ll'l': -I ■ DR A E. FOOIE. I" ■ :i i«. P». ? Lx >* *^ URGEON GENERAL'S OFFICE LIBRARY. Section, xo..J.iil'5rOt \ # < ^ &? /&a^Z^/eri~~ A PRACTICAL TREATISE ON THE CAUSES, SYMPTOMS AND TREATMENT SPERMATORRHEA: S BT M. LALLEMAND, » FORMERLY PROFESSOR OF CLINICAL SURGERY AT THE UNIVERSITY OF MONTPELLIER, ETC. STranslateft antf EUttrtJ 6a ' HENRY J. M°DOUGALL, * * MEMBER OF THE ROYAL COLLEGE OP SURGEONS OF ENGLAND, ETC., ETC. ?^ &*>/■ —- THIRD AMERICAN EDITION. >?p TO WHICH IS ADDED, ON DISEASES OE THE VESICULffi SEMINALES AND THEIR ASSOCIATED ORGANS i * » WITH SPECIAL REFERENCE TO THE MORBID SECRETIONS OF THE PROSTATIC AND URETHRAL MUCOUS MEMBRANE. MARRIS WILSON, M. D. LI BR Ail Y rjRatuV'it... .< ., .:. :'CE .;. * 'O * J / 4 fc 3 $~o. PHILADELPHIA: BLANCHARD AND LEA. 18 58. WX4 LI97J 12 52 fdinn fit- 51,11 no • I AMERICAN PUBLISHER'S NOTICE. A considerable period having elapsed since the publica- tion of the work of M. Lallemand, the publishers have thought that the value of the present edition might be en- hanced by the addition of the little treatise of Dr. Maeeis Wilson, which since its recent appearance in London, has already acquired a high professional character. The reader will thus have the advantage of comparing the views ad- vanced by M. Lallemand, with the latest results of profes- sional experience, embodying the present state of the sub- ject investigated with the aid of modern pathology. Philadelphia, July, 1858. AUTHOR'S PREFACE. During a period of fourteen years, I have collected more than one hundred and fifty cases in which involuntary seminal discharges were sufficiently serious to disorder the health of the patients con- siderably, and even sometimes to cause death. Most of these patients have been sent to me on account of sus- pected cerebral affections of more or less standing. Hence, by a singular chance, it has been in consequence of the publication of my uBecherches Anatomico-Fathologiques, sur Vencephale et ces depen- dances," that I have obtained the most remarkable cases of diurnal pollutions; and I have correctly refused to acknowledge the presence of disease of the brain or its membranes in many cases where the existence of such disease had previously been considered indisputa- ble. Many other of these patients were supposed to suffer from chronic gastritis, or gastro-enteritis; from aneurisms near the heart, the early symptoms of phthisis, &c, &c.; and in other cases from ner- vous affections, and especially from hypochondriasis. These few words show how frequent, important, and difficult of detection, are involuntary seminal discharges, and to what deplorable errors of treatment they daily give rise: it may be foreseen, too, that their causes must be very varied, and their treatment present con- siderable difficulties. TheBrochure of Wickmann and the commentaries on it by Sainte- Maria,1 are the only writings we possess, on a disease that degrades man, poisons the happiness of his best days, and ravages society! Of the researches of these conscientious observers, too, the profession are almost ignorant. They have, nevertheless, done all in their power to call the atten- 1 Dissertation sur la pollution diurne involuntaire; par Wickmann; traduction de Sainte-Maria.—Lyons, 1817. 1 VI PREFACE. tion of practitioners to a subject of which they fully felt the impor- tance, and they have stated many valuable truths. Why is it, then that a more lasting impression has not been made on the medical world ? Doubtless because they have not supported their statements by a sufficient number of well detailed cases, and especially because those related are vaguely and generally stated. Although Wickmann and Sainte-Maria have stated facts which have not been appreciated, they have left numerous omissions to be supplied, and more than one serious error to be corrected. The materials I possess permit me to hope that I shall be more successful; at all events, I consider it my duty to publish them EDITOR'S PREFACE. In laying the following condensed edition of M. Lallemand's im- portant work on Involuntary Seminal Discharges before my profes- sional brethren in an English dress, I have been actuated by the con- viction that the disorder treated of is little understood by the profes- sion generally in this country. The patients affected by it are always hypochondriacal—indeed, the symptoms of hypochondriasis and men- tal derangement are generally by far the most prominently marked in them—and after the usual remedies for digestive disorder and liver disease have been had recourse to without benefit, the practitioner becomes tired of attending a disease which is at best obscure and does not yield to the usual remedies, and either treats his patient as a malade imaginaire, or leaves him a prey to the wretched balsam- selling quacks, who are unfortunately permitted to pollute every pe- riodical publication with their disgusting advertisements. The subject of Spermatorrhoea is an uninviting one—especially to the fastidious—perhaps too fastidious English taste;—hence, with very few exceptions, it has been generally avoided by regularly edu- cated practitioners in this country. An abstract of M. Lallemand's views was indeed published by my friend, Mr. Phillips, in the Medi- cal Gazette in the year 1843, and about the same time some papers appeared in the Lancet on the same subject by Drs. Ranking and Dangerfield, and Messrs. Ryan, Chatto, and Dudgeon. These pub- lications, however, from their transitory nature, were not calculated to remedy the want felt by the profession, of a systematic treatise on this important subject. Mr. Phillips, indeed, in the conclusion of his paper in the Medical Gazette, takes occasion to remark: " Since the publication of the first part of this paper, I have been painfully im- pressed with the conviction, that the evil is more widely spread than I had before conceived; and that it will not be largely alleviated by the means I have adopted for advocating the relief of a particular remedy.....The pages of a strictly Medical Journal do not meet the eyes of the great mass of sufferers." In a notice also of M. Lallemand's work, in the British and Foreign Medical Review, the reviewer took an opportunity of pointing out the importance of the subject. Nevertheless, authors have always seemed to avoid the subject as dangerous ground, and with the exception of viii PREFACE. an excellent chapter in Mr. Curling's work on Diseases of the Testis, and some observations published by Dr. Smyth, in a work entitled '"Miscellaneous Contributions to Pathology and Therapeutics," I believe the present to be the first attempt to render the profession familiar with this disorder, by any special work in the English lan- guage. Indeed, in Dr. Golding Bird's otherwise excellent book on urinary deposits, the author, although he admits that the spermatozoa are fre- quently discovered in the urine by microscopic examination, takes occasion to express his opinion, that the subject of spermatorrhoea is one by no means deserving the importance attached to it. He adds, "It certainly is not very consistent with our national character, to dilate so freely on a subject which, in the great majority of cases, can be treated of only as the effects of a most degrading vice." That any physician should relieve himself from the investigation of a most afflicting disease, because the subject treated of is an unpleasant one, appears to me unworthy the general character of our profession. Had similar opinions been held respecting syphilis—a subject quite as re- pugnant to English feelings as spermatorrhoea,—what misery would have been entailed on the human race! Lecturers on surgery, while entering fully on other diseases of the urethra, appear either not to have been aware of, or by common con- sent to have omitted, spermatorrhoea from their oral lectures and text- books of surgery. Professor Miller of Edinburgh having given a short notice of spermatorrhoea in his "Practical Surgery," published in 1846, is, as far as I am aware, the only exception to this rule. At an early part of my professional life my attention was much en- gaged by two cases, which to me presented peculiar features of interest. One, the case of a near relative, since dead, proved particularly unfor- tunate. The other, the case of a friend of about my own age—also studying medicine,—recovered after several relapses; and the pa- tient is at present practising his profession in her Majesty's service. In both cases the best advice the West of England afforded was ob- tained without success, or indeed, even slight improvement, and in neither case was the cause of the disorder, which particularly affected the brain and digestive organs, recognised. The interest I took in these cases led me to suspect, from certain hints thrown out by the patients, that their disorders were somehow connected with the genital organs. Further experience has con- vinced me that my suspicions were correct. A brief .outline of these cases may not be uninteresting. R. II-------, set. thirty-nine, passed the early part of his life in the country, and was in the habit of taking much and violent exercise. About the age of sixteen, he entered a banking establishment in Lon- don, in which by great diligence and steadiness of conduct he rose, before he was twenty-five, to the post of cashier. The affairs of the house fell into disorder, and ultimately a bankruptcy occurred; Mr. H-------, from the amount of confidence reposed in him by the PREFACE. IX partners of the firm, was much harassed during these unfortunate pro- ceedings. Soon afterwards he became manager of a large mercan- tile establishment in the city, and about this time commenced some speculations in foreign bonds. From fluctuations in the share market he was a loser to a considerable extent; his mind was much harassed, and he began to suspect those about him of dishonesty towards their employers. On investigation these suspicions were proved to be totally unfounded; Mr. H-----gave way to great violence of con- duct, and resigned his situation. About this time his father died; and Mr. II---— was much disappointed at finding that property, which he had incorrectly believed entailed, and consequently his, as eldest son, was left by will to be equally divided between himself and the rest of his family. His conduct at this period was of the strangest description. He dreaded to go out into the streets of the town where his family resided, refused to join in their meals, and ultimately ab- ruptly left their house to return to London. In 1837 his state had be- come such that in consequence of his repeated letters, members of his family visited London, and on their return took him with them into Devonshire. About this time his mental disorder put on a decided aspect; and I had then, as well as later, ample opportunities of ob- serving his conduct; and frequently heard his complaints. Emissa- ries were constantly on the search for him to arrest him for unnatural crimes committed in London; every one who met him in the street read in his countenance the crimes he had committed; tailors made his coats with the sleeves the wrong way of the cloth, in order to brand him with infamy; the sight of a policeman in the street alarmed him beyond measure; and often, if a stranger happened to be walking for some little time in the same direction as himself, he would ex- claim that he was one of the emissaries sent to seize him. At other times he would lock himself in his room and weep by the hour. He never took his meals with the family, and never tasted food or drink without first preserving a portion for chemical analysis, as he was con- vinced his friends were in a conspiracy to poison him slowly, in order to wipe out the memory of his crimes. These ideas haunted him night and day. His digestion was much disordered; his sleep broken and restless, and his bowels excessively constipated. His face was flushed, and periodical attacks of cerebral excitement occurred, during which he complained of vertigo, noise in the head, loss of sight, &c. He complained also of loss of memory, and frequently of bodily weak- ness and lassitude. The best medical advice the neighbourhood afforded was obtained, unavailingly; the opinions of the gentlemen consulted were, that Mr. H----was labouring under aggravated hypochondriasis, complicated with monomania. Various causes were suggested as giving rise to the disorder, but no previous case of in- sanity was recollected in any branch of the family. Mr. H—— now began to talk of leaving England for America, in order to avoid his persecutors; and to prevent this he was placed under the care of a private keeper; while with this person he frequently and bitterly com- Vlll PREFACE. an excellent chapter in Mr. Curling's work on Diseases of the Testis, and some observations published by Dr. Smyth, in a work entitled "Miscellaneous Contributions to Pathology and Therapeutics,'' I believe the present to be the first attempt to render the profession familiar with this disorder, by any special work in the English lan- guage. Indeed, in Dr. Golding Bird's otherwise excellent book on urinary deposits, the author, although he admits that the spermatozoa are fre- quently discovered in the urine by microscopic examination, takes occasion to express his opinion, that the subject of spermatorrhoea is one by no means deserving the importance attached to it. He adds, "It certainly is not very consistent with our national character, to dilate so freely on a subject which, in the great majority of cases, can be treated of only as the effects of a most degrading vice." That any physician should relieve himself from the investigation of a most afflicting disease, because the subject treated of is an unpleasant one, appears to me unworthy the general character of our profession. Had similar opinions been held respecting syphilis—a subject quite as re- pugnant to English feelings as spermatorrhoea,—what misery would have been entailed on the human race! Lecturers on surgery, while entering fully on other diseases of the urethra, appear either not to have been aware of, or by common con- sent to have omitted, spermatorrhoea from their oral lectures and text- books of surgery. Professor Miller of Edinburgh having given a short notice of spermatorrhoea in his "Practical Surgery," published in 1846, is, as far as I am aware, the only exception to this rule. At an early part of my professional life my attention was much en- gaged by two cases, which to me presented peculiar features of interest. One, the case of a near relative, since dead, proved particularly unfor- tunate. The other, the case of a friend of about my own age—also studying medicine,—recovered after several relapses; and the pa- tient is at present practising his profession in her Majesty's service. In both cases the best advice the West of England afforded was ob- tained without success, or indeed, even slight improvement, and in neither case was the cause of the disorder, which particularly affected the brain and digestive organs, recognised. The interest I took in these cases led me to suspect, from certain hints thrown out by the patients, that their disorders were somehow connected with the genital organs. Further experience has con- vinced me that my suspicions were correct. A brief outline of these cases may not be uninteresting. R. H------, at. thirty-nine, passed the early part of his life in the country, and was in the habit of taking much and violent exercise. About the age of sixteen, he entered a banking establishment in Lon- don, in which by great diligence and steadiness of conduct he rose, before he was twenty-five, to the post of cashier. The affairs of the house fell into disorder, and ultimately a bankruptcy occurred; Mr. H-------, from the amount of confidence reposed in him by the PREFACE. IX partners of the firm, was much harassed during these unfortunate pro- ceedings. Soon afterwards he became manager of a large mercan- tile establishment in the city, and about this time commenced some speculations in foreign bonds. From fluctuations in the share market he was a loser to a considerable extent; his mind was much harassed, and he began to suspect those about him of dishonesty towards their employers. On investigation these suspicions were proved to be totally unfounded; Mr. H----- gave way to great violence of con- duct, and resigned his situation. About this time his father died; and Mr. II---— was much disappointed at finding that property, which he had incorrectly believed entailed, and consequently his, as eldest son, was left by will to be equally divided between himself and the rest of his family. His conduct at this period was of the strangest description. He dreaded to go out into the streets of the town where his family resided, refused to join in their meals, and ultimately ab- ruptly left their house to return to London. In 1837 his state had be- come such that in consequence of his repeated letters, members of his family visited London, and on their return took him with them into Devonshire. About this time his mental disorder put on a decided aspect; and I had then, as well as later, ample opportunities of ob- serving his conduct; and frequently heard his complaints. Emissa- ries were constantly on the search for him to arrest him for unnatural crimes committed in London; every one who met him in the street read in his countenance the crimes he had committed; tailors made his coats with the sleeves the wrong way of the cloth, in order to brand him with infamy; the sight of a policeman in the street alarmed him beyond measure; and often, if a stranger happened to be walking for some little time in the same direction as himself, he wo'uld ex- claim that he was one of the emissaries sent to seize him. At other times he would lock himself in his room and weep by the hour. He never took his meals with the family, and never tasted food or drink without first preserving a portion for chemical analysis, as he was con- vinced his friends were in a conspiracy to poison him slowly, in order to wipe out the memory of his crimes. These ideas haunted him night and day. His digestion was much disordered; his sleep broken and restless, and his bowels excessively constipated. His face was flushed, and periodical attacks of cerebral excitement occurred, during which he com'plained of vertigo, noise in the head, loss of sight, &c. He complained also of loss of memory, and frequently of bodily weak- ness and lassitude. The best medical advice the neighbourhood afforded was obtained, unavailingly; the opinions of the gentlemen consulted were, that Mr. II----was labouring under aggravated hypochondriasis, complicated with monomania. Various causes were suggested as giving rise to the disorder, but no previous case of in- sanity was recollected in any branch of the family. Mr. H—— now began to talk of leaving England for America, in order to avoid his persecutors; and to prevent this he was placed under the care of a private keeper; while with this person he frequently and bitterly com- X PREFACE. plained of constant pollutions while at stool, with darting pain, and a sense of weight between the rectum and bladder. He had also urethral irritation attended with discharge, pains in his loins, and in one groin, weakness of his legs, thick urine, piles, and obstinate cos- tiveness. He kept a diary at this time, which is at present in my hands. Not a day is passed in this diary without mention of the dis- tressing seminal discharges from which he suffered. These were treated as of no importance by his medical attendants, although he never ceased to complain of them, and solicited aid so long as he con- tinued in confinement in England. When led away from his dis- order into any discussion on public matters, he was, however, a most amusing and instructive companion; as a man of business he was equally acute, and to a stranger, as long as nothing was done to offend him, he was, to all appearance, a man of observation and experience in life. For about two years and a half he was under the care of various gentlemen, devoted to the insane, and at length he was dis- charged from an establishment near Bath, by the visiting magistrates, as a person confined without due cause. His first act was to com- mence legal proceedings against his friends for his detention, and having gained his action, he immediately proceeded to London, and waylaid and violently assaulted a gentleman of high commercial standing in the city. After this offence he was confined for a con- siderable period in default of bail, and immediately on his liberation it is believed that he proceeded to America. From this time nothing was heard of him until September, 1843, when a letter was received by a gentleman who formerly attended him, in which he stated that the same course of persecution was pursued towards him in America as had been folloAved in England. He complained of not being able to obtain efficient medical treatment, although he had applied to the most eminent practitioners in Cincinnati, and afterwards at Philadel- phia and New York. After this, nothing more was heard of Mr. H----until the year 1845, when an American newspaper was for- warded to his friends by an unknown hand, containing an account of his death, and of an inquest held on him, headed, "Death of a Hermit in West Jersey." It was stated that he lived on a small farm, entirely alone, with the exception of a dog, and that he had shunned all intercourse with his neighbours. He was taken suddenly ill, applied to a neighbouring farmer for assistance, but died in the course of the following day. From information subsequently ob- tained by his friends, it is believed that he died of apoplexy, or per- haps, in one of the attacks of congestion of the brain, from which he frequently suffered before he left his native country. The symptoms of this unfortunate case strongly resemble those of the thirty-second and fifty-sixth cases related by M. Lallemand. It was more aggravated, however, and presented the somewhat uncommon feature of the patient's discovering the frequent pollutions, and con- stantly complaining of them : these, unfortunately, were treated as matters of no importance. Mr. H----'s insanity, at first, constantly PREFACE. XI had reference to his having either committed or been accused of com- mitting unnatural crimes, and this idea never entirely left him, although during the latter part of his life, his more prominent hallucinations had reference to imaginary persecutors constantly watching him, and endeavouring to ruin him by spreading false reports, and to poison him by adulterating his food, and infusing noxious gases into the air. There can be little doubt, on taking into consideration his complaints of weight between the rectum and bladder, with darting pains, &c, in the same region, that the pollutions arose from irritation in the neighbourhood of the prostate, and I think, that if at an early period of his disease this had been relieved, there would have been con- siderable hope of his recovery from the hallucinations he manifested. The other case to which I have alluded as particularly attracting my attention, and which came under my notice about the same time, was that of a young man of high intellectual power and general talents, studying medicine. This gentleman was one of my most constant companions, when almost suddenly a serious change came over him— he shunned society, especially that of females, was morose, taciturn, and frequently shed tears; he sat sometimes for hours in a kind of abstraction, and on being aroused from it, he could give no explana- tion of his thoughts and feelings; he constantly expressed to me his conviction that he should never succeed in his profession, and fre- quently exclaimed that he was ruined both here and hereafter—body and soul—and by his own folly. About twelve months previous to this depression of spirits, he had a very severe attack of blennorrhagia, with orchitis and phimosis. This left a degree of irritability in the bladder which required him to pass urine frequently. His digestion became so disordered that the simplest food would not remain on lus stomach, and he had frequent eructations of fluid, which blazed like oil if spit out into the fire. This gentleman's father was a physician, and being naturally anxious for his son, obtained for him the advice of many of the most eminent of the faculty. No improvement took place however. After he had been six months in this state, I had an opportunity of spending three weeks by the sea side, and my friend accompanied me. We slept in the same room, and he was scarcely ever out of my sight. Before our return his health was almost^ re- established, and his spirits had returned to their natural condition. Twelve months later, however, he again fell into the same state ot despondency, and this time his condition was much worse than on the former occasion. He frequently remained in bed three parts ot the day, and no threats or entreaties on the part of his father could induce him to get up. His intellectual faculties were totally pros- trated, and a vacant stare which took the place of his natural lively expression, induced considerable fears of his ultimately becoming idiotic. I was the only person who possessed any influence over him, which may perhaps be attributed to his feeling that I was aware of the cause of his disorder. This state continued between three and four months, during which time I was with him as much as my other xii PREFACE. duties would permit, and frequently showed him the folly of the course he pursued. At the expiration of this time he gradually re- covered. He has since had a slight relapse once only; he has pur- sued his professional studies with success, and is at present a medical officer in her Majesty's service. On this case, I need only remark that the symptoms did not arise from involuntary seminal discharges, but from excessive dis- charges caused by abuse. The various treatment recommended by the distinguished practitioners consulted, proved unsuccessful, be- cause the origin of the disorder was unrecognised, and the remedies consequently useless, while the habit of abuse was continued. Such were the two cases which first attracted my attention to the influence of the generative organs over the system generally, and the brain especially; and my suspicions once awakened, further observa- tions soon convinced me of their correctness, as well as of the fre- quent occurrence of such cases. I was soon convinced too, that the profession generally, either were not aware of the immense impor- tance of these discharges, or that, by a kind of common consent, they neglected to recognise a subject certainly repugnant to delicacy. As a consequence, sufferers finding themselves neglected by their ordinary medical attendants, rush to find relief wherever there seems to them the slightest chance of its being obtained; and the ignorant and rapacious advertising quacks have a rapid and profitable sale for their injurious nostrums. Several cases of gross imposition by these charlatans have come under my notice, which it is my intention, at some future period, to lay before the profession in one of our medi- cal periodicals. Their introduction here would swell these prefa- tory observations to an inconvenient length. It now remains for me to make a few remarks on one or two points of my own experience respecting the symptoms and treatment of spermatorrhoea. One symptom which I have three times met with as the result of masturbation, is little more than alluded to by M. Lalle- mand—I mean epilepsy. Masturbation is admitted by most medical men to be a frequent cause of epilepsy; and I am surprised to find that M. Lallemand has related no cases in which epilepsy occurred. Two of the three cases to which I have alluded were simple uncom- plicated cases of epilepsy brought on by masturbation. In these, after the masturbation had been arrested the effect ceased. The third case, however, was by no means so successful; it occurred in a lad of weak intellect aged sixteen. The attacks of epilepsy frequently took place as often as twice in the day. He admitted that he was in the constant habit of practising masturbation, and even seemed aware of the influence the practice had in producing his fits. I have reason to believe that this lad corrected himself; but from the weakness of his intellect, much dependence could not be placed on his statements. As long as he continued to attend the dispensary at which I saw him, little improvement took place in his general health, and the epileptic paroxysms continued very frequent. I regret that I took no notes of PREFACE. xiii this case, and still more that I lost sight of the patient, as I am in- clined to believe that the epileptic paroxysms might have been kept up by involuntary seminal discharges, after having been once ex- cited by masturbation. This is a point which I earnestly recommend to the attention of the profession. Another very frequent symptom in cases of spermatorrhoea, is the occurrence of urethral discharge from very slight excitement. Several cases of this kind have come under my notice, the patients having consulted me on account of the discharge. These cases often give rise to distressing suspicions, and much family unhappiness, espe- cially as they often occur in married men. The symptoms are often almost as severe as those of virulent clap, and the discharge is at- tended with great irritation in the neighbourhood of the prostate, and frequent desire of micturition. The discharge came on in one case of a married man who consulted me, after taking a single tumbler of whisky and water at night—this gentleman not having been in the habit of taking spirits for several years, on account of continued ill health. The discharge in these cases is thicker than that of or- dinary clap, and sticks in patches on the linen. These patches may be scaled off, after which there is little mark left, and the discharge seldom penetrates through calico, so that on the opposite side of the shirt there is little or no appearance of stain. On wetting the liner, the discharge feels slippery, and it is washed off with difficulty. I am inclined to believe that these discharges are not contagious; but notwithstanding this, sexual intercourse should be avoided on account of the injury that may result to the patient himself. In most cases, indeed, connexion is impossible during the first stages of the dis- charge, on account of the painful chordee to which excitement gives I have generally, on questioning these patients, found that such discharges were connected more or less with deficiency of generative power. In the case I have above alluded to, impotence was almost complete; and in another similar case occurring in the person of a married surgeon, the powers had greatly declined. Both these pa- tients were in the prime of life, and both had, in their youth, led very irregular lives. . The irritation in these cases, I am inclined to believe, is situated in the posterior part of the urethra. Indeed, the surgeon whose case I have just alluded to, believed himself affected by enlarged prostate—many of the symptoms of which generally accompany the discharge I have described, especially frequent desire to pass water, and a feeling as though the bladder were never completely emptied, or as though two or three drops of urine were retained in the pos- terior part of the urethra. In the treatment of these cases, I have found the application of the solid nitrate of silver most effectual. The condition of the mucous membrane is immediately modified by it; within twelve hours the XIV PREFACE. patient experiences a degree of comfort to which, very frequently, he has long been a stranger. The condition of the membrane, too, seems permanently altered by this treatment; and the discharge has never, as far as my experience goes, returned after subsequent excitement— a circumstance which is very apt to occur when the discharge has been arrested by other means. The involuntary seminal discharges often present in these cases, and to which the diminution of virile power is generally due, are also at the same time arrested, and the patient experiences a return of vigour wholly unexpected. This peculiar form of urethral discharge has hitherto for the most part, I believe, been confounded with contagious clap; indeed, many members of our profession are in the habit of setting down all dis- charges from the urethra indiscriminately as the result of impure con- nexion, however positive the patient may be that such has not taken place. In all the cases I have hitherto met with, however, the pa- tients have admitted that they had previously been affected with con- tagious clap—frequently on more than one occasion. The discharges I have described are, I am inclined to believe, from the number of cases I have met with since my attention was first attracted by the subject, by no means uncommon, and certainly deserving the care- ful attention of the profession. The diagnosis of spermatorrhoea, in aggravated or long-standing cases, is by no means easy. When frequent diurnal pollutions have deteriorated the patient's health—discharge of watery semen taking place almost every time the patient makes water—the spermatozoa are often only distinguishable under the microscope after a long-con- tinued and patient manipulation ; and perhaps for no researches con- nected with medical science is it more important to possess one of the best microscopes. When I first commenced the study of this subject, I was more than once tempted to give it up in despair, in consequence of my not possessing a perfect microscope. At present I use one of Powell's instruments, which I prefer to those constructed by Ross, on account of the greater convenience of the motions of the stage—a matter which will be found of much importance in all researches re- quiring delicate manipulation. The eighth of an inch object glass will be found almost indispensable in the study of these cases, al- though the spermatozoa in healthy semen can be perfectly well ex- amined with an object glass of a quarter of an inch focal length. M. Lallemand has described the operation of cauterization as a very painful one, and its after effects as very severe. This by no means accords with my experience. In no case in which I have performed the operation has the pain been severe, or the subsequent inflammation violent; indeed, I have several times had difficulty in persuading the patients to remain twenty-four hours in bed after the operation—a precaution which I have thought advisable in all cases. At first I feared that sufficient inflammation had not been excited, and that the operation would require to be repeated—this has only hap- PREFACE. XV pened in my practice once, however, and in that case I am inclined to think that the caustic was not properly applied to the surface of the prostate on the first occasion'. The instrument commonly sold for the purpose of cauterizing the prostate, by instrument makers in this country is, in my opinion, ex- ceedingly defective. From its being made nearly straight, it is by no means easily introduced while the patient is lying down—and in no other position ought the operation to be attempted—the irrita- bility of the canal, too, increases the difficulty of introduction, and consequently every possible facility should be given to the operator, by having the instrument constructed of a convenient form. It is difficult, also, to measure the length of the passage exactly by apply- ing a curved catheter to a nearly straight porte-caustique. I have, therefore, had an instrument constructed of precisely the same curve as the catheters I generally use. This instrument is rather larger than those generally sold, being about the size of a number 6 cathe- ter, and its bulbous extremity is two sizes larger, or as large as a No. 8 catheter; with this instrument many of the difficulties of cauteriza- tion are avoided. It can be easily introduced like an ordinary ca- theter Avhile the patient is lying on his back; the moment when the bulb enters the neck of the bladder is clearly distinguishable by the sensation communicated; and the caustic, on account of the greater size of the curvette, is more fairly applied to the whole of the in- ferior surface of the urethra, which is to a certain extent distended by its presence. With regard to the other precautions to be used, I quite agree with M. Lallemand. In translating the following pages I have endeavoured more to render the sense of the author in as few words as possible, than to give a full and literal translation. I must beg my readers to bear in mind that M. Lallemand's treatise consists of three thick octavo volumes—these having been written at different periods, there are of course many repetitions, which I have as much as possible en- deavoured to avoid. The total number of cases related by M. Lalle- mand is one hundred and fifteen. Of these I have selected sixty- two, which, after mature consideration, appear to me to illustrate the subject sufficiently. The same reason which induced me to omit so many of M. Lallemand's cases, has prevented me from inserting cases from my own experience. As I have endeavoured to render this entirely a practical work—I have omitted M. Lallemand's in- teresting researches on the spermatozoa, except as far as they refer to the diagnosis of spermatorrhoea as well as several digressions made by M. L. to topics of no practical interest in this country; of these a disquisition on the character of J. J. Rousseau is one of the most remarkable. . . In speaking of spermatorrhoea arising from contagious urethritis, I have avoided the word gonorrhoea as being a misnomer, substi- tuting for it blennorrheaia, which is certainly more fprrect in its derivation, although also liable to some objections. XVI PREFACE. In conclusion, I must beg to express my thanks to M. Lallemand for the kind and complimentary manner in which he was pleased to grant me permission to undertake my task, as well as for the aid he has more than once afforded me in performing it. If through the medium of the following pages the profession becomes more fully acquainted with, and consequently better able to relieve, one of the most distressing disorders that affect mankind, I shall feel perfectly satisfied in the conviction that the time I have appropriated to the subject has not been entirely misspent. 29, Berners Street. » CONTENTS. Page. Author's Preface, ...... xiii Editor's Preface, . . . . . . xv CHAPTER I. Introduction, . . . . • .33 CHAPTER II. INFLAMMATION OF THE SPERMATIC ORGANS. Pathological Anatomy . . • • .06 Case I.—Blennorrhagia—Diurnal Pollutions—Hypochondriasis—Chronic affection of the Brain and its Membranes—Death. Autopsy— Right Kidney in a state of Suppuration—Prostate nearly destroyed. Ejaculatory Ducts ulcerated—Seminal Vesicles altered—Nothing remarkable in the other organs 3' Cvse II.—Blennorrhagia—Spermatorrhoea—Hypochondriasis—Frequent attacks of Cerebral Congestion—Death. Autopsy-Suppuration in the Seminal Vesicles—Ossific deposit in the Vasa Deterentia— Cystitis—Phlebitis—Old adhesions of the Arachnoid and Pleurae- Abscesses in the muscles of the Neck and Shoulders . • 4_ Case III—Blennorrhagia—Retention of Urine, &c—Apoplexy—Death. Autopsy—Effusion of Blood into the left Ventricle of the Brain- Hypertrophy of the Heart—Gastro-enteritis—Abscess and Tuber- cles in the Kidney and Prostate—Stricture, &c. • • *« Case IV — Mental Derangement—Belief in a change of Sex—Death- Autopsy—Thickening of the Arachnoid—Great alteration ot the Prostate—Atrophy and obliteration of the ejaculatory Ducts . 4y Summary of the preceding Observations.—Symptoms . 49 Lesions in the Prostate . In the Spermatic Organs • • • .53 In the Orifices of the Ejaculatory Ducts . • 54 xviii CONTENTS. In the Ejaculatory Ducts In the Seminal Vesicles In the Qualities of the Semen In the Vasa Deferentia In the Testicles In the Urinary Organs Comparison of the two Sets of Organs Resume • • ■ 54 55 55 55 57 57 58 61 CHAPTER III. CAUSES OF SPERMATORRHEA. Blennorrhagia Case Case V.—Lymphatic Temperament—Blennorrhagia—Orchitis—Nephri- tis—Nocturnal and Diurnal Pollutions—Abuse of Mercurials— Injurious effects of Cold and Tonics—Cure by means of Leeches, the use of Flannel and Milk Diet—Fresh attack of Blennorrhagia —Same Treatment with the same Result .... VI.—Masturbation—Blennorrhagia—Diurnal Pollutions—Failure of the ordinary modes-of Treatment—Cauterization of the Prostatic Portion of the Urethra—Rapid Recovery .... Case VII.—Abuse of Spirituous Liquors—Blennorrhagia—Nocturnal Pol- lutions—Impotency—Frequentdischarge of Urine—Cauterization— Cure ........ Case VIII.—Masturbation—Blennorrhagia, repeated anti-venereal Treat- ment—Diurnal Pollutions—Increasing Weakness, especially of the Mental Faculties—Extreme Emaciation—Cauterization, and Cure after Sixteen Years—Venereal Excess., Relapse—Cauterization again performed with success ...... Case IX.—Blennorrhagia, followed by Excoriations of the Glans Penis— Spermatorrhoea—Cauterization unsuccessful—Artificial Sulphur Baths—Cure ...... Consideration of the Causes Mode of Action ..... Treatment of Spermatorrhoea following Blennorrhagia Symptoms of Spermatorrhoea arising from Blennorrhagia CHAPTER IV. CAUSES OF SPERMATORRHOEA CONTINUED. Cutaneous Affections ..... Case X.—Itch during Ten Months, at about the age of Fourteen—Pain in the Epigastrium—Tumour of the Testicle—Chronic Inflammation of the Bladder—Diurnal Spermatic Discharges—Hypochondriasis. Cure by Cauterization at the age of Twenty-eight . 62 62 66 69 n 74 75 77 79 80 81 CONTENTS. xix Case XI.—Cutaneous affections—Repeated Attacks of Urethritis—Appli- cation of the Nitrate of Silver—Cure . . . .83 Case XII.—Pruriginous Eruption around the Genital Organs—Two at- tacks of Blennorrhagia—Nocturnal and Diurnal Pollutions—Cure by means of Sulphuretted Baths . . . . .85 Case XIII.—Herpes Prajputialis, alternating in a remarkable manner with Irritation in the Prostatic Portion of the Urethra—Nocturnal and afterwards Diurnal Pollutions—Occasional Impotence—Re- establishment by Cauterization—Relapse—Cure by the Baths of Vernet ........ 86 Case XIV.—Lymphatic Temperament—Various Cutaneous Eruptions al- ternating with other Affections—Habitual bad Health—Hypochon- driasis—Spermatorrhoea undiscovered during Twenty-five Years— Cure by Sulphuretted Baths . . . • .88 Consideration of Causes - - - - - 90 Mode of Action - - - - - - 91 Irritation of the Rectum - - - - - 92 Treatment of these Cases - - - - - 92 CHAPTER V. CAUSES OF SPERMATORRHOEA CONTINUED. Influence of the Rectum - - - - - 93 Case XV.—Spermatorrhoea from a Mechanical Obstacle to Defecation- Division of the Stricture—Rapid and Complete Cure . . 93 Case XVI.—Spermatorrhoea induced by Chronic Diarrhoea, and kept up by a Mechanical Obstacle to defecation—Removal of a Scirrhous Tumour from the anus—Rapid and Perfect Cure . . .94 Case XVII.—Hemorrhoids from the age of Puberty—Difficulty in evacua- ting the Rectum at the age of Twenty-eight—Spermatorrhoea— Cure . • • • • • • Case XVIIL—Blennorrhagia, Constipation—Fissure of the Anus—Dis- charge of Semen at Stool—Profound Hypochondriasis—Desire of committing Suicide—Diarrhoea—Cure of the Fissure of the Anus —Disappearance of the other Symptoms . Case XIX.—Horse Exercise—Constipation—Spermatorrhoea—Impotence —Frequent and violent Attacks of Cerebral Congestion—Ascend- ing Douches—Cauterization—Sulphur Baths—Hot and Cold Dou- ches on the Loins and Perineum—Cure Case XX.—Lengthened exposure to severe Cold—Incomplete Paralysis of the Rectum—Seminal Discharges during Defecation—Cure by the application of Galvanism . • • • Case XXI—Intemperance—Lengthened exposure to Cold—Chronic In- flammation of the Bladder—Involuntary Seminal Discharges, &c, -Cauterization-Cure-Relapse-Same Treatment with the same Result—Remarkable influence of the Bladder on the Rectum . i0» 97 95 100 105 Case XXII.-Unsuspected Spermatorrhoea-Attacks of Cerebral Conges- tion-Disorder of the General Health—Ascandes expelled from the Rectum, with immediate Recovery . Ill XX CONTENTS. Case XXIII.—Masturbation at Nine Years of Age—Constant Nocturnal Emissions—Ascarides—Cure in Eight Days . ■ .113 Case XXIV.—Hypochondriasis—Impotence—Attacks of Cerebral Con- gestion—Ascarides—Cure within Eight Days . . - 114 Case XXV.—Nocturnal Pollutions resisting all modes of Treatment during Six Years—Great Physical and Moral Depression—Expulsion of Ascarides with complete Relief . ... 114 Case XXVI.—The habit of Masturbation contracted spontaneously at the Age of Fifteen, and continued until the age of Twenty—Nocturnal and Diurnal Pollutions—Increasing Disorder of the Health until the age of Twenty-nine—'Frequent and prolonged Erections—Pain at the Margin of the Anus, &c,—Cauterization performed without Benefit—The expulsion of Ascarides followed by rapid Recovery . 117 Case XXVII.—Masturbation at the age of Fifteen—Serious disorder— The application of a Blister followed by Involuntary Nocturnal Emissions—Cauterization, Douches, &c, unsuccessful—Expulsion jsf Ascarides followed by a rapid recovery .... 119 Remarkable case of Urethral Discharge kept up by Ascarides, —Editor's note to page - 121 Case XXVIII.—Masturbation at the age of Ten—Seminal Emissions produced by Horse Exercise—Nocturnal, and afterwards Diurnal Pollutions—Constant Erections—Stools Relaxed, and containing abundance of Mucus—Burning at the Anus—Cauterization, with slight benefit—Expulsion of Ascarides followed by rapid and com- plete Recovery . . . . . .123 Resume" ------- 125 CHAPTER VI. CAUSES OF SPERMATORRHEA CONTINUED. Abuse ------- 12G Case XXIX.—Masturbation — Nocturnal Pollutions—Palpitation and Dyspnoea simulating Cardiac Disease—Repeated Venesection fol- lowed by increased Disorder—Sulphuretted Baths and rapid Re- covery ........ 126 Case XXX.—Masturbation at the age of Eight Years—At Twelve, very frequent Emissions of Urine—At Sixteen, Coitus Impossible—Noc- turnal and afterwards Diurnal Pollutions—Cauterization at the age of Twenty-eight, followed by rapid Recovery . . . 127 Case XXXI.—Masturbation at the age of Seventeen, carried so far as to cause emission of Blood, but soon afterwards abandoned—In- creasing Debility during Four Years—Symptoms of Phthisis Laryngea and Chronic Gastritis—Extreme Prostration—Cauteriza- tion followed by rapid re-establishment .... 130 Case XXXII.—Masturbation from Twelve to Twenty-one Years of ao-e —Melancholy—Inclination to Suicide—Serious alteration of the Health—Monomania—Unperceived Diurnal Pollutions—Cauteriza- tion followed by perfect Recovery. . . . .131 CONTENTS. XXI Case XXXIII.—Abuse caused by sleeping on the Belly—Effects of reading Erotic Works—Power of Habit—Alteration of the intel lectual and moral Faculties—Impotence—Chronic Irritation of the Bladder—Nocturnal and Diurnal Pollutions—Cauterization followed by prompt Recovery Case XXXIV.—Sexual ideas at the age of Eight—Abuse at thirteen— Various diseases in consequence, until the age of Thirty-two—Noc turnal and Diurnal Pollutions—Cauterization—Slow, but progres sive Improvement Case XXXV.—Masturbation at Sixteen Years of Age—At Twenty-one compression of the Urethra during Ejaculation, followed by a sen satiou of tearing, and acute pain—Urethral Discharge recurring frequently—Discharges of Semen during Defecation and the emis sion of Urine—Reciprocal Influence of the Discharges on the Di gestive Organs—Chronic Catarrh of the Bladder—Cauterization- Recovery after several Relapses Causes of Abuse Internal or Pre-disposing Causes External or Exciting Causes Varieties of Abuse . Effects of Abuse . Effects on Children and on Females Effects of Temperament, Idiosyncrasy, &c. Urethral Discharges following Abuse Prostatitis .... Cystitis .... Emissions of Blood . Orchitis .... 13: 137 1.39 142 143 143 148 153 155 158 158 159 159 159 159 CHAPTER VII. CAUSES OF SPERMATORRHEA CONTINUED. Venereal Excesses . . . • , • Case XXXVI.—Nervous Temperament—Excessive Intercourse at the age of Twenty-one, continued during Eighteen Months—Increasing Derangement of Health—Symptoms of Gastritis, and of disease of the Heart—Repeated Abstraction of Blood—Nocturnal and after- wards, Diurnal Pollutions; Milk Diet, &c—Acupuncture followed by perfect Recovery . Case XXXVII.—Robust Constitution—Venereal Excesses continued till the a<*e of Twenty-four—Chronic Inflammation of the Bladder- Nocturnal and Diurnal Pollutions—Cauterization followed by per- fect Recovery . Case XXXVIII.—Three attacks of Blennorrhagia—Hypochondriasis— Danger of Suicide—Recovery—Marriage a few months after- Change in the moral Faculties—Disordered Digestion—Consti- 2* 161 161 165 xxn CONTENTS. pation—Agitation—Insomnia—Fits of Passion—Symptoms of Men- tal Derangement—Impotence—Nocturnal and Diurnal Pollutions —Cauterization followed by rapid Recovery—Excesses Repeated— Relapse ........ Case XXXIX.—Strong Constitution—Masturbation at the age of Seven- teen—Serious disorder of the Health until Twenty-six—Marriage —Rapid Improvement—Gradual Relapse after Three Years, not- withstanding the cessation of Coitus—Seminal Discharge during Defecation and the emission of Urine—Hypochondriasis—Inflam- mation of the Genito-urinary Organs—Cauterization—Rapid and complete Cure ...... Case XL.—Sanguineous Temperament—Masturbation from Fourteen to Eighteen Years of age—Marriage at Nineteen—Immediate improve- ment in the Health—Afterwards disorder of the System—Hypo- chondriasis—Inclination to Suicide—Symptoms of Chronic Gastritis treated for Six Years with Leeches, Blisters, &c.—Nocturnal and Diurnal Pollutions—Frequent Discharge of Urine—Cauterization followed by a rapid and complete Cure .... Case XLI.—Nervous Temperament—Delicate Health—Masturbation be- fore Puberty—Urethral discharge after Sexual Intercourse—Or- chitis—Nocturnal Pollutions—Absolute Impotence—Injection with Solution of Nitrate of Silver unsuccessful—Cauterization followed by rapid Cure ....... Case XLII.—Masturbation—Venereal Excesses—Prolonged Horse Ex- ercise—Blennorrhagia—Nocturnal and Diurnal Pollutions—Two Cauterizations—Recovery—Premature Excesses—Relapse — Cure by another Cauterization ...... Case XLIII.—Lymphatic Temperament—Early and Long continued Mas- turbation— Horse Exercise—Infrequent Coitus — Urethritis—Re- peated attacks of Inflammation in the Testicles—Frequent discharge of Urine—Pollutions during Defecation—Imperfect Ejaculation— Two Cauterizations followed by perfect Recovery . Case XLIV.—Lymphatico-Sanguineous Temperament—Coitus when nearly intoxicated, at the age of Twenty-two—Blennorrhagia—Pollutions during Defecation—Disturbance during Ejaculation—Band in the membranous portion of the Urethra—Cauterization—Cure by means of Autiphlogistics and Rest ..... Case XLV.—Coitus in a state approaching Inebriety—Gleet increased by a Journey—Diurnal Pollutions—Cauterization with rapid Improve- ment—Relapse from premature fatigue of the Organs—Cure by means of Autiphlogistics and Rest . Resume* .... Characteristics of Venereal Excesses Age Temperament Genital Instinct Differences of Genital Development Influence of Encephalic Organs Accidental Influences . ■ General Effects of Venereal Excesses Special Effects of Venereal Excesses 166 170 172 173 17. 177 180 182 183 184 187 188 188 188 188 191 192 192 CONTENTS. xxiii CHAPTER VIII. CAUSES OF SPERMATORRHEA CONTINUED. Action of certain Medicines . . B . . 196 Astringents ...... 196 Case XLVI.—Intermittent Fever—Large Dose of Bark—Obstinate Con- stipation—-Diurnal Pollutions—Symptoms of Chronic Gastritis, and of Disease of the Heart—The use of Douches followed by rapid Im- provement . . ... 196 Purgatives ....... 197 Narcotics ....... 198 Case XLVII.—Frequently repeated Narcotism at the age of Sixteen from the Vapour of Tobacco—Dilatation of the Pupils—Vomiting —Constant Headache—Constipation—Nocturnal and Diurnal Pol- lutions—Impotence—Cauterization at the age of Nineteen—Rapid Recovery . . . . . . . .198 Case XLVIII. — Nervous Temperament — Repeated Narcotism from Smoking between the ages of Twenty and Twenty-two — Impo- tence, &c. . . .... 200 Cantharides ...... 201 Camphor ....... 202 Nitrate of Potass ....... 202 Ergot of Rye . . . . . . 203 Coffee . . . . . . .203 Case XLIX.—Excessive use of Coffee—Frequent and profuse Discharge of Urine—Nocturnal and afterwards Diurnal Pollutions—Impo- tence, &c,—Cauterization—Sulphuretted Baths—Recovery • 204 Tea,.......205 CHAPTER IX. CAUSES OF SPERMATORRHOEA CONTINUED.. Action of the Cerebro-spinal System, Case L—Masturbation—Extreme weakness of the Limbs and Senses- Erections excited by Percussion of the Occiput—Catheters left in the Urethra—Rapid Recovery . Case LI.—Sickly Childhood—Nervous Temperament—Masturbation Rare —Coitus still more so—Symptoms of Aneurism and Gastritis— Nocturnal Pollutions—Predominance of Erotic Ideas—Tension at the Nucha—The application of cold Lotions to this Region followed by considerable Improvement . Action of the Spinal Cord, . 206 207 208 211 XXIV CONTENTS. CHAPTER X. CAUSES OF SPERMATORRHOEA CONTINUED. Congenital Predisposition ..... 212 Sebaceous Matter ...... 213 Case LII.—Natural Phimosis—Frequent Nocturnal Pollutions from the age of Puberty—Abundant and Fetid sebaceous Secretion between the Glans and Prepuce—Circumcision at the age of Twenty-three followed by immediate Relief . . . .213 Natural Phimosis ...... 214 Case LIII.—Natural Phimosis—Erections at the age of Eight—Attempts at Coitus at Nine—Vesical Catarrh—Diurnal Pollutions—Paraple- gia, &c. ........ 214 Case LIV.—Very long Prepuce — Badly developed Genital Organs— Childhood Delicate—Incontinence of Urine—Sebaceous Discharge from the Orifice of the Prepuce at the age of Ten—Nocturnal Pollu- tions increasing in frequency—Hypochondriasis—Loss of Memory and failure of Intellect—Constipation—Diurnal Pollutions—Con- stant application of Lotions attended by Relief—Circumcision at the age of Twenty-eight, followed by Cure .... 217 Case LV.—Very long Prepuce—Badly developed erectile Tissues—Abun- dant Secretion of Sebaceous Matter—Seminal emissions induced by Horse Exercise, and afterward, by incomplete Intercourse—Mar- riage unconsummated during Five Years—Diurnal Pollutions— Circumcision followed by rapid Cure . . . .219 Exuberant Prepuce ...... 220 Abundant and vititiated secretion of Sebaceous Matter . 221 Congenital Debility...... 224 Case LVI.—Relaxed Genital Organs—Spermatic Cords Varicose—Few but debilitating Nocturnal Pollutions—Opposite effects of Coitus —Unsuspected Diurnal Pollutions — Constant Headache — Dis- ordered Senses—Intellectual Debility—Hallucination—Tonic treat- ment at the age of Twenty-one, followed by Recovery . . 224 Varicocele ..... 227 Case LVII.—Hypospadias—Impotence—Frequent Seminal Discharge . 228 Case LVIII.—Atrophy of one Testicle at the age of Eight—Nocturnal and afterwards Diurnal Pollutions—Frequent desires of Micturition, &c. . . ...... .230 Case LIX.—Lymphatic Temperament—Incontinence of Urine—Neither Masturbation nor Sexual Intercourse—More and more frequent Noc- turnal Pollutions—Relaxation of the Sphincters of the Anus and Neck of the Bladder—Treatment unsuccessful . . . 231 Case LX.—Sickly Childhood—Extraordinary Nocturnal Pollutions at Six- teen—Sometimes after, Pollutions during Defecation—Ejaculation impossible—Slow discharges of Semen after the subsidence of Erec- tion—Urethra very slightly Sensitive—Prostatic Surface Hard and Cartilaginous ....... 232 CONTENTS. XXV Symptoms of Debility of the Genital Organs Symptoms affecting the Urinary Organs during Childhood . Incontinence of Urine ..... Retention of Urine ...... Hereditary Transmission . Case LXI.—Blennorrhagia at the age of Twenty-one—Pains in the Testi- cles—Pollutions during Four Years—Serious Gastric and Cerebral Symptoms occurring in Paroxysms—Hereditary Predisposition— Iced Milk—Cauterization—Acupuncture—Sulphuretted Baths—Re- covery ...... Case LXII.—Nocturnal and Diurnal Pollutions occurring in Three Bro thers ...... Congenital increased Nervous Susceptibility Long-continued Continence . General Review of the causes of Spermatorrhoea 233 237 237 239 240 240 244 245 246 249 CHAPTER XL SYMPTOMS OF SPERMATORRHEA. Local Symptoms Nocturnal Pollutions Diurnal Pollutions . During Defecation During the'Emission of Urine Appearance of Spermatic Urine Other Diurnal Pollutions Impotence . Diagnosis of Spermatic Urine Chemical Analysis . Microscopic Examination Spermatozoa Appearances on Making Water in a Bath Simplest mode of Detecting the presence of Spermatozoa in the Urine • 251 251 254 255 256 256 258 259 259 260 260 262 264 266 xxvi CONTENTS. CHAPTER XII. SYMPTOMS OF SPERMATORRHEA CONTINUED. General Symptoms . Infecundity .... Changes in the Characters of the Semen Fever .... Symptoms affecting the Digestive Organs Symptoms affecting Nutrition Animal Heat Symptoms affecting Respiration Symptoms affecting the Circulation . Symptoms affecting Innervation Mobility Sensation Symptoms affecting the Special Senses Taste .... Smell .... Hearing .... Sight .... Symptoms affecting the Encephalon Sleep and Waking . Cephalalgia .... Cranial Congestion . Alteration of Character Hypochondriasis Memory .... Intellect .... Insanity .... General and incomplete Paralysis of the Insane General character of the Symptoms of Spermatorrhea Effects of Masturbation on Children and Females Progress of the Symptoms . Spontaneous Recovery CONTENTS. xxvii CHAPTER XIII. TREATMENT OF SPERMATORRHEA. Pollutions arising from Direct Causes . . . 298 Pollutions arising from Ascarides .... 298 Pollutions excited by Cutaneous Eruptions . . . 301 Pollutions arising from altered or increased Secretion of the Sebaceous Glands ..... 302 Pollutions depending on Stricture of the Urethra . . 303 Treatment of the various kinds of Stricture . . 303 Pollutions arising from Hemorrhoids . . . 305 Pollutions caused by Cicatrices in the neighbourhood of the Anus . . . . . . .306 Pollutions caused by Fissure of the Anus . . . 306 Pollutions produced by Constipation . . . 307 CHAPTER XIV. TREATMENT OF SPERMATORRHEA CONTINUED. Pollutions caused by Relaxation and Debility . . 309 Pollutions arising from increased Nervous Susceptibility . 313 Acupuncture ...... 315 Pollutions kept up by Habit .... 316 Pollutions caused by Sleeping on the Back . . . 316 CHAPTER XV. TREATMENT OF SPERMATORRHEA CONTINUED. Pollutions caused by Irritation or Chronic Inflammation Diet ...... Cauterization ..... . 317 . 318 . 319 xxviii CONTENTS. Action of the Nitrate of Silver . . . .323 Cauterization in Chronic Vesical Catarrh . . . 324 Deviation of the Orifices of the Ejaculatory Canals . . 325 CHAPTER XVI. TREATMENT OF SPERMATORRHEA CONTINUED. Convalescence ...... 326 A PRACTICAL TREATISE CAUSES, SYMPTOMS, AND TREATMENT SPERMATORRHEA. CHAPTER I. INTRODUCTION. Involuntary discharge of the seminal fluid presents itself under various conditions, which differ much in their respective degrees of importance. When it occurs spontaneously during sleep in a healthy and con- tinent individual, it doubtless exerts a beneficial influence on the eco- nomy by freeing it from a source of excitement, the prolonged accu- mulation of which might derange the animal functions. In these cases it has an effect analogous to that produced by the epistaxis, common and beneficial during youth. But the discharge may become excessive, or, from the condition of the parts, it may outlive the state that excited it; then, like repeated nasal hemorrhage, it gives rise to inconveniences proportioned to its frequency, its quantity, and the constitution of the individual. Involuntary seminal emissions may be caused by too great excitement of the genital apparatus, following venereal excesses or masturbation. A state of irritation remains in the spermatic organs after such excitement, which induces an in- creased secretion and hurried discharge of the secreted fluid with- out complete erection, and almost without sensation. Lastly, the relaxation of the ejaculatory canals accompanying this state ot irri- tation, may allow the expulsion of the semen without either erection or enjoyment, and this takes place especially during defecation and the expulsion of the urine. The transition between these different stages of seminal evacuation is sometimes so insensible, that it is impossible for the patient, or even for the medical attendant, to specify its exact period. # Every extreme evacuation of the spermatic secretion, in whatever 8 34 INTRODUCTION. manner caused, is capable of producing the same effects on the sys- tem. The different species of spermatorrhoea need not therefore be separated either in theory or in practice. Ordinary nocturnal emissions are easy of diagnosis and of cure; I shall therefore pass them over, and only treat of those evacuations which are sufficiently serious to injure the health, or which are con- nected with discharges not ordinarily perceived. I shall use the expressions diurnal and nocturnal pollutions, be- cause involuntary discharge of the spermatic secretion certainly oc- curs during the night without erection and without pleasurable sen- sations, as well as in consequence of lascivious dreams after sunrise. Neology is only to be excused when used for the prevention of errors; and I think no one will be deceived respecting the meaning of these expressions, which, indeed, are at present generally understood. In order, however, to avoid the repetition of many words, I shall express, by the term spermatorrhea, every excessive spermatic evacuation from whatever cause it may arise. Diurnal pollutions are not always, as is generally believed, the result of venereal excesses, or vicious habits. Many other varied causes, whose influence may be single, successive, or simultaneous, also give rise to them. Some of these causes are already understood, but of many others, the medical world is completely ignorant; and these are the most dangerous, because their influence is the most difficult of appreciation. In all sciences, the study of causes is the most important and the most difficult. This is true of medicine, and especially of the affec- tion forming the subject of this work; for it is principally from the cause of the spermatorrhoea, that we learn its therapeutic indications. It is true that we must also, in each case, take into account the parti- cular condition of the genital organs, and the constitution of the indi- vidual: but these considerations are of little importance with respect to the treatment to be employed, and it is especially in a practical point of view, that I wish to consider this disease. In consequence of not having properly distinguished its causes, explanations, as often false as true, have been published respecting spermatorrhoea, and modes of treatment have been recommended, whose general appli- cation has been sometimes useful, but more often injurious. It is, however, of great importance to study attentively the symp- toms of involuntary spermatic discharges; they are little known, very varied, and capable of simulating a host of other affections; but'their character is independent of the first cause of the disease, and they furnish few indications for the regulation of its treatment. On the other hand, the history of this affection is so much in its infancy, that I feel the necessity of proceeding as if I were treating an entirely new subject. I shall, therefore, relate many single cases before I attempt to arrive at general conclusions. As these cases are very numerous, I must classify them according to some arrangement and I shall place the causes first in this classification, since they are' INTRODUCTION. 35 the most important part of it. Proceeding from the evident to the doubtful, and from the simple to the compound, I shall examine first the causes whose action is most direct and undoubted; and whilst studying the influence of each cause, I shall bring forward the cases in which its action has been energetic, isolated, and, when possible, proved by post-mortem inspection, and I shall afterwards cite cases in which several causes have acted successively or simultaneously. After having examined many cases in this manner, I shall make a general resume, in the course of which, I shall comment on what- ever relates to the symptoms of the treatment. I shall also pay attention to the analogous phenomena which may be observed in the female. I propose then to consider this affection of the genital organs in all its varied phases; I shall pass rapidly over what is already known; I shall, on the contrary, insist on the most remarkable errors, and comment fully on all that may seem doubtful or obscure. If I were to relate all the cases that have come under my notice, tiresome repetitions would result; I shall, therefore, choose only those which best show the characteristic features of the most important distinctions.1 11 have thought it advisable, on account of the great number and length of these cases, to select a few of the most striking only. In answer to a communication from me on this subject, M. Lallemand has favoured me with the following observation. "As regards the cases, their number may be reduced, now that facts are being daily multiplied in confirmation of those I have related; it will be sufficient for you to give the most characteristic." [H. I. M'D.] ( 36 ) CHAPTER II. INFLAMMATION OF THE SPERMATIC ORGANS. Pathological Anatomy. Inflammation of the organs for the secretion and excretion of semen, is the most frequent and most active cause of spermatorrhoea. The influence of this cause may be very easily conceived, and its traces may be detected in the organs after death; I shall therefore commence the subject by its consideration. Works on pathological anatomy have hitherto afforded us very little information respecting this important and delicate matter; the omission arises from several circumstances. Inflammation of the spermatic organs does not threaten life at its commencement; when the patient dies at an early period of the af- fection, it is in consequence of some other more serious disease, which engrosses the care of the attendants, so that after death, ex- amination of the spermatic organs is neglected. When the continued influence of this inflammation produces diurnal pollutions sufficiently serious to destroy life, the periods of their oc- currence are very distant; the symptoms are insidious, and their true cause, in many cases, is not even suspected. Whatever the care taken, then, in examining the body, it generally happens that every part is inspected except the genital organs; incomplete cases are thus published, which are received with the more confidence be- cause the dissection of the viscera, generally, has been made with care. The situation of the prostate and seminal vesicles is another rea- son why their examination is neglected. In order to inspect these parts with the minute care requisite, it is necessary to divide the crural arch near its centre, to remove the abductor muscles of the thighs, to cut through the horizontal rami of the pubes, and the rami of the ischia, so as to remove the testicles, the vasa deferentia the rectum, and the perineum undisturbed. It is by this means only that we can obtain a good view of the or- gans situated in the lower part of the pelvis, examine their relations with care, or observe their colour, consistence and dimensions__cir- cumstances requiring attentive study—since serious symptoms may follow almost imperceptible lesions. Thus, for instance, the orifices INFLAMMATION OF THE SPERMATIC ORGANS. 37 of the ejaculatory ducts may have been rendered uneven by some slight ulceration; their form may have been altered, or their size in- creased, of which I have met with several cases; and we can easily conceive the consequences which may result from even the partial destruction of their little sphincter muscles. The colour, firmness, and exact size of these canals also furnish information of much im- portance. The examination of all these parts requires considerable time, pa- tience, and skill; it is necessary to inspect them thoroughly, in order to appreciate all changes affecting them, and this is impossible if the removal of that portion of the pelvis to which they are attached, be omitted. Thus the section I have described, becomes in a measure indispensable; nevertheless, in general practice it is never had recourse to, except for the purpose of examining some rare affection of the bladder or prostate. In order to understand thoroughly,' the condi- tions of these parts when diseased, it is necessary, also, to have seen them very frequently while healthy: this is neglected even by men who devote themselves specially to the study of pathological anatomy. On this account I shall illustrate their pathological changes by some cases which would under other circumstances be devoid of interest. CASE I. Blennorrhagia—Diurnal Pollutions—Hypochondriasis— Chronic affection of the Brain and its Membranes—Death. Autopsy—Right Kidney in a state of suppuration—Prostate nearly de- stroyed—Ejaculatory ducts ulcerated—Seminal vesicles altered. No- thing remarkable in the other organs. In the month of January, 1824, I was requested to see M. De S- affected with symptoms of cerebral congestion, from which he had suffered for some time. During several consultations I gathered the following facts. M De S____was born in Switzerland, of healthy parents, and his father died suddenly of affection of the brain. M. De S----possessing a strong constitution and au active mind, received an excellent education, and at an early age turned his attention to the study of philosophy and metaphysics; he afterwards studied moral philosophy and politics. _ After having spent some years in Paris pursuing his favourite subjects, he was obliged to undertake the management of a manufactory, and to at- tend to details which wounded his pride. He became, by degrees, peevish and capricious—passed, without apparent cause, from an extravagant gaiety to a profound melancholy—was irritated by the slightest contradiction- showed no pleasure at fortunate events—and gave way to anger on improper occasions; at length he appeared to feel disgust and fatigue at correspon- dence or mental exertion. . At this period he married, and Dr. Butini, of Geneva, his medical at- tendant and friend, wrote respecting him as follows :— _ « With this marriage the most happy period of his existence seemed tn 38 INFLAMMATION OF THE commence; but soon the germs of the disease, whicli so many causes had contributed to produce, became rapidly developed. It was perceived that M. De S----wrote slowly and with difficulty, and his style presented signs of the decay of his faculties; he stammered and expressed his ideas very im- perfectly; he experienced, also, at times, attacks of vertigo, so severe as to make him fall, without, however, losing sensibility, or being attacked by convulsions." One day an attack which frightened the patient seriously, and left a deep impression on his family, came on whilst writing an ordinary letter. His medical attendants attributed his attack, whicli left a weakness of the right side of the body, to apoplexy. Twenty leeches were applied to the anus, and the danger seemed at an end. Similar attacks, however, occurred at Geneva and Montpellier, and seve- ral distinguished practitioners were consulted ; some of these, struck by the misanthropic irritability of the patient, and his solitary habits, regarded the affection as purely hypochondriacal or nervous; others, taking into consider- ation his digestive disorder, considered it an affection of the liver; but the greater number were of opinion that there existed a chronic affection of the brain, such as encephalitis, or chronic meningitis, arising from hereditary predisposition. This last opinion was held by Dr. Bailly, (of Blois.) At all these consultations, the necessity of abstaining from serious occu- pation, the utility of travelling—of various amusements, and of a strict re- gimen—and the importance of free evacuations from the bowels by means of purgatives and injections—were agreed on. Many of the practitioners recommended the frequent application of leeches to the anus, with milk diet, &c.; others thought that assafoetida, baths, and camphor, were indi- cated. None of these modes of treatment produced any considerable amendment; the leeches weakened the patient, and the milk diet disordered his stomach. His constipation continued. Cold plunge baths, and cold affusions to the head, relieved the insupportable spasms M. De S----experienced in his legs and face; the waters of Aix, in Savoy, and the use of douches also appeared to produce some improvement. Still M. De S---- became more irritable, and at the same time more apathetic. His attacks were more frequent and more violent, and he mani- fested greater indifference towards the persons and things he had before been partial to. The weakness of his limbs increased to such an extent that he frequently fell, even on the most level ground. His nights were restless, his sleep very light and often interrupted by nervous tremors, or acute pains accompanied with cramp. The cerebral congestion increased, and the imminent fear of apoplexy rendered leeches to the anus, venesection in the foot, tartar-emetic ointment, blisters, mustard pediluvia, and the "application of ice to the head necessary. Notwithstanding the employment of these energetic measures, another violeut attack of congestion occurred. I was summoned on this occasion and I found the patient restless, agitated, and incapable of remaining two minutes in the same place; his face was red, his eyes projecting, injected and fixed; his physiognomy expressed extreme dread: his walk was uncer- tain, his legs bending under the weight of his body ; his skin cold, and his pulse small and slow. The last circumstance attracted my attention, and I also recommended the application of leeches to the anus. M. De S----immediately threw SPERMATIC ORGANS. 39 himself into a violent passion, and asserted that leeches had always •weak- ened him without giving him any relief I was too much afraid of the oc- currence of apoplexy to pay attention to this assertion, and 1 succeeded in obtaining the application of six leeches. The next day I found the patient very pale, and so weak that he was un- able to walk—a source of much annoyance to him, as he manifested a con- stant desire for motion. An oedeniatous swelling of the parotid gland and of the right check followed, which was succeeded, a few days after, by a similar state of the left leg and foot. Sleep had become indispensable, and the patient was much reduced from the want of it; he told me, with tears in his eyes, that he had lost his appe- tite, and could no longer relieve his bowels. I also learned that he was habitually costive and flatulent; that he often had recourse to injections and purgatives in order to relieve his obstinate constipation ; and, lastly, that his walks, and the evacuation of his bowels had lately become the sole objects of his thoughts and conversation. Having observed analogous symptoms in almost every person affected by diurnal pollutions, I made further inquiries respecting the attack, in which it was supposed that the right side had been paralyzed, and I was soon con- vinced that the intellectual powers had been wanting, and not the power in the hand which held the pen; both sides of the body had, in fact, retained an equal degree of strength. Struck by a remark of Dr.Butini's respecting the progress of the disease soon after marriage, I made inquiries of Mine. De S----, and learned that the character of her husband had become so uncertain, irritable, and tor- menting, that his friends thought he must be unhappy in his marriage. I then suspected that the origin of the patient's disease had been mistaken, and I requested that his urine might be kept for my inspection. The ap- pearance of the urine was sufficient to convince me that my suspicious were well founded ; it was opaque, thick, of a fetid and nauseous odour, resembling that of water in which anatomical specimens have been macerated. By pouring it off slowly, I obtained a flocculent cloud, like a very thick decoc- tion ofbarley ; a glairy, ropy, greenish matter, remained, strongly adherent to the bottom of the vessel, and thick globules of a yellowish white colour, non-adherent, like drops of pus, were mixed with this deposit. I was there- fore convinced that spermatorrhoea existed, together with chronic inflamma- tion of the prostate and suppuration of the kidneys. Notwithstanding the state of M. De S----'s intellect, I was able at a fa- vourable moment to obtain further information. At the age of sixteen he had contracted blennorrhasia; this he carefully concealed, and succeeded m curino- by the use of refrigerant drinks. The following year the blennor- rhagia returned, and was removed by astringents. Two years afterwards from drinkino- freely of beer when heated, the discharge again appeared, and after some time it again returned, from the effects of horse exercise Since tint time M De S-----had felt little sexual desire, and had abstained from intercourse without regret. Ejaculation during coitus had always been very rapid Fully convinced by combining all these circumstances, 1 ex- plained to M. De S-----the nature of his disease, and he promised me to ubserve carefully. . The next day he called me aside, and told me that the last drops of urine were vNcid, and that during an evacuation of the bowels, he had passed a sufficient quantity of a similar matter to fill the palm of his hand. 40 INFLAMMATION OF THE Eight days after, another attack of cerebral congestion occurred, fol- lowed by stertorous breathing, cold skin, and an inappreciable Pu,ls_f ^ *^e patient fell into a kind of syncope, of which he died on the 1st of March, 1824. Post mortem inspection twenty-six hours after death, ine general emaciation of the body was extreme. Head.— Between the dura mater and the arachnoid several bubbles ot air appeared, mixed with a viscid serosity; the vessels of the pia mater, were slightly injected; the arachnoid was a little opaque near the falx, but neither thickened nor granular; two or three spoonfuls of limpid se- rum were found in the ventricles, without any apparent alteration in their serous lining: the brain was slightly injected and soft throughout, but with- out appreciable alteration in any one particular part; the cerebellum, also, was very soft, of natural size, neither more nor less injected than the brain, and without any particular alteration. Three or four spoonfuls of serum were found at the base of the brain and commencement of the vertebral canal. Chest.—Pleura pulmonalis every where adherent by a dense cellular tis- sue to the pleura costalis; lungs crepitant and pale, except at the posterior part; heart of the ordinary size, and firm. Abdomen, tympanitic, green, and exhaling a very fetid smell; liver of natural colour and very firm; a spoonful of bile in the gall bladder; spleen small and of a violet colour; stomach distended by gas; mucous membrane thin, soft, and of a brownish gray colour; small and large intestines equally distended by gas, pale, and thin in their structure, containing a small quan- tity of brown, excessively offensive liquid, fsecal matter. Left Kidney of the ordinary size, of a healthy red, and very firm. Right Kidney a third larger than natural, adherent by a dense, resistant cellular tissue to the surrounding structures; containing in its parenchyma about forty little abscesses, varying from the size of a pea to that of a nut, some of recent formation, and without cysts, others old and encysted, all con- taining thick and creamy pus : the structure of the kidney reduced in four- fifths of its extent to a dense coriaceous membrane, full of cloacas; the lining membrane of its pelvis red and villous; the ureter thin, distended, brownish, and much injected on its mucous surface. Bladder rising as high as the umbilicus, and containing two pints of trans- parent urine. Its parietes thin; the muscular fibres weak and scattered; mucous membrane rose-coloured and slightly injected, but thin and scarcely altered in appearance.1 Prostate projecting three or four lines behind the neck of the bladder, over about an inch and a half in superficial extent. In the TrigoneVesicle there was an effusion of albuminous matter, half a line in thickness, and about two inches in extent, uniting the seminal vesicles to the anterior wall of the rectum. The Left Seminal Vesicle small and brown, but in its-normal position. The Right separated from the corresponding vas deferens, folded on the posterior border of the prostate, atrophied, and surrounded by a very dense fibrous cellular tissue, which was very difficult of dissection. greater care, I removed the parts escribed. SPERMATIC ORGANS. 