LIBRARY OF CONGRESS. ®(fap. - icpgriglji 1a Shelf.X-i'6 UNITED STATE8 OF AMERICA. NERVOUS EXHAUSTION: ITS CAUSE AND CURE. COMPRISING A Series of Bistit Lectures on Debility and Disease, AS DELIVERED NIGHTLT AT Dr. Kahn's Museum of Anatomy, PRACTICAL INFORMATION ON MARRIAGE, ITS OBLIGATIONS AND IMPEDIMENTS. ILLUSTRATED WITH CASES. INCLUDING PICTURES FROM REAL LIFE, OR PHOTOGRAPHIC LIFE STUDIES, ADDRESSED TO THE YOUNG, THE OLD, THE GRAY THE GAY. By DR. L. J. KAHN, LECTURER ON ANATOMY, PHYSIOLOGY, AND SCIENCE ; AUTHOR OF M THE LUNGS IN HEALTH AND IN DISEASE '" MEDICAL ESSAYS AND REVIEWS, ETC., ETC. ffo, 51 EA ST TENTH STREET, bet. University Place & Broadway, JfEW YORK, a. Entered according to Act of Congress, in the year 1870, by Dr. L. J. KAHN, In the Clerk's Office of the District Court of the United States for the Southern District of New York. CONTENTS. PAGE. Preface 5 LECTURE I. The Anatomy and Physiology of the Urinary and Generative Organs , 9 LECTURE II. Physiology of Marriage 18 LECTURE III. Onanism, or Self-pollntion 30 LECTURE IV. Of Nocturnal Emissions, Seminal Weakness, Im- potence, Sterility, and Nervous Exhaustion. . . 53 LECTURE V. The Moral and Physical Effects of Self-abuse, Sper- matorrhea, Impotence 80 Modern Treatment of Spermatorrhoea, Seminal Weakness . and Nervous Debility 89 On Certain Urethral Discharges 95 IV CONTENTS- LECTURE VI. PAGE, Vene* eal Disease : — History 96 Diseases of Infection — Gonorrhoea, or Clap 103 Gleet 106 Stricture 108 Syphilis, or Pox. 10 r J Secondary Symptoms; Effects of Mercury, &c 113 LECTURE VII. Certain Means by which a Correct Knowledge of the Patient's Case may be Obtained 116 LECTURE VIIL On Skin Diseases 120 APPENDIX. Selections from my Case-Book 129 PICTURES FROM REAL LIFE. Picture First : The Young Sensualist 172 Picture Second : The Bachelor Sensualist 177 Picture Third : The Married Sensualist 180 Picture Fourth : The Widower Sensualist 183 Picture Fifth : The Sceptic Sensualist 187 Picture Sixth : The Promiscuous Sensualist 191 To Patients and Invalid Readers 195 PREFACE. The following chapters have been written for the purpose of imparting some little information on subjects of the greatest importance. The frightful ravages of Spermatorrhoea, and the dire effects of Syphilis, are matters which must almost alarm the calm impartial observer. If anything can therefore be done to stay the mighty torrent, he who, having the means at his command, should neglect to do it would be criminal. The cause of humanity — of religion — demands assistance from all who are in a position to give it. Feeling this, I have done w T hat I could. The following pages are pre-eminently prac- tical: I am no theorist. To offer theory when assistance is required is very like giving a stone in answer to a request for bread. Speculation we have enough of — hypothesis we are nearly surfeited with — what we want is something that can be put into practice. I have related my own medical experience, and narrated cases that have come under my own observation. 6 PREFACE. This may seem egotistical, but it is the only- true method of procedure. Why should I de- vote my book to what occurred to others ? I know nothing of it, except by hearsay. What I have seen, that I speak of, because that I know. Nor have I succumbed to that false prudery which is so prevalent in society: Lhave disregarded it because I believe it to be mis- chievous and to have no connection with real, genuine modesty. I have told plain facts, and those who affect to be shocked at them will only remind me of the young lady whose modesty was so great that she could not look at the naked truth. My aim is a good one : if men misinterpret my motive I cannot help it, nor do I care for what they may say. But it is now quite unnecessary to make any apology for publishing a book of this nature. The importance of the subject on which it treats has long been recognized by the Pulpit and by the Press, by the learned and by the unlearned, by the Medical Profession, and by their patients. I do not hesitate to assert that the lessons taught by this little book will prove of the greatest value to all who study them in a proper spirit. The laws of the Creator are absolute and unchanging ; it is impossible to PREFACE. 7 do evil or to violate those laws without ill effects resulting. Health is essential to happiness ; and to enjoy health we must study the unchang- ing laws which govern it, and they are not difficult to understand. Years of experience have proved that many of the most fatal dis- eases to which man is subject arise from unre- strained passions and vicious indulgences. "The solitary vice of Self-pollution, " says Dr. Wood- ward, "spreads desolation through the land." When we see the miserable victims of an in- sidious and unsuspected disease slowly but steadily emaciating ; when we view a series of phenomena faintly and indistinctly character- istic of a great variety of disorders, such as consumption, wasting away, loss of energy, physical and mental, and actual brain disease, can we surrender without remorse — secundum artem, as it were — the unhappy sufferer to his fate ? Shall we not rather, despite false deli- cacy, investigate the origin and causes of such diseases, and endeavor to determine the true principles of their cure ? To these investiga- tions the microscope has proved an invaluable assistance, and the most important recent dis- coveries are due to its aid. The discovery of the §permatozq4 and their existence in the 8 PREFACE, spermatic fluid of all animals, proved that their presence was essential to reproduction. Hence a microscopic examination of urethral dis- charges, or of the urine, furnishes means for a correct diagnosis of some of the most obscure cases of spermatorrhoea and impotence. The author takes this opportunity of tendering his thanks to his numerous friends, patients, and to the public generally, for the favor with which his previous works on the subject have been re- ceived. I have endeavored in this treatise to give the result of my mature experience in lan- guage simple and free from technicalities. If I am successful in warning one who would have fallen of the fearful consequences of vice ; of restoring one to hope who had otherwise been hopeless, this work has not been written in vain. In conclusion, I may observe that those who wish to apply for advice or assistance may confidently do so without hesitation or diffi- dence ; as the most timid may rely on my in- variably regarding that inviolable secrecy which has already proved the basis of an extensive and respectable professional reputation. L. J. Kahst, M.D. M East Tenth Steeet, New York, NERVOUS EXHAUSTION. LECTUKE I. THE ANATOMY AND PHYSIOLOGY OF THE URIN- AKY AND GENERATIVE ORGANS. In these days of general education, every man ought to possess a certain knowledge of the com- position of his frame, the science known as Anatomy ; * and also the mode that nature adopts to carry out the necessities of life, that is Physiology. The present work being devoted to the consideration of special maladies, their causes, prevention, and treatment, it will be sufficient for our object to give a brief and popular description of the generative organs, in order that the nature of the diseases may be fully understood. We are indeed "fearfully * "Anatomy is the science of organization. Physio- logy is the science of life." — Richkrand. 10 KEEVotis Ex&Aumosf. and wonderfully made ;" the great importance of the generative organs, and their preservation in a state of health and vigor, are essential to well-being, both physical and mental. Their admirable construction, form, and use are a striking evidence of skill and contrivance di- rected to the performance of that most im- portant function, the reproduction of the species. The generative organs in man may be divided into external and internal ; the former consist- ing of the testicles and penis, and the latter of the seminal vessels, the urethra, the prostate gland, &c, with their arteries, veins, nerves, and lymphatics. The urinary organs consist of the kidneys, ureters, bladder, and urethra. The kidneys (renes) are two glands, in shape rep- resenting a kidney bean, lying close upon the muscles of the loins, behind and below the stomach. It is supposed these organs are larger in persons of strong sexual passions than in those who are less addicted to venery. The Ureters are long tubes, connecting the kidneys with the bladder, to which they convey the urine secreted by the kidneys. The Bladder is situated in the lowest part of the body, or pelvis; it is a muscular bag or pouch, and consists of at least three coats or XERVOUS EXHAUSTION. U coverings. One being composed of muscular fibres, its contraction causes the expulsion of the urine. At the neck of the bladder is a muscle called the sphincter, by which the in- voluntary flowing away of the urine is prevented. The chemical composition of urine, in health, according to recent analysis, is as follows : — ( Vide Liebig. ) I. Urea Uric acid Coloring matter Odorous principles Kreatine Lactic acid Hippuric acid Separated from the blood by the kidneys. Developed more directly from the food. II. Sulphates Phosphates Chloride of sodium Soluble salts Debris of epithe- lium Phosphate of lime Mucus of the blad- der Saline combinations de- rived from the food. Common to all fluids pass- ing over mucous sur- faces. 12 NERVOUS EXHAUSTION. We direct attention more particularly to this table, as many diseases, in fact nearly all, change in some respect the composition of the urine; and careful analysis enables the medical man to arrive at a correct diagnosis at an early stage of the malady, when any mischief may be easi- ly remedied. In unhealthy urine some one or other of these substances may be in excess, or may be altogether wanting. The elements may be combined in a manner altogether different ; or some substance may be eliminated from the blood and prove a source of considerable danger to life itself. We have not sufficient space to enlarge on this subject ; we will merely refer to one or two of the most serious of these diseases. In Diabetes, not only is there an inmoderate flow of urine, but it is found to contain a large amount of sugar — so much in- deed as to be perceptibly sweet to the taste. Un- less attended to at an early stage, this disease is generally fatal. We have saved many valu- able lives by attending to the indications shown by the urine at a stage when the disease was not suspected. Others we have warned, and not in vain, though at the time it was difficult to convince them. One more illustration of the value of these inquiries. There is a decidedly NEBVOUS EXHAUSTION. 13 marked change in the chemical composition of the urine when a stone is forming in the blad- der. For some time previously, a state of health is indicated which the judicious administration in remedies may remove, and thus prevent the necessity of a serious and painful operation. We may here remark, that an accurate analysis of the urine is one of the most difficult processes in chemistry, and can only be performed, with any approach to correctness, by one who is well versed and constantly engaged in minute in- vestigations of this kind. It requires, also, one who has acquired a thorough knowledge of the microscope, the value of which cannot be over- rated. For many years the author has availed himself of this valuable adjunct to diagnosis, with a success which his attentive practice will The testicles (testes) are two glands enclosed in the scrotum, or purse; they are composed of a vast number of fine tubes, folded in various directions, and enclosed by a membrane called the tunica albuginea. The testicles secrete the semen, and are supplied with blood from the vessels which arise from the main arterial trunk, called the spermatic arteries. The importance which men attach to the due performance of 14 NERVOUS EXHAUSTION. the function of these organs is evident from the number of the suicides caused by their imper- fection. The testicles are sometimes three in number, and occasionally there is only one, though many of the latter cases prove, on exami- nation, to be a retention of the testicle in the abdominal canal. A young man who had been ordered a truss for a supposed rupture, consulted us; we found the case was simply one of reten- . tion of the testicle. Had the truss been applied, he might have been lamed for life. Tlie Seminal Canals (Vasa Deferentia), which ascend on each side from the upper part of the testicle, accompany the spermatic artery, vein, and nerves, and are together called the Spermatic Cord. The seminal bladders (vesiculas) are at the upper part of the bladder, and are considered to be the reservoirs for the semen. They also secrete a peculiar fluid, which is added to the semen in the act of coition. The prostate gland is in front of the seminal bladder; in shape and size it somewhat resembles a chestnut. The fluid which it secretes is of a cream color, and serves to lubricate the surface of the urethra, along which the semen has to pass. The prostate gland is subject to disease and relaxation, and when this is the case the act of copulation is XEEVOUS EXHAUSTION. 15 unsatisfactory and even painful. We have frequently been consulted in cases where there has been a continuous discharge from this gland; the semen is then emitted by the slightest effort, more especially during sleep; this has often been the cause of wasting away, strophy, or consumption. Many surgeon3 have treated these cases as venerial, and their inexperience has proved most injurious. The microscope here lends its valuable aid. The penis is divided into the root, the body and the glands. The spongy substance which forms the glans penis is covered with a thin membrane, under which are placed very sensitive nervous papilla, which are the chief cause of the pleasure in coition. Many in the venerial act have not the glands distended, which arises from a weakened state of the cavernous body of the urethra. When this is the case from Onanism, or other causes, impotence will arise; which, unless its cause be perfectly understood, cannot be cured by any physician. The glans is protected by the prepuce, or foreskin. In healthy men, at the moment be- fore the semen is ejected, the glans and whole body of the penis are extremely rigid; soon after a convulsive motion follows, the semen is dig- 16 KEEVOTTS EXHAUSTION. / J charged by a reflex action, and there is a slight loss of strength throughout the body, which however soon recovers tone. But the erection of the penis may also be produced by mechani- cal irritation, as friction of the glans of the prepuce, caused by a distended bladder, as evinced in the morning after a night's rest, also by tumors or stone in the bladder. This highly complicated and delicate organism, of which we have given a brief outline, is entirely subservient to the proper secretion and ejection of the Semen. The semen is a thick whitish fluid, with a pe- culiar odoriferous smell; it consists of the liquor seminis and certain solid particles. The liquor seminis is colorless, transparent, and albuminous, and contains, floating in it, two principal constituents, viz., spermatozoa and seminal granules. The microscope must here be called into requisition. The spermatozoa are living bodies or animalcula, existing in very considerable numbers in healthy semen. They are also found in the urine, but never excepting the generative organs have become weakened by Onanism or excesses. The animalcula are formed like a tadpole, with a round head or body, and a narrow tail; KERVOITS EXHAUSTION. 17 they move with great rapidity, and their length is about a six-hundreth to a thousandth part of an inch. Wagner has shown that they are developed within cells, and originate from the spermatic granules, being formed by the dispersion of the nuclei of these cells. Their original discovery is due to Lowenhoeck, in 1667. The animalcula are not found in the fluid contained in the seminal organs before puberty, but they are always present afterwards; nor do they disap- pear while the power of procreation is retained. But when the semen is diseased by the debility of the parts, their number becomes fewer, until at last they almost disappear. There is no doubt that the animalcula are essential for the im- pregnation of the ovum in the female, but all our ingenuity and research have been vainly exerted in the attempt to unravel the mysterious process of conception. Life and organization are neither inseparable nor even identical. Man is still ignorant how life begins or ceases. We must turn to the Creator of all things, and though we can explain the structure, the primal cause is beyond all human reason. LECTURE IL PHYSIOLOGY OF MARRIAGE. The sacred ordinance of marriage emanates from the Deity, by whom we are enjoined to "increase and multiply/' — hence it is consider- ed honorable amongst all men, and should not be entered upon carelessly or wantonly, nor without duly considering the causes for which it was originally ordained. Marriage was intro- duced by the Divine Creator, in the time of man's primitive innocence, as the means of his happi- ness and the perpetuation of his race. Its in- fluence extends from individuals to kingdoms, and to the whole world. Jeremy Taylor calls it "the mother of the world, which preserves cities, and fills cities, churches, and even heaven itself." It is the primitive source of morals and society, the nurse of virtue and patriotism, the stay and support of governments. In a word, no other social institution exercises so profound an influence on the well-being of society. The obligations of marriage are mutual and impera- tive; if any deception is practised, those culpable will sooner or later receive punishment in the disappointment of their pleasure, the loss of their NERVOUS EXHAUSTION. 19 health, and the remorse of their own reflections. It unfortunately happens — in the present arti- ficial state of society — that many men are unable to marry before middle life, perhaps after a youth spent in more or less dissipation — perhaps after having acquired the seeds of disease and impo- tence. The question then arises — Is such a man capable of procreating healthy children, or of satisfying those desires inplanted by nature in the most modest and virtuous of women, not less strongly than in man himself? The conscious- ness of deficiency must cause any man to feel abashed, and he can oSer no excuse but what must tend to lessen the love and respect of his wife. Ignorance — of a density unequalled, of an obstinacy unparelieled — long prevailed on the topics which control most completely the fitness of men and women for wedlock. There are certain stages of injured health, capable, by early and skilful treatment, of thorough and speedy cure; but which, if neglected, or in- judiciously dealt with, render aught but disgust and misery in marriage a thing humanly impos- sible. Xo man is so likely to be jealous as the one that is conscious that his wife has just reason for complaint; and no woman is so likely to go astray as one who is tantalized by the abortive toying 20 NERVOUS EXHAUSTION. of an impotent husband. We admit nothing can justify a wife in proving false to the marriage vow, and nothing can ever after restore her to the position of a virtuous woman; but cases fre- quently occur where much might be urged in extenuation, and where he who is considered the injured husband is in reality more guilty than his wife. Women were formed to completerthe well- being of man, and those who abstain from inter- course with them are rarely either happy or healthy. Marriage constitutes the bond of so- ciety, and the respect paid to its ordinances affords the best test of the moral condition of a civilized people; but where generative weak- ness exists, let not the unhappy sufferer augment his own misery by the sacrifice of one from whom he can expect nothing but dislike, re- proaches and contempt, and whose happiness may thus be marred. It may be safely affirmed, that a difference of temperament between married persons is conducive not only to mutual affec- tion but to fertility. Nature appears to desire marriages between different families and nations, because such crossings of the various races im- prove and invigorate the species. Humboldt and others have observed that the offspring of Europeans and Ethiopeans are peculiarly robust KEKVOUS EXHAUSTION. 21 and active. From numerous observations of a similar nature, he argues that the best mode of eradicating hereditary diseases, gout, scrofula, consumption, epilepsy, madness, etc., in their early tendency, is by the commixture of the spe- cies in intermarriage, which often prevents the transmission of disease to the next generation. The mental weakness, as well as mean appear- ance, of some of the European royal families is strongly cofirmatory of the truth of these prin- ciples. Walker, in his admirable and interesting work " On Intermarriage," proves beyond the possibility of cavil, that insanity, idiocy, and numerous physical ailments occur four times above the average in the offspring of "family marriages. v When persisted in for some genera- tions, the race usually becomes extinct. Nor is this confined to man alone — the rule extends from man downwards, through the whole realm of animated nature. The essentials of reproduction on the male side are a healthy condition of the whole gen- erative system: the erection of the penis should be perfect, maintenant and .vigorous, and the secretion and emission of the semen obedient to the command. On the part of the female, the generative organs should be sensible of the 22 NERVOUS EXHAUSTION. approaching impulse; the best test of their healthy state is the presence of desire, and the enjoyment of the orgasm simultaneously with the male. Instances of generative incapacity, local weakness, and utter impotence are very numerous. Again, it is no uncommon circum- stance for a man on his approach to a female, with a view to sexual commerce, though he may possess all the confidence necessary, to find the tone of his inclination suddenly leave him, and to observe a seminal discharge almost im- mediately on contact, or even before; the de- sign is, of course, frustrated, at least for some time, and he has to endure the double mortifi- cation of incurring and giving disappointment. Another frequent deficiency is an insuficiently lasting erection, which prevents the mechanical irritation requisite to excite the proper action of the seminal vessels. Other persons possess both desire and capability, but at very consider- able intervals — a sure sign of approaching decay. Occasionly, from disease, or from want of exer- cising the generative functions, men may be found where the organization is perfect (though the development is rather smaller than usual), yet where there is a total inaptitude, or, at all events, a complete distaste for sexual intercourse. ffERVOUS MHAtJSTlOK. 23 SucH cases are curable without much difficulty. In the early stages of seminal weakness, differ- ent persons are variously affected; some are in- capable of procuring a discharge of the semen into the cavity of the female genitals in a natural way, though they may effect temporary erection; while others cannot perform the act of copulation, from emission taking place too quickly, and before the proper firmness of the male organ has enabled it to effect the requisite penetration. What man, possessing the ordi- nary feelings of a man, can contemplate with- out a shudder these terrible consequences of self -indulgence? The nuptial bed of such an one, instead of teeming with a hallowed, ecstatic and transporting delight, is converted into a scene of blended mortification, disgust, disappoint- ment, and suppressed anger; and it is now that the mistaken bride is made to feel herself the victim of previous sensuality — the poor, deceiv- ed, last hope of vigor — anxious for offspring, yet baffled from day to day in the arms of the man she has vowed at the altar to love and honor; and he, conscious of the cause of his infirmity, the dark secret smouldering in his breast, galling his wretched existence, and not to be imparted even to the wife of his bosom. M HEltVOtTS EXHAUSTION. A gentleman recently wrote to us in the follow- ing powerful language: — "Dear Sir, — You are the first to whom I have plucked up resolution to open my case; I fear it is beyond even your skill, but, for heaven's sake, give it your careful consideration, and above all, let me have your candid opinion; I shall then know how to act. My age is 25; I have practised self -pollution, when a boy, some years, indeed to a very recent period. I married a beautiful young woman three months ago. I experienced an excitement most powerful, my passion was most vehement, and I attempted the sexual act. Immediately a spontaneous emission occurred, the excitement left me, and my emotions and desires became palsied. My system became utterly incompetent to manly or vigorous health. That is the history of my first attempt, and of every succeeding trial. If you can assist me I shall be grateful for life. My wife bears with me with angelic patience, but I cannot long endure my present wretchedness. " In a letter a few months later, this gentleman writes: — "My Dear Sir, — Words fail to express my gratitude for your skill and kindness. I am happy to inform you that my dear wife is now enceinte. This I am aware will not surprise you; but I cannot forbear writing to express NEBYOUS EXHAUSTION. 