^OJbX A PRACTICAL TREATISE ON THE CAUSES, SYMPTOMS AND TREATMENT SPERMATORRHEA: M. LALLEMAND, # * FORMERLY PROFESSOR OF CLINICAL SURGERY AT THE UNIVERSITY OF MONTPELLIER, ETC. frauslateb mtb ®biteb bg HENRY J. McDOUGALL,. * * MEMBER OF THE ROYAL COLLEGE OF SURGEONS OF .ENGLAND, ETC. ETC. d.tf.< FOURTH AMERICAN EDITION, TO WHICH IS ADDED, ON DISEASES OF THE. YESICULE SEMINALES: AND THEIR ASSOCIATED ORGANSr > * WITH SPECIAL REFERENCE TO THE MORBID SECRETIONS OF THE PROSTATIC AND URETHRAL MUCOUS MEMBRANE. MARRIS WILSON, M.D. PHILADELPHIA: BLANCHARD AND LEA. 1861. H97J mi \ PHILADELPHIA! COLLINS, PRINTER, 705 JAYNE STREET. AMERICAN PUBLISHERS' NOTICE. A considerable period having elapsed since the publica- tion of the work of M. Lallemand, the publishers have thought that the value of the present edition might be en- hanced by the addition of the little treatise of Dr. Marris Wilson, which, since its recent appearance in London, has already acquired a high professional character. The reader will thus have the advantage of comparing the views ad- vanced by M. Lallemand, with the latest results of profes- sional experience, embodying the present state of the sub- ject investigated with the aid of modern pathology. Philadelphia, July, 1858. AUTHOR'S 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 " Iiecherches Anatomic o-P athologiques, 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- able. Many other of these patients were supposed to suffer from chronic gastritis, or gastro-enteritis; from aneurisms near the heart, the early symptoms of phthisis, &c. &c.; and in other cases from nerv- o'us affections, and especially from hypochondriasis. These few words show how frequent, important, and difficult of detection, are involuntary seminal discharges, and to what deplorable errors of treatment they daily give rise : it may be foreseen, too, that their causes must be very varied, and their treatment present con- siderable difficulties. The Brochure of Wickmann and the commentaries on it by Sainte- Maria,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. 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 pro- fessional brethren in an English dress, I have been actuated by the conviction that the disorder, treated of is little understood by the profession generally in this country. The patients affected by it are always hypochondriacal—indeed, the symptoms of hypochondriasis and mental derangement are generally by far the most prominently marked in them—and after the usual remedies for digestive disorder and liver disease have been had recourse to without benefit, the prac- titioner becomes tired of attending a disease which is at best obscure and does not yield to the usual remedies, and either treats his patient as a 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 Vlll PREFACE. an excellent chapter in Mr. Curling's work on Diseases of the Testis, aad 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 repugnant to English feelings as spermatorrhoea—what misery would have been entailed on the human race ? Lecturers on surgery, while entering fully on other diseases of the urethra, appear either not to have been aware of, or by common con- sent to have omitted, spermatorrhoea from their oral lectures and text- books of surgery. Professor Miller, of Edinburgh, having given a short notice of spermatorrhoea in his " Practical Surgery," published in 1846, is, as far as I am aware, the only exception to this rule. At an early part of my professional life my attention was much engaged by two cases, which to me presented peculiar features of interest. One, the case of a near relative since dead, proved par- ticularly unfortunate. The other, the case of a friend of about my own age—also studying medicine— recovered after several relapses ; and the patient is at present practising his profession in her Majesty's service. In both cases the best advice the West of England afforded was obtained without success, or, indeed, even slight improvement, and in neither case was the cause of the disorder, which particularly affected the brain and digestive organs, recognized. The interest I took in these cases led me to suspect, from certain hints thrown out by the patients, that their disorders were somehow connected