41 The Prostate double its normal size, and projecting into the rectum; hard on the sides of the neck of the bladder, soft in the centre. Its fibrous envelope having been divided with a bistoury, an opaque, thick, ropy, elastic matter escaped, like pus in colour, and the mucus of the nostrils in consistence. There was a cavity occupying the whole of the anterior and middle parts of the prostate, about fifteen lines in size in every direction, when the purulent matter had been removed; the gelatinous mass was observed to divide into a number of filaments which became impacted in numerous small foramina; the canal of the urethra being closed, these ■filaments came out by the openings of the mucous follicles of the prostate. When this cavity was emptied, it became evident that the two inferior thirds of the prostatic part of the urethral mucous membrane had been detached and had covered the cavity in the prostate in the same manner that the cribriform lamella of the ethmoid bone covers the nasal fossae in the dried skull. The openings of the Ejaculatory ducts, in place of being circular and nipple-shaped, formed a long slit, which was ulcerated, especially on the side towards the bladder; two probes of considerable size introduced through the vasa deferentia passed easily through these openings. The ejaculatory ducts were long and thin, as though dissected, and formed part of the superior wall of the cavity in the prostate. The posterior border of the prostate was not destroyed, but was pale, soft, and easily torn, like all the parts in the neighbourhood of the principal abscess. The Urethra presented no remarkable appearances. The Testicles were small, flaccid, and pale. I leave this case just as I wrote it when under impressions formed at the time, because its recital is well fitted to show those serious errors in diagnosis whicli are much more common than might have been suspected. Now that we have seen the more obscure parts of this case cleared up by degrees, let us consider the chronological order of the facts :— A urethral discharge badly treated in the beginning, reappeared from very slight causes, whose action, however, was easily appre- ciable. The follicles of the prostate, from repeated attacks of inflam- mation, became disorganized; the ejaculatory ducts were laid bare, and their orifices became ulcerated; the inflammation extended to the seminal vesicles, and the peritoneum adjoining. Soon after, a new train of symptoms set in, which became much aggravated after the patient's marriage, in consequence of the unac- customed exercise of the disordered organs. Ejaculation was rapid, because the ejaculatory ducts were in a state of irritation. The erections were incomplete, and at length ceased altogether, because the semen was habitually expelled as soon as secreted. This dis- charge was considerable, for the testicles shared the irritation of the other parts. Daring all this time inflammation was creeping along the urinary apparatus, and ended by destroying the right kidney. Hence the symptoms observed previous to death; hence the very remarkable appearance of the urine, an excretion to whose changes sufficient importance is not attached at the present day, from its exa- 42 INFLAMMATION OF THE mination having been once rendered ridiculous through the preten- sions of quacks. CASE II. Blennorrhagia—Spermatorrhoea—Hypochondriasis—Frequent attacks of cerebral congestion—Death. Autopsy*—Suppuration in the seminal vesicles—Ossific deposit in the vasa deferentia—Cystitis—Phlebitis—Old adhesions of the arachnoid and pleura;—Abscesses in the muscles of the neck and shoulders. On the 25th of September, 1825, Professor Brousonnet granted me the examination of one of his patients who was supposed to have died from cerebral hemorrhage. Before commencing the post mortem I learned the following particulars:— Francis Maurice, aged seventy-three years, formerly a soldier, had com- plained for some time of weakness in his legs; he staggered whilst walking as if he suffered from giddiness, and he would often have fallen if he had not been assisted. Occasionally he had attacks of congestion in his head; his face became red, he lost his senses, and experienced very varying spas- modic symptoms. After these his face became pale, and fainting occurred. These attacks had been treated by bleeding, derivatives, antispasmodics, and leeches. At length, on the 22d of December, a violent attack of congestion in the head occurred; his face became purple, and the next day he died. These symptoms seemed to indicate a chronic affection of the brain or its membranes, producing attacks of congestion, the last of which terminated in apoplexy. On inquiry I could not learn which side of the body had been paralyzed; but it seemed certain that no distortion of the face had ever existed. This circumstance made me suspect that the paralytic symp- toms had always been general. > The cause of the disease was attributed to some hidden care. The pa- tient had spoken little, and always presented a sad and silent appearance; he had complained of a host of different diseases, the greater number of which seemed imaginary, or, at least, much exaggerated. He complained of pain about the occiput, the neck, and the back; colic, distention of the lower part of his belly, and borborygmi affected him frequently. Notwith- standing his weakness, he had a constant desire for motion : he could not remain quiet in bed, and often had recourse to the night-stool. He had an irritable manner; he tormented the nurses and snubbed the pupils, and was generally looked upon by the latter as a hypochondriac. I learned also that he had experienced several attacks of retention of urine, and I recollected having introduced a catheter for him a few days before his death. I suspected, therefore, that the symptoms he had manifested arose from unperceived spermatorrhoea. The following are the results of the inspection of the body :— Head.—Cerebrum and cerebellum slightly softened throughout, but not more so in one part than in another: the cerebral substance slightly but equally, injected, especially in the posterior lobes; several old cellular adhe- sions, five or six lines in extent, in the inferior occipital fossge, intimately uniting the corresponding surfaces of the arachnoid ; the cerebellum equally SPERMATIC ORGANS. 43 adherent to the pia mater in the same situation, and incapable of bein" de- tached without injury to its structure. In the other parts of the interior of the cranium there was not the least local change that could be considered a result of recent disease. Thorax.—Lungs healthy; a few old adhesions of the pleura; on both sides; heart flaccid, of the colour of wine lees, and easily torn; the principal veins without firmness, and of a dark violet colour; the iliac and crural veins presented the same conditions. Abdomen.—The mucous membrane of the stomach slightly injected ; the ^tnall intestines in much the same state; nothing remarkable in the other abdominal organs; the kidneys and ureters healthy. Pelvis.—The bladder, which contained a large quantity of muddy urine, was united to the rectum by cellular adhesions; its mucous membrane was of a dark red, highly injected, and covered by small ecchymoses, from ex- travasation of blood in its structure; the prostate was of its natural size and firmness. The Seminal Vesicles were much dilated, their parietes were very thick and dense, and they presented no markings or inequalities. These organs were attached by strong and much injected cellular tissue to the neighbour- ing parts, and each of them contained about a spoonful of thick yellowish pus enclosed in three or four cavities communicating with each other and with the ejaculatory ducts. The inner surface of these abscesses was un- even, rugous, and lined by a sort of false membrane formed by a layer of thickened pus. The Vasa Deferentia were tortuous, and completely ossified for the extent of about three inches, but not obliterated. They contained a slightly viscid fluid. The mucous membrane of the urethra was much injected, especially from the bulb as far as the bladder; the mucous follicles much developed. The neck of the bladder was thickened, of a reddish brown colour, without te- nacity, and fissured by several recent lacerations. Some days after, the pupils, who were dissecting the muscles of this sub- ject, told me that they had found the subscapularis, and the supra- and infra- spinatus muscles on both sides, as well as several muscles of the neck, in a state of suppuration. Some time after I succeeded in learning the following facts. Maurice whilst in service, at the age of twenty-three years contracted a violent blennorrhagia accompanied by orchitis and inflammation of the spongy tissue of the urethra, which he neglected after the relief of the most urgent symptoms. His character, previously very gay, now changed by degrees ; he experienced attacks of profound melancholy, during which he imagined that every one disliked him: when these attacks were over, he gave himself up to dissipation; he drank freely, but when no longer excited, he relapsed into melancholy, and often complained of pains in his head towards the oc- ciput. . At first he experienced nocturnal pollutions, and soon after he perceived that in evacuating his bowels, especially when costive, he sometimes had a spermatic discharge. By degrees his digestion became much disordered, constipation became habitual, and the spermatic discharges at stool in- creased. He reformed and gave up drinking: his health was, however, ruined; he took cold easily, and suffered from pain in his side and frequent pains in his limbs and loins; he was constantly tormented by flatulence, 44 INFLAMMATION OF THE colic, and diarrhoea, or obstinate constipation. His legs were weak, and his body was frequently affected with tremors ; yet he could not remain in bed; he was tormented night and day by a constant desire for motion, and being very weak he frequently fell. After some time he had difficulty in supporting his head, and he complained of a constant pain in his neck and shoulders, accompanied by tenderness in the vertebral column. The evacuation of urine, previously irregular and dif- ficult, now'became often impossible without the aid of a catheter. Latterly, he became subject to frequent attacks of cerebral congestion, during which his face was purple; he was insensible, convulsed, and appeared to be threatened with an attack of apoplexy. The practitioner, called under these circumstances, never failed either to bleed from the arm, or to apply leeches, and as the attack did not last long, he attributed its relief to the ab- straction of blood. Immediately afterwards, even when bleeding had not been practised, the patient remained exceedingly pale; and at the close of one of these attacks he died. The same causes produced the same effects in this, as in the pre- ceding case; the same symptoms led to the same errors in diagnosis; it was just as difficult to discover the truth, and the same appear- ances were found after death. Cases of this nature are not then so rare as might have been expected. Supposing that in these two cases, we had proceeded to examine the bodies, with the pre-convictions arising from an observation of the symptoms; it is clear we should have found nothing in the cranial cavity, which would have accounted for the cerebral symptoms, for a general and uniform softness of the cerebral matter is observed after all chronic diseases, especially when decomposition has made any progress; it is evident also that we should have found nothing more satisfactory in the other viscera: who knows, then, to how many errors these observations might not have given rise? Among the cases cited by the believers in nervous apoplexy, and special spasmodic affections, lam convinced that a great number arise from spermatorrhoea; but, from the non-examination of the genital organs, it has been impossible hitherto to prove the correctness of this opinion. I trust that soon all practitioners will be able to avoid such errors. But let us reconsider the case of Maurice:—at the age of twenty-three he had urethritis, accompanied by chordee and or- chitis. As soon as the worst symptoms were relieved, he resumed his old habits, and gave himself up to excesses of all kinds. By degrees his health failed under the influence of nocturnal, and af- terwards of diurnal pollutions; he became hypochondriacal, and not- withstanding his forced abstemiousness, he at length died in the same state as M. De S-----. Why did this patient resist the action of the disease longer than the first? Because the alterations were much less serious, and even the state of the pus found in the prostate seemed to announce that the inflammation had taken on an acute character, only during the last stage of the disease. SPERMATIC ORGANS. 45 Can diurnal pollutions, sufficient to destroy life, exist at the age of seventy-three years? Undoubtedly they can, since the vasa de- ferentia still contain, at this age, a viscid secretion, consisting of badly formed semen; besides, the patient had told his friends, shortly before his death, that in going to stool he had passed semen in the palm of his hand. I have before said that Maurice passed for a hypochondriac, and that his diseases were considered imaginary, or at least very much exaggerated; nevertheless, we found, in various organs, recent and old changes, to which we must refer his complaints. By degrees, as his health broke up, he became more easily affect- ed; he complained of pains in his side—his lungs were attached to the walls of the chest by cellular adhesions; he often complained of pains in the head, fixed towards the occiput—the cerebellum was found adherent to the meninges at several spots, at the same time that the membranes were attached to each other: latterly, he com- plained of constant pains in the neck and shoulders—the subscapu- lars and supra- and infra-spinatus muscles of both sides, together with several muscles of the neck, were found in a state of suppura- tion: the patient wras subject to attacks of retention of urine—the neck of the bladder, together with the urethra and vesical mucous membrane, were thickened, and of a brownish red colour. I ought to add, that the principal abdominal, and even the femo- ral veins, were softened, and of a violet hue, and presented traces of phlebitis. We see, therefore, that most of the disorders of which Maurice complained depended on so many really existing local inflamma- tions. I know that many of the symptoms experienced by patients af- fected with spermatorrhoea are purely nervous, and that we find often, after death, no trace of alteration in the organs which had been sup- posed to be diseased; but I also know how the majority of post- mortem examinations are conducted. We forget that the slow and progressive weakening of the consti- tution, following disordered digestion, causes an increased nervous susceptibility in hypochondriacs; and that a less energetic resist- ance of the different organs to the action of causes capable of alter- ing their health also results from it; hypochondriacal patients are thus much more liable to every disease, at the same time that they suffer more from the diseases affecting them. A few words more on the other lesions: the vasa deferentia were ossified in several points: this ossific deposit was not the effect of age, as might be supposed, for I have met with it under similar cir- cumstances in very young subjects: it must, therefore, be attributed to old standing inflammation. In the orchitis that follows blennorrhagia, the inflammation ex- tends from the mucous membrane of the urethra to the testicles, by the ejaculatory ducts, seminal vesicles, and vasa deferentia; the 46 INFLAMMATION OF THE latter are almost cartilaginous in their normal conditions; in chronic inflammation, therefore, they may easily become incrusted with phosphate of lime. ' The neck of the bladder was fissured by several recent splits. When the internes requested me to catheterize this patient, it was be- cause they had been unable to enter the bladder. I learned that they had alwa'ys used the smallest instruments ; by, on the contrary, using the largest I could find, I reached the bladder without difficulty. CASE III. Blennorrhagia—Retention of Urine, &c.—Apoplexy—Death. Autopsy.—Effusion of Blood into the left ventricle of the brain—Hyper- trophy of the heart—Gastro-enteritis—Abscess and tubercles in the kid- neys and prostate—Stricture, &c. Gojon, at the age of forty, contracted an acute blennorrhagia, with orchitis. Treated by irritating medicines, which produced diarrhoea and violent colic, it diminished, but did not entirely disappear, a slight urethral discharge continuing for ten years, with pain in the prostatic region and fossa navicularis. He was also annoyed by obstinate constipation. Between the ages of fifty and sixty he experienced difficulty in discharging his urine, a feeling of uneasiness in the urinary apparatus, weakness of the body, diffi- culty of digestion, considerable loss of flesh, and a remarkable diminution in his intellectual powers. Still later he had frequent attacks of retention of urine, successfully treated by baths and demulcents, intolerable pain in the kidneys and bladder, hypochondriasis, a strong aversion to frequent places, melancholy, and serious debility. On the first of February, 1827, retention of urine occurred, for which leeches were applied to the perineum, and general baths and demulcents were employed without relief; active inflammation of the perineum and cellular tissue of the scrotum took place, for which fomentations were ap- plied. On the 5th, the skin of the perineum gave way in three places, and a large quantity of urine mixed with pus was discharged. On the 10th of February this patient was brought to the hospital. He was sixty-five years of age, his skin was warm, and his pulse full and strong cheeks red, eyes watery, with pain under the orbits; ideas pretty clear, tongue red and dry, severe thirst and a desire for cold drinks; abdomen sen- sitive on pressure, especially in the hypogastric region; attempts at cathete- rism unsuccessful. Fomentations were ordered to the abdomen. On the 11th an attack of apoplexy occurred, and on the 12th he died. POST MORTEM APPEARANCES. Head.—Considerable effusion of florid blood in the left lateral ventricle. Chest.—Lungs crepitant. Hypertrophy of the left ventricle of the heart. Abdomen—Mucous membrane of Jhe stomach red throughout its whole SPERMATIC ORGANS. 47 extent; covered by little spots of ulceration scattered here and there; the injection of the intestines becoming more and more remarkable in the neighbourhood of the anus. Some ulceration in the rectum. Genito-urinary organs.—From ten to twelve abscesses were found in each kidney; and in the left, crude tubercles, about the size of a bean, ex- isted. The ureters were dilated, and their lining membrane red and in- jected. Bladder hardened and columnar, an inch in thickness. Mucous membrane of a violet colour, thick, soft, and ulcerated in several points. Prostate three times its normal size; more developed under the neck of the bladder than towards the rectum; furnishing, by pressure, a very abundant purulent discharge, and containing about thirty little abscesses and as many crude tubercles. This prostate resembled the tissue of a lung full of tu- bercles, of which some are empty, others suppurating, and others immature. The seminal vesicles and vasa deferentia thickened. There was a circular stricture in the urethra, about half an inch in front of the prostate, formed by a tissue of a horny consistence, and scarcely per- mitting the introduction of a No. 2 catheter. An enormous dilatation of the urethra was observed between the stricture and the neck of the bladder, and the mucous membrane of this portion of the canal was thickened, fungous, and softened, and presented in its posterior part a fissure whence three fis- tulas took their origin. The cellular tissue of the perineum and scrotum was full of pus. The testicles were healthy. This patient died the day after his entry into the hospital, and during this short space his state had not permitted us to think of in- voluntary spermatic discharges, always very difficult to detect in cases of this nature. The stricture was, however, seated a little in front of the orifices of the ejaculatory ducts, and the prostatic mucous mem- brane was disorganized by inflammation; nothing is more common than spermatorrhoea under these circumstances. On the other hand the prostate was considerably altered, and the seminal vesicles and vasa deferentia were much thickened. It is then to be presumed that the loss of intellect, the great debility of the system, &c, arose, as in the preceding cases, from habitual spermatic discharges. Death was caused by a large effusion of blood in the left lateral ventricle. Was the hemorrhage the result of one of those cerebral congestions of which we have spoken in the preceding cases? Ana- logy seems to indicate that it was. Hypertrophy of the left ventricle of the heart was present, how- ever, and the influence which the increased development of this or- gan exercises on the brain is well known. If this hypertrophy were not the sole cause of the effusion, it had, without doubt, a large share in producing it. In obscure questions like that which occu- pies us, we must only admit facts that are incontrovertible, and we must resist as much as possible the attraction of pre-conceptions. I have, therefore, reported this case, because^ it confirms what I have stated respecting the facility with which inflammation of the mucous membrane of the urethra extends to all the other mucous membranes connected with it. 48 INFLAMMATION OF THE The first disease was urethritis with orchitis. Thus, at the^ be- ginning the inflammation extended from the urethra to the testicles by their excretory ducts, and the manner of this extension cannot be doubted, because twenty-five years afterwards the vasa deferen- tia and vesiculse seminales were still thickened. The extension of the inflammation in the direction of the urinary passages was still more evident, for not only the prostatic mucous membrane was thickened, fungous, and softened, but that of the bladder was thick and softened, also, violet-coloured and even ulcerated in several points; the ureters were dilated, and their inner surfaces red and injected; lastly, each kidney contained ten or twelve abscesses, tu- bercles also existing in the left. The prostate is the principal seat of blennorrhagic discharges; be- ing situated at the junction of the urinary with the genital appara- tus, it cannot fail to be affected by disorders which extend to tissues very far from their points of origin; thus it was still more diseased than the kidneys. It was three times its normal size, and indepen- dent of the purulent matter furnished by its mucous follicles it con- tained about thirty small abscesses and as many crude tubercles. I shall remark, as I proceed, that the circumstances under which the tubercles of the prostate and left kidney were developed, and the existence of these tubercles by the side of recent abscesses, leave no doubt as to the cause of their formation. Before concluding these reflections, I must also notice that traces of acute gastro-enteritis and even of ulceration of the rectum were present. It is to this complication that we must attribute the red- ness and dryness of the tongue, the extreme thirst, and the sensi- tiveness of the abdomen to pressure—characteristic symptoms of inflammation of the digestive organs, which we must not confound with derangement of their functions, or with the gastralgia that so frequently accompanies spermatorrhoea; neither must we confound the hemorrhage that caused death with the cerebral congestions of which I have spoken in the two preceding cases. Unfortunately, these distinctions are very difficult to be established in some cases, as alterations of tissue often follow purely sympa- thetic functional derangements so suddenly, that it is impossible to specify the moment when the affection becomes really idiopathic. This is, above all others, the circumstance which has hitherto thrown so thick a veil over cases of spermatorrhoea; and which renders the minute examination of each case so necessary. SPERMATIC ORGANS. 49 CASE IV. Mental derangement—Belief in a change of sex.—Death. Autopsy. — Thickening of the arachnoid—Great alteration of the prostate —Atrophy and obliteration of the ejaculatory ducts. I find the following particulars related by Professor Kech respecting an insane person who died under his care. " The intellect had been disordered for a long time; the patient believed he had changed his sex, and, thinking himself a woman, spent much of his time in writing to an imaginary lover: sometimes he fell on his knees and seemed to dig the ground for hours to- gether. He had entirely lost the power of vision in the left eye. His death took place from exhaustion after an obstinate diarrhoea. At the post-mor- tem inspection, the dura mater was found healthy throughout; the arach- noid was thickened in several points, and opacities were found on its sur- face which obscured its transparency. The pia mater contained a consi- derable quantity of serosity, especially between-the cerebral convolutions. The brain, cerebellum, and medulla oblongata were healthy in all their parts. The optic nerve of the right side was atrophied behind the commis- sure to the extent of half an inch, of a grayish colour and very soft. In the left eye, the retina was separated from the choroid by a considerable serous effusion; the vitreous humour, apparently atrophied, formed a reddish and irregular mass. The lungs and heart were healthy, but the latter was re- markable for its small size. " The mucous membrane of the intestines, from the coecum downwards, was red and thickened; and this alteration increased in intensity near the rectum, in which numerous ulcerations existed. "The prostate projected into the bladder, and was nearly two inches in extent in its long, and fifteen lines in its transverse diameter; its structure contained three small abscesses. The ejaculatory ducts were softened, atro- phied, and obliterated. The vasa deferentia, and the vesiculae seminales were on the contrary larger than ordinary." The patient died of a chronic diarrhoea, and the intestinal mucous membrane was injected, thickened, and ulcerated; he had lost his power of vision in the left eye, and this eye was extensively altered, as was also the right optic nerve, before its entering the optic com- missure; he believed himself to be a girl, and the functions of the testes must have been abolished, since the ejaculatory ducts were atrophied and obliterated. If this singular alteration of the genital organs were not the cause of the patient's derangement, it must at least have influenced its peculiar character. SUMMARY OF THE PRECEDING OBSERVATIONS. Symptoms.—In the first two patients only, were involuntary sper- matic discharges discovered, and their general symptoms well de- scribed. The other cases are hardly of importance, except in respect 4 50 INFLAMMATION OF THE of their pathological illustrations. It is only in the first two cases that the progressive deterioration of the spermatic organs can be well followed, from the first blennorrhagia to the patient's death; and that the ever increasing influence of spermatorrhoea over the whole, economy, but especially over the cerebro-spinal system, can be appreciated. The delusions produced in both patients by the last class of symp- toms are well fitted to open the eyes of practitioners as regards cases of this nature. The consequences resulting from them in a thera- peutic point of view are so serious, that we cannot well attach too much importance to their due consideration. But how can extreme cases of spermatorrhoea, so closely simulate affections of the brain, or of its membranes? and by what charac- ters can we distinguish their symptoms from those arising from idio- pathic affections of the same organs? In order properly to discuss questions of this kind, it is indispensable to have before us all the facts influencing them; "but in passing, we may hastily consider those with which we are already acquainted. In the first two cases, the cerebral symptoms were preceded, during a long period, by a remarkable derangement of the other functions: thus, digestion was performed badly; the stomach no longer bore fermented drinks, spiced meats, or very nutritious food; stubborn constipation supervened; the intestinal tube was habitually distended by flatus; sexual intercourse became more and more rare, the act more rapid, and at last entirely impossible. The patients, in these cases, discontented with themselves and their friends, and tormented by flatus, of which they want continually to relieve themselves, shun society and its trammels; they dislike every thing which recalls to them pleasures they are unable to share; tbey become melancholic and irritable, misanthropic and hypochondriacal; ever occupied by the consideration of their health, they manifest the utmost indiffe- rence for all things which do not affect it. The cerebral functions are not more weakened than all the rest, but their disorder produces more serious consequences, and is more readily perceived. It is soon remarked, that memory becomes im- paired, that the train of thought is easily interrupted, and that the least excitement of the intellect induces congestion towards the head. Difficult digestion, more obstinate constipation, and abdomi- nal distention by flatus, supervene in these cases, which end by at- tacks of congestion in the fatigued and weakened brain. But these congestions are accompanied with a remarkable feeble- ness of the pulse, chilliness of the limbs, general uneasiness, anxiety, agitation in every sense, and a remarkable desire for motion. They are immediately followed by pallidity of the countenance, general debility, and alarming faintness, without any one part of the body being more affected than the rest. Apoplectic congestions are never preceded for years by a progres- sively increasing weakness of the economy; the pulse is full and there is a tendency to drowsiness. SPERMATIC ORGANS. .01 ^ The patient whose case I have related in my third observation, died in consequence of an extensive cerebral hemorrhage, which came on suddenly in the left lateral ventricle of the brain; but this patient had hypertrophy of the heart, and the first attack promptly caused death; it is, therefore, probable that the congestion was not due to the same cause, and it certainly did not present the same characters as in the two preceding cases. The disorder observed in the ideas of such patients cannot be confounded with delirium; whenever delirium has been really pre- sent in these cases, true meningitis has been found to exist, of which I have seen numerous examples. The state of the intellect, in these affections, manifests, perhaps, a greater resemblance to de- mency; but demency commonly follows mental derangement; be- sides, it is always easy to obtain, in the cases I am considering, clear and connected answers. It is impossible also to confound the disorder of the digestive func- tions with the symptoms of inflammation of these organs; in all cases in wdiich inflammatory symptoms are observed, gastro-enteritis is actually present. Lesions.—It is chiefly on account of the alterations discovered in the spermatic organs that the cases I have hitherto recorded are of value. The influence of the urethra on all the organs which open into it, is an important phenomenon in the history of sperma- torrhoea. To have a clear idea of this influence, it is necessary especially to prove the facility with which inflammation creeps along the mucous membranes, to even their most distant continuations. Prostate.— Blennorrhagic discharge arises from the mucous folli- cles of the urethra, and of the prostate especially, where they are most developed and most numerous: the prostate, in fact, is formed of these follicles, united by cellular tissue. During the first days after contagion, a tickling in the urethra is felt, with itching heat and pain, especially during the emission of urine. The secretion of the canal is increased, and changes its appearance, but it is not until the inflammation has reached the prostate, that the discharge acquires its greatest severity. It is then principally secreted by the prostate, and experienced patients seem to be aware of this, for in doubtful cases we see them com- press the urethra from the perineum to the glans penis, in order to expel the secretion. Besides, post-mortem examinations permit no doubt to remain on the subject. But the irritating matter which excites the disease is not deposited on the surface of the prostate, and it is not because this matter con- tains a contagious principle, that the inflammation is propagated so rapidly from the orifice of the urethra to the prostatic mucous folli- cles, for leucorrhcea, the menstrual discharge, or the lochia, are fre- quently sufficient to excite a profuse discharge, the seat of which is equally in the mucous follicles of the prostate. 52. INFLAMMATION OF THE It is not the passage of the irritating matter from one point of the mucous surface to another, that favours this propagation, for the discharge passes from behind forwards, and the inflammation extends in the opposite direction. However it may arise, the fact is constant, and it clearly explains the frequency of prostatic disease as a sequel to blennorrhagia. In the beginning of a very acute inflammation, the prostatic folli- cles are gorged with a thick adhesive pus, and form a firm and yel- lowish body like a scrofulous tubercle; the cellular tissue surround- ing them is so far, however, perfectly healthy, so that the follicles can be easily separated from one another throughout their extent, and the nature and seat of their changes can thus be proved. At a more advanced period of the disease, we find the prostate in- filtrated with pus or a pultaceous matter, which may be pressed out in the form of granules; the cellular tissue is now, therefore, attacked by the inflammation, but suppuration is not yet well established. At a still more advanced period, by slightly compressing the pros- tate, pus may be made to exude from all its excretory ducts, and it contains, besides, little abscesses from the size of a linseed to that of a pea. Here the suppuration of the cellular tissue has begun to form into distinct collections. In the third case I have related, the prostate was three times its normal size, and furnished, on pressure, a very abundant purulent matter; it contained besides this about thirty little abscesses, and as many crude miliary tubercles. We observe here the same progress of the inflammation, but the abscesses, in place of discharging their contents, were transformed into tubercles by the absorption of the fluid parts of the pus. In the first case I have reported the prostate was partly destroyed, and contained in its fibrous envelope an elastic and purulent matter, which passed into the canal of the urethra, through a number of foramina in the mucous membrane. These foramina were the orifices of the mucous follicles whose parietes had been destroyed by sup- puration. We see by these observations, then, that the inflammation extends from the urethral mucous membrane to that lining the mucous folli- cles of the prostate, and afterwards to the cellular tissue uniting them; that abscesses form, and either discharge their contents by the mouths of these follicles after having destroyed their parietes,' or in other cases form tubercles, which end in the same way; that the prostate becomes destroyed by degrees, and is reduced to a fibrous envelope, quite perfect, and covered by a kind of perforated membrane, the foramina in Avhich vary in form and size, according as the excretory orifices remain distinct, or are united together by the destruction of the intervening tissue which separates them. When the inflammation of the prostatic cellular tissue is less severe in place of pus, an albuminous matter is deposited, which infiltrates SPERMATIC ORGANS. 53 the part and gives rise to indolent engorgement, and if this be not dispersed promptly and entirely, induration of the prostate will re- sult. I have seen many cases in which this has occurred. Spermatic Organs.—The frequency of orchitis arising from blen- norrhagia shows with what facility inflammation of the urethra extends to the testicles. This extension takes place by means of the mucous membrane. Injury, exposure to cold, &c, may indeed favour the development of orchitis; but its principal cause, often its sole cause, is the influence of the urethral mucous membrane over that lining the excreting organs of the semen. Both patients and practitioners are in many cases much puzzled to understand the appearance of orchitis, and they would be still more so if pre-conceived opinions did not facilitate its explanation. Sometimes it is from having walked too far, or from having sat too long, sometimes from having worn too tight a pair of trousers, or from having bruised the testicles by crossing the legs, that the dis- ease has arisen. But who is not exposed to the action of such causes ? I admit that it is often immediately after a circumstance of this kind that the patient experiences, for the first time, a more or less sharp pain in the testicle, which is soon afterwards followed by the other symptoms of orchitis; but those patients who observe carefully never fail to remark, that they first experience a sense of weight in the inguinal region, and of dragging and pain in the spermatic cord. On examining the cord of the affected side, the vas deferens is then found to be swollen and very sensitive, and it even sometimes hap- pens that the swelling of the cord is so great as to cause a kind of strangulation in the inguinal canal. When, afterwards, the inflammation extends to the body of the testicle, it is attributed to the first cause which drew attention to the morbid sensibility of the organ, and then it is that the urethral dis- charge diminishes or becomes suppressed, according as the new in- flammation is more or less severe. The suppression of the discharge makes the patient imagine that the affection itself has attacked the testicle, and many medical men even believe that the suppression does give rise to orchitis. They are deceived by taking the effect for the cause; but it is not the less true on this account, that the inflammation of the canal has originated that of the testicle; indeed the succession of the symptoms ought to be sufficient to show the course the disease has taken. When both testicles have been affected, both ejaculatory ducts are found altered, and when both seminal vesicles or both vasa defe- rentia have been inflamed, the same alteration is remarked in both the ejaculatory ducts. When one only of the spermatic organs has been inflamed, I have always been able to trace the inflammation to the orifice of the corresponding ejaculatory duct, whilst the other has been found unaffected. I have also seen the inflammation spread without interruption as far as the tunica vaginalis of the testicle or of both tes- ticles, according as the disease has extended on one side or on both. 54 INFLAMMATION OF THE This affection of the tunica vaginalis may be easily explained, since any alteration of the glandular tissue is readily partaken by its fibrous covering, which is intimately united with the serous tissue coating the gland. Inflammation of the seminal vesicles extends itself in the same man- ner, in some cases, to the adjacent peritoneum. In the first case I have related this inflammation was quite recent; the matter depo- sited on the surface of the serous membrane was still albuminous, soft, and unorganized; and in the second case, the bladder was united to the rectum by cellular adhesions, evidently due to the same cause. These observations are of greater importance than they appear; they prove that general peritonitis might easily arise from the dis- eases we have been studying. The old and circumscribed adhesions of peritonitis which sometimes line the bottom of the pelvis, ought also to be noted as being almost certain proof of old inflammation of the seminal vesicles; they may, therefore, assist much in explain- ing the symptoms observed during life, when the alterations of the spermatic organs have passed away, or do not leave any very ap- parent traces. However this may be, these alterations of the pe- ritoneum and of the tunica vaginalis prove that the inflammation is propagated by contiguity of tissue. But it is necessary to examine a little more in detail the state of the different spermatic organs. Orifices of the Ejaculatory Ducts.—In the patient who wTas the sub- ject of the first case, the orifices of the ejaculatory ducts, in place of being circular, formed one elongated and irregular cleft. The ducts themselves were very large. This enlargement has been no- ticed by Stoll1 in a case related by him; and it was still more re- markable in a body I once saw in the School of Medicine, in which the opening admitted a goose-quill. In all these cases still more seri- ous lesions existed, but it is easy to conceive that the dilatation or ulceration of the sphincters which terminate the ejaculatory ducts, may alone possess great influence over the production of spermator- rhoea, and I should not be surprised if we should find sometimes no other lesion capable of accounting for it. The Ejaculatory Ducts generally share the alteration and dilatation of their orifices; besides which, they may be insulated, as though dis- sected, by the suppuration of the prostate, or thickened, hardened, and cartilaginous, or they may even contain osseous granules. These alterations, much more serious than those of their orifices must dis- pose very much to the involuntary escape of the semen. The ducts having lost their elasticity, and even their power of contraction, are no longer able to drive back the semen into the seminal vesicles* or at least they are incapable of retaining it, however gently these re- servoirs may contract, or however little they may be compressed. Pars prima rationis medendi. SPERMATIC ORGANS. oo The pressure exerted on these ducts, by the swelled tissue of the prostate, may cause their atrophy or obliteration, whence, of course, ensues the more or less complete loss of their functions. Seminal Vesicles.—It would appear that pus formed in the seminal vesicles should be easily expelled; but these two receptacles, com- posed of ramified cells, are placed out of the direct course of the se- men, to be used fas reservoirs for it; and they only communicate with the vasa deferentia and the ejaculatory ducts, by a very narrow opening, in front of which the seminal fluid may pass to be discharged directly from the testicles to the urethra; it seems that the swelling produced by inflammation may so much lessen this opening as to form an obstacle to the exit of pus, for a shorter or longer period: in one case which I had an opportunity of examining, the pus had acquired a considerable thickness, and that at the bottom of the cells was still more thickened, exactly resembling tuberculous matter. The resi- dence of the pus in this situation may be even still more prolonged, should the watery part be more completely absorbed; in these cases we find only a yellowish homogeneous substance, soft, like plaster, or even chalky, the true origin of which has been entirely mistaken. It is almost unnecessary to notice that the presence of pus pre- vents the entrance of the semen into the reservoirs intended for it, and that it becomes, from this alone, an immediate cause of sperma- torrhoea. We can easily understand also that after the expulsion of the pus, the parietes of the vesicles must be thickened, and that they may always remain hardened, altered in shape, thickened, car- tilaginous, or even bony. In more favourable cases, also, then- lining membrane must preserve, during a long time, an abnormal sensibility, the influence of which must be very injurious. It is not, however, necessary that such serious alterations should exist in the seminal vesicles in order to account for the irregular and spasmodic contractions of which they are sometimes the seat; or for their influence on the production of spermatorrhoea; but it is useful to understand fully the most striking changes in order the better to appreciate the slighter ones. The qualities of the semen found in the seminal vesicles should also be carefully noticed: I have seen it resemble meconium in one of these receptacles whilst pus existed in the other; and it is pro- bable that the alteration of the secretion of the one testicle was due to a similar influence which, in the same case, had acted still more evidently on the opposite organ. Vasa Deferentia.—Pus formed in the vasa deferentia is not in all cases easily expelled; swelling of their walls may bring about complete obliteration of these vessels in one or more points, whil in others they are distended by the accumu ation of the pus, so that pouches, more or less dilated and separated by contractions, some- what resembling irregular chaplets, are formed. This disposition may extend itself to the epididymis, and to the corpora Highmonana, 56 INFLAMMATION OF THE the mucous membranes of which are continuous with those of the vasa deferentia at one part, and with those of the secretory tubes at another. Pus thus separated and submitted for an indefinite time to the ac- tion of the absorbents, becomes more and more solid, and gives rise to deposits resembling those of tuberculous matter, the aspect and consistence of which may present every degree of alteration in the same individual, according to the age and size of the abscess. From this obliteration of the vasa deferentia, retention of the se- men in the testicles also results, so that the generative power is lost; but it does not necessarily follow from this that the patient should be free from spermatic discharges. If the abscesses of the epididy- mis open externally, we can understand that the semen will escape immediately through this rupture of the excretory canal, and that in this way a true spermatic fistula is formed; and should this take place on both sides, it is clear that the patients would be exposed to the same phenomena as if they were affected by spermatorrhoea. If the obliteration of the excretory canal be not followed by rup- ture, it is probable that the secreting organ, after having been a long time distended, swollen and painful, will in the end diminish by de- grees, and will become completely atrophied, as happens to other glands under the same circumstances. Thus certain cases of atro- phy of the testicles, after very long and painful swelling of them, may be accounted for. When the vasa deferentia are felt hard and knotty there can be no doubt as to the cause of this atrophy; but sometimes the altera- tion takes place in parts where manual examination is impossible, and in these cases the state of the prostate will be likely to furnish important information: when it is found irregular, swollen, and en- larged, the atrophy of the testicles must be regarded as the conse- quence of pressure on the ejaculatory ducts. In an officer whose case I treated, the testicles were not larger than those of a child of six years; the patient had experienced a continued dull pain in them for a long time; the prostate was much altered; his moral faculties had experienced the same changes that occur in cases of spermatorrhoea, but the physical man was not much weakened; the reason of this is evident. Chronic atrophy of the testicles, following more or less acute pain in them, is by no means rare: these pains are usually considered nervous, and the insensible wasting which follows them has not been as yet satisfactorily explained. All the patients of this kind whom I have had an opportunity of observing, had suffered previously from blennorrhagia, of which I am convinced this atrophy was the distant but direct result. We often find the vasa deferentia thickened, hardened cartilagi- nous, or even quite ossified, in patients who have had orchitis. These cases confirm what I have stated respecting the mode of transmission SPERMATIC ORGANS. 57 of inflammation from the urethra to the testicles, for all these shades of induration are so many results of inflammatory action. Testicles.—Every surgeon knows how slowly enlargement of the epididymis and corpus Highmorianum, following orchitis, is dis- persed. This fact alone is sufficient to prove that it is by the vas deferens that the inflammation reaches the testicles, because it is by means of the corpora Highmoriana that the secretory tubes open into the excretory ducts. It is not then surprising that this part of the testicle should be the one most seriously altered, and often even the only one affected. Purulent collections formed in the testicle are notable, like those in the organs we have already considered, to empty themselves by the excretory canals, and the fibrous envelope which encloses the secretory vessels is very resistant; it must, therefore, often happen that slight and very circumscribed inflammations are arrested before suppuration has been able to appear externally. If in these cases complete absorption do not take place rapidly, the thicker part of the pus may form tubercles, the presence of which will, in its turn, be a cause of new inflammation, and the vessels secreting the semen may, like the follicles of the prostate, be destroyed by degrees, so that the gland may become reduced to its envelope only. Other products besides pus may be formed in the cellular tissue of the tes- ticle ; when the inflammation is slight, but of long duration, or fre- quently recurring, a gelatino-albuminous matter is deposited, which thickens and becomes a source of organic alterations like those in the prostate, and the first cause of these also may be usually traced to long-neglected chronic affections of the urethra. I have attached much importance to the thorough understanding the mode of transmission of inflammation from the urethra to the testicles, because the establishment of this point explains in the* most simple way why the presence of a sound in the urethra, or the existence of a stricture, so often excites congestion and inflammation of those organs, and even in some cases the development of hydro- cele, as well as why the removal of the cause suffices generally to make the effect cease. The conciliation of all these circumstances is especially of impor- tance to the study of spermatorrhoea; and the intimate connexion of the urethra with the testicles by means of the vasa deferentia should suffice to forewarn us of the influence which the condition of the mucous membrane surrounding the orifices of the ejaculatory ducts, must exercise on the secretion and expulsion of semen. Urinary Organs.—Analogous phenomena present themselves in the organs secreting and excreting the urine. The inflammation ex- tends from the urethra to the kidneys by means of the bladder, and ureters; it is even easy to trace its progress, without interruption; hence the violet coloured spots of congestion, the ecchymoses, and even ulceration of the mucous membrane lining these organs; hence the swelling and injection of the kidneys; hence the abscesses of all 58 INFLAMMATION OF THE sizes and of all stages, encysted and non-encysted, and mixed with crude or suppurating tubercles, which have been found in the kidneys. As a sequel to these successive attacks of inflammation I have seen the tissue of the kidney destroyed like that of the prostate or of the testicle; almost reduced, in fact, to its external fibrous envelope. There is then an exact similitude between these two classes of or- gans, and if the kidneys could be as easily examined as the testicles this resemblance would appear still more strikingly. Comparison of the two sets of Organs.—We often see, after expo- sure to cold or excessive drinking, a blennorrhagia diminish or cease entirely, and the patient experience at the same time violent and deep-seated pain in the loins: the urine is scanty, and high coloured, and sometimes even bloody. If in these cases we could examine the kidneys as we do the testicles, we should, perhaps, find that at- tacks of nephritis following blennorrhagia are nearly as frequent as those of orchitis. I am convinced that, in the cases I have seen, alterations of the kidneys have been more frequent than those of the testicles. It is not only as a sequel to blennorrhagia or stricture that nephritis takes place; every inflammation of the urinary canals may extend to the kidneys; and this is why acute or chronic cystitis, and the presence of stone in the bladder, are such common causes of inflam- mation of these organs; this is why the kidneys are so often found disorganized when the bladder has been long irritated by the presence of extraneous matters, or by repeated attacks of retention of urine. I believe I have now more than sufficiently shown how easily acute inflammation of the urethra extends to the secreting organs of the semen and urine, by means of their excretory ducts; I have com- pared together the phenomena that occur in both classes of func- tions, because they are presented at the same time, in very nearly the same degree, and with analogous characters. But this resem- blance is not observed in cases of acute inflammation only; it is more easily shown in these cases, and on this account I have com- menced with their consideration. Similar phenomena are, however, observed under the influence of less active causes. When the bladder is irritated the secretion of urine is increased in quantity and altered in quality; and at the same time that it becomes more abundant and more watery, it remains a shorter time in the bladder; the desire of micturition is felt oftener and more suddenly • however the patient may wish to retain the excretion, the sensation is so painful, and the bladder contracts so violently, that the urine is often expelled in spite of every effort, and before the patient has had time to prepare himself for its discharge. The fluid is passed each time in small quantity, the jet is short and feeble, and falls within a little distance of the patient's feet: should this state continue any length of time, the muscular coat of the bladder becomes more deve- loped, the parietes of the organ are thickened, and its capacity dimi- nishes in the same proportion. Those who have noticed the coinci- dence of this limpidity of the urine with its frequent expulsion have SPERMATIC ORGANS. 59 concluded that the more watery the fluid secreted the more it irritates the mucous membrane. But it is impossible for us to admit that the urine should irritate the bladder most when it contains least salts in solution. It is evident that the effect has here been mistaken for the cause. It is because the bladder is irritable that it cannot longer bear the presence of the urine, and this fluid is more watery, because the irritable kidneys secrete it in greater quantity, and it remains a shorter time in the bladder; that this view is correct, is proved by the vesical mucous membrane, when it possesses its normal sensi- bility, submitting for a long time to the presence of a large quantity of watery urine, as occurs daily after meals. If this irritation be prolonged, it may produce in the end a kind of relaxation of the secreting vessels, and degenerate into diabetes. The urine entirely loses its chemical characters; the urea and uric acids are replaced by a saccharine matter, and the system wastes in consequence of furnishing so superabundant a secretion. Exactly the same phenomena are observed in the spermatic organs when they are submitted to the influence of a similar irritation ; the testicles secrete an increased quantity of semen because they are irritated, and their secretion is more watery, because it is less per- fectly formed, and remains a shorter time in its reservoirs before expulsion; it is more rapidly expelled because the seminal vesicles are more sensitive to the impression produced by its presence, and are more readily excited to action. The spasmodic contractions of which these organs become the seat commence by producing ejaculation very rapidly either during sexual intercourse or after erotic dreams; this renders coitus rapid and in- complete, and nocturnal pollutions very frequent; afterwards the weakness and irritability are increased, the semen becomes more abundant, and still more fluid, and the convulsive contractions of the seminal vesicles are more frequent; during this state the approach of a female, or even a lascivious idea may suffice to excite ejaculation; but the semen is no longer projected with energy, erection is never complete, and scarcely any sensation accompanies emission. These injurious contractions are at last excited even by still less distinct causes; the patients feel them come on when least expected, they dread their consequences, and still they are quite unable to prevent them. Lastly, there are cases in which the debility of the genital organs is such that a true spermatic diabetes may be said to be present, as well by the quantity and quality of the secreted fluid as by the frequency of its emission. We have been unable to make the same chemical experiments on the altered semen that have been made on the urine of diabetic patients; but the semen in such cases contains no more spermatozoa than the urine does urea. Let it not be thought that this statement is founded only on analogy; the fact really exists in practice. I have, at this moment, a patient under my care, who is dying, worn out by the effect of diabetes with diurnal pollutions of the same kind. 60 INFLAMMATION OF THE Here, then, we have, from the action of the same causes, the kid- neys, testicles, bladder, and seminal vesicles affected in the same manner, and producing analogous results; and further, these affec- tions seldom occur singly; thus, in stricture, the urinary passages are, indeed, chiefly affected, but I have seen cases in which the spermatic organs have been almost as much disordered; it is not in- flammation alone wrhich may extend in both these directions, but even a simple irritation of the urethral mucous membrane. Diurnal pollutions are too little understood to have been generally noticed in these cases; they are always obscure, and the attention is fixed usually on another object; but I have so often satisfied myself of their presence as a sequel to strictures, that I regard sperma- torrhoea as the true cause of all the cases of hypochondriasis, ischuria, and debility, which are attributed to affections of the urinary organs. This position, is, I think, proved by the weakness and rare occur- rence of erection, the rapidity of ejaculation, and the increased fluidity of the semen observed in most of these patients. Cases of diurnal pollution uncomplicated with chronic catarrh or irritation of the bladder are sometimes rare; and this often renders diagnosis difficult, not only on account of the symptoms of catarrh being present, but also on account of the mucus secreted by the bladder and prostate. On this account, when I see the urine cloudy, I always inquire respecting diurnal pollutions, so that I may not confound mucus with semen. It is very remarkable, also, that those who give themselves up to venereal excesses or masturbation, frequently experience a desire to micturate; this fact gave rise to the saying of the ancients, "raro mingitur castus." I have ever been struck by the truth of this axiom; and the fact proves how easily the urinary organs share the excitement of the spermatic. Another very important circumstance in the history of diurnal pollutions proves how correct is the analogy I have established be- tween irritation of the bladder and that of the seminal vesicles. It is almost always at the end of the emission of urine that the semen escapes; the bladder then contracts forcibly to expel the last drops of urine, and the seminal vesicles also enter into action, and expel with the urine a greater or less quantity of their contents. It has been wrong to attribute this viscid discharge to the prostate, because it does not present all the qualities of ordinary semen; the evacuation is sometimes very abundant, and that it is semen, cannot in these cases, be mistaken. Besides this, when the patients have their attention called to the circumstance, they know very well how to estimate the contractions of the seminal vesicles, which are even in general proportion to the extent of the evacuation. Most patients remark also that when they are threatened with a relapse, it is preceded by a more frequent and very sudden desire to micturate, whether this increased sensibility of the bladder arise from cold or from an excess either of drink or of coitus. This proves that the same causes act at once on both sets of organs. SPERMATIC ORGANS. 61 Persons affected by diurnal pollutions experience, generally, in- jurious effects from t,he use of diuretics. Nearly all those who have taken squills, nitrate of potass, digitalis, &c, have noticed during their use a remarkable increase of the seminal evacuations, and a few, after having been cured during a longer or shorter period, have experienced relapses which could not be attributed to any other cause, and which have spontaneously passed off as soon as they have re- linquished the use of these medicines. It is also well worthy of notice that children subject to inconti- nence of urine, are particularly liable to nocturnal pollutions at the age of puberty; and at a later period to diurnal pollutions. Lastly, I cannot conclude this parallel of the two sets of organs without mentioning that obliteration of the spermatic excretory ducts may be followed by the formation of spermatic fistulae, in the same manner that strictures of the urethra give rise to urinary fistulse. To resume:—All the mucous surfaces of the genito-urinary organs have the greatest analogy and the most intimate connexion wdth one another. It is by them that inflammation creeps by degrees to the secreting organs of the urine and of the semen. The portion of this membrane which lines the prostate, being in intimate connexion with that of the mucous follicles, with that of the ejaculatory ducts, and with that of the bladder—this portion then is the one, the different conditions of which have most effect on all the rest. This connexion takes place by means of the lining membrane of the ducts; and is by no means to be considered the result of sympathy, such as exists between the uterus and breasts. The excretory canal, transmitting the inflammation, must neces- sarily share its influence. The seminal ducts and vesicles, then, cannot remain unaffected by the action they transmit to the testicles, and this is an important consideration wdien we recollect that these are as much the acting organs in the emission of semen, as the blad- der is the organ for the expulsion of urine. We shall often find it necessary to apply these facts to the study and treatment of diurnal pollutions, and in passing, it is as well to notice that the influence of the excretory canals on the secreting organs is not an isolated phenomenon occurring only in the kidneys and testicles, but that it is the result of a general law, applicable to all glands. Suction excites the secretion of milk and changes its qualities; the first drops drawn from the nipple are watery, and the milk af- terwards becomes more abundant and better formed in proportion as the suction continues. The introduction of extraneous bodies between the eyelids increases the lachrymal secretion, which some- times even is so changed, that it irritates and excoriates the skin of the cheeks. The presence of food in the mouth, especially when spiced and savoury, increases the secretion of the salivary glands. During digestion the liver and pancreas are excited; and the 62 CAUSES OF use of emetics and purgatives produces the same effects. The ejaculatory ducts open on the surface of the prostatic mucous mem- brane; is, then, the important part this membrane plays in the pro- duction of spermatorrhoea, a cause for wonder? CHAPTER III. CAUSES OF SPERMATORRHEA. Blennorrhagia. The first case of diurnal pollutions which I had occasion to treat occurred in a student of medicine, twenty years of age, who studied his disease with much care, and described its causes and symptoms with remarkable perspicuity. The following are the facts:— CASE V. Lymphatic temperament—Blennorrhagia— Orchitis—Nephritis— Noctur- nal and diurnal pollutions—Muse of mercurials—Pnjurious effects of colds and tonics—Cure by means of leeches, the use of flannel, and milk diet—Fresh attack of Blennorrhagia—Same treatment, with the same residt. M. N-----, of lymphatic temperament, tall and thin, with a pale face, red hair, white, and habitually cold skin, narrow chest, and soft, feeble voice, had never suffered from any diseases except those about to be described. In January, 1821, M. N----contracted blennorrhagia, which was treated by emollient drinks, general baths, and corrosive sublimate. In the month of April, several doses of Chopart's1 mixture were taken, and arrested the dis- charge, after a duration of four months. Six weeks afterwards he con- tracted a second blennorrhagia, and in September, swelling of the left tes- ticle occurred after horse exercise. This swelling was in a great measure dispersed, but a flaccid state of the scrotum remained, causing painful drag- ging pains in the spermatic cords, which were relieved, however, by the use of a suspensory bandage. At the commencement of 1822, the dis- charge still continuing, local astringents and mercurial frictions were em- ployed, with iodide of potassium and bichloride of mercury internally. 1 The following is the composition of Chopart's mixture: R. Balsam copaib., Alcoholis, sp. gr. 33° Syrupi simplicis. Aq. menth. pip., Aq. flor. aurant., aa partes sexaginta, Sp. aether, nitr. partes octo; M. ft. mist, cujus cochlear, minim, unum nocte maneque summend. SPERMATORRHEA. 63 Under this treatment the discharge diminished, but did not entirely disap- pear. Whilst taking these remedies, M. N----was exposed to severe cold. Cutaneous exhalation was suppressed, and pain in the loins supervened. This was generally of a dull character, but was rendered acute on the least exposure to cold; about the same period M. N-----'s digestion be- came impaired. He attributed this to weakness of the stomach, and sought to stimulate the organ by a generous diet, and by the use of rhubarb and wine. These means, however, only increased his disorder, and, about the month of June, 1822, it became very serious. As soon as food reached the stomach he felt an impression at the praecordia, with difficulty of breath- ins;, general lassitude, and sometimes a desire to vomit; his tongue was white and pasty; his bowels constantly distended with flatus, and he suf- fered from obstinate constipation, with occasionally slight fainting fits; he was quite unable to fix his attention on any subject requiring mental exertion. Although without appetite, he forced himself to eat to keep up his strength, but his digestion became more difficult, and he 'felt himself much overcome by lassitude after meals. He endeavoured to assist digestion by the use of coffee, and with the same view he bathed every morning in cold water; he was, however, unable to remain immersed more than a quarter of an hour at a time without shaking in all his limbs; no reaction took place afterwards, and he always remained a long time before he was able to regain a comfort- able degree of warmth. He obtained relief from eating ices, however, and took them frequently. A slight urethral discharge still continued, and on waking in the morn- ing he perceived a viscid pearly matter at the orifice of the glans. Part of this matter, remaining in the canal, was expelled with the urine, and re- mained suspended in the fluid like a cloud, which after some time was de- posited on the bottom of the utensil. Towards the close of the year 1822, when the cold weather commenced, his bad symptoms increased; he became sad and absent, was unsettled, with- out fixed motives, and very timid. He became shivered on the least expo- sure to cold, the rigour commencing in the lower extremities, and extending over the whole body. He suffered severe pains in the loins, and passed urine frequently, and he now had difficulty in expelling the last drops, which were viscid and always partly passed on his shirt. He no longer had erec- tions or sexual impulse. He often passed semen during sleep, without las- civious dreams or any turgidity of the penis, and he constantly felt an irre- sistible drowsiness. Towards the commencement of 1823 he perceived an abundant reddish sediment in his urine. About the end of February his state had become deplorable: he then ap- plied to me, and I ordered the following treatment—twelve leeches to the anus, cold lotions to be applied to the scrotum and perineum three times a day, iced milk, flannel next the skin, very little wine to be taken with his meals, and, after a short time, complete abstinence from all fermented liquors. A few days after he felt a remarkable change; his digestion was performed better; the pain in his loins and the lassitude disappeared. He became less sad, less timid, and he applied himself to study with ardour; his genital organs acquired energy, and he threw aside his suspensory bandage; his urine no longer deposited a sediment, and erections re-appeared. Leeches wore applied a second time, fifteen days after the first, and he continued 61 CAUSES OF the remainder of the treatment for two months. By that time—about the end of April—his health was re-established, and the warmth of summer proved sufficient to confirm it. In the month of July, 182:5, however, he contracted a third blennorrhagia which did not affect his general health. A month after its appearance it was treated successfully by means of leeches and small doses of copaiba: but when he took the latter in too large quan- tities, he suffered acute pain in the loins. Sea bathing during the month of September contributed much to strengthen the genital organs. M. N---- was afterwards appointed, by concours, senior surgeon to a very important hospital, which proves that he was able to apply himself, after his recovery, to severe study. I have since seen him several times, and have learned that his health continues excellent, but that he is obliged to guard carefully against the effects of cold, and against every over excitement of the diges- tive organs. He finds it necessary every winter to return to milk, with mild and light food, and to drink water with his meals. This patient while suffering under blennorrhagia used horse exer- cise; soon afterwards orchitis occurred; painful dragging sensations were experienced in the spermatic cords, even for a long time after the abatement of the inflammation. It was then by the vas deferens that the inflammation was transmitted from the mucous membrane of the urethra to the testicle. A short time after, from exposure to cold, perspiration became suppressed, and pain in the loins was experi- enced. This pain was probably situated in the secreting organs of the urine; since, simultaneously, its emission became very frequent, the last drops were expelled with difficulty, and its composition was much altered. The inflammation then extended by means of the bladder from the urethra to the kidneys, in the same manner that it extended by the vasa deferentia to the testicles. The urine deposited an abundant gravelly sediment, and at the same, time contained semen in suspension. The bladder had become more sensitive to the presence of urine, for the desire to empty it was often and very suddenly renewed. The seminal vesicles were exactly in the same condition, and the semen was passed without erection during sleep; in addition to which, the contractions of the bladder necessary for the expulsion of the last drops of urine caused con- tractions in the seminal vesicles, and the fluid expelled was viscid and glairy. Both classes of symptoms ceased, re-appeared, and were cured at the same time; and they were evidently due to a state of inflammation, for the antiphlogistic treatment was the only one that succeeded in removing them. The injurious effects of cold were very evident in the case of M. N-----, and may be attributed partly to his lymphatic temperament, but.we often find analogous phenomena in patients of a very different constitution. However this may be, I am convinced that without the habitual use of flannel next his skin, M. N-----would not have been able to preserve himself from further relapses, or permanently to strengthen his constitution. M. N----had undergone several courses of anti-venereal treat- SPERMATORRHEA. 65 ment, although he had only suffered from blennorrhagia, and the ef- fects of mercury were very injurious to him, as his constitution was \ little fitted to withstand its action. He fell also into other very eommon errors, which are the ordinary result of an almost universal false reasoning on the part of the sick. Perceiving that he lost flesh, he ate heartily, and chose the most nutritious kinds of food: diges- tion being performed badly, and accompanied with the development of flatus, because the stomach shared the general weakness, he had recourse to rhubarb, generous wines, and spices. Hence frequently arise the attacks of chronic gastritis, which so constantly accompany old cases of spermatorrhoea. M. N-----'s intellectual functions were weak in common with the rest; he was habitually drowsy, and he took coffee and tea to rouse himself. At length M. N-----, like many other practitioners, began to treat symptoms, and allowed himself to be influenced by the names given to medicines: his urine was thick, deposited a sediment, and was passed with difficulty; he took nitrate of potass as a diuretic, with- out reflecting that the increase of secretion which this medicine pro- duces, is the result of excitement of the urinary organs, and that his were already too much irritated. His bowels being constipated, he took purgatives without seeking the cause of constipation, and without troubling himself about the effect which irritation of the rectum produces on the bladder, the prostate, and the seminal vesi- cles. These are errors of daily occurrence. The abuse of cold in cases of nocturnal and diurnal pollutions is very common. By bathing in the river M. N-----followed the ad- vice laid down by all writers on the subject: it proved injurious to him, however, because the genito-urinary mucous membranes were too irritable not to receive a hurtful shock from immersion in cold water. The patient should have foreseen this result from the bad effects cold had always' produced on him; besides this, he was too weak to obtain a proper degree of reaction after bathing. I shall show by and by that cold baths employed without distinction in cases of spermatorrhoea, have done much more harm than good. Still the patient found that sea-bathing at a later period gave tone to his geni- tal organs, and he was unable to reconcile two effects of so opposite a nature; yet nothing is more simple. When he took sea-baths he was cured; the irritation of the organs had passed off, and their normal condition had returned; the first shock of the cold then was no longer injurious, and the consecutive reaction followed rapidly. It is true that considerable difference exists between sea and river bathing; but it is chiefly to the different states of the system that the two very opposite effects of cold on this patient must be referred. From not having attended to this important distinction, general directions have been given respecting the use of these powerful agents,—directions which daily lead to the most disastrous results. 66 CAUSES OF CASE VI. Masturbation—Blennorrhagia—Diurnal pollutions—Failure of the ordi- nary modes of treatment—Cauterization of the prostatic portion of the ureth ra —Rap id recovery. Alexis Poit, set. 20, short, stout, and of a sanguineous constitution, ap- plied at the Hotel Dieu, Montpellier, to be cured of a venereal taint, which he said, existed in his system, in consequence of an attack of blennorrhagia contracted three months previously, and cured in a few days by the simple use of dandelion tea. Nothing in the appearance of the patient confirmed this statement. He complained, however, of violent pain in his head, pain in his bones, frequent spasmodic tremors in his limbs, and a constant agitation which prevented his enjoying an instant's sleep; of stunning sensations and vertigo, with ringing in his ears; of a sense of suffocation with palpitation of the heart, and of itching in the skin: his eyes were injected, dry, and very sensitive to the impression of light. Out of all his symptoms, the ossific pain was the only one that could fa- vour the idea of a venereal taint; the patient said that he suffered most during the night, but his answers were very obscure and often contradictory. His skin, however, was hot and dry, and covered with pimples. I prescribed for him venesection, baths, and refrigerant drinks. The next and following days, discharges occurred, and he seemed still more satisfied that he laboured under a syphilitic taint. His constitution seemed strong, and his appearance proclaimed health. I thought, therefore, at first, that he had some motive for feigniug various diseases, but as he did not eat, and seemed inclined to submit to moxas and other means of the same nature, I observed him more closely. The pupils looked on him as a hypochondriac or a maniac, because he complained of a fixed pain in the hypogastrium, although his tongue was neither red nor dry; and be- cause he said he heard a continual noise in his belly, and felt a hand of iron pressing on his intestines for several hours together, and then relaxing them suddenly. n When this oppression came on, he felt something ascendino- from the epi- gastrium that almost suffocated him, and ceased suddenly^ his pa^ino- flatus. He was habitually costive, his faeces were very offensive He passed water very often, and complained of pain in the penis and bladder during micturition; this he attributed to the suppression of the blennorrhased as far as the neck of the bladder. Here the pain and spasms were redoubled, and the bladder seemed perfectly closed. At length, after a considerable time, I was enabled to introduce the point of the catheter 68 CAUSES OF into the neck of the bladder, and the instrument was immediately power- fully drawn into the vesical cavity, as though by a kind of suction. When untouched, the catheter was several times suddenly attracted and repelled alternately, by the convulsive action of the muscles of the perineum and bladder; and its extraction was almost as painful and difficult as its intro- duction had been, so firmly was it held by the neck of the bladder. The vesical contents were rapidly and forcibly discharged. All these circumstances confirmed me in the diagnosis I had formed re- specting the cause of the disease, and I immediately applied the solid nitrate of'silver to the prostatic portion of the urethra. The application was rapid— lasting only long enough to incline the caustic to the right and left, so as to make it pass quickly over the inferior surface of the canal. During the first twenty-four hours, the patient suffered much while pass- ing urine. On the second day, the pain was much less severe, and on the third day, it was scarcely worth notice. During these three days, the urine was thick and muddy, and the last drops were streaked with blood. After this time it became transparent, and the patient was able to retain it much longer. Twelve days after the cauterization, the urine was quite normal, without either deposit or cloud—the last drops were expelled easily, and were as transparent as the first. The patient no longer experienced tension or un- easiness in the perineum, or involuntary contractions of the neck of the bladder; but when his bowels were confined, he still noticed a viscid matter at the orifice of the urethra. The first improvement noticed was in his sleep, which became sounder and longer; then the moral and physical man became more energetic; and lastly, the activity of the digestive organs returned. Within fifteen days erections re-appeared, and after some time the patient experienced noctur- nal pollutions, preceded by erotic dreams, and accompanied with lively sensations. The intellectual powers were the last to be entirely re-esta- blished; but they did not appear to have ever been very active in this patient. At the expiration of a month, his health was quite perfect, and he wished to resume his former occupation. This patient was the first on whom I practised cauterization as a remedy for spermatorrhoea; and I have related his case chiefly to show the active and painful contractions of the neck of the bladder and urethra which occur in such cases. These facts may give an idea of the extreme state of irritation of the urethral mucous lining, and of the influence which this condition must exercise over the se- minal vesicles. The phenomena above described are very often observed in pa- tients affected by spermatorrhoea; their study is therefore important in deciding on its treatment—thus, for example, I have noticed that the greater the state of irritation the more certain are the effects of cauterization; in these cases, also, tonics, ice, and cold hip baths are by no means proper. In the case I have just related sperma- torrhoea was, without doubt, caused by the blennorrhagia, but the excessive masturbation to which the patient had been addicted even SPERMATORRHOEA. 69 before puberty, must have contributed much to produce this unfor- tunate disease, and, probably, from this circumstance it arose that a cure was impossible by the employment of the usual simple means. CASE VII. Abuse of spirituous liquors—Blennorrhagia—Nocturnal Pollutions—Pm- potency—Frequent discharge of urine—Cauterization—Cure. J. D---- at an early age accustomed himself to an excess of alcoholic drinks, but in other respects was remarkably abstemious: at the age of twenty he contracted blennorrhagia, which disappeared of its own accord at the end of about three weeks. A short time after he noticed that noc- turnal pollutions occurred very frequently, sometimes happening eight or ten nights consecutively. The day following these discharges D----was depressed in spirits and suffered from headache, noise in the ears, and daz- zling before the eyes: these symptoms induced him to submit to venesec- tion three times, and to apply leeches to the temples, after which D---- entirely lost all virile power. .After the disappearance of the blennorrhagia a yellowish discharge from the anus came on several times, and was accompanied with a very trouble- some itching. Soon after this the patient had a tetter on the face, for which he took alteratives and mercurials. The skin disease disappeared, but symptoms of irritation of the bladder supervened. In 1824, D----, aged twenty-four, came to the hospital of St. Eloi, in the following state. He was of the middle height, and well made, his skin was pale, his hair black, his face very red, his manner gloomy and taciturn ; he was fond of solitude, showed perfect indifference towards women, and great horror of masturbation. His intellect was dull, his digestion painful, and his limbs weak. He passed urine two or three times an hour during the day, and five or six times in the course of the night, attended by scald- ing and pain in the canal. The introduction of a silver catheter of moderate size excited spasmodic contraction and acute pain in the neck of the bladder, which induced me to propose cauterization to the patient: he agreed to it without hesitation, and I performed it immediately. I introduced the caustic holder into the bladder so as to cauterize the parts near its neck, and I passed the caustic over the prostatic surface as well as over the membranous portion of the urethra in withdrawing it. Im- mediately afterwards there was a pressing desire to micturate, and blood passed with the urine. Baths and barley water were ordered. Daring the following night he experienced a painful seminal emission; he passed urine only once, but with an acutely burning pain. ^ On the following day the patient only passed urine four times, but al- ways with burning and a slight discharge of blood. On the third day he no longer passed any blood, and the scalding was very slight. On the fourth day the emission of urine took place every three or four hours only, and the discharge arising from the cauterization had ceased. On the following days emptying the bladder was performed less and less frequently; seminal discharge no longer followed; the patient regained his 70 CAUSES OF spirits; his health became perfectly re-established, and about the fifteenth day after the cauterization he left the hospital. In this patient the blennorrhagia had not been preceded by exces- sive sexual intercourse or masturbation; but the abuse of alcoholic stimulants is almost as pernicious in its effects on the genito-urinary organs; besides this he possessed a strumous habit, which showed it- self by the tetter on the face and the abscess at the margin of the anus. It is especially in cases of this kind, that tonics, ice, and cold bathing fail, and are even injurious; happily, we possess a powerful remedy in cauterization. In this case the tetter on the face having disappeared, inflamma- tion of the vesical mucous membrane occurred; this was very in- tense, the patient passing urine two or three times in the hour; from this time the urinary symptoms predominated, on which ac- count catheterism was accompanied with acute pain in the prostatic region, and spasmodic contractions of the neck of the bladder. Not long since cauterization of the prostatic portion of the urethra was looked on as the extreme of rashness, so much w7as the introduc- tion of the least particle of the nitrate of silver into the bladder dreaded; although these fears were only founded on argument, they were gene- rally received,'and seemed so natural that I was influenced by them for several years. I have stated in another place the means by which I shook off these foolish fears, and the successful results that have followed the application of the nitrate of silver to the mucous mem- brane of the bladder in catarrhal affections of that organ.1 Since that time, whenever I meet with cases in which the affection of the prostatic mucous membrane extends to that of the bladder, I begin by cauterizing the latter, and I continue the application as far as the bulb of the urethra whilst withdrawing the instrument, by inclining it rapidly to the right and left. It is not to take the length of the canal that I introduce a catheter in these cases, but in order to empty the bladder completely, so that the nitrate of silver may act with more energy. We have just seen the effect of this treatment: a patient who previously passed urine two or three times in the hour was enabled to retain the excretion as long as is usual, and at the same time the spermatorrhoea from which he suffered was cured. This case also confirms in a remarkable manner what I have above stated respecting the relations that exist between the diseases of the urinary, and those of the spermatic organs. 