25 my gratitude. My dear wife also desires to be most kindly remembered/' That the happiness of married life may in a great measure be secured or defeated by atten- tion to, or neglect of, what lies in our power previous to its consummation, is as true as that there are duties obligatory alike upon man and wife after marriage. If a man has made a hasty or thoughtless selection, the fault is assuredly his own. Although it cannot be doubted that warm and mutual affection is an essential con- dition to married felicity, it must be remember- ed that passion is a false and treacherous guide, when not founded on well-merited and well- defined respect. It is often inquired, what is the proper age to enter the marriage state ? and the question is one that is difficult to answer. Much depends upon individual health and tem- perament; but as a general rule, we find the happiest unions, and also the most fruitful, when the man marries from the age of twenty- five to thirty-five, and the woman is from five to seven years younger. Dr. Samuel Johnson observes : * ' Those who marry at an advanced age will probably escape the encroachment of their children; but, in diminution of this advantage, they are likely to leave them, ignorant and help- 26 NERVOUS EXHAUSTION. less, to a guardian's mercy; or, if that should not happen, they must at least go out of the world before they see those they love best either wise or great." It is quite certain that on young women marriage will frequently have a most beneficial effect. Hysteria, Nervousness, Irregu- laritiy, sometimes even Consumption, are known to disappear after marriage. In reference also to the male sex, it is quite certain that, in- depently of many morbid affections and habits which marriage removes, it augments the energy of the system of the blood vessels; the distended arteries, pulsating with greater force, transmit warmth and animation throughout the body; the muscles become more vigorous, the step more elastic, the voice firmer, every physical attribute of humanity becomes boldly developed. Marriage, however, is not altogether made up of " sighs and wreathed smiles;" though it has its devotions, it has also its obligations; and the divine command, "increase and multiply," can only be obeyed by those in the full possession of mental and bodily vigor. Even under the most favorable circumstances of youth and vigor, it is necessary to warn the newly-married couple of the danger of excessive indulgence, which injures thQ health of WQmen, and by causing NEBVOUS EXHAUSTION. 27 many painful diseases, soon renders intercourse utterly repugnant. It also prevents or impairs the offspring — for whatever enfeebles or diseases the sexual organs must of necessity have that effect. Temperance in the connubial embrace, as in all other things, is the medium which we should observe and recommend. The following case will illustrate some of the dangers to which we have referred: — W. S. called upon us for consultation early in June, 1862. His age was about twenty-five, and his occupation salesman in a dry-goods house. He had been always very regular in his habits, had. never been guilty of Onanism, nor of illicit connection. His frame was rather delicate, and his temperament nerv- ous-sanguine. About ten months previously he had married a young widow, and for about six months he indulged very freely in the pleasure of the marriage-bed, without feeling any bad effects. About that time, however, he began to lose flesh very perceptibly, and to feel great lassitude on the least exertion. His appetite failed — his sleep became disturbed and unre- freshing — his bowels constipated; in short, all the symptoms proved a general failure of health. Added to this, his sight became impaired, and also his memory — he lost energy and spirit, and 28 HEBVOUS EXHAUSTION. his daily occupation was a trouble to him. He now began to complain of pain in the upper part of the right lung, and considerable diffi- culty in breathing; and soon began to spit blood, of bright red color and frothy appearance. Be- coming seriously alarmed, and suspecting that his illness was caused by excessive indulgence, he called upon us for advice. On examining his chest, I observed some dullness on percussion in the upper portion of the right lung, imme- diately under the clavicle; the respiratory mur- mur was also absent from this part — in other respects the lungs seemed all right. The action of the heart was somewhat irregular, being very much hurried from a slight cause. Of course, it was essentially necessary that he should ab- stain from all sexual intercourse; medicine was prescribed suitable for the case, and within a month he began to recover strength — the pul- monary symptoms gradually declined, and per- cussion elicited the natural healthy sound over the chest. He was under treatment some six or seven weeks, and he promises that the lesson shall not be thrown away. We earnestly advice all who contemplate en- tering the marriage state to take advice from a thoroughly qualified practitioner, as to whether KEEYOUS EXHAUSTION. 29 there is anything to be set right before the mar- riage is consummated. Much misery, perchance innocent lives may be spared by attending to this obvious and easy duty. Sometimes an old venerial contamination maybe lingering in the blood. Careful examination and analysis will decide; and treatment for two or three weeks may prevent long years of unhappiness. In concluding this part of my subject, I may be allowed to observe that it is right and useful that all men should know that there are prin- ciples of personal management which cannot be violated without the incurral of grievous penal- ties; it is right that they should know, when wisdom and regret succeed the heyday of incon- siderate self-indulgence, how these penalties may be mitigated, and how the sting of their remorse may be ultimately removed. The most absurd of all emotions is that of despair. Let the sufferer remember that there is scarcely any degree of weakness or functional derangement to which the timely aid of science cannot apply a cure. LECTURE III. ONANISM, OR SELF-POLLUTION. Manustrapsio, Masturbation, the Sin of Onan, are the names commonly given to this pernicious habit, which may be defined a discharge of the semen by the stimulus of the virile organ with the hand; the habit (it is said) of the solitary monk and recluse, as well as of inconsiderate youth, and too often of those whose riper years should prevent their guilty indulgence in an act so re- volting to humanity, and so destructive to every sentiment and feeling of vigorous manhood. If we refer to the opinions expressed by the most celebrated physicians amongst the ancients or moderns, we find a remarkable uniformity in their opinions on this subject. Celsus remarks, "These habits are always hurtful, and indulgence in them weakens the strongest constitution. " Galen gives a corresponding account of the evils caused by thi3 vice. The late Mr. Benjamin Bell, the eminent surgeon, of Edinburgh, also, in reference to the effects of this indulgence, says, — "A habit so baneful to many of our youth, that I believe it to be more destructive in its effects than a greater proportion of all the NEBVOUS EXHAUSTION. 31 diseases to which in early life they are liable." Besides rendering the patient himself miserable, it evidently entails the severest distress upon posterity by generating languor, debility and disease, instead of that strength of constitution, without which there can be no enjoyment. Lallemand remarks, — "Our lunatic asylums afford many instances of insanity produced by this detestable practice. " Nocturnal pollutions, or "wet dreams" are in most causes brought on by Onanism. After a short period has elapsed, the nocturnal are now conjoined with diurnal pollutions; the semen passes off in the urine, or at stool, without sensation, and there- fore unmarked by the patient. It therefore be- comes a problem of the greatest interest and importance, if there be any means by which the presence of spermatozoa, or the living principle of the seed, may be detected with certainty. "We have introduced into our practice the use of the microscope, which for the purpose of diagnosis is absolutely indispensable. By the examination of a small quantity of the matter or discharge from the urethra, or by the microscopic observa- tion of the urine we are enabled to decide with certainty as to the presence or absence of the seminal fluid, and, consequently, on the neces- 32 NERY0US EXHAUSTION. sary treatment required by the case. A gentle- man called upon us in September, 1866, aged 27. He stated he had been induced to consult us, owing to having observed some yellow-color- ed stain upon his linen. He had been treated for nearly a month for gonorrhoea; but finding himself get worse instead of better, had called for our opinion. We carefully examined the discharge, and also the urine, by means of the microscope, and immediately detected a great loss of semen in the urine, and that the matter consisted almost entirely of the seminal fluid. On inquiry he admitted, though with great reluctance, that he had been in the habit of practising Onanism. A proper course of medi- cine was administered, and in four or five weeks he was entirely well. It frequently occurs, as a result of self -pollu- tion, more especially when practised in early youth, that the testicles do not attain their full size and powers of secreting semen. This state has been termed "an arrest of development " a phrase which simply means that the organs have ceased to grow at a period of life previous to puberty. We have seen the case of a gentle- man, aged 28, whose penis and testicles were not larger than those of a boy ten years old. NERVOUS EXHATTSTIOX. 33 Other cases of a similar character have also presented themselves to our notice. Such in- stances are not beyond the influence of medicine, unless when they occur in the persons of idiots. Wasting or diminution in the size and powers of the organs may occur at any age. The testicle may retain its proper shape though diminished in size; it feels soft to the touch, and loses its elasticity and firmness. In texture it is pale, and the blood-vessels seem diminished in number, the spermatic cord becomes affected by the disease, the nerves shrink, and the cremaster muscle disappears. The thin gelatin- ous semen which is formed is entirely devoid of spermatic granules and spermatozoa. In other words, its fertilizing power is lost, and impuis- sance gradually results. When disease is the cause of the atrophy, the testicles may alter in shape — become uneven and irregular — some- times elongated as well as diminished in size and weight. There is one form of disease which frequently precedes the decay of the organs, and which is seldom observed by medical men — a low inflammation, quite painless, acts upon the testicle, and gradually increases the bulk, at the same time diminishing the firmness and consis- tency; in some instances the testicle almost feels 34 NERVOUS EXHAUSTION. as if dividing. On inquiring into the origin of these cases, we frequently find that a swelled testicle (hernia humoralis) has existed, caused by gonorrhoea. Hence the necessity of curing urethral discharges as rapidly as possible, and the care required in the use of astringent in- jections. Injuries of the head, more especially the back part of the head, have been known to produce decay of the testicle; and this fact may tend to support the theory of the phrenologist that the seat of amatory passions is in the cere- bellum. Doubtless the brain exercises great in- fluence on the desire for sexual intercourse, and it is equally certain that there is a reciprocal action of the generative organs upon the brain. Such is the similarity of structure of the brain and the testicle, and so great the sympathy be- tween them, that an extensive experience during many years has proved that in some instances a species of derangement is caused by diseases of the generative organs. It is chiefly on the youth of both sexes that self -pollution commits most ravages. This is so much more to be deplor- ed, as it thus strikes at the very root of society, and has a direct and immediate tendency to des- troy it, by enervating and debilitating, almost from their very cradle, those whom nature's StEBYOUS EXHAUSTION. 35 God intended as best adapted to preserve and adorn it. How many of the debilitated and ema- ciated objects daily present themselves to our view, with pallid and haggard countenances and sunken eyes, who are indebted solely to the abominable act of masturbation for this wretched state of debility and exhaustion ? Disabled from rendering service either to themselves or friends, they drag on a life totally useless to others and a burden to themselves, in the midst of society in which they are despised. A frequent cause of the practice of Onanism is igxoraxce of the enormity of the crime, a crime, of which an eminent divine has written: — "In itself it is monstrous and unnatural — in its practice filthy and odious to extremity — its guilt is crying and its consequences ruinous — it destroys all con- jugal affection — prevents natural inclination — and tends to extinguish the hopes of posterity. n There are thousands among the youth of both sexes — ingenuous, docile, diligent, and tractable — who, either from example or from accident, have thus learned this vice, who would have abhorred the thought, had they understood the nature of the sin, and been made acquainted with its fearful results. As connected with this subject; we may here observe that anything like 36 NERVOUS EXHAUSTION. attempted concealment respecting it is a practi- cal injury to morality. The Book of books it- self is not only standing evidence of the heinous- ness of "the sin of Er and Onan" but of the necessity of proclaiming it to all mankind. Their sin was committed in the full consciousness of its inherent hatefulness, and therefore their punishment was most signal. Their example has been left on record as a fearful warning to future generations; as a measure of the de- pravity of certain transgressions, and the inevit- able certainty of retributive justice. Another cause of self -pollution is the secrecy with which it maybe committed; all other actions of un- cleanliness must have a witness, this needs none. Again, the laws against adultery, though in many cases inoperative, are sufficient to deter many; whereas in self -pollution neither the cautious nor the covetous imagine they have anything to fear. How strange it is that a man should show bashfulness and the utmost cowardice to his fellow-creature (even should that fellow- creature be the most impotent wretch) and that he should behave with gigantic boldness and impudence to the Almighty Creator of heaven and earth. The most experienced medical practi- tioners are of opinion that the development of NERVOUS EXHAUSTION. 37 the neryous system, and the predominance of its action oyer the other parts of the organism, are also amongst the causes of masturbation. We comparatively seldom see this habit indulged in by robust and vigorous persons, whose muscular and digestive organs are in full development; they are generally more disposed to exercise their limbs, as well as their appetite for the pleasure of the table, in which their minds are too much engaged to allow them to addict themselves to indulgences in other gratifications. This ex- cessive development of nervous sensibility, which is the source of so many praiseworthy actions, as well as of so many vicious enormities, and which, according to the directions it receives, gives rise to the most splendid or to the basest of results, may be derived either from natural disposition or from early education. It is immediately after early infancy, at that epoch when the faculties of the new being commence to be developed with energy, that he runs the greatest danger. If then an unfortunate accident, or, as too frequently happens, the indelicate touches of strange hands, disclose to the young subject what may at this time be considered a new sense, there takes place at this period to- wards the genital organs a greater or less codl- 38 NERVOUS EXHAUSTION. centration of the vital forces, and the patient, led on by the delusive pleasure, gives himself up with fury to a vice which is sure soon to destroy him, or draw down on him evils more terrible than death itself. Another most dangerous pe- riod of life is the approach of puberty, which varies in this climate from the age of eighteen to twenty-two. The rapid growth of the genera- tive organs — the increased power and frequency of erection — the rapid secretion of semen — all lead to the performance of that act which is sure to occasion the deepest remorse. It is the attentive consideration of these varied facts which explains to us how the habitual exercise of the genital organs, either by coition or mastur- bation, may so far get the better of the will of the individual as to force him to indulge in practices, the object of which is to gratify the venerial stim- ulus. In almost all such cases the shameful act when finished, is invariably followed by bitter regret; but as the organs obtain repose, the resolution which he had adopted, of relinquish- ing the baneful practice, and which he had thought nothing could shake, are soon for- gotten. We have frequently heard patients ex- claim: "Oh! how often and often have I solemn- ly sworn never again to pollute myself, and how NERVOUS EXHAUSTION. 39 often have I promised myself, when in the act, that it should be for the last time." We implore those who have addicted themselves to this ruinous and suicidal habit not to rely on their own resolution — not to depend on their own firm- ness and fancied strength of mind; let them ap- peal to Higher Aid — and, above all, let them prayerfully avoid temptation. If we compare the injurious effect of exces- sive indulgence in coition and those of mastur- bation, we shall find that the causes which com- bine to render excess in the former dangerous act with much more energy in the second, and that several circumstances peculiar to the latter render the results of its frequent repetition more serious. It is well known that the man who ad- dicts himself to the solitary and debasing prac- tice of Onanism is kept for a considerable time in a state of general and permanent rigidity of the entire body; this state of tension is sometimes carried so far that very painful cramps are caused by it, and the fatigue which results obliges the patient to relax his efforts occassionaly to take rest. It is sufficient to observe the circumstances which accompany masturbation to see that the nervous system must be directly affected by it, not only from the violent and continued con- 40 NERVOUS EXHAUSTION. tractions which it occasions throughout the en- tire muscular system, but also by the prodigious tension of the imagination, which is in cases wound up to its highest state, in order to repre- sent to the devoted votaries of self -pollution the fantastical object of their disgusting transports. Another cause which renders Onanism more dangerous than excessive indulgence in coition arises from the circumstance that it is much easier to addict one's self to the one than to abuse the other; for when a man gives himself up to the natural pleasures of love, the fatigue felt, as well by his companion as by himself, will have the effect of preventing his exhaustion; whilst on the other hand there is no bridle, no restraint on him who practises self-abuse; the former is in general obliged to wait for a favor- able moment and opportunity to indulge in his excess — every momeni answers the purpose of the latter — all he requires is mere solitude. He constantly carries about him the sting which torments him; he alternately finds his imagina- tion exciting his organs, and his organs inflam- ing his imagination. In short, there is nothing to distract or take up the attention of one who has addicted himself to Onanism, whilst a thousand circumstances are constantly distract- NERVOUS EXHAUSTION. 41 ing the attention of the man who is disposed for the enjoyment of a female. Another serious danger in this vice is the period of life when persons addict themselves to it; we have occa- sionally met with it in quite young children, most frequently amongst full-grown boys and young men, for the various difficulties and impediments which prevent copulation before a certain age do not exist in the case of Onanism — thus the generative propensity, called forth prematurely, and gratified viciously, steps in amidst all the natural efforts of growth, with its unnatural train of moral excitations, sensual shocks, and physical pollutions. No wonder that the Father of Medicine should notice its effects, thus iEtius gives the following description : ' ' Young people have the air and appearance of old age ; they become pale, effeminate, lazy, benumbed, stupid and imbecile; they have a total distaste for every- thing, are totally incapacitated, and may even become paralytic." In short, when we look upon the horrible consequences resulting from this practice, are we not justified in regarding it as a lingering moral and physical suicide ? As we have intimated, the practice of Onanism, when once indulged in, is difficult to abandon; the patient is perhaps for years unconscious of any 42 NERVOUS EXHAUSTION. change, and no one part of the body feels weak- ened more than another; but there gradually comes over a creeping languor, a want of energy, a sensation of lassitude, a depression of spirits, ennui, and a disinclination for society; these feelings at length increase so as to attract the attention of the patient and his friends. He and they are sensible that he is not what he formerly was; his face becomes pallid, the circles around the eyes depressed and darkened, a thin- ness is visible in his looks, his hands are fre- quently cold and clammy, he cannot bear the cold he was wont to do, his old pursuits have no attractions for him, nor do any new ones attract his attention; his memory becomes im- perfect, his vision is not so clear, nor his sight so strong, as formerly; morbid sensations annoy him; at length he sinks into fatuity, and either is carried off by some rapid decline, or hastens his end by laying violent hands on himself. Such is the history of many cases of suicide of which we read in the newspapers. The follow- ing, illustrating many of the above features, is from the work of the celebrated French physi- cian, Tissot: — " , by profession a watchmaker, had been brought up morally, and, until the age of NERVOUS EXHAUSTION. 43 sixteen had enjoyed a state of perfect health; about this period the evil example of a youthful companion initiated him in the habit of self- abuse, which he repeated daily, eyen to the ex- tent of two or three times, and until the seminal emission was followed by a slight insensibility, and a complete prostration of mental and bodily strength; this warning was insufficient to rescue him from his disgusting practices; and the repe- tition of them became more frequent, till he was in a state which gaye reason to apprehend a fatal termination. Too late a penitent, he had become incurable, and the generative organs were so weakened that the slightest irritation caused a partial erection, with an immediate emission of seed, which of course increased his weakness, and, becoming incapacitated, he was obliged to re- linquish his business. Thus, oyerwhelmed with misery and disgrace, he pined for some months without assistance, with the agonizing reflection that he himself was the cause of his awful situa- tion. I was called upon to attend him, and found him past recovery; he was meagre, pale, and al- most incapable of moving; a palish watery matter issued from his nose, and a continued frothing from the mouth; he was affected with diarrhoea, and voided his excrement in bed, without being 44 NERVOUS EXHAUSTION. conscious of it; he had a continued discharge of semen; his eyes were fixed and watery, and his pulse low, rapid, and at times almost imper- ceptibfe; it was with much difficulty he breath- ed, and he was reduced nearly to a skeleton. His mind was equally disordered, his memory was lost, incapable of forming or connecting his ideas — in short, without reflection or any sensation but pain ; he was reduced far below the brute crea- tion, and presented a spectacle hardly possible to describe. I immediately administered tonic medicine in conjunction with anti-spasmodics, without the slightest hope of affording more than a little temporary relief , and haying effected this, I declined attempting to remedy further what was past any human aid. He gradually sunk, and for a few days prior to his dissolution, which took place in the middle of August, he lay in a state of unconsciousness, and was utterly incapable of taking the least nourishment/' Thanks to the exertions of Medical Science, aided by the researches of many skilful physi- cians, who have devoted their lives to the in- vestigation of these diseases (amongst others I may be allowed to record my late lamented teach- er and friend, Lallemand, as the most scientific and keenest observer, the most successful in KERVors EXHAUSTION. 45 practice, and, finally, the most benevolent) — thanks to the important discoveries in chemistry and to the light thrown on the cause of disease by the use of the microscope, we have nof often presented to us cases so desperate as the above. Indeed, during my long experience and ex- tensive practice, I may assert, without hesita- tion, that no one patient has left my charge without having derived immense benefit from my treatment: and many cases, apparently hope- less, where my patients have been far gone in consumption, where the vital energy has been reduced to the lowest ebb, where generative de- bility and impuissance have existed for years, have been restored, under Providence, by my remedies to health, strength and manhood. Still it is difficult to depict a more truly miser- able being than the slave to licentiousness. His imagination burning with filthy, unnatural glow; his bodily organs taxed to the utmost, weary and jaded, refuse to obey the stimulus of that never-slumbering depravity which goads his fancy in the darkness of night, in the dreams of his broken rest, and in the worse than dreamy abstractions of the cheerless day ; he is tormented with desires he can never gratify, shut out from those enjoyments accorded only to virtuous 46 KERVOtTS EXHAtTSTIOK. moderation; the blossoms of youth (perhaps the flower of manhood) the supremacy of mind, all degraded, obliterated, gone ! Let not the in- tensely prurient, yet seeming modest victim of self-pollution lay the flattering unction to his soul that from the eye of his fellow-mortals he can conceal his unmanly practices. It is written upon his forehead; the physiognomy, that faith- ful mirror of the soul and body, gives clear indi- cation of the internal disorder. The complexion and plumpness which jointly confer a youthful look, and which is the sole substitute for beauty — f or without this even beauty produces no other effect than cold admiration — this complexion and plumpness are the things that first disappear; a leanness succeeds; the skin becomes rough, often of leaden tinge; the eyes lose their brilliancy, and by their languor express that of the whole frame; the lips lose their vermillion hue, the teeth their whiteness, the hair falls off, and it is no uncommon thing for the whole body to become bent and distorted. Abashed, the sufferer shrinks from the gaze of his fellow-man, fancying sus- picion in the eye of every one who looks upon his sunken, haggard, pale, unmeaning, inex- pressive face; his dull, lack-lustre eye; his thin and tremulous form, which all hetray him to the NERVOUS EXHAUSTION. 