with the genital organs. Further experience has con- vinced me that my suspicions were correct. A brief outline of these cases may not be uninteresting. R. H------, 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. H----was much disappointed at finding that property, which he had incorrectly believed entailed, and consequently his, as eldest son, was left by will to be equally divided between himself and the rest of his family. His conduct at this period was of the strangest description. He dreaded to go out into the streets of the town where his family resided, refused to join in their meals, and ultimately ab- ruptly left their house to return to London. In 1837 his state had be- come such that in consequence of his repeated letters, members of his family visited London, and on their return took him with them into Devonshire. About this time his mental disorder put on a decided aspect; and I had then, as well as later, ample opportunities of ob- serving his conduct; and frequently heard his complaints. Emissa- ries were constantly on the search for him to arrest him for unnatural crimes committed in London; every one who met him in the street read in his countenance the crimes he had committed ; tailors made his coats with the sleeves the wrong- way of the cloth, in order to brand him with infamy ; the sight of a policeman in the street alarmed him beyond measure ; and often, if a stranger happened to be walking for some little time in the same direction as himself, he would ex- claim that he was one of the emissaries sent to seize him. At other times he would lock himself in his room and weep by the hour. He never took his meals with the family, and never tasted food or drink without first preserving a portion for chemical analysis, as he was con- vinced his friends were in a conspiracy to poison him slowly, in order to wipe out the memory of his crimes. These ideas haunted him night and day. His digestion was much disordered; his sleep broken and restless, and his bowels excessively constipated. His face was flushed, and periodical attacks of cerebral excitement occurred, during which he complained of vertigo, noise in the head, loss of sight, &c. He complained also of loss of memory, and frequently of bodily weak- ness and lassitude. The best medical advice the neighborhood afforded was obtained, unavailingly; the opinions of the gentlemen consulted were, that Mr. H---- was laboring under aggravated hypochondriasis, complicated with monomania. Various causes were suggested as giving rise to the disorder, but no previous case of in- sanity was recollected in any branch of the family. Mr. II—— 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 followed in England. He complained of not being able to obtain efficient medical treatment, although he had applied to the most eminent practitioners in Cincinnati, and afterwards at Philadel- phia and New York. After this, nothing more was heard of Mr. II----until the year 1845, when an American newspaper was for- warded to his friends by an unknown hand, containing an account of his death, and of an inquest held on him, headed, "Death of a Hermit in West Jersey." It was stated that he lived on a small farm, entirely alone, with the exception of a dog, and that he had shunned all intercourse with his neighbors. He was taken suddenly ill, applied to a neighboring farmer for assistance, but died in the course of the following day. From information subsequently ob- tained by his friends, it is believed that he died of apoplexy, or per- haps, in one of the attacks of congestion of the brain, from which he frequently suffered before he left his native country. The symptoms of this unfortunate case strongly resemble those of 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 endeavoring to ruin him by spreading false reports, and to poison him by adulterating his food, and infusing noxious gases into the air. There can be little doubt, on taking into consideration his complaints of weight between the rectum and bladder, with darting pains, &c, in the same region, that the pollutions arose from irritation in the neighborhood of the prostate, and I think, that if at an early period of his disease this had been relieved, there would have been con- siderable hope