1 Vide Le9ons de Clinique, &c. SPERMATORRHEA. 71 CASE VIII. Masturbation—Blennorrhagia, repeated, anti-venereal treatment—Diurncd pollutions—Increasing iveakness, especially of the mental faculties—Ex- treme emaciation— Cauterization, and cure after sixteen yars. Venereal excesses, relapse—Cauterization again performed with success. M. V----, of spare habit and nervous temperament, was addicted to mas- turbation about the age of puberty, but abstained when he perceived his health affected. He again practised it as soon as his strength began to re- turn, and renounced it as soon as he perceived his health endangered. He again regained his strength, and applied himself with diligence and success to the study of law. At the age of eighteen he contracted blennorrhagia, which was treated during six months with injections of acetate of lead, sulphate of copper, &c. The discharge disappeared after a journey on horseback—again came on soon after, and again stopped. Urethral discharge was afterwards often ex- cited by very slight causes. Independently of tonics, injections, and astringents, which were prescribed for this patient without the least discretion, bichloride of mercury, mercurial pills, sarsaparilla, and friction with mercurial ointment, were recommended. His health became more and more disordered; he was subject to headache and pains in his limbs and loins, accompanied with debility, loss of sleep, and frequent attacks of fainting. M. V----attributed all these symptoms to the presence of a venereal virus of the system, and as they increased several times after sexual inter- course, he was persuaded that he had on each occasion received fresh in- fection. At length the care of his health became quite a kind of monoma- nia. He abandoned the career he had followed for eight years, and came to Akmtpcllier to study medicine for the sole purpose of arriving at the cause of his complaint, and finding a remedy for it. Returning always to the idea of a syphilitic virus, he submitted himself successively to all the anti-syphilitic modes of treatment he could discover recommended by au- thors, and combined them together in various ways. Still, however, his strength diminished by degrees; his digestion became painful and laborious; and he was annoyed by flatus and obstinate^ consti- pation, which he combated by the frequent use of purgatives. His intel- lect became so far weakened that he could not fix his attention during a lecture, and soon even he became unable to comprehend what he read. He attended the courses of the faculty, but he was unable to remain during half a lecture without experiencing fatigue and impatience: his head becainc congested, and he felt a constant desire to change his position, or to walk. , Though formerly competent to argue with pleasure on the most abstract propositions, he was now unable to follow the simplest reasoning; and the most recent and important facts escaped his recollection. He was tor- mented by attacks of vertigo, loss of sight, and noise in the ears. The least intellectual excitement induced fits of pain in the head; and slight congestions were often excited by the digestive process, by flatulence, or by efforts at stool. The patient having his mind continually occupied by these symptoms at (2 CAUSES OF length persuaded himself that part of his cerebral substance had been ab- sorbed, and that his cranium only contained the nerves of sense; he thought he could feel these bathed in serum, and he was obstinately of opinion that he was threatened with an attack of apoplexy. On the other hand, his character became sad, variable, and unsociable; he disliked music, of which he had previously been passionately fond; he slighted all his friends, and his misanthropy became so great that when he saw an acquaintance in the street he turned on his heel in order to avoid him. Tormented by a constant desire for motion, he was unable to remain long in the same place; and this restlessness, together with his love of soli- tude, made him wander constantly in all the by-ways of the neighbourhood of Montpellier. He was careless of every thing, and often in distress from having neglected his affairs. At length, after remaining seven years at Montpellier, M. V-----came to consult me. From the first words he said to me I suspected that he suffered from diurnal pollutions, and I questioned him closely on this head; but he had never noticed spermatic discharges either whilst passing urine or fasces, and he persisted in the opinion that his disorder arose from a ve- nereal virus still existing in his system. A short time afterwards, to relieve an attack of cerebral congestion, he applied leeches to the anus, and was unable to leave his bed for three months. The observations he made during this period convinced him that my dia- gnosis was correct, but he still wished to treat himself, and, among other means, placed pounded camphor between the glans penis and prepuce, in order to act directly on the genital organs: a few hours after, on going to stool, he passed a large quantity of semen, fainted, and remained some time before he was able to call assistance. I never witnessed a more repulsive sight than that I saw on reaching M. V—'s residence; the disorder and dirt that surrounded him evinced the most perfect carelessness. Muddy urine, of a fetid smell, filled a dirty ves- sel placed near the head of his bed on a chair covered with dust and clothes. He was extremely pale, and greatly emaciated; he threw himself about on his bed like a person moribund, his limbs were cold, and his pulse weak and irregular. As soon as he was able to understand me, I proposed cauterization of the prostatic mucous membrane to him; he joyfully consented, and I performed it the same day. The moderate sized silver catheter, which I introduced first to empty the bladder, excited spasmodic contractions of the canal, and appeared to "ive considerable pain, especially in the prostatic region—further confirming me in my opinion that the prostatic portion of the urethra had been a 'long- time the seat of chronic inflammation. The application of the caustic presented nothing worthy of record. Two days after the operation, the patient experienced a feeling of vigour in the genital organs, and of general comfort which gave him hope. Soon after he regained his spirits, appetite and sleep returned; his voice acquired strength; he felt his taste for music return; he sought out his friends- his face entirely changed its expression, and his mirth became even boisterous. At the expiration of fifteen days from the operation he experienced ve- nereal desires, and erections were frequent and energetic. His appetite was good, and his digestion acted with an unusual energy. SPERMATORRHOEA. 73 His health continued to progress favourably until, to hasten his restora- tion, he introduced a paste containing acetate of lead and copaiba into the urethra. After this the spermatic discharges reappeared, inflammation ex- tended to the testicles, and suppuration occurred in the left, notwithstand- ing active measures. An ounce of pus, which seemed to me to be dis- charged from the tunica vaginalis, followed a puncture on the left side; after the escape of this, all the disorders disappeared by degrees, and con- valescence proceeded rapidly. Within a month, all M. V----'s functions were performed with a regularity which he had not enjoyed for twenty years previously. M. V----possessed considerable natural talents, and related the sensa- tions he had experienced, the opinions he had formed on his disease, and the motives of his most extraordinary actions, in a very lively manner. Two months afterwards, however, M. V----came to me as sad as ever. He informed me that, being tormented by frequent erections, he had more consulted his desires than his strength. This want of restraint had repro- duced in a fortnight all the irritation under which he had previously suffered, with the disorders following it. He had then broken off these habits, but his health had not become re-established because diurnal spermatic dis- charges had re-appeared. I performed a second cauterization similar to the first, and with an equally good result; and this time M. V----, having gained experience, became more moderate in his conduct and returned to his residence. This case ought to be placed by the side of the first two I have related in which the post-mortem appearances are recorded. The symptoms were almost as severe, they presented the same characters, and gave rise to the same delusions as to the state of the brain. The rapid re-establishment of the intellectual functions in M. V-----proves that he had no greater Cerebral disorganization than the other patients; it seems probable, however, that in the first cases the alterations of the spermatic organs had proceeded further than in the case just related. The obstinacy with which M. V-----continued to treat an imagi- nary venereal affection is remarkable; we have already seen an in- stance of it in the fifth case I have recorded. In neither case were there syphilitic symptoms, either primary or secondary. Such pre- convictions are very common in nervous patients, and their surgeons sometimes share them. The wandering, dull, and deep-seated sen- sations complained of are especially liable to be mistaken for the pain in the osseous system which follows syphilis. This case is well suited to show how difficult it is for patients to discover those seminal discharges which take place whilst emptying the bladder and rectum. M. V-----had only one wish—to discover the origin of his disorder. To this desire he sacrificed every con- sideration, and for this end he came to Montpellier to study medi- cine: he was not far from the truth, for he thought constantly of the blennorrhagia which had preceded the disease, yet after fifteen years of daily observation and seven years of application to medical studies he had not even suspected the existence of involuntary sper- matic discharges. 74 CAUSESOF Lot us judge by this how many hypochondriacs owe their tor- ments to the same cause. CASE IX. Blennorrhagia, followedby excoriations of the glans pen is—Spermatorrhoea — Cauterization unsuccessful—Artificial sulphur baths—Cure. M. B----, Lieutenant of Light Cavalry, affected with varicocele, con- tracted blennorrhagia in 1818. Emollient drinks and warm baths reduced this attack at the end of a month to a slight discharge, which soon after en- tirely ceased; exeoriations had, however, previously appeared around the orifice of the glans penis. These excoriations healed in about twenty days, under the use of cold lotions: they re-appearcd four months after, and were cured by the same means; they afterwards showed themselves periodically every three or four months, and were not in any way affected by anti-vene- real treatment of a very active kind, which the patient submitted to. Each time their appearance was preceded by pain in the perineum and testicles, increased by the passage of fasces. After the expiration of five years, the excoriations ceased, and the pain, which had previously been relieved by their appearance, became permanent, and was accompanied by discharge of semen during defecation. The pa- tient suffered pain in the region of the kidneys, which became insupporta- ble after remaining under arms for a few minutes; his urine deposited a whitish sediment. Sea bathing increased the pain in the perineum, and the difficulty of passing urine: fresh water bathing increased the pain in the loins: his di- gestion was disordered. When M. B----came to ask my advice, I at first suspected that a stric- ture existed, and endeavoured several times to examine the urethra with a soft wax bougie; each time, however, the instrument was arrested in a diffe- rent situation, and when withdrawn, presented a different form. After a few days' rest, I introduced an ordinary catheter into the bladder, without meeting with any permanent obstruction, but with severe pain to the pa- tient, especially in passing the bulb of the urethra. There was, then, in this patient, only a state of extreme irritability of the urethral mucous mem- brane. I hoped to cure this by means of cauterization with the nitrate of silver, as I had done before; but, on this occasion, no effect was produced. Recollecting, then, that the disappearance of the excoriations on the glans penis had been followed by an increase of the disease, I prescribed artificial sulphur baths, containing two ounces of sulphuret of potassium in each. At first, the baths produced an excellent effect, but afterwards a severe ir- ritation of the stomach, and the return of all the symptoms were occasioned. I discovered, however, that sulphuric acid had been added to the last baths: this was omitted, and as soon as the patient resumed the use of the baths containing sulphur of potassium only, his state improved rapidly. At the expiration of a month, his pain had disappeared, his urine was transparent, and the passage of fasces was no longer accompanied by seminal discharge; digestion became active, and M. B---- soon regained his strength and stoutness. SPERMATORRHEA. 75 M. B----, previously to the attack of blennorrhagia, had never suffered from any cutaneous affection; from this date ulceration ap- peared periodically round the glans penis: this might be supposed to have arisen from a syphilitic affection, but it resisted the most ac- tive anti-venereal treatment. Its appearance put an end to the pain in the perineum and testicles: as soon as the sores healed, these symp- toms returned, and diurnal spermatic discharges accompanied them. It seemed probable that the application of nitrate of silver would lessen the morbid irritability of the urethral mucous membrane; it . produced no appreciable effect, however. Artificial sulphur baths were used with advantage when they con- tained only sulphuret of potassium; when sulphuric acid was added, in order to increase their activity, all the symptoms re-appeared; on resuming the use of the sulphuret of potassium alone, the cure proceeded with rapidity. It is remarkable, also, in this case, that river bathing always in- creased the pain in the loins, while sea bathing aggravated the pain in the perineum. Anomalies of this kind abound in the treatment of spermatorrhoea, and much careful research is often necessary to explain them; the relation of such cases will, however, put practi- tioners on their guard by furnishing analogies for their guidance. Baths containing sulphuret of potassium are especially indicated whenever a cutaneous affection co-exists with considerable sensibi- lity of the mucous surfaces; but, when the irritation of the genital organs is very severe, they are often contra-indicated. In such cases, cauterization, though it may not cure, at least will diminish the excessive sensibility.1 Causes.—I have before stated that the cause of spermatorrhoea is a most important circumstance for our consideration. The truth of this becomes more evident as we proceed; but it often happens that several causes act simultaneously or successively, and that we are not able clearly to discover which of them exercises the great- est influence in the production of the disease. Blennorrhagia is the most active and the most direct, as well as the most easily appreciated, of all these causes, and this is why I have commenced by reporting cases in which it has played a princi- pal part. When these cases are examined separately with some attention, we soon perceive that the discharge has been preceded, accompanied, or followed, by some circumstances capable, by their own action, of giving rise to spermatorrhoea. It is necessary to pay attention to this point. In one patient I had occasion to treat, hereditary pre-disposition 1 M. Lallemand has reported many "more cases of involuntary spermatic discharges following blennorrhagia; as, however, they differ very slightly from one another, and the same treatment was applied to all, I have thought it as well to omit the re- mainder of them. In fact, the connexion between blennorrhagia and involuntary spermatic di.-charges, seems so well established by the cases above related, as to re- quire no further confirmation.—[H. J. McD.] 7G CAUSES of probably existed/for his father had been also affected by spermator- rhoea; others had a very marked lymphatic temperament, as in the fifth case I have reported. Many were naturally weak, delicate, and nervous; or their health had been injured by bad habits, or a too sedentary life; others, again, suffered from tetters, hemorrhoids, or varicocele. By far the greater number of the patients who have come under my care, had committed excesses, either in coitus, masturbation, or the use of alcoholic stimulants. Blennorrhagia in many cases is neglected; patients are too timid to mention it, or too careless, and too much occupied to pay atten- tion to it; in other cases, the treatment is rendered useless by im- prudence or excess; but, in many cases the inflammation produces injurious effects by its simple presence for a short time. Many of my patients had had two attacks of blennorrhagia, and in one case as many as seven were experienced, before spermatorrhoea commenced; but, I must remark, that in these cases, the recurrence of the discharge is not always due to a fresh infection, as the pa- tients and many surgeons believe; the facility with which blennor- rhagia often recurs without coitus, is sufficient evidence that it may return spontaneously, or, at all events, from very slight excitement. This disposition to a recurrence of the discharge may be easily un- derstood, if the increased development of the capillary system in the mucous follicles after repeated or continued attacks of inflammation be taken into consideration. These patients almost always in the end suffer from spermator- rhoea. ^ In fact it is difficult to avoid, sooner or later, an extension of the inflammation of the prostatic mucous follicles to the sperma- tid ducts. We must not, however, mistake for semen, the mucus which constantly moistens the urethral orifice in such persons; and, on the other hand, we must be careful to guard against repelling too lightly their apprehensions on this account, because chronic catarrh of the urethra often accompanies spermatic discharges, and is a sign of their presence by no means to be disregarded. In some of the cases I have seen, involuntary spermatic discharges seem to have been kept up by venereal taint, and such have been relieved by anti-venereal treatment; on the other hand, in some cases, the seminal discharges have not seemed to be influenced either by the venereal affection, or the means employed for its cure. Anti-venereal treatment is frequently also employed in patients who have suffered merely from blennorrhagia, and in a very nume- rous class of cases it produces a serious increase of the irritation in the genital organs, and causes the appearance, or exasperates the effects, of involuntary spermatic discharges. Cases of this nature often present considerable difficulties of diag- nosis ; and the solution of these obscurities is always of much im- portance in determining the treatment to be followed. Anti-venereals are not the only therapeutic agents which produce SPERM ATORRHOEA. 77 such unfortunate effects; those which a blind routine of practice em- ploys in cases of blennorrhagia have not been less injurious; among these it is especially necessary for me to mention astringent injections, copaiba, cubebs, tonics, and bitters employed too soon, or in extreme doses. All these means act more or less by exciting the genito-uri- nary organs; it is therefore easy to understand that their untimely or immoderate use must favour an extension of the inflammation from the urethra to the mucous membranes which are continuous with it. I am far, however, from wishing to proscribe the use of these re- medies, and I willingly bear testimony to their beneficial effects, after the inflammatory symptoms have been subdued. A time ar- rives when the mucous membrane of the urethra, like all other membranes of the same class, requires the employment of tonics and astringents; but in the way they are daily prescribed, I am convinced more harm than good results from their use. Lastly, spermatorrhoea is often made worse by the very means employed for its removal, and among these may be ranked cold baths, ice, tonics, bitters, sulphur baths, &c. In all the cases I have so far considered, blennorrhagia has exer- cised the chief influence in inducing spermatorrhoea; it is, however, rarely sufficient singly to bring on this fatal disease, and the causes, which in the cases I have related have been accessory only, may ex- cite, each by its own action, more or less serious involuntary seminal discharges. These accessory causes exercise too great an influence to be passed over in silence: they are numerous and various, and succeed or are combined with one another in different ways—two cases seldom occurring which resemble each other exactly. The further we advance the more plainly we shall see how neces- sary it is for the different forms of spermatorrhoea to be described as simple affections—how necessary it is to regard them in all their aspects, and to take account of all the circumstances which assist in producing them. In practice we find it indispensable to weigh well all the points connected with a case of spermatorrhoea, before de- ciding on our diagnosis, prognosis, or, especially, on our treatment. Mode of Action.—-In all the cases I have related the urethra retained an excessive irritability, especially in the prostatic region; the patients felt constant pain, weight, heat, darting or painful tick- ling in this situation; and these sensations were increased by the passage of urine. Catheterism, though performed carefully, always produced acute pain and spasm, sometimes sufficiently violent to simulate stricture. The catheter was especially arrested at the neck of the bladder, and often it could only be passed on after waiting a considerable time. The patients felt as if the instrument had passed over spots of ulce- ration. They were convulsively agitated, and all the power of a determined will was often insufficient to restrain their expressions of agony. Their faces were distorted, and their whole bodies covered by a profuse sweat. As soon as the catheter was withdrawn, a con- siderable quantity of florid blood was, in most cases, discharged. 78 CAUSES OF These different phenomena, which occur with more or less severity in every case, sufficiently indicate that the mucous membrane of the urethra possesses an extreme irritability, especially in the prostatic region. Several of the symptoms are even sufficient to make one suppose that it is granular, and very vascular or excoriated. ^ A few of the patients I have treated experienced symptoms indicating still more positively an affection of the prostate, such as swelling of the organ, sense of weight in the rectum and perineum, darting pains in the neck of the bladder behind the pubes, &c, and, in one case, the inflammation of the prostate ended in suppuration. In many cases the testicles were swollen, inflamed, and painful (as in thefifth and ninth cases.) The spermatic cords also shared the condition of the testicles as in these cases. Lastly, in some patients who have con- sulted me, the seminal emissions contained blood or pus. Thus, in all such cases the blennorrhagia leaves great irritation and morbid sensibility in the urethral mucous membrane, most se- vere in the neighbourhood of the prostate, the principal seat of the primary disease. In many cases the inflammation extends its influ- ence to the testicles by means of their excretory ducts, and this should make us suspect that the spermatic organs may retain the same irritability as the urethra. The same phenomena are manifested in the urinary organs; indeed, their resemblance to the spermatic is remarkable in more respects than one. Many of my patients had experienced acute inflammation of the bladder, (as in the seventh case.) Others had suffered from symp- toms of chronic inflammation of that organ. In a few, the inflam- mation seemed even to extend to the kidneys, if we may judge from the pain, spasm, and dragging felt in the loins, and the changes ob- served in the urine. These are the only circumstances which enable us to.appreciate the state of the kidneys—organs out of reach of physical examina- tion; but analogy confirms the results deducible from them. After having unequivocally proved the presence of orchitis, under similar circumstances we may well suspect the presence of nephritis, espe- cially when we observe symptoms which are otherwise inexplicable. Post mortem inspections have shown, in many cases, that these analogies do not deceive us, and I have found in the kidneys varied and serious alterations of structure which could only have been pro- duced by inflammation. All such patients, without exception, pass more urine during the twenty-four hours than natural: so that, although the kidneys may not be actually inflamed, it is evident that they are in a state of more or less active irritation, or, at least, of sufficient excitement conside- rably to increase their action. The same condition obtains in»the testicles, for although they may not be the seat of either inflamma- tion or pain, their activity is increased. The semen is not only ex- pelled involuntarily, but it is also secreted in greater abundance SPERMATORRHEA. 79 than natural; for unless the secretion were increased, the seminal emissions would not be so frequent, and the weakening and ex- haustion would not proceed so rapidly. The urine is not only more abundant but its nature is also changed, even after the pus and mucus contained in it have been removed. It is paler and more watery, and contains less urea and uric acid than natural. The semen also loses its peculiar odour, its colour, and its consis- tence ; it is, in fact, less perfectly formed than it ought to be. Lastly, all these patients experience a frequent desire to micturate, depending on the irritation of the bladder. Some are unable to hold their urine more than half an hour or an hour, (case seventh.) In all, the desire of micturition comes on suddenly and imperiously; the spasmodic contractions of the bladder overcome all the efforts of the will, and the emission takes place suddenly and convulsively. This phenomenon gives us an exact view of what passes in the vesiculaa seminales during involuntary seminal discharge; some pa- tients even feel distinctly the contractions which announce an emis- sion as inevitable ; others have not sufficient practical knowledge to re- cognise them, but their statements show that the same phenomena are experienced, even when analogy would not lead us to admit their presence. The analogy is, however, very evident, for it is especially during the expulsion of* the last drops of urine that the spermatic dis- charge takes place, and the two classes of symptoms are in general relieved or exasperated at the same time and by the influence of the same causes. This remarkable resemblance maybe explained very simply by referring to the fact, that blennorrhagia has its principal scat in the prostate, where the spermatic and urinary apparatus meet, and the connexion of the two classes of phenomena enables us still better to understand the causes and mechanism of spermatorrhoea. Treatment.—It is by no means astonishing that in this state the application of the nitrate of silver to the prostatic mucous membrane should produce effects more direct and powerful than those of any other remedy. We know well how promptly and effectually nitrate of silver acts on tissues which are granular, injected or swollen from the effects of prolonged inflammation. Its results are especially evi- dent in the chronic ophthalmia of scrofulous patients. Soon after the nitrate has been applied, the tissues empty themselves, contract and become paler, and they retain an energetic action which pre- serves them from a relapse, to which the patients are often liable when a cure has been obtained by other means. On this account I have employed nitrate of silver in the chronic inflammation of the vagina and neck of the uterus, which keeps up leucorrhceal discharge in °so many cases, and in chronic catarrh of the bladder, which is so difficult of cure by other means; and I have always had cause to be pleased with its action in these affections. The nitrate produces the same effects on the mucous membrane of the prostatic portion of the urethra; the organization and sensibility of the membrane are con- 80 CAUSES OF SPERMATORRHEA. siderably altered, and this change is soon felt by the organs which are immediately influenced by its condition. Hitherto relaxation of the ejaculatory ducts has been alone thought of in cases of spermatorrhoea, and this exclusive idea has been a cause of much malapraxis; but to attribute all cases of spermatorrhoea to irritation of the spermatic organs only, would be quite as erroneous and injurious. One patient I had occasion to treat was cured by tonics, another by antiphlogistics (case fifth;) and I shall have tore- cord other cases of the same nature, but they are very rare. There exist almost always at the same time irritability and debility, extreme sensibility, and loss of tone in the spermatic organs. This state, however, we observe in the chronic affections of all mucous mem- branes; indeed, we may even say, as a general rule, that the weaker the organs or individuals, the more easily are they excited. By acting on the surface of the engorged tissue, its morbid sus- ceptibility is changed, and a contraction is afterward excited in it, which gives it energy. This is why one application of nitrate of silver generally suffices to produce a perfect cure. But when the disease has existed a long time the genital organs share the general debility of the system, and after the chronic in- flammation has disappeared, it becomes necessary to aid the relaxed tissues to resume their former energy; nothing now contra-indicates the exhibition of tonics of all kinds, which complete the cure com- menced by cauterization. This explains how cold and sulphur baths, ice, &c, are useful after cauterization to individuals who were injured by them at first, (case ninth.) Symptoms.—Whilst examining the mode of action of blennorrhagia in producing spermatorrhoea, I have already referred to the symp- toms which occurred in the cases reported; in the other cases I have seen, the symptoms have been common to all kinds of spermatorrhoea, and I cannot notice them here without being exposed, by and by, to useless repetitions. I shall, therefore, only call attention at present to the insidious character of the general symptoms produced by these discharges, which often simulate the characteristic marks of cerebral affections, gastritis, diseases of the heart, urinary calculus, &c. The real cause of the symptoms is very difficult of detection in cases of spermatorrhoea; some of my patients had studied medicine for many years, in the sole hope of discovering it (case eighth;) we maJ Ju(ige from this how frequently cases of spermatorrhoea are'mis- taken for other affections. ( 81 ) CHAPTER IV. CAUSES OF SPERMATORRHOEA. Cutaneous Affections. The following case is that of a student of medicine who came under my care. At my request, he put it into its present form for publication. CASE X. Itch during ten months at about the age of fourteen—Pain in the epigas- trium— Tumour of the testicle—Chronic inflammation of the bladder— Diurnal spermatic discharges—Hypochondriasis—Cure by Cauteriza- tion at the age of twenty-eight. " Up to the age of fourteen, my health was very good, but at this period I was afflicted with psora, which continued for ten months in spite of va- rious modes of treatment. Scarcely was this cured than I felt a sharp cut- ting pain in the epigastrium, after a time becoming dull and extended. The itching I had before felt over the whole body seemed to affect my head, and when I had been exposed to cold or damp, or had kept my head unco- vered, the scalp became covered with little pimples, which, when scratched, formed scabs. " An induration of the left testicle, of about the size and shape of a bean, appeared, and continued during eight months. My digestion became de- ranged; my complexion darkened, and my shoulders became round; the epigastric region was so tender that I could not bear the weight of the bed- clothes, and when erect I seemed to have a weight suspended within me. At this time I was at school, but during the vacation I took an opportunity of consulting my family surgeon; he attributed all I felt to too rapid growth. Not being satisfied with this explanation, I consulted a bone-setter well known in°the neighbourhood, who said my breast bone was dislocated, pre- tended to replace it, applied a plaster, and sent me away as I came. " This state of things continued till I was eighteen, when I experienced a slight pain in making water, and became very costive. The epigastric pain "diminished, however, and I gained flesh. "At the age of twenty-two, after domestic trouble, and perhaps, also, from the effects of some slight excesses, I experienced the following symp- toms:—Progressive emaciation; lassitude after the least exertion; yellow, dry, and earthy skin; burning heat, especially in the palms of the hands and the soles of the feet; creeping sensation over all the body when I began to perspire; habitual sensation of internal heat; constant pain in the epi- gastrium and right hypochondrium; obstinate constipation; difficult diges- tion attended with the secretion of flatus; acid eructations, smelling of 6 82 CAUSES OF SPERMATORRHEA. putrid eggs; sometimes cold and clammy sweats, especially when I had taken any acrid or acid substance, or when I experienced the slightest contradiction, for I had become very irritable; impossibility of enduring hunger; difficulty of holding my urine, with pain at the base of the glans penis, and spasm at the neck of the bladder during its emission; the urine presenting, when cold, a red muddy appearance, with an abundant brick-dust sediment, and a cloud of flocculent matter in suspension; vene- real desires, with entire loss of the power of coitus; a discharge of a trans- parent and viscid matter after the least erection; an abundant discharge of a white, serous, slightly opaque matter from the urethra on going to stool; scurf and itching of the head; noise in the ears; loss of memory; feeling of discontent with myself; extreme timidity; dislike to all amuse- ments save solitary walks; deep melancholy without cause; loss of courage; sadness of countenance. All these symptoms were aggravated after horse exercise. "I consulted various practitioners, all of whom considered my state as nervous, and told me I was hypochondriacal; some, however, recommended emollients, baths, a vegetable and milk diet, with exercise and amusement; others prescribed bitters, tonics, alteratives, preparations of sulphur exter- nally and internally, an issue, &c. All these modes of treatment were use- less, or rather they increased my disorders, and in my painful condition I tried to contract a new itch, without success. "I now, at the age of twenty-eight, came to consult you......The introduction of a catheter gave me violent pain, and caused spasm of the urethra, especially near the bladder. The application of the nitrate of silver dispersed the chronic inflammation which kept up the involuntary discharge of semen, and eight days after the cauterization I felt stronger, my limbs seemed more free, my urine became clear, and I began to hold it longer; my countenance appeared gay, and my complexion became fair. I had a nocturnal emission, a thing I had not experienced for a long time. At the expiration of three weeks I found myself in a perfectly new state; during a period of ten years I had never felt so well. The cerebral func- tions, and those of the stomach, intestines, bladder, and genital organs, were performed with an unaccustomed energy; my skin had lost its yellow and earthy appearance. The internal burning and the cutaneous tingling were removed. Nocturnal emissions, however, have since become very frequent, and from the fourth to this day, the twelfth of July, I have had four • ne- vertheless, my strength has -continued to increase daily, and I hope that a second cauterization will remove altogether a disease which all previous treatment had only served to increase/' I cannot now say whether I yielded to this patient's desire for a second application of the nitrate of silver, but I certainly did not share his uneasiness respecting the noeturnal emissions. When these follow involuntary diurnal discharges of semen, they show a considera- ble improvement in the state of the genital organs; they prove in fact, that the semen is no longer expelled as before in an almost con- tinuous manner. Indeed the patient experienced from this moment a rapid amelioration in all his functions, and an increase of strength which would be inexplicable under other circumstances. The desire for a fresh cauterization was not alone due to the fear of nocturnal CUTANEOUS AFFECTIONS. 83 emissions; it arose partly from a kind of blind faith in a remedy which had produced such prompt and satisfactory results. The desire for a second application'of the nitrate of silver is felt by many of the patients who have once experienced its effects, and I have often been obliged to resist it. We must only return to this remedy when much remains to be effected, and when all improvement has been arrested for some time; so long as progress is made, how- ever slow it may be, there is reason for hoping that regimen, exer- cise, and a moderate use of the organs, will be sufficient to confirm the convalescence. The rapid cure of the hypochondriasis, treated for so long a time, and with such little success, by so many different means, sufficiently testifies that it originated in the involuntary loss of semen. But to what cause can we attribute the spermatorrhoea? After the disap- pearance of the cutaneous affection, symptoms of chronic inflamma- tion of the stomach, and afterwards of the bladder, appeared. Then a tumour arose in the left testicle. The connexion between irrita- tion of the skin and that of the mucous membranes is well known, and I have shown the manner in which affections of the urethra ex- tend to the testicles. It is then easy to understand the course by which irritation extended to the spermatic organs, and excited spas- modic contractions of the seminal vesicles. The pain wrhich the patient experienced in the neck of the bladder proves, also, that the involuntary discharge was really kept up by chronic inflammation in that situation; the frequent desire of mictu- rition and the state of the urine, together with the sensation pro- duced by catheterism, and especially the rapid cure effected by the . nitrate of silver, are further evidences in support of this opinion. CASE XL Cutaneous affections—Repeated attacks of urethritis—Application of ni- trate of silver—Cure. M. N----of an irritable constitution and subject to frequent and varied cutaneous eruptions from his infancy, suffered during youth from several slight attacks of urethritis, which always passed off rapidly; at the age of twenty-one he married. Still, however, the discharges re-appeared several times with various degrees of duration and intensity, alternating sometimes with tetters and at others with boils. The urethritis supervened once on an eruption of pimples on the head which had lasted very long and left cicatrices similar to those of small pox. At other times unyielding attacks of ophthalmia and violent rheumatic pains came on during the absence of the cutaneous affection. Several times slight excoriations became irritated in a remarkable manner, and a simple scratch on the leg kept the patient in bed for several months. In 1820 on an attack of numerous and large furuncles, a more intense and painful urethritis than usual supervened. I found 31. N----■ in an extreme state of prostration and agitation, excited by harassing suspicions as to the nature of this discharge, which was 84 CAUSES OF SPERMATORRHEA. abundant and greenish and resembled in all respects that of an intense blen- norrhagia. As I knew my patient's constitution, I thought that the dis- charge depended on the general cause which had excited the former attacks, and therefore prescribed antiphlogistic^ and derivatives, to which it yielded. I afterwards advised emollients and alterative drinks, and still later the use of the warm sulphuretted springs: M. N----went successively to Cau- terets, Luchon, and Aries, near Perpignan. At the expiration of three years his general health was improved, but the attacks of urethritis re-appeared from time to time, especially in winter, when irritation no longer existed in the skin or any other organ; and he de- sired much to rid himself of these periodic discharges which embittered his existence. I had previously successfully used the nitrate of silver in sub- stance in several cases of inveterate blennorrhagia, and I proposed its use to him with the hope of considerably modifying the action of the urethral mucous surface. He submitted to it with eagerness, and the results sur- passed my most sanguine expectations. Twelve years afterwards, M. N----had not perceived the least trace of his distressing discharges, although he had travelled much, and had not restricted himself to any regimen or privation. But he soon perceived much more important changes. His venereal desires became more active and more imperious, his erections took on a new energy, and ejaculation no longer took place so precipitately as before; in fact he found himself at the age of fifty-five more vigorous, in all respects, than he had been at twenty. This single cauterization produced then a perfect revolution in the state of M. N.-----'s genital organs, and its effects remained even after the expiration of twelve years. To obtain a correct idea of the importance of the change which had taken place in the urethral mucous membrane it is necessary to remark, that M. N----- remained subject to the same cutaneous eruptions, and that they alternated as before with ophthalmia, at- tacks of gout, wandering pains in the breast, abdomen, ^c, but that from this time the urethra was never the seat of the inflammation, which still continued to attack the other organs. Thus, although the first cause continued to act on the other organs, the part cau- terized remained, after twelve years, free from its influence. On the other hand, if we may be allowed to judge by analogy with the preceding cases, and by the general symptoms which accom- panied the repeated attacks of urethritis, they must have produced spermatorrhoea, although the patient himself did not suspect it. This is the only way in which we can explain the increase of energy in the genital organs notwithstanding the effects of age, and the in- creased vigour of the whole economy in spite of more frequent sexual intercourse. In fact, then, the nitrate of silver not only put an end to the dis- position to urethritis, but also destroyed a powerful and continually debilitating discharge, which was undermining the patient's consti- tution, without his being able to discover the cause of his weakness. CUTANEOUS AFFECTIONS. 85 CASE XII. Pruriginous eruption around the genital organs—Two attacks of blennor- rhagia—Nocturnal and diurnal emissions—Cure by means of sulphu- retted baths. M. L----, at the beginning of the year 1824, was attacked by a prurigi- nous eruption on the scrotum, which extended rapidly and covered the ge- nital organs. After the least irregularity of diet, the surface of the scro- tum assumed an inflamed appearance, and secreted a fetid discharge accom- panied with violent itching. Baths, lotions of milk, decoctions of various kinds, and sulphur ointment, only gave temporary relief. In the month of June, 1824, four months after the first appearance of the eruption, M. L----contracted a urethral discharge; the inflammation accompanying this was very slight, and the patient subdued it by baths and emollients. Ee attempted to take balsam of copaiba, but was soon obliged to leave off its use on account of the irritation it produced in the digestive organs. The urethral discharge diminished rapidly, but did not entirely disappear, a slight oozing of a viscid pearly matter remaining, which formed, at the orifice of the glans, a little crust which the patient was obliged to remove in order to give passage to his urine. This discharge he neglected, and shortly after he noticed that semen was passed in large quantity during defecation. In the month of January, 1825, he contracted a second ure- thritis, which was more severe than the first. Acute pain was present in the fossa navicularis, and after a time in the region of the prostate. In a few days the inflammation was accompanied by general fever. The patient was then submitted to a rigid antiphlogistic treatment, and at the expiration of a week the local and general symptoms were much relieved; shortly after the discharge ceased entirely. In the month of February, M. L-----rubbed in mercurial ointment in order to prevent a venereal contagion. This inunction entirely removed the cutaneous disease of the scrotum, but a few days afterwards the old discharge re-appeared, accompanied with itching of the anus, and contrac- tion of the sphincter ani; feeling of arterial pulsation in the lower part of the rectum, especially after meals, when sitting, or during defecation; ob- stinate constipation; urine depositing a quantity of whitish flocculi, which formed on cooling an abundant cloud suspended in the middle of the fluid; constant oozing of a fluid resembling semen, which formed a crust at the orifice of the urethra; abundant seminal emissions during defecation; noc- turnal emissions accompanied by pain of short duration, but sufficiently acute to arouse the patient from a deep sleep; extreme sensibility of the canal on the introduction of a catheter, with acute pain in the prostatic re- gion; the retina very sensitive to the effects of light; noise in the right ear, worse at night than in the morning, and difficult digestion accompanied by abundant discharge of flatus. I ordered for this patient twenty-four sulphuretted baths containing at first one ounce, then one ounce and a-half, and afterwards two ounces of sulphuret of potassium. These means alone sufficed to perform a perfect cure at the expiration of two months. It is possible that both attacks of blennorrhagia in this patient were contracted in the ordinary manner, by contact with blennorrhagic 86 CAUSES OF SPERMATORRHCEA. virus ; but at the same time this does not seem probable, because the suppression of the skin disease on the scrotum was followed by a re- turn of the discharge. The mucous membranes, too, seem to have possessed an extraordinary sensibility, since the balsam of copaiba, given in the usual dose, induced great irritability of the digestive organs after a few days' administration. It is remarkable, too, that the cessation of the discharge followed the omission of the remedy. This susceptibility of the mucous membranes is very common in cu- taneous affections, and explains the frequency of non-contagious at- tacks of urethritis in patients who suffer from them. The disappearance of the disease in the skin of the scrotum was followed by the return of the nocturnal and diurnal pollutions, but this time the irritation was more severe than ever, and was not con- fined to the mucous membrane of the genito-urinary organs; it ex- tended also to that of the rectum, and the patient experienced itch- ing of the anus, spasm of the sphincter, and a feeling of pulsation in the loAver part of the intestine. This coincidence confirmed me still more firmly in the opinion that the previous urethral discharge had not been owing to blennorrhagic contagion, and led me to order sulphuretted baths; cauterization of the urethra would have produced no effect on the irritation of the rectum, and the latter would, alone, probably have sufficed to repro- duce involuntary spermatic discharges. The patient's rapid and perfect cure shows that the indication followed was the correct one. CASE XIII. Herpes prseputialis, alternating in a remarkable manner with irritation in the prostatic portion of the urethra—Nocturnal and afterwards diurnal pollutions—Occasional impotence—Re-establishment by cauterization— Relapse—Cure by the baths of Vcrnet. 31- B----, a magistrate, of a lymphatico-sanguine temperament, had occasionally practised masturbation, but had never committed any venereal excesses. He was attacked, for the first time, at the age of eighteen, with an eruption on the prepuce which disappeared spontaneously, returned soon after, and again disappeared. This eruption was called by his medical attendant herpes praeputialis. From that time it continued to return at periods of increasing^ duration, and, at various times, presented circum- stances worthy of notice. The eruptions generally appeared on different spots, to the number of five or six, and were not, at first, larger than a pin's head, but were accompanied by violent itching; by degrees the spots in- creased in size and became united, after which they dried up, leaving only a degree of redness which soon passed off. The appearance of these°erup- tious was always preceded, during three or four days, by a sensation of lassitude, and of weight at the root of the penis. During the eruption the lassitude left the patient entirely, and the sexual impulse and power were much greater than usual. The return of the eruption took place at first every two or three months, then every year, and after that every two years; and when M. B----consulted me it had not appeared for three CUTANEOUS AFFECTIONS. 87 years. As the eruption appeared more rarely it lost, also, much of its du- ration and intensity. It always yielded to lotions of cold water. Two years after the first appearance of the eruption M. B----had an ulceration on the penis. This was regarded as syphilitic. Still later he had two attacks of urethral discharge, after which a swelling at the anus supervened. All these symptoms were attacked by a rigid and long con- tinued anti-venereal treatment. During the twelve years that M. B----has been married, he has very rarely had sexual intercourse, but he has generally experienced three or four nocturnal pollutions in the course of a month. For the last four years he has felt greater sense of weight at the root of the penis; spontaneous erections have disappeared; those which he has been able to excite have been very rare, and seldom perfect. Ejaculation has always been hurried, and sometimes even has preceded intromission. It has never been accompanied with acute sensation. Intercourse has been followed by sleeplessness, general prostration, irritation and spasms in the stomach, especially if it has taken place in the evening. Nocturnal pollu- tions have been very abundant, have occurred almost without erection, and have been followed by much more serious symptoms than emissions follow- ing coitus. For the last two years, nocturnal emissions have become gradually more rare, and M. B---- has noticed, accidentally, on several occasions, that he has passed semen whilst at stool, although his bowels have not been constipated. On his arrival at Montpellier M. B----was forty-two years of age; his face was red, and he appeared in good health. But his digestion was badly performed; his sleep was disturbed; and he felt his memory and intellect much weakened. The progressive loss of power in the genital organs was a source of much regret to him. His urine was thick and very fetid; it contained a large quantity of mucous flocculi, and deposited a sediment of matter resembling semen. M. B----told me this appearance had been present in it during twelve years. Thus the alteration in his urine dated from about the time of his marriage. On the sixth of May, 1836, I cauterized the urethra from the neck of the bladder as far as the membranous portion; the effect of the operation was prompt and very evident. Sixteen clays afterwards the urine was perfectly transparent, and the general state very satisfactory. He was then compelled to leave Montpellier suddenly. Three months afterwards M. B----informed me that in spite of the irritation caused by travelling, his urine had continued transparent, and that his genital organs had acquired an unaccustomed energy. In fact M. B----found himself so well that he considered it unnecessary to use the mineral waters as I had recommended him. Two years afterwards M. B----had a slight relapse which yielded rapidly to the use of the sulphuretted waters of Vernet, near Perpignan. I shall not inquire here, whether there was really blennorrhagic contagion in this case. I shall only remark that the herpes ap- peared a long time before any sexual intercourse had taken place, and that its return was accompanied by violent pruritus, and in- crease of sexual impulse; intercourse would in consequence take place more frequently during the presence of the eruption. The singular connexion of the skin affection, intermittentwith attacks of blennorrhagia, is worthy of notice; it shows a continual 88 CAUSES OF SPERMATORRHOEA. metastasis of the irritation of the prepuce to the mucous membrane lining the prostate. As soon, therefore, as the eruption appeared, the habitual sense of weight in the prostatic region was relieved, and the activity of the genital organs increased; the symptoms connected with the prostate re-appeared when the herpes was cured. As the eruption diminished in frequency and intensity, and the intervals between its appearance became longer, the functions of the genital organs diminished, and at length, when the herpes had not come on for some time, the patient's impotence was complete. The urine .was muddy from the period of the patient's marriage; it seems pro- bable, therefore, that the greater frequency of sexual intercourse con- tributed to the production of diurnal pollutions. It is also worthy of notice, that as the nocturnal pollutions became rarer, the debility of the genital organs was shown in a more striking manner, and that from this period the seminal discharges during defecation were sufficiently abundant to be remarked by the patient. M. B-----'s impotence was not absolute, because the involuntary discharges va- ried much in amount. This variation in the symptoms is a charac- teristic feature of slight cases of spermatorrhoea, and very probably explains the uncertainty of temper in such patients. In the case I have just reported it is not to be wondered at, when the intermis- sions of the cutaneous affection are taken into account. Another very remarkable case in which blennorrhagia occurred several times as a consequence of the metastasis of cutaneous affec- tions, will be found in my 10th chapter. CASE XIV. Lymphatic temperament—Various cutaneous eruptions alternating with other affections—Habitual bad health—Hypochondriasis—Spermator- rhea undiscovered during twenty-five years—Cure by sulphuretted baths. M-. V——, of very lymphatic temperament, was subject, in his childhood, to chilblains and a cutaneous affection of the scalp; he had also many stru- mous abscesses in his neck. About puberty his health became better, but he was still subject to attacks of ophthalmia, discharge from the ears, and frequent cutaneous eruptions of different kinds, which were very difficult of cure, and alternated with sore throat or chronic affections of the different mucous membranes. He married at the age of twenty-one, and never com- mitted excesses of any kind. He has had several children. About the age of thirty, tetters appeared on his face, neck, arms, legs, scrotum, and perineum; these were sometimes dry and squamous and changed their situation very rapidly. They were often followed by little pimples which appeared in different parts of the body, causing great itchino- at other times boils followed them and lasted for months. M. D____un- derwent various modes of treatment in order to rid himself of these unplea- sant eruptions, but without success—some of the remedies even increasing his disease. & By degrees his health became disordered in a more serious manner • he experienced successively symptoms of pulmonary catarrh, of gastro-ente- CUTANEOUS AFFECTIONS. 89 ritis, and of chronic cystitis; he was also subject to frequent attacks of rheumatism, and was annoyed by obstinate constipation alternating with diarrhoea. His digestion by degrees became difficult, and he was often at- tacked with flatulent colic; his bowels were, indeed, always distended by flatus, of which he was obliged frequently to relieve himself. When attacks of colic came on he seemed on the point of being suffocated; blood rushed to his head; his face became purple; but at length all passed off on the discharge of immense quantities of flatus, which often continued to escape for several hours. From this time he ceased to go into society, and saw only his most inti- mate friends, and by degrees he became nervous and hypochondriacal. An excellent man naturally, he now was ill tempered, peevish, and capricious, and he showed great weakness of character and morbid sensibility. A slightly interesting tale, or the recital of an instance of courage or devotion affected him to a foolish degree, and he was particularly alive to any thing he considered an injustice. His face was often congested and he complained of stunning sensations, for the relief of which leeches were applied to the anus, and he used foot baths and other remedies without benefit. At length his legs failed, and he was obliged to give up the frequent walks he had previously taken. These symptoms were looked on as the forerunners of apoplexy. Leeches were again recommended to be applied to the anus, but the patient refused, because he had never been benefited by their application. Under these circumstances I was consulted, M. D----being then fifty- six years of age. I was for several days unable to discover the cause of these various symptoms, so long and complicated was the history of the com- plaint. At last the patient mentioned a tetter which had covered all the scrotum, and extended to the perineum and margin of the^ anus. I then inquired if he had ever experienced spermatic discharges during the passage of faaces, and I soon learned from the details into which he entered that he had been subject to spermatorrhoea during twenty-five years without sus- pecting it. He had always thought that the urethral discharge during defecation consisted of mucus, and had never attached the least importance to it. These discharges were not habitual nor equally copious at all times, and he was often' quite free from them during many months. As well as he could recollect, these periods of immunity were when he was affected by cutaneous eruptions. He even thought that his "humours" escaped with the urine when he saw the spermatic discharges re-appear, and he then experienced in the rectum and bladder a heat and irritation which he was only able to relieve by means of injections. From the first occurrence of these involuntary discharges his erections and sexual desire bad constantly diminished, and had left him entirely for several years; this he attributed solely to the effects of age. His urine was often muddy and flocculent for a fortnight, and then became limpid during a variable length of time. _ All these circumstances combined, were much too clear to leave the slight- est doubt as to the nature of the disorder; I therefore recommended him to take the natural sulphuretted waters, and he went to those of Yernet, near Perpio-nan. After seven or eight baths a lively itching came on in his skin, especially on the legs. Numbers of small pimples appeared, from which oozed for a month so considerable a quantity of reddish scrosity, that the patient was obliged to surround his limbs twice a-day with several folds of linen. At length this discharge gradually diminished, and the epidermis came off in patches over the whole surface of the body. 90 CAUSES OF SPERMATORRHEA. During this time a complete change took place in the economy:—the fasces were passed easily and regularly; the appetite increased; the invo- luntary spermatic discharges disappeared; the stomach digested with equal facility all kinds of food, and bore the patient's taking wine; his erections re-appeared, and in fact M. D----at fifty-six years of age experienced al- most a return to youth. In this case spermatorrhoea was unsuspected during twenty-five years, and the unhappy patient who thus suffered had passed during all the time for a hypochondriac. Enemas and medicines had been prescribed for him, without any attempt being made to seek the cause of his disease. I hope that these cases will in future receive more attention from medical men; although they do not speedily cause death, it must be admitted that they render existence wretched. How was it that this patient could so long support so serious a dis- ease? Probably because it was not constant. The spermatic dis- charges, in the commencement, seem only to have appeared when irritation occurred in the genito-urinary organs or rectum. At last, however, they threatened the patient's life, and suspicions arose of the presence of cerebral disease, or at least of the danger of apoplexy. Causes.—The cases I have related are sufficient to show the inti- mate connexion that exists between the genito-urinary mucous mem- branes and the skin, especially that of the scrotum and perineum. I do not, however, mean to infer that the connexion between the mucous membrane and the skin is more intimate or special in the genito-urinary than in the other organs of the body. It depends on the same cause, viz.:—the analogy of function between the mucous and the cutaneous tissues. In the tenth and eleventh cases which I have related, the genito-urinary organs were the last affected; the law, therefore, is a general one, but I can only here consider that part of it which relates to spermatorrhoea. Nevertheless, cutaneous affections alone have not, in most cases, been sufficient for the production of this disease, for I have already stated that its causes rarely act singly. It is, however, necessary to consider them singly when we wish to discover the influence due to each, and we ought to take into account all the circumstances which may contribute to produce so serious a disorder. I have reported in the preceding chapter an example (case ninth) of blennorrhagia complicated with cutaneous disease, for the cure of which it was necessary to employ special remedies; in the eleventh and twelfth cases, urethral discharges were present in more or less severity and frequency. It may appear that I should not have se- parated cases so much resembling each other, but I have been guided in so doing by the greater predominance of one or the other pre- disposing affection. There is certainly no reason why an individual affected by cutane- ous diseases should not expose himself to the risk of blennorrhagic contagion, and there is on the other hand every reason why he should CUTANEOUS AFFECTIONS. 91 be easily infected by such exposure; I think, however, that we too generally confound the discharges, to which such persons are subject with ordinary blennorrhagia, and if the patients speak of old cutaneous affections which have disappeared on the occurrence of the discharge, we too often smile, and without taking further notice prescribe the anti-blennorrhagic remedy which we are in the habit of using in all cases. Even well educated and experienced practitioners constantly act thus, from not having sufficiently considered special cases; these cases, nevertheless, occur often enough to merit serious attention. One of my friends, who had been affected for a long time by a pruriginous eruption, consulted an empiric, who ordered an ointment to be applied over all his body for its cure. He was scarcely well when he married. A few days after, an abundant greenish discharge appeared from the urethra, attended by pain, and all the symptoms of violent blennorrhagia. At this he was much alarmed, and con- sulted me. Knowing his history, I did not share his suspicions, but I recommended him to wear flannel from head to foot; in a few days the eruption re-appeared, and the discharge subsided spontaneously. I have, at this time, under my care, a patient who, at the age of fourteen, suffered from an eruption on the scalp; this disappeared about the age of nineteen, and was followed by chronic inflammation of the pulmonary mucous membrane. After the cure of this affection, pain in the neck of the bladder, accompanied with uneasiness, acute cutting pain, and weight in the rectum, came on without any evident causes; urethral discharge appeared; the spermatic cord and testi- cles became swollen and painful, and the patient is now the victim of spermatorrhoea with all its accompanying disorders. In another case for which I have been recently consulted, the patient had never had sexual intercourse. He suffered from cuta- neous affections in early life, and at the age of eighteen experienced inflammation of the testicles from excessive excitement caused by reading an obscene book, and two years afterwards, after unsuc- cessful attempts to obtain the favours of a female, a severe blennor- rhagia occurred, which lasted nine months. After these facts we should think twice before we pronounce on the nature of a urethral discharge*occurring in a person subject to cutaneous eruptions, especially when their suppression has previously been followed by inflammation of some other mucous membrane. Yet we must always bear in mind that these persons are liable, m common with the rest of mankind, to the occurrence of blennorrhagia, which would even put on, in their particular cases, greater virulence than usual, and must therefore greatly increase the predisposition of persons subject to cutaneous diseases to suffer from spermatorrhoea. We find in these cases, as in those recorded in the second chap- ter, that anti-venereal treatment is useless and frequently injurious. Mode of A ction— In what manner do cutaneous affections operate in producing spermatorrhoea? The cases I have reported are suffi- cient to show that they act by a metastasis to the mucous membrane 92 CAUSES OF SPERMATORRHEA. of the genito-urinary apparatus. Thus the patient suffered from re- peated attacks of urethritis (as in the eleventh case,) acute or chronic cystitis (as in the tenth case,) active irritations of the bladder, inflam- mation of the testicles (tenth case,) or the prostate, and pains in the spermatic cords. We find then in these patients the same symptoms that are manifested by those in whom spermatorrhoea has arisen from contagious urethritis. The metastasis of cutaneous affections to the urethral mucous membrane, therefore, produces the same effects as the blennorrhagic virus, and the irritation extends in the same course along the seminal passages. Irritation of the Bectum.—Several of my patients have suffered from affections of the rectum of which I have given no account in the preceding chapters. These affections have consisted of a sense of heat, darting pains, uneasiness, and a feeling of pulsation extending more or less high in the intestine (as in the twelfth case.) These symptoms show that the cutaneous irritation had extended to the mucous lining of the rectum, as well as to that of the genito-urinary organs. Such a complication must increase greatly the chance of spermatorrhoea occurring, by provoking a spasmodic contraction of the rectum, whence results an obstacle to the passage of faeces, and a disposition to contraction in the seminal vesicles. In the next chapter I shall consider the causes of spermatorrhoea which are connected with the rectum, and I shall only now observe, in passing, that their symptoms must not be confounded with those arising from irritation of the prostate. In both cases, constipation and a sense of weight, heat, and uneasiness in the rectum may be present, but when these symptoms arise from an eruptive affection, an intolerable itching, and heat at the edge of the anus are felt, and on examining the parts, they are found red, excoriated, and wet; on drawing out the folds of the skin, a mucous and sometimes a puru- lent discharge is perceptible, and the portions of mucous membrane which can be brought into view are seen to be in the same condi- tion :—in a word, the margin of the anus presents unequivocal marks of cutaneous disease. It is important to establish this distinction, because, in the first case, cauterization of the prostatic portion of the urethra may put an end to the chronic inflammation going on there; but, in the second case, symptoms which have their seat in the rectum are due to a special affection of its mucous membrane. It is, indeed, true that this affection is similar to that of the urethra, and that it arises from the same cause; but the cure of the urethral inflammation would have no effect on that present in the rectum, and we shall presently see that the latter may suffice to excite or keep up spermatorrhoea to a sufficient extent to alter the health seriously. Treatment.—The only means that have been successfully employed in cases of this nature, are cauterization and the use of the sulphu- retted waters. ( 93 ) CHAPTER V. CAUSES OF SPERMATORRHEA. Influence of the Bectum. I HAVE hitherto examined those causes which influence the sper- matic organs by their direct action on the urethral mucous membrane. I now proceed to consider such as act on the seminal vesicles by the mechanical and sympathetic influence of the rectum. CASE XV. Spermatorrhoea from a mechanical obstacle to defecation—Division of the stricture—Rapid and complete cure. Nicholas G-----, the guard of a diligence, of strong constitution, at the age of twenty-five contracted a chancre, followed by bubo and warts. This attack of syphilis was treated with mercurials, without the patient giving up his employment, and, notwithstanding the fatigue consequent on his fre- quent journeys, at the expiration of six weeks all the symptoms had disap- peared. Shortly afterwards he experienced difficulty in defecation, which slowly increased, so that in the course of four or five years considerable efforts were necessary to evacuate the rectum. The faeces were flattened, like a riband, four or five lines in width and about a line in thickness. From this time C----'s health became gradually disordered; his appetite diminished, his digestion was impaired, and accompanied with the develop- ment of flatus; he lost flesh, and his weakness increased daily; his memory- was impaired, and the genital organs underwent the same changes in their functions. When he first consulted me he had scarcely any venereal desires, his erections were imperfect, coitus was rarely possible, and ejaculation was long in taking place; sometimes it did not even occur at all, and it was never accompanied by any lively sensation. > The concurrence of all these symptoms convinced me of the presence of spermatorrhoea. The patient told me that for four years he had been in the habit of passing semen while at stool, and that its discharge in general bore a proportion to the efforts necessary for the expulsion of the faeces; on this account, in order to render them as fluid as possible, he had reduced him- self to a vegetable and milk diet, lie had often attempted to use enemata, but had been unable to succeed. The abundant spermatic discharges had so worn this patient out, that at the age of thirty-four he presented the appearance of a man aged sixty. On examination, I discovered, about two inches from the anus, a nearly circular obstruction, of about half a line in thickness, having an irregular opening iu its centre which would barely admit the extremity of the fore- 94 CAUSES OF SPERM ATORRHCEA. finder. This kind of diaphragm obstructed the passage of faecal matter; it was thin and soft, and felt like a cicatrix. I made transverse incisions through the obstruction by means of a straight probe-pointed bistoury passed along the index finger. These in- cisions were of very trifling depth, and I afterwards dilated the opening by introducing my finger deeply, and pressing it forcibly in the direction of each wound, until by tearing I reached the walls of the intestine. Four loose flaps resulted from this operation, and I prevented their re-union by the frequent introduction of my finger. The operation was attended with very little pain or loss of blood. Some time afterwards I showed the patient how to introduce a rectum bougie, of sufficient size to dilate the portion of gut which had been operated on; this I advised him to practise daily for some time. This simple means proved sufficient to procure sepa- rate cicatrization of the four flaps, after which, the expulsion of the faxes took place without difficulty, and the spermatic discharges ceased. All his functions were soon restored to their natural state, and Nicholas G---- resumed his former occupation. This case gives a very clear view of the mechanical influence of constipation in producing spermatic discharge during the passage of fseces. The sole cause of the spermatorrhoea was the membranous obstacle above the sphincter; and the discharge was caused simply by mechanical pressure on the seminal vesicles during the violent efforts the patient was compelled to make in order to force the faeces through a narrow opening. As soon as the obstacle was removed, the spermatorrhoea ceased, and all the symptoms arising from it dis- appeared. The effects of mechanical compression were in this case then quite unmistakeable. Coitus was very long before ejaculation took place; sometimes even the completion of the act was impossible, and it was never at- tended by lively sensations. The cause of all this was that the seminal vesicles contained little and badly formed secretion; but these organs were not in a state of irritation, and the ejaculatory canals were neither irritable nor relaxed. In most cases of diurnal pollution, ejaculation is, on the contrary, very rapid, because the spermatic organs are either irritated or relaxed, if they are not at the same time in both these conditions. CASE XVI. Spermatorrhoea induced by chronic diarrhoea, and kept up by a mechanical obstacle to defecation—Removal of a scirrhous tumour from the anus— Rapid and perfect cure M----, of good constitution, entered the army at the age of seventeen, and served for eighteen years, during which he was exposed to considerable hardships. He also committed excesses of all kinds. His health, however, continued excellent. In 1814, M----, then aged thirty-five, contracted blennorrhagia which he neglected; the discharge diminished, but did not entirely cease before 1816, when he quitted the army. In 1820, M---- INFLUENCE OF THE RECTUM. 95 married, but did not indulge in any excesses. Some time afterwards, having b'-en engaged as concierge to a club, he passed many nights almost without lying down. In 1824 he was suddenly seized with violent colic, which was relieved by means of emollient injections, repeated baths, and a severe re- gimen, but which did not entirely leave him. Two years afterwards he had a severe hemorrhage from the rectum, ac- companied with very painful tenesmus, during the violent spasms of which he noticed that he passed semen. This hemorrhage relieved the colicky pains he had suffered from, but a dysentery remained, which kept up the tenesmus and with it the involuntary seminal emissions, and caused the prolapse of several hemorrhoidal tumours with eversion of the mucous mem- brane of the rectum. From this period M----'s health became more and more disordered; he lost his habitual spirits together with his sexual appetite, and his sight as well as his memory and physical streugth became weakened, so that in 1827 he was obliged to give up his occupation of concierge. During the years 1827 and 1*28, the chronic diarrhoea decreased in severity, and in 1829, it had become much less frequent. At length, in 1830, it was replaced by a very obstinate constipation, which in its turn also became the cause of spermatorrhoea, and increased the swelling caused by the he- morrhoids and the prolapsed mucous membrane of the rectum. This swell- ing was irreducible; it increased in hardness, was irritated by the friction of his clothes, and at last assumed a scirrhous consistency. Its presence alone formed a considerable obstacle to defecation. On the 28th of March, 1S-31; m----applied at the Hospital St. Eloi, in the following condition :— He was fifty-one years of age; extremely pale; his face pale yellow; skin woolly; hair black; weakness excessive; sensibility very great ;^ profound melancholy; habitual hypochondriasis; digestion difficult, especially after the use of animal food; defecation rendered troublesome by a red, hard swelling, five or six lines in diameter across its base, projecting about an inch, and occupying about half the circumference of the anus; involuntary discharges of semen during the efforts necessary to procure a faecal evacua- tion ; the emission of urine followed by a discharge of a glairy, limpid, and sticky matter; no erections during a long period; absence of all sexual im- pulse; frequent attacks of vertigo; dazzling of the eyes; buzzing in the ears; attacks of heat towards the head from the slightest cause. The tumour of which I have spoken resembled a large cock's comb; contracted hemorrhoids were situated around it; and it seemed to have arisen from the prolapsus of internal hemorrhoids, which had brought down with them a portion of the mucous membrane of the rectum. The contraction of the sphincter ani had prevented the return of this tumour, and had increased its swelling and the friction of the patient's clothes had caused repeated in- flammation and degeneration of its tissue. The base of the tumour occupied more than half the circumference of the anus, and extended above the sphincter ani. It was about six lines in thickness, and its feel was scir- rhous; a sanious discharge exuded from its surface, some points of which had even begun to ulcerated It was, therefore, evident that no time should be lost if it were intended to remove this tumour; the patient was anxious for the operation, and had previously asked several surgeons to perform it; but these gentlemen had refused on account of the depth to which the dis- eased tissue extended. . Bv "entle and gradual traction on the tumour I was able to bring it cn- tirelv through the sphincter, so as to bring the healthy mucous membrane 96 CAUSES OF SPERMATORRHEA. into view. On the 25th of March, therefore, I commenced its removal by an incision in the healthy mucous membrane, and to arrest the severe he- morrhage which ensued, I cauterized the bottom of the wound with a fine heated iron. The tumour was then dissected out, the'parts being touched with the actual cautery as they were divided. After the entire removal of the tumour, the greater portion of the wound ascended within the sphincter. Slight inflammatory symptoms supervened, which yielded to bleeding, &c, suppuration was established, and the cicatrization of the wound was com- pleted by degrees. The first few days after the operation the patient was unable to void his urine without the use of a catheter, and for some time afterwards he micturated very frequently. On the first of May cicatrization was nearly completed, the faeces had re- gained their normal consistence and were passed daily without difficulty, their passage no longer giving rise to involuntary spermatic discharge. The patient regained his strength and spirits ; his appetite returned, and his di- gestion was performed easily; his strength and stoutness increased daily. About the middle of the month his erections re-appeared during the night, and afterwards became more frequent and prolonged; his cerebral functions followed the same course in their re-establishment; the dazzling of sight and cerebral congestions disappeared; and M----left the hospital on the 24th of May, perfectly restored to health. Three years afterwards, when I was summoned to Clermont to preside over a medical inquiry, M----called on me; I recognised him with diffi- culty, so much was his countenance changed. It is scarcely necessary for me to say, that he had resumed his conjugal duties, and his occupation of concierge. The cicatrix of the anus was thin and soft, and did not interfere with defecation. The latter part of this case exactly resembles the preceding one, and the results of the operation prove that the involuntary spermatic discharges were only kept up by the mechanical obstacle to defeca- tion. But the diarrhoea which had caused the prolapse of the hemor- rhoids, and the formation of the scirrhous tumour, was also accom- panied by frequent involuntary emissions. At this time, .then, the seminal vesicles could not have been subjected to compression as the fgeces were liquid, and remained a very short time in the rectum; we must, therefore, admit that the seminal vesicles participated in the irritation of the rectum—that they were affected by the spas- modic contraction which took place in the gut—in a word, that they were influenced by the tenesmus. This case, then, presents a remarkable instance of the double in- fluence possessed by the rectum over the seminal vesicles; in the beginning of the disease this influence was essentially vital; at its termination it was simply mechanical. Both phenomena produced the same results, but they were quite sufficiently distinguished from one another not to be confounded together. It was worthy of remark, also, that the patient, immediately after the operation, was unable to pass his urine without the assistance of a catheter, and that after a short time he experienced a frequent de- INFLUENCE OF THE RECTUM. 