47 practised observer. For self-pollution en- tails upon its victim marks as legible, to the eye that can understand them, as the scars of small-pox; and thus proves a striking fulfilment of the prophetic warning — "There is nothing done in secret that shall not be reveal- ed/' nor hidden, even from the recognition of mortals, that shall not ultimately be made, even to them, evident as noon-day. Shall we not therefore raise our testimony against these vices ? Sir Astley Cooper justly remarks in one of his lectures: u If one of these miserable cases could be depicted from the pulpit as an illustration of the bad effects of a vicious and intemperate course of life, it would, I think, strike the mind with more terror than all the preaching in the world. The irritable state of the patient leads to the destruction of life, and in this way, an- nually great numbers perish. Undoubtedly, the list is considerably augmented from maltreat- ment, and the employment of injudicious reme- dies." And the late learned Dr. Pereira, whose abilities as a practical physician were only equalled by his acquired learning and innate knowledge of human nature, observes, in review- ing "Nervous Exhaustion/' — "There is a vast deal of injury done, not merely to public 48 NERVOUS EXHAUSTION. morals, but to the individual health, by the abuses and excesses of the reproductive func- tions; the primitive fathers and physicians have duly noticed the evils to which I allude, and every experienced medical practitioner can attest their frequent occurrence. It is all very well for sentimentalists and the mock-modest to declaim about the notice of them; but justice, morality, and the preservation of health, as well as the perpetuation of the human race, demand it. Such, however is the hyprocrisy of the day, that even a notice in a dead language is abused and condemned by the ignorant and intolerant, who are unable to appreciate the importance of the subject. This is a bold step in the right direction. v ISTor are the evils of self -pollution confined to the male sex only. That it rages with deathly virulence among young women, especially among young ladies in the higher circles of society, is a matter of notoriety. Dr. Fowler writes, — "That women, young and apparently modest, are dying by thousands of consumption, of fe- male complaints, of nervous or spinal com- plaints, of general debility, and of other osten- sible complaints innumerable, and some of in- sanity, caused solely by this practice/' In con- firmation of this, Mrs. Gore, in her " Lectures XERV0US EXHAUSTION. 49 to Ladies on Anatomy and Physiology," re- marks, — ,,Some years since, my mind was awakened to examine this subject by the perusal of a medical work that described the bad effects of this vice (masturbation) when practised by females. This was the first intimation I had that the vice existed among our sex; since that time I have had much evidence that it is fear- fully common among them. Were this the particular vice of the low and vulgar, there might be more excuse for the apathy and false delicacy that pervades the community respecting it; tut it invades all ranks — professed Christians are among its victims. Our boarding and day schools are sources of intolerable mischief." Mrs. Gore is one of those ladies who, throwing aside conventionality, have studied anatomy and medicine; she passed one of the colleges in the United States, and now enjoys an extensive prac- tice, as well as much reputation for skill, in Boston, Mass. On this subject her testimony is of value, and we do not scruple to make use of it. The effect of self -pollution in the male is similar in the female; the results common to both are impotency in the one, and sterility or barrenness in the other. We observe amongst them much tendency to histerical complaints. Consumption 50 NERVOUS EXHAUSTION. numbers amongst its victims many young and fair, who have first brought on its seed by self- abuse. The glairy discharge, so common and so weakening, and which is generally termed the "Whites," is another frequent result of this error. We do not mean to assert that in every instance this discharge is thus caused. I have known many instances where it has been caused by excessive intercourse with the husband; but when it occurs amongs unmarried women of a certain age, self pollution, though not the in- variable cause, is one of the most prominent and predisposing. But enough on this very painful subject — we probe the wound deeply that we may the sooner heal it. Should this fall into the hands of one who has sinned, let her re- member that science and skill may do much to restore to health and happiness — let her repent, and pray that "she sin no more." Many individuals scarcely turned forty years of age, and sometimes even earlier, who have lived rather freely, are not unfrequently about, that period of life greatly changed in their poivers of sexual intercourse. They may, indeed, in general health and personal appearance, be stout, and for several years not very sensible of the degeneration of their powers, but the frequency KEHVOTJS EXHAUSTION. 51 of their inclination for such duties gradually becomes much diminished, and that is a symp- tom which is at all times indicative of approach- ing impotence; for the inclination gradually and entirely ceasing, the power speedily follows, or rather both are lost together. In others, about the same time of life, the physical power ceases first, and the inclination continuing, often for many years after, they are oliged to gratify themselves in amusements which are the mere pantomime of amorous indulgences I Such in- dividuals, being otherwise in tolerable health, are recoverable. Many who have unwarily acquired the habit of self -pollution have been convinced, by read- ing this treatise, of its iniquity and injurious consequences to health, and have determined to give it up, thinking that by so doing they may recover their pristine health and vigor. In this, however, they are deceived. A new and un- natural association having been established be- tween the organs of generation and the mind, the bad consequences of the practice do not cease when the habit is left off. Involuntary discharges of semen take place during sleep, occurring as frequently as two or three times in the course of one night. The effect of these 52 HERVOUS EXHAUSTION. emissions is extremely debilitating ; all the symptoms already described are aggravated, and the mind sinks into a state of the deepest de- jection. Here there is no time to lose; they should immediately apply for the necessary medicine, and the practice being discontinued (certainly a main point in the case) they may confidently anticipate the speedy renovation of their constitution. I therefore recommend an early application for advice and assistance, which in every case will be given with that kind consideration and undeviated attention that will give confidence to the timid, and restore vigor to the debilitated. LECTURE IV. OF NOCTURNAL EMISSIONS, SEMINAL WEAK- NESS, IMPOTENCE, STERILITY, AND NERVOUS EXHAUSTION. The secretory glands of the human body form an apparatus, the action of which is unvarying and constant. The liver is perpetually employ- ed in the formation of bile; the kidneys, in the separation of urine from the blood. In fact, all the secretions are derivable from the living and vitalizing fluid. The gall-bladder is provided as the temporary receptacle for the bilious soapy fluid secreted by the liver; and as the wants of the system require, it is poured into the first intestine to assist in the separation of the nutritive portion of the partially digested ali- ment. Precisely analogous is the action of the testicles, pouring their appropriate secretion into the receptacles described in the anatomical section of this work, and denominated the "vesi- culce seminales, or seed-bladders" not to be ab- sorbed again into the system, but rather to be excreted as indispensable to the reproductive act. Hence the stimulus arising from distention of these vessels becomes a pleasurable impulse to the 54 KERVOUS EXHAUSTION. necessary multiplication of the species; and if sexual desire were susceptible of gratification only as the result of instinct; if depraved man, instead of lashing his genital organs to exertion by filthy conversation, lewd and impure imagina- tions, and the various causes which are entirely absent among the brute creation; if, like them, he were content to follow the dictates of his unerring organization, diseases from excess would be un- known, equally among us as with them; and their proverbial and almost certain fecundity be but the transcript of our own. As the seminal vessels (like the gall-bladder) will not allow of extra- ordinary distention the thinner portions of the semen become 'partially absorbed; and though thereby the bulk of that secretion be lessened, yet the residuum becoming more acrid and stimu- lating, the impulse to excretion is thus rendered unconquerable; and so nature (in the absence of the act to which the stimulating impulse tends) occasionally relieves herself of the superabundant secretion. Of this act, men are mostly un- conscious; if, however, it arrest attention, its frequency and its consequences are the circum- stances that rouse the proper and natural fears of the sufferer. A popular author on this subject observed,— NERVOUS EXHAUSTION. 55 " The causes of these nightly or *wet dreams,' as they are called, are numerous. In the first place, the testicles must have acquired, through the practice of Onanism, (for involuntary emissions rarely assume the formidable character here de- picted, except induced by masturbation), a morbid sensitiveness, that, on the slightest local or neighboring irritation, they put in action their secretive powers. In fact, the infirmity might not inaptly be termed a consumption of those glands. Consequently, the causes may be, at this period, piles or hemorrhoids, constipation, in- digestion, irritability of the bladder, or kidneys, &c, &c. ; for they all, more or less are present, and, perhaps, severally aggravated by stimuli, of one kind or other, taken during the day or previously to rest. Another occasion may be the loss of tone of the absorbents, and also loss of the sensibility of the passages through which the discharge escapes; thereby acting as somnolent sentinels only to the brain, whereby even the little control the will might possess is lost! So by this we perceive that this infirmity is not merely local debility of the generative apparatus, but that many other functions of life participate in it. The constant drain from the testicles im- poverishes the whole system, and the same phe- 5() HERV0US EXHAUSTION. nomena ensue as when Onanism is practised to the same extent. The semen of a person torment- ed with this infirmity is thin, watery, sickly odored and rarely prolific. Although I have al- ready depicted the consequences of unnatural indulgences in the previous pages, the following passage, from a more able pen than my own, exhibits so well the desolating effects alluded to, that its transcript is too useful to my purpose to neglect: — "The muscles of the youth become soft; he is idle; his body becomes bent; his gait is sluggish, and he is scarcely able to support himself. The digestion becomes enfeebled, the breath fetid] the intestires inactive; the ex- crements hardened in the rectum, and producing additional irritation of the seminal conduits in its vicinity. The circulation being no longer free, the youth sighs often, the complexion is livid, and the skin, on the forehead especially, is studded with pimples. The corners of the mouth are lengthened, the nose becomes sharp; the sunken eyes, deprived of brilliancy, and en- closed in blue circles, are cast down; no look of gayety remains — the very aspect is criminal. General sensibility becomes excessive, producing tears without a cause; perception is weakened, and memory almost destrojed. Distraction, ox SnEBYOUS EXHAUSTION. 57 absence of mind, renders the judgment unfit for any operation. The imagination gives birth only to fantasies and fears without grounds ; the slighest allusion to the dominat- ing passion produces a motion of the muscles of the face, the flush of shame, or a state of despair. The wretched being finishes by shun- ning the face of men, and dreading the obser- vation of women. His character is entirely corrupted, or his mind is totally stupefied. Involuntary loss of the reproductive liquid takes place during the night, and also during the daily motions ; and there ensues a total exhaustion, bringing on heaviness of the head, singing in the ears, and frequent faintings, together with pains, convulsive tremblings, and partial paralysis/' The reproductive potver may not he entirely destroyed ~by that state of generative debility which is engendered ~by nocturnal emissions 3 and yet very painful consequences of another character may unquestionably arise. A healthy female may become pregnant, from the feeble yet exhausting effort of a man whose constitu- tional power is seriously broken, yet it would be unfair, unphilosophical, unsupported by any analogy drawn from the history of the 58 KERVOUS EXHATTSTIOtf. lower animals, to expect that this circumstance would not tell most powerfully and detrimen- tally upon the offspring. The opinions of the learned, in all ages, haye not varied widely on this subject. Lucretius, and a great number of ancient physiologists, admitted this doctrine. That great man considered that there was a mixture of fluids, and that these, united in the sexual organs of the female, were animated, developed, and changed into a being resembling those who furnished them. Further, that the most vigorous of the two determined the sex; and if this principle be admitted, it is easy to trace every puny or diseased peculiarity the father or mother may transmit. It appears to be the general opinion that whichever parent furnishes the most elaborate, the ?)iost abundant seminal fluid would impress the lineaments and form upon the offspring; that the most vigorous parent who would possess most genital power, would determine the sex and physical character of the infant; and consequently that the offspring would most certainly resemble this parent, both in mind and body. If genital power be equal, the child may be expected to resemble both. But this can scarcely be expected, where there is debility of the generative organs NERVOUS EXHAUSTION. 59 in- either parent, and the elaboration of im- perfect fluids, from their too frequent escape. Of Seminal Weakness. — The prominent character of Seminal Weakness is general, not partial, debility. The seminal vessels are fitted to perform certain functions with progressive regularity, which, if undisturbed by disease, or unimpaired by vicious perversion of the : natural sexual habit, they will continue to exe- cute through the whole range of the years of active manhood. Sexual ability in man is a mysteriously compound power, requiring a perfect association in the action of the secret- ory organ of the seminal secretion, and the instrument of its ejaculation and discharge. Any functional irregularity, or want of corres- pondency between the action of the testicles and penis, is therefore an unquestionable state of disease; for since both are so closely and intimately dependent on each other, the least want of exactness in their adaptation might be the cause of Impotence, Whatever be the mode in which this deviation from the healthy and natural action of the parts is first induced, it is not difficult to trace its inevitable effect in the production of Seminal Debility and the ultimate destruction of sexual power. Irrita- 60 NERVOUS EXHAUSTION. tion, however engendered, rapidly propagates itself along the urethra; and chronic inflam- mation of the prostatic and most sensitive portion of that canal is rapidly established,, and the muscles surrounding the membranous division of the urinary passage are sympatheti- cally affected with irregular spasm. The irritation extends itself by continuity of sur- face to the seminal vesicles, and even to the testicles, producing in the former unnatural evacuations, and in the latter an exaggerated thin secretion, too rapidly elaborated, and therefore, for all the purposes of generation, worthless. Among individuals so affected (on attempt- ing intercourse with the sex) the emission is too quickly discharged, nocturual pollutions are frequent (indeed these are often the immediate precursors of seminal weakness) or the semen is expelled during the evacuation of the Madder and lowels. With some, there is more or less complete extinction of venereal desire, the erections become few and feeble, incomplete, or absolutely impossible. This condition of the sexual organs has its appropriate general character, analogous to those which are attribu- table to the wilful and determinate pollutions NERVOUS EXHAUSTION. 61 of earlier youth ; the sufferer, now perhaps too late, sensibly alive to the origin of his weakness, becomes timid, fearful, careless of the world around him, his mind absorbed in the consideration of his malady, until the continual presence and recurrence of the same train of painful thought involve him in the worst form of monomania, or rather the pre- mature childishness of old age. All the func- tions of the body languish and are deranged, until a complete and general degredation sweeps with uncontrolled dominion over every power and faculty, both of body and soul. The semi- nal fluid may dribble away without pleasure, without erections, without the natural ejaculation and its loss, when occurring in this manner, gives rise to the same or infinitely greater evils than those which occur from mere sexual excess, or what is worse, from self pollution. The term Impotence is applied as relative to that inability or incapacity to the performance of the sexual act, which may arise from a va- riety of causes, but from none so frequently as the excesses of Sensualism, more especially the secret, vicious, and solitary indulgences of self- pollution. It is important, in a practical point of view, that we do not confound this condition 62 NERVOUS EXHAUSTION. of the generative system with Sterility, inas- much as a male who is sterile, or a barren female, may possess a perfect aptitude for coi- tion, though for all the purposes of procreation absolutely incapable. In Impotence there is a temporary or permanent destruction of those powers which are absolutely essential for gen- erative purposes. Sterility may therefore be defined as inability to propagate the species, though not to affect the sexual congress; while Impotency in either sex, whether natural or ac- quired, whether as the result of disease or mal- formation, entirely precludes its performance. Impotence, resulting from physical imperfec- tion of the sexual organs, is mostly incurable; but when originating in such disorders of the urinary or genital apparatus as are traceable to irritation or inflammation of those structures, or to conditions however produced, thence re- sulting, such as thickening of the bladder, en- largement of the prostate glands or testicles, wasting of the penis, especially long-continued gleets and strictures, our first efforts are natu- rally directed to the removal of those proximate causes of Impotence; and if the habit be still indulged, the baneful, ultimate, or primary cause of so severe a deprivation. If } under those XERTOrs EXHAUSTION. 63 circumstances, Nature do not readily reassume her wonted functions, if there be remaining de- bility, it is necessary to invigorate the frame by the employment, not merely of those diffusable stimuli which act generally upon the whole sys- tem, but by the administration of remedies which are known to act immediately upon the generative organs. If there be present excessive irritability, it is necessary to employ such reme- dies as tend to diminish irritation in the mor- bidly sensitive organs. The causes of Impotence in man arise from two sources — from vicious malformation of the genitals, or from want of power; but among women, Impotence can only depend on malfor- mation, either natural or acquired. These causes are more commonly observed in man than in the other sex, and this is easily ac- counted for by the greater part the male has to perform in the nuptial congress. This is evi- dent from the phenomena which gave the virile member the form and disposition proper for erection, the introduction of the organ, and the ejaculation of the semen, which are effected by a violent and complicated action, requiring a . concurrence of many indispensable conditions, the organs not only contracting spasmodically ' 84 . KEHVOUS EXHAUSTION. to effect the expulsion of the male fluid, but all the body participating at this moment in a strange convulsion, as though nature at the in- stant forgot every other function. It will be obvious that the treatment must admit of wide modification, as Impotence may be absolute or relative, constitutional or local, direct or indi- rect, transient or apparently permanent. Many defects of conformation are sufficient, more or less completely, to interfere with the sexual act; among men, preternatural length, closure, or adhesion of the foreskin, constituting pliymosis (which may be either congenital or the result of disease.) Cancerous or scirrhous enlargement of the prostrate is frequent in advanced life, and forms another obvious physical bar to copulation Among females, adhesion of the sides of the va- gina is not so common as an imperforate state of the hymen, which occassionally closes so com- pletely the entrance to the internal organs, that the menstrual secretion has been known to ac_ cumulate behind that membrane, and for want of the natural outlet, the cavity of the womb has naturally assumed a distention closely simu- lating that of pregnancy. Some, from constitu- tional frigidity, are impotent ; thus we read that Zenobia, Queen of Palmyra, only admitted NERVOUS EXHAUSTION. 65 her husband's embraces once a month, and then solely in relation to posterity ; it is doubtful whether under such circumstances her sense of duty would atone for the absence of inclination. Excessive venery, and the profuse discharges of flu or alius, or the whites, are susceptible of completely destroying all power of excitement in women; hence prostitutes, from over-stimu- lation of the generative organs, seldom conceive. Transient impotence is often the result of mere apprehension. Too eager desires, too ardent imagination, the ecstatic effect produced by the sight of a beloved object, extreme nervous sus- ceptibility, are often sufficient to produce tem- porary impotence. It ig not unusual to meet with instances of married people becoming quite indifferent to each other's embraces. A patient of mine con- fessed to me his inability to complete the sexual act with his wife, unless, by an effort of the fancy, imagination conjured up the form of some more voluptuous female. Physical defect may constitute the cause of impotence, but more frequently there is neither organic defect nor local disease ; the affection is a mere nervous suspension of power, which is soon removed under proper management. Even this has its 66 NERVOUS EXHAUSTION. wise ordination. Any individual, however ner- vous in his physical capacity, if he anticipate with too intense eagerness intercourse with a beloved object, will seldom perform the act well. Even among the most ardent and pow- erful, it occurs, as many have confessed, that after waiting time after time for opportunity, when that has arrived, they have not had the power to take advantage of it ; a nervous anx- iety, a tremulous delight absolutely indefinable, has completely thrown prostrate all power, and the object of passion has been saved from per- dition by its paralyzing all the fire and ardency of animal desire. If the imagination wander from the task, temporary Impotence is the re- sult ; and many writers are firmly of opinion that impregnation is often impeded from the presence of ideas which interfere with the due performance of the generative act. Sterne has happily commented on this point in one of his most popular works, introducing his maternal parent as asking at a most untimely moment, whether his " father had not forgotten to wind up the clock." His views are strictly physio- logical. Such is the power of the moral over the physical state of man ! NERVOUS EXHAUSTION. 67 Impotence in the male may arise, then, from a wide diversity of conditions. Incapacity of erection, generally referable to self -pollution ; Impotence, arising from a want of power of re- tention in the seminal vessels, induced by a morbid susceptibility of those vessels, and brought about in like manner by a persistence in the same vicious practice ; Impotence, from inability of retention resulting from repletion of these vessels, all demand a variety of treat- ment peculiar to the precise condition of the parts. Impotence from mental influence has also its appropriate management. Exclusive of this, the generative infirmity under considera- tion, though occasionally arising from simple - disease, is ascribable in by far the greater ma- jority of instances to the excesses of Sensualism, either with women, or, more commonly still, from that vile excess to which such frequent al- lusion has been made in these pages. Long- protracted chastity or continence is not to be overlooked as a cause of Impotence : the very reverse of the degrading habit of self -pollution, it is not only comparatively rare, but offers in its very nature the indications of cure. But that long-continued debauchery, whether with women or by masturbation, is to be assigned as 68 NERVOUS EXHAUSTION. the most common and prominent of the causes of Impotence, is a fact admitted by all syste- matic writers, and amply and painfully con- firmed by my own experience. Mons. Pinel observes, — " The Impotence caused by the latter excess reduces youth to the nullity of old age, and is too often incurable" Fortunately, the re- cords of a numerous list of cases prove that re- covery of the powers of manhood is not (under judicious management) so altogether hopeless, as might seem to be the fact, trusting only to the observation of those medical men who have made these subjects their peculiar and exclusive studies. Impotence is often caused by debility of the genital organs, induced by precocious venereal enjoyments, or by the unrestrained abuse of the delicate structures in any method that tends to produce repeated and severe evacuations of the seminal fluid. If impotence result from self- pollution, there is a want of erection, and should a seminal emission take place, the semen does not possess its prolific power, and thus the man is at once Impotent and Sterile. This form of impotence is truly deplorable, and unfor- tunately it is the most prevalent variety ; never- theless, the author has cured many persons la- XERV0US EXHAUSTION. 