Class _JE^_iXl 
 CoiwightN" ' 
 
 CQEmiGHT DEMSm 
 
V 
 
EXCESSIVE VENERY 
 
 MASTURBATION 
 
 CONTINENCE 
 
 THE ETIOLOGY, PATHOLOGY AND TREATMENT OF THE 
 
 DISEASES RESULTING FROM VENEREAL EXCESSES, 
 
 MASTURBATION AND CONTINENCE. 
 
 BY 
 JOSEPH W. HOWE, M. D., 
 
 Author of " Emergencies," " The Breath," " Winter Homes for Invalids," Late Professoc 
 of Clinical Surgery in Bellevue Hospital Medical College, Fellow of the New Yo/K 
 Academy of Medicine, Member of the New York County Medical, Patho- 
 logical and Surgical Societies, Visiting Surgeon to Charity and St. 
 Francis Hospitals, Consulting Physician to the Hospital 
 for the Treatment of Diseases of Mouth and 
 Throat, etc. 
 
 
 NEW YOEK : 
 E. B. TREAT, T71 Broadway. 
 
 1887. Price, $2 75. 
 

 COPYRIGHT, 1887. 
 
 By 
 E. B. TREAT, N. Y. 
 
 ^P? 
 
PREFACE. 
 
 This volume contains the substance of a course of lectures 
 delivered in the Medical Department of the University of New- 
 York, on the Results of Excessive Venery, Masturbation and 
 Continence. In addition to the results of my own experience 
 obtained in hospital and private practice, I have added the 
 peculiar methods of treatment employed by various authorities 
 in Europe and America, thus making the volume complete as a 
 book of reference for the student and practitioner of medicine. 
 
 38 W. 24th St., New York, J. W. H 
 
TABLE OF CONTENTS. 
 
 CHAPTER I. 
 
 GENERAL CONSIDERATIONS . 
 
 Ignorance of Sexual Hygiene and its results — Should Laws Regulating 
 Sexual Functions be taught before years of maturity are reached — Ignorance 
 of function in the married state, and its results — Ignorance as a cause of 
 sexual excess and Masturbation — Cases of Phthisis, from parental excess — 
 The physician as a teacher of Sexual Hygiene— When and How to teach — 
 Lessons to be regulated by the mental and physical peculiarities of the 
 child— Fear as a necessary educational agent — A clergyman's idea of what 
 should be taught of sexual physiology and Hygiene — The schoolmaster 
 as a guardian of school morals. ^7 
 
 CHAPTER II. 
 
 THE GENITAL APPARATUS. 
 
 Anatomy and functions of portions of the male and female genital organs — 
 Erectile Tissues — Peculiarities of erectile tissues — Blood supply of the 
 erectile tissue of the penis — Buck's fascia — Structure of the corpora 
 cavernosa and corpus spongiosum — Action of muscles attached to these 
 organs — The glans Penis — Changes in the glans from Masturbation and 
 Sexual Excess — Dorsal artery of the penis — Membranous urethra — 
 Cowper's Gland — Character of its secretion — Prostatic Urethra — ^Veru 
 Montanum — Prostatic Ducts — Ejaculatory Ducts — Morbid changes from 
 Masturbation — Intimate structure of Prostate gland — Sphincter Muscle of 
 the Neck of the Bladder 28 
 
 CHAPTER III. 
 
 THE SEMINAL FLUID AND THE MECHANISM OF ERECTION. 
 
 Physiological properties of seminal fluid — Chemical composition of semen — 
 Gross Appearances — Characters of Spermatozoa — Peculiar movements 
 under the microscope — Chemical composition of spermatozoa — Various 
 quantities formed and ejaculated — Secretion of Prostate and Cowper's 
 Glands, as forming a part of the Seminal Fluid — Natural and morbid 
 secretions that may be mistaken for semen — Muco-Purulent secretion 
 in Prostatitis, Urethritis and Cystitis — Mixture r>{ mucus with epithelial 
 cells — Chylous Urine— Distinguishing characteristics of each — Mechanism 
 of erection — Nerve centers governing erection — Function of the cerebellum 
 — Effects of removal of the organ — Clots and tumors in the cerebellum 
 — Emissions produced by Shampooing the occiput — Location of the 
 genito-spinal center — Sympathetic Nervous Influence — Analogy between 
 the act of blushing and erection — Influence of the mind — Cases of partial 
 erection 43 
 
Xll CONTENTS. / 
 
 CHAPTER IV. 
 
 DISEASES FROM EXCESS, ETC. 
 
 What constitutes Spermatorrhoea ? — Opinions of Hippocrates, Celsus, 
 Lallemand, Acton, Van Buren, Hamilton, Bartholow, McGraw, Gross, 
 Post, Hutchinson, Morse, and others — ^Various causes of Spermatorrhoea 
 and Impotence — Masturbation, Sexual excesses, Mental emotions. Conti- 
 nence, Diseases of nerve centers. Diseases of Testicles and Penis, 
 Congenital and acquired Malformations — Relative indulgence in the vice 
 of masturbation by inhabitants of savage and civilized countries — 
 Masturbation among animals — Age at which onanism is usually begun — 
 Nurses as teachers of immorality — Dangers of intimate companionship — 
 Influence of certain gymnastic exercises in developing masturbation — 
 Varieties of exercises which should be prohibited — Cases in which swing- 
 ing from poles and bars gives origin to the vice — Morbid changes in the 
 genital organs caused by self-pollution — Constitutional changes from 
 the same cause — Why seminal emissions occur when masturbation is dis- 
 continued , 58 
 
 CHAPTER V. 
 
 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTION. 
 
 Sexual excess not so injurious as masturbation — Seminal losses not 
 unhealthy when they occur from natural causes — Differences between 
 local and general effects of sexual indulgence and masturbation — Excess as 
 a cause of spermatorrhoea and impotence. Mental emotion as a cause of 
 spermatorrhoea and impotence — Effects of emotion in hysteria. Simula- 
 tion of mammitis, peritonitis, etc., by hysterical patients. Graham's bed 
 for impotent patients — Impotence from fear, anxiety, bad odors, business 
 troubles, bad temper, unusual surroundings, etc. — Interesting cases of 
 Hammond's, Rouget's, and others 7^ 
 
 CPIAPTER VI. 
 
 DISEASES PRODUCED BY SEXUAL EXCESS AND MASTURBATION. 
 
 Deterioration of the seminal fluid as a cause of pulmonary consumption- 
 Changes in the healthy character of the secretions — Hereditary weakness, 
 as a source of phthisis — Phthisis developed as a direct result of masturbation 
 — Phthisis among young married persons — Erotic desires of consumptive 
 Patients — Epilepsy — Connection with Onanism — Convulsive seizures 
 during the orgasm — Changes in the nerve centers as a result of 
 the disease — The center of sensation and voluntary motion — -Irritation of 
 the tuber annulare — Causes of the convulsion — Termination of Epilepsy 
 in insanity — Is insanity caused by sexual excess and masturbation — > 
 Opinions of various authorities — Peculiar forms of insanity arising from 
 these diseases — Nymphomania — Its causes — Characteristic cases — 
 Mirriage as a means of cure — Amputation of the clitoris as employed by 
 Baker Brown — Satyriasis — Curious manifestations of the disease — Treat- 
 ment — Aspermatism, et : 92 
 
CONTENTS. XIH 
 
 CHAPTER VII. 
 
 <JISEASES OF THE GENITALS THAT ARISE FROM MASTURBATION AND 
 SEXUAL EXCESS. 
 
 Causes of Varicocele — General changes in the spermatic veins — Effects of the 
 congestion and dilatation of the veins in the neighboring tissues — Mental 
 depression caused by varicocele — Emissions and impotence as a result — 
 Ligation of veins as a means of cure — Caustic applications —Galvano 
 cautery, etc. — Amputation of the scrotum the only safe operation — Ecchy- 
 mosis of scrotum — Neuralgia of the testicle — Irritable Testicle — 
 Various methods of treatment — Neuralgia of the neck of the bladder — 
 Treatment — Spasm of the muscles at the neck of the bladder as a cause 
 of impotence. Congestion and inflammation of the Prostate gland — 
 Treatment , . . - I2i 
 
 CHAPTER VIII. 
 
 DISEASES OF THE GENITALS ASSOCIATED WITH SPERMATORRHCEA 
 AND IMPOTENCE. 
 
 Accumulation of secretions under a tight prepuce as a cause of spermatorrhoea 
 and impotence — Illustrative cases — Reflex irritation produced by Phimosis 
 — Loss of voice from Phimosis cured by operation — Sayre's unique 
 case — General treatment — Congestion of the prostate and inflammation of 
 the prostate — Cases of spermatorrhoea and impotence produced by them — 
 Impotence following the removal of calculi from the bladder by the lateral 
 operation — Spermatorrhoea produced by Hypospadias and Epispadias— 
 Curvature of the penis — Large penis — Prostatic calculi as a cause of 
 spermatorrhoea 145 
 
 CHAPTER IX. 
 
 DISEASES THAT RESULT FROM SEXUAL EXCESS AND MASTURBATION. 
 
 Cerebral Anaemia — Symptoms and course — Peculiarities of Cerebral Ansemia 
 in connection with excess — Spasmodic contraction of voluntary muscles 
 in connection with anaemia — Termination in white softening — Significance 
 of loss of memory — Local paralysis — Effects of hemorrhage in the cere- 
 bellum — Sclerosis of Nerve Fibres of Cerebellum — Hanging — Concussion 
 of the spinal cord — Softening of spinal cord — Impotence from bui, 
 stroke 174 
 
 CHAPTER X. 
 
 CONTINENCE. 
 
 Fulfillment of function necessary to a healthy organization. Impairment 
 of function as a result of disease or inaction — Results of suspending the 
 functions of joints, muscles, eyes, etc. — Loss of s ght in animals secluded 
 from the light — Changes in the genital organs from continence — Reasons 
 why continence is likely to cause Spermatorrhoea and impotence — When 
 continence produces these diseases, and marriage is not attainable, what 
 advice should be given by the physician — Responsibility of the medical 
 adviser — Moral aspect of the case — Views of clergymen on the subject, 
 and their advice — Opinions of Acton and others 183 
 
XIV CONTENTS. 
 
 CHAPTER XL 
 
 CLASSIFICATION OF CASES FOR TREATMENT. 
 
 Universal rules that are not universal — The danger of advising a single 
 method of treatment for all cases of Spermatorrhoea and Impotence, 
 without a special study of each case — Errors in treatment — Bromides as 
 remedial agents. Their effects on the vascular and nervous systems — 
 How they affect the digestive functions — The indiscriminate use of the drug 
 productive of evil — Bromide of potassium as a cause of impotence — 
 Cauterization of the prostatic portion of the Urethra — Its universal use in 
 the treatment of spermatorrhoea — Why a classification of cases is 
 necessary — Four varieties of spermatorrhoea — Peculiarities exhibited by 
 the first class — Cases which are incurable — Second variety — Distinguishing 
 features — Patients amenable to treatment — Peculiarities of third and fourth 
 class of patients — Greater frequency of the milder forms of sperma- 
 torrhoea 202 
 
 CHAPTER XII. 
 
 CONSTITUTIONAL TREATMENT OF SPERMATORRHCEA, IMPOTENCE AND 
 AND ALLIED DISORDERS. 
 
 General Debility a leading feature in the majority of cases — A special diet 
 necessary for each patient — How to select a suitable diet — Cases in which 
 the number of meals should be increased — Condition of the genital 
 organs not to be considered in selecting food — Nutritious articles not to 
 be set aside because they have a tendency to excite the genitals— Eggs, 
 oysters, clams, raw beef, broths, gluten, cracked wheat, cream, milk, etc. 
 Digestible salads — Zvlethod of preparing raw beef — Quantity of food for 
 each meal — Incompatible mixtures of food in the stomach, and their 
 effects — Rules for the selection of compatibles — Food that should be eaten 
 — Food that should be excluded from the bill of fare — !Meat not to be 
 eaten with milk — Other incompatibles — No lard or pork to be used in 
 cooking — Mild wines permitted in the treatment 215 
 
 CHAPTER XIII. 
 
 CONSTITUTIONAL TREATMENT OF SPERMATORRHOEA, IMPOTENCE AND 
 ALLIED DISORDERS. 
 
 Condition of the bowels in spermatorrhoea — Scanty secretion — Diminished 
 peristaltic action — Wliy the use of cathartics is contraindicated — Effect of 
 constipation in increasing the number of seminal emissions — Semen 
 evacuated at stool — Cases in which small doses of calomel may be 
 employed — Action of Belladonna and Physostigma on the bowels — 
 Injections of oil into the rectum — Cold water injections as a remedy for 
 const'.Dation in spermatorrhoea — Local effects of the injections — Cold water 
 bathing — ^\''arious methods of employing cold water in the treatment of 
 spermatorrhoea and impotence — Cold sponge bath — Sitz bath^ — Shower 
 bath — Rubbing bath — Sea bathing — Temperature of bath for weak and 
 nervous patients — Local and general effects of the bath — Sleep and 
 exercise 224 
 
Contents. xv 
 
 CHAPTER XIV. 
 
 treatment of Spermatorrhoea, Impotence, and allied disorders — Indications 
 for the use of tonic medicines — Cases in which they are beneficial — 
 Reasons for their discontinuance — Effects of Strychnia on the spinal cord 
 — Combinations of Strychnia, Iron, Quinine and Glycerine — Tonics and 
 nerve stimulants in nervous depression — Preparations to be employed when 
 there is obstinate constipation — Palpitation of the heart, vertigo,etc. — 
 Employment ot arsenic, iron, nux vomica, ergot, and quinia — Aphrodisiacs 
 — Special indications for their employment. Classes of patients benefited 
 by their use — When they should be discontinued — Peculiar effects of 
 phosphorus on the nervous system and genital organs — Dangers connected 
 with its administration — Compound phosphorus pills — Cantharides as an 
 aphrodisiac — Best mode of administration — Combination of cannabis 
 indica, ergot, nux vomica, sanguinaria, stillingia, water pepper, damiana 
 — Homoeopathic remedies . 239 
 
 CHAPTER XV. 
 
 LOCAL TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 
 
 Electricity the principal remedial agent in treatment of impotence — Effect 
 of the induced and Faradic current — The continuous current — Cases 
 illustrating the effects of electricity — Various Methods of Electrodes — 
 Position of the patient — Urethral and rectal electrodes — Wire brush — 
 Cauterization as a means of cure — Solid and liquid caustics — Lallemand's 
 porte caustique — Precautionary measures to be adopted — Usual results 
 of the operation — Caustic solutions safer — Instrument for introducing 
 caustic solutions to the prostatic portion of the urethra — Acupuncture — 
 Introduction of the needles — Regions in which the needles are inserted 
 — Resulcs of Acupuncture, of astringents and anodyne applications — 
 Medicated bougies— Spermatorrhoea rings, electrodes, rectal pessaries. 252 
 
 CHAPTER XVI. 
 
 TREATMENT OF SPERMATORRHCEA, IMPOTENCE, AND ALLIED DISORDERS. 
 
 Methods of treatment used by Gross, Van Buren, Keyes, Hamilton, Post, 
 Bartholow, Hutchinson, McGraw, Acton, Gant, Humphrey and 
 others 269 
 
EXCESSIVE VENERY, MASTURBATION AND 
 CONTINENCE. 
 
 CHAPTER I. 
 
 GENERAL CONSIDERATIONS. 
 
 Ignorance of Sexual Hygiene and its results — Should laws regulating Sexual 
 Functions be taught before years of maturity are reached — Ignorance ol 
 Function in the Married State — Ignorance as a cause of Sexual Excesses 
 and Masturbation — Instructive case — When and how to teach — Les- 
 sons to be regulated by the Mental and Physical peculiarities of the child 
 — Fear as a Necessary Educational agent — A Clergyman's idea as to what 
 should be taught of Sexual Physiology and Hygiene — The Schoolmastei 
 as a guardian of Morals. 
 
 A knowledge of the sexual functions or of sexual hygiene is 
 rarely considered to be a necessary part of our early educa- 
 tion, and the value of such knowledge as promoting a healthy 
 physical and mental condition is almost entirely overlooked. 
 The age of puberty generally has passed, before the subject is 
 introduced to the youthful mind even in the most casual way. 
 Indeed there is scarcely a subject more completely ignored, 
 although so much of the health and happiness of the race de- 
 pends on it. The physician whose professional duties bring 
 him a clearer insight into the private lives of his patients, be- 
 yond the point where ordinary vision reaches, is about the only 
 one who fully realizes the great necessity for the diffusion of such 
 knowledge, and an education that will prevent those ignorant 
 assaults on the genital organs which in time stunt the vital 
 forces, and whether cured or not, leave their impress on the 
 vital forces of the patients themselves, as well as on their un- 
 fortunate offspring. Outside of the profession there are very 
 few who ever get beneath the thin veneering to the rotten wood 
 
l8 GENERAL CONSIDERATIONS. 
 
 below, and thus see the difference between the fictitious side of 
 life, and the real or true life of suffering occasioned by igno- 
 rance and bad habits, which might easily be avoided by a little 
 care and wholesome advice given by parents, guardians or 
 teachers, or perhaps best of all by the family physician, for he 
 really is the person fitted by his position to give the necessary 
 information in the way or manner that will carry with it its full 
 weight of conviction, and compel a sensible enforcement of the 
 laws which regulate sexual functions, and he can also briefly 
 explain such points in the anatomy and physiology of the or- 
 gans under consideration, as will facilitate the patient's efforts 
 to do what is expected of him in an intelligent manner. But 
 unfortunately, as things are, at the present day, the damage is 
 usually done before there is a full realization of the means for 
 preventing it. So dense, indeed, is the general ignorance on 
 this important subject that it is not an uncommon event for 
 men and women to enter the married state without any prelimi- 
 nary knowledge whatever of the sexual relation. 
 
 Married women, and men too, of much experience in other 
 matters pertaining to the management of their physical natures, 
 have informed me that when they entered the marriage state, 
 they were totally unaware of the nature of the sexual relation, 
 and that many days and nights were passed in the midst of 
 curious sensations, doubts and fears and ridiculous perform- 
 ances before the marriage was consummated. Neither did they 
 comprehend the immediate or remote results of the new rela- 
 tion. They knew not the difference between temperance and 
 excess until disordered nerves and feeble bodies compelled 
 them to seek advice from parents and friends who had passed 
 through the same trials and with similar experiences. And in 
 many instances this advice v/as sought too late for benefit. 
 
