerly sought for, not only 
 on account of its intrinsic merit, but also because 
 the reputation which the elder Barnes, in particu- 
 lar, has secured, carries with it the conviction that 
 any book emanating from him is necessarily sound 
 in teaching and conservative in practice. It is in 
 
 ble teacher and trusted accoucheur, should embody 
 within a single treatise the system which he has 
 taught and in practice tested, and which is the out- 
 come of a lifetime of earnest labor, careful obser- 
 vation and deep study. The result of this arrange- 
 ment is the production of a work which rises above 
 
 deed eminently fitting that a man who has done' so criticism and which in no respect need yield the 
 much towards systematizing the obstetric art, who ! palm to any obstetrical treatise hitherto published. 
 for so many years has been widely known as a capa- i — American Journal of Obstetrics, Feb. 1886. 
 
 PLAYFAIM, W. S., M. D., F. M, C, F., 
 
 Professor of Obstetric Medicine in King's College, London, etc. 
 
 A Treatise on the Science and Practice of Midwifery. New (fourth) 
 American, from the fifth English edition. Edited, with additions, by Eobekt P. Har- 
 ris, M. D. In one handsome octavo volume of 654 pages, with 3 plates and 201 engrav- 
 ings. Cloth, |4 ; leather, $5 ; half Eussia, |5.50. 
 
 This still remains a favorite in America, not 
 only because the author is recognized as a safe 
 guide and eminently progressive man, but also as 
 sparing no effort to make each successive edition 
 a faithful mirror of the latest and best practice. 
 A work so frequently noticed as the present 
 requires no further review. We believe that this 
 edition is simply the forerunner of many others, 
 and that the demand will keep pace with the 
 
 supply.— .4?nerican Journal of Obstetrics, Nov., 1885. 
 Since its first publication, only eight years ago, 
 it has rapidly become the favorite textrbook, to 
 the practical exclusion of all others. A large 
 measure of its popularity is due to the clear and 
 easy style in which it is written. Few text-books 
 for students have very much to boast of in this 
 respect. — Medical Record. 
 
 KING, A. F. A., M, D,, 
 
 Professor of Obstetrics and Diseases of Women m the Medical Department of the Columbian Univer- 
 sity, Washington, D. C, and in the University of Vermont, etc. 
 A Manual of Obstetrics. New (third) edition. In one very handsome 12mo. 
 volume of 376 pages, with 102 illustrations. Cloth, |2.25. Just ready. 
 
 "■ This is the best of the recent handbooks. It is 
 "up to the times." Such a book gives full direc- 
 tions to the students, while it is a memory re- 
 fresher to the practitioner suddenly called upon to 
 do something a little out of the ordinary way. 
 When a doctor is called to a case of labor, it is well 
 for him to take abook like this along with him, and 
 spend the half-hour or more he may wish to "wait 
 
 in the other room" in looking over the possible 
 odds and ends he may have to contend with in a 
 given case. Such a review often serves all the 
 purposes of a consultation at an hour of the night 
 when he wants a bit of information, and yet does 
 not care to rouse his brother practitioner from his 
 repose. It is a good book. — Virginia Medical 
 Monthly, Nov. 1886. 
 
 BABKFB, FORDYCF, AM., M, !>., II. D. Edin., 
 
 Clinical Professor of Midwifery and the Diseases of Women in the Bellevue Hospital Medical College, 
 New York, Honorary Fellow of the Obstetrical Societies of London and Edinburgh, etc., etc. 
 
 Obstetrical and Clinical Essays. In one handsome 12mo. volume of about 
 300 pages. Preparing. 
 
 BAMNES, FANCOUBT, M. !>., 
 
 Obstetric Physician to St. Thomas' Hospital, London. 
 
 A Manual of Midwifery for Midwives and Medical Students. In one 
 royal 12mo. volume of 197 pages, with 50 illustrations. Cloth, $1.25. 
 