of his recovery from the hallucinations he manifested. The other case to which I have alluded as particularly attracting 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 his stomach, and he had frequent eructations of fluid which blazed like oil if spit out into the fire. This gentleman's father was a physician, and being naturally anxious for his son, obtained for him the advice of many of the most eminent of the faculty. No improvement took place, however. After he had been six months in this state, I had an opportunity of spending three weeks by the sea side, and my friend accompanied me. We slept in the same room, and he was scarcely ever out of my sight. Before our return his health was almost re- established, and his spirits had returned to their natural condition. Twelve months later, however, he again fell into the same state of despondency, and this time his condition was much worse than on the former occasion. He frequently remained in bed three parts of the day, and no threats or entreaties on the part of his father could induce him to get up. His intellectual faculties were totally pros- trated, and a vacant stare which took the place of his natural lively expression, induced considerable fears of his ultimately becoming idiotic. I was the only person who possessed any influence over him, which may perhaps be attributed to his feeling that I was aware of the cause of his disorder. This state continued between three and four months, during which time I was with him as much as my other 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 unrecognized, and the remedies consequently useless, while the habit of abuse was continued. Such were the two cases which first attracted my attention to the influence of the generative organs over the system generally, and the brain especially; and my suspicions once awakened, further observa- tions soon convinced me of their correctness, as well as of the fre- quent occurrence of such cases. I was soon convinced, too, that the profession generally, either were not aware of the immense import- ance of these discharges, or that, by a kind of common consent, they neglected to recognize a subject certainly repugnant to delicacy. As a consequence, sufferers finding themselves neglected by their ordinary medical attendants, rush to find relief wherever there seems to them the slightest chance of its being obtained ; and the ignorant and rapacious advertising quacks have a rapid and profitable sale for their injurious nostrums. Several cases of gross imposition by these charlatans have come under my notice, which it is my intention, at some future period, to lay before the profession in one of our medi- cal periodicals. Their introduction here would swell these prefa- tory observations to an inconvenient length. It now remains for me to make a few remarks on one or two points of my own experience respecting the symptoms and treatment of spermatorrhoea. One symptom which I have three times met with as the result of masturbation, is little more than alluded to by M. Lalle- mand—I mean epilepsy. Masturbation is admitted by most medical men to be a frequent cause of epilepsy ; and I am surprised to find that M. Lallemand has related no cases in which epilepsy occurred. Two of the three cases to which I have alluded were simple uncom- plicated cases of epilepsy brought on by masturbation. In these after the masturbation had been arrested the effect ceased. The third case, however, was by no means so successful; it occurred in a 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. Xlll this case, and still more that I lost sight of the patient, as I am in- clined to believe that the epileptic paroxysms might have been kept up by involuntary seminal discharges, after having been once ex- cited by masturbation. This is a point which I earnestly recommend to the attention of the profession. Another very frequent symptom in cases of spermatorrhoea, is the occurrence of urethral discharge from very slight excitement. Several cases of this kind have come under my notice, the patients having consulted me on account of the discharge. These cases often give rise to distressing suspicions, and much family unhappiness, espe- cially as they often occur in married men. The symptoms