69 boring under this distressing complication, al- though several involuntary diurnal as well as nocturnal emissions have regularly occurred without amorous impulse. Xext to Self-pollu- tion, excessive yexery is a frequent cause of impotence, as well as of sterility among the male sex. This is a frequent cause of want of offspring in young married persons. In these cases, the semen may escape without the aid of the ejaculatory muscles, is imperfect in quality, devoid of power until the health be improved; or, if impregnation ensues, the child undoubt- edly partakes of the debility of the parent, soon to be consigned to a premature grave, the vic- tim of that nameless atrophy or wasting decay which hurries thousands of infants annually to the tomb. In these cases the male parent gene- rally suffers from inflammation of the seminal vesicles, or there is a seminal weakness, with more or less involuntary discharge. The surest means by which sound and vigor- ous children may be engendered in a good con- stitution, unenfeebled by excessive waste of those powers which in their assemblage consti- tute the manifestation of the living principle. It is admitted, not merely by philosophic writers who have speculated deeply upon the subject. 70 NERVOUS EXHAUSTION. but by all who have paid the least attention to the facts connected with such a statement, that not merely the physical but the moral dispo- sitions of the parents are transmitted by gene- ration ; hence, if a sound mind in a sound body be the first, greatest, and most lasting blessing, and its deprivation or absence the greatest pos- sible, curse, how imperatively necessary is the obligation to calculate closely the tendency of vicious indulgences, to avoid the contamination of depraved habits, and to correct and elude the consequences of that debility Already im- posed upon the generative organs by sensual excess ! Impotence and Sterility are usually the results of wilful imprudence. Malformation is a direct interposition of creative wisdom ; its occurrence is comparatively rare ; l?ut faili?ig power is not only exceedingly common, but gene- rally constitutes a self-i7iflicted evil. Diseased and delicate parents procreate diseased and weakly offspring. The same results are observed in plants and animals. Can it be supposed that the physical powers, the sympathies of a beau- tiful woman of an excellent constitution are in unison with those of a man whose best ener- gies were long ago expended in the premature and illicit excesses of lawless excitement, whose KERYOUS EXHAtTSTIOX. 71 youth has been a hurried history of wild enjoy- ment, whose passions haYe been lashed past the natural powers of his bodily organization, and who now brings his decrepid efforts as a worth- less offering at the shrine of matrimonial sanc- tity ? Or worse still — is there a mockery more deep, more bitter, than that desolation of spirit which an affectionate woman must feel on find- ing she clasps, entwined within her circling em- brace, the mere wreck of Sensualism, the hor- rible victim of self -pollution ; the creature who, having trained his imagination and bodily powers to mere fancied enjoyments, is now de- prived almost, if not entirely, of the capability of resuming the actions for which his genera- tive organs were destined ? Woman's scorn must be the more intense, because from the very nature of her own position she is precluded from giving vent to her feelings of anger and vexation. Love cannot be reciprocal in such cases ; animal or organic impulse will prefer that which is more accordant with itself ; even beasts prefer males which are possessed of vigor, power, and beauty, and this instinct is implant- ed by Nature in all animals. Whatever per- version civilization may effect in our feelings or manners, it cannot extinguish this instinct. 72 NERVOUS EXHAUSTION". And this is an eminently wise ordination, as tending to the perpetuity of a healthy race of human beings. If Sensualism have impaired the powers, not of both parents, but of one only, the punish- ment of the offence is either Sterility or de- bility; or pain, disease, and death transmitted to the children, and reflected back with sorrow upon the parents. Impotence, then, is the last crowning scourge of sexual imperfection, and demands for its removal the most cautious appli- cation of the resources of the healing art. The treatment of the chronic diseases of the gene- rative system, has been strangely neglected and signally misunderstood. The efficacy of well- directed efforts has been much mistrusted in this matter, and it is remarkable that both the patient and practioner contribute to these im- pediments : for as the latter has been accus- tomed to see his remedies speedy in their effects, he is himself discouraged if they do not imme- diately produce the desired benefit. Nor is it any wonder that the patient becomes incredu- lous of the promised relief, neither of them recollecting that the morbid states have been slowly produced, and cannot therefore be speedily changed. KEBVOUS EXHAUSTION. 73 Self-pollution, the frequent cause of sexual Impotence and Sterility, is generally the habit of the best years of youthful life ; and its dead- ening impress often tells with deplorable cer- tainty, Jong after the "baneful habit has leen re- linquished. Time must therefore be afforded for the rectification of that artificial state into which the powers of the system has been wan- tonly plunged. It is evidently the absence of fixed principles, in our pathology of the slow diseases of the generative system, that has given such unbridled license to quackery. There has always existed a vagueness of opinion re- specting their nature, and an unsettled doctrine as to the most rational methods to be adopted for their mitigation and cure. The communi- cation of disordered action is an inevitable re- sult of indulgence in any mode of Sensualism, either excessive, or contrary to the order of na- ture and the constitution of our being: and the nature of that perverted action may be readily anticipated. In fact, we see it exemplified in excessive irritability of the bladder and seminal vesicles, producing incapability for retention, disease of the spinal marrow and brain, spasm of the urethra, and stricture, an effeminate flaccidity of the penis, testicles, and scrotum. 74 NERVOUS EXHAUSTION. Can it be expected that these organs should be capable under such circumstances of fulfilling their appropriate office in the task of procrea- tion ? Most assuredly not. Where impotence is consequent upon that baneful propensity, ichich cannot be sufficiently stigmatized, its extent of severity is far greater than ivhen produced by excessive indulgence with women, because the vital fluid that could haye improved the stamina of the system has been lost without satisfaction; consequently no gratification of the mind has been had in counterpoise to compensate, and in some measure to repair the expenditure of power. The man who, from his anxiety to indulge to the utmost his libidinous propensities, seeks for variety among women, may certainly find in such variety a new stimulus sufficient for the occasion, and may be able to accomplish more frequent repetitions of the sexual act than the sober married man who is faithful to one ; but we cannot overlook the fact that this is un- doubtedly accomplished at the expense of a cor- responding amount of unnatural excited energy, and the ultimate results of such efforts tell with fearful and tremendous horrors upon the help- less and debilitated votary of greedy pleasure. The nightly partner of a husband's bed silently KERV0US EXHAUSTION. 75 offers only that gratification which is demanded by the sexual organs, when fully charged with the seminal fluid and impatient for relief ; to such a man, the stimulus of variety is unsought, contemned, forbidden, as contrary not merely to all laws, human and divine, but as directly opposed to his well-being, to the maintenance of his animal organization in health, strength, and usefulness. Here, then, the natural laws of his physical constitution harmonize most ad- mirably with the higher sanctions of morality. The actual amount of enjoyment realized by the temperate is, in the long run, far greater; power is maintained until old age, and a vigorous off- spring is engendered ; while the hasty, violent, and forced gratifications of the Sensualist, though vivid for a moment, are succeeded by that worst form of helplessness — insatiable de- sire, appended to diseased and jjowe? 'less organs. The draining of the seminal fluid which occurs either from excessive indulgence in venereal gratifications, or from solitary vice, is not equally great in every instanoe. There are some indi- viduals who are not rendered absolutely, but only partially Impotent. They can accomplish the sexual acts occasionally, and with severe effort, to the disgust, doubtless, of the female, 76 NERVOUS EXHAUSTION. or they are tolerably able, yet unprolific. Their powers are weakened, not altogether destroyed. These patients have resources left in surgical skill, which, if expended in contending against improper or unskilful treatment, are lost FOREVER. The debility produced by masturbation starts a difficulty in the choice of remedies which does not occur in other cases ; to excite, yet not irri- tate, this is the point of divergency, where cau- tious science leaves Plundering quackery to pur- sue her blind injurious course. It is a law of animal organization, that when motion is in- creased, the increase is most considerable in those parts which are most susceptible, and these, among Sensualists, are the parts of gene- ration ; therefore, the effects of irritating reme- dies are most sensibly and instantly felt in these parts, enforcing the utmost circumspection not merely in the selection, but in the administra- tion and employment of medical agents. Thus, Sterility may be in some cases only apparent. Although it is perfectly true that, in a few in- stances, the uterine system of the female may be insensible to the seminal stimulus of a par- ticular individual, yet capable of being acted upon by another, the lapse of a little time is KERVOUS EXHAUSTION. 7? often sufficient (if there have been no debilita- ting causes in operation before marriage) to dis- sipate groundless fear ; and such being the truth, it becomes doubly important, not only that proper treatment be adopted where abso- lutely demanded, but that science should de- termine whether any or what kind of interfe- rence be really necessary. Offspring is frequent- ly denied to newly-married persons from eager- ness in its pursuit. The consequences of ex- cessive venery in these, whom warm passion has united in its indissoluble tie, amount only to the defeat of their wishes. Celsus remarked upon this subject more than eighteen centuries ago: "Earns concubitus corpus exbitat, fre- quens solvit;' 9 which may be freely translated, " The bodily powers are excited by occasional coition, by frequent repetition they become re- laxed," and consequently unprolific ; or as a poet has expressed the same sentiment — " While temperate pleasure spurs the lazy blood. Excess unstrings the nerves, and dries the flood." and so truly is it within the experience of many, that when the first warm anxiety for offspring, and its corresponding efforts, have passed away and subsided, the blessing is granted to less passionate, exciting, and frequent embraces. ?8 NERVOUS EXHAUSTION. The ancient physicians were right in their general rule : the longer parties abstain, the more quickly they generate. Almost all phy- siologists now agree that the retention of semen for some few days, or temporary abstinence from coition, is necessary to generation. During my practice, many persons have consulted me on ac- count of want of family, which entirely arose from this cause. Such cases require great deli- cacy in their investigation, but it is not difficult to learn their nature when science, caution and sympathy are duly exerted. Conj ugal, domestic and social inconveniences must always be avoid- ed ; and it is scarcely to be observed, because of its obvious truth, that excessive sexual enjoy- ment relaxes both parties, and may, even in the married state, defeat its own and, be unfruitful, from too frequent repetition ; and bring on that atony, weakness, and debility of the generative organs, which may end in sterility in the female and impotence in the male. If these things be so (and who will dare to contravene their truth, founded as it is on the ordinary every-day observation of mankind ?) it follows that there are, and may be, varieties of seminal weakness, originating most com- monly in nocturnal emissions, and these, de- NERVOUS EXHAUSTION. 79 pendent in many instances (but not invariably so) on the unnatural practice of self-pollu- tion; to which such ample reference has been made in the foregoing pages. That these em is- sums lead to the most deplorable consequences, independently of the injury done to the genera- tive function, is indisputable. The most studi- ous people, and those of splenetic cast, are sub- ject to this infirmity, and the discharge of semen is commonly so considerable, that they fall into a slow wasting consumption. A Roman phy- sician (whose opinion is supported by John of Acarius, author of a work composed for the Emperor) observes, "If nocturnal emissions continue any time, the necessary consequences are consumption and death; for the most bal- samic part of the human and animal spirit is dissipated ; the whole body falls away, and par- ticularly the back ; the patients become feeble, dry, and pale ; they languish in slow melan- choly agony." Let this antiquated, yet terrifi- cally correct portraiture, deter the thoughtless from practices which lead to such a state ; and those in whom it is commencing, let not in- cipient evil be deemed unworthy of their most serious consideration. LECTUEE V. THE MOKAL AND PHYSICAL EFFECTS OF SELF- ABUSE — SPERMATORRHEA — IMPOTENCE. All the faculties are weakened by indulgence in this yice. The sense of hearing loses its acuteness, and much annoyance is caused by noises and singing in the ears ; sometimes even deafness results. The eyes lose their brilliancy, end appear dull ; the pupils are always more or less dilated. According to Eichter — one of the most eminent of surgical authorities — " No general tvealcening causes operate upon the eyes and occasion total blindness so powerfully and so often as premature and excessive indulgences in venereal pleasures. 77 Another of the evils resulting from self -pollution is a failure in the power of the mind, especially the memory. In short, it may be stated with the utmost confidence that there is not an intellectual faculty with which the beneficent Creator has blessed us that is not liable to be impaired by these causes. It is a curious fact that the habit of self-pollution is invariably followed by a diminution in the size of the penis. The organ shrinks to one-half its former outline, or, in those who have practised XERTOUS EXHAUSTION. 81 it in youth, does not attain to full growth. The power of perfect erection is altogether destin- ed ; when coition is attempted, the requisite solidity is not maintained, or if an entrance in- to the vagina be partially effected, it is followed by a premature emission. Let not the victim, of secret vice natter himself his unmanly act escapes detection. Dr. Armstrong observes — > " I think I should know a person in the streets who has addicted himself to this vice, by merely walking behind him, from his peculiar gait." From the commencement of the unfortunate habit of self -pollution, which is invariably the cause of seminal weakness, there is frequently a loss of desire for sexual intercourse ; or where the desire is felt, a repetition of the unmanly habit is preferred to coition in a natural way. This, when persisted in, causes the face to be- come pale, bloated, and cadaverous, the body feeble and emaciated, and an impeded circula- tion in the extremities. Then occur trembling hands, dim eyes, confused ringing in the ear, sometimes deafness, accompanied with frequent and violent headache. A nervous dread and loss of energy are very common, and we have frequently heard patients confess that they have walked their rooms for hours together at night, 82 i^EKVOUS EXHAUSTIOK. fearing to go to bed. This is often experienced when the nocturnal seminal emissions are nu- merous. We may here observe that the prac- tice of Onanism may sometimes be indulged in without apparent ill effects for a time. Some are affected in a month or two, some may escape for years ; but not any entirely escape, for it is impossible to violate any law of Nature and of Nature's God without evil consequences result- ing. The practice of Onanism is a moral and physical crime, consequently the punishment is twofold. Thus, while the bodily vigor is lost, and the senses lose their keenness, the mind also becomes affected, the memory fails, the judgment becomes defective, and the patient becomes unable to any exertion, bodily or men- tal. Such is the history of many cases of sui- cide of which we read in the newspapers ; cases mysterious, at first sight causeless, but under- stood by the educated physician, regarding them by the clear light of science. Tissot, the cele- brated physician and early writer on this sub- ject, states the result of this practice to be, First : — Total derangement of the stomach, shown in loss or irregularity of appetite and indigestion. In some cases the appetite be- comes almost voracious : Nature thus endeav- tf ERVOtTS EXttAtJSTlOK. 83 ouring to repair the loss inflicted upon her. Second : — Weakness of the respiratory organs ; whence frequently result dry coughs, almost al- most always colds, weakness of the voice, and sense of suffocation on slight exertion. Third : — General relaxation of the nervous system, lassitude by day, painful dreams by night ; the sleep is unrefreshing. Fourth : — Great debility of the organs of generation ; almost all com- plaining of only imperfect erections ; desire no longer exists, and impotence results. Noctur- nal emissions are a terrible scourge to these suf- ferers, and often overwhelm those even whose organs are absolutely senseless when awake. When these patients have had nocturnal pollu- tions, they find themselves the next day in a state of depression, of discouragement, debility, ennui, and lassitude, with pains in the loins, head, and eyes. Fifth : — Eruptions frequently appear on the face and forehead ; the features become changed from the rosy hue of health to a dull, heavy, and sallow complexion. We will conclude this part of the subject with a few words respecting spermatorrhoea and im- potence. This term spermatorrhoea is derived from two Greek w^ords, signifying a flowing of seed, and is applied to all cases in whioh an 84 XERV0US EXHAUSTION. emission of the seed takes place, excepting from coition ; in other words, spermatorrhoea maybe termed an involuntary loss of the semen. The usual causes of this disease are self-pollution, but it may also be the result of immoderate in- dulgence in coition, of ill-cured gleet, and fre- quently of disease of the prostrate gland. Con- stipation of the bowels, and the irritation of the rectum caused by piles, may also predispose. But after all, the influence of these causes is insignificant compared with that of self-abuse. The symptoms of spermatorrhoea may be divided into local and constitutional. The local symp- toms are generally emissions of seed at night ; and we call the particular attention of our readers to this rule. Nocturnal emissions are decided signs of debility and symptoms of ap- proaching impotence. Let it be remembered that every drop that escapes is the habitation of living beings, a particle of the living seed, and that one drop, under favorable circumstances, is sufficient to give life to a future being. With respect to diurnal emissions — which occur at stool, whilst making water, or which are evident in a continual moisture and humidity of the organs — they are of a complicated character, and in many instances are undiscovered and KERVOTJS EXHAUSTION. 85 unsuspected by the patient until the disorder has assumed a most formidable character; for he is quite unconscious of any seminal loss. The nocturnal emissions sometimes leave him entirely, the drain by day being so excessive ; but at last some formidable symptoms force him to seek relief at the eleventh hour. During the progress of spermatorrhoea many patients suffer from a hard dry cough, a difficulty of breathing, pains in the chest, and hence are treated for consumption ; for the constitutional symptoms of spermatorrhoea are innumerable, and when the cause of disease is unknown and unsuspected, the general practitioner will natu- rally attack the symptoms. The appetite, at first, will frequently increase and become vora- cious — it is the effort nature makes to support the failing strength. All the senses are more or less affected — the eye loses its brilliancy, there is always more or less dilatation of the pupil, and the very look of the patient reveals his secret to the glance of experience. The penis and testicles become small and relaxed ; and a high surgical authority observes, the in- firmity may not inaptly be termed a consump- tion of these glands. And we cannot be as- tonished at the frightful effects caused by un- 86 k Eftvous EXtfATisttOtf. natural emissions of seed, when we recollect that physicians of all ages are agreed that the loss of one ounce of semen by self-abuse, noc- turnal emissions, or at stool, injures the system and weakens it more than the abstraction of twelve ounces of blood. In the early stages of seminal weakness, different persons are various- ly affected ; some are incapable of procuring a discharge of semen into the cavity of the female genitals in a natural way, though they may effect temporary erection ; while others cannot perform the act of copulation, from the emission taking place too quickly, and before the proper firmness of the male organ has enabled it to effect the requisite penetration. To recapitu- late briefly the results of our experience : — Im- potence, the effect of long-continued sperma- torrhoea, is the inability to perform the venereal act. Those cases are most difficult to cure w r hich have been caused by self -pollution ; but science, combined with skill and experience, will almost effect miracles, and our treatment of these cases has been moct successful. Impo- tence is also caused by too free indulgence in sexual pleasures ; these cases can be cured with comparative ease by rest and tonic medicines. Impotence is sometimes the result of moral NERVOUS EXHAUSTION. 87 causes — nervousness, too much respect, &c; the treatment is obvious. Impotence, then, is chiefly caused by debility of the genital organs; there is a want of erection, and if a seminal emission takes place, the semen does not possess its prolific power, and the man is at once impo- tent and sterile. Sterility, or barrenness, is sometimes the vice of female organization, and is produced by various causes ; amongst others which entail a loss of vital and productive energy, excessive indulgence is one of the most prominent. Excessive venery is a frequent cause of want of offspring in young married people. In these cases the seed does not ac- quire sufficient vitality to stimulate the ovum in the womb ; and even if a child should come to life, it partakes of the debility of the parent, and is soon hurried to a premature grave, the victim of that nameless atrophy or wasting away which kills its thousands of infants annu- ally. Impotence and sterility are usually the result of wilful imprudence. Malformation is very rare ; but failing power is not only exceed- ingly common, but generally constitutes a self- inflicted evil. The author is frequently con- sulted by those contemplating marriage, and whenever bad habits have existed, or weakness 88 NEEVOUS EXHAUSTION. is experienced, the precaution is most wise, and may prevent much future unhappiness. Like- wise, as respects the married man, it often oc- curs that a few minutes' confidential conversa- tion with one who has made these subjects a special study is attended by the happiest re- sults. There are resources in the science of medicine, and few, very few, need despair of restoration to the power of manhood. But we will refrain from further details ; our object is friendly suggestion, not importunate dictation. We will conclude this chapter with a few words of the celebrated Lallemand: — "Many diseases, when left to themselves, work their own cure, providing only they be not exasperated by the imprudence of the patient. This is not the case with spermatorrhoea, chiefly, perhaps, be- cause the effects produced by the disease itself are favorable to the increase of involuntary dis- charges. The natural tendency of this disease to become aggravated, as the result of its own effects, frequently leads to a fatal termination. The patients generally expire in one of the at- tacks of syncope that follow congestion of the brain. In this way such of the insane who have fallen into a state of dementia usually expire. Many die from diseases (as consumption, &c.) KEHVOUS EXHAUSTION. 