97 sire to micturate. These two phenomena show the intimate con- nexion that exists between the anus, and the neck of the bladder. This case, then, exemplifies the influence of the rectum over the urinary organs, in both its different forms. CASE XVII. Hemorrhoids from the age of puberty—Difficulty in evacuating the rectum at the age of twenty-eight—Spermatorrhoea—Cure. M. A----, of a sanguine temperament, at fifteen years of age was addicted to masturbation; soon after he had a discharge of blood from hemorrhoids, which he regarded as a consequence of his injurious habit, and consequently abandoned it sufficiently early for his health to remain uninjured; but the hemorrhoids teased him much, especially when some time after he entered the army. They were relieved, however, after a campaign in Spain, where the patient suffered much from heat. By returning to his home and by leading a less active life, he hoped with care to rid himself of his troublesome affection; the reverse happened, however—his diet being more stimulating and his habits being sedentary, the hemorrhoids increased in number and size. His stools were followed by a more or less abundant discharge of blood. The internal hemorrhoids were protruded and formed a voluminous and painful mass, which could only be reduced by a long continued pressure. After a time these hemorrhoidal tumours becoming irritated and swollen, presented an obstacle to the discharge of faeces; a larger portion of intestine protruded, and was returned with great difficulty. The patient now perceived that in his efforts at stool he passed a large quantity of semen, his health broke up by degrees, he felt debilitated, his digestion became disordered, his sleep was broken and unrefreshing; his temper was soured, he often ex- perienced sensations of stunning, vertigo, and sometimes even fainting fits. Emollient injections, baths, and demulcents appeared to benefit him at first, but he soon perceived that they increased the relaxation of the parts, and favoured both the prolapsus of the rectum and the spermatic discharges. This state had lasted four months, when the patient first consulted mo. He was twenty-eight years of age, and had the appearance of^being forty; his muscles were well developed, but he was, notwithstanding, without strength or energy. I first relieved the irritation of the rectum by lave- ments of decoction of poppy heads, and afterwards used slightly stimulating ointments containing balsamic applications, at the same time that quinine and preparations of iron were administered. Under this treatment the mucous membrane of the rectum by degrees regained its tone; the hemorrhoids became less sensitive and less volumi- nous, and many of them withered away. The prolapsus of the rectum dis- appeared gradually, and the seminal discharges diminished, at the same time removing the symptoms that depended on them. Hemorrhoids at the early age of fifteen are rare; I cannot, how- ever, believe that masturbation alone caused their appearance in this patient, but I think it probable that he had a considerable pre-dis- 98 CAUSES OF SPERMATORRHOEA. position to them. I do not suppose that the habit he practised for a short time in his youth had any influence in causing the sperma- torrhoea, for it is very easy to account for spermatic discharges in such a case without referring to very remote causes. We must then regard this case as another example of the influence which ob- struction to the passage of faeces exercises on the seminal vesicles. CASE XVIII. Blennorrhagia, Constipation—Fissure of the anus—Discharge of semen at stool—Profound hypochondriasis—Desire of committing suicide—Diar- rhoea— Cure of the fissure of the anus—Disappearance of the other symptoms. At the age of twenty-four F. B----contracted blennorrhagia, which was accompanied with weight in the region of the prostate. By leeches and baths the pains were relieved, and the discharge reduced to a slight gleet. Soon afterwards the left testicle became swollen and very painful, and the discharge increased in consequence of energetic and long continued erec- tions. The patient used leeches and hip baths, and the swelling of the tes- ticle diminished, but the discharge continued. For three or four years this testicle continued very tender; it swelled on several occasions, and be- came painful in consequence of slight yenereal excitement, the urethral dis- charge increasing at the same time. These phenomena returned every spring during four years. In order to cure these symptoms F. B.----took the Bob de Laffecteur,1 after the second bottle of which, an obstinate constipation supervened. Defecation now became very painful, and the focces were covered with blood. The patient had recourse to enemata without benefit; during their administration he felt as if the "anus were torn by heated razors." This state had lasted several months when he experienced attacks of vertigo after going to stool, and sudden attacks of cerebral congestion, passing off rapidly, either while walking or engaged in any kind of employment: his moral condition became affected; he fell by degrees into a deep melancholy; depressing thoughts arose before him incessantly; he seemed compelled to seek solitude and darkness; he felt a horror of suicide, but nevertheless he seemed always to be driven towards it. Wrapped up in his melancholy thoughts he spoke to no one, and if his friends endeavoured to attract his at- tention he responded to them rudely; he felt his venereal desires constantly diminish; but this did not affect him so much as his moral position- he held suicide in abhorrence, yet he felt impelled towards it in spite of his will- his reason wandered until at length he believed himself possessed by the devil and he spent hours together in praying to be delivered from his tempta- tions. A constant feeling of hunger annoyed him, though he ate often and greedily; his digestion was painful and laborious. Notwithstanding the 1 Rob de Laffecteur is composed of a strong decoction of the Arundo Phraqmitis or bulrush, with sarsaparilla and aniseeds, evaporated, and made into a Rob or syrup by the addition of sugar. To this a solution of the bichlpridc of mercury is after- wards added. J INFLUENCE OF THE RECTUM. 99 repeated use of leeches, demulcents, and baths, these symptoms increased to a frightful extent; his sufferings indeed were generally greatest on quitting the bath. One day whilst at stool he noticed the evacuation of a quantity of whitish and viscid matter which he fancied was semen; from that time his attention being called to the fact, he observed that he seldom had an evacuation without more or less spermatic discharge; he noticed also that the matter in its passage produced a kind of tickling accompanied with heat in the urethra. After having passed six months in this deplorable condition, the patient suffered from a serious attack of indigestion, followed by a very copious diarrhoea that lasted a fortnight, and reduced him to an extreme state of debility; but after its relief the faeces regained, by degrees, their normal consistence and were then passed without pain or streaks of blood; the spermatic discharges, which had been excited by efforts at stool no longer took place, and all the moral and physical symptoms above mentioned were, by degrees, completely and spontaneously dissipated. Several years after- wards F. B----enjoyed excellent health, all his functions, without excep- tion, being perfectly performed. In this case the blennorrhagia caused inflammation of one testicle and developed the susceptibility of the genital organs; consequently, 'therefore, it predisposed them to the occurrence of spermatorrhoea; but the constipation brought on by the use of Rob de Laffecteur evi- dently was its immediate cause. The symptoms which ordinarily accompany fissures of the anus appeared soon after; and afterwards those arising from spermatorrhoea. The course of events was pro- bably as follows:—after prolonged constipation a hard copious mo- tion distended the mucous membrane lining the anus, more than usual; it gave way; from that day defecation having become painful the patient put it off as long as possible; the hardened and accumu- lated feces in their turn increased the fissure in the mucous mem- brane:—thus it is that fissures of the anus are usually produced and kept up. The diarrhoea, which lasted fifteen days, allowed the ci- catrix in the mucous coat of the gut to become firm. It is easy, therefore, to account for the appearance and cessation of the semi- nal discharges, together with the anomalous symptoms from which the patient suffered during six months. I have already shown hypochondriasis, in many forms, as a conse- quence of spermatorrhoea, but in no case previously reported did it present characters like those in the case before us. This young man, naturally of a good disposition, was beset during the whole course of his disease, by the most frightful propensities; he was so revolted by them that the loss of his health seemed nothing when compared with the mental torture they entailed on him. His reason was so shaken that he considered the intervention of the devil to be the only mode of explaining his evil impulses! To what must we refer an aberra- tion of intellect which might have produced such fatal results? But to return to the consideration of fissures of the anus. This disease, without doubt, often excites spermatorrhoea. The silence of 100 CAUSES OF SPERMATORRHEA. authors on the subject proves nothing, for, notwithstanding the ac- tivity with which during years I have sought the causes of sperma- torrhoea, I rarely, until lately, profited by the opportunities I had of questioning patients on this point. When the violent efforts ne- cessary to empty the rectum, the acute pain and spasmodic con- tractions of which it becomes the seat, and the disturbances which a very slight excoriation produces throughout the economy, are taken into account, I think it will be readily allowed that fissures of the anus may frequently induce abundant spermatic evacuations. The patients fear to go to stool, on account of the pain the passage of the faeces produces; these, therefore, accumulate and harden in the rectum; when at length the irritable intestine contracts to expel its contents, their passage tears open the fissure; the sphincter, ir- ritated by this increase of pain, contracts spasmodically, and a con- test is thus established between the sphincter and the muscular walls of the intestine, aided by the abdominal muscles. The efforts to evacuate the intestine are so violent and prolonged that respiration is suspended; the face becomes injected and purple, and blood appears ready to start through the skin. It is difficult to conceive how the seminal vesicles can, under such circumstances, escape compression. We must, also, take into account the fixed pain at the verge of the anus, and the spasmodic state of contraction into which all the neighbouring muscles are thrown; for these phenomena act more or less on the genito-urinary organs. Lastly, fissures of the anus are soon followed by changes in the physical and moral state of the patients, of too serious a nature to be attributed only to the pain they cause. I have seen young men arrive at the hospital in a con- dition of weakness and mental despondency, contrasting strongly with the size of their muscles, and the colour of their complexions. It is especially after they have evacuated the bowels that such pa- tients feel most worn out, broken-spirited, and depressed; they have generally lost all venereal desire; their erections are weak, rare, and incomplete. I regret that I have not recorded these cases, but I remember their circumstances perfectly, and all things conduce to make me attribute the symptoms to spermatorrhoea; however this may be, it is a subject for further research, to which I wish to call the attention of the profession. CASE XIX. Horse exercise — Constipation — Spermatorrhoea — Impotence — Frequent and violent attacks of cerebral congestion—Ascending douches—Cau- terization—Sulphur baths—Hot and cold douches on the loins and peri- neum— Cure. M. De B----consulted me in the month of May, 1834, respecting a cerebral affection, on whose nature distinguished physicians could not a°ree but which all regarded as very serious. He was of a middle height, with a large chest, and a well developed muscular system; his hair brown and curly, his beard thick, his face full INFLUENCE OF THE RECTUM. 101 and deeply coloured. Notwithstanding these signs of apparent strength and health, I noticed that his knees were slightly bent, and that he was unable to remain long standing without shifting the weight of his body from one leg to the other; his voice was weak and husky; the motions of his tongue seemed embarrassed, and he articulated his words in a confused manner; his attitude was timid, and his manner had something of incertitude and fear; he had been married fifteen days. His mother-in-law and his young wife, who accompanied him, informed me that within this period he had several attacks of congestion of the brain, during which his face was highly injected. At the first of these attacks the surgeon, called in the night, had bled him to the extent of three pounds, in order to prevent apoplexy; repeated venesection, and the frequent ap- plication of leeches, had relieved such attacks of congestion, but had not prevented their recurrence. The patient had become subject to attacks of vertigo, and was unable to look upwards without feeling giddy; his legs had become so weak that he had fallen several times, even when walking on level ground; his ideas had lost their clearness, and his memory failed rapidly. These symptoms had spread consternation through both the family of my patient and that of his wife, especially as several practitioners of reputation were agreed as to the existence of some serious disease of the brain, although they could not decide as to its nature. Most of them, however, were in- clined to suspect ramollissement. The countenance of the patient during this recital, the coincidence of the congestion with the period of his marriage, and the bad effects of blood- letting, made me suspect the nature of the disorder, and induced me to question the patient separately. When we were alone, he told me, stam- mering, that an unexpected occurrence, immediately after his marriage, had at first prevented any conjugal intimacy, and that afterwards he had found himself completely impotent. He attributed this misfortune to the attacks of cerebral congestion, and to the bleedings he had undergone. On further inquiry, however, I discovered that he was affected by diurnal pol- lutions. The following is the history I obtained from this patient by dint of ques- tioning :—at the age of sixteen he possessed a very strong constitution, and an ardent and passionate character. At school he contracted the habit of masturbation, and at the end of three months he had frequent nocturnal pollutions, with pain in the chest, and troublesome palpitations, which warned him of the danger of the vice, and he renounced it for ever. When he became free from the restraints of school, he subdued the ardour of his temperament by the most violent exercises—especially that of the chase— and he attached himself to agricultural pursuits with much energy. This new mode of life so completely re-established his health, that he was tormented by energetic and continual erections, to subdue which he em- ployed river baths, even in the coldest seasons. He never committed ex- cesses of any kind, and had never suffered from any blennorrhagic or syphi- litic affection. In 1831, the erections were slightly mitigated, but he became very much constipated, which he attributed to the constant use of horse exercise. In 1832, he experienced some numbness and creeping sensations in his feet and legs. In 1833, frequent dazzling of sight occurred, with vertigo, difficulty of 102 CAUSES OF SPERMATORRHOEA. vision, and flushes of heat, towards the head and face; the patient attributed all these symptoms to the effects of his still increasing constipation. At the same time that these symptoms occurred, the patient's erections became rarer, less energetic, and after a time incomplete; his fitness for intellectual labour diminished; the cerebral congestions became more fre- quent, and more severe; his face became habitually very red; his head burning; an almost constant fixed pain came on in the orbits, and his cha- racter became fickle and contradictory. His family physician, attributing all these disorders to a state of plethora, caused blood to be drawn several times without benefit. In March, 1834, M. De B-----engaged himself to a young lady, who lived about two leagues from his estate; and in order to visit her without neglecting the care of his property, he was obliged to make long and fre- quent journeys on horseback; shortly before his marriage, these journeys became so frequent that he might be said to pass the greater part of his time on horseback. His constipation now increased to such a degree that he passed forty days without faecal evacuation; during his efforts at stool he passed semen in large quantities, and in jets, although the penis remained flaccid. He had previously, several times, noticed the same occurrence, but as he attributed it to his long continued continence, he paid little attention to the circumstance. His urine was constantly muddy; it was passed slowly, and with difficulty, and threw down large quantities of thick and flocculent deposit. M. De B. awaited the period of his marriage with a vague uneasiness, of which he could not imagine the cause; he was much attached.to his be- trothed, but, nevertheless, he experienced more embarrassment than pleasure in her society. I have already stated what occurred after his marriage; I should add, that having examined the genital organs, I found them contrary to my expectations, of unusual development, the testicles were large and firm, but the scrotum was slightly relaxed. The patient experienced a strange tingling in the organs, and at times felt as if they were compressed by a hand of iron. These sensations increased when near his wife, and the penis diminished in size, and became retracted towards the pubes, in proportion as he endea- voured to excite erection. The union of all these circumstances could not permit any doubt to remain on my mind as to the nature of his disease; it became evident that all idea of cerebral affection must be abandoned, and that the diurnal pollutions with all the symptoms of which they were the cause, must be referred to the patient's constipation. _ The first indication to be fulfilled, therefore, was to relieve the constipa- tion; indeed I hoped this was all that would be necessary; the youth of the patient, the development of the genital organs, and the strength of his constitution induced me to suppose that his cure would be prompt and easy. Things did not, however, follow so simple a course. The next day the patient began to use ascending douches; and was put on a vegetable diet, with iced milk. The first douches caused the evacuation of an immense quantity of faecal matter in lumps, as hard as bullets, and it was not until after the sixth douche that the fasces were of normal consistence; I then caused the tem- perature of the water to be lowered to 25° of Reamur's1 scale, and after- 1 About 88° of Fahrenheit. INFLUENCE OF THE RECTUM. 103 wards to 20° Beaumur.1 The last douches were given at 16° Reaumur.2 After the twelfth douche had been administered, they were omitted, the bowels having acted regularly every day, without the necessity for the slightest straining. By this time the patient's countenance had lost its purple tint, and pre- sented a more natural appearance; the stunning sensations of which he had complained diminished by degrees, and at length disappeared entirely; his legs' regained their strength, and he was able to continue in a standing pos- ture for a long time without fatigue, and to take long walks without incon- venience; his voice resumed its natural tone, his eye regained its expression, and all his motions acquired firmness. At the expiration of a fortnight the spermatic discharges during defeca- tion had ceased entirely; but his urine still continued thick. His erections had already acquired sufficient energy to make him believe himself cured, but ejaculation took place almost instantaneously. The use of ice and cold lotions did not ameliorate his condition. Such was M. De B----'s state at the end of a month; when, in order to act directly on the orifices of the ejaculatory ducts, I determined to cau- terize the prostatic portion of the urethra. As soon as the inflammation had subsided, his erections became more perfect and energetic; yet ejacu- lation still took place too rapidly. The period for using the mineral waters having arrived, I sent M. De B----to Aix, in Savoy, where I visited him shortly after. He had experienced very little benefit from the use of the waters, either externally or internally. I now prescribed douches, alternately very warm and very cold, on the perineum and loins, the spout being changed when the sensation, either of cold or heat, became very intense. The bath was ended, after about twenty or twenty-five minutes, by the cold douche, and the patient's skin remained highly injected for some hours afterwards. The effects of these douches were conclusive; after the first, the patient's erections acquired a degree of vigour and duration which reminded him of his early torments. He continued the use of the douches for some days after his re-establishment; and when he left Aix the functions of his genital organs were perfect. Ejaculation was a good deal protracted by the use of the douches. I have entered into a somewhat lengthy detail of this case, because the subject affects gravely the most serious interests of society, as well as the happiness and peace of families. Besides, I confess that I was much interested by the unhappy position of a young man whose misfortune was undeserved, and could not have been foreseen, as well as by that of his wife—a young woman scarcely of age, who was obliged to enter into the most unpleasant details. It is evident that in the case of M. De B-----, the constipation was the cause of the involuntary seminal discharges. The patient had practised masturbation it is true, and nocturnal emissions followed ; but he had continued the vice only three months, and his health, i About 81° of Fahrenheit. 2 About 68° of Fahrenheit. 104 CAUSES OF SPERMATORRHEA. though disordered for a short time, was soon re-established by the use of violent exercise. M. De B-----was even tormented during several years by erections which must have been very energetic, if we may judge by the means he took to subdue them. From this time he had never committed any kind of excess, and he had never suffered from either blennorrhagia or syphilis. There is then no circumstance in the history of his life, except his constipation, which would account for the involuntary discharges. But to what is this constipation to be referred? After all I could learn from the patient concerning his mode of life, I could only refer it to his constant horse exercise. In fact, M. De B-----sometimes passed whole days on horseback, either for the purpose of hunting, or of superintending the management of his property. Shortly before his marriage his rides became more frequent and longer, and his bowels at this time did not act during forty days. The weakness of his legs, the stunning sensations, &c, increased in proportion as his costiveness became more confirmed. This case recalls to my mind the well known observation of Hip- pocrates on the impotence of the Scythians, and I have no doubt that his opinion was founded on analogous facts. I shall treat this subject more fully in another place; but since at present I am con- sidering the causes of spermatorrhoea which act on the seminal vesicles through the influence of the rectum, I'report this striking case, showing the effects of long continued horse exercise. M. De B----was accustomed to nutritious food, and of a well marked sanguineous temperament; he had a large chest, powerful muscles, and a highly injected countenance; it is therefore by no means extraordinary that he should have been bled frequently for the relief of the cerebral congestions to which he was subject. On the night of his marriage the blood rushed to his head with greater force than ever, so that an attack of apoplexy was much feared; the weakness of the legs, the frequent falls, and the attacks of vertigo, were therefore afterwards attributed to an advanced stage of disease of the brain. This was a very natural opinion, but it was an incor- rect one; I doubted it from the commencement, although the patient was brought to me in consequence of a supposed cerebral affection. I formed a different impression, because I had previously seen many analogous cases. There exists in all these patients something pe- culiar in the expression of the eyes, in the position, in the voice, and in the general appearance; something of timidity and bashful- ness which I am unable to express, but which is instantly recognised by the experienced, although perhaps it is incapable of explanation. However this may be, the relation of the above case should draw attention to the subject. I admit that venesections seemed to be clearly indicated in the case of M. De B----, but the loss of blood never produced good effects either immediate or remote; and by analyzing the case carefully his attendants would have seen that under this treatment the attacks in- INFLUENCE OF THE RECTUM. 105 creased in frequency. But pre-convictions throw a thick veil over the most acute perceptions. The ascending douches put an end to the constipation; but free- dom of faecal evacuation did not suffice to cure the disease. The seminal discharges, during the passage of faeces, diminished, indeed, or, perhaps, entirely ceased, but the patient's urine remained thick and muddy, and his erections were incomplete. The application of ice and of the nitrate of silver, and the use of sulphureous waters were not sufficient to effect his cure; yet there could not have ex- isted any organic change in his genital organs. We can therefore only attribute the continuance of the seminal discharge, during the emptying of the bladder, to relaxation of the ejaculatory canals, produced by their long habit of allowing the semen to escape in a passive manner—showing how necessary it is to put an end to the habit as early as possible. The alternate use of hot and cold douches on the loins and perineum produced a sudden and decisive change in this as in many analogous cases; I shall therefore return to their consideration by and by. At present I must only remark, that they should never be employed so long as any irritation of the genital organs exist, as under such cir- cumstances they produce the most unfavourable effects. CASE XX. Lengthened exposure to severe cold—Incomplete paralysis of the rectum —Seminal discharges during defecation—Cure by the application of galvanism. M. V----, aged twenty-nine, a captain in an infantry regiment, had suf- fered from five to six attacks of blennorrhagia, and afterwards from a chancre, for the cure of which he took a considerable quantity of the bichloride of mercury. At the end of the treatment, in 1822, he left Metz, to go to Spain. During his journey he was detained three weeks at Lyons, in con- sequence of a disorder of which the most prominent symptom was obstinate costiveness accompanied by fever. During the remainder of his journey he was obliged, for the first time, to support his left testicle, the veins of which were varicose. During the whole campaign he did not suffer from any other disease except occasional hemorrhoids. After having endured the fatigues of war without disorder, M. V----, whilst returning to France, was exposed during an entire night to ex- treme cold, being at the same time very lightly clothed. The next day he felt acute and darting pains in his legs, and these were soon followed by a feeling of cold, referred chiefly to the under part of the left hip joint, and to the hypogastrium. From this period a new train of symptoms appeared. The patient felt his legs daily becoming weaker; he was subject to obstinate constipation. It seemed to him as if the powers intended for the expulsion of the fasces were paralyzed; and he experienced, moreover, in the distended intestine, a feeling of elastic re-action, rather than one of muscular contraction. Abundant seminal discharges attended his efforts at stool. Agitation gene- 106 CAUSES OF SPERMATORRHOEA. rally followed the evacuation of any faeces. The venereal impulse was nearly lost, erections occurred seldom, and were incomplete, and coitus was im- possible, except under very extraordinary circumstances, and very rarely. The patient's digestion became difficult; flatus accumulated in the intes- tines, distended his abdomen, and caused pain in his epigastric and hypo- chondriac regions; his skin became habitually dry and harsh. He wished to take exercise to favour cutaneous transpiration, and was in a continued state of agitation as soon as he remained still for a few minutes; he was easily affected by cold, and his temper became very irritable. The suspensory bandage he wore inconvenienced him, and he left it off before taking a long walk. Shortly after his return, a considerable swelling came on in the left testicle, to disperse which leeches were applied five times unsuccessfully. About this time bichloride of mercury was administered in solution for the treatment of some supposed venereal vegetations around the margin of the anus, but which, in reality, were only contracted hemorrhoids. The different means pursued increased, to a great degree, the patient's weak- ness of the legs and digestive disorder. When Captain V—— came to the hospital of St. Eloi, I was struck by the pallidity of his countenance, and the flaccidity of all his tissues. His form was rounded, with the cellular tissue very abundant and slightly infil- trated with serum, especially in his legs; his skin was white, thin, trans- parent, and habitually cold; his pulse small and feeble. The tumour of the left testicle was evidently only a common hydrocele. Taking into consideration the order of appearance, and the general charac- ter of the symptoms, I thought that the intense and lengthened action of cold had produced a deep and lasting effect on the inferior portion of the spinal cord, as I had before seen in a few cases. Weakness seemed to me to be the symptom predominating, no appearance of irritation being present, either in the rectum or the genito-urinary organs; and I consequently decided on submitting the affected parts to the action of galvanism. The first sitting took place on the 11th of February. The current was established, during twenty minutes, between the sacrum and hypogastrium; and afterwards, for the same period, between the hips. The shocks were very weak, only sixteen drops of sulphuric acid having been added to the quart of water; yet, on the following day, the patient experienced less sen- sation of cold, less numbness in his left leg and in his genital organs, and less difficulty in emptying his bladder; besides which he had a stool. On the 12th a second sitting took place. The shocks were directed through the same parts, and applied during the same length of time; eighty drops of sulphuric acid being used on this occasion. On the 13th a third sitting was held, a hundred drops of acid being used. Stronger shocks were administered. Impressions were now more acutely felt, and the patient's improvement seemed progressively increasing. On the 14th, galvanism was again applied, a hundred and forty drops of sulphuric acid being added to the quart of water. The current was esta- blished occasionally between the loins and the perineum, and the surface of the hydrocele. The following day the patient had a free evacuation with- out enema; he experienced a feeling of power in the rectum with less numbness in the lower extremities, from the pelvis as far as the knees- the legs and feet were in the same state as before; there was a considerable diminution in the size of the hydrocele; the patient's erections had become INFLUENCE OF THE RECTUM. 107 more energetic, and he was altogether more cheerful, notwithstanding the fatigue caused him by the violent shocks to which he had been subjected. He spoke of the galvanism with pleasure, but requested two or three days' rest before being again subjected to its action. From the 15th to the 19th galvanism was not employed. No improve- ment took place during these days. From the 20th to the 24th five sittings similar to the preceding took place, the quantity of sulphuric acid being increased on each occasion. Af- ter these the bowels were opened freely every day, without straining or seminal discharge. His urine was discharged easily, in a full stream. The liquid effused in the tunica vaginalis was completely absorbed. The pa- tient's digestion became active; the intestinal flatulence disappeared, and the warmth and strength of the inferior extremities were restored. Shortly afterwards M. V---- rejoined his regiment, and resumed his duties as before. Four or five years afterwards I met with M. V----, who had attained the rank of general. He told me that his health had not un- dergone the least alteration. This patient had suffered from five or six attacks of urethritis, besides a chancre, and he had undergone many energetic courses of anti-venereals, of which one course only would have been useless, and even injurious. There are, therefore, many reasons why his case should have been placed among those of which I have treated in the third chapter. On the other hand, he had suffered for a long time from hemorrhoids, which were on one occasion even mistaken for syphilitic vegetations, a mistake by no means uncommon. The seminal discharges were, however, due to the distention of the rec- tum, (as in case fourteen,) yet it seems probable that the other cir- cumstances had some share in bringing on the disease, because Cap- tain V-----had suffered from obstinate constipation when at Lyons. These circumstances must, therefore, be taken into account; but the determining cause was, evidently, the extreme cold to which he was exposed during a whole night. This gave the disease a peculiar character, which is not otherwise met with. The first time I saw this patient, I attributed the weakness of his lower extremities, his constipation, &c, to the seminal discharges; but on more mature reflection respecting the sudden effect of this lengthened exposure to cold, I recollected other cases of the same nature, in which cold had left a serious impression of debility in the parts which had chiefly suffered. I was struck by the general and truly characteristic state of the constitution, by the infiltration with serum of the affected parts, by the temperature of the skin, &c.; I concluded, therefore, that the pollutions arose from distention of the rectum, and that this was kept up by a kind of torpidity which the cold had produced in the nerves arising from the inferior portion of the spinal cord. This chain of reasoning led me to think of gal- vanism—a remedy from the use of which I had seen benefit arise in analogous cases. The result proved this indication to be the right one, and the cure was even more rapid and decided than I had ventured to hope for. 108 CAUSES OF SPERMATORRHOEA. The hydrocele which existed in this patient seemed to have been caused by the repeated attacks of urethritis; and the rapidity with which the effusion was absorbed under the use of galvanism, was very remarkable. This circumstance proves galvanism to have been the remedy best suited to the case. I shall relate here another case, illustrating the effects of cold, and which is also remarkable in other respects. CASE XXI. Intemperance—Lengthened exposure to cold—Chronic inflammation of the bladder—Involuntary seminal discharges, &c.—Cauterization—Cure— Relapse—Same treatment with the same result—Remarkable influence of the bladder on the rectum. Gr----, a soldier in the 4th regiment of light infantry, much addicted to intemperance, enjoyed pretty good health, with the exception of two or three slight attacks of blennorrhagia, until the age of thirty. At this age, however, when intoxicated and in an excessive state of perspiration, G---- plunged into cold water as far as his middle, and afterwards allowed hia clothes to dry on his person. Shortly afterwards Gr----felt acute pain in the lumbar region, with weight in the hypogastrium, and a frequent desire to make water, which he passed with some little difficulty. Camphorated frictions on the loins, with rest, and an antiphlogistic regimen, gave him momentary relief; but G----soon perceived that he was more easily fatigued than before, and especially that his legs daily grew weaker. He continued to perform his military duties during eighteen months, though with great and increasing difficulty; and at length he became so weak that he was obliged to apply for his discharge. Having returned to his native town, he commenced business as a tailor, and he had not long followed this employment when he perceived that he passed semen frequently, without either erection or pleasure. These dis- charges grew more and more frequent, and were accompanied by an irre- sistible and frequent call to empty the rectum; his urine was passed with much difficulty, requiring efforts which were very fatiguing. During the years 1830 and 1831, the weakness of his legs continued to increase. His digestion was difficult, and his genital organs were much relaxed. In March, 1832, after a fit of intemperance, Gr----was seized by a com- plete retention of urine, for which baths, fomentations, and emollient drinks were prescribed. This state gave place to one of strangury, soon followed by incontinence of urine. In May, 1832, artificial sulphuretted baths were employed without bene- fit, and in September, the baths of Balaruc, with no better result. On the 4th of October, G----was admitted into the hospital of St. Eloi. Two moxas were applied to his loins, and shortly afterwards four issues lower down. On the 1st of November, Gr----took some soup and wine, and the fol- lowing day acute irritation of the neck of the bladder came on, for which he was treated by leeches to the hypogastrium, baths and camphorated drinks. The pain diminished, but the passage of urine was preceded by a discharge of milky fluid. INFLUENCE OF THE RECTUM. 109 At this time the patient first came under my care. I found him in the following state. He was thirty-five years of age, of moderate stature; his skin white, face pale, hair black and scanty, voice feeble and rather husky, digestion difficult, especially after the use of animal food; he was frequently compelled to go to stool, the presence of a little faecal matter in the rectum inducing a painful feeling, which caused its involuntary expulsion. He passed urine every ten minutes or quarter of an hour, without being aware of its escape, and the fluid contained an abundant deposit of a greenish white colour, which appeared flocculent. The urine decomposed very rapidly. He had no venereal desires, and not the least appearance of erections. His lower extremities were so weak as scarcely to support the weight of his body. His legs were the constant seat of osseous pains, and his feet were habitually cold. He seemed indifferent to every thing. % On the 14th of November I performed a slight cauterization of the neck of the bladder, and of the surface of the prostate. The patient experienced little pain during the operation; there was,no discharge of blood and but little burning afterwards. On the 22d the urinary deposit had considerably decreased in quantity. By the 2Gth the deposit had entirely disappeared. On the 28th the urine appeared quite limpid, and the patient was able to retain it for half an hour, but it was still passed involuntarily. The faeces were not passed so often, and the lower extremities were a little stronger. On the 29th I performed a second and more complete cauterization of the same parts. The pain was considerable, and followed by burning. Bloody urine was afterwards passed very frequently. On the 4th of December the patient was able to walk without the aid of crutches; his appetite and his spirits returned. On the following days the urine and fasces were held longer. On the 11th of December a third cauterization was practised, beginning by the bladder, and ending at the bulb of the urethra. On the 18th the patient was able to retain bis urine, which was quite limpid, for an hour; animal food was well digested; his erections returned; his legs regained their normal strength; his face acquired colour and ani- mation, and his spirits had returned. The faeces were retained as long as in health. On the 20th the patient felt so well that he left the hospital; his con- valescence continued, and indeed, seemed to make more rapid progress in proportion to the amount of exercise he took. In the month of February, 1833, G----having occasion to take a long journey during very severe cold, drank a considerable quantity of wine. In the month of May he re-entered the hospital, in almost the same state as at first. I performed a fourth cauterization similar to the last and with the same good effects. I afterwards prescribed tar-water and the use of artificial sulphuretted baths, and at the end of two months all the symptoms had disappeared, and the patient left the hospital quite re-established. A lengthened exposure to cold was followed in this, as in the pre- vious case, by diurnal pollutions, and by almost complete paralysis of the lower extremities. But here all resemblance between the two cases ceases. 110 CAUSES OF SPERMATORRHOEA. In Captain V-----the cold had acted especially on the nerves which are given off by the lower portion of the spinal cord; these had been affected with a loss of power, from which the rectum had chiefly suffered; hence, its distention by faeces, and the consequent compression of the seminal vesicles. There was not the slightest appearance of irritation in the parts, and, for this reason, the gal- vanism produced such beneficial effects. In the patient G-----, the cold chiefly acted on the bladder, and the chronic cystitis resulting from it extended its influence successively to the seminal vesicles and the rectum. The extreme weakness of the lower limbs arose from the repeated seminal discharges, which wore the patient out. Hence cauterization was followed by the happiest results. I am convinced that in this case galvanism could not have been borne. It is easy to explain why, in the latter case, cold acted so directly on the bladder—the patient's intemperance predisposed that organ to disease. G-----was intoxicated when he went into the water; afterwards, when he experienced a rapid increase of his bad symp- toms, he had taken wine with his soup; and still later, in the jour- ney during the winter, which was the cause of his relapse, he had drunk a considerable quantity of wine. It is, therefore, by no means easy to separate the effects of cold, in this case, from those of intem- perance, the action of which on the urinary organs is easily explained. When considering the effects of blennorrhagia, I reported a case in which cold exercised a considerable influence in the production of spermatorrhoea, (case fifth,) but this effect was shown by very diffe- rent symptoms. Strangely enough, the treatment which cured these three patients was quite different in each case—showing the indis- pensable necessity of observing numerous cases, and of examining minutely all their peculiarities. A phenomenon was present in the case of the patient G-----, which shows that the influence of the rectum on the genito-urinary organs is quite equalled by that of the genito-urinary organs on the rectum. The mucous membrane of the intestine was in this case so irritable that the gut was unable to bear the presence of faecal matter; imme- diately that' the faeces reached the level of the bladder, convulsive contractions of the muscular coat of the rectum were excited, causing their immediate and involuntary expulsion. The stools were not liquid, or mixed with mucus, as in diarrhoea, though, in consequence of their short stay in the rectum, they were by no means solid. No particular treatment was pursued for the removal of the irri- tation of the rectum; it diminished after each cauterization, and dis- appeared at the same time as the inflammation of the bladder. The longer the patient was able to hold his urine, the less frequent his stools became; and both bladder and rectum seemed to return under the influence of the will at the same time. But if the inflammation of the bladder could produce such an effect on the rectum, it must have acted with still greater power on the seminal vesicles. What, then, was the cause of the patient's expe- INFLUENCE OF THE RECTUM. Ill riencing constant discharges of semen, both by day and night, with- out erection, without pleasure, and in the midst of the most perfect repose as regarded veneral excitement? A certain quantity of the spermatic fluid having reached the seminal vesicles, produced in them, by its mere presence, involuntary and irresistible spasmodic contrac- tions, similar to those of the bladder and rectum; the semen was expelled in the same manner as the urine and the faeces, and with- out the characters which it would have acquired after a longer de- tention in the reservoirs destined for its reception. It is evident, then, that an intimate relationship exists between all these parts, and that it is necessary to connect their phenomena in order to obtain a correct and perfect idea of their influence. It must by no means be thought that this effect of the genito-uri- nary organs on the rectum is of rare occurrence; it is, on the con- trary, habitual; but it is seldom so strikingly shown as in the pre- ceding case. I have not hitherto noticed it, because I wished to render the subject as simple as possible; but it is to this intimate connexion that the sensation of uneasiness and weight at the margin of the anus, the habitual contraction of the sphincter, and the ob- stinate constipation, which are so often observed in patients affected by spermatorrhoea, must be attributed. All those on whom I have practised cauterization of the neck of the bladder, have experienced a sudden burning at the margin of the anus, and a sensation of heat in the rectum immediately after the operation; on the following day they have had greater tone in the rectum, and their stools have very soon become more free. I must not, however, at present, enter into further details on this subject. CASE XXII. Unsuspected spermatorrhoea—Attacks of cerebral congestion—Disorder of the general health—Ascarides expelled from the rectum with immediate recovery. M. C----, a Captain of Engineers, aged about thirty-two, nearly bald, very thin and pale, with sunken eyes surrounded by dark circles, a feeble, shrill voice, and a timid, embarrassed appearance, consulted me respecting his health on several occasions : I never attached much importance to his . complaints, but always attributed them to the melancholy bias of his cha- racter. In 1824, however, his digestion became disordered in an alarming manner, and was always accompanied by the disengagement of much fla- tus ; even the ingestion of soup into the stomach was followed by oppres- sion in the epigastric region, and difficulty of respiration, which was espe- cially felt in the situation of the oesophagus, and terminated in the pharynx. This sensation diminished considerably as soon as the patient was able to pass flatus. He felt himself overcome by a sense of general debility, and especially experienced a feeling of weakness in his legs, which contrasted strikingly with his continual desire for motion, and his custom of taking long walks. He suffered from frequent attacks of giddiness, with conges- tion in his head, especially when he stooped, or read, even for a few mi- 112 CAUSES OF SPERMATORRHEA. nutes, and he consequently thought himself threatened by an attack of apo- plexy. His usual spareness of habit had increased; his testicles had dimi- nished sensibly in size, and his genital organs always felt cold. His pulse was weak and soft; his tongue pale and moist, and pressure on the epigas- trium did not give him the least pain. I could not participate in this patient's fears respecting the probability of an attack of apoplexy or the existence of gastritis, for I attributed all his symptoms to excessive discharges of semen, although he would not admit the correctness of this opinion. He had abstained from coitus during a long time, from the fear of injuring his health, and expressed a horror of masturbation; he was not subject to nocturnal emission, and he had never noticed any discharge of semen when passing urine or at stool. I sent him for change of air during the heat of the summer, to Vigan in the Cevennes, requesting him at the same time to watch himself carefully while at stool, and to send me an account of the appearance of his urine. A few days after his arrival at Yigan he sent me word that after each stool he had a discharge of thick, whitish, slightly unctuous matter, of a very weak spermatic odour, and which stained his linen a pale yellow. This discharge was especially abundant whenever his efforts at stool were very violent. It was not, however, during the actual passage of fsecal matter that the discharges of semen occurred, but shortly afterwards; and he ex- perienced at the same time a sense of weight in the rectum, and a spasmodic contraction accompanied by itching and heat. The symptoms were then, as I suspected, really due to excessive spermatic discharges. Yet I did not attach sufficient importance to the singular circumstances which accompa- nied these discharges, and I was satisfied when prescribing cool injections, cold lotions, and vegetable and milk diet, with the intention of relieving the constipation, and of giving tone to the genital organs. These means pro- duced no remarkable change in the seminal discharges; after a time I re- ceived another long letter, which was full of minute and uninteresting de- tails ; on the back, however, the patient had written a postscript, stating that in one of his stools he had passed a number of little worms, and that he frequently felt an itching in the rectum, which he attributed to a herpetic affection. A slight discharge occurred from the rectum, and the fasces were mixed with a good deal of purulent mucus. The parts surrounding the anus were gorged. This state had been present from 1818, and had first appeared after a violent intestinal inflammation, accompanied with colic and tenesmus, which latter re-appeared in 1822. The cause of the spermator- rhoea, now, was evident, and I also understood how it was that the seminal discharge did not take place exactly at the same time as the passage of the fasces, but a little after; these discharges were not produced by mechanical compression arising from such passage, but they were the result of a state of irritation produced by the presence of worms; the sensation of pressure, the spasmodic contraction, the itching, and the heat, which were felt in the rectum, proved this. The patient took, fasting, on three successive mornings, four grains of calomel, and during the day three or four glasses of decoction of Corsican moss, and a tepid enema, followed by a cold one; he once took a small enema of warm milk, and soon after a second, composed of a strong decoc- tion of garlic. At the end of three days, perceiving no more ascarides in his stools, he left off treatment for a week, after which he took, at bed time, four grains of calomel followed by six drachms of sulphate of magnesia, the INFLUENCE OF THE RECTUM. 113 next morning. Four copious stools were obtained, which presented no ap- pearance worthy of note. Soon after this, Captain C---- wrote to me stating that his strength had returned; that his stomach performed all its functions properly; that the spermatic discharges had ceased, together with the discharge from the anus, and the itching, &c, with which he had pre- viously been tormented. The ascarides re-appeared every year, however, at a stated period, and sometimes even twice a year, but the patient was able to treat himself, and immediately that any symptoms announced their presence, he got rid of them in two or three days—his health never becoming disordered. CASE XXIII. Masturbation at nine years of age—Constant nocturnal emissions—Ascarides — Cure in eight days. Henry B----, a Sergeant of Engineers, at the age of nine, was addicted to the vice of masturbation, which he continued to practise up to the age of fifteen, when he corrected himself. From this time he experienced frequent nocturnal pollutions. Loss of flesh, followed, with pains in the chest and a fixed pain in the middle of the back. The whole nervous system was dis- ordered, and the patient's eyes were injected and surrounded by dark circles. After the occurrence of a nocturnal emission, the patient often noticed that he had pricking sensations, as though he had been stung by ants, with acute pain in the lower part of his abdomen, and in his loins. He was completely overcome by fatigue in the morning, and felt, when he rose from bed, as though his legs and arms had been bruised; he com- plained also of oppression at his chest, and a sense of suffocation. He felt buzzing in his ears in the evening: he lost his memory, was uuable to at- tend to his affairs, and performed his military duty with much difficulty. This state had continued for several years, and became daily more serious. Various modes of treatment had been employed by different medical men whom the patient had consulted; among other remedies used may be named quinine, oxide of iron, ferruginous water mixed with wine of Bor- deaux, lime-water in milk, and Hoffman's anodyne at night. River-bathing and cold enemata had also been tried, and the patient had applied, during the coldest season, snow and ice over his kidneys and genital organs. No advantage whatever was derived from all these means, and sal-ammoniac dis- solved in water, to form a cold lotion, only irritated the skin of the penis and scrotum. Henry B----was twenty years of age when he first consulted me; his face appeared coloured and healthy, and his form announced health and vigour. It was therefore difficult to guess the cause of the deep melancholy which his features showed. After much questioning, I at length learned that he had been subject to worms from his childhood—that he passed them every time he went to stool, and that his faeces were sometimes quite covered with them. From the description he gave me, I was convinced that they consisted of oxyures, with perhaps a few trichocephali. I pre- scribed for him four grains of calomel night and morning, with half a drachm of mercurial ointment to be introduced into the rectum night and morning, and enemata composed of potentilla anserina in decoction. Eight 8 114 CAUSES OF SPERMATORRHEA. days afterwards he told me that his pollutions had ceased, and that his health was quite restored. CASE XXIV. Hypochondriasis—Impotence—Attacks of cerebral congestion—Ascarides— Cure within eight days. A-----, a gardener of large and well formed frame, and dark complexion, two years married, perceived, seven or eight months after marriage, that he lost by degrees his virile power; that his appetite at the same time became capricious, and his digestion difficult and accompanied with pain in the epigastrium, the development of flatus, and frequent attacks of vomiting. Pills containing cynoglossus, sedatives, and demulcents of all kinds, had been prescribed for this patient by a distinguished practitioner of Montpel- lier, in order to relieve the irritation of his digestive organs; but his general weakness, and that of the genital organs in particular, increased daily. A feeling of lassitude constantly came over him, he was habitually sleepy, and had frequent attacks of vertigo. These symptoms led other practitioners whom he consulted to fear the occurrence of apoplexy, and consequently venesection was prescribed: but the patient, notwithstanding his uneasi- ness, refused to be bled, saying that he was convinced he had no blood to lose. In 1833, A-----consulted one of my pupils, who, after long ques- tioning, learned that he suffered from obstinate costiveness, with troublesome itching in the rectum, and that he frequently passed a number of oxyures with his fasces. Believing that these oxyures were the cause of seminal discharges which the patient had not discovered, an infusion of mentha vi- ridis was ordered for him, with aromatic enemata, and afterwards enemata of cold salt-water, sufficiently copious to distend the gut and to be expelled with some violence. These injections caused the expulsion of a large num- ber of entozoa. The patient's digestive disorder ceased almost immediately; his erections soon returned, and coitus took place a few days afterwards. He soon re- covered his strength; his spirits resumed their wonted gaiety, and he re- commenced his work with pleasure. This change was the result of only eight days' treatment. CASE XXV. Nocturnal pollutions, resisting all modes of treatment during six years— Great physical and moral depression—Expulsion of ascarides with com- plete relief M. D----, the son of healthy parents, at the age of eleven, contracted, of his own accord, the habit of masturbation; but he soon discovered its per- nicious effects, and corrected himself: his strength returned, and up to the age of fourteen he continued in perfect health. At this period, after read- ing an erotic book, he relapsed into his former habits. He also formed a connexion with a female, who excited his passions without gratifying them. These sources of excitement so enervated him, that palpitation of the heart and tremors in his limbs, supervened. Up to this period M. D-----had never had an involuntary seminal emis- INFLUENCE OF THE RECTUM. 115 sion, and he still retained sufficient power over himself, only to practise masturbation once a week. The irritation he experienced in the genital organs was so great that he was often forced to plunge them into cold water for its relief. He was stout and tall, and his health was robust. On the 25th of October, 1815, on waking in the morning, M. D----- found that he had experienced a copious seminal emission unconsciously while asleep. On every one of the eight following nights he had several involuntary emissions. These discharges produced a remarkable state of weakness, and he lost flesh visibly; still he hoped that the discharges would cease spontaneously, and false delicacy prevented him from mentioning his state. Absorbed in the consideration of his own condition, M. D----now withdrew himself from his companions, and occupied himself in devising means for the relief of the discharges. He attempted numerous ingenious contrivances to prevent the penis from becoming erect during sleep, but none of them succeeded; the disorder of his health continued to increase, until the year 1820, when his condition was deplorable, and he came to Montpellier to place himself under my care. From his account of the sufferings he had endured, I at first thought that the involuntary emissions from which he had suffered, arose from a preternatural sensibility of the genital organs, increased by their premature use. Before commencing any plan of treatment, however, I caused M. D-----to draw up a history of his case, in order that I might have all the facts before me at one view. While reading this history, my attention was arrested by the mention of numerous small worms, which were passed with the faeces, and which were looked on by the unfortunate patient as a sign of speedy dissolution. I examined the anus, and was unable to discover the eruption which he mentioned in his memoir, as giving rise to acute irritation in that neighbourhood, besides which, this eruption would not have produced the itching of the nose of which he also complained. I suspected, therefore, that the involuntary emissions might be kept up by irritation from ascarides, and I drew the patient's attention to the circum- stance. He told me. immediately, that he passed them habitually in his stools; and that frequently, from the violent nature of the itching, he had been compelled to scratch until blood flowed, and even to introduce his finger nail within the margin of the anus, when on withdrawing it, he had removed a living oxyuris. About ten o'clock in the evening the oxyuris especially tormented him by descending into the lower portion of the rectum, and even within the contracted sphincter. He had besides, a constant acid taste in his mouth, and he passed a large quantity of saliva on his pillow during ' the night. Of all the means prescribed for this patient, the administration of cold enemata, and the exhibition of calomel, were the most efficacious. The first injections were employed at a temperature of from 18° to 20° of Reaumur,1 and they were afterwards used at 15° and even at 12° of the same scale.2 Experience soon taught the patient that he received most benefit from their administration about ten o'clock in the evening, at the time when the ascarides descended near the anus, of which he became aware, by the increased itching excited. He found also that in order to obtain the utmost benefit from the injections, it was necessary to throw a 1 Between 70° and 80° of Fahrenheit. 2 About 59° and 68° of Fahrenheit's scale. 116 CAUSES OF SPERMATORRHOEA. large quantity of water into the intestine, as high as possible, and after- wards to pass it suddenly so as to expel the ascarides inhabiting the upper part of the intestine, at the moment when they were benumbed. By these means large quantities of the entozoa were passed on several successive days; after their expulsion the involuntary emissions diminished rapidly and per- manently, and all the accidents arising from them disappeared; the patient's strength and embonpoint, especially, returned very quickly. The involuntary emissions, however, only ceased entirely under the influence of a natural exercise of the organs, with the use of cold bathing, and gymnastic exercise. The patient had previously been obliged, on two occasions, to give up the use of the cold bath—once during the heat of summer, because he was un- able to obtain a proper reaction on quitting the water; yet immediately that his system had recovered a little strength, he found himself much benefited by cold bathing; indeed, after the expulsion of the ascarides, it produced more benefit than any other means employed, and he even commenced the use of the cold plunge during the winter, with considerable advantage. Walking exercise was also very useful, and this perhaps it was that in- duced M. D----, after having completed his medical education at Mont- pellier, to turn his attention to the study of natural history. He has since undertaken long and dangerous travels in the service of science, and the works he has published bear the stamp of an observing mind, and a high range of thought. His labours have always been favourably received by the academy of sciences. M. D----'s health has been completely re-estab- lished twenty-five years. The history sent to me by M. D-----was full of interest; it showed a kind of fatality pursuing him, although he struggled with courage and perseverance against troubles which he had not deserved. It is necessary to have undergone such sufferings, and to write under their immediate influence, in order to relate all their circumstances with correctness. An uninterested observer would be unable to do justice to such a recital. How many such persons as M. D-----do we not meet with, constantly exposed to the relentless animadversions of society, when they ought to be regarded with pity, and to be relieved from their sufferings by the healing hand of the physician! Two of the patients whose cases I have just related, (cases twenty- three and twenty-four,) who suffered in infancy from ascarides, were addicted to masturbation, even before the age of puberty. They afterwards reproached themselves bitterly, and attributed all their misfortunes to this fatal habit. But it appears to me that in order to induce such a habit spontaneously, at so early an age, Ion** before the full development of the genital organs, a degree of abnormal irritation must be present in them. The irritation caused by stone in the bladder often excites, in male infants, premature erections, and pain referred to the fossa navicularis; this they relieve by elongating the penis, so that in such patients, as is well known, the prepuce is of unnatural length. These manoeuvres naturally lead them to habits for which they ou"-ht not under such circumstances, to be held morally responsible. INFLUENCE OF THE RECTUM. 117 The irritation produced by ascarides in the rectum constantly ex- cites the same phenomena, and I have frequently seen children two or three years of age affected with priapism, which could be referred to no other cause. This circumstance is so common, that it has been frequently mentioned to me by nurses, who even employ a po- pular remedy to relieve it, showing, at least, that the influence of the ascarides is well known. Nurses introduce a suppository of lard into the rectum, under the impression that the ascarides come there in search of food, and that they will be able to remove them together with the lard, on withdrawing it. The cause of these pre-. mature erections cannot, therefore, be doubted. Such children, must, in consequence of the irritation of the parts, possess an irresistible tendency to handle them, just as they have, under the same circumstances, to scratch and rub the nose; and the sensation resulting from the friction of the genital organs being very acute, is likely enough to form the basis of a more mischievous habit. When, on reaching puberty, reason assumes its empire, the patients often acquire sufficient command over themselves to re- nounce these fatal practices, and they then suffer from involuntary emissions arising from the same cause that excited the masturba- tion ; that is to say, from the irritation of the genital organs by the worms inhabiting the rectum. Ascarides produce nearly the same effects in the female; I have seen many little girls of tender age, who were tormented by irre- sistible itching of the pudendum, and profuse leucorrhoea, often ac- companied with redness and excoriation of the clitoris and labia minora, all arising from the same source of irritation. The involuntary emissions of semen which accompany defecation in those patients who are affected with ascarides, cannot be attributed to mechanical compression of the seminal vesicles, for costiveness is not present, nor could constipation account for the nocturnal emis- sions; it appears to me that the titillation constantly exercised on the rectum and margin of the anus, by the ascarides, extends its influence to the genital organs, and excites spasmodic contractions of the seminal vesicles. CASE XXVI. The habit of masturbation contracted spontaneously at the age of fifteen, and continued until the age of twenty—Nocturnal and diurnal pollu- tions—Increasing disorder of the health until the age of twenty-nine— Frequent andprolonged erections—Pain at the margin of the anus, &c.— Cauterization performed without benefit— The expulsion of ascarides fol- lowed by rapid recovery. M. R----, a studeut of medicine, enjoyed good health in his childhood, but about the age of fifteen was tormented by frequent and prolonged erections. One evening, for the relief of the itching, of which the extremity of the penis was the seat, he rubbed the organ violently between his hands. This led to the establishment of masturbation as a habit, or rather as a pas- 118 CAUSES OF SPERMATORRHEA. sion, the patient practising it sometimes as often as eight or ten times a day. His health by degrees became so altered that one of his friends suspected his practices, and told him the danger of his situation. By degrees he corrected himself, though not entirely, before he had attained his twen- tieth year. On his renouncing masturbation, nocturnal emissions super- vened, and often occurred two or three times a night. They dimi- nished after a time, but without ceasing entirely, and seminal emissions during defecation and the emission of urine were added to them. Thus his health became daily more and more disordered for nine years, notwithstand- ing absolute continence, a severe regimen, and the use of sedatives, tonics, and anti-spasmodics. At length he grew incapable of any mental exertion. In 1837, he came to Montpellier, at the age of twenty-nine, in the following condition:—Extreme emaciation; face pale; appearance stupid and con- fused; intellect dull; reasoning powers much affected, the patient being in- capable of connecting two ideas on the most simple topic of conversation; loss of memory; constant headache referred to the forehead and temples, and increased by any mental excitement, being then accompanied by nervous tremors, and an almost idiotic state; sleep broken and unrefreshing; con- stant sighing; frequent attacks of congestion of the head, especially at night; violent noise in the ears resembling the sound of a waterfall; vertigo; stun- ning sensations, giving rise to a constant fear of apoplexy; timidity carried to a ridiculous extent; panics of fear even during the day; character gloomy, taciturn, restless and irritable; horror of the least noise, and of all society; irresistible restlessness; great weakness; abundant sweats after very slight exertion; almost constant coryza; frequent dry and hard cough; pains in the base of the chest, the region of the heart, and along the spinal column; appetite voracious; dragging at the pit of the stomach; difficult digestion, accompanied with the development of flatus; grinding of the teeth during sleep; burning at the point of the tongue; darting pains in the bowels, especially in the rectum; obstinate constipation alternating with violent attacks of diarrhoea; stools containing much, mucus and sometimes streaked with blood; periodical pains at the margin of the anus, in the pe- rineum, penis, and testicles; urine passed in large quantities, and very fre- quently, always throwing down a whitish, thick, and very abundant deposit, involuntary emissions during defecation, both when constipated and relaxed; frequent and prolonged erections by day as well as by night; with constant presence of erotic ideas. On sounding this patient, I found the urethra very sensitive, especially towards the neck of the bladder, and I consequently thought that the noc- turnal and diurnal pollutions were kept up by a state of irritation arising from masturbation. I therefore proposed cauterization. This was performed on the following day, and produced the usual immediate effects, but its curative effects did not take place as I had anticipated. I then directed the patient to notice his fasces, and a few days afterwards he told me that he had observed numerous little worms passed in his stools. I now ordered enemata of cold water, and salt and water, which, however, produced only a momentary effect—probably because the ascarides inhabited the upper part of the_ intestine. A few doses of calomel, however, caused them to disappear without returning; and from this moment the involuntary diurnal emissions ceased entirely, the nocturnal emissions became more and more rare, and the patient's re-establishment progressed very rapidly. M. B_____ returned to his studies with ardour, and long afterwards all functions were perfectly well performed. INFLUENCE OF THE RECTUM. 119 It appears evident that the irritation caused by the ascarides in the rectum, first led this patient to practise masturbation, and after- wards kept up involuntary seminal discharges. I did not discover this at first, because the history of his case, sent me by the patient, was so long, and was characterized by such disorder and want of clearness, that I was unable to arrive at any satisfactory conclusions from such a chaos; his answers were still more vague and uncon- nected, so that my attention had been chiefly attracted to the state of his intellect, and the abuses he had committed. But after seeing the little success of cauterization, and again reading his notes, I paid more attention to the circumstances attending the commencement of his practising masturbation, and I noticed several symptoms to which I had not before attached importance, such as grinding of the teeth during sleep; burning pain in the point of the tongue; pain ' in the rectum, and at the margin of the anus; the stools always containing mucus, and sometimes being streaked with blood; and especially the frequency and duration of the erections, and the con- stant presence of erotic ideas. When costiveness is present the stools rarely contain any quantity of mucus; its presence alone, therefore, in such a case, would indi- cate that the rectum is irritated by ascarides. But a still more characteristic point is, the long duration of the erections. When in- voluntary spermatic discharges are induced by any cause except this, the erections diminish in proportion as the disease advances, first becoming incomplete, and afterwards disappearing entirely. When, therefore, energetic and obstinate erections continue, in spite of the great wastings of the body produced by them, they must be kept up by some other stimulus to the organs than the natural one, and I be- lieve irritation by ascarides to be the only cause capable of producing this effect. This, on the other hand, agrees perfectly with what I have already stated concerning their influence on_the genital organs. CASE XXVII. Masturbation at the age of fifteen—Serious disorder—The application of a blister followed by involuntary nocturnal emissions—Cauterization, douches, dr., unsuccessful—Expulsion of ascarides, followed by a rapid recovery. Simon G----, a vine dresser, shojt, stoutly formed, and of sanguineous temperament, reached the age of fifteen without suffering from any disease. At this period, while watching goats with other children, he was led by their example to practise masturbation. At first no emission took place, but at the end of about a month, his manoeuvres caused the discharge of a few drops of blood, with burning at the root of the penis, and pain in the testi- cles. Soon after, a general lassitude supervened, with a sense of fatigue in all his body, and cold sweats. No semen wasydischarged for a long time, and during the first five months that seminal emissions occurred, the dis- charge was very fluid, and produced very little sensation. 120 CAUSES OF SPERMATORRHOEA. After Simon G----had followed these mal-practices for a few weeks, he experienced darting pain in the stomach; flushes of heat in the face, and chilliness about the feet. At the age of sixteen, pain and creeping sensa- tions along the spinal column were added to these symptoms; and still later, severe cramps in the limbs, and weakness of the lower extremities. At the age of seventeen, the patient was much troubled with palpitations of the heart, especially after masturbation. His stools were costive, passed with difficulty and pain, and often streaked with blood. These symptoms were followed by lassitude, pains in the shoulders, difficult digestion, accompanied with acidity and development of flatus, with increased palpitations; his sleep was no longer sound and refreshing. At the age of eighteen, congestions of the head supervened, with burning and redness of the face, occurring as often as five or six times a day; the patient suffered from heartburn, and difficult respiration, with a sensation as » though his throat were compressed. At the age of nineteen, he carried masturbation so far as to produce san- guineous emissions. His debility now became so great that he was unable to follow his occupation, or even to walk a short distance without frequently resting. The use of wine, even in small quantities, always increased his debility and his other disorders. At this time leeches were applied to the anus; blisters to the epigastrium, nape of the neck and shoulders; and re- frigerant drinks were ordered. Shortly after the application of the blisters, nocturnal emissions, preceded by erotic dreams, occurred for the first time, and were followed by cramps in the legs, and griping pain in the stomach. From this period the nocturnal emissions occurred nearly every night, and frequently several times a night. At this time his disorder increased so much, that a medical man was con- sulted. G-----confessed the cause of his illness; promised to correct him- self, and kept his word. The treatment consisted of leeches to the back of the neck; syrup of quinine; about two hundred aromatic baths; friction with camphor over the back of the neck, the spine, and limbs; sleeping on a very hard bed, &c. After having employed these various means during eighteen months, with- out receiving the least benefit, G----left off all treatment, and at length came to Montpellier, and was admitted into the hospital St. Eloi, on the 14th of February. G-----was then twenty-two years of age, and his external appearance announced strength and health; his embonpoint was considerable, and his face full and red; yet he was sad, weak, and without courage, in fact his state had not improved in the least during the two years that he had ceased to practise masturbation; and his nocturnal emissions had ceased for six days at a time, or longer, without his becoming any better. This last cir- cumstance made me suspect that he suffered, at the same time, from diurnal pollutions. His stools were often very constipated; and the hardened fasces, accumulating in the rectum, were discharged with difficulty and pain— semen always escaping, at the same time, in greater or less quantity. The desire of micturition was frequent and sudden, and it generally aroused the patient four or five times during the night; the last drops of urine were thick, viscid, and followed by a still more consistent matter, which remained at the orifice of the glans. The urine itself contained an abundant thick, whitish, and flocculent deposit, like that thrown down by a strong decoc- tion of pearl barley. The mucous membrane of the urethra was very INFLUENCE OF THE RECTUM. 