are often almost as severe as those of a virulent clap, and the discharge is at- tended with great irritation in the neighborhood of the prostate, and frequent desire of micturition. The discharge came on in one case of a married man who consulted me, after taking a single tumbler of whiskey and water at night—this' gentleman not having been in the habit of taking spirits for several years, on account of continued ill health. The discharge in these cases is thicker than that of or- dinary clap, and sticks in patches on the linen. These patches may be scaled off, after which there is little mark left, and the discharge seldom penetrates through calico, so that on the opposite side of the shirt there is little or no appearance of stain. On wetting the linen, the discharge feels slippery, and it is washed off with difficulty. I am inclined to believe that these discharges are not contagious ; but notwithstanding this, sexual intercourse should be avoided on account of the injury that may result to the patient himself. In most cases, indeed, connection is impossible during the first stages of the dis- charge, on account of the painful chordee to which excitement gives rise. I have generally, on questioning these patients, found that such discharges were connected more or less with deficiency of generative power. In the case I have above alluded to. impotence was almost complete ; and in another similar case occurring in the person of a married surgeon, the powers had greatly declined. Both these pa- tients were in the prime of life, and both had, in their youth, led very irregular lives. The irritation in these cases, I am inclined to believe, is situated in the posterior part of the urethra. Indeed, the surgeon whose case I have just alluded to, believed himself affected by enlarged prostate—many of the symptoms of which generally accompany the discharge I have described, especially frequent desire to pass 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 ray experience goes, returned after subsequent excitement— a circumstance which is very apt to occur when the discharge has been arrested by other means. The involuntary seminal discharges often present in these cases, and to which the diminution of virile power is generally due, are also at the same time arrested, and the patient experiences a return of vigor wholly unexpected. This peculiar form of urethral discharge has hitherto for the most 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- nection, however positive the patient may be that such has not taken place. In all the cases I have hitherto met with, however, the pa- tients have admitted that they had previously been affected with con- 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 careful attention of the profession. The diagnosis of spermatorrhoea, in aggravated and long-standing cases, is by no means easy. When frequent diurnal pollutions have deteriorated the patient's health—discharge of watery semen taking place almost every time the patient makes water—the spermatozoa are often only distinguishable under the microscope after a long-con- tinued and patient manipulation; and perhaps for no researches con- nected with medical science is it more important to possess one of the best microscopes. When I first commenced the study of this subject, I was more than once tempted to give it up in despair, in consequence of my not possessing a perfect microscope. At present I use one of Powell's instruments, which I prefer to those constructed by Ross, on account of the greater convenience of the motions of the stage__a matter which will be found of much importance in all researches re- quiring delicate manipulation. The eighth of an inch object glass will be found almost indispensable in the study of these cases al- though the spermatozoa in healthy semen can be perfectly well exa- mined with an object glass of a quarter of an inch focal leno-th. M. Lallemand has described the operation of cauterization as a very painful one, and its after effects as very severe. This by no means accords with my experience. In no case in which I have performed the operation has the pain been severe, or the subsequent inflammation violent ; indeed, I have several times had difficulty in persuading the