GENERAL CONSIDERATIONS. I9 
 
 triends who were more versed in the matter than they were. 
 This ignorance, of course, is more generally confined to women 
 than to men, but there are enough instances among the latter, 
 to make it a matter of surprise even to a physician who ought 
 to be accustomed to surprises. As a case in point, the fol- 
 lowing instance may afford food for reflection. In the summer 
 of '79 while sojourning in the Adirondacks, I was asked to visit 
 a gentleman at a hotel in the neighborhood who was said to be 
 in an advanced stage of pulmonary phthisis. He was about 
 forty years of age, and had been an invalid for three years. 
 Upon examining him, I found, that in addition to his phthisis, 
 he was suffering from a perineal abscess, and a congenital 
 phimosis. The latter had caused a chronic balinitis by pre- 
 venting the secretions from being removed, and the parts from 
 being washed. The extremity of the organ was so painful that 
 the slightest touch gave him great distress. I opened the 
 abscess in the perineum and it soon healed. The pain from the 
 accumulated secretions around the glans, continued with little 
 amelioration, except when relieved by opiates, and I finally 
 slit the prepuce and exposed the inflamed and ulcerated glans 
 and thus relieved him of the greater part of his suffering. He 
 afterwards said to me, *' Dr. I know now that if that operation 
 had been performed when I was a boy, and I had been told 
 anything about the normal condition of my genital organs, I 
 would now be in good health, I would not now be dying from 
 consumption. I blame it all on my parents. When I was a 
 mere lad, I had every night a very painful erection which kept 
 me awake the best part of the night. Again and again I went 
 to my father and begged him to tell me where to go for relief, 
 but he only laughed, and said it was all right. Like appeals to 
 Others had a similar result. Finally the irritation became 
 
20 GENERAL CONSIDERATIONS. 
 
 SO great that without any instruction I commenced to 
 masturbate, and finally went frequently with loose women to 
 such an extent that my health broke down, my lungs gave out, 
 and now I am dying. I never knew until too late what was 
 the cause of my frequent erections, and I was never told that 
 any relief could be afforded by an operation." 
 
 The most singular part of this matter is, that so much 
 ignorance can exist where natural instincts alone might be 
 expected to prompt man, as well as the lower animals. 
 
 The education of the youthful mind in these matters need 
 not be thoughtlessly commenced, or hastily terminated. A 
 gradual and systematic formation of correct ideas and habits, 
 should be fostered as the growth of the boy or girl progresses. 
 And the various steps should be taken with due regard to the 
 mental or physical developement of the child, and necessarily 
 must be varied to suit this or that particular case. The educa- 
 tion should neither be superficial, nor hurried. The teacher 
 must feel the responsibility he is assuming, and have a thorough 
 perception of his work on each point before he undertakes it. 
 The perceptive faculties of children are often much keener 
 than we generally give them credit for, and, like older 
 folk, they have different mental and physical peculiarities, 
 which must receive special study before the necessary knowl- 
 edge is conveyed to them. If the pupil has exhibited signs of 
 unusual sexual precocity, it would be well to point out the re- 
 sults of all unhealthy familiarity with the genitals before dis- 
 coursing upon their uses in the accomplishment of a most bene- 
 ficent plan of nature, to imbue the mind with that laudable 
 sense of fear which should invariably accompany any infringe- 
 ment of the law. Fear is an essential element in controlling 
 this class, which has many, very many members. So many in- 
 
GENERAL CONSIDERATIONS, • 21 
 
 deed are in this class in all walks of life as positive indications 
 that their parents though living in a civilized and christian 
 community, have broken every law as thoroughly as if they had 
 "lived and moved and had their being," where vice prevailed 
 and moral laws were unknown. Such children are often nothing 
 but insignias of disgrace to their ignorant, though, perhaps, well- 
 meaning parents. 
 
 With that other and much smaller class, who inherit healthy 
 minds, as well as healthy bodies, with little or no disfigurement 
 from exuberant natural passions, it is always safe to add to 
 their general knowledge of anatomy and physiology some ad- 
 ditional and special facts relating to the genito-urinary func- 
 tions. The subject can be approached gradually, suiting the 
 amount of information to the age of the child, and the general 
 development of the perceptive faculties. The command to 
 keep the hands away from the organs, if aided by the watch- 
 fulness of a faithful nurse, or mother, will generally succeed in 
 enforcing this sanitary edict. At the same time it is well to see 
 that all sources of temptation to examine themselves should be 
 removed. The tight clothing with which the limbs of most 
 children are encumbered by night, as well as by day, should 
 be removed. Nothing tight, or irritating, or exceedingly warm, 
 should be allowed either in the day or in the night, but 
 especially at night, because then there is the additional weight 
 of the bed clothing to be borne. From the warmth and super- 
 abundant moisture accumulating around the genitals irritation 
 is engendered which naturally prompts the child to rub and 
 finger its parts until the tendency to masturbation is fully 
 formed, and the child is well on the road that leads to all sorts 
 of excesses. Sometimes a warning voice reaches the innocent 
 transgressor through the medium of a quack advertisement in a 
 
22 GENERAL CONSIDERATIONS. 
 
 book or newspaper. Fortunately, these advertisements often 
 send the patient to the family physician, instead of to the 
 charlatan. Yet whatever evils may arise from such quacking, 
 one good at least is often accomplished, namely, the immediate 
 suspension of the pernicious habit, whatever may be its nature. 
 I have had many cases where the patient's reformation and 
 subsequent restoration to health originated from perusing quack 
 advertisements.' I speak of this to show that the educated 
 members of our profession are scarcely doing their duty to 
 humanity by ignoring the importance, and by neglecting or 
 making little of the subject. Fear of evil consequences is with- 
 out doubt a great moral power in this world, and although it 
 may not be the noblest propelling force, it cannot be dispensed 
 with in the cases under consideration. We are all sadly 
 human. Emerson, with a degree of truth, says that " there 
 is a crack in everything that God has made," and this 
 is undoubtedly true of poor human nature. We have 
 not yet reached perfection and probably never will, and we 
 must recognize the value of such a low moral force as fear in 
 the enforcement of sanitary conditions in all matters relating to 
 the sexual or genito-urinary organs. 
 
 The usual and conventional objection to this variety of edu- 
 cation is, that at such an early age the understanding is not 
 ripe enough for such knowledge, and that it might lead to the 
 very evil that it was designed to avoid. If it were not apparent 
 to every one that the evils and the diseases under considera- 
 tion were almost universal as a result of ignorance, then that 
 idea might be entertained, but no one can possibly object 
 under existing circumstances to giving the child legitimate 
 knowledge on a subject of such vital importance, where 
 ijisufHcient teaching has produced such unfortunate results. 
 
GENERAL CONSIDERATIONS. 2$ 
 
 Acton publishes the remarks of a clergyman who seems to 
 have been blessed with more than the ordinary amount of cler- 
 ical common sense on this question. He says : "Advantage 
 could and ought to be taken of the opportunity when a boy 
 says his catechism to explain to him the meaning of some of 
 the terms therein contained. When a child is taught to ' keep 
 his body in temperance, soberness and chastity,' it would not 
 be difficult to explain to him what chastity is, instead of leav- 
 ing him to find it out as best he may. He might be given to 
 understand that it does not merely mean that all indecency and 
 foul language must be shunned. The child might be told that 
 he must keep from meddling with his secret parts, except when 
 the necessities of nature require it, and that any emotion he 
 may experience in these members must not be encouraged, and 
 all thoughts which originate in them must be avoided. And 
 when he grows older every boy should be taught that chastity 
 means continence ; that if he would be chaste he must not by 
 any act of his own, or by the indulgence of lascivious imagina- 
 tions, cause the fruit of his body to be expended. He should be 
 taught that all such expenditure is a drain on his system, and 
 weakens the powers which God has given him to be employed 
 only in the married state. He may be sure that ' his sin will 
 find him out,' and if he marries with his powers undermined by 
 unlawful gratification it will be visited upon his children also. 
 If he is old enough to understand the subject, the youth enter- 
 ing upon puberty might have explained to him some of the mys- 
 teries of life; probably it would not be incompatible with his age 
 to explain to him that the life of the animal and vegetable king- 
 doms is continued and increased through the power of repro- 
 duction, with which the Creator endowed the whole produce of 
 the earth, It is the nature of every herb that it * yieldeth seed,' 
 
24 GENERAL CONSIDERATIONS. 
 
 and of the fruit tree yielding fruit that its ' seed is in itself ' (Gen. 
 i, 12). It is the nature of every living creature *to be fruitful 
 and multiply' (Gen. i, 28). This power of reproduction or of 
 generation constitutes the very essence of life. To enable this 
 vital function to be fulfilled, every plant and every animal is 
 furnished with organs of reproduction. As it has organs of 
 respiration for breathing the air, organs of motion, organs of 
 digestion for assimilating its food, so it has organs of reproduc- 
 tion for handing on the life it has received, and reproducing 
 itself in its offspring. This is the most important function of 
 the whole vital economy of every living form. We might 
 further explain to him that our life is bound up with the repro- 
 ductive organs of the body. Now what every young man, and 
 boy also, ought to know about himself is this : The two appendages 
 of the body, — of which we are too modest to speak, — but which 
 the Holy Scriptures calls the stones, and medical men the testes 
 or testicles, form the laboratory of the human body, where, by 
 a process of which we are quite unconscious, the blessing given 
 to man at the creation is being fulfilled, and out of the system 
 a vital fluid which is the very 'essence of life,' the source of 
 being, is being constantly produced from the time of puberty, 
 to be employed, when he reaches maturity, not in the gratifica- 
 tion of the lusts of the flesh but in the procreation of children. 
 The boy might be taught the immense importance to the human 
 constitution of this vital substance, the seed of the man which 
 is elaborated by the organ of reproduction, and it should be 
 made clear to him how terrible the consequences must be if the 
 life be continually flowing away from the body. The oppor- 
 tunity might be taken of informing the youth that many whose 
 lives are outwardly pure have fallen into secret sins and wasted 
 their substance in solitary indulgence. And the consequence 
 
GENERAL CONSIDERATIONS. 25 
 
 of such indulgence is not limited to the act itself, but the vio- 
 lated body becomes unable to contain its treasure, and as fast as 
 it is elaborated the seed is poured away on the slightest provo- 
 cation in sleep and in the performance of the acts of nature. 
 
 " He might further be informed that many of the sicknesses 
 to which we are subject may be traced to this cause, and that 
 many of those complaints set down as nervous debility, much 
 languor and loss of spirit, much feebleness of mind, much 
 dimness of sight, much loss of manly bearing, — to which we 
 must add many cases of the loss of reason and an imbecile and 
 driveling old age, — are the inevitable result of the expendi- 
 ture of the vital forces in sinful gratification. 
 
 " I would further instruct a youth that this degrading prac- 
 tice obtains such a hold upon any one indulging in it that he 
 seems unable to free himself from its grasp. Again and again 
 he yields to its importunity, and life ebbs away from him, — mind 
 and body becoming undermined. It is a sad and melancholy 
 truth that many whose childhood has been most pure and spot- 
 less have fallen most deeply when their passions have been 
 awakened through absence of all warning on the subject and in 
 ignorance of the self-destruction they were committing." 
 
 Besides this instruction given by the family physician, the 
 tutor, or the schoolmaster under whose eye the ordinary school 
 knowledge is inculcated, should maintain a degree of watchful- 
 ness over the boy which would enable him to detect any private 
 irregularities, and he should also add (with the advice of the 
 physician) any further lessons as to the best methods of regu- 
 lating generally the sanitary condition of the youthful pupil. 
 Upon this point the same author says : " I maintain that a con- 
 scientious schoolmaster's task does not end with providing for 
 cleanliness, decency, and exercise among his boys. In spite of 
 
26 GENERAL CONSIDERATIONS. 
 
 his assumed ignorance of the practice, masturbation and other 
 vices may spread widely through the school unless careful 
 supervision be employed. Against these secret evils there is 
 no better safeguard within his reach than a steady endeavor to 
 raise the moral tone of the whole school by means of the uppei 
 forms, so that the older boys may of their own accord join in 
 discountenancing any ungentlemanly or disgraceful conduct, 
 Without some such auxiliary, the efforts of the best-intentioned 
 master to prevent the practices, with their demoralizing accom- 
 paniments and consequences, will be almost powerless. How 
 diffused secret wickedness may become in schools appears 
 every now and then in scandals so dreadful that the natural 
 tendency of all concerned is to hush them up and forget them 
 as soon as possible. Indeed, it is impossible not to sympathize 
 with the feeling that to be obliged seriously to doubt as to the 
 manliness and, in a rough way, of the purity of our large schools, 
 would be a great calamity. And in the main, this confidence 
 has been, no doubt, hitherto justified. Still there are points on 
 which I think all concerned may be a little too confident, not 
 to say remiss. One in particular I wish to mention. (I can hardly 
 do more.) It seems to me clearly included within the scope of 
 these remarks. I think a schoolmaster should be alive to the 
 excessive danger of the platonic attachments that sometimes 
 become fashionable in a school, especially between boys of very 
 different ages. I am not speaking of ordinary boyish friend- 
 ship, — than which there can hardly be a greater blessing, — either 
 during boyhood or in after life. ^ ^ jj. I am speaking of 
 what schoolmasters cannot be ignorant of, — the sentimental 
 fancy taken by an elder boy to a younger, between whom there 
 can be, in the regular course of the school, little natural com- 
 panionship, and having about it a most unpleasant and danger- 
 
GENERAL CONSIDERATIONS. 2^ 
 
 ous resemblance to abnormal passion. I know that such 
 attachments have led to most melancholy results. I have been 
 made aware that some public school men have declined master- 
 ships in their own school because they knew the custom pre- 
 vailed, — which they were alike unable to sanction and afraid to 
 attack. I have been informed that it has been preached at, not 
 obscurely, from school pulpits; and I could point to living men, 
 with a wretched burden of recollection from it on their con- 
 sciences, which they would give the world to erase." 
 
 There is, no doubt, a vast deal of truth in what Mr. Acton 
 says on the point of immorality in public and private schools, 
 and that the pupils, — good, bad, and indifferent, — need watch- 
 ing ; but I would hardly agree with him in looking with a sus- 
 picious glance on all the friendships of boys differing in age 
 with each other. I would see that the precepts inculcated in 
 the previous pages were frequently dwelt upon, exercise a due 
 amount of care in rooming, and observation of their habits, and 
 leave the rest to the innate manliness of the boy himself. 
 
CHAPTER II. 
 
 THE GENITAL APPARATUS. 
 
 Anatomy and Functions of certain portions of the Male and Female Genital 
 Organs — Erectile Tissue — Peculiarities of Erectile Tissue — Unstriped 
 Muscular Fibres in the walls of the Trabeculse — Blood Supply of the 
 Erectile Tissue of the Penis — Buck's fascia — Structure of the Corpora 
 Cavernosa and Corpus Spongiosum — Action of Muscles on those Organs 
 — The Glans Penis — Changes in the glans from Masturbation and Sexual 
 Excess — Dorsal Artery of the Penis — Membranous Urethra — Cowper's 
 Glands — Character of the Secretion — Prostatic Urethra— Veru Montanum 
 — Caput Gallinagmous — Prostatic Ducts — Ejaculatory Ducts — Morbid 
 changes from Masturbation — Prostate Gland — Internal Structure — Vascu- 
 lar Supply — Communication of Prostatic Plexus with Hemorrhoidal veins 
 — Influence of Constipation on the Prostate and adjacent Parts — Testicles 
 — Tubuli Semeniferi — Cells in which Spermatozoa are manufactured — Vas 
 Deferens — Vesicul8e Seminales^ — Parts of Female Genitals concerned in 
 Masturbation — Clitoris — Labia Minora, etc. 
 
 In order to gain a clear conception of the diseases we are 
 about to study, it will be advisable to briefly examine the 
 various tissues which enter into the formation of the genital 
 organs as they exist in health, and also to study the functions 
 of the organs in their healthy state, before we proceed to the 
 consideration of those morbid changes which take place in the 
 tissues as the result of excesses, or of unnatural habits. 
 
 In the space known as the perineum are the organs to be 
 studied. Here we find located the neck of the bladder, the 
 prostate gland, urethra, penis, scrotum, testicles, anus, and 
 lower part of the rectum. In the female, the same region con- 
 tains the labia, clitoris, urethra, mons veneris, glands of Bartho- 
 line and their ducts, and the entrance to the vagina. 
 
THE GENITAL APPARATUS. 29 
 
 ERECTILE TISSUES — PENIS. 
 
 Erectile tissue invariably consists of interlacing bands of 
 yellow elastic, and white fibrous tissue, and unstriped muscular 
 fibres, which form irregular spaces, enclosing rich plexuses of 
 bloodvessels. It forms the principal part of the penis, being 
 found there in the form of three cylindrical masses, viz : the 
 corpora cavernosa, and the corpus spongiosum. Erectile tissue 
 is also found in the labia minora, clitoris, vaginal walls and 
 ovaries, the nipple of the mammary gland, and the schneiderian 
 membrane. The principal characteristic of this tissue is its 
 great capacity for distension. 
 
 The corpora cavernosa, the two upper cylinders of erectile 
 tissue which form the penis, arise from tue tuberosity of the 
 ischium, by two crura, which unite under the pubes and con- 
 tinue on until they terminate in two rounded extremities in the 
 expanded end of the corpus spongiosum, known as the glans 
 penis. Each cylinder is surrounded by a dense fibrous cover- 
 ing in which elastic fibres predominate, and in which also are 
 situated muscular fibres of the unstriped variety. This incloses 
 the erectile tissue proper. The erector penis, a muscle which 
 is intimately connect!ed with the crura, arises from the inner 
 side of the tuberosity of the ischium (Gray) from the crus, and 
 from the ramus of the pubes, and passing upwards and inwards 
 terminates in an aponeurosis that is attached to the side and 
 under surface of the crus. This muscle compressing the crura 
 prevents the return of the venous blood, and thus assists in 
 keeping up an erection of the organ. 
 
 The corpus spongiosum, the remaining cylinder of erectile 
 tissue, is situated immediately beneath the junction of the 
 corpora cavernosa. It commences in front of the triangular 
 
30 THE GENITAL APPARATUS. 
 
 ligament by a slight enlargement, called the bulb, passes forward 
 and ends in another expansion, the glans penis, which, as before 
 stated, receives the rounded end of the corpora cavernosa. The 
 glans penis is covered by a mucous membrane, the continuation of 
 the mucous membrane of the urethra. In a normal condition 
 the glans has a pinkish color and is highly sensitive ; and it is 
 protected by a fold of the integument covering the penis called 
 the prepuce. Where masturbation has been indulged in or the 
 party has been guilty of excesses for any great length of time, 
 the mucous covering of the gland assumes more of the charac- 
 ter of ordinary integument and loses its sensitiveness, while the 
 prepuce, instead of covering it, is wrinkled back to the base of 
 the corona glandis. The spongy portion of the urethra is 
 contained in the corpus spongiosum, extending from the 
 membranous portion to its termination in the meatus urinarius. 
 There is nothing special to be noted in this portion of the 
 canal, except that the ducts of Cowper's glands open on its 
 floor about half an inch from its commencement. The corpus 
 spongiosum is intimately connected with the accelerator 
 urinse, a m'kss of muscular fibres which are arranged in 
 three layers in the median line of the perineum. The layers 
 arise from the tendinous center of the perineum. The ante- 
 rior layfjr of fibres is inserted into the side of the corpus cavern- 
 osum, but the principal portion of them pass up to the dorsum of 
 the penis, terminating, in a fibrous expansion which, when the 
 muscles contract, compresses the dorsal vein. The middle fibres 
 surround the bulb and the adjacent portion of the corpus spongi- 
 osum and join with the fibres of the opposite side on the superior 
 portion of the same body. The posterior portion or layer is 
 spread out on the anterior ligament. This muscle assists in 
 erection by compressing the bulb and a portion of the corpora 
 
THE GENITAL APPARATUS. 3I 
 
 cavernosa. It also assists in expediting the flow of urine, and 
 in the expulsion of the last few drops of urine which remain in 
 the lower part of the urethra. The other muscles of the peri- 
 neum have no special relation to the points under consideration, 
 and need not therefore be studied here. 
 