121 sensitive, especially towards the prostate; and the passage of a catheter was arrested by spasmodic contraction of the neck of the bladder. After observing these symptoms for seven or eight days, on the 22d of February I performed cauterization from the neck of the bladder to the membranous portion of the urethra. The following night two very painful nocturnal emissions occurred; two more took place on the third night, and they were renewed every second or third night, notwithstanding the use of baths, enemata, cold douches, camphorated emulsions, and morphia. The urine was little altered in appearance, and there was little, if any, improve- ment in the general symptoms. The sleep continued broken and unrefreshing. The patient was always disturbed by painful erections, and an uncomfortable itching at the orifice of the urethra At length, one day he informed me that he had observed in his fasces numerous little worms about six lines long, and pointed at both ends. It was plain, therefore, that ascarides were present in the rectum, and that before benefit could be derived from any other means, it would be necessary to expel them.1 1 The effects produced in the following remarkable case, which has recently come under my notice, appear to me to have been due, in a great measure, to the irritation excited by ascarides; and the circumstance so well illustrates the connexion between the rectum and genito-urinary apparatus, that I am induced to break through my original intention, of not adding any of the results of my own experience to M. Lalle- mand's very full and complete treatise, and to publish the case as it is contained in my note book. Mr. M----, aged about thirty, of florid complexion, two years mar- ried, called on me in a state of great mental excitement and distress, in the beginning of March, 1846. He told me that about a week before, while getting up one morning, he had observed a slight gluey discharge between the lips of the urethra, that he had taken no notice of the circumstance, but had employed himself about his affairs as usual. He was in perfectly good health, and in fact had forgotten the occurrence, until on the third morning it was recalled to his recollection by the appearance of a considerable discharge in the same situation, accompanied with pain during micturition. As he had a slight cold at the time, he attributed these symptoms to its effects, and contented himself, for that day, with remaining within doors, and restricting his diet to vegeta- bles and slops. Still, the pain during micturition continued, the discharge increased in quantity, and became thicker and greenish. He now became a prey to the most harassing suspicions, though he still was unwilling to seek advice, in the hope that the discharge would cease spontaneously, as it had arisen. In this state the patient continued, until the morning of the 10th of March, by which time he was wrought to the highest pitch of mental excitement by the thoughts that constantly obtruded themselves on his mind. He told me that he had suffered from three attacks of blennorrhagia:—the first, a very severe one, about the age of nineteen,—the last, about twenty-five. He had never had any syphilitic affection. With the first attack of blennorrhagia he had been confined to his bed nearly a week, from irritability of the bladder attended with strangury, &c, and that he had frequently, since that time, suffered from slight at- tacks of vesical irritation, after exposure to wet or cold, or after very slight excess at table. He could not account for the present symptoms in any way, unless by re- ferring them to a very slight cold which hi,d entirely passed off, or by giving credit to suspicions which would entirely overthrow his domestic happiness, and for which he had, otherwise, not the most remote cause. From the state of my patient's feelings, I saw that something must be immediately done, to remove suspense; I therefore assured him that cases of urethral discharge, from slight excitement, were not uncommon, especially in persons like himself, who had repeatedly suffered from blennorrhagia, and were predisposed to irritability of the organs. When he became a little more composed, on examining the genital organs, I found a viscid greenish discharge from the urethra, not exactly resembling the ordinary thick, dark, discharge of blennorrhagia, but containing a considerable quantity of mucus, and of a glairy consistence. The orifice of the urethra was neither swollen 122 CAUSES OF SPERMATORRHEA. I accordingly ordered four, six and eight-grain doses of calomel, to be followed by injections for this purpose. The patient's condition immediately beo-an to improve rapidly; his nocturnal emissions ceased; his urine became transparent; the local and general symptoms disappeared; and he left the hospital on the 1st of April quite re-established in health Masturbation, excited by bad example, produced from the first a serious disorder in this patient's health. On two occasions the prac- nor red, and on inquiry I found that although the patient suffered from painful erec- tions, they by no means resembled the chordee from which he had suffered on previous occasions, but that the pain was rather situated in the prostatic and membranous portions of the urethra. He suffered much from strangury, and his urine was highly acid. The chief pain that occurred during its emission was felt in the perineum, and the scalding near the orifice of the urethra, which usually attends blennorrhagia, was scarcely sufficient to attract his notice. Under these circumstances, believing the case to be simply irritation of the neck of the bladder from cold, I considered that I might at once relieve his anxiety as to the nature of the discharge, by positively as- suring him that it was not venereal, and that with care he would probably be well in a few days. I ordered for him a warm hip bath, and some bicarbonate of potass in gum-water, with tincture of henbane, and requested him to abstain from all stimulants, and to be careful to avoid exposure to cold or damp. The following day he called on me, con- siderably relieved from his strangury, and with his urine in a much more healthy state; but the discharge continued as severe as before, and there was still considerable pain in making water. A contiuuance of the same remedies was prescribed, and patience enjoined. The two following days the patient did not call, and I had begun to suppose that he was quite recovered, when on the 15th he returned, almost as much excited as at first. He was convinced, he said, that his disease was more serious than I had led him to believe, and that there was only one way of accounting for it; he was a ruined man, &c. After he had become a little calm, he stated to me that the irritation had returned, that the discharge was more abundant, and he was convinced, that had it been simple irritation of the neck of the bladder, all these symptoms would have ceased long before. He complained of a burning heat, and a sense of weight in the rectum, which induced me to request an examination of the prostate. When proceeding to do so, I observed the parts in the neighbourhood of the anus red, hot, and excoriated, and on questioning, he told me that he had long suffered severely from itching in the neighbourhood, but that he had omitted to mention it to me, as he had not considered it of any importance, believing it to arise from little worms which he often passed in his stools. This fact threw a new light on the case, and I began to suspect that the irritation produced by ascarides was the cause of the vesical irri- tation and urethral discharge. On being questioned, he recollected that the stran- gury always increased towards night, when he generally suffered most from the itch- ing of the rectum, and that he had felt itching and severe burning pain in the neigh- bourhood of the rectum, long before the occurrence of the present attack of irritation, and before the appearance of the urethral discharge. I now ordered, in addition to his former medicines, a dose of calomel at bed time, to be followed by a smart pur- gative in the morning, and a copious injection of salt and water to be thrown into the rectum as rapidly as possible, whenever he found the irritation and itching very troublesome. The following day the patient called to let me know that he was much improved. The purgative, and one injection which he had used, had brought away a perfect nest of ascarides. The injection was repeated on the second night, and a few entozoa were discharged. On the 22d of March Mr. D---- called to say that the urethral discharge, scalding and vesical irritation, had entirely ceased, and that he no longer suffered from the intolerable itching that had previously almost constantly annoyed him; I advised him to use an enema occasionally, for a month or two, to prevent a return of his tormentors; this he has done, and the last time I saw him, some months after his recovery, he was in excellent health and spirits, and able to' enjoy all the comforts of domestic felicity. INFLUENCE OF THE RECTUM. 123 tice was carried so far as to induce emissions of blood. His testicles became painful; his urethra was exceedingly sensitive; and the ap- plication of blisters induced nocturnal emissions for the first time. It seemed, therefore, unnecessary to seek further for the cause of the seminal discharges which wore the patient out; yet the result proved that they wTere kept up by the presence of ascarides in the rectum, the expulsion of which was followed by a sudden change and rapid im- provement, whilst no other treatment had produced the least amend- ment. This case shows how important it is to seek all the causes which may either excite or keep up involuntary seminal emissions. I say excite or keep up, because in this case the ascarides do not appear to me to have at all contributed to produce the disorder at its commencement. It was by the influence of bad example that Simon G-----was led to practise masturbation, and not by the presence of priapism, as is the case when the habit is excited by irritation from ascarides. The first nocturnal emissions, too, followed the applica- tion of blisters; and I shall, in a future chapter, have occasion to relate other cases of the same nature: such occurrences are easily explained by absorption of the cantharides. It seems likely, then, that the ascarides were only developed at a later period, and per- haps as a consequence of the deranged state of the patient's diges- tive organs. As they were not present in any very great quantity, it appears likely that they would not have produced such serious effects, if the spermatic organs had not been previously in a state of irritation; but I believe that in the existing state of the parts, the presence of the worms was sufficient to keep up involuntary noc- turnal and diurnal emissions. By reflecting on a few of the symp- toms that attended the spermatorrhoea in this case, I might have earlier discovered the presence of ascarides; thus, the erections were frequent, prolonged, and importunate—circumstances the op- posite of those observed in patients worn out by ordinary pollutions. The troublesome itching, also, which constantly existed at the root of the penis, should have aroused my suspicions. CASE XXVIII. Masturbation at the age of ten—Seminal emissions produced by horse exer- cise—Nocturnal, and afterwards diurnal,pollutions—Constant erections ■—Stools relaxed, and containing abundance of mucus—Burning in the anus— Cauterization with slight benefit—Expulsion of ascarides followed by rapid and complete recovery. Alexander A----, of moderate stature, the son of robust peasants, en- ticed by the example of his companions, contracted, when about ten years old, the habit of masturbation, which he practised for a year before he ob- tained any seminal emission. From seventeen to eighteen he had sexual intercourse, but he afterwards returned to his former habits. He soon complained of general lassitude, weakness of the extremities, shortness of breath, and a sense of suffocation after the least exertion; loss of appetite; difficulty of digestion. Aery abundant seminal emissions were frequently 121 CAUSES OF SPERMATORRHOEA. excited by horse exercise, and occurred without erection, although not without slight sensation. At a later period he suffered from severe and prolonged palpitation from slight causes; frequent colds, and an almost habitual cough, attended with expectoration of mucus mixed with much blood. At this period, A----mentioned his condition to a medical man, who explained the cause of his disorders, and A----at once corrected him- self; but nocturnal pollutions soon appeared. At first these were very fre- quent, but after a short time they only occurred three or four times a week, and at last only three or four times a month. Still the patient's palpita- tions, difficulty of• breathing, and digestive disorder, continued to increase.' Flushes of heat to the head were added to these symptoms, together with pain in the loins, which extended, with a creeping sensation, along the ver- tebral column, and was distributed to the shoulders and arms; frequent cramps and chilliness of the extremities; extreme weakness of the legs, and a frequent desire to micturate and defecate. The patient gave up music, in which he was a proficient, and took a dislike to society, especially that of women: timid, irritable, and unsettled, incessantly occupied by thinking of his disease, he was unfit for any_ occupation, became a prey to despair, and was several times on the point of yielding to the impulse to suicide, which constantly obtruded itself before him. In this condition A----came to consult me, in the month of October, 1836, being then twenty-one years of age. I at once perceived that the noc- turnal emissions had given place to diurnal ones, and the minute details into which the patient entered confirmed me fully in this opinion. Each time that he went to stool, he had an emission from the penis of a greater or less quantity of viscid matter, which presented the characteristics of badly formed semen. His stools were repeated two or three times a day; they were liquid, contained a large quantity of mucus, and left a severe burning pain in the rectum. His urine was habitually muddy, thick, and of a disagreeable smell, and after its emission a thick gummy matter, which left a mark on his linen, remained at the orifice of the glans. The patient was, besides, annoyed day and night with incomplete but very constant erections. Having observed, for several days, the presence of semen in the urine, I performed cauterization of the prostatic portion of the urethra. Fifteen days afterwards, a sensible improvement was evident in almost all the symp- toms; yet no farther progress was made, notwithstanding the use of Spa water, iced milk, &c. The stools still continued liquid, and mixed with mucus, resembling a thick solution of soap in water. This really dispirit- ing condition continued during three months, when I learned that the patient had several times noticed ascarides in his stools. In a few days after, he was freed from this source of irritation by means of injections, and from that moment his re-establishment progressed rapidly. His love of occupation soon returned, and he applied himself diligently to the study of pharmacy. This, then, was a case in which the involuntary emissions were kept up by the irritation of ascarides in the rectum, although it would appear that masturbation was the cause of their origin. I have re- cently been consulted by one of my former pupils, for a similar case, in which the discharges were very serious, and had resisted the most various modes of treatment. They were attributed to masturbation, INFLUENCE OF THE RECTUM. 125 and the patient's confessions justified this opinion; yet a passage in his letter convinced me that a mistake had arisen on, at least, one point. After speaking of supposed hemorrhoids, which irritated the margin of the anus, the patient added that the pain and itching he felt there were such, that he often introduced his finger forcibly into the rectum, and had several times brought down ascarides on with- drawing it. This circumstance, previously neglected, caused me to think that the ascarides, if they had not caused the pollutions, at all events kept them up, and I prescribed accordingly, with success. We must remember, then, that the emissions may be kept up in per- sons who have practised masturbation, by the presence of ascarides, even in cases in which these entozoa have not excited the habit; and on this account it is necessary to consider their presence with much attention. On the other hand we must be on our guard against attaching too much importance to the occasional presence of one or two of these worms in the faeces. In such cases the want of success of vermifuge remedies shows that the ascarides are not of so much importance as they may have been considered. We must, therefore, be careful in all cases, not to draw conclusions too precipitately from first appearances. No disease, in fact, requires more patient re- search and greater tact in its diagnosis and treatment, than are necessary in complicated cases of spermatorrhoea. To resume. The cases reported in this chapter show that affec- tions of the rectum excite involuntary emissions. First, mechani- cally ; by compressing the seminal vesicles during the passage of faeces. Secondly, vitally; by the extension of irritation from the rectum to the seminal vesicles. All causes which oppose an obstacle to the exit of faeces act in the former manner. I have recorded cases in which the mechanical obstacle was placed at the margin of the anus, (cases 15, 1G, 17, and 18,) because, in such cases, the cause is perfectly isolated, and its action is evident: but it is also evident that any physical action like that resulting from horse exercise, (nineteenth case,) from carriage exercise, or from remaining too long in a sitting posture, as well as all medicines which tend to produce constipation, may be followed by the same effects. In all cases of this kind the influence of the rectum on the seminal vesicles arises from its distention by feces, and is a perfectly mechanical action. The other phenomenon is essentially vital. The diarrhoea, (case sixteenth) the ascarides, (cases 22, 23, 24, 25, 26, 27, 28) and the eruptions at the anus, (case twelve) could only act in this manner. The same may be said concerning the action of injections, either too hot or too cold, and of certain drastic purgatives. In many cases too, the distention and the irritability of the intes- tine act simultaneously on the seminal vesicles. Hemorrhoids and fissures of the anus, for instance, cause pain and irritation, and give rise to spasms of the sphincter, at the same time that they form an 126 CAUSES OF SPERMATORRHEA. obstacle to defecation. Obstinate and continued costiveness too, is rarely exempt from heat and irritation in the rectum and its neigh- bourhood; and eruptions about the anus are often accompanied by an irritability of the sphincters, opposing defecation. We have seen (case twenty-one) that chronic inflammation of the urinary organs may excite, by its influence, so great a susceptibility of the rectum, that the faeces are no longer able to be retained; and here cauterization of the mucous membrane of the genito-urinary passage sufficed to dispel the irritation of the rectum, so that the patient got rid, at once, of his diarrhoea, his incontinence of urine, and his involuntary seminal discharges. The influence of the rec- tum on the genito-urinary organs is then reciprocal; and it plays a much more important part in causing spermatorrhoea, than if it acted only by mechanically compressing the seminal vesicles. Its due consideration is, therefore, of much importance in the treat- ment of these cases. CHAPTER VI. CAUSES OF SPERMATORRHEA. Abuse. I understand by the term abuse, when applied to the organs of generation any irregular or premature exercise of their functions; any application of them which cannot have, as its results, the propa- gation of the species. There are, undoubtedly, many points of re- semblance between such abuses and venereal excesses, but the plan of this work requires that I should examine them separately. I concluded the last chapter by relating some cases in which the presence of ascarides in the rectum, more or less connected with masturbation, induced or kept up involuntary spermatic discharges; I shall commence the present one by relating some cases in which the spermatorrhoea was due to masturbation alone. CASE XXIX. Masturbation—Nocturnal pollutions—Palpitation and dyspnoea, simulating cardiac disease—Repeated venesection, followed by increased disorder__ Sulphuretted baths, and rapid recovery. M. D----, of nervous temperament, and energetic and restless charac- ter, contracted the practice of masturbation while at school. Shortly after- wards he suffered from a severe attack of fever, which occasioned his re- moval; this fever was followed by loss of voice, and afterwards by rheu- ABUSE. 127 matic pains, pain in the chest, sensation of suffocation, habitual shortness of breath, and violent palpitations, which were increased on the slightest exertion. At the age of nineteen he broke himself of his habits; but, soon afterwards, he experienced nocturnal pollutions, which became daily more and more frequent. About this time an issue was inserted in his left thigh. The following winter the palpitations and difficulty of breathing increased, and his legs became slightly cedematous; he was treated by repeated vene- sections, and the administration of diuretics, and at the approach of summer he became a little better, the improvement being of course attributed to the effects of the medical treatment. The following winter the same symptoms reappeared, and were again combated by venesection, with a severe regimen. The patient now became exceedingly emaciated. His nocturnal emissions increased in frequency, and his dyspnoea and palpitations were aggravated. For these symptoms he was again bled three times. At the age of twenty-three M. D----came to Montpellier. A minute examination of his chest assured me that his lungs were perfectly healthy, and that the heart's action was neither more violent, nor heard over greater extent than natural; still, notwithstanding his emaciation and extreme de- bility, and the cedematous state of his legs, he was constantly recurring to the supposed plethora, to which his attendants had attributed his symptoms. I found it difficult to prevent him from having recourse to further abstrac- tion of blood. The use of artificial sulphuretted baths gave tone to his genital organs, and diminished their excessive irritability. The nocturnal pollutions be- came less frequent; the patient's appetite returned, and his digestion was performed with greater energy. After a month's treatment, I sent him to the sulphuretted waters of the Pyrenees, where his cure was soon com- pleted. This is one of the most simple cases of nocturnal pollutions in- duced by masturbation. It is chiefly remarkable on account of the predominance of the palpitations and dyspnoea over the other symp- toms, and the grave errors which had been committed in its diag- nosis and treatment. CASE XXX. Masturbation at the age of eight years—At twelve, very frequent emissions of urine—At sixteen, coitus impossible—Nocturnal, and afterwards, di- urnal pollutions— Cauterization, at the age of, twenty-eight, followed by rapid, recovery. M. D----, of Philadelphia, of a very robust constitution, contracted the habit of masturbation at school, when only eight years old. The first effect produced was a frequent desire to pass urine, and at twelve years of age this irritability had become so great, that he was sometimes unable to retain his urine a quarter of an hour. Before entering a house he always took care to micturate several times in rapid succession; and, notwithstanding this precaution, he soon experienced renewed uneasiness. He felt as though his bladder was never entirely empty, and the smallest quantity of urine induced spasmodic contractions. The irritability of the urinary 128 CAUSES OF SPERMATORRHEA. organs diminished by degrees after the period of puberty, but never ceased entirely, notwithstanding the various means which were employed on differ- ent occasions. At the age of sixteen, M. D----endeavoured to break off his injurious habits by sexual intercourse, but he found himself completely impotent, and shame induced him to return to masturbation. He afterwards made further attempts to correct himself, but he experienced nocturnal pollutions, which often made him lose courage. At length, after many relapses, he succeeded completely, without observing any further nocturnal emissions. Still his health, instead of improving, became more and more impaired. His erec- tions were less frequent, less prolonged, incomplete, and at length gradually ceased, together with all venereal desire. At the age of twenty-eight, the state of his urine, its frequent discharge, and the wandering pains in the perineum and testicles, induced a fear of cal- culus ; sounding, however, only showed a morbid sensibility of the urethra, especially towards the neck of the bladder. In the beginning of May, 1837, M. D----came to Montpellier, in the following condition:—much debilitated; unsteady in his walk; easily chilled, and taking cold very cmickly; wandering pains all over his body; skin dry; memory impaired; digestion difficult; extremities cold; scrotum relaxed, and testicles soft, very sensitive, and often causing a dull pain, as if they were forcibly compressed; the semen (from the account he gave of the last nocturnal pollutions he had experienced,) clear, aqueous, and inodorous; seminal emissions with the last drops of urine, which were clammy, and passed with difficulty, and excited a sensation of tickling in the neighbour- hood of the anus, which extended to the orifice of the urethra; he often had diarrhoea, but at other times was very costive, and his stools were passed with difficulty and pain. He did not, however, often pass semen while at stool. I discovered, several days following, the presence of semen in M. D----'s urine, and catheterisin showed an excessive irritability of the urethra, espe- cially in the neighbourhood of the prostate, which, on examination, was found slightly enlarged. Nearly a table-spoonful of blood followed the withdrawal of the catheter. These circumstances did not leave the least doubt on my mind as to the state of the mucous membrane in the vicinity of the ejaculatory ducts; and, consequently, I immediately performed cau- terization, from the neck of the bladder, as far as the membranous portion of the urethra. Twenty days afterwards, M. D----left Montpellier for Italy, and when he returned three months afterwards, he was completely cured— no involuntary seminal emissions having afterwards appeared. His urine was_transparent, and could be retained seven or eight hours without incon- venience; its discharge took place without effort, and was not accompanied by any remarkable sensation. Lastly, the patient's impotence, which had been present nearly twelve years, had given place to a virility previously unknown to him; I need hardly state that his physical and moral eneray had shared in this regeneration. I have often had occasion to notice the connexion that exists be- tween the spermatic and urinary organs; and I have shown that there is scarcely a cause of spermatorrhoea which does not act more or less on the bladder and kidneys. The cause I am now investigating ABUSE. 129 affords us numerous examples of this connexion—of which the case I have just related is a remarkable instance—the irritation of the urinary organs having been developed very rapidly, having shown very marked symptoms, and having existed alone during several years. The patient was only eight years of age when he first became addicted to masturbation; at this early age the urinary organs alone possessed activity, and therefore they alone were able to suffer dis- turbance of their functions; on this account the symptoms were con- fined for a long time to the urinary organs. The character of the symptoms showed that they arose from a chronic state of inflammation, or from an acute irritation of the urinary organs, and this state must have extended also towards the spermatic organs. Thus the in- creased secretion of the kidneys, and the extreme irritability of the bladder, would give a very clear idea of what took place in the sper- matic organs at the period of puberty. As soon as the testicles bega n to act, they fell under the same influence as the kidneys; the semi- nal vesicles were in the same condition as the bladder; in other words, the semen was secreted in large quantities, and was retained a very short time in its reservoirs. Being, therefore, imperfectly formed, the usual effect on the erectile tissues produced by its presence, did not take place, and coitus was impossible at the age of sixteen. The occurrence of impotence at so early an age is sufficient to show that diurnal pollutions had already commenced, although the patient did not discover them for a long time afterwards. He was still, how- ever, able to practise masturbation; and this is a circumstance which has great effect in preventing persons addicted to the vice from re- nouncing their fatal habits. At a later period, nocturnal pollutions, which occurred after a few days' care, shook the patient's resolution. This is a much less serious circumstance than the one just mentioned, but at the same time much more common. At length the patient left off his habits, and nocturnal pollutions disappeared; yet the dis- order of his health continued to increase. His prudence, exercised too late, did not arise from the strength of his will, but from the weakness of his genital organs; the disappearance of his nocturnal emissions did not arise from the remedial measures used, but from the increase of his involuntary diurnal discharges, of which he only be- came aware long afterwards. These common errors are the more dan- gerous, because medical practitioners are apt to participate in them. In the case of M. D----- the irritability of the canal was very great, and the effect of the cauterization was correspondingly prompt and decided. 9 130 CAUSES OF SPERMATORRHEA. CASE XXXI. Masturbation at the age of seventeen, carried so far as to cause ^ emissions of blood, but soon afterwards abandoned—Increasing debility during four years—Symptoms of phthisis laryngea and chronic gastritis—Ex- treme prostration—Cauterization, followed by rapid re-establishment. I am indebted for the following remarkable case to the kindness of Dr. Daniel, of Cette. "On the 26th of May, 1836, I was called to F----, a baker, aged twenty-two. I found him in bed, in the following condition:— great moral prostration, carried even to a hatred of existence; prostration of strength; emesia; lips pale and shrivelled; remarkable pallidity; eyes sunken; expression of countenance dull; great emaciation; skin hot and dry; pulse small; voice hoarse, and so low that it was with difficulty a few words could be heard by approaching the ear; constant eouhg, scarcely permitting an instant's repose; general wandering pains, most severe in the loins and the sides of the chest; great irritability of the stomach—vomiting being excited after taking almost any kind of liquid or solid food. "At first I thought that I recognised in this patient the symptoms of phthisis laryngea, complicated with chronic gastritis; but the examination of his chest and abdomen did not support this opinion. The epigastric re- gion was not painful on pressure; the respiratory murmur was heard all over the chest, and percussion emitted a healthy sound, except under the left false ribs, where it was slightly dull, and the patient felt pain. "His debility did not permit me to practise abstraction of blood; and, indeed, the pleuro-pneumonia of the left side did not seem either very ex- tensive or very acute; I therefore ordered a large blister to be applied over the affected spot, and prescribed a solution of tartar emetic, and a strict diet. The pain in the side disappeared, and two days afterwards the sto- mach could retain milk and barley water. Still nothing explained the patient's emaciation; his almost total loss of voice, hoarseness, and constant cough. His parents attributed these symptoms to hereditary phthisis, and mentioned that several members of the family had died of that disease. Minute and repeated examination of F-----'s chest, however, assured me that this was not the case. On the other hand, the symptoms were very severe, and I could not discover any visceral lesion sufficient to account for them. In this state of uncertainty, your views on spermatorrhoea at- tracted my attention. I immediately questioned the patient respecting his past life, and learned that at the age of seventeen he had practised mastur- bation with such fury that he had frequently passed aqueous semen, mixed with blood: frightened by these accidents, he had corrected himself com- pletely. But, after about a fortnight's abstinence, he noticed that his urine contained a deposit of thick, whitish, flocculent matter. He never attached any importance to this, although during four years he observed it con- stantly, and noticed that it was more abundant after he had been much fatigued in his business. He observed also, that the last drops of urine were thick and viscid, and that a small quantity of viscid matter generally remained at the orifice of the urethra. His bad symptoms first commenced at this time; his erections and desires entirely disappeared; and, by the time he had attained the age of twenty-one, he was obliged to give up his ABUSE. 1 3"i XOj. employment, and shortly afterwards, his symptoms becoming aggravated, he was unable to quit his bed. " I examined his urine, and found it in the condition he had described; the deposit contained in it being about an ounce in quantity. I noticed that his testicles were soft, and his scrotum flaccid. He agreed to my proposition of cauterizing the prostatic portion of the urethra with eager- ness, and I performed it on the following day. The effect of the cauteriza- tion was rapid: the second night afterwards, the patient slept soundly; the third day, a change was observed in his voice; and erections occurred during the night. On the fourth day, the patient was able to get up and take some light food, which was well digested; his wandering pains had disappeared; and by the ninth day after the cauterization, the patient's strength had returned. Tonic regimen, and the use of sea bathing, con- firmed his restoration. Dr. Daniel added to the history of this case a detailed statement drawn up by this patient himself: as it contains no important facts, I have omitted it here. I have, however, several times myself exa- mined this patient, and have assured myself of the exactitude of the report. F-----had carried masturbation to such an extent, that he passed aqueous semen, mixed with blood; the seminal vesicles were there- fore in a morbid condition when he left off the habit. A fortnight afterwards, he noticed a deposit in his urine, which he had never before perceived, and which continued constantly afterwards. During four years, he never relapsed into his former habits, and he was not affected by nocturnal emissions; yet he continued to lose flesh. Im- mediately after the cauterization he became convalescent. Is it not evident, that the absence of venereal desires and of nocturnal emis- sions during so long a period, was owing to the occurrence of invo- luntary diurnal pollutions? Is there any other mode by wrhich we can explain the continued disorder of the patient's health, and its sudden restoration? The answer is evident. Whenever F-----fatigued himself more than usual, the urinary deposit became more abundant. This may appear to be an excep- tion to the usual good effects which patients experience from pedes- trian exercise. Every thing depends on the strength of the sys- tem, and on the quantity of that strength expended. Fatigue is as hurtful in such cases, as exercise is beneficial. CASE XXXII. Masturbation from twelve to twenty-two years of age—Melancholy—In- clination to suicide—Serious alteration of the health—Monomania— Unperccivcd diurnal pollutions—Cauterization followed by perfect re- covery. At the beginning of April, 1836, M. Emile Gr----was sent to consult me, by Dr. Cauviere of Marseilles. He was twenty-five years of age, and 132 CAUSES OF SPERMATORRHEA. had attracted notice from the brilliancy of his intellect. At twenty-one years of age, he had been admitted an advocate in a highly flattering man- ner. He stooped much, and though his bony system seemed to announce a strong constitution, his limbs were small, and his muscles soft. His hair was black and thin, his skin was pale, and his face without expression. His eyes were dull, and constantly cast down; his voice weak and husky; and his general appearance announced great timidity. His legs were con- stantly in motion. I learned that M. G----had contracted the habit of masturbation at school, at twelve years of age; and that whilst studying law in Paris, at the age of nineteen he found a change in his character commencing: this I will describe in his own words:—At first I felt a gradually increasing disgust of every thing and a constant sense of ennui. From that period I only saw the dark side of life. Thoughts of suicide soon afterwards oc- curred to me, and this state of mind continued for twelve months, after which other ideas took the place of those respecting suicide. I considered myself a subject of ridicule, and fancied that the expression of my counte- nance, or my manner, excited an insulting gaiety in the persons I met. This notion each day acquired new strength, and often when in the street, or even when at my own house, or in a room surrounded by my relations and friends, I fancied I heard insults which were aimed at me. / think so still. At length, as my state became worse, I thought that every one in- sulted me, and I still think so. If any one expectorates or blows his nose, coughs, laughs, or puts his hand or his handkerchief before his face in my presence, I experience the most painful sensation. Sometimes, I feel en- raged, but more frequently a depression of spirits, ending in involuntary tears. I look at no one, and my eyes are never fixed on any object. Wrapped up in my own thoughts, I am indifferent to all external impres- sions. These signs arc evidently those of imbecility. I admit that I may have had, and that I may even now have, hallucinations, but I am fully persuaded that these ideas are not without foundation; I am convinced that the expression of my countenance has something strange in it, that people read in my looks the fears which agitate, and the ideas which torment me, and that they laugh at this unhappy weakness of intellect, which they ought rather to pity. The patient experienced a sense of heaviness and oppression in his head, and although fatigued by slight exercise was constantly in motion. Two years before he consulted me he began to correct himself by degrees; and for^nine months he had entirely renounced^the practice of masturbation, yet notwithstanding this, his state daily grew worse. His digestion was disordered; he suffered from obstinate constipation; and his erections and venereal desires had left him for a long time. Yet he did not mention the last facts in the written statement of his case which he sent me* they were minor evils; one idea alone absorbed him—the conviction that he was an object of contempt and ridicule to all who approached him; this idea was aggravated by the knowledge of his impotence, and by shame for the cause which had produced it. This patient's urine usually contained an abundant flocculent deposit, resembling a thick decoction of barley; it decomposed very rapidly, and emitted a disagreeable smell. After eVery stool the point of the glans penis was covered with a clammy viscid matter, resembling a thick solution of gum. ABUSE. 133 These circumstances confirmed mc in the idea that the involuntary seminal discharges alone opposed the patient's recovery. The frequent emission of his urine; the sensibility of the spermatic cord, of the testicles, and especially of the urethral mucous membrane, and the injected state of the orifice of the urethra, made me attribute these evacuations to irritation of the spermatic organs rather than to their relaxation. As, however, the patient refused to submit to cauterization, I ordered him iced milk mixed with Spa water, cold lotions, &c; but he found himself much worse after the use of these means; all his symptoms were aggra- vated; his urine became thicker, and left a glairy deposit adhering to the bottom of the vessel. At length, on the 23d of April, I persuaded M. Gr----to submit to cau- terization, and I performed it immediately, chiefly on the neck of the bladder and the prostatic portion of the urethra: nothing particular occurred, except that the inflammation of the urethra, which followed the application, was not entirely removed for three weeks. This, I believe, arose, in a great measure, from the severe weather which prevailed at the time. 1 ordered two or three warm baths to be taken in the week, and a few warm injections and demulcent drinks. At the expiration of a month, the patient took pleasure in going out, and occupied himself with gardening; he felt stronger, and took longer walks; he was able to employ himself longer without fatigue; he also experienced nocturnal emissions, preceded by erotic dreams and lively sensations. At this he was at first alarmed, but he gained cou- rage when he saw that he was not injured by them. I had not seen him for more than a month, when one day he called on me quite dispirited, to say that he should never get well, as he was relapsing into his former habits. I blamed him, but at the same time I explained to him that the fact was a proof of his having regained his former virility, of which he should make more proper use. M. G----'s mother came to me soon after to speak of the propriety of marriage for her son, whom she saw exposed to various dangers. I easily persuaded her, that before deciding on marriage, it would be necessary for him to be firmly assured, during a considerable period, of his perfect and decided recovery. M. G----had then regained his spi- rits, his boldness, and his position in society, and eighteen months after- wards, all his functions being performed with energy, he married. Six months after his marriage I heard that his health had not for a moment been disordered. With this patient I received the following consultation from Dr. Esquirol. " The undersigned cannot mistake a case of hypochondriasis which has lasted three years. It is evident that the nervous affection was produced by the habit of masturbation to which the patient was addicted from the age of puberty, and of which he only succeeded in breaking himself seven months since. The hypochondriasis continues very obstinately, as the cause which produced it acted for a long time, and very seriously weakened the nervous system. The undersigned attributes the little success attending medical treatment to the unfa- vourable weather, to the indocility of the patient, who lives in seclu- sion and in physical and moral torpor, and to the weakness of his mother, who allows herself to be led away by the sight of false or exaggerated sufferings. The means advised are those usually ordered • 134 CAUSES OF SPERMATORRHEA. in cases of hypochondriasis:—Tonics, antispasmodics, leeches to the anus, purging, change of scene, travelling, sulphuretted baths, sea- bathing," &c. Dr. Esquirol sums up his opinion, in concluding, as follows:—"I must repeat what I have said above: weakened innerva- tion is the cause of the disease, and every thing which can strengthen the nervous system will be useful." It was clear that masturbation had been the first cause of the physical and moral derangement, called hypochondriasis; but the patient had renounced this, vice during nine months, and his state became worse daily, instead of improving. It was evident, therefore, that some other cause acted in keeping up the disorder; and it was just as evident that this cause was involuntary diurnal seminal discharges. It is not necessary for me to show that masturbation can, acting alone, induce involuntary discharges, or that the cure was due to cauterization only, although its effects wTere not manifest for a month after the application of the caustic; but I must i nsist on the pathological condition of the genital organs exciting these involuntary evacuations, since they have been too frequently ascribed to a state of debility or relaxation of the tissues. The tonics ordered by Esquirol had produced no benefit: I have described the symptoms which led me to suspect acute irritation of the prostatic portion of the urethra, and I have shown the injurious effects of cold lotions, iced milk, Spa water, &c. It was, then, not by causing contraction of the orifices of the ejaculatory canals, that the cauterization pro- duced its beneficial effects, but by dispersing the chronic engorge- ment of the mucous membrane. The advantage derived from warm baths during convalescence corroborates this opinion. In M.' G----'s case a predominating symptom attracted the atten- tion of the practitioners; hence they looked on the disease as being hypochondriasis, monomania, or hallucination, continuing after the cessation of its exciting cause, and becoming, consequently, an idio- pathic affection. I have, however, shown that all the functions had been altered more or less; I should add, that the digestion was the last to be re-established perfectly. Such mistakes are very common, and very serious, and I cannot too strongly impress their importance on the attention of the profession. Esquirol justly stated that the hypochondriasis took its origin from masturbation; that the nervous system was weak and excited; but he mistook the cause which kept up this condition of the brain. When masturbation has not induced involuntary seminal emissions, recovery soon follows, on leaving off the habit which has destroyed the health; within a week the patients begin to experience a notable improvement, and in a very short time they are hardly recognisable, whatever may have been the degree of weakness to which they were reduced. But when Dr. Esquirol wrote his opinion, seven months had elapsed, during which M. G----'s conduct had been irreproachable, and when I saw him two months later, his state was even worse, although he had never resumed his former habits. The symptoms were, however, kept up by involun- tary diurnal discharges. ABUSE. 135 The effects of the cauterization were very conclusive, and as soon as its curative action was felt, the patient, of his own accord, took various kinds of exercise, and sought out the different amusements, which had been, in vain, ordered for him previously; he entered into society, and did, without being pressed, all that he had before re- fused to do; his ideas and his necessities altered in proportion as his functions were re-established. It is in vain that we say to the so-called hypochondriac,—amuse yourself, employ your mind, go into society, seek agreeable conver- sation ; so long as we have not removed the cause of his disorder, he is unable to profit by our counsels. How can we expect that when a man is fatigued by the least exercise, he shall occupy himself with walking or gardening? How can we desire him to go into society, when the simple presence of a woman intimidates him, and recalls all his former misfortunes? How can we expect him to enjoy conversa- tion, when he loses its thread every moment? When his memory leaves bim, and when he feels his nullity? We persuade him to seek amusements and pleasures, but are they such to him? Is not the happiness of others his greatest punishment? Because he is una- ble to follow our advice we accuse him of unwillingness, and we wish to compel him. Let us first remove the cause of our patient's dis- ease, and we shall soon see that his character and conduct will change, and that he will return to his natural tastes and habits. It is not long, in such cases, before we are embarrassed by ques- tions about the propriety of marriage being put to us: this is a matter which is serious in all its aspects, and on which the least scrupulous should not pronounce, without having had sufficient assurance of their patient's return to health. The question of our patient's health is now not the only one, nor is even his future happiness alone impli- cated; the fate of the innocent being who is about to be associated with him, is the matter of chief importance, and justice to her de- mands that we do not counsel matrimony, until sufficiently long proof has been given that our patient's re-establishment is permanent. CASE XXXIII. Abuse caused by sleeping on the belly—Effects of reading erotic icorks— Power of habit—Alteration of the intellectual and moral faculties—Im- potence— Chronic Irritation of the bladder—Nocturnal and diurnal pol- lutions— Cauterization followed by prompt recovery. Eugene C----, at seven years of age, was strong and healthy, but about this period he contracted the habit of lying on his belly at night. In this position the genital organs were heated during sleep, and the penis became erect, although the boy did not present the least sign of puberty. Pressure against the bed produced titillation, and induced a habit of abuse, as in- jurious in its effects as masturbation. The child was perfectly free from any sexual feelings, and had never been exposed to the influence of bad example; besides which, he was naturally modest and reserved. The first 136 CAUSES OF SPERMATORRHEA. impression was, therefore, quite instinctive and accidental, but the habit was soon confirmed into an irresistible passion. Between the ages of nine and eleven the child's character changed ;^ he became restless and quarrelsome, but his intellectual faculties were active, and he was able to keep up with his companions in their studies, and to make himself feared by them, on account of his quarrelsome disposition. Be- tween the ages of eleven and thirteen, however, he yielded to the practice, two or three times a night, and became idle, timid, and weak; he fell behind his fellow students in his studies; and though he was easily provoked to quarrel, he found himself always beaten. On this account he sought soli- tude. At the age of fourteen, the habit he had contracted was temporarily broken off, by his brother's sleeping with him; but at the expiration of three months, when left to himself, he relapsed. At the age of fifteen, a remonstrance received before his fellow students by one of his masters, caused him to abstain during eight months; he regained his strength, his character altered, and he made up for the time he had lost in his studies. At the end of the year he even wrote so remarkable an essay at the com- petition for prizes, that he was supposed to have copied it. On this account, at another competition some time afterwards, he was separated from his companions, and carefully watched. In the mean time, however, some obscene books had fallen in his way, and excited his imagination. He re- sumed his habits with fury, and when the day of competition arrived, his condition had become worse than ever. He passed all the time allowed for the trial in a state of febrile excitement, without writing a word. Some time afterwards, he made a strong resolution to correct himself, but the habit had become so strong, that he often had recourse to it, unconsciously, du- ring sleep. By degrees, however, he corrected himself, but very frequent nocturnal pollutions supervened, and destroyed all the benefit that arose from the change. xAt the age of seventeen the patient came to Montpellier to obtain the degree of bachelor of letters: the state of his intellectual faculties prevented this; indeed, out of ten hours spent in his study, nine were passed in think- ing of his condition, and of the different means by which he Could commit suicide. He attempted sexual intercourse, but found himself quite impo- tent. Horse exercise, and the various tonics and stimulants which were prescribed for him, only.increased his disorder. I need not relate all the functional derangements which the patient un- derwent; but it is necessary that I should notice a chronic inflammation of the bladder, of which the cause was unknown, and diurnal pollutions, which he did not discover, although they were much more serious than the noc- turnal emissions which had become more and more rare during the previous twelve months. About the end of November, 1836,1 cauterized the neck of the bladder, and the prostatic portion of the urethra. Fifteen days afterwards, the pa- tient was better, and he immediately went into the country, where his cure was soon confirmed. M. C---- has since studied medicine with much energy; and has passed the examinations of B. L. and B. A. with credit. His character has become frank and kind, and it is evident that he is in good health and spirits. This case shows the importance of the apparent trifles that occur in ABUSE. 137 childhood, and at the period of puberty; and the serious effects which a slight neglect of them may produce during the whole of after life. CASE XXXIV. Sexual ideas at the age of eight—Abuse at thirteen— Various diseases in consequence, until the age of thirty-two—Nocturnal and diurnal pollu- tions— Cauterization—Slow, but progressive improvement. M. A----, when a child, was remarkable for precocity of intellect; but was troubled with worms during the early years of his life. Being allowed to sleep with his governess, when about eight years of age, he remarked differences of form, which he had never before seen. His active imagina- tion dwelt on these incessantly, and at length he fell into a state of melan- choly, of which the cause was far from being suspected. At the age of thirteen, a young female took advantage of him, but without permitting intromission. Shortly afterwards, when at school, these circumstances constantly recurred to his imagination, and during the night he took care to place himself as much as possible in the same position, in order to renew the same sensations. He thus contracted a habit quite as injurious as masturbation. His health became affected, even before any seminal emis- sion had taken place; his growth was arrested; his sight, memory, and intellect, became weak. At the age of seventeen, emissions occurred during defecation, and were followed by a diminution of the patient's erections and venereal desires, as well as of his abuses. At nineteen years of age, he had a chronic gastritis, head-ache, pain in the hypochondriac regions, and noc- turnal pollutions. For these symptoms, a milk diet was prescribed, and adhered to for a year, together with baths, enemata, and country exercise. At the age of twenty-two, chronic gastro-enteritis supervened, and was fol- lowed by inflammation of the bladder, which passed into a state of chronic vesical catarrh. After about two years, the patient's health was restored. By degrees, his old habits and nocturnal pollutions returned, and induced a new derangement of his health; at the age of twenty-five, chronic inflam- mation of the digestive organs and bladder again appeared, but was re- lieved by emollients and a severe regimen. About the age of twenty-eight, his health partially returned, but his sleep continued heavy and unrefresh- ing, and was often interrupted. At thirty, his digestion was much disor- dered; constipation and diarrhoea occurring alternately. The patient's condition gradually became* worse, until he came to Mont- pellier, in February, 1836. He was then thirty-two years of age, and pre- sented the following symptoms: appearance, sad, restless, and timid; legs weak; constant restlessness; feeling of icy coldness in the thighs, lower part of the belly, and genital organs; appetite capricious; digestion labori- ous, and accompanied with discharge of flatus; memory treacherous; dis- like of society; irritability of temper; overruling egotism; constant pre- sence of lascivious ideas, contrasting strongly with the weakness of the genital organs; mental debility; sleep broken, and unrefreshing; frightful dreams; frequent desire to micturate, especially during the night; uvine thick and muddy, generally presenting an abundant flocculent precipitate, and giving off a disagreeable smell; genital organs very little developed; prepuce long; and testicles small. After observing the patient for several days, I cauterized the bladder and 138 CAUSES OF SPERMATORRHEA. prostatic portion of the urethra; the operation was followed by a more in- tense inflammation than usual, probably due to the bad weather. As soon as he was able, the patient quitted Montpellier, to return home. Not having heard from him, I augured that the cauterization had been unsuccessful, when one day, several months afterwards, as I was passing through Lyons, I was accosted by M. A----, who was so changed that I hardly recognised him. He stated, that a slow, but progressive improve- ment had taken place after his leaving Montpellier; the pollutions he had before experienced during defecation disappeared; his urine became clear, and was passed less often and less suddenly; nocturnal pollutions occurred seldom, and his erections became energetic. The abuses practised on the genital organs had the same cha- racter in this, as in the preceding case; and in both, they produced the same effects as masturbation. We observe in the last case, that sexual ideas preceded for a long time the development of the sexual organs; and that the venereal desires had no relation what- ever to the amount of development of the generative organs. The influence of a premature liaison on these abuses is also worthy of notice. The remembrance of such irregular and prema- ture enjoyments constantly presented itself before the patient's imagination, and caused his frequent relapses. The habit at length overcame the will, and even took its place, provoking the same acts during sleep. The power of habit was just the same as in the pre- ceding case. At the age of seventeen, M. A-----noticed that he passed semen while at stool; he had, therefore, thus early, diurnal pollutions. He did not pay attention to these, because he was not aware of their importance; but it is evidently to the occurrence of such discharges that we must attribute the feebleness of his erections, the impossi- bility of coitus, and the long series of sufferings he afterwards en- dured. As to the other symptoms presented by M. A-----, I need not enter into their consideration,—I have already done so several times,—such symptoms being common to all cases of spermatorrhoea. Were the discharges in this case due to a state of atony? This would seem to be the case, If we only regarded the small develop- ment of the organs, and the habitual weakness of the erections; but the acute attack of cystitis, and the chronic catarrh of the bladder, showed clearly enough, that the seminal vesicles and ejaculatory canals must have been also in a state of irritation. The curative effects of cauterization were postponed for a considerable time, so that I almost despaired of benefit from the operation; yet, no other treatment having been employed, the improvement was evidently due to the cauterization alone. In case thirty-two, I have already noticed the same circumstance, and it is worthy of remark, that both these cases were operated on during a very wet and cold sea- son. Whether this be the correct explanation or not, such cases are not rare, and I wish particularly to point them out, because I ABUSE. 139 have met with many patients affected with spermatorrhoea, who had been cauterized three, four, or five times, or even still more often, in the space of a month. This subject I shall treat fully, when speaking of the treatment of spermatorrhoea. CASE XXXV. Masturbation at sixteen years of age—At twenty-one, compression of the urethra during ejaculation, followed by a sensation of tearing, and acute pain—Urethral discharge recurring frequently—Discharges of semen during defecation and the emission of urine—Reciprocal influence of these discharges on the digestive organs—Chronic catarrh of the bladder — Cauterization—Recovery, after several relapses. M. G----, of sanguineous temperament, and robust constitution, con- tracted the habit of masturbation when about sixteen years old. The fol- lowing year, he was troubled with disordered digestion, oppression, and difficulty of respiration. At the age of twenty-one, he determined to con- quer his propensity, but after a few days' continence, he relapsed, in conse- quence of the violent erections he experienced. During this contest between his will and his passion, he one day compressed the urethra forcibly, when on the point of ejaculation. On the instant, he experienced a sensation of tearing in the interior of the canal, followed by acute pain, which afterwards frequently returned; the following day, after an erection, he felt the glans wet, and found the orifice of the urethra filled with a viscid matter, resem- bling a very thick solution of gum. From that time, this kind of discharge always continued, varying only a little in appearance and quantity, according to circumstances; the patient's erections became less energetic, and the sensations produced by ejaculation grew progressively weaker: at the same time, the functions of his stomach were disordered and frequent attacks of indigestion took place. At the end of two years, the urethral discharge increased suddenly after coitus; at the same time assuming a blennorrhagic appearance. This was treated by emollients and copaiba, and at the end of three months, the former state returned; the discharge was easily in- creased, however, by the least error of diet, as well as by very slight venereal excitement. The patient's erections now became less energetic and incom- plete; and, on the other hand, his digestion was more and more disordered and accompanied with colic, flatulence, and constipation—the efforts at stool giving rise to seminal discharge. Various remedial means were adopted, but without success. At the age of twenty-eight, the patient, after a slight error of diet, experienced an exacerbation of all his symptoms, and in addi- tion, his urine became thick, muddy, and fetid, and its discharge very fre- quent, and accompanied by an acute pain at the root of the penis, and in the bladder. In this state the patient came to Montpellier, on the 19th of April, 1826, being then about thirty. After observing himfor several days, 1 noticed that his urine was constantly muddy and fetid, and contained a red sediment, which adhered to the sides of the vessel, and a thick and flocculent deposit, which fell to the bottom; a slightly opaque cloud occu- pying the upper part, while on the surface a thin iridescent pellicle floated. The urethral mucous membrane was also very irritable, especially towards the neck of the bladder. On the 2d of May, I slightly cauterized the bladder 140 CAUSES OF SPERMATORRHEA. near its neck, and more severely the prostatic portion of the urethra, closing the instrument before it reached the bulb. The operation produced its usual effects. Five days afterwards, the urine no longer contained blood, and within fifteen days it was passed without pain or inconvenience. A month after the operation the urine was quite clear, the digestive organs had regained their energy, and the patient was able to eat heartily without being inconvenienced. His stools became regular, and were passed easily; the seminal discharges diminished; his strength returned, and allowed him to take long walks, and his sleep became sound and refreshing. In this state of convalescence M. G----left Montpellier, about six weeks after the cauterization. Five months afterwards, I received a letter from M. G----in which he stated that his recovery had proceeded by degrees, and that his health had been excellent during three months, when he had eaten a large quantity of grapes, some of which were not ripe; a severe attack of indigestion resulted, after which his old symptoms returned, and strangely enough, he felt, during the emission of urine, a sensation in the prostatic portion of the urethra, re- sembling that produced by the application of caustic. He had scarcely re- covered from his relapse, when he a second time committed an error in diet, which brought on a more serious indigestion than the first, and was followed by an aggravation of all his former symptoms. In this condition M. G---- wrote for advice. Four months afterwards, I received another letter from him, stating, that before he had received my previous answer, he had en- tirely recovered; but that, forgetful of the past, he had suffered from ano- ther indigestion, with another slight attack of his former symptoms. I in- sisted on the necessity of strict diet, and further recommended a trial of the sulphureous waters of the Pyrenees. As I have not since heard from this patient, I am warranted in supposing that his health is at length perma- nently established. This case shows us the dangers which may arise from an impru- dent compression of the urethral canal during the ejaculatory or- gasm. Such attempts have been made for various reasons—some- times in the hope of preventing a nocturnal pollution—and they are generally followed by the same result. At the moment of emission, a kind of tearing of the canal takes place; this is attended with acute pain, and, in the case before us, was followed by a mucous discharge, which continued nearly ten years. The patient, as well as the different surgeons who attended him, regarded his discharge as spermatic, because it was increased by ve- nereal excitement, and because the patient's virility constantly dimi- nished, at the same time that the general symptoms of spermatorrhoea were present. But the circumstances which preceded the discharge were sufficient to show that it arose from the mucous follicles, inflamed or irritated by a laceration at some point of the passage. Was it astonishing, then, that every excitement of the organs should have increased this discharge ? The blennorrhagic character which it pre- sented for some time proves, even still more certainly, that the dis- charge was not spermatic. The changes that took place in the ABUSE. 141 patient's health, and in his generative functions, are explained by the occurrence of diurnal pollutions, both during defecation and the emission of urine; and the occurrence of these diurnal pollutions after chronic inflammation of the urethra is easily explained, by re- ferring to the tendency of irritation to extend from the prostatic mucous membrane to the adjacent tissues. In consequence of this disposition, the urinary organs presented well marked symptoms of chronic inflammation, and the state of these gives a good idea of what was going on in the spermatic or- gans. We must conclude, then, that the constant discharge from the canal was only an ordinary blennorrhoea, and that the patient's im- potence, and the derangement of his health, are to be attributed solely to the spermatic discharges which took place during defeca- tion and the emission of urine. I have attached considerable importance to the right understanding this fact, because attacks of blennorrhagia are often complicated with diurnal pollutions, and this frequent coincidence has caused the utmost confusion in the opinions given on the subject, since Aretaeus first spoke of a constant seminal discharge. It is at once evident, that the semen being contained in distinct reservoirs cannot constantly run off like the secretion of the open mucous follicles. I shall examine this simple question more fully in a future chapter, but, as I proceed, I shall show, as opportunities occur, that the symptoms attributed to these constant discharges arise really from unsuspected pollu- tions happening during defecation and the emission of the urine. Another result of this easy extension of irritation from the prostate to the adjacent mucous membrane in the case under consideration, was the chronic affection of the bladder, and probably also of the kidneys. I mention this circumstance here, to show how difficult all these complications render the diagnosis of diurnal pollutions. The urine contained an abundant lithic acid deposit, and was covered by an iridescent pellicle: it was also muddy from the presence of a large quantity of mucus, a thicker deposit occupying the lower por- tion of the fluid. The abundance of salts contained in the secretion arose from the irritation of the kidneys; the bladder and the prostate furnished the greater part of the other matters; but did the urine contain semen? I believe that neither chemical analysis, nor mi- croscopical research, would have been able to decide this point. The last drops of urine emitted were of the viscid consistence of a solution of gum or starch, and this matter could only be semen. It is unfortunate that these complicated cases should be the most common, as well as the most serious. But of wdiat importance to the practitioner is the existence of blennorrhagia, or the mixture of vesical mucus, of prostatic fluid, or of different salts, with the urine? It is not from one symptom only, that he should judge of the disease, but from the whole. The most important point in these embarrass- ing cases, is to understand fully the cause and connexion of such 142 CAUSES OF SPERMATORRHEA. complications, in order to ascertain a means of cure. Happily, the same treatment is suited to all the symptoms, because they all de- pend on the same cause. In this case, for example, the cauteriza- tion put a stop at the same time to the blennorrhoea, the chronic affection of the bladder, and the diurnal pollutions—diseases that had existed nine or ten years. I may remark, in passing, that the curative effects of cauteriza- tion did not show themselves, in this case, until a month had elapsed; and that from this time they progressed slowly, but steadily, so that the recovery was complete at the end of three months. This shows the impropriety of repeating the use of caustic without waiting to see the effects of the operation. Two remarkable features in the case were, the influence exer- cised by the spermatorrhoea over the digestive organs, and the effect which disordered digestion produced on the genital organs. The stomach was the organ which first suffered from the masturbation; and which, afterwards, was chiefly affected by the spermatorrhoea; whilst, on the other hand, a violent indigestion much increased the severity of the symptoms; and at a later period, when the cure seemed perfectly established, four attacks of indigestion were fol- lowed by an equal number of more or less serious relapses, and by diurnal pollutions, and irritation of the bladder, with pain in the urethra, resembling that caused by cauterization. But I shall re- sume the consideration of this sympathy between the generative and digestive organs when speaking of the symptoms and treatment of spermatorrhoea. The cases which I have related—few in number, but circum- stantial and varied—are sufficient to give an idea of the principal abuses of which the generative organs are the seat, and of the man- ner in which such abuses bring about more or less serious and re- sisting spermatorrhoea. Of all the causes capable of producing this unfortunate result, none is, at present, more common. I ought, perhaps, only to consider here the mode by which abuses act in producing spermatorrhoea, such being the object of this chapter; but the complicated chain of circumstances attaching to the subject, forbids this; and I must ascend by degrees to the causes of the abuses, in order that they may be avoided, or, at least, that their danger may be diminished. Of such an occurrence it is especially of importance to prevent the evil, inasmuch as, when once esta- blished, it is occasionally without remedy, and generally leaves its traces during the rest of the patient's life. There is, perhaps, no single question of more importance to the happiness of families, or to the welfare of society, than this. In order, then, to examine the numerous facts I have collected in their proper order, I shall first speak briefly of the causes of abuse. Causes of Abuse.—These may be divided into two classes:— Fir§t, causes inherent in man, or those acting from within; these may be considered as predisposing causes; secondly, external ABUSE. 143 causes, or those arising from accidental circumstances; and these may be considered as exciting causes. Internal or Predisposing Causes.—Of the first class of causes, the most important is undoubtedly due to the hurmln organization. In the lower animals the male and female live together, as if there were no difference of sex, except during the short rutting season. This period passed, perfect calm is restored. In the human species, the secretion of semen constantly goes on, from the time of maturity until extreme old age; the secretion may indeed be increased or diminished by excitement or repose of the organs, but, during this period, it is never entirely suspended as long as the secreting tissues are healthy. Still, this universal and important fact has been much neglected: its application is evident. The form of the superior extremities in the human race also possesses considerable influence in predisposing to abuse. Many animals are always fit for fecundation—spermatozoa being found in them at all seasons. They are, however, unable to excite seminal emissions without the aid of the female. Other animals, again, which, during the rutting season, show an almost incredible amount of erotic fury, are still unable, by their own actions, to cause spermatic discharge; their form alone prevents this, for they often attempt it, and a few even succeed. It is well known with what fury apes are addicted to masturbation; the ape being, of all the lower animals, the nearest to man in form. To this original disposition, more perfect in man than in any other animal, must be added the influence of pathological causes. I have already spoken of the irritation caused by ascarides in the rec- tum, of the erections they excite, and of the abuses induced by them. We shall see, by and by, that herpetic eruptions on the penis and prepuce may produce the same effects, and I shall show, also, that an accumulation of sebaceous matter between the prepuce and glans may have a similar influence. I must also mention irritation of the cerebellum, as inducing serious abuses, of which I shall give cases in their proper place. There is even some connexion between the organs of generation and distant diseases; for Dr. Desportes has mentioned a kind of angina, which is frequently preceded by a considerable increase in the venereal desires, and consequently try a disposition to all kinds of abuses. Pulmonary phthisis, also, is often attended by considerable vene- real excitement. It may as well, then, be at once admitted, that causes predisposing to masturbation exist in the human organization itself. External or Exciting Causes.—Of these, I shall lay particular stress on such as act before puberty, because they have hitherto attracted very little attention. The most anxious parents believe that there is no occasion to watch over the actions of their children with regard to their genital organs, previously to the epoch of puberty; and few, 144 CAUSES OF SPERMATORRHEA. even of our own profession, are led to suspect bad habits before that period. This is a fatal error, against which it is necessary to be on our guard: numerous causes may give rise to abuses, at a much ear- lier period—infancy being hardly exempt from them. I saw one unfortunate child, which, while still at the breast, nearly fell a victim to the stupidity of its nurse. She had remarked, that handling the genital organs appeased its cries, and induced sleep more easily than any other means, and she repeated these manoeuvres, without no- ticing that the sleep was preceded by spasmodic movements. These increased, and took on a convulsive character, and the child was losing flesh rapidly, and becoming daily more irritable, when I was consulted. At first I attributed the disorder to worms, teething, &c, but my attention being attracted by certain signs, I examined the genital organs, and found the penis erect. I was soon told all, for the nurse had no idea she was doing wrrong. It was necessary to dismiss her, for her presence alone sufficed to recall to the child's memory sensations which had already become a habit. Time and strict watching were required before these early impressions were entirely effaced. Dr. Deslandes relates two similar cases, and Pro- fessor Halle;, in his lectures on hygiene, used to mention many such; Chaussier, too, has told me of several that came under his notice; and both these observers believed such cases to be less rare than they are usually considered. These manoeuvres quiet the children very rea- dily, and nurses always endeavour to obtain quiet at any sacrifice; they have no idea of the consequences of their conduct. At a later period, children are exposed to the same dangers, on the part of the servants having charge of them; and in these cases, it is not of igno- rance that the attendants are to be accused. Many patients have ► consulted me, who owed their disorders to this cause; and in case 61,1 have shown the influence which such early abuse exerts on after life. In some children there is a kind of precocity of sexual instinct, which leads to very serious results. In these, it often happens that the sexual instinct arises long before puberty; such children manifest an instinctive attraction towards the female sex, which they show by constantly spying after their nurses, chambermaids, &c. These freaks of children are usually laughed at; but if they were regarded with more attention, it would become evident that the sexual impulse has been already awakened. Rousseau, in his confessions, has well described the influence which early sexual impulse exercised on his whole life, and I have received numerous confidences of the same nature, which, however, it would be of no service to relate here. One case, however, is so remarkable, that an abstract of it may be instructive. M. D----, the son of a distinguished physician, between five and six years of age, was one day in summer in the room of a dressmaker who lived in his family; this girl, thinking that she might safely put herself at her ease before such a child, threw herself on her bed, almost without clothing. The little D----had followed all her motions, and regarded her figure with a greedy eye. He approached ABUSE. 145 her on the bed, as if to sleep, but he soon became so bold in his be- haviour, that after having laughed at him for some time, the girl was obliged to put him out of the room. This girl's simple imprudence produced such an impression on the child, that when he consulted me, forty years afterwards, he had not forgotten a single circum- stance connected with it. The continual occupation of his mind by lascivious ideas did not produce any immediate effect, but about the age of eight, the most insignificant occurrence served to turn his recollections to his de- struction. Having mounted one day on one of the moveable frames which are used for brushing coats, he slid down the stem which sup- ports the transverse bar, and the friction occasioned caused him to experience an agreeable sensation in his genital organs. He has- tened to remount, and to slide down in the same manner, until the repetition of these frictions produced effects which he had been far from anticipating. This discovery, added to the ideas constantly before him, gave rise to the most extraordinary abuses, and, after a time, to excessive masturbation. I need not mention all the miseries which followed this fatal pas- sion; it will be sufficient for me to relate the means to which he had recourse for its correction. He slept on a very hard bed without a shirt, in order to avoid all friction, and covered by a single coverlet sustained by a cradle; his arms wrere raised, and crossed above his head; a servant remained by his side during the night, with orders to awake him if he changed his position. When he got up, he put on, next his skin, a shirt of mail weighing twenty-two pounds, resembling those worn by the knights of old, except that it had no sleeves, and that it was attached, at its lower extremity, to a silver basin, fitted to receive the genital organs, and provided with openings for the thighs. This shirt of mail was open in front, in order to be easily put on and taken off; and when on, it was laced up with a steel chain, a padlock being attached to the end, the key of which was kept by the servant, who had orders not to give it up on any pretence whatsoever. Guarded by the silver basin, the genital organs were completely removed from the touch, a little opening only being left for the discharge of the urine. As a still greater precaution, the patient had caused four sharp points to be fixed in front of this case, in order directly to op- pose any erection. This apparatus he continued to wear for nine or ten years, although it frequently caused inflammation of the testicles and spermatic cord, by its pressure. Notwithstanding all these pre- cautions, the patient's moral and physical condition was deplorable, which led me to suspect the presence of diurnal pollutions. I should observe, that in all the cases of which I have just spoken, the children were five or six years of age—at most eight—that they did not show signs of puberty for several years afterwards, and that they were not exposed to the influence of bad example. Their sexual ideas were, therefore, spontaneously developed, several years before the development of the genital organs. The same precocity is often ' 10 146 CAUSES OF SPERMATORRHEA. observed in children of the other sex. Of this I shall treat more fully hereafter; at present, I shall merely call attention to the case related by Parent Du Chatelet,1 of a little girl, who, from the age of four years, gave herself up to the most unbridled abuses. From these facts an important scientific conclusion may be de- duced, viz.: that in many children the genital instinct shows itself with much energy many years before the age of puberty. A no less important practical precaution presents itself, viz.:— that the age of puberty should not be waited for, in order to sur- round children with prudent circumspection, and to prevent their curiosity from being gratified. Many parents are remarkably careless on the latter point; they permit children of both sexes to play together, promiscuously, for hours, without any surveillance, provided that they are removed from all danger of accident, and that their noise is not annoying. The confidence of many parents, also, in the ignorance of their children, makes them careless of the marks of familiarity which are given to each other in their presence: children's sleep is not always so real or so sound as it seems. It is sufficient to point out these facts; every person can deduce the conclusions; and now I hasten to consider a question, the gra- vity of which has been allowed by all who have written respecting masturbation—I mean the influence of example in educational establishments. If I may judge from my own observations, out of ten persons whose health has been deranged immediately or remotely from the effects of masturbation, nine first contracted the habit at school. All that I have read on the subject has led me to conclude that this proportion is not exaggerated. A child brought up in the bosom of his family is, it is true, surrounded by many causes sufficient to arouse his curi- osity and excite his imagination; but such causes act accidentally, and in an isolated manner—they only produce a serious effect on a few ardent imaginations; a thousand circumstances may remove the attention from them. At school it is admitted that such causes do not exist, but there are others, less numerous and less varied, but which operate in a much more active and continuous manner; the effects of these are direct, and almost inevitable. The child finds, on his first arrival, a focus of contagion, which soon spreads itself around him; the vice is established endemically, and is transmitted from the old pupils to those newly arriving. If a few privileged indi- viduals escape being initiated, they are only such as do not experi- ence any gratification. But their time will come at a later period; when the passions make themselves felt, the same circumstances will be presented to the mind, under a less disgusting aspect. I shall not ^nnales d'Hygiene publique et de m^decine legale, torn. vii. Ire Partie, 1832, pag. 173. ABUSE. 147 enter into details on this subject; but from all that has come to my knowledge, from various and direct sources of information, I do not hesitate to affirm, that nowhere are obscene books circulated more freely and boldly, than in educational establishments; that the origin of the vice is not solely in the scholars, but also in the ushers and servants; that the abuses are not always confined to masturbation; and that they are not always propagated by example or persuasion, but are sometimes enforced by threats and violence. Let it not be thought that I am now speaking of rare and exceptional cases, or that I exaggerate;1 I possess multiplied and convincing proofs of my assertions. I would not, either, that I should be misunderstood. I am far from denying the advantages of education in a public school; and I am ready to admit that the competition among a number of children produces emulation, forms the future character, early shows each his own value, and lays the foundation of friendships which endure through life.2 A too sedentary life is injurious at all ages, especially in childhood, when there exists such constant desire for exercise and change. Gymnastics, therefore, should on this account alone occupy an im- portant position in the system of education ; but they must be viewed under a much more serious aspect. Nothing can prevent the genital organs, at the time of their development, from reacting on the eco- nomy and giving rise to new sensations and ideas. It is impossible to prevent the attention from being attracted by the impressions caused by these organs; impossible to restrain the imagination and to pre- vent it from frequently dwelling on such impressions. The slightest circumstances may, in such a case, lead to a fatal discovery, even if the information be not transmitted directly, and enforced by example. How are such discoveries to be prevented, or rather, how are their results to be guarded against? Study gives us no aid here; indeed, the continued sitting necessarily heats the organs already too excited. The eyes may be fixed on the book, the ears may appear to listen to the master, but who can guard against the wandering of the imagina- tion? At night it is still worse; no surveillance can prevent this. There exists only one means capable of counteracting it, and that is, 1 M. Lallemand of course speaks of the colleges and private schools in France. I regret to say that his statements apply with nearly the whole of their force to the schools of England. Vice is common in them, neglect of physical education and the contracted nature of the studies to which pupils are confined in our classical semina- ries—the understanding being unappealed to, and the reasoning faculties unexercised —the natural sciences neglected, and the whole of the pupil's life until the age of seventeen employed in the study of the dead languages—are matters of vital impor- tance, to which society has only recently begun to direct its attention. [H. J. McD.] - M. Lallemand enters very fully on the subject of education as conducted in France, and well exposes the errors of the system. Most of his remarks apply to our own educational system, yet, as the subject is not strictly medical, and as, moreover, M. Lallemand has treated it at considerable length, I think it best to refer those of my readers who may wish information on it to the original work. Vol. I. page 425. [H. J. McD.] 148 CAUSES OF SPERMATORRHEA. muscular exercise carried so far as to induce fatigue. This alone is able to deaden the susceptibility of the newly acting organs which excite the economy; exercise alone, by requiring matter for the re- pair of the muscular waste it causes, withdraws a stimulus from the genital organs, and induces sound and refreshing sleep. Varieties of Abuse.