 J?ABBY, JOSN S., M. I>., 
 
 Obstetrician to the Philadelphia Hospital, Vice-President of the Obstet. Society of Philadelphia. 
 
 Extra - Uterine Pregnancy : Its Clinical History, Diagnosis, Prognosis and 
 Treatment. In one handsome octavo volume of 272 pages. Cloth, $2.50. 
 
 TANNER ON PREGNANCY. Octavo, 490 pages, 4 colored plates, 16 cuts. Cloth, S4.25. 
 
30 
 
 Lea Brothers & Co.'s Publications — Midwfy., Dis. CMldn. 
 
 LEISSEMAJS^, WILLIAM, M. D., 
 
 Regtus Professor of Midwifery in the University of Glasgow, etc. 
 
 A System of Midwifery, Including the Diseases of Pregnancy and the 
 Puerperal State. Third American edition, revised by the Author, with additions by 
 John S. Parry, M. D., Obstetrician to the Philadelphia Hospital, etc. In one large and 
 very handsome octavo volume of 740 pages, with 205 illustrations. Cloth, $4.50 ; leather, 
 $5.50 ; very handsome half Russia, raised bands, $6.00. 
 
 The author is broad in his teachings, and dis- 
 cusses briefly the comparative anatomy of the pel- 
 vis and the mobility of the pelvic articulations. 
 The second chapter is devoted especially to 
 
 the study of the pelvis, while in the third the 
 female organs of generation are introduced. 
 The structure and development of the ovum are 
 admirably described. Then follow chapters upon 
 the various subjects embraced in the study of mid- 
 wifery. The descriptions throughout the work are 
 plain and pleasing. It is sufficient to state that in 
 
 this, the last edition of this well-known work, every 
 recent advancement in this field has been brought 
 forward. — Physician mid Surgeon, Jan. 1880. 
 
 To the American student the work before us 
 must prove admirably adapted. Complete in all its 
 parts, essentially modern in its teachings, and with 
 demonstrations noted for clearness and precision, 
 it will gain in favor and be recognized as a work 
 of standard merit. The work cannot fail to be 
 popular and is cordially recommended. — N. O. 
 Med. and Surg. Journ., March. 1880. 
 
 LANDIS, MBWRY G,, A, M., M, 2)., 
 
 Professor of Obstetrics and the Diseases of Women in Starling Medical College, Columbus, O. 
 
 The Management of Labor, and of the Lying-in Period. In one 
 
 handsome 12mo. volume of 334 pages, with 28 illustrations. Cloth, $1.75. Just ready. 
 
 This is a book we can heartily recommend. 
 The author goes much more practically into the 
 details of the management of labor than most 
 text^books, and is so readable throughout as to 
 tempt any one who should happen to commence 
 the book to read it through. The author pre- 
 supposes a theoretical knowledge of obstetrics, 
 
 and has consistently excluded from this little 
 work everything that is not of practical use in the 
 lying-in room. We think that if it is as widely 
 read as it deserves, it will do much to improve 
 obstetric practice in general. — New Orleans Medi- 
 cal and Surgical Journal, Mar. 1886. 
 
 SMITH, J, LEWIS, M, D., 
 
 Clinical Professor of Diseases of Children in the Bellevue Hospital Medical College, N. T. 
 
 A Treatise on the Diseases of Infancy and Childhood. New (sixth) 
 edition, thoroughly revised and rewritten. In one handsome octavo volume of 867 
 pages, with 40 illustrations. Cloth, $4.50; leather, $5.50 ; half Russia, $6.00. Just ready. 
 
 but one book on the diseases of children, we 
 would unhesitatingly say, let that book be the one 
 which is the subject of this notice. — The American 
 Journal of the Medical Sciences, April, 1886. 
 
 No better work on children's diseases could be 
 placed in the hands of the student, containing, as 
 it does, a very complete account of the symptoms 
 and pathology of the diseases of early life, and 
 possessing the further advantage, in which it 
 stands alone amongst other works on its subject, 
 of recommending treatment in accordance with 
 the most recent therapeutical views. — British and 
 Foreign Medico-Chirurgical Review. 
 