 The bulb of the corpus spongiosum can be felt through the 
 ridge in the median line of the perineum. The membranous 
 portion of the urethra extends from the apex of the prostate to 
 the triangular ligament in front. Around this portion of the 
 urethra is attached the compressor urethrse, or *' cut-off " muscle. 
 (It is important to remember the attachments and action of 
 this muscle, as we shall see further on.) It arises from the 
 ramus of the pubes on each side, passes inward and divides 
 into two parts, one going above the urethra and the other going 
 below it, the two parts ultimately uniting in the median line. 
 Immediately underneath this muscular layer there is a circular 
 layer of unstriped muscular fibres, which is continuous with 
 the circular fibres of the prostate and bladder behind, and with 
 the circular layer of fibres in the spongy urethra in front. The 
 muscle is supplied by muscular branches of the pudic nerve. 
 Irregular or spasmodic action of this muscle may interfere both 
 with the expulsion of the urine and the emission of semen. 
 
 The membranous portion of the urethra measures three- 
 quarters of an inch in length. Underneath its anterior part the 
 glands of Cowper are situated. They are surrounded by the 
 transverse fibres of the compressor, and their ducts, an inch in 
 length, pass forwards and open on the floor of the bulbous por- 
 tion of the canal. They secrete a viscid, glutinous fluid which 
 appears in small quantities when there is much sexual excite- 
 ment. It is exceedingly profuse when there is much relaxation 
 of the genitals from masturbation or excessive sexual inter- 
 
32 THE GENITAL APPARATUS. 
 
 course. It resembles the white of an uncooked egg more than 
 anything else. It is said to perform the same function in the 
 male that the secretion of Bartholin's gland does in the female, 
 viz : the lubrication of the organ during sexual intercourse. 
 
 The prostatic portion of the urethra is situated in the sub- 
 stance of the prostate gland, and extends from the neck of the 
 bladder to the apex of the prostate, or commencement of the 
 membranous portion of the urethra. It measures one inch 
 and a quarter in length. On the floor of the prostatic urethra, 
 the body known as the veru montanum or caput gallinaginous 
 is situated. It is raised one or two lines above the level of the 
 mucous membrane. The supply of nervous elements, and fine 
 capillary bloodvessels to this organ is much greater than it is 
 to any other portion of the urethra, hence it is supposed to be, 
 and undoubtedly is, the principal seat of the peculiar sensations 
 which terminate the action of coitus. In front of the veru 
 montanum is a pouch called the sinus pocularis. At the orifice 
 of this pouch are found the orifices of the ejaculatory ducts 
 through which the seminal fluid is poured into the canal of 
 the urethra. The ducts are formed by the union of the duct 
 of the vas deferens with the ducts of the vesiculae seminales. 
 On each side of the veru montanum the ducts from the pros- 
 tate glands open. In cases of confirmed masturbators, all 
 these ducts are immensely increased in size and the veru mon- 
 tanum is elongated and hypertrophied to such an extent as to 
 occasionally afford an obstacle to the passage of the sound or 
 bougie, catching on the point of the instrument, and very 
 liable to be torn. The sound in passing over this portion of 
 the canal also causes intense pain, a point which I regard as 
 diagnostic of onanism, or excessive sexual indulgence, except 
 where inflammation of the prostate exists of an acute char- 
 
THE GENITAL APPARATUS. $^ 
 
 acter. The penis, which is made up of all the tissues just 
 described, has an exceedingly loose integumentary covering, 
 which contains little or no subcutaneous fat. The integu- 
 ment is prolonged over the glans to form the prepuce. In 
 a healthy condition, the prepuce should cover the glans and 
 protect it. When masturbation has been persisted in for any 
 length of time, the veins of the integumentary covering of the 
 penis become very much enlarged and tortuous, and the skin 
 itself becomes of a dull yellow color, with a tendency to wrinkle. 
 The dorsal artery of the penis may be felt pulsating between, 
 in the furrow made by the union of the corpora cavernosa. 
 The penis is held in position by a dense layer of fibrous tissue, 
 which forms the suspensory ligament. It is attached to the sym- 
 physis pubis, and thence spreads out over the penis, envel- 
 oping the corpora cavernosa and then splitting to form a sheath 
 for the corpus spongiosum. This tissue is known as Buck's 
 fascia, and is continuous below with the superficial layer of 
 the triangular ligament. 
 
 The vascular plexuses in the erectile tissue of the penis 
 secure their principal supply of blood from the dorsal artery 
 of the penis (a branch of the internal pudic) though the artery 
 of the bulb, and the arteries of the corpora cavernosa, also fur- 
 nish some. From eight to twelve branches arise from the main 
 trunk, and surround the penis, anastomosing with those below, 
 and finally piercing the corpora cavernosa. Langer says that 
 some of the arteries terminate in capillaries, as other arterial 
 capillary arteries do, while the others terminate directly 
 in the venous spaces of the erectile tissues by funnel-shaped 
 orifices. The arteries of the corpus spongiosum terminate in 
 ordinary capillaries. Rouget says, " the arterial trunks in the 
 bulb and at the roots of the corpora cavernosa do not divide 
 
34 THE GENITAL APPARATUS. 
 
 in the usual way into dichotomic branches, but are surrounded 
 on all sides by branches of vessels, which arise from three to 
 ten in number, from short common trunks. These vessels are 
 not merely short diverticula, but traverse for some distance the 
 large sinuses of the corpora cavernosa and of the bulb, and 
 penetrate, after numerous anastomoses and subdivisions, especi- 
 ally about the periphery, the muscular trabeculae. After travers- 
 ing these fibres, the arteries pass through the surface, through 
 slit-like openings ; but from their origin to their termination 
 in the muscular fibres, the vessels from the arterial branches 
 are twisted on themselves in abrupt and closely compressed 
 spiral folds, interlacing, entwining, and anastomosing, so as to 
 form a sort of vascular tangle, and this, unlike any simple flex- 
 ions which a slight distension suffices to obliterate, persists 
 during even complete erection, and closely resembles a beauti- 
 ful network." 
 
 The penis receives its nervous supply from branches of the 
 pudic, and the cavernous plexus of the sympathetic. The 
 latter is distributed mainly to the erectile tissue of the corpora 
 cavernosa, while the former is distributed to the integument 
 and to the urethra (KoUiker). 
 
 PROSTATE GLAND. 
 
 The gland which surrounds the prostatic urethra also plays 
 an important part in the diseases under consideration. It 
 extends from the bladder to the membranous urethra, the 
 muscular fibres being continuous behind with the circular 
 fibres at the neck of the bladder, and in front with the circular 
 fibres of the membranous part of the urethra. The principal 
 part of the muscular tissue of the gland is found at the cir- 
 cumference, while the follicles which form the glandular portion 
 
THE GENITAL APPARATUS. 35 
 
 of the organ are located in the interior. From the cortical 
 muscular layer, bands of muscular fibres pass to the interior 
 or center of the gland, and between these cords or bands all 
 the glandular tissue of the prostate is situated (Strieker). 
 There are also bands of striped muscular fibres, blending or 
 passing between the layers of smooth muscular fibres. Some 
 few of these bands pass also into the interior of the gland, or 
 glandular substance. 
 
 The nervous supply to the gland is very considerable. Large 
 nerve trunks containing a great number of ganglion cells pass 
 upwards to the superficial muscular layer. Medullated nerve 
 trunks are also found in the cortex, connected with large gan- 
 glion cells. 
 
 A plexus of veins, closely packed, also surrounds the 
 gland. The veins are of greater size than usually obtains in 
 ordinary venous plexuses. The dorsal vein of the penis ter- 
 minates in this plexus, returning the blood to this point from 
 the principal portion of the penis. This plexus of veins also 
 communicates with the hemorrhoidal and inferior mesenteric 
 plexuses. It can thus be seen what an important factor con- 
 stipation would be in promoting congestion of the prostate 
 and its connections. Any obstruction at this point, no matter 
 what its nature, must necessarily conduce to a continuance of 
 nocturnal pollutions and other allied affections. Indeed, in- 
 direct obstruction to the return circulation does more harm 
 than is generally supposed. With regard to the function of the 
 prostate, there is some difference of opinion. It undoubtedly 
 performs several offices. In the first place, it furnishes some 
 of the liquid which is required to dilute the seminal fluid. The 
 intermixture occurs at the time of the orgasm. Then the 
 muscular fibres, are so arranged that during contraction 
 
$6 THE GENITAL APPARATUS. 
 
 they press on the follicles and empty them at the time of 
 ejaculation. In this way only could a sufficient quantity of 
 prostatic fluid be obtained. Besides this function, the gland 
 undoubtedly acts as a sphincter muscle to the neck of the 
 bladder. 
 
 Every patient with functional or organic disease of the geni- 
 tals or any suspected constitutional disorder arising therefrom 
 should have a careful and thorough examination of the peri- 
 neum and a rectal exploration of the prostate gland. When 
 it is enlarged and highly sensitive, the soreness and enlarge- 
 ment may be felt outside by pressing firmly with the finger in 
 the median line an inch above the verge of the anus. Before 
 examining per rectum the patient should be placed in a 
 lithotomy position and a sound carefully introduced into the 
 neck of the bladder ; the left index finger is then to be 
 slowly inserted through the anus. In doing this special atten- 
 tion should be paid to the fact that if undue force is used there 
 will be a spasmodic contraction of the sphincter ani which will 
 thus oppose the introduction of the finger and cause intense 
 pain. A useful means of preventing this is to press firmly on 
 the sphincter before the attempted introduction, and finally to 
 rotate the finger as it enters. Just inside the sphincter, the 
 finger, pressed upward, v/ill come in contact with the sound 
 separated only from it by a thin layer of mucous membrane. 
 This is the membranous portion of the urethra. As the fin- 
 ger is carried on it is gradually separated from the sound, that 
 is, the thicker tissue of the prostate intervenes so that it takes 
 some degree of pressure to ascertain the exact position of the 
 sound. The gland can easily be distinguished and the exam- 
 ination wall or should furnish evidence of the amount of con- 
 gestion or inflammation existing, if any, as well as the degree 
 
THE GENITAL APPARATUS. 37 
 
 of enlargement. In cases where excessive masturbation is 
 suspected firm pressure over the whole rectal portion of the 
 gland, on the removal of the sound, will be followed by a 
 considerable discharge of prostatic fluid. In healthy states 
 this will not occur. The question is sometimes asked, what 
 does the normal gland feel like through the rectum of the 
 adult ? As a student the question often puzzled me quite as 
 much as it did my interlocutor. Without taking into consider- 
 ation the measurements of the gland which can be approxi- 
 matively made out, the question can be indirectly answered 
 thus : if there is no feeling of tension in the rectum when the 
 finger is resting on the gland, or of soreness or of special 
 discomfort at that point, the exact dimension of the gland is of 
 little importance. The probabilities are that the gland is 
 normal in size and condition. A feeling of tension over the 
 gland, as if the membrane were tight and distended, and a 
 feeling as if the gland were protruding into the gut shows 
 abnormality in size even when there is no special tenderness. 
 Besides this, pressure on the gland in the sensitive condition 
 mentioned, produces a tendency to evacuate the contents of 
 the bladder. 
 
 The passage of hardened fecal matter over a diseased gland, 
 that is a gland diseased from excess or from pollutions, will 
 squeeze out the prostatic fluid and make the unfortunate 
 patient believe that it is a discharge of semen. 
 
 THE TESTICLES. 
 
 The testicles in health are firm to the touch and not sensi- 
 tive unless the pressure made is excessive. The left one hangs 
 a little lower than the right. In persons who are the victims 
 of evil habits, the organs are generally soft and flabby to the 
 
38 THE GENITAL APPARATUS. 
 
 touch and do not give that sense of firmness so characteristic 
 of the healthy testicle. The testicle, like the brain, has three 
 coverings, a serous, fibrous, and vascular coat. The vascular 
 covering closely invests the lobules of the testicle. The tunica 
 albuginea covers the tunica vasculosa, and sends fibrous diver- 
 ticula into the interior of the testicle, between which are 
 arranged the lobules of the testicle. The serous covering, or 
 tunica vaginalis, is derived from the peritoneum and forms the 
 most external covering. Beeres gives the number of lobules 
 as 250, but there are probably more. Each lobule is composed 
 of tubes, the tubu'l seminiferi about sixteen feet in length. 
 Each testicle has about 500 tubes. The epithelial lining 
 of these tubes consists of large corpuscles having many nuclei, 
 and it is in these corpuscles that the spermatozoa are formed. 
 These tuber unite to form larger tubes, which pass out at the 
 back part of the testicles, and passing upward form the globus 
 major of the epididymus, the body of the epididymus and the 
 globus minor. From the extremity of the globus minor the 
 excretory duct of the testicle, the vas deferens, is given off. 
 This duct passes upward to the inguinal canal through which 
 it passes, and then dipping into the pehds by the side of the 
 bladder to its base where it joins with the duct of the 
 vesiculce seminales to form the ejaculatory ducts which (as 
 before stated) pass through the prostate, and open on the floor 
 of the prostatic urethra, at the upper edge of the sinus pocu- 
 laris. The vas deferens is two feet in length, forming the prin- 
 cipal part of the spermatic cord, and can easily be recognized 
 by the touch because it feels under the finger like a hard cord. 
 It conducts the spermatozoa from the testicles to the vesiculae 
 seminales — receptacles or reservoirs for the seminal fluid. 
 These reservoirs are two irregularly shaped sacs, about two 
 
THE GENITAL APPARATUS. 39 
 
 inches in length, situated at the base of the bladder and resting 
 on the rectum. They form the lateral boundaries of the space 
 at the base of the bladder which is uncovered by peritoneum 
 and which can be touched by the finger as it passes over the 
 posterior edge of the prostate in the rectum. The vesiculae 
 seminales manufacture a secretion of their own which mixes 
 with the spermatic fluid brought there by the vas deferens. 
 The surplus semen remains in these receptacles or storehouses 
 until it is thrown off in sexual intercourse, in masturbation, or 
 in nocturnal emissions. Because these vesicles after death 
 often contain no spermatozoa, some writers think that the 
 unused semen is absorbed, and that there is no accumulation 
 of it in the vesicles. There is no proof of this absorption. In 
 man the manufacture of seminal fluid is going on constantly. 
 If the patient is in a normal condition, and his genital organs 
 are fulfilling their legitimate functions in a proper way the 
 surplus stock is disposed of naturally. If the patient is sick 
 and the vital forces below par, the secretion must be 
 impaired. When the disease lasts long enough to threaten 
 life, it is reasonable to suppose that the secretion must be 
 very much less, if not altogether lost, so that after death no 
 seminal fluid exists in these storehouses. This I think prop- 
 erly explains the absence of liquid on post mortem examina- 
 tions. 
 
 FEMALE ORGANS CONCERNED IN MASTURBATION, ETC. 
 
 The mons veneris covers the pubes, and acts as a protector 
 during intercourse, preventing injury from pressure on the 
 sharp edges of the bones. It consists of a thick layer of integu- 
 ment covered with hairs, and supported by a, considerable 
 quantity of subcutaneous fat. 
 
40 THE GENITAL APPARATUS. 
 
 The labia majora extend from the mons veneris on either side 
 down to the anterior part of the perineum. They consist of in- 
 tegument, mucous membrane, dense cellular tissue, muscular 
 fibres and large sebaceous glands, and the terminations of the 
 round ligament of the uterus. The labia minora are made up 
 principally of erectile tissue similar in structure to the erectile 
 tissue of the penis, and mucous membrane; they are from an inch 
 and a half to two inches in length. They commence above the 
 clitoris and run down internal to the labia majora and become 
 lost on the sides of the entrance to the vagina; at their com- 
 mencement above, each labium splits in two layers which sur- 
 round the clitoris, forming the preputium clitorides, and the 
 frenum of the clitoris (Gray.) 
 
 The clitoris consists of two crura of erectile tissue like the 
 corpora cavernosa of the penis, attached behind to the rami of 
 the pubis and ischium, and they terminate in front in a sensi- 
 tive point analogous to the glans penis. It has also, like the 
 penis, a suspensory ligament, and two small muscles correspon- 
 ding to the erector penis. 
 
 The female urethra extends from the neck of the bladder to 
 the lower portion of the vestibule. The vestibule is a triangular 
 space, bounded on each side by the labia minora, also by the 
 clitoris, and below by the entrance of the vagina. The urethra 
 is an inch and a half in length, and is made up of muscular 
 tissue and mucous membrane and a layer of erectile tissue. It is 
 about an inch below the clitoris. It is more sensitive than the 
 male urethra, and is often employed by masturbators as well as 
 the clitoris for purposes of excitation. Hair pins, lead and 
 slate pencils, leather thongs, sealing wax, and other like sub- 
 stances are passed in and out of the canal, until the necessary 
 degree of excitement is produced. They often slip from the 
 
THE GENITAL APPARATUS. 4I 
 
 fingers of the operator into the bladder, where they remain to 
 form nuclei for cystic calculi. 
 
 The vagina also contains together with its muscular and 
 mucous layers a layer of erectile tissue rich in nerves. It is 
 highly sensitive and is often employed by masturbators, who in- 
 troduce foreign bodies, such as candles, stiff rubber tubes, etc., to 
 produce an artificial excitement. It has been stated to me by 
 good authority, that a large income is derived from the sale of 
 a rubber machine, made for the purpose mentioned. They are 
 said to be manufactured in some of the prominent factories in 
 the country, and sold by means of unscrupulous female agents 
 to school girls and others who will not take the risks incurred 
 in ordinary sexual intercourse. 
 
 The glands of Bartholin are two in number, and are situated 
 on each side at the entrance to the vagina. The glands open by 
 ducts in front of the hymen ; they secrete a liquid which is 
 analogous to that manufactured by the glands of Cowper. This 
 secretion is poured out in large quantities when there is much 
 sexual excitement, and it serves to lubricate the parts during 
 coitus. During the orgasm there is a discharge from the ducts 
 of these glands analogous to the ejaculation of semen in the 
 male. 
 