—I think it will be useful for me to give a few details, respecting the different kinds of abuse which have come under my notice, and of which I have seen the hurtful influence on the genital organs. I shall omit all such remarks as have not a strictly practical bearing. We have already seen the dangers to which compression of the urethra, to prevent the discharge of semen during ejaculation, may give rise (case thirty-five.) In the case I have related, it seems likely that a rupture took place in the mucous membrane, because the patient felt, at the instant, an acute pain, and the following day a discharge commenced, which continued until the application of the nitrate of silver. Soon after the commencement of the discharge, involuntary seminal emissions occurred, attended with serious symp- toms. It was immediately behind the glans that this patient com- pressed the urethra, and it is quite conceivable that the sudden and violent distention of the canal might cause a tear in the mucous membrane. But this is not always the case; one of my patients writes as follows:—"At the age of fourteen I practised masturbation three or four times a week, and sometimes frequently during the day. In order to prevent the discharge of semen, I compressed the root of the penis firmly. Nothing escaped at the time, but I soon ob- served that the semen was discharged with my urine, the first time I passed it. I followed this practice for about two years." Diurnal pollutions soon appeared, and grew more and more serious. The remainder of the case presents nothing which is not met with in all cases of spermatorrhoea. What I wish to call attention to here, is, that the compression was made close to the orifice of the ejaculatory ducts, and that the patient thought at first, that his manoeuvres were not followed by any loss of semen, although he at length discovered the contrary. Fournier and Begin report a similar case.1 It was that of a young man who, at the moment of ejaculation, compressed the most remote parts of the urethra, so that not a single drop of semen could escape. Yet the result was the same as in ordinary cases. Notwithstanding his precautions, his strength diminished, and his disorder made just as rapid progress as if the seminal emis- sion had been perfect. The following is even a more remarkable case. I shall allow the patient to speak for himself. "I am thirty-two years of age, and I have had nocturnal pollutions from the age of fourteen ; I have also suffered from discharges while at stool, for ten years. The cause of these pollutions cannot be referred to masturbation, for I have not 1 Dictionnaire des Sciences Medicales, Art. Masturbation, page 125. ABUSE. 149 practised it twenty times during my whole life. The pollutions are rather owing to reading obscene books, for they commenced soon after. At first, ejaculation was preceded by dreams, and accompa- nied by active erections and acute sensations, the semen being ejacu- lated with force. I tried various means to prevent these discharges. I have slept, during whole nights, with my penis dipped in cold water, or compressed between two pieces of wood formed on purpose. I have tried to keep myself awake in order to prevent an emission, because, when I succeeded, the following day I felt stronger, but after two or three nights, sleep always overpowered me; I often awoke, however, in sufficient time to prevent the catastrophe of my dreams, but frequently it was too late; on such occasions, to delay the discharge or to render it less copious, I compressed the base of the penis firmly; but it seems that these compressions greatly injured the parts, without preventing or diminishing the discharge, which took place inwardly, as I have often been convinced by inspecting my urine. From that period the pollutions have no longer been pre- ceded by dreams; and the sensations have left me, so that I am not now aroused from sleep. My erections diminished, and have even, latterly, ceased entirely. For three years erections have rarely ac- companied the emissions; when they do occur I am always less fatigued. There is one thing which I have not been able to understand, and which will, without doubt, appear absurd to you; it is, that I experience pollutions without erection, sensation, or the escape of semen by the urethra. I believe that the discharge passes in a retro- grade direction, and becomes mixed with urine, because, the next morning, I find little globules, a cloud of filaments, in- that fluid, just as when I formerly prevented ejaculation by compressing the root of the penis; whilst my urine contains nothing during the day, or the next morning, when I have not experienced these pollutions. On waking, I am perfectly awaYe of what has occurred, by the sweat that covers my face, the fatigue I feel in all my limbs, the headache and dazzling that affect me, the dark circles that surround iny eyes, &c. I have tried cold and iced applications, with slight benefit. For some time the pollutions were rarer, and were accompanied with erection and sensation ; but soon they became as before, and emission did not take place outwardly. These internal pollutions have always been the most weakening. Whenever I succeed in passing the night without sleep, my urine is transparent in the morning, and I feel strong. After several nights without sleep, I generally have an energetic emission, which fatigues me little; but soon those without erection, and without external discharge return, and then I alway3 feel worn out on wTaking." This patient's medical attendant would not believe in the possi- bility of pollution without external discharge; but it seems clear that the patient really had internal emissions without perceptible dis- charge ; that is to say, that the semen passed into the bladder, and was 150 CAUSES OF SPERMATORRHEA. discharged with the urine, as had occurred before when ejaculation wras prevented by pressure on the perineum. This compression was made in front of the ejaculatory canals, and was very often repeated. It seems, therefore, likely that it was the frequent repetition of these manoeuvres that, at length, caused the spontaneous passage of the semen into the bladder. But this is a question to which I shall have occasion to return. Yet all these manoeuvres scarcely differ from the various means recommended by some surgeons for preventing nocturnal pollutions; and we may thus perceive how little confidence is to be placed in the instruments invented for that purpose, and the inconveniences to which they may give rise. It seems likely that the dangers would be nearly the same, in whatever part of the penis the compression is made; except that if there be sufficient space in the urethra, between the point compressed and the ejaculatory ducts, to contain all the semen, it would be discharged directly the compression is removed. When, on the other hand, the compression is made immediately in front of the orifice of the ejaculatory ducts, the semen flows back, at least, in great measure, so as to induce the patient to believe that the discharge has been stopped, or at all events, in great measure di- minished, and to induce a degree of security which leads to further abuses. But to return to the description of the abuses which have been admitted to me by so many other patients. One of these informed me, that about the period of puberty, while hanging one day by his arm, he experienced an energetic erection accompanied with pleasure, and that by his efforts to raise his body, he caused an abundant seminal emission. This was the first. The next day he repeated the same motions, and noticed the same phe- nomena, and from that time he knew no other pleasure. From the principles which had been early instilled into him, he would have thought himself degraded by connexidn with a female, or by the least manual contact with his genital organs; but his conscience was quiet with regard to these practices, because they had not been forbidden him. He continued, therefore, to hang by the hands, from the furni- ture, doors, &c, without being suspected by any one, and fell, by degrees, into a state of debility and wasting equal to those caused by the most unbridled masturbation. After a time, from weakness, the patient lost the power of hanging, and his voluntary emissions ceased; but they were soon replaced by nocturnal emissions, which were very difficult of cure. The following are a few passages from a letter I have recently received./ " Being of an ardent temperament, I abused myself, from the age of eight years, by practising masturbation, or rather, by still more hurtful manoeuvres. By compressing the penis between my legs, or against the seat on which I was sitting, I produced excite- ment, which was commonly followed by the discharge of a few drops of a viscid and transparent fluid. This practice I repeated several ABUSE. 151 times a day, up to the age of sixteen, when I ceased entirely, having been frightened by the discharge of nearly pure blood, which occurred several times. From this time I only sought natural enjoyments, but I found it impossible to obtain a complete erection. This state was attributed to weakness, and was combated by tonics, stimulants, and even irritants of all kinds, which have done me much injury. I used, also, cold bathing and cold lotions." I have seen an officer of high rank who had fallen into the same condition, from the practice of similar manoeuvres. He experienced his first sensation against the leg of a table, at the early age of ten years, and continued for several years to employ the same means. I have already related the case of another child, who allowed himself to slide down a wooden pole, and the deplorable influence which this circumstance exercised on the remainder of his life. In a few of my patients, horse exercise caused the first seminal emissions. I shall relate, by and by, the case of one of these who knew scarcely any other pleasure, and who became quite impotent at the age when virility is generally greatest. The extreme suscep- tibility which the genital organs manifest at the period of puberty, should prevent horse exercise from being commenced about this period, as is usually done. It should be begun a few years earlier, or a few years later. I have already spoken of the danger of allowing children to sleep on the abdomen, (see case thirty-three.) I should add, that many of my patients thus contracted habits which ruined their health. Inde- pendently of the inconveniences to respiration, digestion, &c, which arise in this position, erections are favoured. The least friction awakens new sensations, and once on the track, progress is soon made. Sometimes recollections have caused the choice of this posi- tion ; of this I have related a remarkable example, (see case thirty- four;) at other times, scruples early instilled by a sage foresight, but which the violence of the impulse has at length succeeded in eluding, have induced it. Thus, I have been told respecting one of my patients, that he would suffer death rather than defile himself by touching the genital organs, yet, for five or six years, he seldom passed a night without working his own destruction while lying on his abdomen. It is not necessary for me to enter into a description of the other means by which patients have sought to satisfy their genital impulses, without transgressing the religious and moral prin- ciples which had been taught them from infancy. Suffice it to say, that if they have succeeded in satisfying their consciences, they have not succeeded in preserving their health. But to abstain from all direct action on the genital organs, is not always sufficient to preserve the patient from serious disorders. A purely nervous excitement, awakened by the other senses, or directly produced by erotic ideas, may bring the same results as the worst abuses if prolonged or repeated erections are caused by it. The following are a few such examples:— 152 CAUSES OF SPERMATORRHEA. A student, aged twenty-two, born in Switzerland, of sanguine temperament, and great muscular power, fell into the most complete state of impotence, after having been for some time exposed to un- gratified excitement. He had never practised any solitary vice; but violent and prolonged erections came on, and were produced during the day by the influence of the memory. These erections caused abundant and frequent nocturnal pollutions. Absence put an end to the excitement. The nocturnal pollutions diminished by degrees, and at length ceased entirely. Yet this patient fell into the same state of impotence as if he had committed the greatest excesses in masturbation, and at the same time preserved the appearances of health and strength. The cause of his impotence was evident on examining his urine, and causing him to watch for diurnal pollutions while at stool, but the cure of these pollutions was only perfect after two years' treatment. I have seen another case of the same kind, in a young man who passed from a state of habitual priapism to one of absolute impotence, without any other cause than violent excitement of the genital organs by an ardent attachment; he had never given way to excess of any kind. I shall record by and by another case of the same kind. I also had under my care an English officer, who left Calcutta in per- fect health and arrived in London completely impotent, after having suffered during two months from almost constant erections, excited by the presence of a female on board ship. This state, so opposed to that which had preceded it, continued for two years—the whole of this time not being marked by the least sign of virility. It is scarcely necessary to add, that this state was produced by diurnal pollutions. I related a case, a few pages back, (page 136,) in which nocturnal pollutions were caused by reading an obscene book: I have seen a multitude of cases of this nature. From these I conclude, that in certain very excitable individuals, reading such works, the sight of voluptuous images, lascivious conversation, in a word, all things that can excite or keep up irritation in the spermatic organs are capable of producing the same effects as actual abuse, even when the will is sufficiently powerful to prevent the thoughts from leading to the acts. On the other hand, an abundant secretion of semen with importunate erections, irritation of the urethra and prostate, always results under such circumstances; and these favour the occurrence of nocturnal and diurnal pollutions as serious, and perhaps more difficult of cure than those produced by masturbation, because it is impossible to act directly on the memory or the imagination. It is not sufficient then to prevent all material action on the genital organs; it is necessary also to prevent all erotic excitement of the senses and all concentration of the ideas on lascivious objects. For- tune's favours are so distributed that numbers live in absolute indo- lence without being blamed by the world, because they demand nothing of any one. This inaction produces results, the only remedy for which that I am aware of, is daily fatigue of the body by va- rious kinds of exercise. ABUSE. 153 Effects of Abuses.—The effects produced by the different kinds of abuse of which I have been treating, vary according to the age of the patient, his idiosyncrasy and the different organs chiefly af- fected. I have laid particular stress on the causes which may lead to bad habits some time before puberty; I must now consider their effects during this period. The symptoms arising from masturbation in the child have been always hitherto confounded with those produced in the adult; they present certain distinctive characters, however, whicli require our consideration. However young they may be, children lose flesh, and become pale, irritable, morose and passionate; their sleep is short, disturbed, and broken. They fall into a state of marasm, and at length die, if not prevented from pursuing their courses. Examples of such a termination are so well known that I forbear to quote them. Analogous symptoms are shown in the adult—follow nearly the same course—and may lead to the same termination ; but in infancy more or less severe nervous symptoms are superadded, which are not found in those who have commenced the practice after puberty, or which at least are not in the latter case manifested to the same ex- tent. Such are spasms and partial or general convulsions, eclampsia, epilepsy, and paralysis, accompanied with contraction of the limbs: these phenomena were present in all the children whose cases I have noticed, and numerous similar facts have been published by different authors. Contractions of the limbs have been well investigated by Dr. Guer- sent,1 and he notices that they especially affect such children as are lank, unhealthy-looking, nervous, and worn out by bad habits. The following case is sufficiently remarkable. In 1824 a woman brought her son, aged eight, to the hospital St. Eloi; he had lost the use of his lower extremities for some months. The limbs were fixed, and drawn together, and all the muscles contracted. The child was extremely thin, and his intellect was much disturbed. Mastur- bation, the cause of all these disorders, had only been discovered by his mother a few weeks before she placed him under my care, but she had used every means she could devise to prevent it, without effect. After two or three trials I found it was of.no use trusting to the strait-waistcoats and other means usually employed, and accordingly I determined to pass a gum-elastic catheter into the bladder, and to fix it so that the patient should be unable to withdraw it. The pre- sence of the foreign body excited inflammation of the urethra, as I expected: when this occurred, I withdrew the instrument, but re- placed it as soon as the inflammation had subsided. I kept up, in this manner, a constant state of inflammation for a fortnight, which rendered the parts so painful that the child was unable to touch them. This treatment produced more decisive success than I had ventured 1 Gazette Me'dicale de Paris, Fe>rier, 1842. 154 CAUSES OF SPERMATORRHEA. to hope; within eight days the lower extremities had regained suffi- cient strength and mobility to allow the child to get up, and in ano- ther* fortnight he was able to run about the wards. I then sent him away, threatening him with a return of the same treatment if he re- lapsed. The pain caused by the catheter seemed to have removed all the other impressions, for his health continued good, and growth followed its ordinary course. I have since employed the same means in many cases, with just as much success, and I think it more sure than any other, because it is impossible to rely on the patient's will, or on the assiduity of those who are appointed to watch over him. In children too, it leaves an impression on the memory which is often sufficient to destroy the empire of habit, and to prevent a return to the former manoeuvres. But to resume the consideration of the symptoms observed in chil- dren. In childhood, seminal emissions are never experienced, but nevertheless the patients fall into a state of marasm, to which some even succumb. These effects, like those observed under the same circumstances in the female, have induced some authors to leave out of their consideration the seminal discharges which are produced by the same acts at a later period. They have attributed the debility which follows all abundant discharges of semen to the nervous ex- citement and convulsive motions, which usually accompany the dis- charge. The accidents observed before puberty are evidently only due to the effects on the nervous system; and, the same sensation accompanying voluntary emissions after puberty, it is natural to sup- pose that the nervous system plays as active a part then, as in child- hood. I willingly admit the importance of this nervous exhaustion, in whatever manner it may be supposed to operate; and supposing, even, that its action on the economy is just as important as during childhood, (which is not the case, as I shall presently show,) this is no reason why the actual discharges should not be taken into ac- count, seeing that they greatly modify the character and conse- quences of the nervous disturbance. I have already noticed that the symptoms produced by abuses during childhood present a spasmodic character: this character, with- out doubt, is derived fsom the predominance of the nervous system at that period, rendering children so alive to external impressions. This excessive sensibility also explains the great disorder of the eco- nomy which children suffer from such manoeuvres. Deslandes1 re- lates a case, showing that any action of the same kind may produce the same effects at this early age. He says: "An observer worthy of credit, Dr. Nurambeau, has communicated to me the case of a child who procured himself similar sensations by drawing out the navel. His health became much disordered from the effects of this strange habit, which had such a power over him that coercive measures were 1 De l'Onanisme et des autres abus ve'ne'riens, page 462. ABUSE. 155 required for its correction. It is worthy of remark that this patient showed neither erection, nor any other phenomenon of the genera- tive organs, which at all referred to sexual intercourse." The or- gans of generation, therefore, had no influence in producing the sensations experienced by this child; but the repeated titillation of a very sensitive part produced the same disorder as masturbation. It was proved in the debates on a recent criminal trial that death may be caused by prolonged tickling the sole of the foot. Nervous disorder, arising from such proceedings, may then be carried so far as to cause dearth, and from this may be imagined the effects of the multiplied convulsive shocks which irritable children produce, by acting on the most sensitive organs in the economy. Every excessive loss of semen, also, even when unaccompanied by sensation, is followed by debility, and this may be carried so far as to cause death; I have related several such cases in the beginning of this work. There exist, then, two distinct causes; nervous disturbance and de- bilitating discharges; and both these act at once, when seminal emis- sions are produced by the influence of the will. It is not to be won- dered at, that both these causes should produce nearly the same symptoms, because they both weaken the economy. The action of the first on the nervous system is direct and immediate, and the symptoms that result from it are of a more spasmodic character. It is very easy to confound these two causes when they act simultane- ously ; but I have just shown that they can be considered separately. The following reason shows the importance of so doing. Whenever we succeed in entirely putting a stop to the habits of abuse in children, we may make sure of obtaining their return to health, and that very quickly. This I have remarked in all the cases of children that have come under my care. I do not mean to infer that the disorder done to nutrition during the progress of development is easily repaired, but that the acute symptoms rapidly disappear, and that all the functions are quickly re-established. If the effects pro- duced are active and serious they cease very rapidly, as soon as the cause is removed, and return to health becomes certain. Unfortu- nately, matters do not follow so simple a course after puberty. "What I have just said respecting children, applies equally to females: this is easily shown by examining the cases in which excision of the clitoris has been performed for the cure of nymphomania. The state of these unfortunates must have been deplorable indeed to justify the resort to such means; yet they recovered very rapidly. Why in these two classes of cases, is the cure certain and the return to health rapid, as soon as the vice has been mastered? It is that the cause of the weakness immediately ceases to act on the economy. Why is it that so many men continue to waste away after they have entirely left off their habits of abuse ? It is because diurnal pollutions have commenced, which are even more debilitating than the abuses which gave rise to them. 156 CAUSES OF SPERMATORRHEA. Dr. Deslandes and many others have discovered that there is a great difference in the conditions of persons who have practised masturbation for some time, and then renounced it; but they have not sought the explanation of this fact. It is, however, very im- portant to know why some are cured rapidly and completely, while others continue to suffer and languish during the remainder of their lives. The symptoms experienced by the latter are those produced by diurnal pollutions. But if we inquire why some should be affected by diurnal pollu- tions while others are exempt, we discover that we have been com- paring two very different classes of patients. The one class conquered their bad habits by the force of their will; the other class were com- pelled to renounce them by impotence. The former resisted their desires while they were yet active; they required much perseverance and moral energy in order to succeed; the latter only left off as they were less tempted—the progressive decrease in their erections being due to the presence of undiscovered diurnal pollutions. Such patients deceive themselves as to the cause of their changing their habits, and are astonished at not finding any benefit arise from such change. Some of them even remark to their medical atten- dants that it is after they have left off their mal-practices that their health has become altered. All these circumstances, embarrassing at first sight, are easily ex- plained on a little reflection. At first the genital organs are healthy; the constitution is uninjured; no seminal emissions occur except those that are induced voluntarily; and the activity of the digestive organs permits a rapid repair of the losses. But as soon as irritation is set up in the spermatic organs, a large quantity of semen is se- creted and escapes every day, and several times a day, without the patient's knowledge; the digestion is disordered; the erections and voluptuous sensations diminish, because the semen is less perfectly formed; the provocatives are therefore weakened by degrees, and the patient renounces, without difficulty, habits which only inspire him with disgust. He wonders that his health still continues to grow worse, for he has not discovered that he passes daily, by often repeated evacuations, more semen than he formerly passed in a per- ceptible manner, and he does not take into account the difficulty felt by his economy of repairing these frequent discharges. We must not, then, confound those whose virility leaves them, with those whom the power of their will causes to recover, and we must not be surprised at seeing the alteration in the habits of each followed by very different consequences. In order to make the distinctive characters of these two positions clear, I have laid stress on their most striking points, but there are numerous slight shades of distinction, which I have not mentioned. For instance, in some cases the two classes of phenomena occur suc- cessively in a very distinct manner, at very near periods. Many patients having corrected themselves once, find their health promptly ABUSE. 157 re-established. But when, after recovering their strength, they have relapsed into their former habits, on renouncing them a second time they obtain no benefit. These different results under apparently similar circumstances can only be explained by the occurrence of diurnal pollutions in consequence of the return to habits of abuse. Case thirty-one is a clear and perfect proof of the correctness of this explanation; the patient recovered twice after having twice con- quered his passion, but the third time he only gave it up through disgust, and his health continued to deteriorate until cauterization arrested the diurnal pollutions from which he suffered. There are many circumstances which interfere with the good reso- lutions of those addicted to masturbation. After a few days of abso- lute continence, attained with much difficulty, they frequently suffer from nocturnal pollutions, the more frequent and the more abundant in proportion as the spermatic organs have been much irritated: the patients always feel more debilitated by these involuntary discharges, than by those which they previously excited. Instead of combating these pollutions by suitable means, or after having employed one or two plans successfully, they think they will be able to diminish the evil by recurring to their former habits at distant intervals, and they thus relapse, increasing still more the irritation of the parts. Soon after diurnal pollutions commence, and rapidly produce their effects, but as these are not discovered, the patients rejoice to find the nocturnal discharges gradually disappearing. But their health daily grows worse; this they cannot comprehend, and are frequently led to imagine that they have mistaken the cause of their disorder. Sexual intercourse has been generally recommended in such cases, and sometimes with advantage; but this means is like all others; the patient must be able to employ it, and even then it is necessary to distinguish the circumstances in which it is hurtful, from those in which it is advantageous. Very often the patients find intercourse impossible; while, on the other hand, many of those who have been able to accomplish the act, have had an exacerbation of their symptoms as the result. Whence arises this difference of result, in individuals placed in ap- parently similar circumstances? , Some have diurnal pollutions kept up by the irritation of the organs, while others are exempt from them. All authors consider masturbation to be one of the most frequent causes of hypochondriasis, but the reason why this affection con- tinues so long after the patients have left off the habit has not been hitherto explained. If it only arose, as has been supposed, from weakness of the system, or disorder of the nervous functions, how is it that the various modes of treatment employed—the travelling exercise, and amusements of every kind, should produce no effects? In every case of this nature that I have met with, I have found the hypochondriasis kept up by diurnal pollutions, which were unsus- pected by most of the patients; the intellectual and moral faculties, together with the digestion, sleep, &c, improved in such patients in 158 CAUSES OF SPERMATORRHEA. proportion as the pollutions diminished, and the return to health was complete as soon as they had entirely disappeared. The thirty- second case is a remarkable instance of this kind, and shows the strange monomania, which accompanied hypochondriasis, as well as the rapidly beneficial effects derived from cauterization of the ure- thra. Many authors have noticed the indifference which persons addicted to masturbation show towards the opposite sex. This sen- timent is, indeed, very common in those who have carried their abuses to a great extent; but I do not think it arises, as has been stated, from the long habit of solitary vice; at all events, I can as- sign a more direct cause for this indifference, viz., the relative im- potence of the patients; I say relative impotence, because they pos- sess sufficient power of erection to permit the practice of mastur- bation, but not enough to admit of sexual intercourse; and such pa- tients seldom manifest any dislike to the opposite sex until they have experienced several disappointments, the remembrance of which constantly haunts them. Their views change immediately that the diurnal pollutions which kept up this impotence are arrested. Effects of Temperament, Idiosyncrasy, o cause superficial ulceration. I have frequently seen the surface of the glans excoriated with elevated papillae and drops of blood exuding from them; at other times I have found the glans deprived of epithelium with excavated ulcers. In such cases, the corresponding surface of the prepuce was always more or less excoriated, or ulcerated also; and these excoria- tions were often accompanied with inflammatory swelling of the lym- phatic glands in the groin. These ulcerations have been confounded with chancres; but their edges are thinner, and they are less deeply excavated; the neighbouring parts too, are covered with a layer of sebaceous matter of caseous aspect and fetid smell. Such ulcerations disappear after the removal of the prepuce, their appearance be- coming changed even in twenty-four hours. Fomentations and cleanliness do all the rest. Such is the condition which the parts present in cases of recent balanitis; and these are the inflammations and ulcerations that cause more or le3S extensive adhesions of the prepuce to the glans; such adhesions are generally cellular, but sometimes fibrous or even carti- laginous, according to the severity and frequent repetition of the inflammation. Various degrees of induration also result, according to the intensity, the duration, and the frequency of the phlogosis. Thus I have often found the mucous membrane hardened, thickened, and covered with numerous papillae, sometimes fibrous or even cartilaginous, with three times its natural thickness. I have also met with cases in which the prepuce has become cancerous. I have operated in several cases of cancer of the penis too, which certainly arose from no other cause. The patients were generally peasants between fifty and sixty years of age, who had never known other than their wives, but who had frequently suffered from balanitis, attended by abundant discbarge, swelling of the prepuce, and excoriation of its opening, wThich wras so contracted as to prevent the passage of the glans. I have seen one case also, in which balanitis, irritated by a forced march, and the abuse of alcoholic stimulants, passed into gangrene, by which the greater part of the glans was destroyed. Such have been the accidents which I have observed in those whose prepuce was too narrow to permit the glans being uncovered; accidents which I can only attribute to the long retention of the sebaceous matter in a kind of cul de sac, into which a certain quan- tity of urine passes every time the patient makes water. But natural phimosis is not the only cause of the injurious effects produced on the genital organs by the sebaceous matter; as the fol- lowing case will show. CONGENITAL PRE-DISPOSITION. 217 CASE LIV. Very long prepuce—Badly developed genital organs— Childhood delicate— Pncontinence of urine—Sebaceous discharge from the orifice of the pre- puce at the age of ten—Nocturnal pollutions increasing in frequency— Hypochondriasis—Loss of memory and failure of intellect—Constipa- tion—Diurnal pollutions—Constant application of lotions attended by relief—Circumcision at the age of twenty-eight, followed by cure. M. J. B----, of Amsterdam, of delicate constitution and lymphatic tem- perament, was subject during childhood to incontinence of urine, and always suffered from frequent desire to make water. About the age of ten, a whitish matter formed, and was discharged from underneath the prepuce; after which erections occurred, and were soon followed by emissions: a very disagreeable smell accompanied the preputial discharge. The seminal dis- charges increased as the patient's passions were roused, and he grew sad, silent, discontented, and constantly occupied with the origin of his disorder. He imagined that the whitish discharge arose from venereal disease, al- though he had never had connexion. His health became much disordered, and at the age of nineteen he mentioned his condition to his medical attendant. Lotions were prescribed, which removed the sebaceous matter, and produced considerable improvement in the patient's health. M. B----'s bowels became constipated, however, and he perceived that he passed semen while at stool, in consequence of the efforts necessary. The nocturnal pollutions diminished in frequency, but still occurred occa- sionally. When M. J. B----consulted me in November, 1836, he presented the following condition:—small stature, limbs slight and chest narrow; skin fair and soft; hair white and thin; face very pale; manner timid and em- barrassed; hesitation; habit of stammering, arising from disorder in the in- tellect and loss of the memory; genital organs remarkably small; penis small and short, hidden among long scanty white hairs; prepuce very long, form- ing numerous folds in front of the glans; surface of the glans covered by a thin layer of sebaceous matter, notwithstanding the utmost cleanliness on the part of the patient; scrotum compressed and much folded, containing only the right testicle, about the size of an almond, the left being felt in the inguinal canal attached to a portion of omentum. No spinal curvature, (wbich the patient had feared,) his mistake arising from the projection of the hips and pelvis, which resembled those of a woman. I removed the prepuce entirely in order to put an end to the influence of the sebaceous matter on the glans; catheterism not giving much pain, I did not consider cauterization necessary; but in order to give tone to the organs I left a catheter in the bladder for an hour or two at a time once a week, and ordered the free use of cold douches to combat the constipation. The patient's temperament being exceedingly lymphatic, I afterwards pre- scribed three or four aromatic baths weekly, with the habitual use of Spa water. These means lengthened the periods between the nocturnal pollutions, diminished the constipation, and lessened the involuntary discharges that took place when the efforts at stool were considerable. Acupuncture of the perineum and prostate produced more rapid and decided effects. After 218 CAUSES OF SPERMATORRHEA. this had been practised, sixteen days were passed without nocturnal pollu- tions, and the efforts at stool did not cause any seminal discbarge. By de- grees the patient's face became more healthy-looking and animated; his strength and energy returned; his character regained its boldness and gayety; erections became frequent and energetic; and his health altogether having become as good as could be desired, M. B---- returned to his home. Six months afterwards I accidentally met M. B---- in Paris; he fre- quented theatres and amusements, and went into society; indeed, his cha- racter was quite changed. I have seen few men so badly developed as M. B----. It was certainly to the poor development of the penis that the length of the prepuce was attributable—the skin of the penis not being longer than natural, though it proved exuberant when compared with the parts it was intended to cover. The scrotum presented the same appearance as the prepuce, and from the same cause. It was re- tracted towards the pubes, and formed numerous and deep folds,— the testicles not being more developed than in a child of eight years; the left one, too, was entangled in the corresponding inguinal canal. This slow descent of the testicles is a sign of weakness, which cor- responded with their small dimensions. The incontinence of urine to which M. B-----was long subject, announced debility of the urinary passages, from which no opinion could be drawn in favour of the power of the spermatic. The con- nexion between the two systems showed itself to the last—a frequent desire to micturate accompanying the seminal discharges. The fancied deformity of the spinal column was merely a projec- tion of the hips, which gave the form of the female sex—a conforma- tion which I have frequently observed with extreme weakness of the genital organs. I should notice that M. B-----was born and brought up in Holland; that his childhood was delicate, and that his tempe- rament was very decidedly lymphatic. It may be readily conceived, that with these predispositions M. B----escaped all bad habits, and that he continued continent; yet at ten years of age he was subject to frequent nocturnal pollutions. How was this? The pollutions seem to have arisen from the stimu- lating influence of the sebaceous matter collected between the pre- puce and glans. The improvement derived from the use of lotions at the age of nineteen corroborates this opinion. These means, however, only gave momentary relief; circumcision at the age of twenty-eight, did not suffice alone to bring about perfect re-establish- ment, in consequence of the debility of the genital organs and the obstinate constipation which had excited diurnal pollutions, added to the difficulty of breaking a habit which had continued eighteen years. Aromatic baths, Spa water, frequent douches, and lastly, acupunc- ture, were employed to combat these complications. The remark- able effect of the last remedy shows that habit had much to do with keeping up the pollutions. CONGENITAL PRE-DISPOSITION. 219 CASE LV. Very long prepuce—Badly developed erectile tissues—Abundant secretion of sebaceous matter—Seminal emissions induced by horse exercise, and afterwards by incomplete intercourse—Marriage unconsummated during five years—Diurnal pollutions—Circumcision followed by rapid cure. M. C----, of robust constitution, born in Switzerland, the son of healthy and strict parents, was early imbued with rigid moral and religious princi- ples. At the age of eighteen he experienced for the first time, while on horseback, an abundant seminal emission, and he afterwards frequently had .recourse to the same means to excite a return of the voluptuous sensations, against which he had never been warned. After a time, too, he found a means of procuring them by other manoeuvres. Still he did not prac- tise these abuses very often, often abstaining for a month or two at a time; and consequently his health was uninjured. At the age of twenty-five, having never had sexual intercourse, he married. Four years afterwards, being disappointed at not having children, M. C----consulted his medical attendant, who, by dint of questioning, discovered that the marriage had never been properly consummated. Frequent and abundant emissions had indeed taken place, even with much facility; but they had been produced by simple pressure, or, at most, by slight external friction. Unfortunately for M.C—---, his erections, which had been very energetic at first, had progressively diminished, so that he was now quite unable to profit by the instructions he received. Ferruginous preparations, friction on the loins, cold injections into the urethra, and various tonics, were employed, and did more harm than good. M. C----was, therefore, sent to consult me in July, 1837, five years after his marriage. He was'then thirty years of age, tall, strongly built, and apparently in excellent health; lie experienced, however, a degree of debility in his hands and legs; all his functions with the exception of those belonging to gene- ration, were well performed. The penis was remarkably small; the pre- puce, on the contrary, much longer than the erectile tissues, formed nume- rous folds in front of the glans, and was lined with a large quantity of se- baceous matter; several thick layers of it were also accumulated on the sur- face of the glans, which was much injected and extremely sensitive. The urine always contained a more or less abundant flocculent deposit, in which I invariably discovered spermatozoa. I immediately performed excision of the prepuce, and a few days after- wards, the urine became transparent, and the erections reappeared—weak at first, but soon acquiring energy. The object of marriage was at length properly fulfilled. I have recently learnt that M. C-----is about to become a father. The abuses to which this patient was impelled spontaneously were too rarely practised to have had any power in producing this singular affection; besides, immediately after his marriage his erections were frequent and active enough, but ejaculation took place too rapidly: by considering this in connexion with the fact of seminal emissions 220 CAUSES OF SPERMATORRHEA. having been excited by horse exercise, we must arrive at the opi- nion that the penis was excessively sensitive. This could not be at- tributed to predominance of the erectile tissues, these being, on the contrary, remarkable for their paucity; some irritating cause must, therefore, have excited and kept up the abnormal sensibility of the glans, and this irritation could only arise from the sebaceous matter on its surface being altered by too long retention. This opinion is strengthened by the simple excision of the prepuce sufficing to ar- rest the diurnal pollutions, and to bring about complete performance of the genital functions. Exuberant Prepuce.—In the cases I have just related the genital organs were remarkable for their small development. The corpora cavernosa were small and short, and were surmounted by a very small glans, the whole forming a kind of vermiform appendage in front of the pubes, composed almost entirely of corrugated skin, and nearly hidden among long and scarce hairs. The scrotum presented an analogous disposition; it was retracted towards the pubes, and formed numerous and deep folds. The testicles were remarkably small, and in the 54th case, one of them had not passed the ingui- nal canal. The extreme length of the prepuce, as well as its nu- merous folds, must be attributed to the small development of the erectile tissues; and the numerous and deep folds of the scrotum arose from the smallness of the testicles. These circumstances are, therefore, frequently met with together, and very often congenital hernia, varicocele, or great width of the pelvis, with the rounded form of the female, are superadded. All the patients of this kind that I have met with have possessed a delicate constitution, and had passed a sickly childhood; they were generally, too, of nervous or lymphatic temperament. Most of them had received a very strict education. Still, these patients have generally suffered from nocturnal pollu- tion arising without any kind of excitement, about the ages of ten or twelve; or they have been led spontaneously to commit serious abuses before the age of puberty; (one of my patients committed venereal excesses at a very early age;) and they all fell promptly into a state of complete impotence, arising from diurnal pollutions. The premature erections from which these patients suffered are certainly not attributable to the rudimentary condition of the genital organs, nor to their sickly infancy; the circumstances in which they were placed, too, had no influence in causing abuse; and the patients did not suffer from ascarides. The premature activity, therefore, arose from simple local excitement of the penis; and this was not produced by the presence of semen, because in many cases the tes- ticles had not begun to secrete. The accumulation of the seba- ceous matter around the glans, is the only sufficient explanation of this habitual abnormal irritation; and this opinion is strengthened by the more or less frequent occurrence of discharges, and by the habitual excoriation of the opening of the prepuce; by the frequent CONGENITAL PRE-DISPOSITIO N. 221 attacks of inflammation, by the tenderness of the glans, and the injection of its surface. The remarkable effects produced by clean- liness, and by excision of the prepuce, leave no doubt on this sub- ject. Such persons, then, as have the prepuce very long and folded in front of the glans, are exposed quite as much as those who have a natural phimosis, to all the inconveniences which arise from the col- lection and putrefaction of the sebaceous matter; and the irritation in both cases extends to the urinary and spermatic organs. There is, however, one point of difference between natural phi- mosis and exuberant prepuce, which it is of importance to notice. Excessive length of the prepuce generally depends on paucity of erectile tissues, and is frequently coincident with rudimentary testi- cles; it results, therefore, that in this case the irritation acts on weak and mal-formed organs, which are easily affected by the abuses or excesses which it excites: the involuntary seminal discharges that occur in these cases are, therefore, very difficult of cure. In cases of natural phimosis, on the other hand, circumcision alone generally suffices to bring about a cure, because the narrowness of the prepuce does not, like its exuberance, accompany a small de- velopment of the genital organs. In cases of exuberant prepuce, things are not so simple, for it does not suffice to remove the part, or even to relieve the irritation of the urethra and bladder; congenital debility of the genito- urinary organs remains, which it is often very difficult to remove by tonics, on account of the susceptibility of the tissues arising from their long irritation; this debility, too, arises from the primary or- ganization of the parts, and is consequently difficult to cure entirely. Such patients seldom possess extraordinary vigour. I have still to speak of cases in which there is an excessive or vitiated sebaceous secretion, although the prepuce may be of proper form. Abundant and vitiated secretions of sebaceous matter.—In many cases the sebaceous matter is not confined by a too narrow or too long prepuce; it seems rather to be reproduced very rapidly, or its properties to be modified by some pathological condition. The mucous follicles of the glans and prepuce are much more developed and more active in some individuals than in others, and furnish ha- bitually a much greater quantity of sebaceous secretion. This parti- cular disposition shows itself early, and continues during the whole life; it is a permanent condition, and its effects may show themselves at any moment. Extreme cleanliness might perhaps prevent any in- convenience being felt; but as the gravity of the consequences that may result is not suspected, and as, besides, this peculiar predisposi- tion cannot be foreseen by parents, there is no motive for causing children to practise ablution or friction of the parts—which, indeed, by drawing their attention, might be dangerous. These cares are not practised then at the period of puberty; yet it is then especially 0 00 CAUSES OF SPERMATORRHEA. that they are requisite in cases where the sebaceous secretion is disordered, on account of the orgasm which at that age seizes the whole of the genital apparatus. I am thoroughly convinced that this particular circumstance is the direct cause of numbers of cases of involuntary discharges, as well as very frequently of the sponta- neous abuses of which young lads are the subjects. There are other cases in which the secretion is increased or altered by a morbid condition, which is ordinarily intermittent, arising almost always from a special disposition of the economy, particularly from cutaneous diseases, often enough hereditary ones. The constitution of such patients is ordinarily weak and delicate; their childhood, sickly. The first symptoms of these cutaneous affections which generally sooner or later attack the mucous membranes, are mostly experienced in the head or face. The children are subject to ring- worms, acne, tetters, abscesses in the neck, alternately with attacks of ophthalmia, otorrhoea, coryza, angina, &c. At the approach of puberty, these weakly constitutions generally improve, and seem about to become hardy; but the revolution effected by that import- ant crisis has not always the durable and salutary effect on the constitution that could be desired. The genital organs become the centre, and attract the congestion which formerly acted chiefly to- wards the head; and hence cutaneous eruptions occur in the neigh- bourhood of the anus, in the perineum, on the interior of the thighs, or the scrotum, at the base of the penis, and more than all, on the prepuce—bringing the most unfortunate consequences. Whatever may be the species of these eruptions, however unimportant they may appear, it is of the utmost consequence to pay attention to them when they attack the prepuce or glans.1 From them arise frequent balanitis, more or less abundant, and acrid sebaceous dis- charge, excoriations, herpes, erysipelatous redness of the prepuce and glans, frequent attacks of urethritis, often as severe as virulent clap, and almost always more difficult of removal, frequently also giving rise to serious errors of treatment. This irritation, too, sometimes suddenly attacks parts at a considerable distance from the orifice of the excretory canal; hence the sudden appearance of pain in the perineum, or neck of the bladder; hence the painful swelling of the vasa deferentia and testicles; hence also the no less sudden disap- pearance of these symptoms, on the unexpected appearance of inflammatory disorder on some other part of the body. It is easy to conceive that these irritations may provoke abuses or temporary excesses, as well as more or less serious occasional semi- nal discharges; but as these are not merely nocturnal pollutions, ana as diurnal ones are more common, more serious, and very dif- ficult of discovery by the patients—their existence is seldom sus- pected; so that they do not know how to account for the periodical 1 See Chapter V. CONGENITAL PRE-DISPOSITION. 223 derangement experienced in their health precisely at the times when they are not troubled with apparent disorder. Their friends under- stand still less the frequent and sudden changes of character they experience—the alternations of gayety and hypochondriacism, of ac- tivity and torpor. Such patients are, therefore, very often regarded as maniacs; their peevish restlessness, and strange paroxysms, are attributed to wrong-headedness, to attempts at originality or to some other equally erroneous explanation. After a time diurnal pollutions occur almost constantly; and now there are only slight remissions in the symptoms: the health remains imperfect, and the paroxysms occur more and more fre- quently: at last matters grow still worse, and the patient's disorder becomes constant. Both the patients and their medical attendants are led astray du- ring the most severe periods of the disease, by the diminution or en- tire cessation of the nocturnal pollutions; diurnal discharges, whose effects are much more serious, take their place; and this is why, on the entire cessation of nocturnal pollutions, the disorder becomes permanent, and complete impotence is often established. Lessening of the nocturnal pollutions is not likely to lead the patients to sus- pect the true cause of their disorder; they imagine themselves the victims of a syphilitic affection, founding their opinions on the dis- charge and excoriations that occur in the neighbourhood of the glans and prepuce, or on the attacks of urethritis to which they are sub- ject. I have met with many patients who had spent a considerable portion of their lives under courses of mercurial treatment, which had been repeated over and over again, because intercourse scarcely ever took place without producing excoriations: these they fancied were chancres, however little cause there might have been to sus- pect syphilitic contagion. In such patients, too, the mucous mem- brane of the urethra becomes altered in structure, so that they are more and more exposed to urethral discharges from very slight causes; and the repetition of such discharges confirms their belief in a syphilitic taint. In these cases cauterization is the most powerful means we can employ. Still it is necessary, after considerably modifying the con- dition of the urethral mucous membrane, not to neglect acting on the skin and on the whole economy by means of the sulphuretted baths. It is wiser also to perform circumcision, than to trust to the patient's cleanliness, in order to guard against the inconveni- ences arising from superabundant secretion of the mucous follicles of the prepuce and glans, and to remove the parts beyond the pos- sibility of further irritation. I have spoken several times of the influence exercised by excre- tory canals on the glands that supply them: on comparing the glans penis with other openings to excretory ducts, we see that it alone possesses an extensively developed erectile and nervous tissue. It is true the nipple presents something similar, and its influence over 224 CAUSES OF SPERMATORRHEA. the lacteal secretion is well known; but there is a vast difference between the vessels and nerves of the nipple and those of the glans penis. In the glans every thing seems arranged to increase the ex- quisite sensibility of the surface. Is it to be Avondered at, then, that the functions of the seminal vesicles and testicles are much in- fluenced by every action on so impressionable a surface? and that the accumulation of sebaceous matter provokes importunate erec- tions before puberty, and abuses or precocious excesses, in persons who would seem to be out of danger of them, on account of the small development of their genital organs? The divisions under which I have treated this subject are intended to show that the irritating action of the sebaceous matter may arise either from its too long retention, from a local affection, or from a general disposition. In the first case excision of the prepuce is in- dispensable, and when there is simply a natural phimosis, this is ge- nerally sufficient. But when the prepuce is excessively long, after its removal, and even after cauterization of the prostatic surface, we have still to combat the natural debility of the organs—a debi- lity sufficiently evident by the exuberance of the skin in front of the rudimentary erectile tissues. In cases of superabundant secretion of sebaceous matter, of herpes preputials, or other skin affections, having a tendency to fix themselves on the prepuce, it is more pru- dent to circumcise the patient than to trust to the most careful cleanliness; there is no comparison between this trifling operation and the importance of the involuntary discharges which may return with a return of the preputial irritation, even if once relieved by the use of sulphuretted waters or other means. Indeed, after having long and seriously reflected on the numerous cases that have come under my notice, I have arrived at the opinion, that the disconti- nuance of the practice of circumcising children is to be regretted; the operation is, without doubt, unnecessary in many cases, but it can never be injurious, and in a great proportion it would be ex- ceedingly useful. Congenital Debility. CASE LVI. Relaxed genital organs—Spermatic cords varicose—Feio but debilitating nocturnal pollutions—Opposite effects of coitus—Unsuspected diurnal pollutions—Constant headache—Disordered senses—Intellectual debility —Hallucination—Tonic treatment at the age of twenty-one, followed by recovery. In the month of June, 1835, General Mina placed under my care the son of one of his friends, who had been treated unsuccessfully for a chronic cerebral affection by distinguished practitioners, both in England and Ger- many. M. P. G----, twenty-one years of age, was well made, of moderate height, and robust appearance; his face and embonpoint bespoke health, CONGENITAL PRE-D ISPO SITION. 225 although he had complained of headache for several years, and often showed serious derangement of his ideas, which were generally wandering and ob- tuse. His feeble and husky voice, and timid and embarrassed manners, led me to suspect masturbation; I was completely mistaken, however. Whilst examining an inguinal hernia, which had come on without apparent cause, I noticed evident! marks of semen on the patient's shirt; and he told me that while travelling the night before, he awoke deluged with this glairy matter; that he often experienced similar evacuations without dreams, erections or any other sensation sufficient to awake him. Further examination convinced me that the patient passed semen also at stool, and that his urine constantly contained a considerable quantity. I was, therefore, convinced that the supposed chronic cerebral affection was nothing more than mistaken sper- matorrhoea—which the result soon confirmed. The cause of these discharges was sufficiently obscure. The patient's parents were strong and healthy, and he had ten brothers and sisters all in good health; there was no hereditary disease in his family, and his infancy had been passed without ailment. At the age of sixteen nocturnal pollutions had occasionally appeared, without dreams, and without sensation; the pa- tient was completely ignorant of every thing appertaining to sexual inter- course, as well as masturbation. He was passionately fond of study. At the age of seventeen he had frequent headache, and disordered vision; ob- tusCness in his ideas; loss of memory; intellectual employment fatiguing and unrepaying; he had several times, too, long fits of unconsciousness without apparent cause. At the age of eighteen M. P. G----was placed in a com- mercial school at Paris; two months afterwards he left his studies one eve- ning on account of a violent headache; a vague but imperious feeling, to which he yielded, impelled him towards the other sex. The following day he was much better; he felt more vigorous both physically and morally. But notwithstanding this beneficial effect, the patient yielded only once more, although he felt much relieved on that occasion also. Soon afterwards M. P. G----was placed in a commercial house in Lon- don, where he worked assiduously for two months, at the end of which time he suffered from headaches, giddiness, disordered vision, noise in his ears, &c; residence in the country produced a slight improvement, which was, however, lost on the patient's returning to the same occupation; so that after a short time he was unable either to write or to keep his accounts. He experienced such frequent giddiness, and so great weakness in his legs that he dared not go out alone. At length his intellect became deranged to such an extent that he doubted every thing he heard or saw, all that he did, and even his own existence. By degrees his digestion also became deranged, and his medical attendants sent him to travel in Belgium and Germany. During this long journey he became more and more dis- ordered; every thing seemed illusory and fantastic; he fancied himself in a painful dream. He imagined too that every one was ridiculing him, and conspiring against him ; and he especially suspected three Englishmen who followed the same route, and who he thought were plotting together against him. One of these was especially hateful on account of his ironical man- ner; and the patient was a hundred times tempted to precipitate this gen- tleman into the Rhine as he passed him on board the steamboat: these hallucinations remained on the patient's memory after his recovery, like a kind of nightmare. At the close of this journey he was brought to consult me. 15 2:20 causes of spermatorrhea. When I saw him his nocturnal pollutions recurred only at intervals of ei^ht or ten days, which did not, however, prevent their debilitating effects; these were the more remarkable when contrasted with those of coitus, al- ready mentioned. The patient too experienced the same state of weakness when he had erotic dreams or venereal desires, even although no apparent discharge took place. These phenomena were easily explicable by the presence of diurnal pol- lutions; but there was nothing to account for the early development and constantly increasing recurrence of these abundant discharges. The exa- mination of the inguinal hernia gave some information. I have already stated that it came on without appreciable cause; announcing great relaxa- tion in the inguinal rings; the opposite side too showed a marked disposition to the occurrence of hernia; the veins of both spermatic cords were varicose; the penis of moderate size, was very long and soft, and the scrotum was so relaxed that the patient was obliged to wear a suspensory bandage. I passed a very large catheter, too, into the bladder, without experiencing the least resistance, and without the patient's giving the least sign of pain. The union of all these circumstances led me to conclude that the sperma- torrhoea was exclusively due to atony of the ejaculatory ducts; and con- sequently, I daily left a catheter in the urethra for two hours at a time; at the same time the patient took iced milk three times a day; and iced wine mixed with Spa water at his meals; and used cold lotions frequently, with a hard bed, and horse exercise. These means brought about a prompt and decisive change; within a fortnight the patient's headache had left him to- gether with the aberrations of intellect which had accompanied it; his per- ceptions became clear, his ideas precise, his motions prompt and decided; the use of mineral waters, especially of alternate hot and cold douches on the loins and perineum, consolidated his cure. I saw M. P. G---- the following year, and also in August, 1838; his diurnal pollutions have not re-appeared; nocturnal pollutions happen after prolonged continence; they are energetic, and do not injure the health. All his functions are perfectly well performed. This case is another example of the powerful effects produced on the brain by involuntary seminal discharges. In the present case the pollutions' evidently arose from congenital atony of the genera- tive organs. It is likely enough that 1 should not have discovered these debilitating discharges, had I not done so accidentally while examining the patient's inguinal hernia. Nothing in the patient's conduct could have led me to suspect the presence of pollutions, and his constitution, as well as the history of his family, did not point out any local weakness. On the contrary, circumstances were pre- sent which would lead away from the true cause of his disorder; his nocturnal pollutions were very rare, and coitus was on both occa- sions followed by remarkable improvement in the health. This may be easily explained by bearing in mind what I have already said respecting the different effects of different kinds of spermatic dis- charges ;—the excitement produced by the normal act diminishing the relaxation of the tissues and the abundance of the involuntary discharges. CONGENITAL PRE-DISPO SITION. 227 How was it that this patient did not show more inclination towards the other sex, especially after having noticed the beneficial effects of his first intercourse? He attributed this indifference to the pro- found melancholy which possessed him from the period of puberty; but this sadness disappeared, and his ideas completely changed after his cure. The indifference, then, arose from the diurnal pollutions of which he was the victim. This patient's hallucinations were of the same nature as those of Esquirol's patient, (Case thirty-two,) only that the conviction of a general conspiracy against him was more confirmed. If in one of his moments of rage he had thrown his supposed enemy into the Rhine, would this hallucination have been admitted? If so, would its cause have been even suspected? Varicocele.—I have met with many cases of involuntary seminal discharges occurring in patients who were affected with varicocele. I have at present before me three consultations and numerous notes of such cases; but they are for the most part incomplete, because I am ignorant of the results of the means employed. I will, however, briefly relate all that can be gained from them relative to sperma- torrhoea. One of these patients was addicted to masturbation about the age of ten; he practised it, however, much less frequently than the ma- jority of his companions; and corrected himself at the age of fifteen. Another committed some slight venereal excesses, but very irregu- larly and for a very short time on each occasion. A third suffered from simple blennorrhagia, after which swelled testicle came on the day after a ball. A distinguished barrister first experienced noctur- nal pollutions during the period of his examination; afterwards he had numerous relapses, following the excitement of important causes, and was obliged to give up his profession, notwithstanding his talent, be- cause the pollutions, becoming diurnal, weakened his memory. It is probable that in these cases no bad effects would have been pro- duced if the patients had not been pre-disposed to them. Other patients affected with varicocele and pollutions pursued courses of life which might be considered exemplary, if compared with the lives led by hosts of individuals who never suffer any bad effects from such proceedings. I have besides questioned those patients who have consulted me for varicocele alone, and I have found that the greater number complained of want of power in the organs. Hel- pech made the same remark; and he attributed this want of power to the torpidity of the venous circulation which retarded the sperma- tic secretion; he thought too, that by taking away the varicose veins he would be able to restore the functions to their normal condition; the unfortunate death of the author of this proposition is sufficient to show its fallacy.1 As far, however, as regards the debility of the 1 The unfortunate Delpech was assassinated in the middle of the day by a patient from Bordeaux, on whom he had previously operated for varicocele. The murderer immediately afterwards blew his own brains out. 228 CAUSES OF SPERMATORRHEA. spermatic organs in such persons, I agree with him perfectly; in- deed, it is a point which I have observed too often to admit of my doubting it. I have also remarked that in many of these cases the testicles are soft and small, and when the spermatic veins of one side only were varicose, I have invariably remarked that the testi- cle of that side did not correspond in development to that of the other. Pott has related several cases of the same kind. If masturbation, venereal excesses, orchitis, &c, favour the deve- lopment of varicose veins in the spermatic cords, this can only take place in persons who are pre-disposed to that disease by congenital weakness of the parts; for many persons are exposed to the opera- tion of all these causes without having varicocele, which disease often comes on without appreciable cause. The same thing happens here as in varicose veins of the lower extremities; fatigue of the parts, as well as every thing which hinders the free return of blood, un- doubtedly contributes to render the veins varicose; and yet are there not many who pass hours together standing, and who wear tight garters, but nevertheless do not suffer from varices ? whilst there are numbers on the other hand who are victims of this in- firmity without being particularly exposed to the action of such causes. It must, therefore, be admitted in the latter class of cases, that there is some primary weakness or congenital disposition in the affected veins to become varicose. Since, then, we see want of energy in the genital organs so fre- quently accompanying varicocele, it is evident that the venous sys- tem is not alone in a state of atony or relaxation; and it is, there- fore, of consequence to pay attention to the condition of the veins in order to judge of the power of the genital organs as well as of the pre-disposing causes of involuntary emissions. Such signs point out the remedies to be used in these cases. CASE LVII. Hypospadias—Impotence—Frequent seminal discharges. Morgagni relates with his customary precision, an interesting case of im- potence, which he attributes to the malformation of the glans, but which was evidently due to involuntary discharges; the following are the princi- pal circumstances. The patient was scarcely thirty; he was by no means strong, and was affected with an old ophthalmic disorder. He admitted that although he had been married two years, he had never had sexual intercourse; this he attributed to the glans penis being curved downwards, and perforated near its base, instead of at its point. The inferior wall of the urethra was in fact wanting in the neighbourhood of the glans, and a little behind it; the prepuce was divided in the same manner and resembled that of the clitoris. The penis was of its natural development, the testicles were large, but the scrotum appeared relaxed. At the period of puberty, the erections had been complete, .the glans being fully injected as well as the rest of the penis; an uncomfortable sensation even arose in the part where the urethra was CONGENITAL PRE-DISPOSITION. 229 wanting; but this sensation diminished by degrees in proportion as the glans entered less into erection. At the time of the patient's marriage the tume- faction of the glans took place very rarely; at last it ceased entirely; " the glans remaining flaccid and insensible from the time when, in useless efforts at in tercourse, the patient discharged large quantities of semen, which escaped very promptly." Morgagni is inclined to think that the absence of the urethra underneath the glans was the cause of its not becoming erect in this case; the rest of the penis was capable of erection, but the glans being a portion of the corpus spongiosum, and receiving its blood from the bulb, was incapable of becoming so. This explanation, although plausible and founded on the distribution of the arteries of the penis, rests on an incorrect hypothesis; for in cases of this nature the parietes of the urethra are not wanting, there is only de- fective union in the median line, which by no means interferes with the presence of the corpus spongiosum, nor with its receiving its proper arteries. Besides, the malformation in Morgagni's case was equally present at the age of puberty, yet the patient experienced erections at that time into which the glans entered, so much so, in- deed, as to cause a painful sense of dragging in the situation of the urethra. The patient's impotence was, therefore, due to some other cause, and this cause was evidently the same that acted in case fifty- five. The impotence, therefore, arose from habitual and unperceived seminal discharges, favoured by the congenital debility of the organs. Morgagni's last sentence is sufficient to prove this. When did the glans entirely cease to become erect? "From the time when in useless efforts at sexual intercourse, the patient discharged large quantities of semen, which escaped very promptly." These repeated and abundant seminal discharges then rendered the erections less and less energetic, and at last thoroughly imperfect. The rapidity with which ejaculation took place is observed in all cases of this nature; and this hasty emission, whether it arise from irritation or debility, or both, which opposes intromission as much a3 the insufficiency of the erections, is always accompanied by diurnal pollutions: to these, therefore, the impotence is due, (although very often they are unsuspected,) and they are invariably exasperated by unavailing efforts at coitus, which increase the irritation and debility of the parts. On the other hand, too, such appreciable discharges joined to those which are unsuspected, sufficiently explain why the erections become daily less energetic, and the formation of the semen less perfect. The remarkable coincidence of hypospadias with debility of the genital apparatus has induced me to quote the above case. Hypos- padias is a rare malformation, and has never been studied in reference to its connexion with weakness of the organs. It is well known that Louis XVI. had hypospadias, and the Memoirs of Madame de Cam- pan leave no doubt that his marriage was not consummated for several years. I have met with one case of hypospadias in the 230 CAUSES OF SPERMATORRHEA. hospital St. Eloi; it was accompanied with nocturnal and diurnal pollutions, but I only had an opportunity of observing the patient for two or three days, and I cannot say decidedly that these pollu- tions arose solely from a natural weakness of the organs. CASE LVIII. Atrophy of one testicle at the age of eight—Nocturnal and afterwards di- urnal pollutions—Frequent desire of micturition, &c. I have at present a student, a3t. twenty-seven, under my care, who, from the period of puberty, has been troubled, with nocturnal at first, and after- wards with diurnal pollutions. All his functions are deranged, and he is now incapable of any intellectual employment. He has never had sexual inter- course, and he has not been addicted to masturbation. Wben about eight or nine years of age he suffered from inflammation of the left testicle without evident cause. After having continued very large for some time the organ atrophied by degrees, so that it is reduced to the size of a horse bean, the spermatic cord being also very thin. The urethra is extremely sensitive, especially in the neighbourhood of the prostate, and the patient makes water very frequently—this symptom dating from his childhood. There existed without doubt in this unfortunate individual a con- genital disposition to phlogosis of the genito-urinary organs; this showed itself at the age of eight, by spontaneous inflammation of the left testicle; from that time irritation continued in the neighbourhood of the bladder, and extended its influence to the right testicle. This accounts for the occurrence of nocturnal pollutions at the age of puberty. Spontaneous inflammation of the testicles in childhood is then a sign of a morbid condition of the genital organs, and the de- struction of one of the testicles does not remove the patient from the danger of involuntary seminal discharges, which may even be sufficiently abundant to injure the health. Natural Belaxation of the Ejaculatory Ducts.—There are a certain number of cases of involuntary seminal discharges, which it is impossible to attribute to any satisfactory cause; which are not accompanied by any sign of irritation; and to explain which we are obliged to admit a natural disposition, debility or congenital re- laxation of the spermatic organs, and especially of the ejaculatory ducts. This condition sometimes coincides with more or less charac- teristic external signs, but in other cases it is only shown by its effects. The following remarkable case will explain what I have to say on this obscure but important subject. CONGENITAL PRE-DIS P OSITIO N. 231 CASE LIX. Lymphatic temperament—Incontinence of urine—Neither masturbation nor 'sexual intercourse—More and more frequent nocturnal pollutions—Re- laxation of the sphincters of the anus and neck of the bladder— Treat- ment unsuccessful. M. M----of very marked lymphatic temperament, was subject to in- continence of urine up to the age of twelve or thirteen. His religious enthusiasm induced him to embrace the ecclesiastical profession. He had never practised masturbation nor had sexual intercourse. Puberty did not take place until the age of eighteen, but was accompanied with nocturnal pollutions—rare at first—then more frequent; and at length occurring daily and quite passively. All his functions were successively deranged, and at the age of twenty-three, five years from the commencement of the disorder, M. M----consulted me in the following condition. Skin white, cold, and clammy; limbs rounded; hair white; no beard; pelvis very large; hips projecting; flesh soft; genital organs pretty well de- veloped, but very flaccid; scrotum much relaxed; hair very scanty; blindness nearly total; enormous dilatation of the pupils; considerable decrease of in- tellect and memory; extreme weakness of the limbs; progression almost impossible without the support of a stick; digestion difficult; involuntary discharge of faeces several times a day; micturition frequent during the day; iucontinence of urine at night; nocturnal pollutions repeated se- veral times at ni^ht without erection or sensation; semen very fluid; urine often muddy. I passed an immense catheter into the bladder without ex- periencing the least resistance, or giving the patient the slightest pain; the anus was almost wide open, permitting the introduction of three fingers into the rectum, without the least difficulty, %and without exciting any action of the sphincters. I prescribed aromatic baths, stimulating frictions and applications; ice internally and externally, Spa water, quinine, &c; and I performed two cauterizations of the urethra, all without the least success; after four months' treatment I lost sight of this unfortunate patient, leaving him in just the same state as when he first consulted me. All circumstances combined in this case to convince me that the patient spoke truth when he asserted that he was ignorant of mastur- bation and had never had sexual intercourse. The incontinence of urine and feces; the form of the pelvis; the flaccidity of the genital organs; the general state of the economy; all seemed to show that the ejaculatory ducts shared the relaxation of the sphincters of the anus and bladder, and that this original atony was the sole cause of the nocturnal and diurnal pollutions. This case is the most remark- able one of the kind that I have ever met with, on account of the combination of circumstances that accompanied the relaxation of the ejaculatory ducts, and from the absence of every complication that could have excited involuntary seminal discharges; it enables us to understand cases in which there are similar but less marked predis- 232 CAUSES OF SPERMATORRHEA. positions, and which are accompanied by less evident or even nearly inappreciable signs. CASE LX. Sickly childhood—Extraordinary nocturnal pollutions at sixteen—Some time after, pollutions during defecation—Ejaculation impossible—Slow discharge of semen after the subsidence of erection—Urethral canal very slightly sensitive—Prostatic surface hard and cartilaginous. In the year 1825, I was consulted by a medical student, set. twenty-one, of small stature and spare habit, in consequence of deafness, which had made considerable progress during two years. After injecting the Eusta- chian tube a few times, applying a seton, &c, the beneficial effects of which were very trifling, the patient spoke to me about nocturnal and diurnal pollutions which were accompanied by extraordinary circumstances. The following are the chief facts of the case. The patient's health was weak until the age of sixteen, when puberty occurred, and he suffered from frequent erections and nocturnal pollutions. These discharges continued from that time; they were often excited by lascivious dreams, but were not always preceded by erections; when erec- tion occurred, it was not during its continuance that the discharge of semen took place, but only after the swelling of the penis had passed off, the matter discharged dribbling over the neighbouring parts instead of being forcibly thrown off as in true ejaculation. This matter resembled white of egg, and stained the linen in the same manner; it was often so abun- dant that the patient was compelled to change his shirt. The evacuations were followed by debility, languor, and headache. Whatever quantity of semen was passed he never experienced the slightest voluptuous sensation, so that at first he thought himself affected with incontinence of urine, and when these abundant discharges took place, not being able to prevent them, he rose suddenly to micturate. Often while at stool a similar discharge took place in greater or less quantity, according to the degree of constipa- tion. Sexual intercourse had been very rare, and always accompanied with similar circumstances; the erections were energetic and long continued; indeed, they lasted an indefinite time, for fatigue alone put an end to the act: seminal discharge never under any circumstances took place until the cessation of the erection. The same thing occurred during a few attempts at masturbation, which the patient practised from curiosity, for he never experienced sufficient pleasure either in these manoeuvres or in coitus, to practise them from inclination; he had an ardent desire to get rid of his nocturnal pollutions, which he believed arose from defective contractility in the seminal vesicles. This patient was very thin and remarkably pale; his digestion was much disordered; his memory treacherous; his intellect weakened; and the least application to study excited obstinate and almost constant headache. He experienced noise in his ears; and this deafness was very probably due to the same cause, although he imagined himself the subject of some local affection. I did not observe any thing particular in the patient's form nor in the size and consistence of the external organs of generation, but on passing a CONGENITAL P RE-DI S POSITION. 