patients to remain twenty-four hours in bed after the operation—a precaution which I have thought advisable in all cases At first I feared that sufficient inflammation had not been excited and that the operation would require to be repeated—this has only hap- PREFACE. XV pened in my practice once, however, and in that case I am inclined to think that the caustic was not properly applied to the surface of the prostate on the first occasion. The instrument commonly sold for the purpose of cauterizing the prostate, by instrument makers in this country, is, in my opinion, exceedingly defective. From its being made nearly straight, it is by no means easily introduced while the patient is lying down—and in no other position ought the operation to be attempted—the irrita- bility of the canal, too, increases the difficulty of introduction, and consequently every possible facility should be given to the operator, by having the instrument constructed of a convenient form. It is difficult, also, to measure the length of the passage exactly by apply- ing a curved catheter to a nearly straight porte-caustique. I have, therefore, had an instrument constructed of precisely the same curve as the catheters I generally use. This instrument is rather larger than those generally sold, being about the size of a number 6 cathe- ter, and its bulbous extremity is two sizes larger, or as krge as a No. 8 catheter; with this instrument many of the difficulties of cauteri- zation are avoided. It can be easily introduced like an ordinary catheter while the patient is lying on his back ; the moment when the. bulb enters the neck of the bladder is clearly distinguishable by the sensation communicated ; and the caustic, on account of the greater size of the curvette, is more fairly applied to the whole of the infe- rior surface of the urethra, which is to a certain extent distended by its presence. With regard to the other precautions to be used, I quite agree with M. Lallemand. In translating the following pages, I have endeavored more to render the sense of the author in as few words as possible, than to give a full and literal translation. I must beg my readers to bear in mind, that M. Lallemand's treatise consists of three thick octavo volumes—these having been written at different periods, there are of course many repetitions, which I have, as much as possible, en- deavored to avoid. The total number of cases related by M. Lalle- mand is one hundred and fifteen. Of these I have selected sixty- two, which, after mature consideration, appear to me to illustrate the subject sufficiently. The same reason which induced me to omit so many of M. Lallemand's cases, has prevented me from inserting cases from my own experience. As I have endeavored to render this entirely a practical work—I have omitted M. Lallemand's inter- esting researches on the spermatozoa, except as far as they refer to the diagnosis of spermatorrhoea, as well as several digressions made by M. L. to topics of no practical interest in this country ; of these a disquisition on the character of J. J. Rousseau is one of the most remarkable. . . In speaking of spermatorrhoea arising from contagious urethritis, I have avoided the word gonorrhoea as being a misnomer, substi- tuting for it blennorrhagia, which is certainly more correct in its derivation, although also liable to some objections. XVI PREFACE. I 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 fed 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 . . . . .36 Case I.—Blennorrhagia—Diurnal Pollutions—Hypochondriasis—Chro- nic 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 —Nothing remarkable in the other organs . . .37 Case II. — Blennorrhagia — Spermatorrhoea — Hypochondriasis — Fre- quent attacks of Cerebral Congestion—Death. Autopsy—Suppu- ration in the Seminal Vesicles—Ossific deposit in the Vasa Defer- entia—Cystitis—Phlebitis—Old adhesions of the Arachnoid and Pleurae—Abscesses in the muscles of the Neck and Shoulders . 42 Case III.—Blennorrhagia—Retention of Urine, &c.—Apoplexy—Death. Autopsy—Effusion of Blood into the left Ventricle of the Brain— Hypertrophy of the Heart—Gastro-enteritis—Abscess and Tuber- cles in the Kidney and Prostate—Stricture, &c. . . .46 Case IV.—Mental 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 . 