 Rarely does a pleasanter task fall to the lot of 
 the bibliographer than to announce the appearance 
 of a new edition of a medical classic like Prof. J. 
 Lewis Smith's Treatise on the Diseases of Infancy 
 and Childhood. For years it has stood high in the 
 confidence of the profession, and with the addi- 
 tions and alterations now made it may be said to 
 be the best book in the language on the subject of 
 which it treats. An examination of the text fully 
 sustains the claims made in the preface, that "in 
 preparing the sixth edition the author has revised 
 the text 10 such an extent that a considerable 
 part of the book may be considered new." If the 
 young practitioner proposes to place in his library 
 
 KBATIWG, JOHW M., M, D., 
 
 Lecturer on the Diseases vf Children at the University of Pennsylvania, etc. 
 
 The Mother's Guide in the Management and Feeding of Infants. 
 
 one handsome 12mo. volume of 118 pages. Cloth, $1.00. 
 
 In 
 
 Works like this one will aid the physician im- 
 mensely, for it saves the time he is constantly giv- 
 ing his jaatients in instructing them on the sub- 
 jects here dwelt upon so thoroughly and prac- 
 tically. Dr. Keating has written a practical book, 
 has carefully avoided unnecessary repetition, and 
 
 successfully instructed the mother in such details 
 of the treatment of her child as devolve upon her. 
 He has studiously omitted giving prescriptions, 
 and instructs the mother when to call upon the 
 doctor, as his duties are totally distinct from hers. 
 — American Journal of Obstetrics, October, 1881. 
 
 owuw, EiyMuwiy, m. b., f. m. c, s., 
 
 Surgeon to the Children's Hospital, Oreat Ormond St., London. 
 
 Surgical Diseases of Children. 
 
 chromo-lithographic plates and 85 woodcuts. 
 ical Manuals, page 4. 
 
 One is immediately struck on reading this book | 
 with its agreeable style and the evidence it every- 
 where presents of the practical familiarity of its 
 author with his subject. The book may be | 
 
 In one 12mo. volume of 525 pages, with 4 
 Just ready. Cloth, $2. See Series of Clin- 
 
 honestly recommended to both students and 
 practitioners. It is full of sound information, 
 pleasantly given. — Annals of Surgery, May, 1886. 
 
 WEST, CHAMLES, M. D., 
 
 Physician to the Hospital for Sick Children, London, etc. 
 
 On Some Disorders of the Nervous System in Childhood. 
 
 12mo. volume of 127 pages. Cloth, $1.00. 
 
 In one small 
 
 WEST'S LECTURES ON THE DISEASES OF IN- 
 FANCY AND CHILDHOOD. In one octavo vol. 
 CONDIE'S PRACTICAL TREATISE ON THE 
 
 DISEASES OF CHILDREN. Sixth edition, re- 
 vised and augmented. In one octavo volume of 
 779 pages. Cloth, S5.25; leather, $6.26. j. 
 
Lea Brothers & Co.'s Publications — Med. Juris., Miscel. 
 
 31 
 
 TIJDY, CJEEABLBS MBYMOTT, M. B,, F. C. S., 
 
 Professor of Chemistry and of Forensic Medicine and Public Health at the London Hospital, etc. 
 
 Legal Medicine. Volume II. Legitimacy and Paternity, Pregnancy, Abor- 
 tion, Rape, Indecent Exposure, Sodomy, Bestiality, Live Birth, Infanticide, Asphyxia, 
 Drowning, Hanging, Strangulation, Suffocation. Making a very handsome imperial oc- 
 tavo volume of 529 pages. Cloth; $6.00 ; leather, $7.00. 
 
 Volume I. Containing 664 imperial octavo pages, with two beautiful colored 
 plates. Cloth, $6.00 ; leather, $7.00. 
 