 The clitoris and the labia minora are supposed to be the seat 
 of the sensation in coitus. When masturbation has been in- 
 dulged in to any great extent the clitoris generally loses its 
 sensitiveness, though at times it is hypersensitive, and it is elon- 
 gated and hangs down, often as far as the meatus urinarius. 
 The labia majora and the whole entrance to the vagina is 
 intensely red and congested, and the parts are often bathed in 
 a profuse secretion of mucus. The labia minora are elongated 
 and pulled out beyond the edge of the labia majora. I have 
 
42 THE GENITAL APPARATUS. 
 
 seen cases in the hospital where they resembled the ear of a 
 small spaniel; when the hymen exists, it will be found relaxed, 
 and it does not close as much of the aperture of the vagina as it 
 does in a healthy condition. 
 
CHAPTER IIL 
 
 The Seminal Fluid and the Mechanism of Erection. 
 
 Physiological Properties, and composition of Seminal Fluid — Gross Ap« 
 pearances — Spermatozoa — Peculiar movements under the Microscope — • 
 — Chemical Composition of Semen — Various Quantities formed and Ejac- 
 ulated — Secretion of Prostate and Cowper's Glands as part of Seminal Fluid 
 — Natural and Morbid Secretions that may be mistaken for Semen — Mu- 
 co-purulent Secretion in Prostatitis, Urethritis and Cystitis — Mixture of 
 Mucus with Epithelial Cells, Chylous Urine, etc. — Distinguishing Char- 
 acteristics of each — Mechanism of Erection — Nerve Centers Governing 
 Erection — Function of the Cerebellum — Effects of removal of the Organ 
 — Clots and Tumors on the Cerebellum — Emissions produced by Sliam- 
 pooing the occiput — Genito-spinal Center — Sympathetic Nerve Influence 
 — Analogy between the act of Blushing and Erection — Influence of the 
 Mind — Cases of Partial Erection. 
 
 The seminal fluid, as stated before, is a product of several 
 distinct glands, differing in chemical composition and physical 
 properties. A large constituent of the fluid is furnished by the 
 prostate and Cowper's glands, the remainder by the testicle and 
 the vesiculse seminales. The prostatic secretion is opaque, the 
 secretion from Cowper's glands is transparent and viscid. The 
 fluid in the epididymis is slightly opaque. The secretion of the 
 vesiculse seminales which I have only had an opportunity to 
 examine after death, is sometimes opaque and other times 
 transparent. In two cases where death resulted from Bright's 
 disease of the kidneys, it was transparent and of a jelly-like 
 consistency. In a patient who died of phthisis in Charity 
 Hospital, it resembled seminal fluid, being both viscid and 
 opaque, and containing a few spermatozoa. 
 
 Seminal fluid is of a dull white color, alkaline in reaction, 
 
44 THE SEMINAL FLUID, ETC. 
 
 having a strong odor of lime. It is viscid, and rapidly gelatin- 
 izes on exposure to air. It contains salts of soda, lime, potas- 
 sium, and a peculiar protein compound, called by Frerichs 
 birioxide of protein. There is also a phosphorized fat in the 
 body of the spermatozoa. 
 
 The procreative factors of the seminal fluid are known as 
 spermatozoa, and they are its principal constituents. They 
 were first discovered by John Ham, who by a variety of experi- 
 ments proved that they were the fertilizing element in the male. 
 For instance, he found that if the spermatozoa were removed 
 carefully from the seminal fluid by filtration, it lost all power of 
 impregnating the female ovum. It has also been ascertained 
 that they are entirely absent in some animals, except at the 
 time of heat. The spermatozoon resembles a tadpole in ap- 
 pearance, having a large head and a prolongation which re- 
 sembles the tail. Under the microscope they appear to be pos- 
 sessed of rapid propulsive power, moving rapidly in every di- 
 rection with an undulatory motion very much like the swim- 
 ming movements of the tadpole. This power of movement or 
 motion may, under proper conditions, continue for forty-eight 
 hours without being outside of the genital organs. They lose 
 that power when thrown into water. KoUiker states that strong 
 solutions of salt, sugar or albumen, " will restore the motion 
 which has been lost by the action of water." The active move- 
 ments of the spermatozoa will continue in the vagina for a 
 period of eight days (Strieker.) In connection with the 
 spermatozoa, there are also found seminal granules, measuring 
 ^oQ-th of an inch in diameter. Nothing is known concerning 
 them, but it is probable that they are undeveloped spermatozoa. 
 
 Spermatozoa may be considered as embryonic cells, from 
 which all cells or all tissues are derived. The conditions necessary 
 
tHE SEMINAL FLUID, ETC. 
 
 45 
 
 for their development are that the spermatozoa should become 
 located in the ovule of the female, and receive there the sus- 
 tenance necessary for the developmental changes. 
 
 In this connection the following table from Acton will be of 
 interest as showing the result of various examinations of the 
 vesicul^ : 
 
 
 
 
 Examined 
 
 Age. 
 20 
 
 Condition of Vesiculae Seminales. 
 
 Condition of Vasa Deferentia. 
 
 hours after 
 death. 
 
 Slightly viscid ; brown tint 
 
 Starchy 
 
 II 
 
 20 
 
 Starchy, and gelatinous 
 
 Few animalcules; not brown 
 
 4 
 
 27 
 
 Partly thick and partly thin 
 secretion 
 
 
 10 
 
 27 
 
 Few spermatozoa, but glo- 
 
 Healthy, with few spermatic 
 
 32 
 
 
 bules 
 
 animalcules 
 
 
 27 
 
 Gelatinous; well-formed ani- 
 
 No distinct animalcules, glo- 
 
 12 
 
 
 malcules 
 
 bules 
 
 
 29 
 
 Gelatinous, thick, globules 
 
 No fluid in 
 
 3 
 
 30 
 
 Similar to that in vasa def. 
 
 Numerous animalcules in 
 active motion 
 
 6 and 48 
 
 31 
 
 Fluid thick at fundus, in the 
 interior, fluid 
 
 Globules and fragments 
 
 27 
 
 32 
 
 Fluid opaque, purulent 
 
 Cream or purulent appear- 
 
 16 
 
 30 
 
 Mucilaginous ; animalcules 
 numerous 
 
 ance 
 Cream-like globules 
 
 22 
 
 32 
 
 Purulent ; animalcules abun- 
 dant 
 
 Few animalcules 
 
 32 
 
 33 
 
 Small in quantity, brown, 
 
 Dilute, purulent — animal- 
 
 15 
 
 
 opaque 
 
 cules few 
 
 
 33 
 
 Small in quantity ; no ani 
 
 Small particles ; large glo- 
 
 26 
 
 
 malcules 
 
 bules 
 
 
 33 
 
 Globules ; no animalcules 
 
 Minute globules ; no ani- 
 malcules 
 
 6 and 36 
 
 39 
 
 Showed no animalcules ; no 
 
 Purely purulent, with glo- 
 
 2 
 
 
 globules 
 
 bules ; no animalcules 
 
 
 39 
 
 Gelatinous ; no animalcules 
 
 Of a cream or purulent co- 
 
 6 
 
 
 or globules 
 
 lor ; no animalcules 
 
 
 41 
 
 Mucilaginous ; many ani- 
 malcules 
 
 Particles, but no animalcules 
 
 58 and 68 
 
 42 
 
 Slightly opaque ; abundant 
 animalcules 
 
 A few animalcules 
 
 37 
 
 49 
 
 Animalcules abundant, dead 
 
 Abundant animalcules, lively 
 
 10 and 17 
 
 
 in seventeen hours 
 
 ten hours 
 
 
 57 
 
 Abundant vestiges of ani 
 
 Purulent ; animalcules abun- 
 
 5 
 
 
 malcules ; few distinct 
 
 (i.mr dead 
 
 
4^ THE SEMINAL FLUID, ETC. 
 
 " From the above table it appears that the spermatozoa, or 
 spermatic animalcules were found equally in the vesiculas semi- 
 nales and in the vasa. It is curious to remark that, in all the 
 cases in which spermatozoa were found in the vasa deferentia, 
 similar animalcules were noticed in the vesiculse seminales. In 
 cases in which the body was examined a few hours after death 
 the spermatozoa were found alive, and moving actively, while in 
 a few hours later they were motionless and dead, and warmth 
 had no effect in re-animating them. In some cases the animal- 
 cules were not perfect, portions only of imperfect spermatozoa 
 being found. In other cases no animalcules could be discov- 
 ered either in the vasa deferentia or vesiculae ; they were re- 
 placed by large or minute globules, small particles, or fragments. 
 The age of the individual appeared to have little to do with this 
 condition of the spermatozoa, or, indeed, with their presence, 
 numbers, or total absence. It is curious further to remark that, 
 although spermatozoa were found frequently in the vesiculae 
 and vasa deferentia, they were only found twice in the testes. 
 The fluid expressed from the testes was transparent, generally 
 contained globules nearly equal in diameter to the blood cor- 
 puscles, and invariably contained dense particles, apparently 
 spherical, from ten to fifteen times smaller. Dr. Davy thinks, 
 first, that chronic wasting diseases terminating in death arrest 
 the secretion of the testes, or the production of those animal- 
 cules on which there is much reason to believe the active powers 
 of the semen depend. Secondly, that the contents of the vesi- 
 culae and vasa deferentia, under the influence of disease, retain 
 their characteristic qualities longer than the contents of the 
 tubuli ; and, thirdly, that there is least fluid in the vesiculae and 
 in the vasa deferentia, and that it is most altered in instances of 
 chronic diseases of the abdominal viscera, and especially 
 
tHE SEMINAL FLUID, ETC. 4^ 
 
 of the intestines." — Edinburgh Med. and Surg. Jour., vol. 
 I. p. 14. 
 
 The seminal fluid when not removed by intercourse, accumu- 
 lates in the vesiculae seminales, and is thrown off at night 
 under the influence of lascivious dreams. Every man in a 
 healthy condition is subject to these emissions at periodic in- 
 tervals. The length of time between these emissions depends 
 on peculiarities of temperament, habits and conditions of life. 
 As a general rule it may be stated that seminal ejaculations 
 occur once at least in two or three weeks. Still it is not indi- 
 cative of an unhealthy condition when emissions occur once a 
 week. Oftener than this, however, is generally a sign of undue 
 irritability and relaxation of the genital organs, the result of 
 sexual excess or masturbation. 
 
 Emissions are not peculiar to men. Women also have them 
 at night, and accompanied by the same sensations and lasci- 
 vious dreams which characterize their occurrence in the oppo- 
 site sex. The secretion poured out is formed in the glands of 
 Bartholin, and is used for lubricating purposes, but under the 
 influence of unsatisfied desires and morbid mental excitement, 
 it is manufactured in excessive quantities, and ejected, distend- 
 ing the duct as it passes out, thus probably assisting in the pro- 
 duction of the orgasm. Except in coition, healthy women 
 are never subject to these discharges. They do not, however, 
 occur invariably from venereal excesses ; for any chronic con- 
 gestion of the uterus, ovaries, or vagina, or of the glands of Bar- 
 tholin, may produce frequent nocturnal emissions in the female. 
 
 The quantity of seminal fluid thrown off depends on the 
 previous habits of the individual. If he is plethoric, and at 
 the same time continent, the quantity is large. If intercourse 
 is freely indulged in the amount is comparatively small. The 
 
4^ fHE SEMINAL FLUID, ETC. 
 
 quantity in each emission varies from a drachm to half an ounce. 
 When there is congestion of the prostate, or inflammation of 
 the prostate, chronic in character, or much irritability of the 
 genital organs the amount of seminal fluid ejected is increased, 
 its viscidity lessens and it often assumes a slightly yellowish 
 tinge. The secretions which may be mistaken for spermatic 
 fluid are in order of frequency : 
 
 Secretion of Cowper's glands. 
 
 Prostatic secretion. 
 
 Muco-purulent secretion of Prostatitis. 
 
 Muco-purulent exudation of Urethritis. 
 
 Muco-purulent exudation of Cystitis. 
 
 Mucus mixed with epithelial cells. 
 
 Chylous urine. 
 All of these discharges are sources of anxiety to timid and 
 nervous patients. A person who has at any period of his past 
 life misused his genital organs, is exceedingly apt to regard 
 every unusual secretion as unmistakable evidence of seminal 
 losses, and weakness of the genital organs. If the patient is 
 unfortunately led to consult an advertising practitioner, he will 
 probably have his fears confirmed. He is told that the dis- 
 charge is seminal fluid, and that the involuntary loss is a posi- 
 tive sign of approaching impotence. Indeed it is not an un- 
 usual thing for these imposters to exhibit under the microscope 
 specimens of seminal fluid, and claim that it is a portion of the 
 fluid left by the patient for examination. In this way they 
 work on the morbid sensibilities of their patients, and reap 
 rich harvests as the result of their detestable deceit. 
 
 The history of each case is generally sufficient for a diagnosis, 
 but if the history is not clear, a microscopical examination of the 
 suspected secretion will determine its character by the presence 
 
THE SEMINAL FLUID, ETC. 49 
 
 or absence of spermatozoa. Spermatozoa are rarely seen in 
 any fluid but the seminal fluid. Occasionally, a few spermatozoa 
 may be seen in the urine after an emission, but they are rarely 
 if ever found in the secretions previously mentioned. 
 
 The secretion of Cowper's glands is transparent and viscid, 
 like the white of an uncooked egg. It resembles pure mucus. 
 Where intense sexual excitement exists or where there is much 
 relaxation of the genital organs, the secretion is poured out in 
 large quantities. In a healthy state of the organs, a small 
 quantity only is used for purposes of lubrication. The glands 
 probably serve the same purpose in the male that the glands of 
 Bartholin do in the female. The absence of opacity, and of 
 spermatozoa, renders the secretion easy of recognition. 
 
 The opaque, muco-purulent secretion which characterizes 
 gleet is often confounded with seminal fluid. Persons who have 
 masturbated are apt to attribute the discharge to their early in- 
 discretion. In the majority of such cases there is a history of 
 preceding gonorrhoea. The exudation usually occurs in the 
 morning, filling up the meatus urinarius. It is yellower than 
 semen, and not so viscid. The peculiar odor of semen is also 
 absent. Under the microscope, it will be seen to consist of 
 pus and epithelial cells. No spermatozoa will be found unless 
 the patient has had an emission the night previous to the ex- 
 amination. 
 
 The mucous secretion of the urethral canal sometimes be- 
 comes temporarily opaque, from the admixture of epithelial cells. 
 The opacity usually lasts a day or two and then disappears. I 
 have known it to occur during a paroxysm of intermittent fever. 
 The use of sounds for the relief of irritation in various parts of 
 the urethral canal will often occasion it. So also will prolonged 
 coitus under the influence of alcohol. The probabilities are 
 4 
 
$0 THE SEMINAL FLUID, ETC. 
 
 that it never occurs when the mucous membrane throughout 
 the canal is in a healthy state. 
 
 In prostatitis and cystitis, the urine may contain large quan- 
 tities of mucus and pus. The mixture of these in ammoniacal 
 urine, forms a gelatinous stringy mass which sinks to the bottom 
 of the liquid and adheres to the side of the vessel. In 
 prostatitis and cystitis there is pain on micturition, and a fre- 
 quent desire to micturate. The opaque exudation of muco- 
 pus appears with the last parts of the urine. In prostatitis, 
 acute or chronic, the passage of fecal matter from the rectum 
 may force out the secretion into the urethral canal. Patients 
 invariably regard this as semen and are much alarmed. An 
 additional proof of the existence of prostatitis, may be obtained 
 by introducing the finger into the rectum. If the gland is in- 
 flamed it will be much larger than usual and will be very pain- 
 ful on pressure. The passage of a sound also produces great pain, 
 in cystitis as well as in prostatitis. Then again the ammoniacal 
 odor of the urine is a guide to us in cystitis, as well as the pain 
 on pressure over the hypogastric region, the passage of a sound, 
 etc. A microscopical examination shows the presence of epi- 
 thelial and pus cells. 
 
 Chylous urine is of rare occurrence, intemperate or northern 
 latitudes. It is more frequent in tropical climates. It arises 
 generally from some disturbance of assimilation by which 
 the chyle passes unchanged into the urinary tract. Chylous 
 urine looks as if mixed with milk. The new ingredient coagu- 
 lates on cooling, and soon after separates into two portions, viz : 
 fibrin and fat. If allowed to stand for a short time the fat col- 
 lects on the surface of the liquid. Under the microscope fat 
 globules are seen in large amount but no spermatozoa. 
 
MECHANISM OF ERECTION. 51 
 
 MECHANISM OF ERECTION. 
 
 In order to treat a case of spermatorrhoea or impotence suc- 
 cessfully, we must understand all the varied elements that are 
 concerned in producing the normal as well as the abnormal 
 erection of the penis. Specially must we examine the nerve 
 centers which are supposed to govern the genital or procreative 
 function. Very little, it is true, is known about them, but that 
 little may guide the conscientious student in the right direction 
 toward further development and new discovery. Gall, the cele- 
 brated phrenologist, located the governing power of the sexual 
 instincts in the cerebellum or " little brain." Removal of the 
 organ sometimes produces atrophy of the testicles in the male 
 and of the ovaries in the female. When it is removed from the 
 rooster, and the bird is placed with his family of hens, he will 
 attempt to perform his functions as usual, but in vain, He is 
 unable to co-ordinate his muscular movements for the act, 
 though there is every evidence of desire being still present. 
 This experiment shows only that the cerebellum has a govern- 
 ing power over the co-ordination of our muscles. Tumors of 
 the cerebellum, and clots of blood in the same organ, have 
 produced satyriasis in the male and nymphomania in the female. 
 A patient under my treatment had an emission whenever the 
 barber shampooed his occiput. Other cases of a similar nature 
 are recorded, but they prove nothing absolutely, because the 
 barber's brush at the occiput covers other nervous structures, 
 such as the medulla and the upper cervical nerves. Besides 
 all these cases occurred in persons who had masturbated ex- 
 tensively, thus rendering the nerves exceedingly sensitive, and 
 any pleasureable irritation applied to other parts ot the nervous 
 system might have produced a like result. 
 