49 Summary of the preceding Observations.—Symptoms . 49 Lesions in the Prostate . . . . .51 In the Spermatic Organs . . . .53 In the Orifices of the Ejaculatory Ducts . . 54 2 XV111 CONTENTS. In the Ejaculatory Bucts 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 53 61 CHAPTER III. CAUSES OF SPERMATORRHEA. Blennorrhagia . . . . • .62 Case V.—Lymphatic Temperament—Blennorrhagia—Orchitis—Nephri- tis—Nocturnal and Diurnal Pollutions—Abuse of Mercurials— Injurious effects of Cold and Tonics—Cure by means of Leeches, the use of Flannel and Milk Diet—Fresh attack of Blennorrhagia —Same Treatment with the same Result . . . .62 Case VI.—Masturbation—Blennorrhagia—Diurnal Pollutions—Failure of the ordinary modes of Treatment—Cauterization of the Pros- tatic Portion of the Urethra—Rapid Recovery . . .66 Case VII.—Abuse of Spirituous Liquors—Blennorrhagia—Nocturnal Pollutions—Impotency—Frequent discharge of Urine—Cauteri- zation—Cure ....... 69 Case VIII.—Masturbation — Blennorrhagia, repeated anti-venereal Treatment—Diurnal Pollutions—Increasing Weakness, especially of the Mental Faculties—Extreme Emaciation—Cauterization, and Cure after Sixteen Years—Venereal Excess, Relapse—Cau- terization again performed with success . . . .71 Case IX.—Blennorrhagia followed by Excoriations of the Glans Penis —Spermatorrhoea—Cauterization unsuccessful—Artificial Sul- phur Baths—Cure ...... 74 Consideration of the Causes . . . . .75 Mode of Action . . . . . .77 Treatment of Spermatorrhoea following Blennorrhagia . 79 Symptoms of Spermatorrhoea arising from Blennorrhagia . 80 CHAPTER IV. CAUSES OF SPERMATORRHEA—CONTINUED. Cutaneous Affections . Case X.—Itch during Ten Months, at about the age of Fourteen__Pain in the Epigastrium—Tumor of the Testicle—Chronic Inflam- mation of the Bladder—Diurnal Spermatic Discharges__Hypo- chondriasis. Cure by Cauterization at the age of Twenty-eight . 81 81 CONTENTS. XIX CHAPTER V. CAUSES OF SPERMATORRHEA—CONTINUED. Influence of the Rectum .... Case XL—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 Praeputialis, alternating in a remarkable manner with Irritation in the Prostatic Portion of the Urethra—Noctur- nal 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 alternating with other Affections—Habitual bad Health—Hypo- chondriasis—Spermatorrhoea undiscovered during Twenty-five Years—Cure by Sulphuretted Baths . . . .88 Consideration of Causes . . • • .90 Mode of Action . . • • • .91 Irritation of the Rectum . . . • .92 Treatment of these Cases . • • • .92 93 93 97 98 Case XV.—Spermatorrhoea from a Mechanical Obstacle to Defecation- Division of the Stricture—Rapid and Complete Cure . • Case XVI.—Spermatorrhoea induced by Chronic Diarrhoea, and kept up by a Mechanical Obstacle to defecation—Removal of a Scirrhous Tumor from the anus—Rapid and Perfect Cure . . 94 Case XVII.—Hemorrhoids from the age of Puberty—Difficulty in evac- uating the Rectum at the age of Twenty-eight—Spermatorrhoea —Cure . • • • • ' Case XVIII.—Blennorrhagia, Constipation—Fissure of the Anus—Dis- charge of Semen at Stool—Profound Hypochondriasis—Desire of committing Suicide—Diarrhoea—Cure of the Fissure of the Anus —Disappearance of the other Symptoms Case XIX.—Horse Exercise — Constipation — Spermatorrhoea—Impo- tence—Frequent and violent Attacks of Cerebral Congestion- Ascending Douches—Cauterization—Sulphur Baths—Hot and Cold Douches on the Loins and Perineum—Cure . • 1UU Case XX.—Lengthened exposure to severe Cold—Incomplete Paralysis of the Rectum—Seminal Discharges during Defecation—Cure by the application of Galvanism . . . . 105 Case XXI.—Intemperance—Lengthened exposure to Cold—Chronic In- flammation of the Bladder—Involuntary Seminal Discharges, &c. —Cauterization—Cure—Relapse—Same Treatment with the same Result—Remarkable influence of the Bladder on the Rectum . 108 Case XXII.—Unsuspected Spermatorrhoea—Attacks of Cerebral Con- gestion—Disorder of the General Health—Ascandes expelled from the Rectum, with immediate Recovery . . .111 XX CONTENTS. Case XXIII.—Masturbation at Nine Years of Age—Constant Nocturnal Emissions—Ascarides—Cure in Eight Days . .113 Case XXIV.—Hypochondriasis—Impotence—Attacks of Cerebral Con- gestion—Ascarides—Cure within Eight Days . . 114 Case XXV.