 The satisfaction expressed with the first portion 
 of this work is in no wise lessened by a perusal of 
 the second volume. We find it characterized by 
 the same fulness of detail and clearness of ex- 
 pression which we had occasion so highly to com- 
 mend in our former notice, and which render it so 
 valuable to the medical jurist. The copious 
 
 tables of cases appended to each division of the 
 subject, must have cost the author a prodigious 
 amount of labor and research, but they constitute 
 one of the most valuable features of the book, 
 especially for reference in medico-legal trials. — 
 A7neriean Journal of the Medical Sciences, April, 1884. 
 
 TAYLOM, AJLFBJED S,, M, D., 
 
 Lecturer on Medical Jurisprudence and Chemistry in Ouy^s Hospital, London. 
 
 A Manual of Medical Jurisprudence. Eighth American from the tenth Lon- 
 don edition, thoroughly revised and rewritten. Edited by John J. Reese, M. D., Professor 
 of Medical Jurisprudence and Toxicology in the University of Pennsylvania. In one 
 large octavo volume of 937 pages, with 70 illustrations. Cloth, $5.00 ; leather, $6.00 ; half 
 Russia, raised bands, $6.50. 
 
 The American editions of this standard manual 
 have for a long time laid claim to the attention of 
 the profession in this country; and the eighth 
 comes before us as embodying the latest thoughts 
 and emendations of Dr. Taylor upon the subject 
 to which he devoted his life with an assiduity and 
 success which made him facile princeps among 
 English writers on medical jurisprudence. Both 
 the author and the book have made a mark too 
 deep to be affected by criticism, whether it be 
 censure or praise. In this case, however, we should 
 
 only have to seek for laudatory terms. — American 
 Journal of the Medical Sciences, Jan. 1881. 
 
 This celebrated work has been the standard au- 
 thority in its department for thirty-seven years, 
 both in England and America, in both the profes- 
 sions which it concerns, and it is improbable that 
 it will be superseded in many years. The work is 
 simply indispensable to every physician, and nearly 
 so to every liberally-educated lawyer, and we 
 heartily commend the present edition to both pro- 
 fessions. — Albany Law Journal, March 26, 1881. 
 
 By the Same Author. 
 
 The Principles and Practice of Medical Jurisprudence. Third edition. 
 In two handsome octavo volumes, containing 1416 pages, with 188 illustrations. Cloth, $10 ; 
 leather, $12. Just ready. 
 
 For years Dr. Taylor was the highest authority 
 in England upon the subject to which he gave 
 especial attention. His experience was vast, his 
 judgment excellent, and his skill beyond cavil. It 
 is therefore well that the work of one who, as Dr. 
 Stevenson says, had an "enormous grasp of all 
 
 matters connected with the subject," should be 
 brought up to the present day and continued in 
 its authoritative position. To accomplish this re- 
 sult Dr. Stevenson has subjected it to most careful 
 editing, bringing it well up to the times. — Aineri- 
 can Journal (y the Medical Sciences, Jan. 1884. 
 
 By the Same Author. 
 
 Poisons in Belation to Medical Jurisprudence and Medicine. Third 
 American, from the third and revised English edition. In one large octavo volume of 788 
 pages. Cloth, $5.50 ; leather, $6.50. 
 
 BJEBJPJEJR, AUGUSTUS J., M. S,, M. B,, F. B. C. S., 
 
 Examiner in Forensic Medicine at the University of London. 
 Forensic Medicine. In one pocket-size 12mo. volume. Preparing. See Students'' 
 Series of Manuals, page 4. 
 
 LEA, JEEENBY C, 
 
 Superstition and Force : Essays on The Wager of Law, The Wager of 
 Battle, The Ordeal and Torture. Third revised and enlarged edition. In one 
 handsome royal 12mo. volume of 552 pages. Cloth, $2.50. 
 