52 MECHANISM OF ERECTION. 
 
 In Kirke's handbook of physiology, M. Flourens says ; 
 " There is no proportion between the size of the cerebellum and 
 the development of the sexual passions. On the contrary, 
 many instances may be mentioned in which a larger sexual ap- 
 petite co-exists with a smaller cerebellum, e.g., rays and eels, 
 which are among the fish that copulate, have no lamina on their 
 almost rudimental cerebellum, and codfish, which do not copu- 
 late, but deposit their generative fluids in the water, have com- 
 paratively well developed cerebellums. Among amphibia, the 
 sexual passion is apparently very strong in frogs and toads, yet 
 the cerebellum is only a narrow bar of nervous substance. 
 Among birds there is no enlargement of the cerebellum in the 
 males that are polygamous ; the domestic cock's cerebellum is 
 not larger than the hen's, though his sexual passion must be es- 
 timated at many times greater than that of the horse. Among 
 mammaha the same rule holds good, and in this class the ex- 
 periments of M. Sassaigne have plainly shown that the abolition 
 of the sexual passion by the removal of the testicles early in life 
 is not followed by any diminution of the cerebellum, for in 
 mares and stallions the average absolute weight of the cerebel- 
 lum is 6 1 grains, and in geldings 71 grains, and its proportion- 
 ate weight compared with that of the cerebrum is on an average 
 as i: 5-57 in mares ; as i : 5-97 in geldings, and only as i : 7- 
 07 in stallions. On the whole therefore it appears advisable 
 to wait for more evidence before concluding that there is any 
 peculiar and direct connection between the cerebellum and the 
 sexual instinct or sexual passion." 
 
 There is another portion of the nervous system which also 
 has some direct influence over the genital apparatus. It is lo- 
 cated in the spinal cord, in the dorso-lumbar region. Various 
 kinds of irritants applied at this point affect the genital organs 
 
MECHANISM OF ERECTION. 53 
 
 in both sexes. An electrical current sent through will cause 
 contraction of the bladder, retraction of the testicles, and some- 
 times erection of the penis. In the female it excites contrac- 
 tions of the uterus, vagina, and bladder. If the dorsal nerves 
 of the penis are cut erections will not be maintained until the 
 cut ends are again joined. This operation is sometimes 
 performed in order to render stallions impotent. 
 
 Under healthy conditions every ejaculation of seminal fluid 
 is accompanied by an expansion of the erectile tissue of the 
 penis, and by a pleasureable sensation, known as the orgasm. 
 Some think that the peculiar sensation arises from a distension 
 of the veru montanum, a raised ridge of mucous membrane in 
 the prostatic urethra, which has been previously described. 
 This body is highly sensitive, and when distended prevents the 
 regurgitation of seminal fluid into the bladder. It is very proba- 
 ble that the distension of the ejaculatory ducts when the semen 
 is passing, may influence the orgasm quite as much as the dis- 
 tension of the veru montanum. The erectile tissue, like every 
 other vascular tissue in the body, is under the direct control of 
 the sympathetic nervous system, a control which is entirely in- 
 dependent of the will, and influenced solely by the emotional 
 nature. An excellent illustration of this is seen in the simple 
 act of blushing. An emotion of a certain kind acting through 
 the sympathetic nerves will cause the capillary bloodvessels of 
 the cheek to dilate. They become distended with blood, and 
 cause the warmth and reddening, which is called a blush. An 
 emotion of a contrary nature will cause contraction of these 
 bloodvessels, and a resultant paleness. 
 
 In like manner, uninfluenced by the will, certain emotions 
 which it is not necessary to enumerate, will produce a dilatation 
 in the bloodvessels of the penis, and expansion of the erectile 
 
54 MECHANISM OF ^ERECTION. 
 
 tissue, and an active determination of blood to the corpora 
 cavernosa and corpus spongiosum, which causes a physiological 
 erection. The permanency of the erection depends first on the 
 increased afflux of blood to the parts ; second, upon tonic con- 
 tractions of muscles connected with the penis, and third, a certain 
 amount of obstruction to the return circulation from the organ. 
 The muscular fibres of the accelerator urinae take an active 
 part in this partial and physiological obstruction. Its middle 
 fibres compress the erectile tissue of the bulb of the corpus 
 spongiosum, and the anterior fibres compress the dorsal vein of 
 the penis during erection. The fibres of the erector penis com- 
 press the corpora cavernosa during the contraction. In this 
 connection we must not lose sight of the fact that the invol- 
 untary muscular fibres of the erectile tissue of the penis take an 
 active part in the erection of the organ, and lack of tonicity in 
 these muscular fibres, as well as in the voluntary muscular 
 fibres, is one of the principal causes in impotence. 
 
 Many physiologists deny that there is any obstruction to the 
 return circulation ; that such obstruction is not necessary to the 
 permanency of the erection. They say further that the erec- 
 tion is maintained simply by an increased supply of blood to 
 the organ, and consequent distension of the erectile tissue. It 
 is an undisputed fact, that the muscles mentioned are con- 
 tracted during erection, and that irregular spasmodic contrac- 
 tion of these muscles will interfere with the erection, that is, 
 diminish its power. From their situation and attachments it is 
 impossible for them to contract without compressing the veins 
 bringing blood from the penis, as well as the erectile tissue of 
 the corpora cavernosa and corpus spongiosum. Without this 
 interference with the current of blood coming from the organ 
 the blood would be forced out of it during intromission. 
 
MECHANISM OF ERECTION. 55 
 
 The erectile power is often lost in enervated individuals by 
 the relaxation of these muscles, or by their spasmodic action. 
 Indeed I regard this lack of contraction as entering largely 
 into the causation of impotence. In this connection, it will 
 perhaps be well to examine the views of other authorities on 
 the subject. Kobelt says : " Thus on the one hand the glans 
 penis, endowed as it is with sensibility, and on the other hand 
 the irritable muscular apparatus of the bulb, act and react 
 upon one another as reciprocal exciting causes. The glans 
 penis when excited reacts on the bulb, which sends more and 
 more blood, the exciting material, towards it. Each new rush 
 of blood to the glans penis exalts its sensibility, the bulbo-cav- 
 ernous muscle, irritated in its turn, progressively accelerates 
 its contractions, in order to satisfy the requirements of the 
 glans, which also increases more and more till at 
 last, by alternate actions, the entire apparatus reaches its 
 highest point of excitement. At this moment a new series of 
 secondary reflex phenomena are suddenly produced between the 
 glans penis and the muscles which produce evacuation of the 
 vesiculae seminales, these muscles become excited, a spermatic 
 ejaculation is produced, and at this point the currents ex- 
 change, the special function is accomplished and the organ, as 
 soon as nature has gained her end, returns to its ordinary state 
 of repose and vegative life." 
 
 " Erection is caused by a relaxation of the muscular elements 
 in the trabeculse of the cavernous and spongy 'bodies, and of 
 the tunica media of the arteries of these parts, in consequence 
 of which the tissue, like a sponge which has been compressed, 
 expands and becomes filled with blood. The rigidity ensues 
 so soon as the muscles are completely relaxed, and the sinuses 
 filled to the utmost, without thejre being any necessity that the 
 
56 MECHANISM OF ERECTION. 
 
 return of blood should be impeded and the circulation stopped. 
 It ceases when the muscles again contract, the venous spaces 
 become narrowed, and the blood is expressed from them." 
 Rouget says : " The distention of the vesiculse seminales is the 
 first cause of natural erection. The latter commences by a 
 species of spasm, which develops itself in the muscular appa- 
 ratus of the generative system, is transmitted de proche en 
 proche to the bundles of the root of the cavernous body and 
 the bulb, and tends to propagate itself to the whole extent of 
 the penis. The obstacle to the course of blood in the veins 
 of the plexus of Santorini, imposed by the first muscular con- 
 traction, has for its immediate effect the dilatation of the areola 
 of the cavernous bodies by the blood, and the tension of the 
 liquid by the blood struggles energetically against the muscular 
 tonicity up to the moment when ejaculation being accom- 
 plished, spasm ceases little by little in the same situations 
 where it began ; the circulation then becoming free, muscular 
 contraction gets the better of the tension of the blood, and 
 partially drives on the liquid. The organ then itself gradually 
 resumes its natural dimensions." 
 
 In this connection, the following peculiar case of partial 
 erection is of interest : Two years ago I was consulted by 
 a gentleman who had been a sufferer from chronic gonorrhoea 
 and stricture for a long period. He said that for five years his 
 erections had not been complete, as only the upper part of the 
 organ partook in the distension. The corpus spongiosum 
 seemed to take no part whatever in the erection, and the organ 
 when erect was flat. He said his penis seemed flat whenever 
 erect. There was no lack of strength in the patient. His 
 emissions were not too frequent, and in other respects seemed 
 to be natural. The only thing that troubled him was the pe- 
 
MECHANISM OF ERECTION. 57 
 
 culiar shape of the penis, when expanded. I saw him again 
 six months ago, but there had been no change in the character 
 of the erections and he had no difficulty in sexual intercourse, 
 or any lack of pleasure therein. 
 
CHAPTER IV. 
 
 SPERMATORRHCEA AND IMPOTENCE. 
 
 What Constitutes Spermatorrhoea — Opinions of Hippocrates, Celsus, Lalle- 
 mand, Acton, Van Buren, Hamilton, Bartholow, McGraw, Gross, Post, 
 Hutchinson, and others — Various causes of Spermatorrhoea and 
 Impotence — Masturbation, Sexual Excesses, Mental Emotions, Conti- 
 nence, Diseases of nerve centers, diseases of Testicle and Penis, Congen- 
 ital and acquired Malformations — Relative Indulgence in the Vice of Mas- 
 turbation by Inhabitants of Savage and Civilized Countries — Masturbation 
 among Animals — Age at w^hich Onanism is usually begun — Nurses as 
 Teachers of Immorality — Dangers of Intimate Companionship — Influence 
 of certain Gymnastic Exercises in Developing Masturbation — Varieties of 
 Exercises that should be Prohibited — Cases in which Swinging from Poles 
 and Bars should be Prohibited — Morbid changes in the Genital Organs 
 caused by Self- Pollution — Constitutional changes from the same cause — 
 Why Seminal Emissions continue when Masturbation is discontinued. 
 
 Spermatorrhoea, or Spermatozemia, is a disease characterized 
 by involuntary discharges of seminal fluid. The name in its 
 strictest application is confined to those rare cases in which 
 ejaculations of semen occur without desire, sensation or excite- 
 ment. Modern usage, however, has made the term applicable 
 to all cases of involuntary seminal discharges, which occur with 
 such frequency as to produce a perceptible deviation from a 
 healthy state. 
 
 Impotence, or loss of power to copulate, is usually an accom- 
 paniment of spermatorrhoea. They rarely occur separately. 
 Exciting and predisposing causes of the one are exciting and 
 predisposing causes of the other. The etiology and treatment 
 of both are the same. Their consideration, therefore, under 
 the same general head, will be more advantageous to the reader, 
 
SPERMATORRHEA AND IMPOTENCE. 59 
 
 than if a symptom, such as impotence really is, were studied in 
 another chapter. 
 
 Spermatorrhoea has been recognized from the earliest antiquity. 
 The oldest writers gave it ample space and consideration. Every 
 manifestation of the affection has been studied for nearly two 
 thousand years, yet there is still a wide difference of opinion 
 as to what constitutes a true case of spermatorrhoea. This is 
 well illustrated by the following extracts from published works 
 and correspondence. Hippocrates called the disease Tabes 
 Dorsalis. He says " it proceeds from the spinal cord, and is 
 frequently met with among newly married people and libertines. 
 There is no fever, the appetite is preserved, but the body falls 
 away. If you interrogate the patients, they will tell you that 
 they feel as if ants were crawling down the spine. In making 
 water or going to stool they pass much semen. If they have 
 connection the congress is fruitless ; they lose semen in bed, 
 whether they are troubled with lascivious dreams or not. They 
 lose on horseback or in walking. Their breathing becomes 
 difficult : they fall into a state of feebleness, and suffer from 
 a weight in the head and a singing in the ears. If in this condi- 
 tion, they become affected with a strong fever, and die with 
 cold extremities." Celsus, evidently referring to spermator- 
 rhoea, says : 
 
 " There is also a disease of the genital organ, an excessive dis- 
 charge of semen, which is rendered without a sexual intercourse 
 or nocturnal illusions, to such an excess that in time a man 
 may be carried off by consumption." 
 
 Araetius, says " The semen flows away, nor is it capable of 
 being suppressed even during sleep, whether the man be asleep 
 or awake the discharge is kept up, nor is there any cessation of 
 
6o SPERMATORRHCEA AiSTD IMPOTENCE. 
 
 Galen thought that constant and involuntary discharges of 
 semen constituted gonorrhoea. In fact that was the opinion 
 held by many of the ancient writers, and the term gonorrhoea 
 means a flow of semen. Moschon says that "gonorrhoea is 
 an emission of semen without desire." Rufus of Ephesus 
 was of the opinion that " nocturnal emissions, pollutions, 
 disordered men more than coitus, because when pollution hap- 
 pens to a man oppressed with sleep, and his powers asleep, it 
 more oppresses and more affects the man." Sartorius thought 
 that spermatorrhoea disposed to calculus, diminished the natu- 
 ral heat, and brought on weakening and loss of sight. 
 
 Coming down to later times, we find Ambrose Pare speaking 
 of an involuntary flow of semen running from all parts of the 
 body to the genital organs, caused by the resolution and paral- 
 ysis of the retentive faculty of these parts, and from too great 
 an abundance of blood and seminal matter within the body. It 
 is probable that he referred to gonorrhoea and not to sperma- 
 torrhoea. 
 
 Lallemand says, " I shall express by the term spermatorrhoea, 
 every excessive spasmodic ejaculation from whatever cause it 
 may arise." 
 
 In Acton's valuable treatise on the reproductive organs we 
 find the following : 
 
 " Great exaggeration has doubtless been indulged in by many 
 of those who have described the complaint, and this from ob- 
 vious and infamous motives, but I am convinced that many of 
 the most obstinate complaints which the medical man meets 
 with, arise from the repeated loss of semen. The condition or 
 ailment which we have characterized as spermatorrhoea then, 
 as we shall use the word, is a state of enervation produced at 
 l^ast permanently, by the loss of semen." 
 
SPERMATORRHCEA AND IMPOTENCE. 6l 
 
 Gross says " a loss of semen is one of the natural consequences 
 of manhood, it is a necessity of the system, and is therefore to 
 be regarded as a disease only when it occurs too frequently, or 
 when it is produced by improper means." From this statement 
 •it is to be inferred that any seminal losses which affect 
 the general health, come under the head of sperma- 
 torrhoea. 
 
 Van Buren and Keyes, in their work on genito- urinary sur- 
 gery, say " that spermatorrhoea is an escape of seminal fluid con- 
 taining spermatozoa, is an escape without ejaculation, and with- 
 out pleasurable sensation or orgasm, usually at stool, with the 
 urine, or to a slight extent at all times during prolonged erection 
 under extreme sexual excitement. A small amount of the semi- 
 nal fluid is apt to escape into the prostatic sinus, and to be 
 passed at the next erection or urination." 
 
 R. Bartholow thinks the term spermatorrhoea should be 
 restricted to that condition in which involuntary losses occur 
 with sufficient frequency to produce a well defined morbid 
 state. 
 
 Hamilton McGraw, of Detroit, says : " I do not believe that 
 even a daily emission of semen will do serious damage to a 
 healthy vigorous man." I fear that few physicians of experi- 
 ence will be found to agree with this view. 
 
 Dr. Vandeveer thinks that three out of every ten cases of 
 so called spermatorrhoea are imagination. 
 
 The vast majority of authorities however agree in the opinion 
 that spermatorrhoea and impotence are active factors in a 
 development of mental and physical derangements and 
 in the transmission of constitutional weakness from 
 father to child. The general recognition of this fact has 
 not yet been productive of a systematic plan of treat- 
 
62 SPERMATORRHCEA AND IMPOTENCE. 
 
 ment. Vagueness, uncertainty, and contradiction, abound 
 in nearly every system of medication recommended 
 Hence, the field is almost monopolized by quacks, who reap 
 rich harvests in the management of the disease. 
 
 The causes of spermatorrhoea and impotence, in the order of 
 frequency, are : — 
 
 Masturbation. 
 
 Sexual excess. 
 
 Mental emotion. 
 
 Diseases of nerve centers. 
 
 Continence. 
 
 Diseases of testicle and penis. 
 
 Congenital and acquired malformation. 
 
 Diseases of the rectum and urethra. 
 
 Drugs. 
 
 MASTURBATION. 
 
 Masturbation is a universal vice in civilized countries. A 
 very large majority of human beings of both sexes indulge in 
 the habit from early childhood. 
 
 In savage lands it is of rare occurrence. Savages live in a 
 state of nature. No moral obligations exist which compel 
 them to abstain from a natural gratification of their passions. 
 There is no social law which prevents them from following the 
 dictates of their lower nature. Hence they have no reason for 
 adopting onanism as an outlet for passions. 
 
 The moral trammels of civilized society and ignorance of 
 physiological laws give origin to the vice. The dread of the 
 consequences of sexual intercourse begets continuous indul- 
 gence in the other sin because it is less liable to be found out. 
 But masturbation is not confined to human bipeds. The lower 
 
SPfiRMAtOkRHCkA AND IMPOTENCfi. 6$ 
 
 order of creation sometimes display lascivious proclivities in that 
 direction. Dogs, cats, monkeys, and rats have been known to 
 masturbate. Such cases must be exceedingly rare, because the 
 opportunities for sexual congress among animals are unlimited. 
 Indeed, it is more than probable that the creatures so indulging 
 must have been taught the habit by some depraved beings of 
 the human species. 
 
 Children commence the habit at a very early age. Cases are 
 on record of babes at the breast masturbating. A strong ele- 
 ment of doubt necessarily surrounds such records. They 
 must be taken cum grano salis^ though the observer may have 
 been honest in his belief. It is possible to mistake the ordinary 
 spasmodic movements of a delicate child, laboring under undue 
 excitement, from worms, or a scrofulous vulvitis, for well di- 
 rected efforts at masturbation. It is an authenticated fact, how- 
 ever, that children at the breast are often excited by their 
 nurses, in order to keep them quiet. The titillation of the 
 child's genitals produces sensations of pleasure which allay its 
 cries. Thus the seeds of a loathsome disease are often sown. 
 With matureryearSjthe recollection of past experience awakens 
 in their young breasts an exaggerated venereal sense, and pro- 
 longed onanism results as a natural consequence. Often, in- 
 deed, the cessation of excitation at the hands of the nurse 
 marks the commencement of personal pollution. Children have 
 been known to begin the habit at the early age of five. Though 
 there are no spermatozoa formed at that period of life — not, in- 
 deed, before puberty — emissions and erections are produced by 
 the friction. The fluid which forms the emission is probably 
 the production of the prostate and Cowper's glands. 
 
 From eight to sixteen may be called the masturbating period. 
 At sixteen or eighteen they are apt to be frightened from the 
 
64 Spermatorrhcea and impotence. 
 
 practice by reading, or hearing from friends, of the mental and 
 physical decay which threatens to overtake them. 
 