—Nocturnal Pollutions resisting all modes of Treatment during Six Years—Great Physical and Moral Depression—Ex- pulsion of Ascarides with complete Relief . . .114 Case XXVI.—The habit of Masturbation contracted spontaneously at the 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 of Ascarides followed by a rapid Recovery . . .119 Remarkable case of Urethral Discharge kept up by Ascarides —Editor's note to page .... 121 Case XXVIII.—Masturbation at the age of Ten—Seminal Emissions produced by Horse Exercise—Nocturnal, and afterwards Diurnal Pollutions—Constant Erections—Stools Relaxed, and containing abundance of Mucus—Burning at the Anus—Cauterization, with slight benefit—Expulsion^ of Ascarides followed by rapid and complete Recovery ...... 123 Resume ....... 125 CHAPTER VI. CAUSES OF SPERMATORRHEA—CONTINUED. Abuse ....... Case XXIX.—Masturbation—Nocturnal Pollutions—Palpitation and Dyspnoea simulating Cardiac Disease—Repeated Venesection fol- lowed by increased Disorder—Sulphuretted Baths and rapid Re- covery ..... Case XXX.—Masturbation at the age of Eight Years—At Twelve, verv frequent Emissions of Urine—At Sixteen, Coitus Impossible- Nocturnal and afterwards Diurnal Pollutions—Cauterization at the age of Twenty-eight, followed by rapid Recovery Case XXXI.—Masturbation at the age of Seventeen, carried'so far as to cause emission of Blood, but soon afterwards abandoned__In- creasing Debility during Four Years—Symptoms of Phthisis" Laryngea and Chronic Gastritis—Extreme Prostration—Cauteri- zation followed by rapid re-establishment Case XXXII.—Masturbation from Twelve to Twenty-one Years of iv'c —Melancholy—Inclination to Suicide—Serious alteration of the Health—Monomania—Unperceived Diurnal Pollutions__Cauteri- zation followed by perfect Recovery . 126 126 127 130 131 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— Nocturnal and Diurnal Pollutions—Cauterization—Slow, but pro- gressive improvement ...... Case XXXV.—Masturbation at Sixteen Years of Age—At Twenty-one, compression of the Uretha during Ejaculation, followed by a sen- sation of tearing, and acute pain—Urethral Discharge recurring frequently—Discharges of Semen during Defecation and the emis- sion of Urine—Reciprocal Influence of the Discharges on the Di- gestive Organs—Chronic Catarrh of the Bladder—Cauterization— 135 137 139 ivecuvery aiier several reiapaeB . . Causes of Abuse . . 142 Internal or Predisposing Causes . 143 External or Exciting Causes . . 143 Varieties of Abuse .... . 148 Effects of Abuse . . . . . 153 Effects on Children and on Females . . 155 Effects of Temperament, Idiosyncrasy, &c. . 158 Urethral Discharges following Abuse . 158 Prostatitis ..... • 159 Cystitis ..... . 159 Emissions of Blood .... . 159 Orchitis ..... . 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—Increas- ing Derangement of Health—Symptoms of Gastritis, and of disease of the Heart—Repeated Abstraction of Blood—Nocturnal and afterwards, Diurnal Pollutions; Milk Diet, &c—Acupuncture followed by perfect Recovery . Case XXXVIL—Robust Constitution—Venereal Excesses continued till the age of Twenty-four—Chronic Inflammation of the Bladder- Nocturnal and Diurnal Pollutions—Cauterization followed by per- fect Recovery ....••• Case XXXVIIL—Three attacks of Blennorrhagia—Hypochondriasis— Danger of Suicide—Recovery—Marriage a few months after- Change in the moral Faculties—Disordered Digestion—Consti- 161 161 165 XXII CONTENTS. pation—Agitation—Insomnia—Fits of Passion—Symptoms of Mental Derangement—Impotence—Nocturnal and Diurnal Pol- lutions—Cauterization followed by rapid Recovery—Excesses Re- peated—Relapse ....... 166 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 ....... 170 Case XL.—Sanguineous Temperament—Masturbation from Fourteen to Eighteen Years of age—Marriage at Nineteen—Immediate im- provement in the Health—Afterwards disorder of the System— Hypochondriasis—Inclination to Suicide—Symptoms of Chronic Gastritis treated for Six Years with Leeches, Blisters, &c.—Noc- turnal and Diurnal Pollutions—Frequent Discharge of Urine— Cauterization followed by a rapid and complete Cure . . 172 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 ...... 173 Case XLII.