89 aggravated and inflamed by unsuspected sper- matorrhoea ; the symptoms are treated by the physician, but the great cause, spermatorrhceal remains unsuspected." MODERN TREATMENT OF SPERMATORRHEA, SE- MINAL WEAKNESS AND NERYOUS DEBILITY. Like many other intractable diseases, sperma- torrhoea has been the "opprobrium? medicorum" of the regular practitioner. From its tedious- ness, the medical man is wearied of it ; and like an obstinate gleet, after trying all possible remedies, has given it up in despair. Nor is this altogether to be wondered at, when we consider the extreme difficulty of the diagnosis, excepting by microscopic observations ; and to use the microscope in these cases with effect re- quires skill, care, experience, and a thorough knowledge of the disease. Spermatorrhoea is a drainage, a waste, a dribbling away of the semi- nal fluid. As already explained, it may exist unknown, and, consequently, unattended to until great mischief has been inflicted on the constitution and vital powers. Now, what are the indications of treatment ? Naturally, to give tone to the vessels that neglect their office; to prevent the too profuse secretion of tha 90 HERVOTJS EXHAUSTION. impoverished fluid ; to esablish a healthy reli- ance between the two ; to remove the provoking causes that brought about the first estrange- ment ; to repair the mischief done to the gene- ral health ; to cultivate the mind into a higher notion of its importance, and thereby withhold the irritating consequences of disordered im- agination. The treatment, then, of spermator- rhoea and its accompanying affections, mental and physical, may be divided into — First: — Local and Constitutional; Second: — Moral and Dietetic. The first step on which we must in- sist is the relinquishing of those practices which have occasioned the disease. This is essential ; the most careful and the most scientific treat- ment must otherwise increase the mischief, and, by giving greater temporary strength, en- able the patient to inflict on himself more per- manent evils. A due attention to air, exercise, sleep, and regimen is in all eases proper, and entirely within the control of the patient. A local remedy of great value is cold water ; the sponge-bath or shower-bath should be used in the morning, a small quantity of bay salt being dissolved in the water. Coarse towelling and flesh-brushes should be used after the bath ; a suspensory bandage should be used ; the diet NERVOUS EXHAUSTION. 91 should be generous, but not stimulating, animal food in moderation, and he should eat a little and often, rather than take too full a meal. Exercise must not be neglected, moderate at first, and gradually augmented. Stimulating drinks are improper, spirits in all cases hurtful; a glass or two of wine may be taken if demand- ed by previous habit. In this case a pale dry sherry will be best. With respect to medicines, a sketch only of the treatment can be offered. Cases vary so widely, that the curative means must be varied accordingly. The class of drugs which allay excitement and irritability are first likely to be required, for the stomach is so weakened and capracious that the disease is frequently mistaken for indigestion. Mild and cordial laxatives, alterative drugs, with neutral salts, febrifuges, and sedatives, will soon quiet the system, and enable it to tolerate tonic or restorative medicines ,which if commenced with are decidedly injurious. But what is the mean- ing of tonic ? for no word is so much misap- plied. One man means quinine, another iron, a third the mineral acids, whilst a fourth means stimulants, and so on through the whole Phar- macopoeia. Now, we mean, not any one, but the whole class of medicines combined, changed. 92 NERVOUS EXHAUSTION. increased, or diminished to suit the particular case ; in this consists the real art of scientific prescribing. One man gradually gathers strength from quinine, which would not suit another, whose deteriorated blood-globules will become red and healthy under the exhibition of iron, in some of its numerous preparations. The peculiarity of our treatment consists not only in the selection of hitherto undiscovered remedies, but in the practical adaptation of those we already possess. And the above are but a few of the remedies we employ in gene- rative diseases or debility. Amongst the most certain and most valuable for the total cure of spermatorrhoea — which control that disease completely, even when caused by long continued habits of self-abuse — are medicines whose very names are unknown to the general practitioner. Under the tropical sun of India, in Thibet, and the mountainous ranges of North-eastern Hindustan, in the forests of Ceylon, are found plants and herbs grown from the virgin soil, rich in balsamic virtues, aromatic and cordial. India, the land of ancient civilization, the original home of medicine, still retains secrets which baffle the wisdom of learned physicians. Who has not read and wondered at the marvel- NERVOUS EXHAUSTION. 93 lous stories of the power and influence exerted by the " Old Man of the Mountains ?" The means by which he exerted his influence, by which he retained the power of life and death over his followers, by which he compelled them to the most desperate enterprises, were com- prised simply in his knowledge of the herbs, flowers, and grasses under his feet. Have these wondrous gifts of Nature now lost their virtue? I boldly answer, No ! I am in possession of remedies marvellous in their influence, most effective in their result, by which I control the worst cases of disease and debility, and which account in a measure for the extraordinary suc- cess I have . met with in special practice. So when Debility has weakened the mental facul- ties ; when a long course of dissipation and solitary habits has destroyed enterprise, energy, and courage ; when a man feels that he is a wreck in body and in mind, and dares not even own it to himself — surely in such cases these remedies are called for. And no man can treat successfully the diseases described in these pages whose medicines are limited to those con- tained in the American Pharmacopoeia. It is a question often asked — Is sexual intercourse indispensable to health ? The reply may be 94 NERVOUS EXHAUSTION. taken that at least Nature destined the act of generation for procreative purposes, and that not only should it contribute to the delight of mankind, but also to their health. Hence copulation is permissible and necessary, ex- treme chastity frequently injurious ; and we often find it advisable to recommend marriage. It should also be remembered that copulation should never be an effort. This is a golden rule, and where great languor, drowsiness, de- pression, and a feeling of physical exhaustion follow the act, the time chosen has been inapt, or the limits have been exceeded. We will con- clude this part of the subject with a few words respecting treatment. Having enjoyed for many years the friendship of the late celebrated Lallemand during our residence in Paris, our practice in cases of spermatorrhoea has neces- sarily been most extensive. The peculiarity of our treatment is to act directly on the seminal vessels, to strengthen without exciting, and so restore health by removing the cause of disease. It would be easy to recommend various reme- dies ; but medicine in the hands of the timid, the irresolute, or the ignorant, is more likely to produce evil than advantage. In all cases let the best advice be sought from one who has NERVOUS EXHAUSTION. 95 made these diseases a special study. Some may be prevented from applying for assistance from dread of accidental exposure ; it may, there- fore, be proper to remark, that it is our rule to destroy all correspondence at the termination of each case ; or, if preferred, to return it to the writers. Inviolable secrecy and certain re- lief are the boons we offer to suffering humanity. Unfortunately, practitioners in this country have long been averse to selecting this branch of medical art as a study ; many distinguished men have risen to fame and affluence by devo- ting their talents to midwifery, operative sur- gery of the eye and ear, &c. The author of this treatise is content to brave the sneers of the ignorant and envy of the malicious, when he reflects on the gratitude of those whom he has rescued from an untimely grave ; he knows that in selecting this peculiar department of medi- cine his usefulness has been increased, and that he deserves well of his fellow-men. OX CERTAIN URETHRAL DISCHARGES. We shall not here consider the gonorrhoeal discharge, as that is treated on in another part of the work. There are, however, other dis- charges, and of a serious nature, which often 96 HEftVOUS EXHAUSTION. call for skilful' and attentive treatment. The first of these is termed gleet, which is the con- sequence of an ill-cured or neglected gonorrhoea or clap. There is another discharge, a dis- charge of semen, without sensation, which is the result of a debilitated frame, and is fre- quently induced by long-continued self -pollu- tion, or long residence in hot or cold climates. The penis is invariably damp and clammy ; there is a slight mucous discharge rather thicker than ordinary clap, which sticks in patches on the linen, and between the nut and foreskin of the penis. Under the microscope this dis- charge is found to consist of spermatozoa, fre- quently in a mutilated state, and free from vitality. The affection is characterized by the emission of semen upon the very first attempt at sexual intercourse, and often before a regular erection can take place; sitting in a warm room, horse exercise, and many trivial causes will produce it. The emission causes little or no sensation, excepting sometimes a slight spasm. These discharges are not contagious, but sexual intercourse should be studiously avoided on account of the great injury that may result to the patient. Such discharges are generally connected with deficiency of generative power. KERVOUS EXHAUSTION. 97 In one instance under our notice, impotence was almost complete ; in another (a married professional man), the powers had greatly de- clined. These patients were in the prime of life ; both had, however, led irregular lives. The irritation in cases of this nature will gene- rally be found to exist in the prostate gland, which is often enlarged ; hence a frequent de- sire to urinate, and a feeling as if the bladder were never completely emptied, and as though a few drops of urine were retained in the pos- terior part of the urethra. This form of dis- charge is generally confounded with a common contagious clap, and treated vigorously with copaiva, cubebs, and injections. A cure by these means is utterly impossible ; the disease is increased, as the general health suffers from the remedies. It is, however, quite true that these patients have previously suffered from gonorrhoea, in some instances more than once. But in order to cure, we must purify the blood, and strengthen the parts. The subject, alto- gether, is well worthy the careful attention of the profession, for these cases are decidedly on the increase. LECTIIBE VI. VENEREAL DISEASE — HISTORY. Had the disease, since known by the name of Venereal, been a familiar one, possessing no features different from those already recognized as characterizing affections of the genital or- gans, and yielding to an already ascertained treatment, we naturally should expect that the authors who might notice it would never have thought of designing it as new and unknown ; neither would they have expressed terror at encountering it, nor expressed their entire ignorance as to the means of cure. Such, however, we find to be the fact, from universal testimony of the writers of the age. The ap- pearance, indeed, of this new form of disease was an event so important that mention of it was made, not only by physicians, but the his- torians living at the period also record the cir- cumstance. We will cite the authority of Gonzalo Hernandez de Oveido, and refer our readers to his curious volume, in black letter, in the library of the British Museum. The date is 1526, "Sumario cle la Natural Hystoria NERVOUS EXHAUSTION". 99 de las Indias ;" and Oveido distinctly states the American origin of venereal, and the inability of the physicians to cure it. Another historian of the period, Lopez de Gomera, writes, "Be- cause it was a new disease no one knew what to do." Other contemporary writers, Paul Jovius Guieciardini, &c, express themselves to the same effect. Most of the early writers attribute the disease to God's anger ; some to conjunction of the planets ; others, of more matter-of-fact views, were disposed to ascribe its origin to another kind of conjunction, of not so celestial a nature ; for there are authors of this date who distinctly notice the primary sores or chancres, and trace them to their real origin — contagion by impure intercourse ; they mention strong salivation by mercury as a cure. Joseph Greenbank, who describes his own case, in a work written with much purity of Latinity for the age, attributes the cause to planetary in- fluence. He wished to keep it secret from his friends, but they found him out "from the change in his complexion ;" and no sooner was it known (and the fact shows in what terror the disease was held), than " his dearest friends and relations fled his presence, as they would an enemy with a drawn sword." The notion 100 NERVOUS EXHAUSTION". prevailed that it could be caught by merely breathing the same air with the infected per- son ; hence the lower orders were driven into the woods and fields, and left to perish with- out solace or assistance. It formed one of the charges against Cardinal Wolsey, that " when laboring under venereal he had breathed upon the king in whispering to him.' 7 Hence, being looked upon as a contagious disease to which any one was liable, the physicians of the age did not scruple to publish the cases of princes — and even churchmen — who had the disease; and most of the medical works on the subject are dedicated either to princes or dignitaries of the Church. Another opinion was very prevalent — even now the belief is not yet extinct — that any one having the disease, by transmitting it to another relieved himself ; though it was asserted that, to make the experiment success- ful, it was necessary that the person to whom the infection was to be transferred should never before have had sexual intercourse. It is scarcely necessary to add that this atrocious and ridiculous belief gave rise to most disgrace ful outrages. The manner in which the new disaase ran its devastating course, spreading in distant countries with a rapidity which, joined KEKYOUS EXHAUSTION. 101 to a complete ignorance of treatment, truly appalled mankind, must be acknowledged to constitute a proof of its newness — and univer- sal testimony leaves no doubt on that score. That it was first brought from the island of St. Domingo, then called Hispaniola, by the fol- lowers of Columbus, there is abundant and satisfactory proof. Few of the Spaniards es- caped who had connection with the native wo- man, and the ships of Columbus proceeding to different ports, the disease spread over Europe with wonderous rapidity. In 1526, Joseph Grunback informs us "that on returning from his travels, he found disease prevailing all over Germany — in every town, city, camp, village, and cottage — as well as the greater part of Eu- rope." In the same year we are told by Sebas- tian Brant that it had got to Britain ; and in 149 7, James IV. of Scotland, in consequence of the frightful prevalence of venereal in Edin- burgh, issued the celebrated proclamation ban- ishing the infected from the city. The original is preserved in the records of the town council, dated September 22d, 1497, and is a very curi- ous document. His "Majesty charges all man- ner of persons being within the freedom of this burt, (juilks are infectit, or has been infectit. 103 NERVOUS EXHAUSTION. uncurit with this said contagious plague, called the G-randgor, devoyd, red, and pass furt of this toun, and compeir upon the sandis of Leith, at ten hours before none/' — those evading this ordinance "selle be brynt on the cheik with the marking irne, that they may be kennit in tyme to cum." "We may also cite here the more generally known a Arreste " of the Parliament of Paris, respecting the venereal, dated March 6th, 1496, stating that " Because in thys City of Paris many persons were sick of a certain disease called the ' Great Pocks/ which had raged in this kingdom for the last two years, as well in Paris as in other parts of France ;" and as there was reason to apprehend that it would increase as the spring advanced, it was advised to pro- vide accordingly. Thus all strangers having the disease were to leave in twenty-four hours, and forbidden to enter the city until perfectly cured. The 2d article ordained, " That every citizen being diseased confined himself to his house." No communication was allowed be- tween the sick and the inhabitants, under pen- alty of imprisonment ; and the city gates were carefully watched. The general prevalence of the disease can only be accounted for by the HERVOUS EXHAUSTION. 103 undoubted licentiousness of the age— -as we have no reason for believing that then, any more than at present, could it be propagated except by actual contact of the venereal matter. We have enlarged on this subject rather more than we intended, in order to prove the great difficulty experienced from the earliest period in eradicating this disease. We have studied the subject closely — we have reviewed the mode of treatment from the earliest period up to the present time, and we most unhesitatingly and emphatically declare that we have reduced the treatment to a certainty ; that we possess the means of eradicating the venereal virus from the constitution without the smallest inconve- nience to the patient, and that no case leaves our charge without a thorough and perfect cure being effected ; that we prevent the possibility of secondary symptoms, and the numerous skin diseases to which it gives rise ; and, lastly, our treatment applies to all who have taken mer- cury, or have been improperly treated by others. DISEASES OF I^FECTIOX — GONORRHOEA OR CLAP. Gonorrhoea may be defined to be a contagious inflammatory disease of the mucous membranq of the urethra or urinary canal, caused by 104 iSTEEVOUS EXHATJSTIOK. impure sexual connection. It sometimes ap- pears the first or second day, but the usual average is from seven to eight days after inter- course. On the other hand, it is sometimes delayed for two, three, or even four weeks. At first, the patient feels an itching at the tip of the urethra, the lips of which appear swollen and of a deep red ; this is followed by a dis- charge of matter and great pain and scalding in making water. In all cases of gonorrhoea, advice should be obtained as early as possible ; early attention insures a speedy cure ; and it may be laid down as a general rule, that the longer the disease is allowed full scope, the more difficult and obstinate is its removal. Where there is much inflammation, the bowels should be kept open with the following aperient draught : — R. Magnes. sulphatis, unciam j. Infus. sennae comp., unc. vss. Ext. glycyrrh., scrup. ij. Tinct. jalapi, drachm, iij. Spt. amnion, aromat., drachmam j. Mis. Fiat mist, aperient. Cap. 1-4 partem pro re nata. NERVOUS EXHAUSTION. 105 That is,, take of — Epsom salts, 1 oz. Compound infusion of senna, 5 ^ oz. Extract of liquorice, 2 scruples. Tincture cf jalap, 3 drachms. Spirit of aromatic ammonia, 1 drachm. Mix, and take one-fourth part as occasion re- quires. A cooling lotion may also be useful. Apply the following two or three times a day : — R. Muriat. amnion., drachmam j. Liq. plumbi diacet, drach. ij. Spt. yini rect., unciam j. Aq. font., una y. Mis. Fiat lotio. That is, take of — Muriate of ammonia, 1 drachm. Liquor of lead, 2 drachms. Rectified spirits of wine, 1 oz. Dilute acetic acid, 1 oz. Spring water, 5 oz. Mix for a lotion. [The bottle should be carefully labelled, " The Lotion."] 106 NEftVOUS EXHAUSTION. During the progress of gonorrhoea, attention to cleanliness cannot be too strongly recom- mended. A warm bath should be taken occa- sionally, and the penis should be bathed as frequently as possible in warm water, or milk and water, to destroy the acrimony of the dis- charge, and to prevent its irritating action on the skin. Great comfort will be experienced by the patient suspending the testicles in a small bag so as to support them while walking, &c. This simple precaution frequently pre- vents swelled testicles, one of the most painful effects of gonorrhoea. The diet should be care- fully regulated in the early inflammatory stage; the food should be light, but nutritious, and not highly seasoned. Wines, spirits, and malt liquors should be avoided ; the patient may drink freely of thin linseed tea, or barley-water. The following may also be grateful: — Cream of tartar, one oz. ; boiling water, two quarts; strain, and sweeten with lump sugar, according to taste. We frequently cure slight cases oFgon- orrhoea in four-and-twenty hours ; others in three days ; and, with common attention on the part of the patient, and observance of the above simple rules, our average of severe attacks is from six to eight days. NERVOUS EXHAUSTION. 107 GLEET, In which the discharge loses its irritable malig- nity, is of alarming consequence in its duration. It cannot be too frequently asserted that gleet is highly contagious, and produces a gonorrhoea as speedily and as certainly as the more inflam- matory disease. Gleet will remain chronic for weeks, months, or even years, and vary in in- tensity according to changes in diet, &c. ; so much so, indeed, that well-informed medical men have mistaken it for a fresh contagion of gonorrhoea, and by treating it accordingly have caused much misery to the luckless patient. In these cases microscopic observation is of essen- tial importance ; by its means the true cause of disease is at # once detected, and its extent clearly defined. Gleet and seminal weakness, gonorrhoea and seminal weakness, arising from self -pollution, are frequently co-existent, though not necessarily connected. When they do exist together, the disease assumes a most obstinate form. The value of the microscope is that it proves, with certainty, if spermatozoa, or the seminal fluid, be present in the discharge or in the urine. The treatment must vary accordingly. A new and unsuspected feature is introduced, 108 NERVOUS EXHAUSTION. icMcli baffles the routine adopted by the general practitioner. Hence the importance of a special and careful study of these diseases. In cases of mismanagement or carelessness, and some- times by suddenly stopping the discharge by means of astringent injections, an active in- flammation of the testicles may occur, accom- panied with much pain and swelling. The fol- lowing case occurred in our practice a few months ago : — A gentleman, who had just re- turned from a continental tour, consulted us. Three years before he had contracted gonor- rhoea, which terminated in gleet ; he had been under the care of several gentlemen, the last a practitioner at Berlin, who prescribed an injec- tion, which brought on swelled testicles ; be- sides which he suffered from a stricture. The immediate pain and swelling had been relieved by the repeated application of leeches, but the smallest exposure to cold or damp brought on a return. The testicles felt hard, and there was not the slightest inclination for sexual in- tercourse. We caused, by our remedies, a very considerable discharge from the penis, which we encouraged as much as possible. This soon removed the hardness of the testicles, tfERYOUS EXHAUSTION. 109 and reduced them to their natural size. The gentleman was perfectly cured in ten weeks. STRICTURE Is generally caused by a long-continued gleet, though there are cases in which it is produced by Onanism. The first symptoms of a stricture are a slight difficulty in the act of urinating, and a division or twisting of the stream of water. In all cases, however slight, apply immediately for medical assistance. Stricture never yields unassisted ~by art. Much suffering may be avoided by observing this rule. SYPHILIS, OR POX, Is the most dangerous and malignant of all forms of venereal disease. It hangs about the system for years, producing secondary and ter- tiary symptoms, intense pains in the back and loins, ulcerated sore throat, &c. In syphilis we have a virulent blood-poison, through which every tissue is affected. Indeed, the complica- ted mischief arising from this malady is known only to him who has an opportunity of seeing it in every shape and form under which it ap- pears. The syphilitic disease kills great num- bers in the prime of life, destroys the comfort 110 tfERVOffS EXtl AtlSTIOH. of the matrimonial bed, and transmits morbid predispositions to declining years. To conceal their imprudence the inexperienced permit themselves to be surcharged with mercury, which, in this variable climate, is liable to in- duce the most fatal inflammations and pulmo- nary diseases, to which they ultimately fall victims, without creating in their families the slightest suspicion of the real cause of their death. A most important feature in the history of syphilitic diseases is the fact of their trans- mission from the parents to the offspring. Dr. Burns, in his work on "Midwifery," observes that "infection may happen when neither of the parents has at any time any venereal swell- ing or ulceration, and perhaps many years after a cure has been apparently effected. I do not intend to explain here the theory of syphilis, but content myself with well-established facts. " In these cases miscarriages frequently occur without evident cause ; or should the child be born alive, it is covered with copper-colored spots on various parts of the body ; the eyes are inflamed, and there is a mucous discharge from the nostrils. Should it unfortunately survive infancy, it will only be to fall a prey to scrofula or consumption at a later period. Dr. NERVOUS EXHAUSTION. Ill Hunter records a case of a couple who had been married twelve years, during which neither party was diseased, nor had been unfaithful. The husband had syphilis two years before marriage, but considered himself cured. The two first children were healthy ; the next two feeble, and soon died ; the last child was put out to nurse, and having a sore mouth, soon affected the nurse with sore nipples, and blotches resembling syphilitic sores. Dr. Hunter treated both husband and wife for secondary symptoms; the lady, who had been weakly for years, was soon restored to vigorous health ; and three children, who were subsequently born, remained perfectly well. The local sores produced by syphilis are term chancres : they are sometimes single ; sometimes two, three, or four are pre- sent. The chancre generally makes its appear- ance four or five days after the impure inter- course ; but, as in gonorrhoea, the time varies from one day to thirty. A small inflamed spot is first perceived, the scab drops off, and a larger one is formed beneath, which rapidly enlarges. An excavation appears in the centre, the skin in the neighborhood is indurated and thickened, the hard base being characteristic of syphilitic sores. After some time, and even 112 KERYOUS EXHAUSTION. when the original spot is healed, the groin (one or both) becomes affected ; they suppurate and burst, forming what are called buboes. The throat, the nose, tne shin, the iones, are suc- cessively attacked, and if neglected or maltreat- ed, death may and does frequently ensue. Syphilis, perhaps, may not be regarded as a directly fatal disease, although its effects are so deplorable, especially in bad constitutions. It is indirectly that this disease is so very destruc- tive to life by poisoning and debilitating the frame, and thus exposing it to innumerable forms of disease. In questioning patients in hospitals and dispensaries as to their previous history, how often is it found that venereal disease is the first link of the chain which is dragging them to the grave ! Syphilis was firft recognized in Paris, in 1497 ; for along time no hospitals would receive patients, and the poorer classes of them were driven to the woods and fields, and left to die without com- fort or assistance, even by medical men. Some years after, the mercurial treatment was adopt- ed, which, with few exceptions, is used at the present day. Now, it may be confidentially asserted that as much misery has been and is caused by the use of mercury as by the disease NERVOUS EXHAUSTION. 