 This valuable work is in reality a history of civ- 
 ilization as interpreted by the progress of jurispru- 
 dence. . . In " Superstition and Force " we have a 
 philosophic survey of the long period intervening 
 between primitive barbarity and civilized enligh^ 
 enment. There is not a chapter in the work that 
 
 should not be most carefully studied ; and however 
 well versed the reader may be in the science of 
 jurisprudence, he will find much in Mr. Lea's vol- 
 ume of which he was previously ignorant. The 
 book is a valuable addition to the literature of so- 
 cial science. — Westm,inster Review, Jan. 1880. 
 
 By the Same Author. 
 Studies in Church History. The Rise of the Temporal Power — Ben- 
 
 efit of Clergy — Excommunication 
 
 octavo volume of 605 pages. Cloth, $2.50. 
 
 The author is pre-eminently a scholar. He takes 
 up every topic allied with the leading theme, and 
 traces it out to the minutest detail with a wealth 
 of knowledge and impartiality of treatment that 
 compel admiration. The amount of information 
 compressed into the book is extraordinary. In no 
 other single volume is the development of the 
 
 New edition. In one very handsome royal 
 
 Just ready. 
 
 primitive church traced with so much clearness, 
 and with so definite a perception of complex or 
 conflicting sources. The fifty pages on the growth 
 of the papacy, for instance, are admirable for con- 
 ciseness and freedom from prejudice. — Boston 
 Traveller, May 3, 1883. 
 
Allen's Anatomy .... 
 
 American Journal of the Medical Sciences 
 
 American System of Gynaecology . 
 
 American System of Practical Medicine . 
 
 An American System of Dentistry 
 
 Anderson on the Skin 
 
 *Ashhurst's Surgery .... 
 
 Ashwell on Diseases of Women 
 
 Attfield's Chemistry .... 
 
 Ball on the Rectum and Anus 
 
 Barker's Obstetrical and Clinical Bssays, 
 
 Barlow's Practice of Medicine 
 
 Barnes' Midwifery .... 
 
 *Barnes on Diseases of Women 
 
 Barnes' System of Obstetric Medicine 
 
 Bartholow on Electricity 
 
 Basham on Renal Diseases . 
 
 Bell's Comparative Physiology and Anatomy 
 
 Bellamy's Operative Surgery 
 
 Bellamy's Surgical Anatomy 
 
 Blandford on Insanity 
 
 Bloxam's Chemistry .... 
 
 *Bristowe's Practice of Medicine . 
 
 Broadbent on the Pulse 
 
 Browne on the Ophthalmoscope . 
 
 Browne on the Throat 
 
 Bruce's Materia Medica and Therapeutics 
 
 Brunton's Materia Medica and Therapeutics 
 
 Bryant on the Breast .... 
 
 *Bryant's Practice of Surgery 
 
 *Bumstead on Venereal Diseases . 
 
 ♦Burnett on the Ear .... 
 
 Butlin on the Tongue .... 
 
 Carpenter on the Use and Abuse of Alcohol 
 
 •Carpenter's Human Physiology . 
 
 Carter & Frost's Ophthalmic Surgery 
 
 Century of American Medicine 
 
 Chambers on Diet and Regimen 
 
 Charles' Physiological and Pathological Chem, 
 
 Churchill on Puerperal Fever 
 
 Clarke and Lockwood's Dissectors' Manual 
 
 Classen's Quantitative Analysis 
 
 Cleland's Dissector .... 
 
 Clouston on Insanity .... 
 
 Clowes' Practical Chemistry 
 
 Coats' Pathology .... 
 
 Cohen on the "Throat .... 
 
 Coleman's Dental Surgery 
 
 Condie on Diseases of Children 
 
 Cornil on Syphilis 
 
 'i'Cornil and Ranvier's Pathological Histology 
 
 Cullerier's Atlas of Venereal Diseases 
 
 Curnow's Medical Anatomy 
 
 Dalton on the Circulation 
 
 ♦Dalton's HumanPhysiology 
 
 Davis' Clinical Lectures 
 
 Draper's Medical Physics 
 
 Druitt's Modern Surgery 
 
 Duncan on Diseases of Women 
 
 *Dunglison's Medical Dictionary . 
 