 At least ninety per cent, of the persons addicted to the vice 
 owe their misfortune to the instructions obtained from domes- 
 tics or from older and more vicious playmates. Or they are 
 taught by erotic nurses in whose care they are placed by con- 
 fiding parents. A gentleman of my acquaintance, who for 
 years suffered from the consequences of onanism, informed me 
 that his first experience occurred between five and six years of 
 age. The nurse, who slept in his room, carried him one night 
 to her own bed, and gave him his first lesson in the art, a lesson 
 which cost him years of feeble health, anxiety and pain. His 
 case is only one in thousands. It shows that the character and 
 habits of the nurse and domestic have often more to do with the 
 future welfare of the child than the character and habits of the 
 parents. All nurses, good, bad, and indifferent, need watch- 
 ing. And in order to determine whether the children have 
 been tampered with or not by the nurses, a critical examina- 
 tion of the genitals should be made from time to time. Fric- 
 tion of the genitals soon manifests itself by looseness of the 
 integumentary covering of the penis in the male' and of the 
 labia in the female. In females the redness is the principal ef- 
 fect noticed, though a large amount of the normal mucous se- 
 cretion is generally also present. In aggravated cases the se- 
 cretion may be muco-purulent. It must, however, be borne in 
 mind, that in scrofulous children there is often present a leucor- 
 rhoea entirely independent of masturbation, but the consequent 
 irritation of which often gives rise to the habit. 
 
 It has been suggested that a rigorous law on the statute book, 
 with a fitting penalty attached, would deter, if it did not com- 
 pletely stop, depraved nurses from transferring their lewdness 
 
SPERMATORRHCEA and IMPOTiENCE. 65 
 
 to the innocent minds of the children under their charge. A 
 few examples of punishment might be of benefit to the rising 
 generation. 
 
 As a rule it is wrong to allow children to sleep in the same 
 room with their nurses, or in the same bed with other children. 
 Nor should they be allowed to frequent lonely places or be 
 away from the observing eye of a watchful tutor or friend. 
 The natural curiosity of children, combined with the animal 
 instinct for sexual pleasures, leads them to an examination 
 and finally to a titillation of their genital organs, often without 
 the aid of any vicious instruction. 
 
 There are certain gymnastic exercises provocative of mastur- 
 bation. These exercises are common in all gymnasiums, and 
 in many school grounds. My attention was first called to this 
 subject by the history which a confirmed masturbator gave me 
 of his first experiences. He entered school at the age of 
 seven. The day after his admission he visited the school gym- 
 nasium. His attention was attracted to the swinging pole 
 around which a number of boys were enjoying themselves. 
 He took hold with the rest, sustaining the whole weight of the 
 body by the hands, swinging himself around the circle for 
 some time. In a few minutes he had such peculiar sensations 
 about the genitals that he was forced to discontinue the move- 
 ment and rest. Again and again he swung himself around 
 until he experienced the same effect, the sensations becoming 
 more positive and intense. The next day, on trying the same 
 experiment, the tingling sensations terminated in an orgasm. 
 This led him to a closer examination of his organs, and also to 
 new methods of increasing the same excitement, until finally 
 he became a confirmed masturbator. 
 
 Another, a patient now under treatment, said that the first 
 5 
 
66 SPERMATORRHCEA AND IMPOTENCE. 
 
 time he ever felt pleasurable sensations in his genitals, was 
 while he was engaged in sliding down the mast of a whale 
 boat. The first repetition of the exercise produced an orgasm, 
 and from that grew the habit for which he was under treat- 
 ment. A somewhat similar history has been given me by 
 others, one a female, who learned the art by sliding down the 
 stair-bannisters. Lallemand relates the case of a boy who 
 commenced masturbating by straddling down transverse bars, 
 and another who excited himself while hanging by the arm and 
 thus sustaining the whole w^eight of the body. So numerous 
 are such cases, related by experienced men, that there can be 
 no doubt of the injurious results of such exercises, nor of the 
 salutary effects which would arise from their prohibition. 
 Gymnastic exercise, such as climbing, sliding down poles, 
 clinging to rings, bars and ropes, swinging by the hands, in 
 fact every exercise in which the whole weight of the body is 
 sustained by the hands, should be excluded from school gym- 
 nasiums. Boys under eighteen should not be allowed to 
 indulge in any gymnastic exercise tending to produce a deter- 
 mination of blood to the genital organs. After that age there 
 is less likelihood of producing evil from these peculiar gymnas- 
 tics. There are many occupations which, after puberty, are 
 apt to produce the habit of masturbation. Boys and young 
 men who are confined all day in stores and factories, who use 
 tobacco or alcohol, and take little or no exercise out doors, 
 are liable to become victims. Erotic tendencies and inordi- 
 nate irritability of the genital organs are fostered by confine- 
 ment and sedentary habits. Boys out of doors, breathing pure 
 air, in active employment, rarely indulge in the vice or con- 
 tinue it to their injury. Onanism, developed after puberty in 
 persons of sedentary habits, is more pernicious in its effect 
 
SPERMATORRHCEA AND IMPOTENCE. 67 
 
 than when it is commenced in early childhood. The repeated 
 nervous shocks which it occasions are stronger, and make a 
 deeper impression on the system. The individual becomes 
 more wedded to the vice, and is more likely to persist in his 
 transgression than those younger patients who, with the first 
 dawn of manhood, have been warned of the evil consequences 
 of the habit which they commenced, before their reasoning 
 faculties controlled them. 
 
 Masturbation, though injurious to both sexes, is less so to 
 females than males. The worst features of the vice are always 
 more apparent in the latter from an equal amount of indul- 
 gence. Girls hide most of the ravages of the vice under 
 " general nervous excitement ; " boys have not this convenient 
 refuge. It is generally supposed that every masturbator carries 
 his sign out, and that the face is a never failing tell-tale. Such 
 is not invariably the case. The majority of masturbators 
 show no more signs of the secret vice than married men do of 
 free sexual intercourse. It is a great mistake not to make a 
 diagnosis because the often detailed signs are not perceptible in 
 every feature. There is always difficulty in getting at the 
 truth from patients when the external signs and manifestations 
 are not prominent, because positive denials of the practice are 
 almost always made. And it is a good rule to disbelieve these 
 denials, unless a local examination confirm their statements. 
 It is only when the sin has been a besetting one for a long 
 period of years, and when it has destroyed many of the finer 
 instincts of manhood, that you notice the characteristic 
 pale expressionless face, with sunken eyes, that seldom meet 
 yours, but steal sidelong glances, when your attention is drawn 
 in another direction. Only in such chance chronic cases do 
 we find the patients cowardly, easily startled, sleepless, inani* 
 
6% SPERMATORRHCEA AND IMPOTENCE. 
 
 mate, forgetful, stupid, troubled with vertigo and epilepsy, 
 mere animals in everything, — in desire, as well as in action. 
 We rarely meet with such cases, because the years of discre- 
 tion bring an appreciation of the danger, that either diminishes 
 or permanently stops indulgence in the vice. As before stated, 
 this change is likely to occur about the age of eighteen, at 
 which time too the local effects are plainly evident to the per- 
 sonal observation of the patient himself, and these too add to 
 the fears and assist the attempts at reformation which generally 
 are successful, unless indeed he is completely controlled by un- 
 governable and beastly sensuality. Though the effects of 
 years of masturbation may not stamp itself indelibly on the 
 features, or remarkably impair the general health, at least so 
 far as the uneducated can discover, yet there are characteristic 
 marks on the genitals which cannot be mistaken. The local 
 lesions are sufficient for a diagnosis, even where no correct his- 
 tory of the case is obtainable. 
 
 LOCAL EFFECTS OF MASTURBATION. 
 
 The penis is thinner and smaller than usual. It is often 
 elongated, and cold to the touch at different points. The glans 
 is much larger than the rest of the organ; this enlargement of the 
 glans is due to the frequent handling, to the relaxed condition of 
 vascular spaces in the erectile tissue, and the gravitation of 
 blood to the most dependent portion of the organ. The veins 
 of the integumental covering are dilated and varicose. In many 
 patients the penis is bent laterally, and the inclination is gener- 
 ally toward the left side; this condition is probably due to 
 partial paralysis of the muscular fibres of the opposite side. I 
 have sometimes in such cases found the opposite or convex 
 side deficient in sensibility. Nearly all persons suffering from 
 
SPERMATORRHCEA AND IMPOTENCE. 69 
 
 the effects of masturbation or excessive sexual congress, present 
 this peculiar change in the shape of the organ. The deformity 
 is more apparent in those who commence the habit before 
 puberty. 
 
 The scrotum is also relaxed and elongated. The testicles are 
 small and soft, and the left one hangs much lower than it does 
 in health ; sometimes they are extremely sensitive, and very 
 slight pressure gives rise to pain. The sensitive testicle may 
 atrophy, and it is generally smaller than the other. An enlarged 
 and varicose condition of the veins of the spermatic cord is 
 present in many cases. 
 
 The mucous membrane of the urethra is injected throughout, 
 but the greatest amount of congestion is to be found in the 
 prostatic portion of the urethra. The morbid changes are here 
 very well marked. The mucous membrane lining this portion 
 of the canal is intensely congested and swollen, but in the lower 
 part the changes are more extensive. The lining membrane is 
 thickened by the formation of new connective tissue, and in- 
 filtration of cells ; it is of a dark red color, and has lost much 
 of its epithelium. The veru montanum, whose distension 
 during coitus causes the orgasm and prevents the semen from 
 going backwards into the bladder — is increased to twice its 
 ordinary size. Indeed it is often so large as to afford an ob- 
 stacle to the passage of the sound. Its sensitiveness is usually 
 increased. In very bad cases where there is absolute paralysis, 
 sensation in it may be entirely absent — but as a rule it is exag- 
 gerated. Patients complain constantly of an itching or tingling 
 sensation in the part which seems to them like a commencing 
 orgasm, and that sensation may be increased by very little 
 excitement, so as to terminate in an orgasm. The mucous 
 lining of the prostatic urethra, and of that portion of the mem- 
 
70 SPERMATORRHCEA AND IMPOTENCE. 
 
 brane of the bulb near where the ducts of Cowper's glands 
 empty, presents very much the same appearance as granular 
 lids do in long standing cases. The orifices of the prostatic 
 ducts, which line each side of the veru montanum, are much 
 larger than usual, are darker colored than the rest of the mucous 
 membrane, and, like the other parts, divested of epithelium. 
 Their mouths may contain a quantity of muco-purulent exuda- 
 tion. Sometimes there is ulceration at the orifices of these ducts. 
 The mouths of the ejaculatory ducts which open near the edge of 
 the sinus pocularis, present similar changes. With regard to 
 this fact Lallemand says : 
 
 " The ejaculatory ducts generally share the alteration and 
 dilatation of their orifices, besides which, they may be insulated 
 as though distended, by the suppuration of the prostate, or thick- 
 ened, hardened and cartilaginous, or they may even contain 
 osseous granules. These alterations, much more serious than 
 those of the orifices, must dispose very much to the involuntary 
 escape of semen, the ducts, having lost their elasticity and even 
 their power of contraction, are no longer able to drive back the 
 semen into the seminal vesicles ; or at least they are incapable 
 of retaining it, however gently these reservoirs may contract 
 or however little they be compressed ; the pressure exerted on 
 these ducts by the swelled tissue of the prostate may cause their 
 atrophy or obliteration, whence, of course, ensue the more or less 
 complete loss of their functions. 
 
 " The vesiculae seminales may be dilated and thickened ; they 
 may lose their characteristic irregular, uneven surface, and be- 
 come firmly adherent to the surrounding structures. Their 
 lining membrane maybe covered with lymph or granular fun- 
 goid vegetations. They may be filled with pus or tuberculous 
 matter. I have almost always found in the vesiculae seminales, 
 
SPERMATORRHCEA AND IMPOTENCE. 7 1 
 
 particularly at the bottom of the depressions, a thick granular 
 shining liquid, variable in aspect, color and consistence, but 
 resembling pretty thick glue, and more or less transparent. 
 Under a power strong enough to observe the spermatozoa, the 
 particles {grumeaux) of this secretion appear somewhat irregu- 
 lar in size, more or less opaque, and of a uniform shape. These 
 are evidently the products of the internal membrane of the 
 vesiculae seminales ; for they are found with analogous char- 
 acters in the accessory vesiculae of the rat, etc., which never 
 contain animalcules, and do not directly communicate with the 
 vas deferens. These canals never contain similar bodies in any 
 species. This secretion, then, is analogous to that produced by 
 the prostatic follicles, Cowper's glands, etc. Its use is the same 
 and it deserves for many reasons our special attention." 
 
 The prostate gland is enlarged and tender on pressure. This 
 enlargement may remain when other vestiges of the diseased 
 action have altogether disappeared. Pressure on the gland 
 through the rectum, may or may not be painful, but is usually 
 followed by the appearance of an opaque fluid at the orifice of 
 the urethra, either immediately following the pressure or at the 
 next act of urination. It is composed of prostatic secretion, 
 pus and epithelial cells. The passage of a sound over these 
 parts occasions considerable pain. When drawn out it may 
 be followed by the same opaque discharge as that produced by 
 pressure on the prostate, or by a discharge of clear viscid 
 mucus. Patients in this condition micturate very frequently 
 and the act is rarely accomplished without some sense of dis- 
 comfort at the neck of the bladder or rather at the prostatic 
 portion of the urethra, when the passage of the urine irritates 
 the sensitive and abraded mucous membrane. 
 
 The local changes in the female genital organs always demon' 
 
72 SPERMATORRHCEA AND IMPOTENCE. 
 
 strate plainly enough the results of masturbation, even when the 
 patient denies the habit. The labia minora are elongated. In 
 some cases the pulling to which they have been subjected in- 
 creases their size to an enormous extent. I have known them 
 to measure two inches and a half in breadth and to look very 
 much like the ears of a spaniel. They are dark colored at the 
 edges, and sometimes are like parchment to the touch. At 
 the base they are red and swollen. The clitoris is also elon- 
 gated and thicker than in health. In some cases it loses its 
 ordinary sensitiveness, at others (and these are in persons who are 
 comparatively new to the habit) there is a remarkable increase in 
 the sensitiveness. Near the entrance to the vagina there is in- 
 tense redness, and in spots excoriation, and these parts are 
 sometimes bathed in a muco-purulent secretion. The ducts 
 of Bartholin's glands which open in front of the hymen are much 
 enlarged. A digital examination is certain to increase the 
 normal secretions, and produce turgescence of the clitoris and 
 nymphae. 
 
 CONSTITUTIONAL CHANGES. 
 
 As before remarked it is not often that the patient shows un- 
 mistakable signs of onanism in the features. It is only in cases 
 where the habit has been long practiced, and where the natural 
 manhood or womanhood of the individual has been subverted 
 by lasciviousness, that we notice marked changes there. In 
 other things tlie effects are plain enough to the experi- 
 enced eye. The superficial veins of the integument covering 
 the hands and feet on the dorsal aspect, are very much enlarged 
 or dilated. This is a normal condition in some thin skinned 
 people, advanced in years, but when noticed in young persons 
 it is C(.nnected with sexual excesses, or masturbation. The 
 
SPERMATORRHCEA AND IMPOTENCE. 73 
 
 hands are often moist and clammy. While the patient is sit- 
 ting, his shoulders stoop, and both hands are generally placed 
 on the inside of the thighs. The muscles are flabby ; the face 
 is usually pale and sallow. Under the eyes there are heavy 
 dark circles. In women, this is a normal condition when 
 pregnancy exists and also in persons who have indulged in in- 
 tercourse to excess. In uterine diseases it is likewise present. 
 In severe cases the eyes lose their firm expression and are luster- 
 less, and they rarely meet the gaze of friend or physician. 
 Emaciation is often present. The gait is "draggy," as if a 
 weight were attached to the heels. Acne is frequently present 
 on the face, giving it a disgusting appearance. It is found gen- 
 erally in patients with a dark complexion. But it must be re- 
 membered that the erruption often occurs independently of 
 lascivious indulgence. 
 
 The alimentary canal suffers like the rest of the body. The 
 tongue is coated ; constipation is almost always present, due 
 to lack of tone in the muscular coat of the bowels and deficient 
 secretion. Acid eructations and a feeling of weight in the 
 stomach after eating appear with the constipation. In short, 
 all the symptoms of indigestion or dyspepsia may be present. 
 Vertigo is a common and a very troublesome symptom to deal 
 with. It is often accompanied with headache. Sleeplessness, 
 with nervous twitching of the muscles, especially those of the 
 extremities, and palpitation of the heart are common accom- 
 paniments of sexual as well as of solitary indulgence. There is 
 general lassitude and an inability to apply the mind to continuous 
 work. Memory is deficient, and there is a general incapacity 
 for any kind of mental labor. At this time too, certain diseases, 
 both of mind and body, are apt to be developed and which will 
 be considered in another chapter. 
 
74 SPERMATORRHCEA AND IMPOTENCE. 
 
 SEMINAL EMISSIONS. 
 
 When the patient ceases to indulge in the habit, he will in a 
 short time thereafter be troubled with emissions of seminal 
 fluid, at night, accompanied by lascivious dreams and sensations 
 of pleasure. Erections may accompany the discharge of semen, 
 but they are often absent or imperfect. The impressions made 
 on the nervous system by constant discharges of seminal fluid 
 soon exhibit themselves, in the general symptoms previously 
 enumerated, and require the attention of the physician. Lalle- 
 mand gives the following curious method of examining for semen, 
 which I fear will be of little use in general practice at the 
 present day : " I have already stated that on causing patients 
 to make water in a bath, the semen passed may be easily 
 recognized by means of its globules which whirl about in the 
 middle of a cloud of foam toward the close of micturition. From 
 what we have just seen it is evident that these globules come 
 from the internal membrane of the seminal vesicles. They may 
 be wanting in very few cases where the semen has no time to 
 acquire consistency ; but their presence leaves no doubt, as to 
 the existence of diurnal pollutions, because they can only be 
 furnished by the seminal vesicles. On the other hand, I have 
 invariably found spermatozoa in the urine of patients who ob- 
 served the phenomena in a bath. The same remarks hold good 
 when applied to the globules which the urine deposits in cer- 
 tain cases of diurnal pollutions, and which have been compared 
 by some to grains of bran, others to millet seed, pearl barley, 
 etc., according to the size. These globules are perceived as 
 soon as the urine is passed ; they are roundish, very soft, and 
 do not give any sensation when squeezed under the thumb ; 
 they cannot therefore be confounded with urinary salts, which 
 
SPERMATORRHCEA AND IMPOtENC£. 7^ 
 
 are deposited only when the urine has cooled, have a crystal- 
 line form, and give the sensation of a hard body to the finger. 
 The vesical mucus is deposited only on cooling and does 
 not furnish brilliant granules. As to us its appearance 
 is easily determined. I have found animalcules whenever 
 these globules appeared in the urine ; and hence it is that I 
 have pointed them out as certain signs of diurnal pollutions. I 
 have also noticed that in some cases the urine, when held 
 against the light, presents in the middle of a flocculent cloud 
 multitudes of quite characteristic brilliant points. These are 
 smaller and consequently lighter globules than those which in 
 other patients fall to the bottom of the vessel. They are 
 neither observed in the mucus of the bladder nor in the pros- 
 tatic fluid, which alone presents clouds analogous to those of 
 diurnal pollutions. Such brilliant points also arise from the 
 seminal vesicles, and their presence is therefore an indication 
 that the urine contains semen. This I have often verified with 
 the microscope. I should, however, warn those who wish to 
 repeat my experiments, that it is not in the midst of the floccu- 
 lent cloud that the zoosperms are to be sought, but at the bot- 
 tom of the vessel, to which they soon fall on account of the 
 greater specific gravity." 
 