233 large catheter into the canal, I remarked that it possessed very little sensi- bility; and especially in the prostatic region, where the instrument was arrested. On taking a smaller one I succeeded in reaching the bladder; and in passing the prostate, the instrument seemed to rub on a hard carti- laginous surface, which, however, was quite smooth and regular. The patient remained quite passive during this examination, which lasted a long time. The prostate examined through the rectum did not seem large or less regular than natural. Its firmness presented nothing remarkable. These examinations, repeated at the intervals of several days, always gave similar results. I performed cauterization of the prostatic portion of the urethra in the hope of modifying its abnormal condition, but no benefit was obtained. Dilatation by means of gum elastic catheters was not of great service. This is the only case of the kind of which I am aware; it presents characters quite different from those which generally accompany nocturnal and diurnal pollutions; but it does not the less belong to the class of such cases caused by original disposition in the spermatic organs. The patient's statements bore the semblance of truth. He suffered from pollutions many years before attempting either coitus or masturbation; indeed, it was only in the hope of relieving his dis- order that he committed these acts; for he was not enticed to them by any feeling of pleasure. His remarkable seminal discharges seem to have arisen from the induration and loss of sensibility of the sur- face of the prostate and neighbouring parts, and this condition seems to have been congenital. Symptoms of Debility of the Genital Organs.—Before proceeding further, it maybe as well to consider for a moment the characteristics we have already noticed, as showing debility of the genital organs. We have seen that excessive development of the prepuce arises from smallness of the penis, and that in the same individual the scrotum is often much folded and retracted towards the pubes, be- cause the testicles are very small. Such an elementary condition of the erectile tissues and secreting organs necessarily augurs little energy in these fundamental parts of the genital apparatus, and must prove an unfavourable prognostic as regards the condition of the ejaculatory ducts, seminal vesicles, and other parts removed from external examination. But these characters are not always equally marked, and do not always stand alone. Hypospadias arises from defective union of the opposite parietes of the urethra; and whatever may have been the cause of this arrested development, it indicates debility of the parts, because their forma- tion has not been completed. The parts have wanted energy or vital force from the beginning. Is it likely that this condition will be altered later in life? All I have seen of these cases, leads me to a negative conclusion. Cases of epispadias, too, consisting of defec- tive union of the corpora cavernosa, and, still more serious, eversion of the bladder arising from a similar cause, support this opinion; 234 CAUSES OF SPERMATORRHEA. such individuals are even more feeble in respect of their genital functions, than those afflicted with hypospadias. The following circumstance, too, may be referred to the same cause, although it is less evident. All surgeons who are frequently in the habit of passing instruments into the urethra, are aware that great differences exist with respect to the size of the meatus. In some cases it is exceedingly small, and placed at the summit of the glans; in others, again, it is large, gaping and extends from the apex to the corona glandis, or even lower. It is evident, that this increased size of the meatus arises from the same cause as hypospadias, that is to say, from defective union of the two walls of the urethra. In some cases, it seems a commencing hypospadias, the opening descend- ing lower than the glans. Now, I have met with few cases of in- voluntary seminal discharges where the urinary meatus was very contracted, and in all cases of this kind that I have seen, the disorder had been produced by repeated attacks of blennorrhagia, serious and long continued abuses, or great sexual excesses, thus showing con- siderable activity of the genital functions; whilst, on the other hand, I have met with numerous involuntary discharges in those whose meatus was larger, and such discharges have been produced by com- paratively slight causes, and were much more difficult of relief. My practice of examining all such patients with a large catheter, in order to ascertain the degree of sensibility of the urethral mucous membrane, led me to make this observation long since, and I have since found it remarkably constant. Generally, in cases of large orifice, the remainder of the urethra as well as the neck of the blad- der is also very large, which might leave one to suppose that the ejaculatory ducts may partake of the same condition. However this may be, I believe I may mention extended orifice of the urethra, as a sign of congenital debility of the organs, and consequently of pre- disposition to involuntary discharges. The firmness of the erectile tissues, also, differs much in different individuals, independently of their size and form. Whenever I have observed the penis resting on the scrotum, the corpora cavernosa empty, soft, flaccid, and without resistance or elasticity on pressure, I have remarked that the organs possessed little energy, and that the powers of resistance to causes capable of inducing involuntary dis- charges was very slight, whilst these were always difficult of cure. In cases, too, where the glans presents a remarkable development in proportion to the penis, the latter being long in the corpora caver- nosa, whilst the former is swollen, overshadows the corpora caver- nosa, and is always uncovered, or at all events, badly covered by the prepuce; the parts want energy. The erections are often in- complete in such cases, especially towards the base of the penis. As regards the testicles, their smallness is not the only circum- stance worthy of consideration. Many of my patients have been afflicted with inguinal hernia, frequently congenital. CONGENITAL PRE-DISPOSITIO N. 235 Congenital hernia must be attributed to one of the following causes: either the inguinal canal has wanted contractile power, the process of peritoneum accompanying the testicle has been distended with serum, or the testicle has descended late into the scrotum. Under all these circumstances there is evidently radical debility of the parts. It may, indeed, diminish considerably as age advances, but we can never expect to find the parts remarkable for their energy. Since I have directed my attention to this subject, I have constantly noticed, that patients afflicted with congenital hernia presented much smaller testicles than those of healthy persons of corresponding age. The following fact, too, is very decisive. When hernia is present on one side only, the corresponding testicle is always smaller than the op- posite one, and frequently this difference extends to half the size of the organs. For a long time I fancied this small size of the testicle arose from compression of the parts by the hernial sac, but I have met with the same circumstance in persons who early wore a truss. I then thought that compression of the cord by the pad of the truss, might give rise to this defect, but I have not noticed corresponding conditions in those who have worn a truss for accidental hernia. The descent of the testicle into the scrotum often does not take place until long after birth, and in one of the cases I have related, it was not complete until the age of twenty-eight, (case fifty-four.) In all the cases of this kind that I have had opportunities of observing, the organ has been far from possessing its normal size and form; and still further, in cases where I have had an opportunity of examining, after death, the bodies of those whose testicles had not descended, I have invariably found the body of the gland small, soft, and elongated, and the epididymis deformed and unfolded. I have frequently, too, ascertained the exactitude of the opinions of Cloquet on the causes that oppose the descent of the testicle; this distinguished observer has pointed out that the testicles are always detained either by some malformation or adhesion, and such alterations must necessarily in- fluence the functions of the organ. To resume, then: congenital hernia, slow descent of the testicles into the scrotum, or their final retention in the abdomen, must be attributed to debility of the parts, to adhesions or to alterations in their structure, which must more or less injure their functions. The form of the testicle is also of considerable importance. The body ought to be ovoid, regular, and smooth; the least inequality observed on its surface denotes some internal organic alteration. The size of the epididymis should be proportioned to that _ of the gland itself; any swelling of this part shows that inflammation has taken place, and has not been entirely removed. Such inflammation may have left marks of its presence in other parts through which the semen passes, and consequently, in the seminal vesicles, and even after it has been completely removed, is very likely to return in the altered tissues. It often happens that neither children nor their parents are able to assign any cause for the occurrence of these 236 CAUSES OF SPERMATORRHEA. inflammations, either because they take place during early childhood, or because they come on without any appreciable injury. I have met with more than one patient who fancied that he had three testicles, and this delusion has generally arisen from the increased develop- ment of the epididymis forming a kind of supplementary swelling attached to the testicle. Whenever I have found this swelling con- siderable, the true testicle has been smaller than natural, and in a few cases it was completely atrophied. The investigations I have made in such cases have convinced me that the organ did not act, or acted badly. The patients are not, however, removed from the dangers of involuntary discharges by this circumstance, because the two organs are not equally affected. I have related a case, in which one of the organs was completely atrophied from infancy, notwith- standing which, obstinate nocturnal pollutions occurred at puberty: these were only attributable to active irritation of the other organ. Every alteration then in the form of the testicles, must be attri- buted to some old standing affection, and announces some internal lesion, which necessarily injures the functions of the part, and warns us of the possible occurrence, at some time or other, of other affec- tions of the same organs. However slight it may be, this alteration in the form of the testicles merits serious consideration in attempt- ing to appreciate the amount of the virile powers, and the disposi- tion to other diseases of the spermatic organs. I may make just the same remark concerning the vasa deferentia. When they are so thin that difficulty occurs in distinguishing them from the other structures of the spermatic cord, it is a sign of de- bility ; but this sign is never met with alone; the testicles are always small, sometimes even rudimentary; all the secreting apparatus seems to remain in the same condition as before puberty. When, on the other hand, the vasa deferentia are swollen, knotty, or enlarged towards the epididymis, it is evident that they have been previously the seat of some inflammation. Softness and flaccidity of the testicles also show little energy in the gland, whatever may be its size. I have met with this symptom in many patients remarkable for their continence, and the severity of whose voluntary discharges bore no relation to the slight acci- dental causes that excited them. On the other hand, this flaccidity of the testicle is usually accompanied by a similar condition of the corpora cavernosa, which justifies one in presuming that the portions of the genital apparatus which are removed from external examina- tion, partake of a like disposition. I have already stated, that varicocele must be regarded as a sign of debility of the genital organs. This debility of the venous system of the testicle justifies us in supposing a want of energy in the re- mainder of the secretory apparatus; besides which the stoppage of the circulation through the veins of the cord must injure the capil- lary circulation in the testicles, and consequently, retard the secretion of semen. I have noticed this in cases of simple engorgement of CONGENITAL PRE-DIS POSITIO N. 237 the veins of the cord, especially when coincident with considerable elongation of the organ. Encysted hydrocele developed in the midst of these vessels pre- sents the same indication for the same reasons. Again, all the parts of which I have spoken may possess their ordi- nary volume and natural form, but yet may present a decided flac- cidity announcing serious debility. This relaxation especially, is easily noticed in the scrotum. Not only does this organ extend to a great length, but is soft, smooth, and without hair or folds; its surface is moist; no motion occurs in it from the contraction of the dartos or cremaster muscle, and its cellular tissue is often infiltrated with serum. The most remarkable case of this kind that I have met with, is that related at page 231, case 59, in which no sexual desire was ever manifested, but the subject of which, at the age of puberty, became subject to pollutions which nothing relieved. Lastly, all my patients whose virile powers were originally weak, had very sharp intonation of voice, sometimes quite falsetto. Their hairy system, too, was little developed. One patient, at the age of seventeen, had not a single hair on his chin or his genital organs. These characters resemble those found in eunuchs, with this differ- ence, that the health of eunuchs does not become disordered. Symptoms affecting the Urinary Organs during Childhood.—The spermatic apparatus does not attain its full development until the age of puberty, but the urinary organs perform their functions from the period of birth. The connexion that exists between the two systems is so intimate, that the observations drawn from the one first in action foreshadow the affections to which the other may become liable. Incontinence of Urine.—It must have been noticed, that in several of the cases in which involuntary discharges were manifested spon- taneously or from very slight causes, the patient had been subject to incontinence of urine from infancy. I have met with numerous cases in which this wras the case, and they were all remarkable for the facility with which involuntary discharges occurred. I shall, therefore, briefly review such circumstances in these cases, as may throw any light on the connexion existing between congenital affec- tions of the urinary passages and involuntary seminal discharges. In proportion as the child's intellect becomes awakened, he un- derstands the care lavished on keeping him clean, and accustoms himself to assist, until at length he arrives at an age when he has acquired sufficient empire over his habits to avoid soiling his bed or his clothes, at least except in cases of accident. This period varies according to the child's education and mental progress. But when the cerebral functions are thoroughly developed, and the most determined will, and best sustained attention, are not sufficient to prevent the untimely discharge of the urine, there is a more or less disgusting infirmity. Punishment has no effect; it is from the me- dical man that aid must be sought. 238 CAUSES OF SPERMATORRHEA. This condition of the urinary organs may present infinite shades of variety; the wrorst is that in which the child is unable to hold his urine, even when awake, so that it escapes in an almost continu- ous manner without his knowledge. This degree of incontinence is seldom observed, except in idiots, whom we must leave out of the question, because of their want of intelligence, leaving them in precisely the same condition as the infant in its cradle. Next come those cases in which the neck of the bladder does not contract strongly enough to prevent, for any length of time, the passage of urine, even during walking; so that when the desire cannot be im- mediately satisfied, the want of power in the neck of the bladder al- lows a portion of the urine to escape, notwithstanding all the efforts of the will. It is evident, that in such patients the urine will escape much more readily during the night. When it is only during sleep that the escape of urine takes place, the infirmity is grievous enough, but even then it may present many shades of severity. In some cases, the involuntary emission takes place every night; in others it only occurs when the bladder was not carefully emptied before the patient went to sleep, or because a large quantity of fluid had been drunk during the evening. And lastly, in a few cases, the discharge is nearly voluntary, because it follows some dream excited by the distention of the bladder; in these cases it may be considered ra- ther as an accident than as a habit. Great difference also exists in the duration of this infirmity: in the worst cases it continues after puberty—more or less changed, however, according to the influence which this important period of life exercises on the constitution. In all my patients who had pol- lutions after incontinence of urine, I have remarked that the latter infirmity continued at least until the age of seven or eight years; in many it continued until the approach of puberty, and such patients always retained a frequent desire of emptying the bladder, as well as considerable difficulty in resisting that desire, especially when acting energetically. It is evident, from what I have just stated, that incontinence of urine diminishes in proportion as the constitution gains strength, and that it generally ceases entirely at the age of puberty, or is, at least, always considerably modified; and this is enough to show, that the infirmity arises from original debility of the urinary passages. The treatment, too, that is most successful, supports this opinion. All useful remedies are derived from the tonics and astringents. I have invariably found benefit from aromatic baths in such cases, and I have now treated a vast number of them. I consider, there- fore, that incontinence of urine arises from atony or debility of the neck of the bladder. It is not without reason, then, that the approach of puberty is con- sidered likely to effect a cure in such cases: such a result is explained by the urinary passages sharing the excitement set up at this period in the genital organs; and this intimate connexion is sufficient to CONGENITAL PRE-DIS PO SITI ON. 239 point out that incontinence of urine in childhood is a bad symptom, when considered in connexion with the powers of the genital organs, in after life. The cases I have seen leave no doubt on my mind on this subject; and I should add, that aromatic baths have been very useful in cases complicated in this manner. After aromatic baths I may mention cold bathing, ferruginous preparations, qui- nine, columba, &c, which are also useful in relieving the inconti- nence of urine itself. Sulphuretted baths have also frequently pro- duced good effects. Betention of Urine.—This accident is very rare in childhood. I have, however, notes of two cases of obstinate involuntary discharges in which it occurred. In the first case, frequent retention took place about the age of two years, and was occasionally so serious that the aid of the catheter was required for its relief. Up to the age of sixteen, too, the patient was never able to pass urine with- out making ineffectual efforts for a quarter of an hour or more; and even when he consulted me he was obliged to wait five or six mi- nutes before the discharge took place. He was also subject to he- morrhoids from infancy—which is very rare. The susceptibility of the genital organs was so great in this patient, that pollutions were produced by viewing lithographic plates showing the anatomical de- tails of pregnancy. The other patient was a young man, set. twenty-one, who con- sulted me for pain in his chest and stuttering, which had come on after puberty. Retention of urine occurred occasionally during his childhood up to so advanced a period that he was able,to furnish an exact detail. At the age of fifteen, after haying travelled some time with a female—causing him considerable excitement—he passed a large quantity of semen with the last drops of his urine; after- wards the same circumstance frequently occurred without any previ- ous excitement. He noticed also that he paSsed_ semen during efforts at stool. He occasionally practised masturbation, but at very distant intervals, and he never passed on such occasions more than two or three drops of semen. He had opportunities of sexual inter- course six times in four years, and on each occasion found himself completely impotent. This patient deceived himself curiously as to the cause of his want of power: once he imagined that it arose from the disgust inspired by a prostitute; once from the respect he felt towards a mistress; on another occasion he eat too much before going to his rendezvous; at other times he had drunk too much punch, eaten too many strawberries, &c. I mention these subter- fuges, because patients who are in this unfortunate position take vast trouble to deceive themselves. The impotence in this case arose from diurnal pollutions which had evidently long preceded the rare attempts at masturbation which the patient committed. He came to consult me for an affection of the chest, and stated that he should return shortly. Two years after- wards, however, I learned from his elder brother, who consulted me 240 CAUSES OF SP-ERMATORRHEA. for a similar affection, that he became so ill as to be unable to under- take the journey, and that he died at the expiration of three months. His brother strikingly resembled this patient, not only physically but morally; he was also affected with stuttering. There was, there- fore, in these two brothers, a congenital predisposition to involun- tary seminal discharges, shown in the younger by very early reten- tion of urine. The younger one, too, died, while the other recovered easily enough. The following consultation has recently been sent me. The pa- tient's grandfather died of a calculous affection; his father is of very nervous temperament, and subject to retention of urine arising from affection of the prostate; the patient himself, born during the distur- bances in La Vendee, has always been delicate and very irritable. He has never been able to empty his bladder completely, whatever efforts he may make for that purpose, and the first jet of urine is always long in appearing. He practised masturbation very rarely when between fourteen and fifteen years of age. He is, however, subject to debilitating nocturnal pollutions, which have injured his health. Warm baths, abstinence from wine, and a non-stimulating diet, together with refreshing beverages, were the means which pro- duced most benefit. In all cases of early retention of urine, a decided disposition to irri- tation of the prostate is to be suspected, instead of debility and re- laxation of the parts such as are found in persons who have been subject to incontinence when children. To resume, then: incontinence of urine is a symptom the more seri- ous in respect to the genital functions in proportion as it is more complete and prolonged, and the pollutions which follow it so easily are to be attributed, in a great majority of cases, to congenital re- laxation, or debility. Such pollutions are always very obstinate. Retention of urifhe announces just as surely a disposition to phlo- gosis in the prostatic portion of the urethra; and this is more marked in proportion as the retention occurs early in childhood, a period at which the organs are not exposed to the irritations that act on them after puberty. Hereditary Transmission. CASE LXI. Blennorrhagia at the age of twenty-one—Pains in the testicles—Pollutions during four years—Serious gastric and cerebral symptoms occurring in paroxysms—Hereditary predisposition—Iced milk— Cauterization— Acupuncture—Sulphuretted baths—Recovery. In November, 1835, Dr. Guillemot requested my opinion on a patient of his, whom he thought affected with chronic cerebral affection. The fol- lowing are the chief facts. CONGENITAL PRE- DISPO SITIO N. 241 31. M----, of lymphatico-nervous temperament, and excellent disposition, whose father had been weak and unhealthy, passed his childhood without suffering from any serious disease, but was always subject to diarrhoea ac- companied by very painful tenesmus, which generally yielded to slight me- dical treatment, but was reproduced from very slight causes. He led a se- dentary studious life, and had never committed excesses of any kind. In 1827, at the age of twenty-one, he contracted simple blennorrhagia, which yielded quickly to the use of demulcents; soon after, he experienced a vague dull pain in the testicles, which troubled him much on account of its seat and its constancy, although his medical attendants did not consider it of consequence. He had also repeated nocturnal pollutions, followed by fatigue and general uneasiness, especially when they occurred very frequently. His erections, too, were sometimes painful. During four years, he suffered constantly from indisposition; he had frequent attacks of indigestion, repeated headache, and sudden attacks of giddiness, although these were slight and passing. His memory and aptitude for intellectual employment were dimi- nished. In 1831, he had strange noises in his right ear, accompanied with buzzing and momentary deafness, which went off and returned without evi- dent cause. The attacks of cerebral congestion became more severe, but were still of short duration. In March, 1832, the first serious attack occurred; it was ushered in by an abundant discharge of urine with notable digestive disorder, and was after- wards marked by violent spasms and constant giddiness, which did not allow the least motion of the head without loss of consciousness. Venesection and leeches were had recourse to, with marked increase of the agitation and other symptoms. Blisters and a seton in the nucha were followed by mo- mentary relief; but similar attacks soon recurred. In 1833, the patient experienced much dread of the cholera; he had symp- toms of hypochondriasis, which were attributed to fear, and completely lost his hearing on the right side. In November, he was bled in the foot, and injections of vapour and fluid into the ears were practised without benefit. Russian and Egyptian baths were used; immediately afterwards, several violent attacks occurred, exactly similar to those before.suffered. A severe reo-imen was now ordered, together with a large issue in the nucha; no be- nefit resulted. A venereal taint was now suspected by Recamier, and mer- curial baths ordered without any effects worthy of notice. The attacks were now supposed to be periodical, and sulphate of quinine was ordered; but on the third day of this new treatment, a still more serious attack occurred, and Marjolin and Baudelocque were consulted. Presh issues were made in the nucha, and mercurial pills and decoction of sarsaparilla were ordered. DuriDg three months little change occurred. There was violent pain in the right shoulder, with an eruption in the neck. In the spring of 1834, a slight improvement took place, which lasted two months, after which, the same attacks returned with increased frequency and severity. Valerian and belladonna were now prescribed without benefit. In the spring of 1835, another remission in the symptoms took place; but at the end of the summer, the same accidents recommenced. When I saw the patient, his last attack had continued upwards of a month almost without remission; his emaciation and pallidity were striking; he lay on his back quite motionless, not daring to lift his head from the pillow, or even to turn from right to left; on the least attempt at motion all things around him seemed to turn at the same time that he turned with O 16 242 CAUSES OF SPERMATORRHEA. them, and the room appeared to sink with him; his cephalalgia was intense and constant, and especially felt in the region of the right ear; the corre- sponding temporal region was more sensitive than the other, and the mouth was drawn to the opposite side when his lips were in motion. There was constant stiffness of the neck; he was unable to bear the least light or noise, and even a slight motion of the air increased bis irritability, and caused se- rious symptoms. His pulse was feeble and remarkably slow; his urine passed abundantly, was muddy, and deposited much sediment, containing phosphate of lime, with a thin mucus uniformly mixed, and a denser de- posit which occupied the lower layer. It seemed evident that this deposit contained semen in abundance, although I was unable to satisfy myself completely of the presence of sper- matorrhoea, on account of the quantity of urinary salts present. The patient asserted, that several of his most severe attacks had come on imme- diately after abundant nocturnal pollutions, and that he always felt worse the day after they had taken place. Still the deafness on the right side, the pain in the neighbourhood of the right ear, and the deviation of the mouth to the opposite side, seemed to indicate a chronic affection of the right in- ternal ear, which probably had extended to the membranes of the brain in the neighbourhood. On the other hand, both the patient and Dr. Guillemot had noticed that every attack had been preceded by an abundant secretion of clear colourless urine, with marked disorder in the digestive organs. I still feared that I might be misled, by having my mind preoccupied with the subject of spermatorrhoea, and I therefore, at this time, declined to advise cauterization. Iced milk, however, I ordered, and it re-established the functions of the stomach in a short time, and increased the patient's appetite, which he was obliged to satisfy frequently under the penalty of again suffering from cere- bral symptoms. Camphor was insupportable on account of its influence on the head, and opiate enemata produced constipation. Syrup of nymphea, however, had a better effect. After its use the nocturnal pollutions became more rare, and the urine, after several variations, at length con- tinued perfectly transparent, (excepting on the days following nocturnal pollutions,) during forty days. By degrees, the severe attacks became less frequent, and the patient at last passed two months without experiencing any: his deafness was less complete; his attacks of giddiness ceased, and at length he had resumed his ordinary diet, and thought himself cured, when in the middle of March, 1836, his nocturnal pollutions again became more frequent; the urine constantly contained an abundant spermatic de- posit; his digestion grew difficult, and with the symptoms of gastric derange- ment, the giddiness and cephalalgia returned. Decoction of nymphea in in- jections, and the presence of a catheter in the urethra for an hour or two at a time, caused these nocturnal and diurnal pollutions to diminish considerably, but the coincidence of new disorders accompanying the return of the pollu- tions, left no doubt as to the origin of the disease, and I therefore advised cauterization. This was performed some time afterwards, and still later, I used acupuncture. These means produced a profound and lasting change in the functions of the spermatic organs, for, from this tiaie, the nocturnal pollutions became more and more rare, and the urine rarely contained either spermatic deposit or mucous cloud. The other symptoms also gradually diminished from this period, clearly showing that they arose from involuntary seminal dis- CONGENITAL P RE-DI SPOSITION. 243 charges. The attacks of giddiness disappeared so completely, that M. M----, in travelling through Switzerland shortly after, was able to pass on a mule along narrow precipices, and on the brink of torrents, without suffering the least inconvenience. M. M----, being convinced of the return of all his functions, has mar- ried, and became a father a few months since. From the conclusion of this case, it is impossible to doubt the true cause of the gastric and cerebral disorder, and it is evident, that their habitual coincidence was owing to their arising from the same cause. The frequent intermittences of the disorder are not won- derful after the cases I have already related, besides, during these intervals of a month or two at a time, the health was never per- fectly re-established. The patient was only less ill than usual. Be- fore having severe attacks, too, the patient had suffered from slighter ones, to which he paid no attention, but which only differed from those which occurred afterwards in their intensity and duration. M. M----had complained for a long time of dull and wandering pains in his testicles, painful erections, and frequent debilitating nocturnal pollutions. If, therefore, his medical attendants had paid attention to these symptoms, they must soon have discovered the cause of his disorder. It was impossible to mistake the influence of blennorrhagia in ex- citing these nocturnal and diurnal pollutions, and I did not seek any other cause; but Dr. Guillemot sent me some very judicious observations, which I must mention here. M. M-----'s father was always an invalid; he was subject to frequent and obstinate catarrhs; his appetite was irregular and his stomach very inactive. The state of his digestion, too, exercised great influence over his character. All his family noticed the analogy between his symptoms and those of his son. M. M----has also a brother who resembles him physically as well as morally, and who suffers from frequent but less severe at- tacks of giddiness. He is also subject to nocturnal pollutions, espe- cially when travelling, and Dr. Guillemot has often found traces of spermatic deposit in his urine. He is frequently constipated, and passes a certain quantity of semen during his efforts at stool. He is subject also" to eruptions on the glans and prepuce. For these symptoms he has quite recently consulted me. The similarity of these circumstances recurring in M. M-----'s father and brother is worthy of notice; indeed, there is no reason why the genital organs should not partake of the family resemblances, that exist in features, height, temperament, &c. I think, therefore, that in this case the involuntary discharges, and the serious disorder to which they gave rise, depended more on hereditary predisposition than on the blennorrhagia. The following is a very remarkable circumstance of the same kind, which came under my notice in 1830. 244 CAUSES OF SPERMATORRHEA. CASE LXII. Nocturnal and diurnal pollutions occurring in three brothers. In 1822, M. C----, set. nineteen, suffered from frequent nocturnal pollu- tions, although he had frequent sexual intercourse. One night on awaking he endeavoured to prevent ejaculation from taking place, by firm pressure on the bed; he succeeded; but the next morning, without any other evi- dent cause, the passage of urine was painful; the second day the pain in the urethra increased; the patient had discharge, fever, dysuria, and even strangury. These symptoms lasted a month and more, their severity bein Vesiculitis . . . Excessive secretion; with mspissation. Prostate Gland . Prostatitis J Excessive secretion; increased amount ) of salts. Urethra . . . Urethritis . . . Excessive secretion of mucus. SPERMATORRHEA ASTHENICA. [Spermatorrhea Atonica—Mason Good.] STRUCTURE. FUNCTION. Testes. . . . Atrophy. . . . \ Impotence; watery secretion; absence r ) of spermatozoa. Vesiculae Semi- \ t •,,■■,.. w . ,. > Irritability . . . Watery secretion. Prostate Gland . Chronic Irritation | ^JJcuU SeCreti°n and SaltS'' ^"^ Urethra . . . Ulceration . . . Purulent discharge. It cannot be admitted -as a necessary law of healthy individual existence, that the organs of generation should be brought into ex- ercise. The functions of the body may be carried on perfectly well without their employment. On the other hand,* taking society as at present constituted, and considering the large amount of nourish- ment usually taken into the system, it must be allowed that the moderate use of the generative organs is perfectly consistent with the highest degree of health. By moderate use of this function, and by the healthful activity which accompanies its exercise, the general system is, to a certain extent, relieved and lightened, and the tone both of mind and body improved. The too frequently re- peated exercise of this function, on the other hand, is apt to occa- sion an unhealthy state of excitement of the organs, which is prone to terminate in disease. After a time the morbid excitement, as- suming by continuance a chronic character, takes on an action inde- pendent of its cause, progresses gradually, and occasions a constant secretion of seminal fluid. The exhaustion proceeding from so ab- normal and constant a drain upon the powers of the constitution, quickly undermines the most vigorous strength, and establishes a state of serious disease. The secretion of the seminal fluid, destined for the important purpose of preserving the species, demands for its perfection, if not the highest, at least a high standard of vital energy. Its excessive loss, for the same reason, occasions an immediate and destructive impression, on the health. This symptom, therefore, as the most obvious, and apparently the most dangerous, will naturally attract the attention of the medical practitioner, and probably induce him to direct the entire of his efforts to accomplish its removal. Lallemand based his system of classification on the character of the emissions, dividing them into nocturnal and diurnal. A careful consideration of the importance of the symptoms he has attached to each division, shows that the idea these terms convey does not clearly define his meaning. His arrangement resolves itself more into a question of 350 PATHOLOGY OF SPERMATORRHCEA. degree, among a certain set of symptoms, controlled by peculiar cir- cumstances, than of difference in the pathological conditions of the structure affected. Emission is nothing more than the effect of some previous condition of stimulus or excitement. The classification of the species of sper- matorrhoea, by the variations of this one symptom, even though that symptom be most important, must create uncertainty as to the part of the apparatus to which the seat of the morbid action should be assigned. Nocturnal emissions, arising from excessive activity of the organs, are looked upon as showing the first stage of the dis- ease. They are attended with all the evidences of the normal state, by erection, and by venereal ecstacy. They are to be attributed to the reaction on the brain of the local nervous excitability, oc- curring either during partial sleep, or in active conditions of the imagination. Diurnal emissions, on the contrary, are marked by an absence of venereal desire and ecstacy, by an absence of sper- matic fluid, and an equal absence of erection, and all sthenic condi- tion. A division has also been proposed, characterized by emissions occurring in the same individual both by day and night. This can- not, however, be received as a clearly separate state, but rather as combining the different stages of the two former conditions, or, per- haps, more correctly, the stage of diurnal emissions accompanied by occasional erection of the penis. But these terms, nocturnal and diurnal, evidently do not express the conditions of the affected parts with sufficient precision. The structural and functional dif- ferences are capable of more exact discrimination, and are suffi- ciently distinct to enable us to estimate the symptoms separately, as depending, for example, on affections of the testicles, vesiculse seminales, prostate gland, or urethra. Before proceeding to the separate consideration of these latter forms of the disorder, it may however be well to remark, that the laws by which the spermatozoa are governed differ altogether from those affecting the structures or functions. The existence of these animalcules is independent of the functional power, independent even, as I have already pointed out, of the place of their produc- tion; and they may be present or absent, for reasons quite irrespec- tive of the healthy condition and fertilizing quality of the semen. So long therefore as disease of the testicle produces no essential change in the quality of the secreted fluid which affords them nou- rishment, the spermatozoa will continue to be reproduced at about the same average rate. As, however, the quantity of the fluid may be largely increased by excessive action, without any material change in its character, so will it happen that the number of sper- matozoa in relation to the bulk of the secretion may be diminished. SPERMATORRHCEA STHENICA TESTICUL2E. Sthenic spermatorrhoea, arising from disease affecting the struc- PATHOLOGY OF SPERMATORRHCEA. 351 ture of the testicle, is attended with inflammatory symptoms more or less acute. The testicles are swollen and painful on pressure, a sense of weight extends along the spermatic chord, accompanied usually with pains in the loins, and with all those symptoms which constitute an ordinary attack of inflammation of the testicle, or or- chitis. It seldom happens, however, that orchitis, originating in this way, is attended with resolution of substance and purulent de- position, even although the early stages of the inflammatory action be attended by a considerable amount of severity. The function of the testicle is greatly stimulated by the excitement, and the secre- tion of spermatic fluid is largely increased. The peculiar influence of this excitement is shown by erection of the penis and emissions, and I have observed that so long as spermatic fluid, possessing a fecundating power, is secreted by the testicles, its emission is con- stantly attended by erection. SPERMATORRHCEA ASTHENICA TESTICULiE. When the sthenic state has existed for some little time a material change takes place in the symptoms, with respect to structure and function. The activity that characterized the earlier stages of the disease gives place to a condition of atony, and loss both of sub- stance and power ensues. This is the spermatorrhoea asthenica. The orchitis is relieved, in proportion as the structural excitement ceases, but function is sacrificed at the same time. The testicles begin slowly to diminish in size as their structure is absorbed, and they become flaccid and shrivelled. The spermatic secretion as- sumes a watery character, gradually ceasing altogether, and the spermatozoa disappear. This condition of the function of the tes- ticle is quickly followed by complete impotence. Severe and dan- gerous effects to the constitution naturally accompany these changes. The brain and nervous system, on which the testicles depend for their activity, are continually being exhausted by efforts for the re- storation of the functional power of the latter, and the constitutional symptoms assume characters of the highest degree of irritability. SPERMATORRHCEA STHENICA VESICULiE. The vesiculae seminales are differently constituted, in reference to their morbid phenomena, to the testicles. The results of exces- sive action in them are the direct opposite to those produced by ir- ritation of the testicles. They have no special function to perform dependent upon nervous influence for its completion. Their secre- tion is only an important accessory to that of the testicles. The injurious effects to the constitution, of diseases affecting them, are seldom first shown by impressions on the nervous system. Their irritable activity increases with the continuance of excitement, and instead of being relieved by the excited function, they acquire a permanence of morbid action, by which the constitution is seriously undermined. 352 PATHOLOGY OF SPERMATORRHCEA. The sthenic state of spermatorrhoea in relation with the vesiculfe seminales is attended with inflammatory action, as shown by the ex- citement of those organs, though this inflammation does not rise to any high degree of intensity. I have designated this state by the term vesiculitis, meaning thereby, an inflammatory condition of the structure of the vesiculae. It is attended by a sensation of dull pain or aching at the back of the bladder, becoming more painful as the latter organ is distended with urine. The effect of inflammation on the function of the vesiculae is an excessive increase in the quan- tity of their secretion, which -escapes under almost every sudden contraction of the surrounding muscles. The coats of the vesiculae are thin and fibrous, and admit of an active exosmosis. Inflammation sometimes increases this exosmosis, and by that means the fluid portion of the secretion is more rapidly removed, the consequence being inspissation of their contents to a degree amounting occasionally to almost complete solidification. When this happens to any great extent, and the cellules of the vesi- culae become much distended, their structure is liable to undergo destructive absorption. A less degree of inflammation often occurs, by which the secre- tion, instead of preserving its pure transparent condition, assumes the appearance of pus. SPERMATORRHCEA ASTHENICA VESICUL^I. After inflammation of the vesiculae has lasted for an uncertain time, the active symptoms gradually cease, leaving behind an atonic or asthenic condition. This condition is associated with irritability, in a greater or less degree, and the functional result is the produc- tion of a watery secretion, and a gradual diminution in the quan- tity of that secretion. Impotence may arise from this cause, with- out an actual deterioration of the fecundating fluid of the testicle, although it is rare for one of these diseased states to happen inde- pendently of the other. When the vesiculae have become distended with secretion, either naturally or under excitement, their evacuation may be attained by the contraction of their coats, or by the mere physical effect of exces- sive distention, by pressure from repletion of the rectum, contraction of the levatores ani muscles, or compression of the viscera of the pel- vis, occasioned by the position of the body, as in sitting. These effects, it is evident, may take place independently of disease, and if rarely called into exercise, we should hardly look for serious effects from them alone. On the other hand, if the evacuation take place fre- quently, more or less serious effects will result from its repetition, for we may be sure, whether the cause be morbid or otherwise, that so unnatural a mode of evacuation could not take place without the presence of a morbid cause. The simple emission of this fluid can have little or no effect upon the constitution of the patient, but the debility and exhaustion which succeed are occasioned by the often re- PATHOLOGY OF SPERMATORRHCEA. 353 peated nervous excitations, or efforts which are rendered necessary for the restoration of the lost secretion. It is therefore very unwise to consider and to treat the mere injection as the actual disease. The nervous phenomena here referred to are not those which ac- company a state of healthy stimulus, but are the direct effect of that morbid state termed irritability. A continuance of this mor- bid condition would lay the foundation for the destruction of the organs themselves, and so much of the general system as might be brought by sympathy under the same morbid influence. The muscles in these cases beeome wasted, the quantity of blood dimi- nishes, it loses its red globules, and the digestive organs and their secretory glands undergo a gradual but total derangement. These conditions usually come on slowly, and without the demonstration of any very sudden symptoms. Should they continue long, the vital power will be exhausted, and the constitution laid open to the in- vasion of still more acute and serious disorders. SPERMATORRHCEA STHENICA PROSTATA. The prostate gland is liable to numerous and complex changes, by which the symptoms affecting it, and depending peculiarly on spermatorrhcea, are very apt to be obscured. Like the other asso- ciated organs, however, it is subjected to sthenic and- asthenic con- ditions; the first of which, exhibiting all the evidences of inflamma- tion, I have named prostatitis. The structural effects of the disease are the same as those accompanying excitement of the prostate gland, arising from other causes. In the active form of the disease abscess of the prostate is liable to take place, and the presence of that affection is evinced by a discharge of purulent mucus. The functional activity of the organ is much increased under the in- fluence of morbid irritation, and there is a copious production of mucus containing a superabundance of phosphatic salts. The quan- tity of these salts varies considerably under different circumstances, independently of alterations-in the more fluid portions of the secre- tion ; and these variations generally indicate some peculiarity m the progress of the disease, while the immediate effect of extreme dilution of the prostatic mucus is that of rendering its neutralizing power insufficient for the preservation of the fecundating fluid against the destructive reagency of mucic and other acids present in the urethra. „ ., ,.11 ± i. Concentration of the prostatic fluid may also take place to such an extent as to permit the formation of crystals of phosphate of lime, which give rise to much irritation, both in the gland itself, and to the mucous membrane of the urethra in its passage along that canal. To this circumstance, as it appears to me, some of the forms of blen- norrhea may be referred; such as that which consists in a discharge of thick greenish yellow mucus, and is independent of any impure origin. 23 351 PATHOLOGY OF SPERMATORRHCEA. SPERMATORRHCEA ASTHENICA PROSTATiE. In the asthenic morbid state of the prostate gland, the effect taking place is an irritability, which may be termed chronic, as distinguish- ing it from the active irritability accompanying the inflammatory condition of prostatitis. The gland loses its power of producing healthy mucus; the secretion becomes watery and diminished in quantity, and the salts remain behind in the ducts, and there ag- gregate and form calculous concretions. Chronic irritability most generally occasions enlargement of the gland, with the production of impediments to the free passage of urine. The symptoms indi- cative of disease of the prostate gland are commonly felt in the re- gion of the neck of the bladder, and the lower part of the rectum. SPERMATORRHCEA URETHR.E. The mucous membrane of the urethra must necessarily have a place in any system of classification of the common phenomena of spermatorrhoea. It may be, and undoubtedly is, difficult to point out positive evidences of the presence of this disease in the urethral membrane, but we must not on that account be deterred from their investigation and consideration. There are two important and dis- tinctive states which constitute the foundation of a classification of the diseases of this part—namely, urethritis, and ulceration of the mucous membrane; the former representing the sthenic, the latter the asthenic condition. Urethritis is attended with more or less generally a considerable discharge from the mucous membrane, and all the symptoms of acute inflammation. From the inflamed mem- brane irritation may be propagated throughout the whole of the generative apparatus, producing peculiar effects in each separate por- tion. Ulceration of the mucous membrane of the urethra indicates a condition of depressed nervous energy, in which most of the surround- ing organs participate, to the destruction of their natural sensibi- VltJ- Having thus examined the diseased conditions of the different portions of the genital apparatus separately, I must remind the reader that such states of complete isolation rarely or never occur in practice. On the contrary, it constantly happens that the whole of the associated organs, without exception, are involved in one con- fused assemblage of symptoms, which will require much care to dis- entangle and distinguish with accuracy. The due reference of each symptom to its proper source, and a knowledge of the diseased alter- ations of each portion of the genital system, constitute in reality the pathology of spermatorrhoea. IMPOTENCY. 355 CHAPTER IV. IMPOTENCY. The subject of impotency has been partially discussed when con- sidering the condition of the testicles, under the head of asthenia of those organs in my table of classification. That reference was more particularly directed to functional incapacity, resulting from alter- ation of structure of the testicles, and consequent change in the con- stitution of the seminal fluid, such change being induced by sperma- torrhoea. Impotency, such as I am now about to direct attention to, has, however, an existence altogether independent of the above disease. It consists in an imperfect development of the generative power, or its partial or complete abnegation; the former succeeding to a de- fective organization of the apparatus of generation, the latter to an asthenic alteration in the condition of the same parts; the result of the presence of these conditions being an incapability of propa- gating the species. This definition of the term gives a wide scope for the introduction of collateral causes, and points out many mi- nute circumstances capable of exciting the malady. The most remarkable character connected with this disease is, that the organs of generation are rendered unfit for the performance of their natural functions without the exhibition of an amount of diseased action equivalent to the incapacity which succeeds. This character appears to be occasioned by certain imperfections and gradual alterations in structure of the parts themselves, by which the generative function becomes arrested. The fact which I have mentioned in a former portion of this work, of the independence of individual healthy existence of the function of generation, is exemplified in the perfect state of health which may coexist with an incapability of procreation. The active per- formance of this function demands that an amount of nervous in- fluence should always be in readiness for the purpose of properly developing its effects; but this nervous influence may not be called into action. The expenditure of this influence, on the other hand, would occasion those inroads upon the constitution, which, in sper- matorrhoea, arise from the frequent repetition of the nervous phe- nomena. . . Imperfect organic development, as occasioning impotency, presents us with extreme conditions, though at the same time the 356 IMPOTENCY. states of the disease are so definite, as almost always to enable us to form an immediate and correct judgment as to the result. Thus, when the defective organization is the consequence of amputation, or serious injury to the penis, of non-evolution of the testes,or of defect in any other of the generative organs, the nature of the case itself forbids every chance of success. Other impediments admit of removal, such as phymosis, incurvation of the penis from short- ening of the fraenum, and partial occlusion of the orifice of the urethra. The knife or the caustic, under such circumstances, offers ready means of relief. Asthenic impotency shows itself by a deficiency of power in the generative act, and assumes gradually a state of more or less complete incapacity for reproduction. This disease is brought on by several causes, one of the most influential of which is a natural diminution of power, resulting from inactivity of the generative func- tion. It results also from exhaustion of power, following excessive in- dulgence in a life of debauchery; and it may be the consequence of paralysis of the nerves of the generative organs. When impotency arises from causes of such powerful influence over the constitution, the treatment naturally offers considerable difficulties, but the case is far from being incurable. The same phenomena sometimes follow from blows on the loins, and from other means of concussion to the spinal chord. The principle of treatment in this affection is very obvious. The disease is attended with considerable loss of power, and once esta- blished, continues to exist for that reason ; to the restoration of this lost power, all means should be made subservient. General and local tonics, stimulants, and the cold bath, are the modes by which this end may be accomplished; and though they often require con- siderable time, they will eventually be successful when properly di- rected, and sufficiently persevered in. There is a set of symptoms, however, which may as effectually prevent the continuance of the species, and therefore cause impo- tency, as those I have named, even though the functional power may not be wanting. These symptoms depend remotely on circumstances principally affecting the nervous system, and admit of treatment usually with a fair hope of success. The immediate effects are oc- casioned by irregularities in the character of the actual emissions. The first of these diseases is the consequence of high nervous ex- citement, developing itself in the structural, instead of the functional, portion of the generative apparatus; producing, in fact, a state of priapism. It naturally happens from this condition of the parts, that the nervous power, which ought to have been supplied for the stimulation of function is absorbed in the production of structural ex- citement, and the consequence is a deficiency in emission, and there- fore, impotency. The mode of relief in a case of this kind, is to reduce the tendency to excitement pervading the system through the constitution; to regulate the diet; and relieve structural excitement, IMPOTENCY. 357 by directing its activity to another channel, through the means of increased muscular exertion. If, as sometimes happens, the ex- citement occurs from some abnormal local cause, it may then become necessary to apply local remedies for its relief. The venereal orgasm in persons of great nervous irritability is liable to cause such commotion throughout the system, and to stretch to so high a tension the excitement of the brain, as occasionally to induce an epileptic spasm. At the moment of such a seizure, the continuance of other excitations would cease, and with them na- turally the condition of excitement, on which the act of proper emission depends. Under such circumstances impotency follows as a matter of course. The frequent recurrence of epileptic attacks so caused, would place the life of a patient affected with them in jeopardy, and no doubt the opportunity for such recurrence should be avoided; at the same time I am forced to admit that oc- casional indulgence in the practice is one of the readiest modes of subduing over-excited irritability of the nervous function. The treatment of this form of impotency consists in reducing the irrita- tion of the system by depletive measures, such as aperients, and a strict regimen. At the same time let it be borne in mind, that due judgment must be exercised to ascertain whether the excitement may not arise from an entirely opposite cause—namely, from debility of constitution, and an asthenic irritability of the generative organs inducing reaction in the brain. In such a state the plan of treat- ment will consist in supporting the constitution by tonic and stimu- lant medicines, and reducing excessive local action by sedatives. Two other circumstances, namely, that which arises from a too precipitate emission, and that which arises from the opposite con- dition of a too tardy one, may become causes of impotency; the former from the emission occurring before the female orgasm, the latter from its happening afterwards. The first of these states de- pends upon a large amount of irritable excitement, so great occa- sionally as to cause emission before the introduction of the penis into the vagina, the second from deficient excitement._ From the latter circumstance it happens that no distinct emission does ac- tually take place, but that the seminal fluid gradually oozes away from the urethral orifice. The nature of these cases so clearly in- dicates the method which should be adopted in their treatment, that I shall be excused for not dwelling upon them. Another cause of impotency connected with imperfection in the accomplishment of emission, is a condition of the urethra, by which the seminal fluid is prevented from issuing from its orifice, and is made to pass backwards by a refluent action into the bladder, or in some cases probably is not permitted to enter the urethra at all, on account of the swelling of the ejaculatory and prostatic open- ings. This state may arise from congestion of the mucous mem- brane of the urethra, from irritability and spasm of the canal, or 358 CAUSES OF SPERMATORRHCEA. from stricture. The treatment under these circumstances should be such as to remove the diseased conditions of the urethra, and with them, the effects of this form of impotency would also disappear. I have thought it expedient to make my remarks on this subject as concise as possible, and avoid repetition; I have therefore merely taken a general view of the principles of treatment. Those which apply to spermatorrhcea, and are more fully detailed in the chapter on the treatment of that disease, will be found to be very generally suitable to the phenomena of impotency. CHAPTER V. CAUSES OF SPERMATORRHCEA. The knowledge of the precise cause of any given disease is of the first importance to a proper understanding of its treatment and cure. Where the phenomena presenting themselves are obscure, and difficult to trace to their proper source, as in the case of sper- matorrhcea, the careful investigation of them, and of their mutual relations, becomes an urgent necessity. Inferences drawn from external appearances are frequently the first and only guide to the cause of the disease. As often happens, also, the indications of spermatorrhoea can only be traced to their true head, through a set of symptoms, which, considered as independent diseases, would na- turally be referred to a very different origin, and lead away the mind from the supposition that disarrangement of the genital sys- tem was indeed their primary origin. Increased difficulty also arises from the moral delicacy of the subject, and from the disin- clination that most patients suffering from this distressing malady have to the investigation of a state of suffering, which, in their mor- bid fancy, is associated with degradation. The diseases which it thus becomes necessary to look upon some- times in the light of .causes of spermatorrhcea occasionally assume the characters of cerebral and nervous affections, of derangements in the circulating and digestive systems, of congestions of various organs, and excessive general and local debility. These constitu- tional causes of the disease are numerous, and require judgment in their diagnosis, from the difficulty of determining the relative pro- portion of the symptoms assignable to a simple disarrangement of the function of any particular organ, and that due to primary dis- ease of the structure of the part. The brain and nervous system are of all the organs of the body the most susceptible of serious morbid changes originating in this causes of spermatorrhcea. 359 disease; and upon them the first impression of disturbance is most readily shown. The least dangerous but at the same time the most persistent of these morbid conditions, is simple excitement of the brain, developed by the most ordinary external circumstances, and by the commonest occurrences of daily life. Excitement of this kind increases in importance, in proportion as the mind is subjected for a longer or shorter period to its influence. And although this state must be considered more as a perversion of healthy action than one of actual disease, still it is better to endeavour to effect its removal while in a recent stage, than to allow it to acquire a firmer hold on the system. The symptoms now referred to depend on congestion, which, if permitted to continue, will eventually in- crease to a degree of extreme intensity, and assume all the characters of threatened apoplexy. At other times the irregular distribution of irritability will occasion serious inflammatory attacks, followed by such an amount of exhaustion that .the patient often sinks beneath their violence; and unless.the symptoms be arrested before they reach this degree of activity they are apt to proceed on to struc- tural disorganization, and then admit of very feeble prospects of relief. The progress of these psychological conditions may therefore be arranged into three stages: the first, and simplest, may be con- sidered as merely a special tendency of the mind to erotic imagi- nation while sleeping or waking, influencing directly the generative system, the state of the brain being healthy; the second embraces the effects of congestion and inflammation, the brain being diseased; while the third exhibits a state of paralysis, occasioned by structural decay. Constitutional effects, therefore, in relation with the brain, may arise from any circumstance sufficiently powerful to excite that organ into undue action; from unchaste ideas created by the perusal of licentious books; from exciting passions; from close appli- cation to study; from long continued attention to business. These conditions affect the brain directly, and bear a sort of self-evidence of their capability to produce diseased action in the genital system. But there are other and more indirect sources whence the same ef- fect is likely to arise, such as violent and excessive exercise, acci- dental violence, or exposure to extremes of heat and cold. The disease may in short be occasioned by any thing that overstrains the mind, or by whicli the bodily powers are weakened. _ Such states of excitement can exist for a very short time indeed without involving in a greater or less degree the other systems of the body that depend for their performance on nervous activity. One of "the first among these to participate in the disorder is that of digestion, and it soon becomes necessary to contend against the lon'Amin of symptoms which accompany disorder of the assimi- lating functions". When disarrangement of the circulation, such as is present with an apoplectic tendency, is added to these symp- toms, it may easily be conceived that the difficulty of diagnosis is indeed seriously complicated. 360 causes of spermatorrhcea. Congenital debility is sometimes, though by no means frequently, a cause of asthenic spermatorrhcea. When such is the case, the malady is not very amenable to treatment, but it occasionally hap- pens that a careful and judicious management is of essential bene- fit, if not in entirely removing the symptoms, at least in modifying them to a great extent, and thus improving the condition of the patient. Even those that are apparently the worst cases, sometimes yield sufficiently to awaken hope and confidence in favour of the steady pursuance of a proper course of treatment. The most frequent local causes of spermatorrhoea are to be found in the urethra. Inflammation seated in its mucous membrane, thence communicated to the prostate gland, and giving more or less evidence of its presence, usually precedes the same condition in the vesiculae seminales and testes. Inflammatory attacks of this kind are by no means unfrequent, and arise from various causes, among which exposure to cold is not uncommon. In that state the mem- brane frequently takes on a disposition to active secretion, attended with inflammation, showing itself in the form of urethral catarrh, in the way that cold generally affects the mucous membrane; and the inflammatory action spreads more or less rapidly to the other contiguous structures. This condition is very different from the urethritis and mucous discharge, which arise as a consequence of primary irritation of the seminal organs, occasioned by structural disease, and independent of functional disorder. The remote causes of spermatorrhoea sometimes take their rise in irritation of the kidneys and bladder. The spread of inflamma- tion from the urinary organs is direct, by virtue of the continuity of the mucous membrane, extending along the surfaces of the semi- nal secreting organs. The severity of the attack will be usually found less in degree, and more easily treated, in proportion to the remoteness of the local exciting cause. Next to inflammation of the kidneys and bladder, and proceeding from actual structural disease, as a cause of spermatorrhoea, must be arranged irritations excited in these organs, as well as in the urethra, by the abuse of spirituous liquors, the ingestion of certain articles of diet and particular medicines. Strong infusions of tea and coffee, the local action of cantharides, nitrate of potass, and camphor, naturally occur to the mind in considering a list of articles likely to produce excitement of the genital organs, by their local as well as by their constitutional influence on the system. Venereal excesses are a fertile and common source of seminal disease, but not exactly proportionate to the amount of their indul- gence. It constantly happens that an excess which in some persons would occasion only temporary derangement, would in others be sufficient to establish a permanent and exhausting discharge. Much depends upon the natural excitability of the constitution, and much also upon the predominant tendency to local irritations. If, com- bined with such a constitutional susceptibility, an attack of go- CAUSES OF spermatorrhcea. 361 norrhoea should occur, symptoms of seminal disease more or less complete, seldom fail to be produced. A subsidence of the active symptoms of the disease may and usually does follow upon the dis- appearance of the gonorrhoea, but this subsidence must not be mis- taken for a proof of the complete restoration of the genital apparatus to a state of health. The seminal disease requires only a certain amount of irritation to recall it into a condition of activity. Some- times, however, the apparent subsidence really indicates that the disease is assuming gradually the passive or asthenic stage; in other words, is passing into a state of rebellious inveteracy. A condition of the urethra occasioning stricture of the canal may become an exciting cause of spermatorrhoea, and when the local in- flammation attending it diminishes to the state usually understood by the term atonic, the abrasion or ulceration which succeeds, then continues to keep up the disease. The prostate gland is also an occasional cause of spermatorrhoea, either from inflammation primarily arising in the texture of the gland itself, or from diseased action induced in it by irritation of the urethra. It is probably not often a primary source of the dis- ease, for reasons incident to its situation and function. When it does become so, the effects produced on the gland are marked by great permanence, and long after irritation of all the surrounding organs has apparently ceased, the prostate seems to contain within itself the elements for a recommencement of the spermatorrhoea. A varicose state of the veins of the prostate is also conducive to sustained irritation in the gland. The rectum is subject to several diseases, both of a mechanical and structural nature, and its proximity to the vesiculae seminales naturally influences in a considerable degree the irritations whiph affect those organs. The close vicinity of the intestine renders its ordinary distention, and the contractions of the levatores ani mus- cles, active in the production and continuance of the vesicular form of spermatorrhoea, especially when the vesiculae are more than usually susceptible of irritation. This susceptibility excites the function of secretion, and the pressure or muscular contractions then cause an ejection from the urethra of a quantity of transparent glairy mucus, immediately or soon after the passage of the faeces. The occurrence of this circumstance leads the patient to an attentive examination of his state, and he discovers probably that it is almost constant on going to stool. To the medical practitioner this occur- rence will be the evidence of an undue excitement already com- menced in the vesiculae, which, without proper treatment, must end in a permanently diseased action. If the vesiculae be examined by the aid of the finger at this time, they will be found unusually tense, and distended with secretion, and this condition is accompanied with a sensation of dull, heavy aching pain. I have observed that the fluid which is then emitted is generally thin and transparent. It differs materially in its characters from urine, for which it is liable 362 CAUSES OF SPERMATORRHCEA. to be mistaken, especially as there is frequently a spasmodic ex- pulsion of the last few drops of urine from the bladder, immediately after the passage of the faeces. At the commencement of the dis- ease, the fluid excreted during these muscular contractions contains no spermatozoa, but after a time, when the testicles participate in the excitement, the animalcules become numerous, and the evidence of spermatorrhoea for that reason more distinct. When such effects arise from simple mechanical disease of the rectum, they are gene- rally temporary and removeable, but occasionally sufficiently dis- tressing and weakening to require careful and prolonged treatment' for preventing a relapse. Among the simplest mechanical inducements of irritation are collections of faecal matter in the rectum and ascarides. These, however, present no great difficulty in their management. A vari- cose state of the hemorrhoidal veins, by causing distention of the structures around the rectum, may also have a large share in pro- moting the conditions likely to occasion irritability of the vesiculae, and therefore must be looked upon as a cause of spermatorrhoea. Diarrhoea, acute and chronic, and dysentery, may also induce excitement of the vesiculae. When the more important diseases of the rectum become the excitants of spermatorrhoea, the treatment is rendered particularly tedious and complicated, and the disease will depend for its relief upon the progress of the exciting cause. Those structural diseases of the rectum which may be admitted into the list of causes of this disease are tumours, stricture, and scirrhus; and it will be understood at once that causes so persistent offer almost insurmountable difficulties to successful treatment. Happily these serious maladies, as causes of spermatorrhoea, are the exception and not the rule. The position of the testicles renders them liable to accidental violence, and they are apt, in consequence, to take on sometimes an inflammatory action. Orchitis, or inflammation of the testicle, arising from a blow, from sympathetic action, or from any other cause, readily communicajtes its excitement to the neighbouring parts, and by the lining membrane of the vas deferens, directly to the vesiculae seminales. Should the inflammation assume a chronic character and continue for any length of time, there is danger of its exciting the structures permanently, and thus establishing sper- matorrhoea. In enumerating the list of causes of spermatorrhcea, structural irritation of the vesiculae seminales must not be omitted, but a purely independent structural excitement is probably not often fixed in them. When such is the case, it arises in very few instances from actual organic change. Functional excitement, on the contrary, occurs more frequently, and depends upon the general irritable con- dition of the nervous system. It seldom demands much attention, and will most probably cease entirely as the balance of nervous energy becomes restored. CAUSES OF SPERMATORRHCEA. 363 There is another point of view, however, from which the vesiculae seminales must be regarded in relation with spermatorrhcea, for though not frequently subject to become the origin, they are un- doubtedly the centre around which all the diseased actions of the generative system are apt to congregate. Their structure and func- tions are such as to render them not easily liable to disturbance; but for the same reason, when really excited into morbid action and disarranged, it is very difficult to bring about a cessation of that disturbance. When once sufficient irritation is established to oc- casion spermatorrhoea, then the disease progresses independently of the first exciting cause, kept up, indeed, by the participation of the neighbouring organs in the irritation. For this reason it is that spermatorrhoea hardly ever admits of spontaneous recovery, when it has been allowed to obtain and secure a firm hold upon the vesiculae seminales. One of the most serious of all the causes of spermatorrhcea, and one which includes in its terrible embrace both the physical power of the constitution and the moral condition of the mind, is self-abuse. This habit is usually contracted at an early age, most frequently at school, and at a time when the moral power is insufficient to op- pose the contagion of bad example, or the force of violent and pre- cocious animal passions. Indulgence of this habit under these cir- cumstances ought not, in'my opinion, to be classed in the list of moral crimes, as too frequently happens, but rather in that of dis- ease. The principal difficulty in the management and cure of this fatal propensity is the incapability of making the patient, at an early age, fully understand the injurious influence upon the con- stitution or its after effects. It is not an easy matter to convince him that he is pursuing a course that demands the very strictest attention and counteraction to save him from the most evil conse- quences to his health. To him the necessity for a strict resistance is quite incomprehensible; he is practising, as he believes, a simple sensual gratification merely, and if at any time it occurs to his mind, that he is doing something which is wrong, the impression unfor- tunately is so slight as scarcely to occasion him a moment's uneasi- ness. He relies, perhaps, on his capability of giving up the habit at a later a^e, before it becomes injurious to his health. In this idea, however, he will find himself sadly mistaken. When the mind has become morbidly directed to this subject, it is continually and irresistibly seeking the means of reproducing its pleasurable sensa- tions. There is no departure from the idea, every moment unoc- cupied in bodily exertion is devoted to erotic fancies, and even sleep is not exempt from the mental fascination. As the disease increases in intensity, the mind wearies of any direction but the one, and how- ever much it may be distracted for a short time, wanders back un- consciously to its morbid train of thought. The expenditure of nervous energy thus carried on, rapidly wastes and enervates the body, independently of the destruction of the function which sub- 364 CAUSES OF SPERMATORRHCEA. sequently follows. It is not long under these circumstances before permanent irritability becomes established, and the patient sinks exhausted by all the fearful symptoms that accompany this terrible condition of disease. Hufeland, in his "Art of Prolonging Life," has so well and so aptly described the effects of this habit, as influencing the duration of life, and his description so perfectly agrees with my own obser- vations, that I have considered it would add to the completeness of my work to introduce his remarks on the subject in this place. "Of all the means of hastening death, with which I am acquaint- ed, there are none so highly destructive, and in which every baneful property is so much united, as in these. None comprehend so per- fectly all the four requisites for that purpose, .which I have already laid down; and indeed these melancholy excesses may be considered as the most highly concentrated process for shortening vital duration. This I shall immediately prove. "The first mean of shortening life was, lessening the vital power itself. But what can more lessen the sum of the vital power within us than wasting those juices which contain it in the most concen- trated form, as well as the first vital spark for a new being, and the most powerful balsam for our own blood? "The second manner of shortening life consists in lessening the necessary solidity and elasticity of the vessels and organs. But it is well known that nothing tends so much to relax, to soften, and to corrupt, as this dissipation. "The third manner, or more rapid consumption, can be promoted by nothing so much as by a circumstance, which, as appears from the example of all nature, is the highest degree of vital activity; and which, as before shown, is in many beings the conclusion of their whole life. ! "Lastly, proper restoration is thereby prevented in an uncommon degree, because that rest and that equilibrium necessary for re- pairing what has been lost are impeded, and the organs deprived of the power requisite for the same purpose; but, in particular, because these debaucheries have a peculiar weakening effect on the stomach and the lungs, and thereby specifically desiccate the grand source of our restoration. "To this may be added the danger of imbibing, amid such irre- gularities, that most dreadful of poisons, the venereal, against which no one is secure who has illicit intercourse with the fair sex—a poison which may not only shorten life, but render it also painful, miserable, and loathsome, and of which I shall speak at more length when I come to treat on Poisons. "I must here mention also several other concomitant circum- stances which are connected with this dissipation, and among these, in particular, that of the mental faculties being weakened. It ap- pears that between both these organs, that of the soul (the brain,) and those of generation, as well as between the two functions, that CAUSES OF SPERMATORRHCEA. 