 Edes' Materia Medica and 'Therapeutics 
 
 Edis on Diseases of Women . 
 
 Ellis' Demonstrations of Anatomy 
 
 Emmet's Gynaecology 
 
 *Erichsen's System of Surgery 
 
 Esmarch's Early Aid in Injuries and Accid'ts 
 
 Farquharson's Therapeutics and Mat. Med. 
 
 Fenwick's Medical Diagnosis 
 
 Finlayson's Clinical Diagnosis 
 
 Flint on Auscultation and Percussion 
 
 Flint on Phthisis .... 
 
 Elint on Physical Exploration of the liUngs 
 
 Flint on Respiratory Organs 
 
 Flint on the Heart .... 
 
 Flint's Essays ... 
 
 *Flint's Practice of Medicine 
 
 Folsom's Laws of TJ. S. on Custody of Insane 
 
 Foster's Physiology' .... 
 
 •"Fothergilrs Handbook of Treatment . 
 
 Fownes' Elementary Chemistry 
 
 Fox on Diseases of the Skin . 
 
 Frankland and Japp's Inorganic Chemistry 
 
 Fuller on the Lungs and Air Passages . 
 
 Galloway's Analysis .... 
 
 Gibney's Orthopsedic Surgery 
 
 <3ould's Surgical Diagnosis . 
 
 *Gray's Anatomy ..... 
 
 Greene's Medical Chemistry . 
 
 Green's Pathology and Morbid Anatomy 
 
 Griffith's Universal Formulary 
 
 Gross on Foreign Bodies in Air- Passages 
 
 Gross on Impotence and Sterility . 
 
 Gross on Urinary Organs 
 
 *Gross' System of Surgery 
 
 Habershon on the Abdomen 
 
 '*Hamilton on Fractures and Dislocations 
 
 Hamilton on Nervous Diseases 
 
 Hartshorne's Anatomy and Physiology . 
 
 Hartshorne's Conspectus of the Med. Sciences 
 
 Hartshorne's Essentials of Medicine 
 
 Hartshorne's Household Medicine 
 
 Hermann's Experimental Pharmacology 
 
 Hill on Syphilis ..... 
 
 Hillier's Handbook of Skin Diseases 
 
 Hoblyn'a Medical Dictionary 
 
 Hodge on Women .... 
 
 Hodge's Obstetrics .... 
 
 Hoffmann and Power's Chemical Analysis 
 
 Holden's Landmarks .... 
 
 Holland's Medical Notes and Reflections 
 
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 ♦Holmes' System of Surgery 
 
 Horner's Anatomy and Histology . 
 
 Hudson on Fever 
 
 Hutchinson on Syphilis 
 
 Hyde on the Diseases of the Skin . 
 
 Jones (C. Handfield) on Nervous Disorders 
 
 Juler's Ophthalmic Science and Practice 
 
 Keating on Infants .... 
 
 King's Manual of Obstetrics . 
 
 Klein's Histology .... 
 
 Landis on Labor .... 
 
 La Roche on Pneumonia, Malaria, etc. . 
 
 La Roche "on Yellow Fever . 
 
 Laurence and Moon's Ophthalmic Surgery 
 
 Lawson on the Eye, Orbit and Eyelid 
 
 Lea's Studies in Church History 
 
 Lea's Superstition and Force 
 
 Lee on Syphilis 
 
 Lelimann s Chemical Physiology . 
 
 *Leishman's Midwifery 
 
 Lucas on Diseases of the Urethra . 
 
 Ludlow's Manual of Examinations 
 
 Lyons on Fever ..... 
 
 Maisch's Organic Materia Medica . 
 
 Marsh on the Joints 
 
 May on Diseases of Women . 
 
 Medical News 
 
 Medical News Visiting List . 
 
 Medical News Physicians' Ledger . 
 