CHAPTER V. 
 
 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 
 
 Sexual Excesses not so injurious as Masturbation — Seminal Losses not un- 
 healthy when they occur from natural causes — DiSerences between Local 
 and General Effects of Sexual Indulgence and Masturbation — Excess as a 
 cause of Spermatorrhcea and Impotence — Mental Emotion as a cause of 
 Spermatorrhoea and Impotence — Effects of Emotion in Hysteria — Simula- 
 tion of Mammitis, Peritonitis, etc., by Hysterical Patients — Graham's 
 Bed for Impotent Patients — Impotence from Fear, Anxiety, Bad Odors, 
 Business Troubles, Bad Temper, Unusual Surroundings, etc. — Interesting 
 cases of Hammond's and Rouget's. 
 
 The natural fulfillment of every function exerts a beneficial 
 influence on the economy. Deleterious effects only mani- 
 fest themselves when the bounds of moderation are passed. 
 Even when an organ is overworked by natural means there is 
 much less harm done the system than there is from excessive 
 work in an unnatural direction. Men seldom suffer as much 
 from inordinate sexual congress as they do from the same 
 amount of self-pollution. The occurrence of seminal ejacu- 
 lations three or four times a week from legitimate sexual 
 congress will not be felt very much by a healthy man, while 
 the same number of losses from masturbation or nocturnal 
 pollutions will soon superinduce mental and physical debility. 
 Indeed there are many persons in robust health who indulge in 
 daily intercourse with impunity, while others with perhaps 
 equal stamina, lose flesh from two or three weekly pollutions. 
 The reasons for this are obvious. One act is performed in ac- 
 cordance with the dictates of nature — the other is subversive 
 and degrading. During sexual intercourse the expenditure of 
 
RESULTS OJ" SEXUAL EXCESS AND MENTAL EMOTIONS. 77 
 
 nerve force is compensated by the magnetism of the partner. 
 In all cases, or almost all cases, there is some return of that 
 nature, which prevents injury. The masturbator feels that his 
 act degrades his manhood, while the man who indulges in 
 legitimate intercourse is satisfied that he has fulfilled one of 
 his principal natural functions. There is a healthy instinctive 
 expression of passion in one case, an illegitimate perversion of 
 function in the other. The sexual appetite, like any other appe- 
 tite, varies with the individual. The capacity for sexual inter- 
 course also varies with the individual. That which would be un- 
 pardonable excess for one, would be moderate indulgence for 
 another. There is no invariable law for all to observe. But we 
 have, nevertheless, an easily followed rule as a guide in this mat- 
 ter as in everything else. Whenever sexual intercourse fails to 
 produce its tonic effect, when, instead of exhilaration of spirits 
 and clearness of intellect, there are depression, weakness, tremu- 
 lousness, anxiety and diminished power of concentration, then 
 the act is injurious and the intervals between each co-habita- 
 tion should be lengthened. If these warnings of nature are disre- 
 garded, a disordered condition of mind and body similar to 
 that which arises from onanism will soon appear. 
 
 With reference to this part of the subject Lallemand says : 
 "When connection is followed by a joyous feeling, bien etre 
 general^ as well as fresh vigor, when the head feels lighter, the 
 body more elastic and ready for work ; when a greater disposi- 
 tion to exercise of the genital organs evinces an increase and 
 activity, we may infer that an imperious want has been satisfied 
 within the limits necessary for health. The happy influence 
 which all the organs experience is similar to that which follows 
 the accomplishment of every function necessary to the 
 economy." 
 
78 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 
 
 On the same point Acton says : " Whilst one individual will 
 suffer for days after a single attempt, or even from a voluntary 
 emission, another will not evince the least sign of depression, 
 although the act be repeated several times in succession or on 
 several consecutive nights. Still, as a general rule, the act is, 
 and ought to be, repeated but rarely. In newly married people, 
 of course, sexual intercourse takes place more frequently, and 
 hence it happens that conception often fails during the first few 
 months of wedlock, depending, probably, on the fact that the 
 semen of the male contains but few perfect spermatozoa. In 
 such cases it is only when the ardor of the first love has abated 
 and the spermatozoa have been allowed the time requisite for 
 their full development, that the female becomes impregnated." 
 
 " In some persons the termination of the orgasm is accom- 
 panied by an epileptiform convulsion of more or less severity. 
 This is succeeded by a great amount of prostration. There can 
 be little doubt that such cases inherit hypersensitive organiza- 
 tions, the result, in all probability, of great excess in early adult 
 life." Acton says, " This is seen in a very exaggerated form in the 
 buck rabbit, who, after every copulation, may be noticed to fall 
 on his side in a sort of epileptic fit ; the whites of his eyes are 
 turned up, he gives several spasmodic twitches with his hind 
 legs and lies panting for several moments, until the nervous 
 system recovers itself. 
 
 " There are some men in whom this sort of epileptiform 
 orgasm takes place every time connection is indulged in. Na- 
 poleon I. is said to have been subject to epilepsy, when, resting 
 from his great labors, he indulged in sexual intercourse. No 
 doubt can exist that deaths which have occurred in houses of 
 ill-fame, as well as on the marriage couch, have arisen from this 
 cause' acting upon highly susceptible organizations. Entomo- 
 
RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 79 
 
 logical works abound with cases in which the male dies after 
 the act of copulation. The following, which reads almost like 
 a romance, may be explained, perhaps, by this epileptiform 
 attack killing the frail insect. It is a brief history of the es- 
 tablishment and growth of a colony of termite ants, related 
 by Burmeister : 
 
 " ' At the termination of the hot season, the young males and 
 females quit the nest and appear on the surface of the 
 earth, where they swarm in innumerable hosts, and pair. 
 The busy workers then convey a chosen male and female 
 back into the dwelling and imprison them in the central 
 royal cell, the entrance to which they decrease and guard. 
 Through these apertures the imprisoned pair receive the nour- 
 ishment they require. The male now, as amongst all other in- 
 sects, speedily dies after impregnation has been effected ; but 
 the female, from this period, begins to swell enormously, from 
 the development of her countless eggs, and by the time she is 
 ready to commence laying, her abdomen is about 1500 or 2000 
 times larger than all the rest of her body.' " 
 
 Impotence usually precedes the spermatorrhoea, as a result 
 of sexual excess, though sooner or later the latter accompanies 
 it. They are rarely separated. In the majority of cases the 
 excess is continued until there is complete inability to copulate. 
 The seminal sacs being comparatively empty, there is no other 
 symptom. At first the patient notices that his ejaculations 
 occur much sooner than they should, often long before there is 
 any specially pleasurable sensation excited by the contact. 
 Then he rests, or desists from his intercourse for a while, and 
 is surprised at the occurrence of nocturnal emissions. He again 
 essays sexual congress, and perhaps has an emission before 
 penetration occurs. This disheartens him, and he refrains, only 
 
8o RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 
 
 to suffer again from the emissions. If the impotence continue, 
 as it probably will, the semen, which is constantly being manu- 
 factured, fills the seminal vesicles, the nocturnal pollutions are 
 trebled in frequency, and very soon all the phenomena which 
 characterize spermatorrhoea are present, and such phenomena 
 must necessarily follow every form of impotence from excess. 
 But there are still cases in which spermatorrhoea is the primary 
 manifestation. From various causes, — not always from, lack of 
 virility, — the individual who has indulged to excess ceases his 
 wickedness. The irritation which excess has produced in the 
 genital organs keeps up the rapid manufacture of seminal fluid. 
 It passes away with the fecal matter, or rather is squeezed out 
 from the seminal vesicles by the hardened feces. Horseback 
 riding or similar exercise may also occasion the loss. The 
 majority of patients who lose their virility through excessive 
 intercourse are often in the enjoyment of average health, with 
 the exception, of course, of their local trouble. Many of them 
 are of robust build, full-blooded and muscular, and their ani- 
 malism is at its maximum development. The local paralysis of 
 the penis, which brings them first to the surgeon, is the direct 
 result of over-work and exhausted nerve force. Few general 
 changes are manifested, except in cases of long stand- 
 ing. In such cases, the morbid appearances noted will be sim- 
 ilar to those which arise from long continued masturbation. 
 When patients reach this stage there is more difficulty in 
 obtaining good results from treatment than there is with those 
 affected from masturbation. Recent cases are always amenable 
 to treatment. The surgeon can promise a cure if there are no 
 cerebral lesions. 
 
RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 8l 
 
 MENTAL EMOTIONS. 
 
 The influence of the mind over the body is usually under- 
 estimated. We are accustomed to regard the mind as some- 
 thing apart from the mechanism of the body, and by so doing 
 often fail to correctly appreciate its influence in producing 
 physical changes of an abnormal nature. "A powerful imagi- 
 nation will create that which it imagines " in a short space of 
 time. A new mental creation, without a basis in fact, 
 obscures and distorts that which is real. The records of hos- 
 pital and private practice show that there is little limit to the 
 power of this influence in creating organic changes where the 
 nervous system of the patient is abnormally sensitive. In the 
 manifestations of that hydra-headed affection called hys- 
 teria the fact is fully illustrated. While an interne of Bellevue 
 Hospital, a patient suffering from hysteria was placed in a bed 
 adjoining another suffering from peritonitis. Twenty-four 
 hours afterwards the abdomen of the hysterical patient became 
 tympanitic and swollen, and she vomited at frequent intervals. 
 In other words she developed all the symptoms of peritonitis 
 without having any peritoneal inflammation whatever. She 
 was removed to another ward, appropriate medicines adminis- 
 tered^ and recovery took place in a few hours. 
 
 A few days after the above occurrence, a patient with inflam- 
 mation of the mammary gland was admitted to the same ward. 
 The hysterical woman soon, called my attention to the fact that 
 her breast was exceedingly painful and swollen. On examin- 
 ing the gland, I found that it was indeed larger than the one on 
 the opposite side, and it appeared to be tender on pressure. 
 Remembering her previous simulation in the same line, she 
 6 
 
82 RESULTS OF SEXUAL EXCESS ANB MENTAL EMOTIONS. 
 
 was removed to another ward and treated with a good shower- 
 bath of three minutes' duration. She recovered rapidly. 
 
 Twelve months after she had left the hospital, I was asked by 
 the house surgeon to look at a case of inflammatory softening 
 of the brain, which was supposed to be rapidly approaching a 
 fatal termination. The visiting physician, suspecting a fatal 
 result, told the house surgeon to notify him when dissolution 
 occurred, so that he might be present at the post-mortem. The 
 patient was confined in one of the cells of the institution, and, 
 when I entered, was in a dark corner of the apartment. Her 
 limbs were flexed on the body, and her muscles were rigid. 
 The thumbs were tightly clinched by the fingers. She seemed 
 to be in a state of deep coma, and breathed like a person 
 approaching death. I moved her a little, so as to let the light 
 shine on her face, and to my amazement discovered my old 
 hysterical patient who, the year previous, gave so many mani- 
 festations of the influence of the mind in developing morbid 
 changes. I called her by name, shook her, and by persuasion 
 and a little force made her assume a standing position and 
 walk around the cell. The cure was completed in a day or two. 
 
 A few years ago I was consulted by a broker who had sus- 
 tained severe losses in Wall street, which, while they had not 
 made him ill, increased his sensitiveness to an extraordinary 
 degree. No matter how insignificant the occurrence might be, 
 a deep impression was left, which gave him sleepless nights and 
 distressed him during the hours of day. He read in a news- 
 paper one morning of a gentleman falling down in a fit on the 
 street and dying, and the thought immediately came that it 
 would be dangerous for him to go out alone, for fear of a sim- 
 ilar fate befalling him. He made up his mind that he could 
 not move a step without company. He would not go alone 
 
RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. S$ 
 
 anywhere, — refused to ride on the cars or in a carriage of any- 
 kind, — not even across the street, unless accompanied by a 
 friend or servant. This condition had lasted a year before he 
 consulted me. I tried by argument to show him that it was 
 impossible that any accident such as he dreaded could happen 
 to a man with his physique and with his otherwise healthy con- 
 dition, but without avail. I finally prevailed on him to leave 
 his house without company the next morning, promising him if 
 he did so that I would, at 9 a. m., meet him one block from his 
 abode. He did come out alone, and I met him as by appoint- 
 ment. The same thing was repeated the next day, though he 
 was in a state of intense excitement when I reached him. I 
 then made him promise to meet me a block further away the 
 next day, and at the appointed hour was at the meeting place, 
 but I stood out of the way, where I could see him and yet not 
 be seen by him when he came out. When he stepped out of the 
 house he looked around for a moment hesitatingly, and then 
 started with a rapid movement for the place of appointment, 
 looking anxiously about for me. When he had accomplished 
 about half the distance he suddenly stopped and grasped the 
 railing, and if I had not immediately stepped out and shouted 
 to him he would have certainly fallen, from fear only, and 
 might possibly have suffered seriously. When I reached him 
 he was deathly pale; he trembled like an aspen; his hands and 
 face were cold and clammy, and his pulse could scarcely be felt 
 at the wrist. 
 
 It was only with a great deal of difficulty that I got him safely 
 to his room. After that I persuaded him to meet me a block above 
 the last place, and continued to meet him daily, each time ex- 
 tending the length of his walk alone until he was able to reach 
 his office unattended. I subsequently increased his walk to 
 
84 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 
 
 60th street, two miles from his boarding place, and besides 
 which, I induced hira occasionally to ride on the horse car ; 
 gradually working him into a better state of mind by develop- 
 ing his self-reliance, he finally recovered. 
 
 Dr. Carter relates the following : " A lady who was watching 
 her little child at play, saw a heavy window-sash fall upon its 
 hand, cutting off three of the fingers ; and she was so much 
 overcome by fright and distress as to be unable to render it any 
 assistance. A surgeon was speedily obtained, who, having dress- 
 ed the wounds, turned himself to the mother, whom he found 
 seated, moaning and complaining of pain in her hand. On 
 examination, three fingers corresponding to those injured in 
 the child, were discovered to be swollen and inflamed, although 
 they had ailed nothing prior to the accident. In four and 
 twenty hours incisions were made into them and pus was evacu- 
 ated ; sloughs were afterwards discharged, and the wounds 
 ultimately healed. Now in this case there can be no doubt that 
 the mother's emotion was directed, by observation of the 
 parts injured, upon the corresponding parts of her own system, 
 thus working a change in the circulation or nutrition, sufficient 
 to excite acute inflammatory action." 
 
 Mental emotions have a more powerful influence over the 
 functions of the genital organs than they have over any other 
 functions in the body. No organs respond so quickly to this 
 influence. Mental emotion is a powerful factor in all cases of 
 impotence connected with sexual excess or masturbation. It 
 occasions impotence among married men, as well as among those 
 who are single. Even where men have been abstemious, and 
 moderate in the indulgence of their passions and entirely free 
 from the reproach of onanism, they are subject to impotence 
 from mental causes. An exceedingly slight cause operating 
 
RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 85 
 
 through the mind, may result in its sudden and untimely de- 
 velopment. A disagreeable object, a jest out of place, a fit of 
 indigestion, troubles in business, family jars, leucorrhoeal odors, 
 pre-occupation of mind, unusual surroundings, fatigue, a doubt 
 whether the act can be completed, have all been recorded as 
 sources of failure in sexual intercourse. Fear, or anxiety, is 
 probably the most frequent cause of failure, especially with those 
 who have masturbated. Being subject to emissions when not in- 
 dulging in intercourse, and knowing them to indicate relaxation 
 and weakness, they read pamphlets on the subject and thus 
 further increase the fear of failure. Their minds run on the 
 mental decay and loss of manhood which arise from impure 
 habits, and with this thought torturing the mind, the first at- 
 tempt at intercourse necessarily ends unsuccessfully. The first 
 failure is a sure precursor of other failures to follow, all due to 
 the emotion of fear, and this fear will last and keep up the im- 
 potence until relief is obtained from the physician. In connec- 
 tion with this temporary impotence, the hourly concentration 
 of the mind on the parts disorders the circulation, increases 
 the irritation of the genitals, and if spermatorrhoea has not 
 manifested itself previously, it will do so at this stage, as the 
 result of mental influences and bad habits. Even in persons 
 of vigorous health, impotence may result from fear. Impotence 
 has been produced in a healthy man by a friend's recital of his 
 own surprising failure. The thought of the accident that befell 
 the friend occurred at the time of intercourse, and he too failed. 
 A married patient of mine, a lawyer, with excellent physique, 
 the father of two children, became temporarily incapacitated in 
 this way ; reading in a medical journal that impotence might 
 attack healthy persons, temperate in all things, and without 
 notice, he became impressed with the fear that a similar acci- 
 
86 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 
 
 dent might befall himself. Curiously enough, the next time he 
 attempted intercourse, the fear took complete possession of him, 
 and he became temporarily impotent. 
 
 Roland speaks of a gentleman who, while on a visit to the 
 country, was seduced by a lady in full walking costume. Dur- 
 ing a period of one year, he continued to cohabit with the same 
 woman, under similar conditions, namely, she was invariably 
 dressed. He finally married an estimable and healthy woman, 
 and though in the full exercise of all his mental and physical 
 powers, he was unable to begin or even to complete the act. 
 Repeated trials ended like the first. His previous intercourse 
 with a woman in full dress had disturbed his equilibrium so much 
 that he could not complete the act until his wife had her clothes 
 on. 
 
 In Hammond's interesting work on impotence I find the 
 following : " A married gentleman who, before entering into the 
 matrimonial state, had been excessively given to sexual inter- 
 course, but who had no reason to think that his powers were 
 exhausted, or even materially weakened, found himself on his 
 wedding night and for some days thereafter, absolutely incapa- 
 ble of consummating the marriage. His wife was a highly edu- 
 cated, intelligent, refined and beautiful woman ; he was devo- 
 tedly attached to her, and on marrying had once and for all 
 given up all the evil associations of his younger days. His 
 passions were strong, but as soon as he attempted intercourse, 
 the desire, which he had previously entertained, vanished at the 
 thought that it was a profanation for a man like him to subject 
 so beautiful and pure a woman to such an animal relation as 
 sexual intercourse. ' She is too good for me,' he would say to 
 himself, ' I ought to have married a woman used to this sort of 
 thing, or, better still, have remained single and gone on in the 
 
RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 87 
 
 old way.' This happened several times, and then, in disgust with 
 himself, he paid a visit to one of his former female associates, and 
 in a short time satisfied himself that his powers were as good as 
 ever. Again he essayed the act with his wife, and again he met 
 with disappointment. He had now been married a week, and 
 the marriage was still unconsummated. He then came under 
 my care. A case like his presented very little difficulty. I re- 
 minded him of the fact that in all probability, however pure and 
 noble his wife might be, there was no profanation in sexual in- 
 tercourse, chastely undertaken ; that she had sexual organs 
 which were intended for the performance of certain functions ; 
 that these functions were all connected with the propagation of 
 the human species ; that there was but one way that I knew of 
 by which the species could be propagated ; that she had se- 
 lected him for the one man who was to put her in the way of 
 fulfilling her office in the grand scheme of nature, and that my 
 advice to him was to lower his estimate of her angelic character, 
 and to look upon her in the not less worthy light of a woman to 
 be treated as other women are treated under like circumstances. 
 He left, promising to be less exalted in his appreciation, but the 
 next morning he returned with the information that it was no 
 use : he had tried his best, his erections were strong and re- 
 peated, but as soon as he went further towards the object he 
 had in view his desire became utterly extinguished. * She was 
 too good, too delicate for an animal like him ; he could not 
 desecrate her beautiful body by any such vile act,' etc., etc. 
 