113 itself. Witness the rotten skulls and diseased bones exhibited in our anatomical collections ! Let us again urge all patients suffering from syphilis in any of its forms to apply at once to a qualified and experienced medical man. We have seen so much misery, loss of health, loss of ©very enjoyment which renders life a bless- ing, resulting from this disease, and from its improper treatment by mercury, that we will not countenance, even indirectly, any attempt at self-cure. SECONDARY SYMPTOMS, EFFECTS OF MERCURY, &C. Some weeks after a chancre is apparently healed, especially after the use of mercury in any of its forms, a slight redness is perceived oh. the scar, which becomes rather painful ; or a swelling appears in the groin. A general sobsq of, discomfort is experienced, and in a short time the well-marked secondary symptoms occia.r. When the poison attacks the throat or palace, the roof of the mouth becomes red and inflamed ; a small pimple is formed, which ulcerates and exposes the bony palate. If al- lowed to pass unchecked, the bone exfoliates, a connection is formed between the mouth and nose, the voice is most unpleasantly changed, 114 NERYOUS EXHAUSTION". and an offensive discharge secreted. When the tonsils are affected, ulcers appear similar in ap- pearance to chancres. The soreness of the throat is not at first very severe ; there is mere- ly a slight tickling sensation when a crust or a.ny dry food is swallowed. But this, if un- checked, is one of the most severe forms of syphilis. The larynx is next attacked, on the top of the windpipe, and if not arrested will soon destroy life. Eruptions of the face and skin are one of the most common sequelia of syphilis treated mercurially. They make the skin thick, rough, and unequal ; the counte- nance acquires a livid hue ; the spots are gene- rally of a reddish, brownish, or copper color, and appear and disappear repeatedly. The following letter will illustrate the various effects of secondary symptoms : — "Albany, 1ST. Y., March 18. " Dear Sir — I am truly happy to inform you that all traces of that insidious disease with which I was so long afflicted have left me. I am now quite well ; shin quite clear from spots, throat entirely healed, and shin hones strong and entirely free from swellings. After being under so many medical men, I did not KERVOUS EXHAUSTION. 115 think it possible you could have cured me so quickly. All I can do is to tliank you. You may publish the case if you think proper, so that all may be benefited. " I am, sir, yours faithfully and obliged, D. M." This gentleman was suffering from a compli- cated case of secondary symptoms ; he had been salivated three times, and consequently his system was saturated with mercury. Our first object was to eliminate the mineral ; sec- ond, to strengthen and invigorate the constitu- tion. The case occupied a period of nearly nine weeks. LECTTTKE VII. CERTAIN MEANS BY WHICH A CORRECT KNOWL- EDGE OE THE PATIENT'S CASE MAY BE OB- TAINED. The only certain means we can adopt for ob- taining a knowledge of the Patient's case is by testing the urine with our Newly-Constructed Microscope, with powerful Lenses. We are thus able to discover two most important points, by which our treatment is greatly in- fluenced. Firstly, we can ascertain whether the urine contains a portion of the seed — that is to say, whether in urinating there is a co?i- stant loss of the seminal fluid. Secondly, and of even greater importance, whether the ani- malculce or spermatozoa, of which the seminal fluid is principally composed, be endued with that vitality without which the semen is unfitted to perform its functions. In short, the micro- scope enables us to ascertain whether the seed le alive or dead. It need scarcely be observed, that when the seed is deficient in vitality the virile functions are greatly impaired, and the man soon becomes impotent as well as sterile. KERTOUS EXHAUSTION. 117 With the aid of our microscope we can uner- ringly ascertain whether a discharge be from the prostate gland, from the seminal vessels, or from impure connection ; and many cases which have been improperly treated, as gonor- rhoea, for months, we have thus been enabled to cure in a week or ten days. It is our prac- tice to request patients in the country to send a small quantity of their urine for examination by means of the microscope. Any patient con- sulting us by letter will, therefore, enclose a two-ounce flat bottle, containing the urine passed on rising in the morning, securely corked and sealed, packed carefully in wool to prevent breaking, in a seidlitz box, which, with the flat bottle, may be obtained at any druggist's. The parcel may be addressed, carriage paid, Dr. L. J. Kah^, 61 East 10th Street, New York. The patient is requested to be as minute as possible in the details of his case. Dr. Kahn , has also made arrangements by which his* medi- cines can be forwarded, safely packed and free from observation, to any part of the world. LECTURE VIII. OK SKIK DISEASES. Dr. Kahn has invited the attention of the public and of the profession to his important discoveries in the treatment of skin diseases ; and, although he cannot complain that his views have been neglected, still the subject is one of so great importance as to require no apology for enlarging upon it. We all know that for many years the remedies generally re- lied on in these cases were arsenic, mercury (corrosive sublimate), antimony, and caustic ; that medical men looked upon skin diseases in general (as too many, indeed, continue to do) as something to be hammered at, without much hope of relief, with all the most deadly drugs of the Pharmacopoeia. The almost invariable result was, and is, that even if the disease is cured, which is exceedingly doubtful, the con- stitution is ruined for the remained of the life. Let any man take up a medical work on skin diseases, and he will find, even now, that arsenic is looked on as the sheet anchor, and that hun- dreds of cases are reported in which arsenic succeeded in curing after all other treatment ITERYOUS EXHAUSTION. 119 had failed. Now^ I have carefully, and for years, watched the results produced by this plan of treatment. I have always found it injurious. In many cases, after a time, there is a return of disease worse than before, and almost invariably, cure or no cure, I have found serious organic mischief affecting the heart or the lungs. I am here simply stating results — results which I have met with daily in a most extensive prac- tice. It is scarcely worth while to enter into causes ; for it is quite in accordance with com- mon sense that we should expect deadly poisons to produce deadly results. Why these particu- lar organs should be so affected is certainly of interest to medical men. Few diseases have been more minutely classified and described than the various forms of skin diseases, and it would be easy to enumerate fifty or sixty Latin and Greek names which have been applied to them ; but I fear the information would not be interesting to the general reader. For myself, I am in the habit of applying one general prin- ciple of treatment in all the varied forms which I see daily. My principle is simple enough and general enough to take rank as a great dis- covery. It is a principle I have acted upon in practice and have advocated in public for years, 120 NERVOUS EXHAUSTION. and certainly my success has been most extra- ordinary. I will explain it in a few words. Let alone tre Skin Disease — Purify the Blood. Instead of classifying skin disease under ten, twenty, fifty, or a hundred heads, I find, as a general rule, they take rank under three, and that treatment must vary according to diag- nosis — still acting on the golden rule, " purify the blood." Skin diseases are: — 1 st. — Hereditary. 2d. — Of syphilitic origin. 3 d. — Accidental, occasional, and anomalous. Hereditary Skin Diseases are, undoubt- edly, difficult to cure. The impure blood of the parent descends to the children. The re- sult is an intractable form of disease, and the only hope of cure is in steady, persevering treatment. Every globule of the blood is viti- ated from the very cradle ; and if the smallest trace of the impurity is allowed to remain in the system, all the labor is in vain, for the patient in a short time will be as bad as ever again. Hereditary skin disease is frequently consumption or scrofula in a rather milder form. There is no doubt in my mind of the intimate connection between these forms of HERVtms EXHAUSTION. 141 disease. It is obvious that all local remedies must be of necessity ridiculous, and even dan- gerous. In fact, the best dressing, where there is great irritation, is a little cold or lukewarm water on lint. Above all, avoid greasy appli- cations or caustics. In this, as in other forms of skin disease, I am frequently consulted by those who have taken sarsaparilla for months or for years in large quantities, and desire my opinion as to the benefit to be derived from its use. My experience is that sarsaparilla in itself is practically inert in cold or in temperate climates. But it is perfectly wholesome and harmless ; it is a pleasant drink, and a decidedly nice vehicle for the administration of certain drugs. On the other hand, in tropical climates, or during exceptionally hot weather (as all through the summer of last year), sarsaparilla exerts a slight action upon the skin which is decidedly cooling and beneficial. In all forms of skin disease I attach considerable impor- tance to the use of the bath ; not that the theory of the water-doctors will satisfy — but I am willing to accept truth even from opponents; and certainly their plan approaches more nearly to the correct principle than the wholesale ad- ministration of poisonous minerals. I may add 122 NERVOUS EXHAUSTION. that, applying the same remedies, I have been signally successful in my treatment of scrofula and consumption. Skin diseases of syphi- litic origin I have named as another great class of disease ; and certainly their importance entitles them to a rank apart. It is unnecessary in this part of the work to allude more particu- larly to their origin. Nor do I intend to in- clude what we may more properly class as "Secondary Symptoms." In cases of disease of the true syphilitic type there is always dan- ger that secondary and tertiary symptoms may ensue, especially when the patient is improperly treated and salivated by the imprudent admin- istration of mercury. But these cases are suf- ficiently obvious, and any mistake in their diagnosis is not probable, whatever there may be in their treatment. I make this observation because it unfortunately happens that in these, as in the primary disease, it is far too much the fashion to prescribe mercury. But skin dis- eases of syphilitic origin may occur many years after the original disease, and when, in fact, the cause is unthought of and forgotten. They are brought on by a taint, virus-poison, or germ, produced by the original disease, and which has remained dormant in the blood for months or NERVOUS EXHAUSTION. 123 for years. I cannot tell you the reason. of this extraordinary phenomenon : I can only tell you the fact. But it is easy to give an illustration of the unexplainable effects produced by animal poisons. A man is bitten by a dog, perhaps so slightly as just to draw blood. The wound heals in a day or two, and the circumstance is entirely forgotten. But three months, six months, or (cases are recorded) even twelve months afterwards, he is seized with hydro- phobia, and death in a day or two is certain. So with syphilis: the poison may remain dor- mant for months or for years, and then, break- ing out, cause skin diseases of the most serious and intractable character. It is here important to remark, that it does not necessarily follow because a patient has suffered previously from syphilis, and is afterwards affected by skin dis- ease, that the disease is of syphilitic origin. I have been consulted by numerous patients, whose lives have been rendered miserable by groundless fears, and have found, on careful examination, no trace whatever of syphilitic taint. How is it possible to discover ? may be asked ; and my reply is, by one means and by one means only — and that is, careful chemical and microscopical examination and analysis ox 124 NERVOUS EXHAUSTION. the urine. My treatment of skin diseases of syphilitic origin is precisely the same in prin- ciple as of skin diseases generally. It is neces- sary to bear in mind that the blood is affected by a specific poison or virus, which must be neutralized. Purify the blood, and the work is done. Accidental, Occasional, Anoma- lous skin diseases are such as arise without ap- parent cause; or they may result from errors of diet, hard living, exposure to the weather. I have frequently seen them as the result of bad provisions, impure water, &c, during a pro- longed voyage. Salt food is injnrious to some constitutions. To write at length on the vari- ous forms of disease which may be classed under the head anomalous would exhaust far more space than I have at command. It is obvious that in their treatment, even more than in other forms of the disease, my dogma is the only one consistent with common sense, truth and rea- son ; and even at the expense of being con- sidered prolix, I must again repeat, purify THE BLOOD. DR. KAHN'S BLOOD-PURIFYING TREATMENT Has now been used by the discoverer for a long series of years, Its action is purely upon the NERVOUS EXHAUSTION. 125 bloody which it vitalizes, enriches, cleanses, and thoroughly purifies. The consequence is, that it is absolutely specific in all cases of skin dis- ease, no matter from what cause arising. That this is so isiproved by the undoubted testimony of thousands who have used it with unfailing effect during the last ten years. To prevent any possibility of disappointment, Dr. Kahn wishes it to be distinctly understood that it is necessary to continue treatment for a certain length of time. Skin diseases are in their na- ture intractable and difficult to cure ; and to promise a rapid and permanent cure with a sin- gle bottle of medicine would be to bring dis- credit upon it, however valuable. But the improvement will be found to be immediate, and no matter how serious or of how long- standing, the disease is certain to yield to a proper course of the system, which is destined to effect a revolution in the medical treatment of these cases, and is In truth the most impor- tant discovery in medical science since the introduction of vaccination by Dr. Jenner. Many persons, who have imagined themselves cured of the venereal disease, have had the misfortune to find the disease break out again six or seven years afterwards, A proof of this 126 NERVOUS EXHAUSTION. happened in our practice lately. A gentleman was afflicted with the complaint, and was cured, as he thought, by the advice and prescriptions of an eminent surgeon. He afterwards married; a few months after which he caught a severe cold, which terminated in a sore throat. He applied to a medical man, who prescribed the usual remedies, but entirely without success. Haying been advised to consult us, he called upon us, and after a careful investigation, we informed him it proceeded from an old vene- real complaint. It was some time before he would admit this to be the fact, and he perse- vered with the old remedies nearly a month longer, till at length the disease became so serious thct he was compelled to place himself under our care ; the rapid improvement under our treatment was sufficient proof of the truth of our diagnosis. We therefore recommend extreme care that the disease be thoroughly eradicated from the blood ; for this purpose our medicines are very generally employed, and will be found most valuable, particularly in the after consequences, in removing all corruptions, contaminations, and impurities from the vital stream, searching out the morbid virus, and radically expelling it through the skin, APPENDIX. EX TABULIS ^GKOTORUM MEIS. {Selections from my Case-Booh.) In adding these cases, I may be permitted to observe that they are selected, not because they are the worst which have come under my obser- vation and treatment, but as being interesting to the general reader, and as containing some point likely to be useful as an example. These cases are correct in every particular, they are true to nature, and are a fair sample of those which I am, and have been for years, in the daily habit of meeting with in my extensive practice. That my success in treatment has been so uniform, I attribute (under Providence) to my extreme care in diagnosis, and to my use of purely natural remedies, eschewing those dangerous mineral poisons so entirely depended on by the general practitioner. It is not my intention to add to these cases in future editions of this work. Inviolable secrecy is the rule of my practice, and may always be relied on. I have never yet published a case, excepting with 128 NERVOUS EXHAUSTION. the express permission of the patient, and fre- quently at his request ; and the initials em- ployed are arbitrary. IMPOKTANT NOTICE. Patients are informed that no case is pub- lished in this work without the written con- sent, AND GENERALLY AT THE REQUEST, of the iudiyidual referred to ; and the most invio- lable SECRECY MAY BE FAITHFULLY RELIED on in all communications. Case 1,787. " New Orleans. " Sir — A perusal of your excellent work has induced me to hope you will be able to render me some assistance ; I accordingly feel the greatest confidence in submitting the following- case for your opinion and advice. I am twenty- four years of age. At the age of fifteen I was induced to indulge in the habit of self-abuse, which I practised unremittingly once or twice a day for six years. Though I have entirely given up the practice for the last two years, I am, however, suffering from its cruel effects. XERV0US EXHAUSTION". 129 During the time above mentioned I led an ex- tremely regular life, never drank much spiritu- ous liquor, nor had I intercourse with females. In fact, so timid was I that I had not courage enough to address a woman on the subject. I was remarkably short and slender ; and every morning when I. awoke, a yellowish matter which had issued from my mouth during the night stained the pillow. I constantly com- plained of determination of blood to the head and of great nervousness. My sight and mem- ory began to fail me. I felt pain over the abdomen after each act, but was still ignorant of the enormity of the vice and of its dire effects. In the spring of 1867, whilst at church? I had a rush of blood to the head, and fainted. I was brought home and had leeches applied to the back. The medical attendant hinted at the practi ce of self -pollution as the cause of the affection. This opened my eyes to the truth, though I concealed it. My sufferings, mental and bodily, now became dreadful. My inteK lectual faculties became entirely confused. J now became a mere skeleton. My eyes were quite dead, and bluish streaks were perceptible below my eyelids. I constantly staggered in walking, and frequently was near falling. I 130 NERVOUS EXHAUSTION. had constant dizziness in the head, and a host of symptoms, principally from the head, for which no one could account. From shame, I did not reveal my condition till, being affected with a pain in the chest, I consulted a medical man, and was somewhat relieved. My accu- mulated sufferings now brought on a profound melancholy. Travelling being now recom- mended, I came up to New York, where change of scene and plenty of exercise have worked a great improvement in my condition ; still, how- ever, I have severe sufferings, which I beg leave to enumerate to you. I have involuntary emissions of semen both when asleep and when awake, in the company of females or before a fire. I am affected with constant dizziness in the head. My sense of hearing as well as that of sight is impaired — a sort of mist before my eyes — a kind of undulating pain in the chest. I am entirely incapacitated for sexual inter- course. A constant feeling of terror is con- stantly hanging over me. Such is as accurate an account as I can give of my present and former state ; may I therefore solicit your im- mediate reply to my distressing case ? " I am, &c, &c, "W. R. T." NERVOUS EXHAUSTION. 131 Remarks. — If ever a subject presented him- self for exemplifying all the dire effects of self- abuse, it was this individual. The order, too, in which the disastrous consequences of this habit were observed to follow each other, is very remarkable, and in perfect accordance with the pathological principles advanced in the previous part of this work ; in fact, this one case would serve as an illustration of all we have said on the subject. First, the patient was observed to be remarkably short and slen- der. Here we see how the practice of self- pollution, by disturbing and destroying in the first instance the functions of digestion, im- paired the growth and nutrition of the body. The next ravages committed by it were on the nervous system, and first on the brain; the sense of vision being impaired was a conse- quence of this ; the disturbance of the nervous system was also evinced by the determination of blood to this organ. The failure of memory, too, and of all the intellectual faculties, the state of melancholy, so perceptible in this case, are further proofs of the destructive influence of this habit. Kor was the brain the only part of the nervous centres affected : the spinal system also became deeply implicated, as proved 132 NERVOUS EXHAUSTION. by the wandering pains in the chest and over the abdomen ; the staggering gait of the patient, the state of muscular debility into which he was thrown, the involuntary seminal discharges, the total inability of the patient to perform the generative act, are still further instances of the melancholy effects of the habit of mastur- bation. After impressing on this patient the absolute necessity of abandoning this habit, which, ac- cording to his own account he had himself done, Ave undertook the treatment of the case ; and by prescribing such medicinal and dietetic rules as the complicated nature of the patient's con- dition seemed to require, we succeeded, in about two months in restoring the patient to the en- joyment of perfect health. Case 1,615. Eangoon, January 20th, 1868. Sir — I find myself constrained to fly to you at last, and reveal a secret which I can no longer keep to myself. You will readily understand what it is, although I am filled with shame and confusion to acknowledge it even to you. But I feel assured thro^.ng myself into your hands tfEKYOUS EXHAUSTION. 133 alone will save me, and render me happy as a man in this world. I am one of those unhappy beings who early fell a victim to that pernicious an I accursed habit, self -pollution, which has already rendered me impotent, and it will not be long, perhaps, before its symptoms exhibit themselves in all their severity upon me. Would to God that I had never known this soul-destroying crime. How happy had I been if, even after knowing it, I had that moral restraint upon myself to check it, as a rational being and a Christian ought to do. I was let into knowledge of this forbidden habit (I curse the day it was) at such an early age as fourteen. I am now entering upon twenty-four, and it will be as superfluous as unnecessary for me to tell you to what state these nearly ten years' indulgence in this nefa- rious act must have reduced me. You can divine that yourself better than I can describe. Your little work, which fell into my hands, providentially I think, soon convinced me of my imprudence, and awakened me to a true sense of my position, and made me look, as if with a new eye, upon the blackness of this vice, which I have at last given up, I hope forever, 134 NERVOUS EXHAUSTION. The long continuance, however, played all the misch ief imaginable upon me. My health visibly gave way to it. My memory fails me, and is no faithful companion of mine to trust. My mind is daily sinking into a state of stupe, faction, and is unwilling or unable to exert it- self, and my strength is so prostrate that I feel an utter aversion to all bodily exercise. Yet to all outward appearance I look hearty and strong, being corpulent ; and none, I think, would suspect me as addicted to this vice, un- less, indeed, a keen observer discover it, if that be possible, in my eyes, which look vague and dull. It appears to me strange that, unlike many who were subject to this vitiating habit, I have ample hair about my face, thick mous- taches coming on my upper lip, and have ample and thick whiskers ; I feel no particular pain about back or loins worth mentioning. My bowels are generally costive, testicles pendulous, and penis rather short than of ordinary length. I get emissions at night, on an average of per- haps once a month. These, sir, as I describe to you, are the symp- toms as appear to me. I do not know by what wonderful providence I am still kept to look like a man, although without the essence or KERTOUS EXHAUSTION. 