—Masturbation—Venereal Excesses—Prolonged Horse Ex- ercise—Blennorrhagia—Nocturnal and Diurnal Pollutions—Two Cauterizations—Recovery—Premature Excesses—Relapse—Cure by another Cauterization ...... 175 Case XLIII.—Lymphatic Temperament—Early and Long continued Masturbation—Horse Exercise—Infrequent Coitus—Urethritis__ Repeated attacks of Inflammation in the Testicles—Frequent dis- charge of Urine—Pollutions during Defecation—Imperfect Ejacu- lation—Two Cauterizations followed by perfect Recovery . 177 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 Antiphiogistics and Rest . . igo Case XLV.—Coitus in a state approaching Inebriety—Gleet increased by a Journey—Diurnal Pollutions—Cauterization with rapid Im- provement—Relapse from premature fatigue of the Organs—Cure by means of Antiphiogistics and Rest Resumd 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 . 182 • . 183 • . 184 • . 187 • . 188 . 188 • . 188 • . 188 . 191 • . 192 • . 192 CONTENTS. XXlll CHAPTER VIII. CAUSES OF SPERMATORRHEA—CONTINUED. Action of certain Medicines ..... 196 Astringents ....... 196 Case XLVI.—Intermittent Fever—Large Dose of Bark—Obstinate Con- stipation—Diurnal Pollutions—Symptoms of Chronic Gastritis, and of Disease of the Heart—The use of Douches followed by , rapid Improvement ..... 196 Purgatives ....... 197 Narcotics . . . . . . . 198 Case XLVII.—Frequently repeated Narcotism at the age of Sixteen from the Vapor of Tobacco—Dilatation of the Pupils—Vomiting —Constant Headache—Constipation—Nocturnal and Diurnal Pol- lutions—Impotence — Cauterization at the age of Nineteen— Rapid Recovery ..... . 198 Case XLVIII.—Nervous Temperament—Repeated Narcotism from Smok- ing between the ages of Twenty and Twenty-two—Impotence, &c. 200 Cantharides . Camphor Nitrate of Potass Ergot of Rye Coffee Case XLIX.—Excessive use of Coffee—Frequent and profuse Discharge of Urine—Nocturnal and afterwards Diurnal Pollutions—Impo- tence, &c.—Cauterization—Sulphuretted Baths—Recovery . 204 Tea........205 CHAPTER IX. CAUSES OF SPERMATORRHEA—CONTINUED. Action of the Cerebro-spinal System .... 206 Case L.—Masturbation—Extreme weakness of the Limbs and Senses- Erections exited by Percussion of the Occiput—Catheters left in the Urethra—Rapid Recovery .... 207 Case LI.—Sickly Childhood —Nervous Temperament — Masturbation Rare—Coitus still more so—Symptoms of Aneurism and Gastritis —Nocturnal Pollutions—Predominance of Erotic Ideas—Tension at the Nucha—The application of cold Lotions to this Region fol- lowed by considerable Improvement .... 208 Action of the Spinal Cord . . . . .211 . 202 . 202 . 203 . 203 XXIV CONTENTS. CHAPTER X. CAUSES OF SPERMATORRHEA—CONTINUED. Congenital Predisposition . *y" Sebaceous Matter ...••• 213 Case LIL—Natural Phimosis—Frequent Nocturnal Pollutions from the age of Puberty—Abundant and Fetid sebaceous Secretion be- tween the Glans and Prepuce—Circumcision at the age of Twenty- three followed by immediate Relief . «1«> Natural Phimosis ...••• 214 Case LIIL—Natural Phimosis —Erections at the age of Eight—At- tempts at Coitus at Nine—Vesical Catarrh—Diurnal Pollutions —Paraplegia, &c. .... • -14 Case LIV.—Very long Prepuce—Badly developed Genital Organs— Childhood Delicate—Incontinence of Urine—Sebaceous Discharge from the Orifice of the Prepuce at the age of Ten—Nocturnal Pollutions increasing in frequency—Hypochondriasis—Loss of Memory and failure of Intellect—Constipation—Diurnal Pollu- tions—Constant application of Lotions attended by Relief—Cir- cumcision at the age of Twenty-eight, followed by Cure . . 217 Case LV.—Very long Prepuce—Badly developed erectile Tissues— Abundant Secretion of Sebaceous Matter—Seminal emissions induced by Horse Exercise, and afterward, by incomplete Inter- course—Marriage unconsummated during Five Years—Diurnal Pollutions—Circumcision followed by rapid Cure . . 219 Exuberant Prepuce ...... 220 Abundant and vitiated secretion of Sebaceous Matter . 221 Congenital Debility ...... 224 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 treatment 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 Micturi- tion, &c. . . . . . . .230 Case LIX.—Lymphatic Temperament—Incontinence of Urine__Neither Masturbation nor Sexual Intercourse—More and more frequent Nocturnal Pollutions—Relaxation of the Sphincters of the Anus and Neck of the Bladder—Treatment unsuccessful