365 of thinking and that of generating, the one spiritual, and the other physical creation, there is a very intimate connexion; and that they both require the noblest and most refined part of the vital power. We find, therefore, that they both act alternately on each other, and have a mutual and contrary effect. The more we strain the mental faculties, the less vigorous will be our power of generation; the more we stimulate the generative power and waste its juices, the more does the soul lose its faculty of thought, its energy, its acuteness, and its memory. Nothing in the world can so much and so irretrievably ruin the brightest mental talents as excess of this kind. "It may, perhaps, be here asked, what is meant by excess in physical love ? My answer is, when either sex indulges that pas- sion too early, before the body is completely formed—females be- fore the age of eighteen, and males before that of twenty; when this enjoyment is too often and too violently repeated, which may be known by the following consequences:—lassitude, dejection, and loss of appetite; when one, by a frequent change of object and cir- cumstances, or by*the artificial stimulus of spiceries, heating liquors, and the like, excites new desires and the relaxed powers, or makes that exertion during the time of digestion; and, to include the whole in a few words, when one enjoys physical love without mar- riage; for it is only under the matrimonial tie, which excludes the stimulus of variety, and directs the physical propensity to a higher moral object, that this passion can be physically refined, that is to say, be rendered salutary and useful. "Every thing that has been here said is applicable, in an emi- nent degree, to onanism also; for that forced and unnatural vice in- creases, in an extraordinary manner, the straining of the organs, and the weakening connected with it; and this is a new proof of the principle I before laid down, that nature avenges nothing so dreadfully as transgressions against herself. When transgressions prove mortal, they are always crimes against nature. It is, indeed, highly worthy of remark, that a dissipation which seems to be so perfectly alike in all its parts should, however, be so different in its consequences, according as it is confined to a natural or unna- tural method; and as I am acquainted with judicious men who can- not be fully convinced of this different, I shall embrace the pre- sent opportunity of showing how onanism, in either sex, does infi- nitely more mischief than natural enjoyment. Horrid is the im- pression stamped by nature on such an offender 1 He is like a faded rose, a tree blasted in its bloom, a wandering skeleton. All his fire and spirit are deadened by this detestable vice; and nothing remains but debility, languor, livid paleness, a withered body, and a degraded soul. The eyes lose their lustre and strength; the pnpils seem sunk; the features are distorted and lengthened; the rosy complexion of youth vanishes, and the visage appears ot a pale-white leaden colour. The whole body becomes affected, and sensible of the slightest impression; the muscular power is lost; pan truly say addition to obstetrical literature. The operative guegestions and contrivances which Mr. Brown de- scribes, exhibit much practical sagacity and skill, We have no hesitation in recommending this book to the careful attention of all surgeons who make female complaints a part of their study and practice. —Dublin Quarterly Journal. 6 BLANCHARD & LEA'S MEDICAL CARPENTER (WILLIAM B.), M. D., F. R. S., &c, Examiner in Physiology and Comparative Anatomy in the University of London. PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief applications to Psychology, Pathology, Therapeutics, Hygiene, and Forensic Medicine. A new American, from the last and revised London edition. With nearly three hundred illustrations. Edited, with addi- tions, by Francis Gurney Smith, M. D., Professor of the Institutes of Medicine in the Pennsyl- vania Medical College, &c. In one very large and beautiful octavo volume, of about nine hundred large pages, handsomely printed and strongly bound in leather, with raised bands. $4 25. In the preparation of this new edition, the author has spared no labor to render it, as heretofore, a complete and lucid exposition of the most advanced condition of its important subject. The amount of the additions required to effect this object thoroughly, joined to the former large size of the volume, presenting objections arising from the unwieldy bulk of the work, he has omitted all those portions not bearing directly upon Human Physiology, designing to incorporate them in his forthcoming Treatise on General Physiology. As a full and accurate text-book on the Phy- siology of Man, the work in its present condition therefore presents even greater claims upon the student and physician than those which have heretofore won for it the very wide and distin- guished favor which it has so long enjoyed. The additions of Prof. Smith will be found to supply whatever may have been wanting to the American student, while the introduction of many new illustrations, and the most careful mechanical execution, render the volume one of the most at- tractive as yet issued. For upwards of thirteen years Dr. Carpenter's work has been considered by the profession gene- rally, both in this country and England, as the most valuable compendium on the subject of physiology in our language. This distinction it owes to the high attainments and unwearied industry of its accom- plished author. The present edition (which, like the last American one, was prepared by the author him- self), is the result of such extensive revision, that it may almost be considered a new work. We need hardly say, in concluding this brief notice, that while the work is indispensable to every student of medi- cine in this country, it will amply repay the practi- tioner for its perusal by the interest and value of its contents.—Boston Med. and Surg. Journal. This is a standard work—the text-book used by all medical students who read the English language. It has passed through several editions in order to keep pace with the rapidly growing science of Phy- siology. Nothing need be said in its praise, for its merits are universally known ; we have nothing to say of its defects, for they only appear where the science of which it treats is incomplete.—Western Lancet. The most complete exposition of physiology which any language can at present give.—Brit, and For. Med.-Cnirurg. Review. The greatest, the most reliable, and the best book on the subject which we know of in the English language.—Stethoscope. To eulogize this great work would be superfluous We should observe, however, that in this edition the author has remodelled a large portion of the former, and the editor has added much matter of in- terest, especially in the form of illustrations. We may confidently recommend it as the most complete work on Human Physiology in our language.— Southern Med. and Surg. Journal, December, 1855. The most complete work on the science in our language.—Am. Med. Journal. The most complete work now extant in our lan- guage.—N. O. Med. Register. The best text-book in the language on this ex- tensive subject.—London Med. Times. A. complete cyclopasdia of this branch of science. —N. Y. Med. Times. The profession of this country, and perhaps also of Europe, have anxiously and for some time awaited the announcement of this new edition of Carpenter's Human Physiology. His former editions have for many years been almost the only text-book on Phy- siology in all our medical schools, and its circula- tion among the profession has been unsurpassed by any work in any department of medical science. It is quite unnecessary for us to speak of this work as its merits would justify. The mere an- nouncement of its appearance will afford the highest pleasure to every student of Physiology, while its perusal will be of infinite service in advancing physiological science.—Ohio Med. and Surg. Journ. BY the same author. (Lately Issued.) PRINCIPLES OF COMPARATIVE PHYSIOLOGY. New American, from the Fourth and Revised London edition. In one large and handsome octavo volume, with over three hundred beautiful illustrations, pp. 752. Extra cloth, $4 80; leather, raised bands, $5 25. The delay which has existed in the appearance of this work has been caused by the very thorough revision and remodelling which it has undergone at the hands of the author, and the large number of new illustrations which have been prepared for it. It will, therefore, be found almost a new work, and fully up to the day in every department of the subject, rendering it a reliable text-book for all students engaged in this branch of science. Every effort has been made to render its typo- graphical finish and mechanical execution worthy of its exalted reputation, and creditable to the mechanical arts of this country. This book should not only be read but thoroughly studied by every member of the profession. None are too wise or old, to be benefited thereby. But especially to the younger class would we cordially commend it as best fitted of any work in the English language to qualify them for the reception and com- prehension of those truths which are daily being de- veloped in physiology.—Medical Counsellor. Without pretending to it, it is an encyclopedia of the subject, accurate and complete in all respects— a truthful reflection of the advanced state at which the science has now arrived.—Dublin Quarterly Journal of Medical Science. A truly magnificent work—in itself a perfect phy- siological study.—Ranking's Abstract. This work stands without its fellow. It is one few men in Europe could have undertaken; it is one no man, we believe, could have brought to so suc- cessful an issue as Dr. Carpenter. It required for its production a physiologist at once deeply read in the labors of others, capable of taking a general. critical, and unprejudiced view of those labors and of combining the varied, heterogeneous materials at his disposal, so as to form an harmonious whole. We feel that this abstract can give the reader a very imperfect idea of the fulness of this work, and no idea of its unity, of the admirable manner in which material has been brought, from the most various sources, to conduce to its completeness, of the lucid- ity of the reasoning it contains, or of the clearness of language in which the whole is clothed. Not the profession only, but the scientific world at large, must feel deeply indebted to Dr. Carpenter for this freat work. It must, indeed, add largely even to is high reputation.—Medical Times. AND SCIENTIFIC PUBLICATIONS. 7 CARPENTER (WILLIAM B.>, M. D., F. R. S., Examiner in Physiology and Comparative Anatomy in the University of London. THE MICROSCOPE AND ITS REVELATIONS. With an Appendix con- taining the Applications of the Microscope to Clinical Medicine, &c. By F. G. Smith, M. D. Illustrated by four hundred and thirty-four beautiful engravings on wood. In one large and very handsome octavo volume, of 724 pages, extra cloth, $4 00 ; leather, $4 50. Dr. Carpenter's position as a microscopist and physiologist, and his great experience as a teacher eminently qualify him to produce what has long been wanted—a good text-book on the practical use of the microscope. In the present volume his object has been, as stated in his Preface, " to combine, within a moderate compass, that information with regard to the use of his ' tools,' which is most essential to the working microscopist, with such an account of the objects best fitted for his study, as might qualify him to comprehend what he observes, and might thus prepare him to benefit science, whilst expanding and refreshing his own mind " That he has succeeded in accom- plishing this, no one acquainted with his previous labors can doubt. The great importance of the microscope as a means of diagnosis, and the number of microsco- pists who are also physicians, have induced the American publishers, with the author's approval, to add an Appendix, carefully prepared by Professor Smith, on the applications of the instrument to clinical medicine, together with an account of American Microscopes, their modifications and accessories. This portion of the work is illustrated with nearly one hundred wood-cuts, and, it is hoped, will adapt the volume more particularly to the use of the American student. Every care has been taken in the mechanical execution of the work, which is confidently pre- sented as in no respect inferior to the choicest productions of the London press. The mode in which the author has executed his intentions may be gathered from the following condensed synopsis of the CONTENTS. Introduction—History of the Microscope. Chap. I. Optical Principles of the Microscope. Chap. II. Construction of the Microscope. Chap. III. Accessory Apparatus. Chap. IV. Management of the Microscope Chap. V. Preparation, Mounting, and Collection of Objects. Chap. VI. Microscopic Forms of Vegetable Life—Protophytes. Chap. VII. Higher Cryptoga- mia. Chap. VIII. Phanerogamic Plants. Chap. IX. Microscopic Forms of Animal Life—Pro- tozoa—Animalcules. Chap. X. Foraminifera, Polycystina, and Sponges. Chap. XI. Zoophytes. Chap. XII. Echinodermata. Chap. XIII. Polyzoa and Compound Tunicata. Chap. XIV. Molluscous Animals Generally. Chap. XV. Annulosa. Chap. XVI. Crustacea. Chap. XVII. Insects and Arachnida. Chap. XVIII. Vertebrated Animals. Chap. XIX. Applications of the Microscope to Geology. Chap. XX. Inorganic or Mineral Kingdom—Polarization. Appendix. Microscope as a means of Diagnosis—Injections—Microscopes of American Manulacture. medical work, the additions by Prof. Smith give it a positive claim upon the profession, for which we doubt not he will receive their sincere thanks. In- deed, we know not where the student of medicine will find such a complete and satisfactory collection Those who are acquainted with Dr. Carpenter's previous writings on Animal and Vegetable Physio- logy, will fully understand how vast a store of know- ledge he is able to bring to bear upon so comprehen- sive a subject as the revelations of the microscope ; and even those who have no previous acquaintance with the construction or uses of this instrument, will find abundance of information conveyed in clear and simple language.—Med. Times and Gazette. Although originally not intended as a strictly of microscopic facts bearing upon physiology and practical medicine as is contained in Prof. Smith's appendix; and this of itself, it seems to us, is fully worth the cost of the volume.—Louisville Medical Review, Nov. 1856. BY THE SAME AUTHOR. ELEMENTS (OR MANUAL) OF PHYSIOLOGY, INCLUDING PHYSIO- LOGICAL ANATOMY. Second American, from a new and revised London edition. With one hundred and ninety illustrations. In one very handsome octavo volume, leather, pp. 566. S3 00 In nublishinff the first edition of this work, its title was altered from that of the London volume, k,, K .Ihifuft on of the word "Elements" for that of « Manual," and with the author's sanction 'Elements" is still retained as being more expressive of the scope of the treatise Those who have occasion for an elementary trea- tise on Physiology, cannot do better than to possess themselves of the manual of Dr. Carpenter.—Medico. I Examiner. The best and most complete expose" of modern Physiology, in one volume, extant in the English language.—St. Louis Medical Journal. the title of To say that it is the best manual of Physiology now before the public, would not do sufficient justice to the author.—Buffalo Medical Journal. In his former works it would seem that he had exhausted the subject of Physiology. In the present, he gives the essence, as it were, of the whole.—J\. X. Journal of Medicine. BY the same author. (Preparing.) PPTNPTPLES OF GENERAL PHYSIOLOGY, INCLUDING ORGANIC PSi™sTKY AND HISTOLOGY. With a General Sketch of the Vegetable and Animal SSm £!^Eb?2 J very handsome octavo volume, with several hundred illustrations. Tlufsubject of general physiology^mf ^^^ att^'whS El iTesKm^ tholgSy^nd fuft ThaXs ye't Ln attempted, and'w&ch may be regarded as an introduction to his other works. BY THE SAME AUTHOR. a PTUZE ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH AND DISEASE. New edition, with a Preface by D F. Condie, M. D., and explanations of fcXntmo words. In one neat 12mo. volume, extra cloth, pp.178. 50 cents. 8 BLANCHARD & LEA'S MEDICAL CONDIE (D. F.), M. D., «tc. A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. Fifth edition, revised and augmented. In one large volume, 8vo., leather, of over 750 pages. $3 25. (Now Ready, December, 1858.) In presenting a new and revised edition of this favorite work, the publishers have only to stute that the author has endeavored to render it in every respect "a complete and faithful expjsition of the pathology and therapeutics of the maladies incident to the earlier stages of exiMcnce—a full and exact account of the diseases of infancy and childhood." To accomplish this he has subjected the whole work to a careful and thorough revision, rewriting a considerable portion, and adding several new chapters. In this manner it is hoped that any deficiencies which may have previously existed have been supplied, that the recent labors of practitioners and observers have been tho- roughly incorporated, and that in every point the work will be found to maintain the high reputation it has enjoyed as a complete and thoroughly practical book of reference in infantile affections. A few notices of previous editions are subjoined. Dr. Condie's scholarship, acumen, industry, and practical sense are manifested in this, as in all his numerous contributions to science.—Dr. Holmes's Report to the American Medical Association. Taken as a whole, in our judgment, Dr. Condie's Treatise is the one from the perusal of which the practitioner in this country will rise with the great- est satisfaction.—Western Journal of Medicine and Surgery. One of the best works upon the Diseases of Chil- dren in the English language.—Western Lancet. We feel assured from actual experience that no physician's library can be complete without a copy of this work.—N. Y. Journal of Medicine. A veritable paediatric encyclopaedia, and an honor to American medical literature.—Ohio Medical and Surgical Journal. We feel persuaded that the American medical pro- fession will soon regard it not only as a very good, but as the very best "Practical Treatise on the Diseases of Children."—American Medical Journal. In the department of infantile therapeutics, the work of Dr. Condie is considered one of the best which has been published in the English language. —The Stethoscope. We pronounced the first edition to be the best work on the diseases of children in the English language, and, notwithstanding all that has heen published, we still regard it in that light.—Medical Examiner. The value of works by native authors on the dis- eases which the physician is called upon to combat, will be appreciated by all; ani the work of Dr. Con- die has gained for itself the character of a safe guide for students, and a useful work for consultation by those engaged in practice.—N. Y. Med. Times. This is the fourth edition of this deservedly popu - lar treatise. During the interval since the last edi- tion, it has been subjected to a thorough revision by the author; and all new observations in the pathology and therapeutics of children have been included in the present volume. As we said btfore, we do not know of a better book on diseases of chil- dren, and to a large part of its recommendations we yield an unhesitating concurrence.—Buffalo Med. Journal. Perhaps the most full and complete work now be- fore the profession of the United States; indeed, we may say in the English language. It is vastly supe- rior to most of its predecessors.—Transylvania Med. Journal. CHRISTISON (ROBERT), M. D., V. P. R. S. E., &c. A DISPENSATORY; or, Commentary on the Pharmacopoeias of Great Britain and the United States; comprising the Natural History, Description, Chemistry, Pharmacy, Ac- tions, Uses, and Doses of the Articles of the Materia Medica. Second edition, revised and im- proved, with a Supplement containing the most important New Remedies. With copious Addi- tions, and two hundred and thirteen large wood-engravings. By R. Eglesfeld Griffith, M. D. In one very large and handsome octavo volume, leather, raised bands, of over 1000 pages. $3 50. COOPER (BRANSBY B ) F R S LECTURES ON THE PRINCIPLES AND ' PRACTICE OF SURGERY- In one very large octavo volume, extra cloth, of 750 pages. $3 00. COOPER ON DISLOCATIONS AND FRAC- TURES OF THE JOINTS.—Edited by Bransby B. Cooper, F.R.S., &c. With additional Ob- servations by Prof. J. C. Warren. A new Ame- rican edition. In one handsome octavo volume, extra cloth, of about 500 pages, with numerous illustrations on wood. $3 25. COOPER ON THE ANATOMY AND DISEASES OF THE BREAST, with twenty-five Miscellane- ous and Surgical Papers. One large volume, im- perial 8vo., extra cloth, with 252 figures, on 36 plates. $2 50. COOPER ON THE STRUCTURE AND DIS- EASES OF THE TESTIS, AND ON THE THYMUS GLAND. One vol. imperial 8vo., ex- tra cloth, with 177 figures on 29 plates. $2 00. COPLAND ON THE CAUSES, NATURE, AND TREATMENT OF PALSY AND APOPLEXY. In one volume, royal 12mo., extra cloth, pp. 326. 80 cents. CLYMER ON FEVERS; THEIR DIAGNOSIS, PATHOLOGY, AND TREATMENT In one octavo volume, leather, of 600 pages. $1 50. COLOMBAT DE L'ISERE ON THE DISEASES OF FEMALES, and on the special Hygiene of their Sex. Translated, with many Notes and Ad- ditions, by C. D. Mkigs, M. D. Second edition, revised and improved. In one large volume, oc- tavo, leather, with numerous wood-cuts. pp. 720. S3 50. CARSON (JOSEPH), M. D., Professor of Materia Medica and Pharmacy in the University of Pennsylvania. SYNOPSIS OF THE COURSE OF LECTURES ON MATERIA MEDICA AND PHARMACY, delivered in the University of Pennsylvania. Second and revised edi- tion. In one very neat octavo volume, extra cloth, of 208 pages. $] 50. CURLING (T. B.), F. R.S., Surgeon to the London Hospital, President of the Hunterian Society, tee. A PRACTICAL TREATISE ON DISEASES OF THE TESTIS, SPERMA- TIC CORD, AND SCROTUM. Second American, from the second and enlarged English edi- tion. In one handsome octavo volume, extra cloth, with numerous illustrations, pp.420. $2 00. AND SCIENTIFIC PUBLICATIONS. 9 CHURCHILL (FLEETWOOD), M. D., M. R. I. A. ON THE THEORY AND PRACTICE OF MIDWIFERY. Edited, with Notes and Additions, by D. Francis Condie, M. D., author of a "Practical Treatise on the Diseases of Children," &c. With 139 illustrations. In one very handsome octavo volume, leather, pp.510. $3 00. To bestow praise on a book that has received such marked approbation would be superfluous. We need only say, therefore, that if the first edition was thought worthy of a favorable reception by the medical public, we can confidently affirm that this will be found much more so. The lecturer, the practitioner, and the student, may all have recourse to its pages, and derive from their perusal much in- terest and instruction in everything relating to theo- retical and practical midwifery.—Dublin Quarterly Journal of Medical Science. A work of very great merit, and such as we can confidently recommend to the study of every obste- tric practitioner.—London Medical Gazette. This is certainly the most perfect system extant. It is the best adapted for the purposes of a text- book, and that which he whose necessities confine him to one book, should select in preference to all others.—Southern Medical and Surgical Journal. The most popular work on midwifery ever issued No work holds a higher position, or is more de- serving of being placed in the hands of the tyro, the advanced student, or the practitioner.—Medical Examiner. Previous editions, under the editorial supervision of Prof R. M. Huston, have been received with marked favor, and they deserved it; but this, re- printed from a very late Dublin edition, carefully revised and brought up by the author to the present time, does present an unusually accurate and able exposition of every important particular embraced in the department of midwifery. * * The clearness, directness, and precision of its teachings, together with the great amount of statistical research which its text exhibits, have Berved to place it already in the foremost rank of works in this department of re- medial science.—N. O. Med. and Surg. Journal. In our opinion, it forms one of the best if not the very best text-book and epitome of obstetric science which we at present possess in the English lan- from the American press.—Charleston Med. Journal, guage.—Monthly Journal of Medical Science. The clearness and precision of style in which it is written, and the great amount of statistical research which it contains, have served to place it in the first rank of works in this departmentof medical science. — N. Y. Journal of Medicine. Few treatises will be found better adapted as a text-book for the student, or as a manual for the frequent consultation of the young practitioner.— American Medical Journal. Were we reduced to the necessity of having but one work on midwifery, and permitted to choose, we would unhesitatingly take Churchjll.—Western Med. and Surg. Journal. It is impossible to conceive a more useful and elegant manual than Dr. Churchill's Practice of Midwifery.—Provincial Medical Journal. Certainly, in our opinion, the very best work on the subject which exists.—N. Y. Annalist. BY THE SAME AUTHOR. (Just Issued.) ON THE DISEASES OF INFANTS AND CHILDREN. Second American Edition, revised and enlarged by the author. Edited, with Notes, by W. V. Keating, M. D. In one large and handsome volume, extra cloth, of over 700 pages. $3 00, or in leather, $3 25. In preparing this work a second time for the American profession, the author has spared no labor in giving it a very thorough revision, introducing several new chapters, and rewriting others, while every portion of the volume has been subjected to a severe scrutiny. The efforts of the American editor have been directed to supplying such information relative to matters peculiar to this country as might have escaped the attention of the author, and the whole may, there- fore be «afelv pronounced one of the most complete works on the subject accessible to the Ame- rican Profession. By an alteration in the size of the page, these very extensive additions have been accommodated without unduly increasing the size of the work This work contains a vast amount of interesting matter, which is so well ananged and so curtly worded that the book may be regarded as an ency- clopaedia of information upon the subject of which it treats. It is certainly also a monument of Dr. Churchill's untiring industry, inasmuch as there is not a single work upon the diseases of children with which we are acquainted that is not fully referred to and quoted from in its pages, and scarcely a con- tribution of the least importance to any British or Foreign Medical Journal, for some years past, which is not duly noticed.—London Lancet, Feb. 20, 1858. Availing himself of every fresh source of informa- tion. Dr. Churchill endeavored, with his accustomed industry and perseverance, to bring his work up to the.present state of medica J™owledge,m all the contribution for the illustration of its topics. The material thus derived hasbeen used with consummate skill, and the result has been a work creditable alike to the author and his country.—N. A. Medico-Chir. Review, May, 1858. After this meagre, and we know, very imperfect notice of Dr. Churchill's work, we shall conclude by saying, that it is one that cannot fail from its co- piousness, extensive research, and general accuracy, to exalt still higher the reputation of the author in this country. The American reader will benarticu- larly pleased to find that Dr. Churchill has done full justice throughout his work to the various American authors on this subject. The names of Dewees, Eberle, Condie, and Stewart, occur on nearly every page, and these authors are constantly referred toby the present state ^.^^^^^ndeavor he i ^author in tern, of the highest praise, and with has3we feerbound to say.Cn eminently success- the most libera! courtesy .-The Medical Examiner. ful ' Besides the addition of more than one hundred W(j Tecommend the woric 0f Dr. Churchill most and thirty pages of matter, we observe »"»* Bon\e \ cordially, both to students and practitioners, entirely newand important chapters are introauceu, , vaiuableand-reiiableguide in the treatment of tl CUlUiailJ) UVHI nv dvi««w»»«w »..— ,..-------------, — — valuableandreliable guide in the treatment of the dis- eases of children.—Am. Journ. of the Med. Sciences. We know of no work on this department of Prac- tical Medicine which presents so candid and unpre- judiced a statement or posting up of our actual knowledge as this.—N. Y. Journal of Medicine. Its claims to merit both as a scientific and practi- „,,H cal work, are of the highest order Whilst we language. ™e "^"'"'£""5 £" those who have j would not elevate it above every other treatise on production can only'^n^d °l^( note pub- the same subject, we certainly believe that very few bned wT hYn^he laT twenly nXears in theV ' are equal .to it and none superior.-So-^m Med. ferent taliguagM of Europe having been laid under I and Surgical Journal. BY THE SAME AUTHOR. FSSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PE- ?TTT IAR TO WOMEN. Selected from the writings of British Authors previous to the close of the Eighteenth Century. In one neat octavo volume, extra cloth, of about 450 pages. $2 50. v. '• on "pTaty,i syphU,;, pht-hisis, sclerema, *c &c As the work now stands, it is we believe, the most comprehensive in the English language upon the diseases incident to early life.—Dublin Quarterly Journal, Feb. 1858. It brings before the reader an amount of informa- tion not Comprised in any similar production in the language The amount of labor consumed upon its 10 BLANCHARD & LEA'S MEDICAL CHURCHILL (FLEETWOOD), M. D., M. R. I. A., See. ON THE DISEASES OF WOMEN; including those of Pregnancy and Child- bed. A new American edition, revised by the Author. With Notes and Additions, by D Fran- cis Condie, M. D., author of " A Practical Treatise on the Diseases of Children." With nume- rous illustrations. In one large and handsome octavo volume, leather, of 768 pages. (Just Issued, 1857.) $3 00. This edition of Dr. Churchill's very popular treatise may almost be termed a new work, so thoroughly has he revised it in every portion. It will be found greatly enlarged, and thoroughly brought up to the most recent condition of the subject, while the very handsome series of illustra- tions introduced, representing such pathological conditions as can be accurately portrayed, present a novel feature, and afford valuable assistance to the young practitioner. Such additions as ap- peared desirable for the American student have been made by the editor, Dr. Condie, while a marked improvement in the mechanical execution keeps pace with the advance in all other respects which the volume has undergone, while the price has been kept at the former very moderate rate. extent that Dr. Churchill does. His, indeed, is the only thorough treatise we know of on the subject; and it may be commended to practitioners and stu- It comprises, unquestionably, one of the most ex- act and comprehensive expositions of the present state of medical knowledge in respect to the diseases of women that has yet been published.—Am. Journ. Med. Sciences, July, 1857. We hail with much pleasure the volume before us, thoroughly revised, corrected, and brought up to the latest date, by Dr. Churchill himself, and rendered still more valuable by notes, from the ex- perienced and able pen of Dr. D. F. Condie, of Phil- adelphia.— Southern Med. and Surg. Journal, Oct. 1857. This work is the most reliable which we possess on this subject; and is deservedly popular with the profession.—Charleston Med. Journal, July, 1857. Dr. Churchill's treatise on the Diseases of Women is, perhaps, the most popular of his works with the profession in this country. It has been very gene- rally received both as a text-book and manual of practice. The present edition has undergone the most elaborate revision, and additions of an import- ant character have been made, to render it a com- plete exponent of the present state of our knowledge of these diseases.—N. Y. Journ. of Med., Sept. 1857. We now regretfully take leave of Dr. Churchill's book. Hud our typographical limits permitted, we should gladly have borrowed more from its richly stored pages. In conclusion, we heartily recom- mend it to the profession, and would at the same time express our firm conviction that it will not only add to the reputation of its author, but will prove a work of great and extensive utility to obstetric practitioners.—Dublin Medical Press. We know of no author who deserves that appro- bation, on "the diseases of females," to the. same dents as a masterpiece in its particular department. The former editions of this work have been com- mended strongly in this journal, and they have won their wav to an extended, and a well-deserved popu- larity. This fifth edition, before us, is well calcu- lated to maintain Dr. Churchill's high reputation. It was revised and enlarged by the author, for his American publishers, and it seems to us that there is scarcely any species of desirable information on its subjects that may not be found in this work.—Th* Western Journal of Medicine and Surgery. We are gratified to announce a new and revised edition of Dr. Churchill's valuable work on the dis- eases of females We have ever regarded it as one of the very best works on the subjects embraced within its scope, in the English language; and the present edition, enlarged and revised by the author, renders it still more entitled to the confidence of the profession. The valuable notes of Prof Huston have been retained, and contribute, in no small de- gree, to enhance the value of the work. It is a source of congratulation that the publishers have permitted the author to be, in this instance, his own editor, thus securing all the revision which an author alone is capable of making.—The Western Lancet. As a comprehensive manual for students, or a work of reference for practitioners, we only speak with common justice when we say that it surpasses any other that has ever issued on the same sub- ject from the British press.—The Dublin Quarterly Journal. DICKSON (S. H.), M. D., Professor of Practice of Medicine in the Jefferson Medical College, Philadelphia. ELEMENTS OF MEDICINE; a Compendious View of Pathology and Thera- peutics, or the History and Treatment of Diseases. In one large and handsome octavo volume, of 750 pages, leather. $3 75. As an American text-book on the Practice of Medicine for the student, and as a condensed work of reference for the practitioner, this volume will have strong claims on the attention of the profession. Few physicians have had wider opportunities than the author for observation and experience, and few perhaps have used them better. As the result of a life of study and practice, therefore, the present volume will doubtless be received with the welcome it deserves. This book is eminently what it professes to be; a distinguished merit in these days. Designed for " Teachers and Students of Medicine," and admira- bly suited to their wants, we think it will be received, on its own merits, with a hearty welcome.—Boston Med. and Surg. Journal. Indited by one of the most accomplished writers of our country, as well as by one who has long held a high position among teachers and practitioners of medicine, this work is entitled to patronage and careful study. The learned author has endeavored to condense in this volume most of the practical matter contained in his former productions, so as to adapt it to the use of those who have not time to devote to more extensive works.—Southern Med. and Surg. Journal. Prof. Dickson's work supplies, to a great extent, a desideratum long felt in American medicine.—N. O. Med. and Surg. Journal. Estimating this work according to the purpose for which it is designed, we must think highly of its merits, and we have no hesitation in predicting for it a favorable reception by both students and teachers. Not professing to be a complete and comprehensive treatise, it will not be found full in detail, nor filled with discussions of theories and opinions, but em- bracing all that is essential in theory and practice, it is admirably adapted to the wants of the American student. Avoiding all that is uncertain, it presents more clearly to the mind of the reader that, which is established and verified by experience. The varied and extensive reading of the author is conspicuously apparent, and all the recent improvements and dis- coveries in therapeutics and pathology are chroni- cled in its pages.— Charleston Med. Journal. In the first part of the work the subject of gene- ral pathology is presented in outline, giving a beau- tiful picture of its distinguishing features, and throughout the succeeding chapters we find that he has kept scrupulously within the bounds of sound reasoning and legitimate deduction. Upon the whole, we do not hesitate to pronounce it a superior work in its class, and that Dr. Dickson merits a place in the first rank of American writers.—Western Lancet. AND SCIENTIFIC PUBLICATIONS. 11 DRUITT (ROBERT), M.R. C.S., &c. Tlh\ PRINCIpLES AND PRACTICE OF MODERN SURGERY. Edited n t ^k" Sargent> M. D., author of « Minor Surgery," &c. Illustrated with one hundred and ninety-three wood-engravings. In one very handsomely printed octavo volume, leather, of 576 large pages. $3 00. Pr- Druitt's researches into the literature of his suDject have been not only extensive, but well di- rected; the most discordant authors are fairly and impartially quoted, and, while due credit is given to each, their respective merits are weighed with an unprejudiced hand. The grain of wheat is pre- served, and the chaff is unmercifully stripped off. The arrangement is simple and philosophical, and the style, though clear and interesting, is so precise. that the book contains more information condensed into a few words than any other surgical work with which we are acquainted.—London Medical Times and Gazette. No work, in our opinion, equals it in presenting so much valuable surgical matter in so small a compass.—St. Louis Med. and Surgical Journal. Druitt's Surgery is too well known to the Ameri- can medical profession to require its announcement anywhere. Probably no work of the kind has ever been more cordially received and extensively circu- lated than this. The fact that it comprehends in a comparatively small compass, all the essential ele- ments of theoretical and practical Surgery—that it is found to contain reliable and authentic informa- tion on the nature and treatment of nearly all surgi- cal affections—is a sufficient reason for the liberal patronage it has obtained. The editor, Dr. F. W. Sargent, has contributed much to enhance the value of the work, by such American improvements as are calculated more perfectly to adapt it to our own views and practice in this country. It abounds everywhere with spirited and life-like illustrations, which to the young surgeon, especially, are of no minor consideration. Every medical man frequently nt«ds just such a work as this, for immediate refer- ence in moments of sudden emergency, when he has not time to consult more elaborate treatises.—The Ohio Medical and Surgical Journal. Druitt's work, condensed, systematic, lucid, and practical as it is, beyond most works on Surgery accessible to the American student, has had much currency in this country, and under its present au- spices promises to rise to yet higher fav»r.—Tht Western Journal of Medicine and Surgery. A better book on the principles and practice of Surgery as now understood in England and America, has not been given to the profession.—Boston Medi- cal and Surgical Journal. It may be said with truth that the woTk of Mr. Druitt affords a complete, though brief and con- densed view, of the entire field of modern surgery. We know of nowork on the same subject having the appearance of a manual, which includes so many topics of interest to the surgeon ; and the terse man- ner in which each has been treated evinces a most enviable quality of mind on the part of the author, who seems to have an innate power of searching out and grasping the leading facts and features of the most elaborate productions of the pen. It is a useful handbook for the practitioner, and we should deem a teacher of surgery unpardonable who did not recommend it to his pupils. In our own opinion, it is admirably adapted to the wants of the student.— Provincial Medical and Surgical Journal. DALTON, JR. (J. C), M. D. Professor of Physiology in the College of Physicians, New York. HUMAN PHYSIOLOGY DESIGNED FOR MEDICAL STUDENTS. In one very handsome octavo volume, with about two hundred and fifty original illustrations. (Pre- paring.) DUNGLISON, FORBES, TWEEDIE, AND CONOLLY. THE CYCLOPAEDIA OF PRACTICAL MEDICINE: comprising Treatises on the Nature and Treatment of Diseases, Materia Medica, and Therapeutics, Diseases of Women and Children, Medical Jurisprudence, &c. &c. In four large super-royal octavo volumes, of 3254 double-columned pages, strongly and handsomely bound, with raised bands. $12 00. *** This work contains no less than four hundred and eighteen distinct treatises, contributed by sixty-eight distinguished physicians, rendering it a complete library of reference for the country practitioner. titioner. This estimate of it has not been formed from a hasty examination, but after an intimate ac- quaintance derived from frequent consultation of it during the past nine or ten years. The editors are practitioners of established reputation, and the list of contributors embraces many of the most eminen professors and teachers of London, Edinburgh, Dub- lin, and Glasgow. It is, indeed, the great merit of this work that the principal articles have been fur- nished by practitioners who have not only devoted especial attention to the diseases about which they have written, but have also enjoyed opportunities for an extensive practical acquaintance with them, and whose reputation carries the assurance of their competency justly to appreciate the opinions of others, while it stamps their own doctrines with high and just authority.—American Medical Journ. The most complete work on Practical Medicine extant; or, at least, in our language.—Buffalo Medical and Surgical Journal. For reference, it is above all price to every prac- titioner.—Western Lancet. One of the most valuable medical publications of the day__as a work of reference it is invaluable.— Western Journal of Medicine and Surgery. It has been to us, both as learner and teacher, a work for ready and frequent reference, one in which modern English medicine is exhibited in the most advantageous light.—Medical Examiner. We rejoice that this work is to be placed within the reach of the profession in this country, it being unquestionably one of very great value to the prac- DEWEES'S COMPREHENSIVE SYSTEM OF MIDWIFERY. Illustrated by occasional cases and many engravings. Twelfth edition, with the author's last improvements and corrections In one octavo volume, extra cloth, of 600 pages. 93 20. DKWEES'S TREATISE ON THE PHYSICAL AND MEDICAL TREATMENT OF CHILD- REN The last edition. In one volume, octavo, extra cloth, 548 pages. »2 80. DFWEES'S TREATISE ON THE DISEASES OF FEMALES. Tenth edition. Inonevolume, octavo xtra cloth, 532 pages, with plates. S3 00. DANA ON ZOOPHYTES AND CORALS. In one volume, imperial quarto, extra cloth, with wood- cuts. $15 00. Also, AN ATLAS, in one volume, imperial folio, with sixty-one magnificent colored plates. Bound in half morocco. $30 00. DE LA BECHE'S GEOLOGICAL OBSERVER. In one very large and handsome octavo volume, ex- tra cloth, of 700 pages, with 300 wood-cuts $4 00. FRICK ON RENAL AFFECTIONS; their Diag- nosis and Pathology. With illustrations. On« volume, royal 12mo., extra cloth. 75 cents. 12 BLANCHARD & LEA'S MEDICAL DUNGLISON (ROBLEY), M.D., Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia. NEW AND ENLARGED EDITION, Now Ready, 1858. MEDICAL LEXICON; a Dictionary of Medical Science, containing a conciae Explanation of the various Subjects and Terms of Anatomy, Physiology, Pathology, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Jurisprudence, Dentistry, &c. Notices of Climate and of Mineral Waters; Formulae for Officinal, Empirical, and Dietetic Preparations, &c. With French and other Synonymes. Fifteenth edition, revised and very greatly enlarged. In one very large and handsome octavo volume, of 992 double-columned pages, in small type; strongly bound in leather, with raised bands. Price $4 00. Especial care has been devoted in the preparation of this edition to render it in every respect worthy a continuance of the very remarkable favor which it has hitherto enjoyed. The rapid sale of Fifteen large editions, and the constantly increasing demand, show that it is regarded by the profession as the standard authority. Stimulated by this fact, the author has endeavored in the present revision to introduce whatever might be necessary " to make it a satisfactory and desira- ble—if not indispensable—lexicon, in which the student may search without disappointment for every term that has been legitimated in the nomenclature of the science." To accomplish this, large additions have been found requisite, and the extent of the author's labors may be estimated from the fact that about Six Thousand subjects and terms have been introduced throughout, ren- dering the whole number of definitions about Sixty Thousand, to accommodate which, the num- ber of pages has been increased by nearly a hundred, notwithstanding an enlargement in the size of the page. The medical press, both in this country and in England, has pronounced the work in- dispensable to all medical students and practitioners, and the present improved edition will not lose that enviable reputation. ' The publishers have endeavored to render the mechanical execution worthy of a volume of such universal use in daily reference. The greatest care hns been exercised to obtain the typographical accuracy so necessary in a work of the kind. By the small but exceedingly clear type employed, an immense amount of matter is condensed in its thousand ample pages, while the binding will be found strong and durable. With all these improvements and enlargements, the price has been kept at the former very moderate rate, placing it within the reach of all. This work, the appearance of the fifteenth edition of which, it has betome our duty and pleasure to announce, is perhaps the most stupendous monument of labor and erudition in medical literature. One would hardly suppose after constant use of the pre- ceding editions, where we have never failed to find a sufficiently full explanation of ever) medical term, that in this edition "about six thousand subjects and terms have been added," with a careful revision and correction of the entire work. It is only neces- sary to announce the advent of this edition to make it occupy the place of the preceding one on the table of every medical man, as it is withoutdoubt the best and most comprehensive work of the kind which has ever appeared.—Buffalo Med. Journ., Jan. 1858. The work is a monument of patient research, skilful judgment, and vast physical labor, that will perpetuate the name of the author more effectually than any possible device of stone or metal. Dr. Dunglison deserves the thanks not only of the Ame- rican profession, but of the whole medical world.— North Am. Medico-Chir. Review, Jan. 1858. A Medical Dictionary better adapted for the wants of the profession than any other with which we are acquainted, and of a character which places it far above comparison and competition.—Am. Journ. Med. Sciences, Jan. 1858. We need only say, that the addition of 6,000 new terms, with their accompanying definitions, may be said to constitute a new work, by itself. We have examined the Dictionary attentively, and are most happy to pronounce it unrivalled of its kind. The erudition displayed, and the extraordinary industry which must have been demanded, in its preparation and perfection, redound to the lasting credit of its author, and have furnished us with a volume indis- pensable at the present day, to all who would find themselves au niveau with the highest standards of medical information.—Boston Medical and Surgical Journal, Dec. 31, 1857. Good lexicons and encyclopedic works generally, are the most labor-saving contrivances which lite- rary men enjoy; and the labor which is required to produce them in the perfect manner of this example is something appalling to contemplate. The author tells us in his preface that he has added about six thousand terms and subjects to this edition, which, before, was considered universally as the best work of the kind in any language.—Silliman's Journal, March, 1658. He has razed his gigantic structure to the founda- tions, and remodelled and reconstructed the entire pile. No less than six thousand additional subjects and terms are illustrated and analyzed in this new edition, swelling the grand aggregate to beyond sjxty thousand ! Thus is placed before the profes- sion a complete and thorough exponent of medical terminology, without rival or possibility of rivalry. —Nashville Journ. of Med. and Surg., Jan. 1858. It is universally acknowledged, we believe, that this work is incomparably the best and most com- plete Medical Lexicon in the English language. The amount of labor which thedistinguished author has bestowed upon it is truly wonderful, and the learning and research displayed in its preparation are equally remarkable. Comment and commenda- tion are unnecessary, as no one at the present day thinks of purchasing any other Medical Dictionary than this.—St. Louis Med. and Surg. Journ., Jan 1858. It is the foundation stone of a good -medical libra- ry, and should always be included in the first list of books purchased by the medical student.—Am. Med. Monthly, Jan. 1858. A very perfect work of the kind, undoubtedly the most perfect in the English language.—Med. and Surg. Reporter, Jan. 1868. It is now emphatically the Medical Dictionary of the English language, and for it there is no substi- tute.— N. H. Med. Journ., Jan. 1858. It is scarcely necessary to remark that any medi- cal library wanting a copy of Dunglison's Lexicon must be imperfect.—Cin. Lancet, Jan. 1858. We have ever considered it the best authority pub- lished, and the present edition we may safely say has no equal in the world.—Peninsular Med. Journal, Jan.1858. The most complete authority on the subject to be found in any language.— Va. Med. Journal, Feb. '58. BY THE SAME AUTHOR. THE PRACTICE OP MEDICINE. A Treatise on Special Pathology and The- rapeutics. Third Edition. In two large octavo volumes, leather, of 1,500 pages. $6 25. AND SCIENTIFIC PUBLICATIONS. 13 We believe that it can truly be said, no more com- plete repertory of facts upon the subject treated, can anywhere be found. The author has, moreover, that enviable tact at description and that facility and ease of expression which render him peculiarly acceptable to the casual, or the studious reader. This faculty, so requisite in setting forth many graver and less attractive subjects, lends.additional charms to one always fascinating.—Boston Med. and Surg. Journal, Sept. 1856. The most complete and satisfactory system of Physiology in the English language.—Amer.Med. Journal. DUNGLISON (ROBLEY), M.D., Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia. HUMAN PHYSIOLOGY. Eighth edition. Thoroughly revised and exten- sively modified and enlarged, with five hundred and thirty-two illustrations. In two large and handsomely printed octavo volumes, leather, of about 1500 pages. $7 00. In revising this work for its eighth appearance, the author has spared no labor to render it worthy a continuance of the very great favor which has been extended to it by the profession. The whole contents have been rearranged, and to a great extent remodelled ; the investigations which of late years have been so numerous and so important, have been carefully examined and incorporated, and the work in every respect has been brought up to a level with the present state of the subject. The object of the author has been to render it a concise but comprehensive treatise, containing the whole body of physiological science, to which the student and man of science can at all times refer with the certainty of finding whatever they are in search of, fully presented in all its aspects; and on no former edition has the author bestowed more labor to secure this result. The best work of the kind in the English lan- guage.—Silliman's Journal. The present edition the author has made a perfect mirror of the science as it is at the present hour. As a work upon physiology proper, the science of the functions performed by the body, the student will find it all he wishes.—Nashville Journ. of Med. Sept. 1856. That he has succeeded, most admirably succeeded in his purpose, is apparent from the appearance of an eighth edition. It is now the great encyclopaedia on the subject, and worthy of a place in every phy- sician's library.— Western Lancet, Sept. 1856. BY THE SAME author. (Now Ready.) GENERAL THERAPEUTICS AND MATERIA MEDICA; adapted for a Medical Text-book. With Indexes of Remedies and of Diseases and their Remedies. Sixth Edition, revised and improved. With one hundred and ninety-three illustrations. In two large and handsomely printed octavo vols., leather, of about 1100 pages. f6 00. From the Author's Preface. " Another edition of this work being called for, the author has subjected it to a thorough and careful revision. It has been gratifying to him that it has been found so extensively useful by those for whom it was especially intended, as to require ih&t a. sixth edition should be issued in so short a time afier the publication of a fifth. Grateful for the favorable reception of the work by the profession, he has bestowed on the preparation of the present edition all those cares which were demanded by the former editions, and has spared no pains to render it a faithful epitome of General Therapeutics and Materia Medica. The copious Indexes of Remedies and of Diseases and their Remedies can- not fail, the author conceives, to add materially to the value of the work." This work is too widely and too favorably known to require more than the assurance that the author has revised it with his customary industry, introducing whatever has been found necessary to bring it on a level with the most advanced condition of the subject. The number of illustrations has been somewhat enlarged, and the mechanical execution of the volumes will be found to have undergone a decided improvement. The work will, we have little doubt, be bought and read by the majority of medical students; its size, arrangement, and reliability recommend it to all; no one, we venture to predict, will study it without profit, and there are few to whom it will not be in some measure useful as a work of refer- ence. The young practitioner, more especially, will find the copious indexes appended to this edition of great assistance in the selection and preparation of suitable formulae.—Charleston Med. Journ. and Re- view, Jan. 1858. In announcing a new edition of Dr. Dunglison's General Therapeutics and Materia Medica, we have no words of commendation to bestow upon a work whose merits have been heretofore so often and so justly extolled. It must not be supposed, however, that the present is a mere reprint of the previous edition: the character of the author for laborious research, judicious analysis, and clearness of ex- pression, is fully sustained by the numerous addi- tions he has made to the work, and the careful re- Vision to which he has subjected the whole.—N. A. Mcdico-Chir. Review, Jan. 1858. BY the same author. (A new Edition.) NEW REMEDIES, WITH FORMULA FOR THEIR PREPARATION AND ADMINISTRATION. Seventh edition, with extensive Additions. In one very large octavo volume, leather, of 770 pages. $3 75. Another edition of the « New Remedies" having been called for, the author has endeavored to add everything of moment that has appeared since the publication of the last edition. The articles treated of in the former editions will be found to have undergone considerable ex- pansion in this, in order that the author might be enabled to introduce as far as practicable the results of the subsequent experience of others, as well as of his own observation and reflection, and to make the work still more deserving of the extended circulation with which the preceding editions have been favored by the profession. By an enlargement of the page, the numerous addi- tions have been incorporated without greatly increasing the bulk of the volume.-Preface. One of the most useful of the author's works.— Southern Medical and Surgical Journal This elaborate and useful volume should be found in every medical library, for as a book of re- ference for physicians, it is unsurpassed by any other work in existence, and the double index for diseases and for remedies, will be found greatly to enhance its value.—New York Med. Gazette. The great learning of the author, and his remark- able industry in pushing his researches into every source whence information is derivable,have enabled him to throw together an extensive mass of facts and statements, accompanied by full reference to authorities; which last feature renders the work practically valuable to investigators who desire t» examine the original papers.—The American Journal of Pharmacy. H BLANCHARD & LEA'S MEDICAL ERICHSEN (JOHN), Professor of Surgery in University College, London, &c. THE SCIENCE AND ART OF SURGERY; being a Treatise on Surgical Injuries, Diseases, and Operations. New and improved American, from the second enlarged and carefully revised London edition. Illustrated with over four hundred engravings on wood. In one large and handsome octavo volume, of one thousand closely printed pages, leather, raised bands. $4 50. (Now Ready, December, 185S.) The very distinguished favor with which this work has been received on both sides of the Atlan- tic has stimulated the author to render it even more worthy of the position which it has so rapidly attained as a standard authority. Every portion has been carefully revised, numerous additions have been made, and the most watchful care has been exercised to render it a complete exponent of the most advanced condition of surgical science. In this manner the work has been enlarged by about a hundred pages, while the series of engravings has been increased by more than a hundred, rendering it one of the most thoroughly illustrated volumes before the profession. The additions of the author having rendered unnecessary most of the notes of the former American editor, but little has been added in this country; some few notes and occasional illustrations have, however, been introduced to elucidate American modes of practice. It is, in our humble judgment, decidedly the best book of the kind in the English language. Strange that just such books are notoftener produced by pub- lic teachers of surgery in this country and Great Britain. Indeed, it is a matter of great astonishment. but no less true than astonishing, that of the many works on surgery republished in this country within the last fifteen or twenty years as text-books for medical students, this is the only one that even ap- proximates to the fulfilment of the peculiar wants of youngmen just enteringupon the study of this branch of the profession.— Western Jour, of Med. and Surgery. Its value is greatly enhanced by a very copious well-arranged index. We regard this as one of the most valuable contributions to modern surgery. To one entering his novitiate of practice, we regard it the most serviceable guide which he can consult. He will find a fulness of detail leadinghim through every step of the operation, and not deserting him until the final issue of the case is decided. For the same rea- son we recommend it to those whose routine of prac- tice lies in such parts of the country that they must rarely encounter cases requiring surgical manage- ment.—Stethoscope. Embracing, as will be perceived, the whole surgi- cal domain, and each division of itself almost com- plete and perfect, each chapterfull and explicit, each subject faithfully exhibited, we can only express our estimate of it in the aggregate. AVe consider it an excellent contribution to surgery, as probably the best single volume now extant on the subject, and with great pleasure we add it to our text-books.— Nashville Journal of Medicine and Surgery. Prof. Erichsen's work, for its size, has not been surpassed; his nine hundred and eight pages, pro- fusely illustrated, are rich in physiological, patholo- gical, and operative suggestions, doctrines, details, and processes; and will prove a reliable resource for information, both to physician and surgeon, in the hour of peril.—N. 0. Med. and Surg. Journal. We are acquainted with no other work wherein so much good sense, sound principle, and practical inferences, stamp every page.—American Lancet. ELLIS (BENJAMIN), M.D. THE MEDICAL FORMULARY: being a Collection of Prescriptions, derived from the writings and practice of many of the most eminent physicians of America and Europe. Together with the usual Dietetic Preparations and Antidotes for Poisons. To which is added an Appendix, on the Endermic use of Medicines, and on the use of Ether and Chloroform. The whole accompanied with a few brief Pharmaceutic and Medical Observations. Tenth edition, revised and much extended by Robert P. Thomas, M. D., Professor of Materia Medica in the Philadelphia College of Pharmacy. In one neat octavo volume, extra cloth, of 296 pages. $1 75. FOWNES (GEORGE), PH. D., &c. ELEMENTARY CHEMISTRY; Theoretical and Practical. With numerous illustrations. Edited, with Additions, by Robert Bridges, M. D. In one large royal 12mo. volume, of over 550 pages, with 181 wood-cuts We know of no better text-book, especially in the difficult department of organic chemistry, upon which it is particularly full and satisfactory. We would recommend it to preceptors as a capital " office book" for their students who are beginners in Chemistry. It is copiously illustrated with ex- cellent wood-cuts, and altogether admirably "got up."—N. J. Medical Reporter. A standard manual, which has long enjoyed the reputation of embodying much knowledge in a small space. The author has achieved the difficult task of condensation with masterly tact. His book is con- cise without being dry, and brief without being too dogmatical or general.— Virginia Med. and Surgical Journal. In leather, $ 1 50; extra cloth, $1 35. The work of Dr. Fownes has long been before the public, and its merits have been fully appreci- ated as the best text-book on chemistry now in existence. We do not, of course, place it in a rank superior to the works of Brande, Graham, Turner, Gregory, or Gmelin, but we say that, as a work for students, it is preferable to any of them.—Lon- don Journal of Medicine. A work well adapted to the wants of the student It is an excellent exposition of the chief doctrines and facts of modern chemistry. The size of the work, and still more the condensed yet perspicuous style in which it is written, absolve it from the charges very properly urged against most manuals termed popular.—Edinburgh Journal of Medical Science. FISKE FUND PRIZE ESSAYS. THE EFFECTS OF CLIMATE ON TUBERCULOUS DISEASE. By Edwin Lee, M. R. C. S., London, and THE INFLUENCE OF PREGNA.NCY ON THE DEVELOP- MENT OF TUBERCLES. By Edward Warren, M. D., of Edenton, N. C. Together in one neat octavo volume, extra cloth. $1 00. (Just Ready.) FERGUSSON (WILLIAM), F. R. S., Professor of Surgery in King's College, London, ice. A SYSTEM OF PRACTICAL SURGERY. Fourth American, from the third and enlarged London edition. In one large and beautifully printed octavo volume, of about 700 pages, with 393 handsome illustrations, leather. $3 00. No work was ever written which more nearly I The addition of many new pages makes this work comprehended the necessities of the student and | more than ever indispensable to the student and prac- practitioner, and was more carefully arranged to titioner.—Ranking's Abstract. that single purpose than this.—N. Y. Med. Journal. \ AND SCIENTIFIC PUBLICATIONS. IS FLINT (AUSTIN), M. D., Professor of the Theory and Practice of Medicine in the University of Louisville, &c. (An Important New Work.) PHYSICAL EXPLORATION AND DIAGNOSIS OF DISEASES AFFECT- ING THE RESPIRATORY ORGANS. In one large and handsome octavo volume, extra cloth, 636 pages. $3 00. We can only state our general impression of the high value of this work, and cordially recommend it to all. We regard it, in point both of arrangement and of the marked ability of its treatment of the sub- jects, as destined to take the first rank in works of this class. So far asour information extends, it has at present no equal. To the practitioner, as well as the student, it will be invaluable in clearing up the diagnosis of doubtful cases, and in shedding light upon difficult phenomena.—Buffalo Med. Journal. This is the most elaborate work devoted exclu- sively to the physical exploration of diseases of the lungs, with which we are acquainted in the Englirt language.— Boston Med. and Surg. Journal. A work of original observation of the highest merit. We recommend the treatise to every one who wishes to become a correct auscultator. Based to a very large extent upon cases numerically examined, it carries the evidence of careful study and discrimina- tion upon every pasre. It does credit to the author, and, through him, to the profession in this country. It is, what we cannot call every book upon auscul- tation, a readable book.—Am. Jour. Med. Sciences. NOW COMPLETE, GRAHAM (THOMAS), F. R. S., THE ELEMENTS OF INORGANIC CHEMISTRY, including the Applica- tions of the Science in the Arts. New and much enlarged edition, by Henry Watts and Robert Bridges, M. D. Complete in one large and handsome octavo volume, of over 800 very large pages, with two hundred and thirty-two wood-cuts, extra cloth. $4 00. #*# Part II., completing the work from p. 431 to end, with Index, Title Matter, &c, may be had separate, cloth backs and paper sides. Price $2 50. The long delay which has intervened since the appearance of the first portion of this work, has rendered necessary an Appendix, embodying the numerous and important investigations and dis- coveries of the last few years in the subjects contained in Part I. This occupies a large portion of Part II., and will be found to present a complete abstract of the most recent researches in the general principles of the science, as well as all details necessary to bring the whole work thoroughlf up to the present time in all departments of Inorganic Chemistry. Gentlemen desirous of completing their copies of the work are requested to apply for Part li. without delay. It will be sent by mail, prepaid, on receipt of the amount, $2 50. From Prof. J. L. Crawcour, New Orleans School of Medicine, May 9, 1858. It is beyond all question the best systematic work on Chemistry in the English language, and I am gratified to find that an American edition at a mo- derate price has been issued, so as to place it within the means of students. It will be the only text-book I shall now recommend to my class. It is a very acceptable addition to the library of standard books of every chemical student. Mr. Watts,well known as the translator of the Cavendish Society edition of Gmelin's Chemistry, has made in the supplement an able rfesumfe of the progress of the science since the publication of the first volume. It is plain from the number and importance of the topics there discussed, that great progress has been made in the interval, both in chemical physics and in general inorganic chemistry. Noreader of Eng- lish works on this science can afford to be without thisedition of Prof. Graham's Elements.—Silliman's Journal, March, 1858. From Prof. O. P. Hubbard, Dartmouth College, N. .H.,May20, 1858. I am impressed with the great amount and variety of its contents, and its great value to chemists who have not access to all the current literature of the day in chemistry. Its appendix embraces a great deal of recent investigation not found in any other American republication. From Prof. Wolcott Gibbs, N. Y. Free Academy, May 25, 1858. The work is an admirable one in all respects, and its republication here cannot fail to exert a positive influence upon the progress of science in this country. From Prof. E. N. Horsford. Harvard College, April 27, 1853. It has, in its earlier and less perfect editions, bee« famil'ar to me, and the excellence of its plan and the clearness and completeness of its discussions, have long been my admiration. GRIFFITH (ROBERT EJ, M. D., 8lc. A UNIVERSAL FORMULARY, containing the methods of Preparing and Ad- ministering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceu- tists. Second Edition, thoroughly revised, with numerous additions, by Robert P. Thomas, M. D., Professor of Materia Medica in the Philadelphia College of Pharmacy. In one large and handsome octavo volume, extra cloth, of 650 pages, double columns. $3 00; or bound in sheep, $3 25. It was a work requiring much perseverance, and when published was looked upon as by far the best work of its kind that had issued from the American press. Prof Thomas has certainly "improved," as well as added 'o this Formulary, and has rendered it additionally deserving of the confidence of pharma- ceutists and physicians.—Am. Journal of Pharmacy. We are happy to announce a new and improved edition of this, one of the most valuable and useful works that have emanated from an American pen. It would do credit to any country, and will be found of daily usefulness to practitioners of medicine; it is better adapted to iheir purposes than the dispensato- ries.— Southern Med. and Surg. Journal. It is one of the most useful books a country practi- tioner can possibly have in his possession.—Medical Chronicle. This is a work of six hundred and fifty one pages. embracing all on the subject of preparing and admi- nistering medicines that can be desired by the physi- cian and pharmaceutist.— Western Lancet. The amountof useful, every-day matter, for a prac- ticing physician, is really immense.—Boston Med. and Surg. Journal. We predict a great sale for this work, and we espe- cially recommend it to all medical teachers.—Rich- mond Stethoscope. This edition of Dr. Griffith's work has been greatly improved by the revision and ample additions of Dr. Thomas, and is now, we believe, one of the most complete works of its kind in any language. The additions amount to about seventy pages, and no effort ha? been spared to include in them all the re- cent improvements which have been published in medical journals, and systematic treatises. A work of this kind appears to us indispensable to the physi- cian, and ih<»reis none .ve rnn more cordially recom- mend.—N. Y. Journal of Medicine. 16 BLANCHARD & LEA'S MEDICAL GROSS (SAMUEL D.), M. D., Professor of Surgery in the Jefferson Medical College of Philadelphia, Ice. New Edition (Now Ready.) ELEMENTS OF PATHOLOGICAL ANATOMY. Third edition, thoroughly revised and greatly improved. In one large and very handsome octavo volume, with about three hundred and fifty beautiful illustrations, of which a large number are from original drawings. Price in extra cloth, $4 75; leather, raised bands, $5 25. The very rapid advances in the Science of Pathological Anatomy during the last few years have rendered essential a thorough modification of this work, with a view of making it a correct expo- nent of the present state of the subject. The very careful manner in which this task has been executed, and the amount of alteration which it has undergone, have enabled the author to say that " with the many changes and improvements now introduced, the work may be regarded almost as a new treatise," while the efforts of the author have been seconded as regards the mechanical execution of the volume, rendering it one of the handsomest productions of the American press. A very large number of new and beautiful original illustrations have been introduced, and the work, it is hoped, will fully maintain the reputation hitherto enjoyed by it of a complete and practical ex- position of its difficult and important subject. We most sincerely congratulate the author on the successful manner in which he has accomplished his proposed object. His book is most admirably cal- culated to fill up a blank which has long been felt to exist in this department of medical literature, and as such must become very widely circulated amongst all classes of the profession. — Dublin Quarterly Journ. of Med. Science, Nov. 1857. We have been favorably impressed with the gene- ral manner in which Dr. Gross has executed his task of affording a comprehensive digest of the present state of the literature of Pathological Anatomy, and have much pleasure in recommending his work to our readers, as we believe one well deserving ot diligent perusal and careful study.—Montreal Med. Chron., Sept. 1857. BY THE SAME AUTHOR. A PRACTICAL TREATISE ON*THE DISEASES, INJURIES, AND MALFORMATIONS OF THE URINARY BLADDER, THE PROSTATE GLAND, AND THE URETHRA. Second Edition, revised and much enlarged, with one hundred and eighty- four illustrations. In one large and very handsome octavo volume, of over nine hundred pages. (n leather, raised bands, $5 25; extra cloth, $4 75. A volume replete with tTuths and principles of the utmost value in the investigation of these diseases.— American Medical Journal. On the appearance of the first edition of this work, the leading English medical review predicted that it would have a " permanent place in the literature of surgery worthy to rank with the best works of the present age." This prediction has been amply ful- filled. Dr. Gross's treatise has been found to sup- ply completely the want which has been felt ever since the elevation of surgery to the rank of a science, of a good practical treatise on the diseases of the bladder and its accessory organs. Philosophical in its design, methodical in its arrangement, ample and sound in its practical details, it may in truth be said to leave scarcely anything to be desired on so im- portant a subject, and with the additions aud modi- fications resulting from future discoveries and im- provements, it will probably remain one of the most valuable works on this subject so long as the science of medicine shall exist.—Boston Med. and Surg. Journal. Whoever will peruse the vast amount of valuable practical information it contains, and which we have been unable even to notice, will, we think, agree with us, that there is no work in the English language which can make any just pretensions to be its equal.—N. Y. Journal of Medicine. BY THE SAME AUTHOR. A PRACTICAL TREATISE ON FOREIGN BODIES IN THE AIR-PAS- SAGES. In one handsome octavo volume, extra cloth, with illustrations, pp. 468. $2 75. A very elaborate work. It is a complete summary conclude by recommending it to our readers, fully of the whole subject, and will be a useful book of \ persuaded that its perusal will afford them much reference.—British and Foreign Medico-Chirurg. practiral information well conveyed, evidentlv de- Review. ; rived from considerable experience and deduced from A highly valuablebook of reference on a most im- j an ample collection of facts. — Dublin Quarterly portant subject in the practice of medicine. We I Journal, May, 1855. BY the same author. (Preparing.) A SYSTEM OF SURGERY; Diagnostic, Pathological, Therapeutic, and Opera- tive. With very numerous engravings on wood. GLUGE (GOTTLIEB), M.D., Professor of Physiology and Pathological Anatomy in the University of Brussels, &c. AN ATLAS OF PATHOLOGICAL HISTOLOGY. Translated, with Notes and Additions, by Joseph Leidy, M. D., Professor of Anatomy in the University of Pennsylva- nia. In one volume, very large imperial quarto, extra cloth, with 320 figures, plain and colored, on twelve copperplates. $5 00. GARDNER'S MEDICAL CHEMISTRY, for the use of Students and the Profession. In one royal I'imo. vol., ex. cloth, pp. 396, with illustrations. $1 00. HUGHES' CLINICAL INTRODUCTION TO THE PRACTICE OF AUSCULTATION AND OTHER MODES OF PHYSICAL DIAGNOSIS, IN DISEASES OF THE LUNGS AND HEART. Second American, from the second London edition. 1 vol. royal 12mo., ex. cloth, pp. 304. $1 00. HUNTER (JOHN). (See " Ricord," page 26, for Ricord's edition of Hunter on Venereal.) AND SCIENTIFIC PUBLICATIONS. 17 HOBLYN (RICHARD D.), M. D. A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE COLLATERAL SCIENCES. A new American edition. Revised, with numerous Additions, 1 io° Hays» M. D., editor of the " American Journal of the Medical Sciences." In one large royal 12mo. volume, leather, of over 500 double columned pages. $1 50. If the frequency with which we have referred to tins volume since its reception from the publisher, two or three weeks ago, be any criterion for the future, the binding will soon have to be renewed, even with careful handling. We find that Dr. Hays has done the profession great service by his careful and industrious labors. The Dictionary has thus become eminently suited to our medical brethren in this country. The additions by Dr. Hays are in brackets, and we believe there is not a single page but bears these insignia; in every instance which we have thus far noticed, the additions are really needed and ex- ceedingly valuable. We heartily commend the work to all who wish to be au courant in medical termi- nology.—Boston Med. and Surg. Journal. To both practitioner and student, we recommend this dictionary as being convenient in size, accurate in definition, and sufficiently full and ■Complete for ordinary consultation.—Charleston Med. Journ. and Review. Hoblyn has always been a favorite dictionary, and in its present enlarged and improved form will give greater satisfaction than ever. The American editor, Dr. Hays, has made many very valuable additions. —N. J. Med. Reporter. To supply the want of the medical reader arising from this cause, we know of no dictionary better arranged and adapted than the one bearing the above title. It is not encumbered with the obsolete terms of a bygone age, but it contains all that are now in use ; embracing every department of medical science down to the very latest date. The volume is of a convenient size to be used by the medical student, and yet large enough to make a respectable appear- ance in the library of a physician.—Western Lancet. Hoblyn's Dictionary has long been a favorite with us. It is the best book of definitions we have, and ought always to be upon the student's table.— Southern Med. and Surg. Journal. HOLLAND (SIR HENRY), BART., M.D.,F. R. S., Physician in Ordinary to the Queen of England, ice. MEDICAL NOTES AND REFLECTIONS. From the third London edition. In one handsome octavo volume, extra cloth. $3 00. As the work of a thoughtful and observant physician, embodying the results of forty years' ac- tive professional experience, on topics of the highest interest, this volume is commended to the American practitioner as well worthy his attention. Few will ri^e from its perusal without feel- ing their convictions strengthened, and armed with new weapons for the daily struggle with disease. HABERSHON (S. O.), M. D., Assistant Physician to and Lecturer on Materia Medica and Therapeutics at Guy's Hospital, &c. PATHOLOGICAL AND PRACTICAL OBSERVATIONS ON DISEASES OF THE ALIMENTARY CANAL, OESOPHAGUS, STOMACH, CAECUM, AND INTES- TINES. With illustrations on wood. In one handsome octavo volume. (Publishing in the Medical News and Library for 1858.) HORNER (WILLIAM E.), M. D., Professor of Anatomy in the University of Pennsylvania. SPECIAL ANATOMY AND HISTOLOGY. Eighth edition. Extensively revised and modified. In two large octavo volumes, extra cloth, of more than one thousand pages', handsomely printed, with over three hundred illustrations. $6 00. BY THE SAME AUTHOR. ANATOMICAL ATLAS. page 28. By Professors Horner and Smith. See Smith, HAMILTON (FRANK H.), M. D., Professor of Surgery, in Buffalo Medical College, &c. A COMPLETE TREATISE ON FRACTURES AND DISLOCATIONS. one handsome octavo volume, with several hundred illustrations. (Preparing.) In JONES (T. WHARTON), F. R. S., Professor of Ophthalmic Medicine and Surgery in University College, London, tee. THE PRINCIPLES AND PRACTICE OF OPHTHALMIC MEDICINE AND SURGERY. With one hundred and ten illustrations. Second American from the second and revised London edition, with additions by Edward Hartshorne, M. D., Surgeon to Wills' Hospital, &c. In one large, handsome royal 12mo. volume, extra cloth, of 500 pages. $1 50 We are confident that the reader will find, on perusal, that the execution of the work amply fulfils the promise of the preface, and sustains, in every point, the already high reputation of the author as an ophthalmic surgeon as well as a physiologist and pathologist. The book is evidently the result of much labor and research, and has been written with the greatest care and attention; it possesses that best quality which a general work, like a sys- tem or manual can show, viz : the quality of having all the materials whencesoever derived, so thorough- ly wrought up, and digested in the author's mind, as to come forth with the freshness and impressive- ness of an original production. We entertain little doubt that this book will become what its author hoped it might become, a manual for daily reference and consultation by the student and the general prac- titioner. The work is marked by that correctness, clearness, and precision of style which distinguish all the productions of the learned author.—British and For. Med. Review. 18 BLANCHARD i>d-en