 Meigs on Childbed Fever 
 
 Miller's Practice of Surgery . 
 
 Miller's Principles of Surgery 
 
 Mitchell's Nervous Diseases of Women . 
 
 Morris on Diseases of the Kidney . 
 
 Morris on Skin Diseases 
 
 Neill and Smith's Compendium of Med. Scl. 
 
 Nettleship on Diseases of the Eye . 
 
 Norris and Oliver on the Eye 
 
 Owen on Diseases of Children 
 
 *Parrish's Practical Pharmacy 
 
 Parry on Extra-Uterine Pregnancy 
 
 Parvin's Midwifery .... 
 
 Pavy on Digestion and its Disorders 
 
 Pepper's System of Medicine 
 
 Pepper's Forensic Medicine ... 
 
 Pepper's Surgical Pathology 
 
 Pick on Fractures and Dislocations 
 
 Pirrie's System of Surgery . 
 
 Playfair on Nerve Prostration and Hysteria 
 
 *Playtair's Midwifery . 
 
 Politzer on the Ear and its Diseases 
 
 Power's Human Physiology ... 
 
 Purdy on Bright's Disease and Allied A fifections 
 
 Ralfe's Clinical Chemistry 
 
 Ramsbotham on Parturition 
 
 Bemsen's Theoretical Chemistry . 
 
 ♦Reynolds' System of Medicine 
 
 Richardson's Preventive Medicine 
 
 Roberts on Urinary Diseases 
 
 Roberts' Compend of Anatomy 
 
 Roberts' Principles and Practice of Surgery 
 
 Robertson's Physiological Physics 
 
 Ross on Nervous Diseases 
 
 Savage on Insanity, including Hysteria . 
 
 Schafer's Essentials of Histology, 
 
 Schreiber on Massage . 
 
 Seller on the Throat, Nose and Naso-Pharynx 
 
 Series of Clinical Manuals 
 
 Simon's Manual of Chemistry 
 
 Skey's Operative Surgery 
 
 Slade on Diphtheria 
 
 Smith (Edward) on Consumption 
 
 *Smith (J. Lewis) on Children 
 
 Smith's Operative Surgery . 
 
 Stllle on Cholera 
 
 *Still6 & Maisch's National Dispensatory 
 
 *Still6's Therapeutics and Materia Medica 
 
 Stimson on Fractures .... 
 
 Stimson's Operative Surgery 
 
 Stokes on Fever ..... 
 
 Students' Series of Manuals . 
 
 Sturges' Clinical Medicine 
 
 Tanner on Signs and Diseases of Pregnancy 
 
 Tanner's Manual of Clinical Medicine . 
 
 Taylor on Poisons .... 
 
 ♦Taylor's Medical Jurisprudence . 
 
 Taylor's Prin. and Prac. of Med. Jurisprudence 
 
 ♦Thomas on Diseases of Women 
 
 Thompson on Stricture 
 
 Thompson on Urinary Organs 
 
 Tidy's Legal Medicine .... 
 
 Todd on Acute Diseases 
 
 Treves' Manual of Surgery . 
 
 Treves' Surgical Applied Anatom.y 
 
 Treves on Intestinal Obstruction . 
 
 Tuke on the Influence of Mind on the Body 
 
 Visiting List, The Medical News . 
 
 Walshe on the Heart .... 
 
 Watson's Practice of Physic . 
 
 ♦Wells on the Eye .... 
 
 West on Diseases of Childhood . fc . 
 
 West on Diseases of Women . *. 
 
 W^est on Nervous Disorders in Childhood 
 
 Williams on Consumption . 
 
 Wilson's Handbook of Cutaneous Medicine 
 
 Wilson's Human Anatomy . 
 
 Winckel on Pathol, and Treatment of Childbed 
 
 Wohler's Organic Chemistry 
 
 Woodhead's Practical Pathology . 
 
 Year-Books ol Treatment for 1884 and 1885 
 
 Books marked * are also bound in half Russia. 
 
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