135 attribute. I can .only fly to you at this ex- tremity, and look upon you, next to the Almighty, as one who alone can restore and give back to me all that I have brutally and ignorantly lost. I have not been in circum- stances till now to apply to you for help and cure ; and what I can at present afford I send you for your priceless and invaluable remedies, the taking of which only could, I am confident, make me whole and renew my happiness. Give, sir, I beseech you, such attention to the case of one who throws himself into your hands as the severity of this disorder merits, and who will consider and respect you next to his God for the cure which cannot be got elsewhere in the world but in your hands. Please be good enough to see the medicines you send me well packed, so that the rough usage they will meet with may not damage them. It will be also esteemed a favor, your letting me know your opinion. All your instructions will be thank- fully and gratefully obeyed. Aw r aiting your reply with greatest anxiety, I beg to remain sir, your obedient servant. Please address me thus: To Mr. . care of , Kano-oon, Burmah. 136 NERVOUS EXHAUSTION. Kemarks. — This gentleman required active treatment for a period of four months. He was thoroughly and effectually cured, and has since returned to the United States and married. A few months since I received a letter announc- ing that his wife had been safely delivered of a fine boy. Case 3,765. San Francisco. A clergyman, about thirty years of age, con- sulted me not long ago in reference to genera- tive debility, arising from habits, the ultimate results of which were unforeseen, but now suf- ficient to embitter existence. About three months previously to the date of his first appli- cation to me, he married, and much to his sur- prise and mortification, had been unable to consummate the ends of that institution, in consequence of premature and involuntary emis- sion invariably preceding the attempt, and thus destroying sexual power. After waiting a few weeks, he became painfully convinced that without interference this state would become permanent ; and in his intercourse with me I elicited the fact that, when a schoolboy, he was initiated by some of his precocious fellow-pupils 2STEBV0US EXHAUSTION. 137 into the habit of self-pollution. This, indeed, became truly a habit, from which he dreaded no ill consequences, excepting from its too frequent repetition, and generally twice a week by manual friction he was accustomed to seek tnat iuv., ^ , . , , . . ■ natural on ^^^e sexual propensity is the feared the loss of power, tffi&g£ at he . never haunted by ill-defined nervous indigestionftiSz true cause of which never occurred to his thoughts, and the absence of all apprehension arose from the supposed consciousness that he never lashed these organs to efforts for which they did not appear perfectly prone and capable. Xow, however, the tendency of this injurious habit flashed upon his conviction in all its terri- ble reality. It appears that during ten years previously to his marriage he had been the sub- ject of nocturnal emissions occurring irregu- larly, but generally once in every week or ten, days ; but to this he was accustomed to attach not the slightest importance, under the idea that the discharge was perfectly natural, and in no way connected with the habit of his boyhood. The consciousness of his impotence, and the perception of its cause, preyed upon his mind jso as to render him completely wretched, unfit 138 NERVOUS EXHAUSTION. not merely to reciprocate the interchange of domestic and matrimonial felicity, but un- nerved for all the purposes of serious thought, and the high duties of his sacred vocation. In full possession of the facts of the case, and having secured his unlimited confide^;^ mencedthete^tm^^^j^ of cold agtrin . ml pJ> vvashes to the enfeebled organs, with a view to destroy the morbid irritability. Con- joined with this, he steadily persisted during two months in my course of alterative and tonic remedies, maintaining a resolute abstinence from all attempts at sexual gratification during that period. The primary effects of these restorative agen- cies was the entire sttppression of nightly emis- sions; and at the end of seven weeks desire became so ungovernable, that, attempting in- tercourse, my patient had the happiness to find the healthy and natural action of the genera- tive organs entirely restored ; a circumstance that in itself tended, by its effects upon his joyous mind, to maintain their newly acquired power. I received a letter from him a month afterwards, conveying the grateful expression of his warmest thanks ; and I had afterwards NERVOUS KXHAtTSTXOK. 1S9 the satisfaction to perceive, from an announce- ment in the newspaper published in the locality in whi«h he resides, that he has become a parent. doubtless very much to the mutual satisfaction of himself and the partner of his affections. Case 1,900. Albany, N". Y. With the permission of a gentleman, whose introduction professionally to me has termi- nated in the formation of a lasting friendship, I transcribe such portions of one of his letters as will illustrate his position on his first appli- cation to me for advice, and the results of my treatment. He observes: "From my earliest youth I have manifested a susceptible tempera- ment, highly and easily excitable, and, in ref- erence to the sex, the long-suffering victim of passions which I never sought to control. An ardent imagination was the bane even of my school-days, and, in the society of youths, over whom, as well as myself, no vigilant eye was watchful, or perhaps evaded, I gave loose to the indulgence of each prurient emotion as it rose ; while feebleness, loss of appetite, and the incipient symptoms of consumption resulted as the disregarded indications of violence, un- 140 NERVOUS EXHAUSTION. naturally inflicted upon 7)iy debilitated powers through self-pollution. I was always accounted what the world calls 'nervous,' and, under the hope of recruiting my shattered constitution, and that I might no longer be tempted to seek for gratification in unhallowed propensities, / determined to marry. My partner (since de- ceased), and lately the mother of my only child, was every way worthy of manly choice, and in the first impulses of passion, and until the charm of novelty was destroyed, I underwent no uneasiness from the failure of sexual power. This state of things did not last long. Anx- iously hoping for offspring, and feeling hourly that some strange change had befallen me, the dreadful truth flashed upon my tortured con- science, and I felt that the excesses of youth, though of slow retribution, were dreadfully sure and painful in maturer age. And now the long train of *my nervous ailments darkened around me with tenfold severity; my wife's very silence reproached me with more keenness than open recrimination ; I cursed my very being, or rather the weakness that had rendered me the victim of that early and horrible delu- sion. I doubted of my powers, weakened as they truly were, till the very doubt ensured KEEYOrS EXHAUSTION. 141 their incapacity ; despair, self-loathing, and an apparent cureless melancholy invested the first years of manhood with gloom, and the pros- pect with hopelessness ; as to the gratification of my wish to perpetuate my name, that I had long resigned as a well-merited impossibility. My ordinary medical adviser either did not or would not understand me, and was fain to treat the ailment which evidently distressed all around me upon principles which (knowing he was ignorant of the true cause of such suf- fering) only could tend to aggravate the mis- chief. Under these circumstances, as I confess with much reluctance, and with not the sligh- test hope of benefit, I ventured, first anony- mously, to consult you by letter. The tone of your letter emboldened me to make a personal application, and confidence and respect became mutual ; your manner riveted that confidence, and from that hour I found a friend, who has inspired the gratitude every man must feel who has been rescued from the cold and cheerless jaws of destruction. I followed your remedies, I implicitly adopted your general advice, and incipient improvement kindled hopes as to the ultimate result, which has been most happily realized. I shall not easily forget the feeling 142 NERVOUS EXHAUSTION. with which my first-born was placed in my arms. Death has removed her, with whom, but for the circumstances previous to our union, I might have passed, in the first years of married life, a happier time ; at least I feel the returned possession of vigorous manhood, my nervous apprehensions of incapacity are scattered to the winds, and the bitterness of her loss is miti- gated in no trifling measure by the conscious- ness that she saw and hailed my returning health before I was deprived of her forever." Case 3,765. Brooklyn. Sir — Accept equally my gratitude and hom- age to your skill. I assure you it gives me in- finite pleasure to report progress in accordance with your request; it is now just four weeks since I commenced with your course of medi- cine. During the night of the loth November, I had an emission ; on the l&th your medicine came to hand. / have had one emission since — during the night of the Hth of December; twenty- one dear days. The first time I took the medicine I felt it beneficial, but the pills have had a strikingly XERYOUS EXHAUSTION. 143 wonderful effect ; after taking them I feel so well, so happy, so full of joyous spirit, that I am like a holiday schoolboy next day. I must tell you that my health and strength are wonderfully increased ; my duties, so wearisome before, are new light and easy. I work and never lose my energy, or become wearied. In short, I have lately felt that life is a pleasure. Day by day I have felt better. My friends, public and private, are surprised to see me so well, so strong ; I am most san- guine of future health and manly strength. I thought the emission would never occur again ; imagined myself perfectly cured. How- ever, the last emission was only slight, but I felt weak in my knees, and had a feeling of exhaustion for all the day after; but it went off, and I felt well and strong again, and still continue so. The penis has assumed a much larger appear- ance, and feels more natural and vigorous ; it has lost that flabhiness, feels warm, and is never clammy. I begin to feel the natural geniality of the organs. I have rigidly adhered to your rules and advice ; the glutinous matter does not now escape with my urine ;'my bowels have been costive and irregular. 144 STEKY0US EXHAUSTION. My sudden acquisition of strength surprises me; the dreams are not so frequent, nor so lascivious. Will the emission be altogether pre- vented? Shall I endanger my health by marry- ing in twelve months' time ? Will the rules you have given be necessary: I mean with re- gard to diet, sponging, exercise, sleeping, &c., after I am 7nedicinally cured ? I already hail you my regenerator. Anxiously awaiting a reply, permit me to re- main, with grateful feelings, Your obedient patient, L. D. K To L. J. Kahst, Esq., M.D. Case 2,190. u Milwaukee. " Deak Doctok — Haying been an eye-witness of the extraordinary success of your treatment in the case of a friend of mine, who was re- duced to the last stage of debility in conse- quence of his indulging in the habit of Onanism, and being myself a victim to the same vicious indulgence, I have summoned sufficient courage to make application to you to solicit the benefit of your skilful advice. For the last ten years I have indulged in the habit, on an average, KERVOUS EXHAUSTION. 145 five or six times every week ; the consequences have been very marked and striking. I am at present very much debilitated, and wasted away in flesh. My appetite is become extremely bad, though at first it became actually vora- cious after I first commenced the practice. I can with difficulty digest the lightest food ; my limbs are extremely feeble, and I never feel by any chance the least desire for sexual inter- course ; indeed, such an idea never enters my head, though at the age of sixteen I was rather forward in that particular. I am also unable to apply my mind for any time to any one train of thinking ; and as for memory, I have scarcely any. I also labor under an inconti- nence of urine ; and, both during sleep and when at stool, I am troubled with seminal dis- charges. Under this state of things, I applied some months ago to a medical practitioner of some repute in this place, but after taking medicine to no end, as prescribed by him, I find not the least improvement in my condition. I have, since reading your book, almost entirely discontinued the ruinous habit which has been the cause of all my sufferings and sorrow ; yet, so inveterate has been my addiction to the habit, that I am still dragged into the gratifi- 146 NERVOUS EXHAUSTION. cation of it, — but very, very rarely. I find my intellect sometimes in a very strange state ; in- deed, to be candid, I am sometimes afraid my reasoning faculties are more or less impaired. I trust this exposition of my present feelings and state of health will lead you into a knowl- edge sufficient to enable you to undertake my case. My sole hope of ever becoming a mem- ber of society rests on you. The friend of mine who directed me to you is now so per- fectly re-established in health and strength, that I entertain strong hopes that my case is not entirely desperate. Certainly he was not so bad as I now am. " May I beg of you to take my distressing and pitiable case into your consideration, and to send me word what I must do. Hoping to hear from you as soon as you conveniently can, "I am, Sir, yours respectfully, "S. M, "To Dr. Kahn." "Milwaukee. " Dear Doctor — To state to you in adequate language the grateful sentiments I feel towards you for the state of health and strength to which you have restored me,- would be out of KERVOUS EXHAUSTION. 147 my power. I thought such a thing beyond the power of medicine. Oh ! sir, what a difference in my present state of vigor and of mental quiet from what I was in but three months since. All that time I was a wretched, debili- tated, and emaciated being, ashamed and de- graded in my own eyes, from a consciousness of having been the cause of my own degrada- tion. ISTow I can hold up my head like a man, can feel like a man, and have good reason to know that I can act like a man — for which I am in a fair way of being made parentally to pay. I would like to know whether it will be necessary for me to continue the use of the medicine any longer. The small bottle in the last packet seemed to be a clincher. It w r ound up all my energies, like the works of a clock. In fact, it seemed to act on me like magic. " I beg to return to you my w r armest thanks for the patience you have had in listening to my many tales of woe, and restoring me to the possession of the happiness I now feel. " Believe me, Yours, very gratefully, "S. M. "To Dr. Kahx." 148 NERVOUS EXHAUSTION. Case 2,927. "New Jersey. " Sir — One of the most pitiable objects that ever addressed you now claims your mercy and attention. " I am now twenty-four years of age, but sadly debilitated. I no longer approach a woman. I feel satiated or disgusted with the sight of one — my appetite is nearly gone — my digestive powers are greatly impaired — and I feel no interest whatever in what is passing around me ; and what is still stranger, the hair of my head has fallen off in a great measure, so that I am almost bald — strangers take me for forty years of age. Having perused your book very lately, a ray of hope darted through my mind that I might find some relief in your judicious treatment. Can you do anything for me ? In the hope that you will undertake my case, I enclose you your fee of $5, which shall be repeated when necessary ; only do not delay, I implore you, in writing to me. My only hope is now in your skill and experience. If that fail me, I have not a hope left. Do, then, take pity on me, as I am nearly broken-hearted. " Your unfortunate correspondent, "Dr. Kahn," "A. B. C. HERVOUS EXHAUSTION. 149 "New Jersey. "Dear Sir — In my last communication I stated to you that the most unfavorable of the symptoms were gone ; that my appetite was re- established ; the seminal discharges in my sleep and at stool, were gone ; and that my strength and energy were perfectly re-estab- lished. I have now the pleasing duty to state that my baldness is very much diminished, so that I have given up the idea altogether of wear- ing a wig. My desire for sexual intercourse is perceptibly returning, so that I now stand a fair chance of being a better man than I ever was. Oh, sir ! what a lesson I could read to those unfortunate youths who indulge in ex- cessive venery at a .premature period of youth. How dreadful have been my sufferings of both mind and body. Thanks to your unremitting and assiduous care, however, my health is now better than I remember it ever to have been. "I should very much like to have another packet of your medicine, as I am obliged to go a considerable distance from home in ten or twelve days hence, and shall not return for three months. Any advice you may consider 150 HERVOUS EXHAUSTION. necessary you will be kind enough to impart to me in your next. " I am, Dear Sir, your grateful patient, "A. B. 0. "Dr. Kahnt." Case 3,759. A threatening of Pulmonary Consumption from excessive Venery. M. W., aged twenty-five years, of rather deli- cate frame, a clerk in a large commercial estab- lishment, had been always of very regular habits in every respect — had been residing in one of the outlets of New York for the last two years, and, about twelve months before we saw him, he married a young widow in whose house he had been lodging, and continued to indulge very freely in the pleasures of the marriage-bed for the first nine months without feeling any bad effects ; about this period, however, he be- gan to lose flesh very perceptibly, and to feel great lassitude on the least exertion ; his appe- tite for food also began to fail him ; his sleep became disturbed and unrefreshing, bowels be- came constipated ; in fact, all the symptoms indicating a general deterioration of all the functions, both bodily and mental, began to NERVOUS EXHAUSTION. 151 show themselves ; his **'ght became impaired, as also his mem^T ; in fact, his mind was so absorb^ 1 m ^ ne one engrossing idea, namely, jnat of the gratification of the venereal appetite, now increased beyond all bounds, that he be- came unable to devote the proper degree of at- tention to his ordinary occupation. He now also began to complain of pain in the upper part of the right lung, and of considerable difficulty of breathing on ascending an emi- nence; these symptoms having continued for two or three weeks, he began to perceive a sense of heat in the top of the fauces, as also a saltish taste in the mouth, a little after which he be- gan to spit blood of a florid red color and frothy appearance. Being alarmed at this, and having for some time suspected that the cause of his present impaired health was his inordinate in- dulgence in venery, he called on us, and de- tailed the history of his case, as w r e have now given. On examining his chest we observed some dullness on percussion in the upper por- tion of the right lung, immediately under the clavicle ; the respiratory murmur was also ab- sent from this part ; in every other part of the chest the respiratory function seemed all right; the action of the heart was somewhat irregular, 152 NERVOUS EXHAUSTION. being very much hun^d occasionally, and from the slightest cause. We directed that he should forth witn -v^tain from all sexual intercourse instanter, a con- dition imperatively required for the re-estab- lishment of his health ; we also prescribed a peculiar diet, and such medicines as the nature of the case seemed to indicate. After being about three weeks under treatment, he began perceptibly to recover his strength, his appetite returned, as also his sleep, the pulmonary symptoms gradually declined, the haemoptisis had not returned after the first week he had been under our care, the pulmonary tissue was now perfectly pervious to air, and percussion elicited the natural healthy sound over the chest ; in fact, after being under treatment, in all about six weeks, he was entirely restored to health. Apprehensive, however, lest he might return to his former inordinate indulgence, we recommended his leaving New York for a month or so and returning to his native place, which was in some part of Jersey ; he has done so, and it is but a few days ago since we re- ceived a letter from him announcing the perfect restoration of his health and strength, and his in- tention of resuming his former employment. HEftTOtS EXHAUSTION. 153 Remarks. — This was a case where conside- rable difficulty presented itself ; a patient ex- hausted in strength, with a very serious affec- tion of the lung, for the relief of which de- pleting measures appeared necessary. It is evident, however, that if such treatment was carried to any extent in this case, the patient must sink ; thus, then, we had to restore strength, and, at the same time, to combat in- flammatory symptoms of rather an alarming nature. By closely watching from day to day the effects of our remedies, we finally succeeded in gradually restoring the strength, and at the same time in keeping down inflammation by the local application of counter-irritants. Case 1,387. A. E. M. , about twelve months before seeing us had contracted gonorrhoea from a casual connection. A slight discharge and scalding made their appearance about seven days after the intercourse. The age of this gentleman was 32, and although he had led a very free life, he had never before contracted disease. His occupation was head-salesman and manager of a large mercantile house ; his pursuits active ; he was a man of great energy, clever in busi- 154 KERVOUS EXHAUSTION. ness, well educated, and of social habits ; un- married ; temperament nervous-sanguine. Of course he knew very well what was the disease, and without loss of time consulted a physician, a friend of his, in large practice. Wishing to cut short the disease as soon as possible, the doctor ordered large doses of balsam copaiva and cubebs, and also applied an injection of nitrate of silver. These active measures seemed at first to produce the desired effect. The dis- charge, which had never been very copious, was decidedly lessened ; but the patient complained somewhat more of the scalding and pain in urinating. The treatment was continued a few days longer, but the discharge remained and the pain increased. He also found con- siderable irritation of the bladder — so that he was unable to hold his urine for any length of time. There was also much heat and inflam- mation about the penis, and small red pustules began to make their appearance on the body, causing intolerable irritation. The appetite was lost, and, in addition, whateve was eaten caused sickness and indigestion. The stomach revolted entirely from the medicine, which, when taken, was immediately rejected. His friend now discontinued treatment, and ordered NERVOUS EXHAUSTION. 155 warm baths and mild aperients. Some six or seven weeks had gone by, and A. E. M. found himself, as far as the disease w r as concerned, certainly no better, but in addition greatly re- duced in strength, and his digestion so seriously impaired that his stomach could not bear any- thing in the shape of medicine. A temperate drinker before, he had entirely given up all his usual stimulants, having been so advised by his friend. For a w r eek or tw 7 o longer, sometimes a little better, at other times a little worse, he still continued taking medicine when he could stand it, occasionally trying a mild injection. The discharge w r as thick and greenish in color, scanty in quantity — the nut of the penis and the lips of the urethra blood-red. The pain in urinating now became extreme, and one day, having been much on his feet, he found, to- wards evening, that he was compelled to pass urine every five minutes. He had been suffer- ing from severe pain in the back all through the day, and he felt himself so ill that he im- mediately undressed, w T ent to bed, and sent for one of the first surgeons in the city of New York. It proved that inflammation of the bladder had set in, and so much had the patient been reduced, and so obstinate was the case, 156 NERVOUS EXHAUSTION. that it was three months before he was able to rise from his bed. But A. E. M.'s troubles were not yet ended. After the inflammation was reduced, a very copious urethral discharge came on, which the surgeon very properly en- couraged by every means in his power. It now became important to endeavor to stop this dis- charge, which was attempted carefully and ten- tatively. Just as it was stopped, and the pa- tient was congratulating himself that his dis- ease was cyred, the left testicle began to swell, and so great was the pain and inflammation, that he was again obliged to take to his bed. Another month, when the other testicle was attacked. The treatment adopted was leeching, cold lotions, and aperients. It would be tedious to continue the history of this case. Suffice it to say, when we were consulted we found con- siderable discharge, which, directly it was checked, caused immediate swelling of one or both testicles, obliging the patient to lay up, the slightest exertion or exercise causing intole- rable pain. What was to be done ? I must confess this case required deep consideration, and, when I heard the history, I felt some mis- givings as to the result. At first I thought it possible that some complication in the form of NERVOUS EXHAUSTION. 157 seminal discharge might be present ; but a careful microscopic analysis convinced me that such was not the case. The discharge was purely gonorrhoea!, and although so long a time had elapsed since the infection, strange to say, there was no stricture. Seeing that the patient was so much reduced, I determined to act against all the usual laws of medical men in the treatment of generative inflammation and urethral discharges. I prescribed powerful tonic treatment, and ordered in addition at least two bottles per diem of the best London porter. Although the discharge was copious, and the pain in urinating very severe, so much was the patient reduced and weakened, that I determined at all risks to improve his general health and condition, even if the local disease were thereby increased. But such was not the result. I saw him daily, and from the first hour improvement set in. The diet and medi- cine together caused a visible alteration from day to day. At the end of a week all pain in urinating, and all tendency to inflammation, had left him. During a month the character of the discharge gradually changed, and, though no special remedies were employed, the quantity greatly diminished, I now found the 158 NERVOUS EXHAUSTION. patient well enough to attempt cautiously to stop the flow. In this I succeeded in ten days, keeping up the medicine a week or so longer, lest there should be a return, though I did not fear it. But everything went on well, and I discharged A. E. M. thoroughly cured, and in a perfectly sound, healthy condition, within six weeks of his first consultation. From that day to the present time there has been no re- turn of the disease, and no unpleasant symp- toms whatever. Eemarks. — It is very frequently supposed, especially by young men, that gonorrhoea is a disease of little or no consequence. There is no doubt but that occasionally a cure may be very easily effected. On the other hand, there are constitutions to which one dose of the reme- dies which are so generally used will act as a virulent poison. To discriminate one from the other requires the acute instinct of the educated medical observer. In my hands the "abortive" treatment of gonorrhoea, by which a cure is frequently effected within three days, has proved invariably successful. Why ? Because I never attempt it, except in cases which my experience tells me are amenable to that vigor- ous treatment, And surely it is better to take KERVOUS EXHAUSTION. 159 a week to cure, if necessary, than adopt treat- ment nearly certain to fail, and which must, in case of failure, protract the disease for a length- ened period. Another week of the "usual remedies ' ' must have cost A. E. M. his life, and when I first saw him I did not feel by any means certain that I could restore him to health. Case 4,798. " Boston, Mass. " Sir — The critical and pressing circum- stances in which I find myself placed oblige me urgently to solicit your immediate attention to this my communication. I shall give as briefly as possible the history of my case. I am now in the forty-fifth year of my age, and have never been married. I begin to find my- self less vigorous in my embraces, and less in- clined, because less able, to repeat them. I also experience pains in the lower part of the spine, gleety discharge, occasional dizziness in the head, and, when at stool, emissions of semen. At first, and for considerable time, I took no notice of these things, and did not at all sus- pect the causes which could have given rise to them. I happened, however, to read in a medi- cal work, some time since, an allusion made to 160 NERVOUS EXHAUSTION. these symptoms which I have stated that I felt, and some (certainly obscure) reference to im- perfect coition and premature secession from the female as their probable cause. I then consulted your book, and found that the real cause of my symptoms, which have since, by the way, become much aggravated, was to be referred entirely to the habit in which I had been for so many years indulging. As I wish to be as minute as possible in this my commu- nication to you, I find brevity impossible. I therefore must speak a little in detail : For the last three years I experienced a sort of tremor under mental agitation, whether such agitation be occasioned by ordinary business (I am a merchant) or by venereal feelings. This tremor is only occasional, but its recurrence is very frequent, especially of late. I am becoming less confident every day of my virile powers, for I find them much deteriorated. I have lived a bachelor up to my present time, have never been diseased with syphilis, and have now a very excellent opportunity of an extreme- ly good match with a young lady somewhat, nay, considerably younger than myself. One thing only deters me from marrying — debility of the genital organs, and premature emission KERVOUS EXHAUSTION. 161 of semen. I have endeavored to make my case as open to you as possible. It is within your power, or the power of medicine, to restore me to anything like adequate strength to consum- mate the act of coition ? I am nervous — I am afraid. Write to me as soon as possible your opinion, and if you think medicine can relieve me, send it to me immediately. The occasion is urgent — that must plead my apology. I en- close fee. If you restore me to the state in which a husband is expected to be, I shall gladly acknowledge it, and remunerate you handsomely. Yours obediently, E. S. T." " Boston, Mass. " Dear Doctor — I have, I know, worried and teased you very much ; but you know too much of the wretched state of a man's mind, circumstanced as I was, till I consulted you, to feel annoyed at my unceasing importunities and interrogatories. I now find myself completely set to rights — everything as it should be — healthy and vigorous. I no longer feel any delicacy in undertaking the duties and respon- sibilities of a husband. From your assiduous and truly scientific directions and medicines, I am to be married in two or three days. Ought I not continue your last bottle a little longer ? 162 NERVOUS EXHAUSTION. I enclose check, but I never can repay you for your kind indulgence to all my pettishness and over-anxieties. If of any service, you are at perfect liberty to publish the case — of course, omitting my name and address. "Ever your obliged, "B. S. T." Case 1,226. A gentleman of about thirty years of age, who was studying for the bar, consulted me in order to know if I thought it possible I could ever restore him to a vigorous state of health. He had, he said, when a boy, been taught the hor- rible habit of self-pollution by one of his father's stable lads, with whom he, boy-like, used to ramble about the stables and grounds, and this practice he had continued even long after both his judgment and his health had warned him to desist ; in fact, he told me he was ashamed to say that it was only by slow degrees that he had succeeded in obtaining the mastery of himself, and that he had only very recently been able completely and utterly to abstain. So firmly had the vice fixed itself upon him, that, even after he had made the strongest resolutions, the mere sight of anything KSBYOUS EXHAUSTION. 163 in the least calculated to excite amatory feeling, or the reading of the most innocent paragraph in a newspaper or book, suggestive, even in the most remote way, of sexual enjoyment, was sufficient to scatter his good intentions to the winds, and cause him to seek the earliest oppor- tunity of solitarily gratifying his most odious propensity. While mentioning these and other circumstances with the utmost candor, he told me at the same time that no mere bodily suf- fering or ordinary consequences of his yicious- ness would have induced him to undergo the pain of thus unbosoming himself, and of mak- ing the disgraceful confession, were it not for two circumstances. One of these was, that un- less he could get absolutely cured, he was de- prived of all hope of his being able to succeed in his profession ; and the other, that having, for not less than seven years, been engaged to a young lady of great personal beauty and highly cultivated mind, between whom and himself the warmest attachment subsisted, the time was speedily approaching when either he must entirely debar himself her society, and leave her to imagine him (without power of explanation on his side) one of the basest and most insulting of men, or fix some period, 164 NERVOUS EXHAUSTION. however remote, for their marriage, as the po- sition in life of both parties were such that no obstacle existed to their union. This he very properly declared he never would assent to while in his present condition — and a frightful condition it was. Although stout in body, his face was thin, hollow, and cadaverous ; his flesh was flabby, the scrotum was hanging loose, his limbs were weak, his hands unsteady and trem- bling, his breath waa so short that he dared not take even a short walk ; he had pains in his back and loins, besides a variety of other symp- toms. He found, moreover, that a gradual incapacity for study had for a long time been creeping over him, a confusion of ideas, an im- possibility of fixing his attention upon any sub- ject, and a constant state of wavering uncer- tainty, restlessness, and disquiet, the sure fore- running symptoms of mental imbecility. Un- der these circumstances he entreated my aid, if it was at all possible for that aid to be success- fully exerted. I undertook the case, and although the evils I had to eradicate were deep seated and of long standing, I at length, by perseverance and a careful study of his consti- tution and ailments, succeeded in effecting his restoration to a state of thorough health and KEKVOXJS EXHAUSTION. 165 vigor. He has now been three } T ears married, has two children, and last year made a success- ful debut at the bar. Case 2,572. A gentleman, a large manufacturing chemist, called ujDon me early in May, 1862. He was suffering from a severe case of secondary symp- toms. About three months previously, after a casual connection, he had noticed chancres ; and having studied medicine, his business, too, giving him a first-rate knowledge of drugs, he thought he could soon cure himself. He there- fore began to take blue pills, with a lotion of sulphate of copper. He was slightly salivated, but the chancres healed, and he was delighted to find himself quite well. But, ten days be- fore seeing me, secondary symptoms broke out with the greatest virulence. His throat was severely attacked ; spots broke out all over his body ; his hair fell off (a common effect of mercury), and his constitution seemed com- pletely shattered. I also found, on careful examination and analysis of his urine, that he was suffering from spermatorrhoea — in fact there was a loss of seed every time he passed water. As was to be expected, the seed was 166 NEKV0US EXHAUSTION. diseased ; in fact, syphilis had affected every tissue and secretion of the body. The case re- quired prompt treatment, and for three or four days the disease continued to make head against the medicine. However, I am happy to add that I soon controlled it, and in the course of seven weeks Mr. was perfectly restored to health and vigor. Case 2,596. Philadelphia. Captain M. A. , three months before consult- ing me, had observed a small pimple under the prepuce or foreskin, after a casual connection. Having rubbed it off, it was succeeded by another, rather larger, when, thinking it was "the heat of the body" he took mild aperient medicines. It remained stationary for some weeks, and then began to increase rapidly ; he also noticed a large swelling in each groin. Becoming alarmed, he determined, by the ad- vice of a friend, a brother officer, to consult me ; but, unfortunately, urgent business de- tained him some days longer. I immediately saw that the case was very serious ; the poison had acquired terrible virulence by remaining so long in the body, and, in spite of the most NERVOUS EXHAUSTION. 167 powerful remedies, lie continued to get worse for some days. The chancres progressed so rapidly as to threaten the entire loss of the penis, and both buboes burst, leaving a large cavity in each groin. However, by the most energetic means, he was brought under the in- fluence of the medicines, and began to improve, though at first very slowly. This case required three months' constant attention before a cure was effected, and even then it was necessary to prescribe strengthening medicines for some weeks longer. I instance this case to prove the importance *of an early application in case of syphilis. Had the patient applied to me in the first instance, one week's attention would have been quite sufficient to insure a thorough cure, without pain or annoyance. I have lately re- ceived a letter from Captain M. A., stating that he is now thoroughly well, and as strong as ever. PICTURES FROM REAL LIFE. These are not intended to challenge criticism, nor to excite idle curiosity. Many may see them for whom they will have no interest — who may, perhaps, hardly understand them. They will, however, fall into the hands of some few who will thoroughly comprehend their purpose, and for whom they will have a solemn interest. They are, to those few, addressed in earnest solicitude, by one who desires to minister to their sorrows and to mitigate their infirmities. I ask, in good faith and kindness of heart, one favor from the person who may receive this copy. I beg of him to read it care- fully, thoroughly ; and if he finds in it nothing that has a personal application to him, to pre- sent it to some young man of his acquaintance. It may thus find a reader for whom it will have a peculiar personal interest. I entreat that reader to weigh my words calmly and delibe- rately, for on the decision of that present ten minutes will hang in all human probability, the happiness or misery of his future days. In that NERVOUS EXHAUSTION. 169 time may be determined whether he shall live an ornament to society, an honor to his name, a healthy, happy man ; or whether he shall sink into the poor, pitiful, joyless, nerveless, prematurely old man, without heart, health, or hope. PICTURE FIRST I THE YOUNG SENSUALIST. 14 The glory of a young man is his strength." In the great battle of life there is need that each combatant should have a brave heart and well-braced nerves, for the fight is long and arduous, and the weak and timid have no chance therein. Nor is the work all toil : the high endeavor — the end in view — makes of it a pleasure, and as we watch the busy passers-by in the broad thoroughfares of the city, every face seems eager and earnest. No, not every face. Here comes one, alone — a solitary one. He is young, but he has none of the busy char- acteristics of his fellow men. Listless in his manner, timid in his air, he wanders rather than walks through the crowded street. Maybe he is a clerk, or a student, or a mechanic. But why is he so vacant and so sad ? It is but three or four short years since, with a father's bless- ing and a mother's prayers, he went forth into 170 NERVOUS EXHAUSTION. the world to conquer fortune, and " to make himself a man." Then his nerves were Arm, his mind was buoyant, his step was light, and his hopes were high. But these few short years have wrought a sad and fearful change. "JSTow neither hope nor ambition finds a place in his bosom. The fresh vigor of his youth is replaced by a weariness of life, even while his foot is yet but on its threshold. See how vacant and objectless is his gaze ! His hand wanders to his forehead, w T hich it feverishly presses, whilst a deep sigh escaping him tells of nervous exhaustion, and of a mind brooding over dark- ling thoughts. If you knew him as a child you are struck with the change. Then he was robust and stout ; now he is thin and pale. Then his eye would flash fire, as he dashed with energy into some boyish game ; now he turns aside from old companions, and frowns on what were once delights. And, hark ! that hectic cough that shakes his frame, exhausts* his breath, and tells of an undermined constitu- tion, and, perhaps, of the dread approach of consumption. Speak to him. What says he ? " He has been ill, and growing worse for a year or so. He cannot account for it, and the doc- tor does not seem to do him any good, or to NERVOUS EXHAUSTION. 171 know what is the cause of his illness. His eyes are weak and his memory gets very bad." Poor fellow ! It is a sad tale. Is there n# solution ? Yes ; come with me. It is night time. He has retired to his bed. Let us lift the yeil of night, and gaze on him when he fondly fancies that no eye is upon him. Does he sleep the sleep of conscious rectitude — enjoy the welcome repose of a self-satisfied mind ? No, alas ! What tempest of passion — what hurricane of lust is this that sweeps across his soul ! Why do his strained eye-balls glare on vacancy ? Why does his cheek flush now like fire, now become pallid as death ? Why does his poor heart now beat as if it would burst through its tenement of flesh and bone, and anon scarce indicate a fitful pulse ? And now, why does he sink, sighing and exhausted, heljriess and almost lifeless on his pillow ? The fearful truth is all revealed. Sensuality has only too faithfully painted its deep lines on his body and mind. The picture is only too com- plete. Before you lies a poor, self-destroying, self-debauching, nerveless, joyless Onanist. " A shocking picture, indeed I" some of my readers exclaim, "but surely a little over- drawn ? " Not so. The silent tortures, the 172 KERV0US EXHAUSTION voiceless sorrows endured by those who persist, from year to year, in the practice of Onanism exceed the descriptive power of my pen, or of any other. Instead of exaggerating, every true mind sinks appalled from the magnitude and sternness with which these evils haunt the foot- steps of those who persist in the practice, whether wilfully or ignorantly. The following description of his case was written to me some years ago by one who is now a happy husband and father : — " I was well and happy until the age of fif- teen, when I learnt the habit from a companion at school. To me it was like a new revelation, and my ardent temperament caused me to in- dulge to a fearful extent. As I became older a sentiment of shame withheld me to a certain extent ; but only three months ago, when I be- came possessed of your admirable book, did I entirely relinquish the habit. And now, through fatal ignorance, what have I become ? A wretched, nerveless invalid ; dreaming instead of working. My energies exhausted, my face pallid, my forehead covered with blotches, my appetite sometimes voracious and unnatural, end anon not to be tempted by the choicest viands. Pain, heavy pain, and deep languor KERVOUS EXHAUSTION. 173 from morning till night. My eyeballs ache and throb ; I suffer acutely when I pass water : my groins seem weak, so that I cannot enjoy exer- cise. When it is morning, I long for the night; and then, what nights I pass ! Lascivious dreams disturb my rest ; my sleep is fitful and unrefreshing. Long hours I lie awake, fre- quently in a profuse perspiration, reflecting on my awful condition, and my thoughts em- bittered by the knowledge that surely my 'sin has found me out. 5 Oh ! sir, as you hope for blessings here and hereafter, exert your utmost skill to rescue from destruction a blighted wretch. v This is a picture drawn by the hand of a suf- ferer. A few short weeks more, perhaps, and his application to me would have been in vain. His constitution would have been utterly ruined. Again, had he applied to a general prac- titioner, who lacked the special opportunities I have now for thirty years enjoyed of studying the intricacies of these cases, he would probably long ago have been consigned to the grave, instead of surviving, as he does, in health, honor, and happiness. 1*74 XERVOUS EXHAUSTION. PICTURE second: the bachelor sensualist. In every community there are many middle- aged men, who from choice or necessity have not assumed the responsibilities of married life. It may be they have failed to secure one whom they have fondly loved in youth ; it may be that they have determined to secure a higher position and a more assured income before marriage. As a general rule these men are hard-working, energetic men of business, strictly temperate, well educated, saving in their habits, and highly esteemed in society. But there are amongst them others altogether different — men of shy habits and downcast looks, sometimes of morose and peevish minds. In what should be the very prime of their life they find their consti- tutions failing them. They have well-grounded fears that manhood, vigor, mental and bodily, are fast leaving them. I have been consulted by many such. Their usual theme has been, " Why do I suffer ? Have I not led a sober, temperate, sensible life ? Have I ever been guilty of dissipation or debauchery ? My life has been regular ; I have kept early hours — lived in good, well-ventilated, cheerful homes ; my diet has been sound and wholesome, and I NERVOUS EXHAUSTION. 175 have taken sufficient and regular exercise." All this is true. Every rule tending to health and happiness has been observed, save one. Under- stand, my friend, the blood is the life. Do you know that one ounce of the semen is equiva- lent to forty ounces of blood? Be no longer ignorant — you are answered. The secret sin— the sin of Onan— has been draining your heart's blood for years. Be assured that no man can commit evil without evil consequences — for " Sorrow tracketh wrong forever and ever." When the constitution is healthy and vigor- ous, it may resist the consequences for years ; but the ultimate effect will be all the more aggravated. The vital force, unable to bear the waste of more than life, gives way suddenly. The healthy middle-aged man becomes a con- firmed invalid. Worse — infinitely worse is it when such a man ignorantly marries. I re- member such a case. The gentleman was about forty years of age. He had gradually worked his way up (without canitai) trom the position of book-keeper, at a few shillings a week, to salesman, buyer, and ultimately part- ner in one of the greatest commercial houses in the city of G. This fact speaks volumes for his mental activity and unblemished integrity. 176 KEKVOUS EXHAUSTION. He was a personable man, stout of limb, healthy in appearance, but a confirmed private sensua- list. Years had passed since he first addicted himself to the unfortunate habit — yet hitherto his system had resisted the constant drain upon its vital resources. Not that he has been with- out warnings. Sometimes a failing eye, a wan- dering mind, an unwilling stomach, perchance restless nights, and vague discomfort. He soothes his conscience, and says, " I work too hard, I have indigestion, I will take a holiday." And now he thinks it is time he should marry. His position is assured— he is a wealthy man — his ambition is satisfied, and he will seek to be happy. He is to all outward appearance an acceptable husband ; his character is beyond reproach. He only knows of one disreputable phase which disfigures it, and that he deter- mines to abandon forever, in order that he may be fit for the pure and virtuous embraces of his bride-elect. His sin has found him out ; those who will not be warned must be punished ; unhappily, too, the innocent must suffer also. He marries, and on the nuptial couch, in the arms of her he loves, he — poor self-deluded, self-ruined sensualist — discovers that the vigor of manhood has departed from him forever ! NERVOUS EXHAUSTION. 177 PICTURE THIRD: THE MARRIED SENSUALIST. The sacred ordinance of marriage emanates from the Deity, by whom we are enjoined to "increase and multiply. 7 ' Hence it is con- sidered honorable amongst all men, and should not be entered upon carelessly or wantonly, nor without duly considering the causes for which it was originally ordained. A happy marriage is the bond of social purity, as it is the crown of domestic joys. But it frequently happens that young men injure themselves seriously — and even permanently — by the lengths to which, during the first year or two after marriage, they carry the indulgence — or, to speak more accu- rately, the coercion — of the sexual faculties. Those who have never had the advantage of friendly advice are apt to make serious mistakes as to the extent to which intercourse should take place. Let me warn the newly married couple of the dangers of excessive indulgence, which not only ruins the health, but soon renders intercourse utterly repugnant. In such a case, when the virile powers of the man fail him, and he no longer discharges with alarcity and effect the duties of a husband, the wife, not knowing 178 NERVOUS EXHAUSTION. that she herself contributed to his impotency, but feeling a lack of warmth and vigor in his embrace — if not an absolute incapacity for sexual duties — begins to believe that it is else- where he seeks for gratification ; and jealousy and discord mar domestic peace. It is my solemn duty, therefore, to entreat those newly-married, who may have " o'er- stepped the modesty of nature," to pause ere the knell of all their mutual joys boom forth in the solemn words, " Too Late ! " — and to take steps to counteract the evils they have, perhaps unwittingly, invoked. Ten minutes' advice and instruction, added to skilful and mild treatment for two or three weeks, are often sufficient in these cases to restore tone to the debilitated organs, and renew, as it were, the bonds of love between husband and wife. The lesson, too, proves valuable, and is not often forgotten. But there is another and more frequent cause of matrimonial unhappiness — a cause to which I have already directed attention. Subjects of grave and painful importance re- quire plain and intelligible language. I will therefore say, emphatically, that the destruc- tive habit of self-abuse, practised in early life, XERV0VS EXHAUSTION. 179 fearfully injures the energies concerned in the reproduction of our species, and the due fulfil- ment of the nuptial rite. And it unfortunately happens that a man may abandon self-abuse as a voluntary act, and yet not be free from the consequences of his former folly. A new and unnatural association has been established be- tween the organs of generation and the mind — involuntary discharges of semen take place during sleep ; the seed is lost in the urine, at stool ; and muscular fibres surrounding the seminal ducts become relaxed, and all control oyer their actions is entirely lost. Let not any, then, imagine that having incurred the judg- ment of guilt they shall wholly escape the penalty, unless by prudent and prompt action, and attention to skilled advice, the instant the knowledge of that guilt and the certainty of its fearful consequences occur to them, they adopt the only measures by which the scourge can be averted. Therefore let us solemnly warn any young man now contemplating marriage, and who may at times have indulged in the secret vice of the solitary sensualist, not to take upon himself the sacred obligations and responsi- bilities of a husband until he is fully satisfied that his blood, his nervous system, and his 180 HERVOtTS EXHAtJSTIOK. procreative powers are free from the morbid effects of his past indulgence. PICTURE FOURTH : THE WIDOWER SENSUALIST. A man who could sit in my consulting room and listen day by day to the weary tales of sin and suffering, folly and remorse, which are continually poured into