 " From a few words which he let drop, I became convinced 
 that the lady was not so platonic a creature as he thought, and 
 that if I could have a few words of conversation with her, I 
 could probably end the matter to the satisfaction of both parties. 
 I therefore expressed a wish to see his wife, and that afternoon, 
 
88 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 
 
 with his concurrence, called on her at the hotel at which they 
 were stopping during their wedding tour to New York. I found 
 her to be a very sensible woman, not at all ethereal, but anxious 
 to do her share towards relieving her husband from his embar- 
 rassing position, of which she only half comprehended the 
 character. I requested her to be a little more free in her man- 
 ner with her husband than she had yet been, and told her I 
 thought that if she pursued that course there would be no 
 further disappointment, but that she was not to act as though 
 she had received any instruction from me, but rather as though 
 she was disregarding what I had said to her. ^The details, of 
 course, I left to her own good sense and womanly feeling. The 
 plan was eminently successful, as her husband told me with 
 great glee the next day. ' She told me,' he said, 'that she did 
 not want any doctors about her ; that she could settle this af- 
 fair herself.' 'The rest,' he continued, Ss confidential be- 
 tween her and me, but, by heaven, it reminded me of old times ! ' 
 It is scarcely necessary to add that there was no further 
 trouble." 
 
 Another example of the influence of unusual surroundings 
 over the genital functions was furnished me by a medical man 
 who consulted me about his failing virility. He stated that 
 about five years before he had for the first time in his life 
 cohabited successfully. Subsequently he attempted the act in 
 the day time, while dressed, and found himself impotent. 
 Being of a determined disposition, he continued his attempts 
 under the same circumstances, and with the same results. He 
 had no hope of recovery and was completely broken down in 
 mind on account of his repeated failures. On examining his 
 genital organs, I found no sign of abuse or relaxation. He 
 denied all excesses. I ordered him to abstain from any attempt 
 
RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 89 
 
 for some weeks — to travel, and to occupy his mind with other 
 subjects, and I advised him at the end of this probationary- 
 period to marry, as I considered him perfectly competent to 
 indulge his sexual organs in a legitimate manner. He took my 
 advice, married, and found no difficulty in sexual congress. 
 Two months subsequent to his marriage he attempted cohabit- 
 ation with his wife when dressed, and failed as he had in the 
 beginning. This second mishap compelled him again to seek 
 advice. Feeling assured that it was only the difference in 
 surroundings which caused his failure, I told him to dispense 
 with all experiments of the kind mentioned, and only indulge 
 his venereal sense in the seclusion of the chamber, and without 
 the accompaniment of dress. Since he confined himself to this 
 rule, he has had no further trouble. It is extremely probable, 
 however, that he will always be impotent whenever he has his 
 clothes on. 
 
 Grimaud de Caux relates the case of a prominent mathe- 
 matician, who married a lady in every way suited to him. 
 Both were in perfect health, and desired children, yet at every 
 attempt to complete intercourse some abstruse problem would 
 insinuate itself into the mind of the professor and destroy at 
 once all capacity for the performance of the act, and he was 
 compelled to give up the attempt. Again and again the same 
 accident occurred. It seemed utterly impossible for him to 
 control his mind in the matter of mathematical problems, 
 sufficiently long to accomplish anything. The family physician 
 finally counselled him to get partially under the influence of 
 alcohol and then try. He took the advice, and was enabled to 
 reach the desired goal without any further trouble. I recall a 
 somewhat similar case, a young professional man who had been 
 sued for a large sum of money, that had been used by other 
 
 \ 
 
90 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 
 
 people, but for which he was responsible. The thought of his 
 unjust debt entering his mind at the moment that he was 
 attempting intercourse, rendered him completely impotent. 
 And notwithstanding the fact that his erections were perfect, 
 he was by this interruption, this mental perturbation, rendered 
 absolutely impotent until arrangements had been made to 
 remove the debt that troubled him. 
 
 The history of the celebrated quack, Graham, who flourished 
 in London many years ago, shows that the influence of mental 
 emotion on the functions in copulation was well recognized by 
 him. His shrewdness and intuition struck at a most important 
 fact, which the scientific minds of the profession of his day did 
 not grasp. Graham prepared a richly canopied bed, of large 
 dimensions, and with glass legs. He offered the use of this bed 
 to persons suffering from spermatorrhoea and impotence, 
 guaranteeing perfect success in sexual congress to all who 
 made use of it. (Bartholow.) One hundred pounds per night 
 was the price charged for its use. The bed proved a brilliant 
 success and cured many who considered their virility as hope- 
 lessly impaired. 
 
 The mental distress occasioned by a chronic clap, or gleet, is 
 often a cause of impotence. A patient of mine, now under 
 treatment, always fails if he notices the discharge before retiring. 
 Another that I know, is impotent with his own wife, but with 
 strange women has no trouble whatever. Another is impotent, 
 unless he is able by a powerful effort of the imagination to 
 make himself believe that the legal partner of his bed is some 
 one for whom he has a stronger feeling. Here, of course, there 
 must be an entire absence of that magnetic attraction which 
 begets a feeling of desire or attachment and that regard and 
 esteem which render marriage endurable — or an uncontrollably 
 
 / 
 /■ 
 / 
 
RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 91 
 
 aversion, which working together with other causes produces 
 the impotence. 
 
 All physicians who have much experience in the treatment 
 of cases of impotence and spermatorrhoea have long ago recog- 
 nized the fact that a very large majority are entirely of mental 
 origin. No matter what local manifestations of the disease 
 may present themselves to the eye of the physician, there is 
 always an element of mental influence in the development of 
 the impotence which should never be lost sight of. Such cases 
 are by some called false impotence. I can see no reason for 
 such a name. The impotence while it lasts is real — and it 
 often lasts months and years, and indeed may last during a 
 lifetime, if not properly treated. And if the cause of it is not 
 removed, it certainly will last a lifetime. A division might be 
 made by classing them as incurable and curable cases. And it 
 must be borne in mind that almost all of the cases can be cured. 
 
 Where the disturbed mentality is a cause of impotence, 
 every abnormal or even normal discharge is magnified a hun- 
 dred-fold. The disturbed and distorted mental condition reacts 
 on the genitals, interfering with their proper blood-supply, 
 diminishes the nerve force, and brings into being phases of 
 genital weakness. The nocturnal as well as the diurnal emissions 
 are increased, and all the mental depression which accompanies 
 them. Indeed, were it not for the disturbed mentality which 
 these disorders of the genital function excite, physicians would 
 have little to do in the way of treatment. The mental dis- 
 order is the great obstacle to successful treatment. And though 
 the patient may be aware that his disease is imaginary, he 
 cannot regulate or command his ideas in the matter, cannot 
 bring himself to a reasonable state of mind, no matter what 
 advice he receives, until he perceives some diminution in the 
 local trouble, procured by therapeutic measures. 
 
CHAPTER VI. 
 
 DISEASES WHICH RESULT FROM EXCESS AND MASTURBATION. 
 
 Deterioration of the Seminal fluid as Cause of Pulmonary Consumption — 
 Changes in the Characters of the Secretions — Hereditary Weakness — 
 Why Phthisis develops as a direct result of Masturbation — Phthisis among 
 young Married Persons — Erotic desires of Consumptive Patients — Epilepsy 
 — Connection of Epilepsy with Onanism — Changes in the Nerve Centers 
 as a Result of the Disease — Convulsive Seizures during the Orgasm — 
 The Center of Sensation and Voluntary Motion — Irritation of the Tuber 
 Annulare causes Convulsions — Termination of Epilepsy or Insanity — Is 
 Insanity caused by Sexual Excess and Masturbation — Opinions of 
 Various Authorities — Peculiar forms of Insanity arising from these 
 Causes — Nymphomania and its causes — Characteristic Cases — Marriage 
 and Amputation of the Clitoris as a Cure for the Disease — Satyriasis — 
 Curious manifestations of Satyriasis — Aspermatism — Sterility. 
 
 *' The sins of the father shall be visited on the children, even 
 unto the third and fourth generation." Nowhere in the cate- 
 gory of disease is the truth of this saying so manifest as in the 
 case of masturbators. The evil that they do lives long after 
 them. Their vicious habits, continued as they are through the 
 period when nature is endeavoring to create a vigorous condition 
 which will resist the wear and tear of active adult life, leave an 
 indelible impress on the , whole structure. All the tissues and 
 secretions of the body are affected, and the seminal fluid par- 
 takes of the general deterioration. It is thinner, more watery, 
 of a pale yellowish white color, and contains fewer spermatozoa 
 than it does in a healthy condition. The movements of the 
 spermatozoa as seen under the microscope seem to have much 
 less activity than the spermatozoa from a healthy, vigorous 
 
DISEASES FROM EXCESS AND MASTURBATION. 93 
 
 man. Pus and epithelial cells are likewise present in variable 
 quantities. This defective seminal fluid is sure to give to the 
 foetus the seeds of weakness and decay which are ready to 
 germinate with the first exciting cause. There is no more 
 potent factor in the development of disease. The child of 
 masturbating parents enters the world with vitality so impaired 
 that there is a constant invitation to the a^ttacks of every affec- 
 tion. The child commences life with a highly organized 
 nervous system, morbidly sensitive to every external impression. 
 The muscular and osseous tissues are much softer than they 
 are normally. I have never yet seen a case of rickets in a^ 
 child whose parents did not give some voluntary or involuntary 
 evidence of a pernicious habit, or of sexual excess of some 
 description. 
 
 The digestive and assimilating organs work feebly, little 
 nourishment is taken into the stomach and a portion of that 
 which enters that organ passes unchanged through the 
 alimentary canal. Dyspeptic symptoms of all kinds are com- 
 monly present. The integument is thin and pale, and the deli- 
 cate blue veins are easily traced through its transparent surface. 
 The lymphatic glands are enlarged and liable to suppurative 
 inflammation. The child frets and worries, is generally peevish, 
 complains of headache and grows up thin, puny and weak with 
 all the tendencies which are said to characterize a scrofulous 
 diathesis. 
 
 Many cases of pulmonary consumption are directly traceable 
 to the secret sin of the father. It is not so easy to detect the 
 mother's share in the results, for the simple reasons that she 
 cannot be questioned about the matter at all, and because many 
 of the appearances which are found connected with old habits of 
 masturbation are also seen in various forms of uterine disease. 
 
94 DISEASES FROM EXCESS AND MASTURBATlOi^. 
 
 An examination of the labia and vagina of the mother 
 when it can be obtained without exciting her suspicions will 
 often show the changes due to excessive friction and pulling, 
 and establish the amount of responsibility that rests on her 
 shoulders for the existence of the disease in the child. I have 
 for many years made it a practice to get at the history of the 
 parents of consumptive children and my examinations so in- 
 variably confirm my suspicions that I have now no doubt what- 
 ever of the direct relation between masturbation and hereditary 
 phthisis. I know that others in active practice have examined 
 and treated such cases and have been able also to trace the lung 
 disease to its legitimate origin. But though consumption re- 
 sults from the transmitted weakness descending from parent to 
 child, it is also developed directly in young men and women 
 from long continued masturbation as well as from sexual excess. 
 This fact was first brought prominently before my mind by an 
 examination of fourteen young patients suffering from phthisis 
 in Charity Hospital. Only two gave a positive history of 
 hereditary predisposition to the disease. Ten of the number 
 acknowledged that they had been addicted to onanism in their 
 childhood and had practiced it for years. It was of course im- 
 possible to learn anything of the character or habits of the 
 parents of these hospital patients, for they were not present to 
 be examined, and it is possible that the tendency might be 
 transmitted. Since that experience, however, I have repeatedly 
 put the question to other sufferers and have accumulated con- 
 vincing evidence on the point. I am repeating nothing new 
 when I say that those whose nutrition is poor and below par 
 are peculiarly liable to attacks of phthisis. One of the effects 
 of excessive indulgence is a disarrangement, or, rather, an ex- 
 haustion of the nervous system or of the nervous force, from 
 
Diseases froM excess and MAstukBAxioJt. 9^ 
 
 the successive shocks of the orgasm. Then follow indigestion, 
 constipation, (which is only a result of indigestion) and 
 lassitude, all tending to impoverish the blood, and the road is 
 thus opened for the first bad cold to set up chronic inflammation 
 in the lungs, or other forms of pulmonary consumption. 
 
 The erotic tendency of consumptives has been the subject 
 of remark by many different authorities. It is mentioned as a 
 peculiar phenomenon connected with or caused by the disease. 
 The truth is, however, that the erotic tendencies antedate the 
 phthisis. They are the direct result of excess, sexual or other- 
 wise, and are not the result of the destructive processes at 
 work on the lung. Phthisis is the legitimate effect of 
 ignorant assaults on the genital organs, carried on through that 
 part of the lifetime when the active forces should have been 
 devoted to the protection and the development of the rapidly 
 growing tissues. Gall relates the case of a consumptive who 
 exhibited this tendency in its worst aspects. The patient was 
 a married lady who had been the victim of untrammeled de- 
 sires. She developed phthisis at thirty and the disease ran a 
 rapid course towards a fatal termination. She nevertheless 
 curtailed none of her sexual enjoyments. Indeed they seemed 
 to grow with the disease, until they became her sole thought 
 and care. A day or two before her death while lying in a mori- 
 bund condition, unable to move and not able to speak above a 
 whisper, with every mark of rapid dissolution about her, she 
 importuned her husband to engage again in sexual congress 
 with her. The case is a painful but not an uncommon one. 
 
 Professor James R. Leaming of this city thinks " that phth- 
 isis, especially of the fibroid variety, is induced by any cause 
 which lowers the vitality of the life of the body, expressed in 
 the ganglionic system of nerves, and in the blood. Over 
 
9^ DISEASES FROM EXCESS AND MASTURBATION. 
 
 sexual indulgence and onanism certainly lower the vitality 
 greatly and are the more frequent causes of commencing phthisis- 
 plastic interpleural exudation in quite young men and women." 
 Excessive sexual indulgence often brings about similar 
 affections of the lungs, but such cases cannot be traced as 
 readily as those arising from masturbation. Many of the cases 
 of phthisis occurring among young married people during the 
 first year of their new life, are attributable to excessive cohabi- 
 tation. Certainly they are frequent enough to give strong pre- 
 sumptive evidence that some form of excess is the primal cause 
 of the mischief, or at least that some hereditary weakness has 
 been assisted by their own over indulgence. Here again is 
 another result of ignorance concerning the sexual function, and 
 its ultimate purposes in the economy of nature. It is reasonable 
 to suppose that even a very moderate amount of information 
 concerning the use and abuse of the genitals — even less than 
 advised in a previous chapter, would diminish the number of 
 these distressing cases in every community. 
 
 EPILEPSY. 
 
 It was noticed many years ago, that patients suffering from 
 epilepsy were in the habit of gratifying the venereal sense in 
 many curious ways. Their erotic tendencies were developed 
 without regard to time, place or circumstances. And it was 
 believed that epilepsy, or the same lesions in the nerve centers 
 which produced epilepsy, were the prime factors in disordering 
 the sexual functions. Further investigation, however, showed 
 that the sexual vagaries of the patient existed long befoie con- 
 vulsions appeared, preceding them by many years, and that the 
 epilepsy of such patients was due to over-excitation of the 
 
DISEASES FROM EXCESS AND MASTURBATION. 97 
 
 nervous system by the secret vice. Of this there can be no 
 doubt. The irritability of the nerve centers is remarkably 
 increased in all onanists. Specially is this true of that portion 
 of the brain known as the ticber aiinulare^ a collection of gray 
 matter in the pons varolii. This point is the great center which 
 governs sensation and voluntary motion. Longet says that all 
 sensations coming from the periphery to the brain, are con- 
 verted into motor impulses through this ganglion. And any 
 undue irritation of the part will excite irregular muscular 
 movements. 
 
 The abnormal excitability of the medulla oblongata, which 
 also arises from the secret habit, is said to be an important 
 factor in producing these convulsions. Hammond considers 
 that all forms of eclampsia arise from abnormal irritability of 
 this portion of the nervous system. Wherever the actual start- 
 ing point of the convulsions may be, one thing is certain, viz., 
 the condition of the nervous system is such that slight irrita- 
 tion from within or without may develop involuntary spas- 
 modic contractions of the muscles ordinarily under the con- 
 trol of the will. Dr. Baker, of the Cambridgeshire Asylum, 
 says, "in seven out of ten cases of chronic epilepsy in the 
 male sex, the genital organs are the great sources of excitation, 
 and generally from the morbid state in which they are kept by 
 the habits of the patient." Dr. Flint relates the case of a 
 young lady twenty years of age who suffered from daily epi- 
 leptic fits for three years. She stated that the habit of mas- 
 turbation was taught her at the age of six, and had been 
 indulged in daily until she was sixteen. Afterwards her mind 
 was constantly filled with lascivious dreams, and during the 
 three years of her epilepsy lascivious dreams attended by an 
 orgasm had occurred every night. Baker Brown, of London, 
 7 
 
98 DISEASES FROM EXCESS AND MASTURBATION. 
 
 attributed the cause of epilepsy in young females to the same 
 cause, and partially proved his theory by amputating the cli- 
 toris of each case coming under his care. The operation was 
 remarkably successful, a large majority of his patients making 
 a complete recovery after the operation. Some years ago I 
 had an epileptic masturbator under treatment in Charity 
 Hospital. He foiled every attempt made to prevent him from 
 masturbating. The penis and scrotum were blistered, so that 
 he could not touch them, but he still managed to complete the 
 act by rubbing the perineum with his fingers. His hands were 
 tied behind his back, but this also was unsuccessful, for the 
 next day he was seen to slide down to the foot of the bed, and 
 rub his perineum against the foot piece. He was finally tied 
 hand and foot to the bed, so that he could not move a muscle. 
 This plan of course could not be continued, and whenever he 
 was released in order to change the bed clothes, or to perform 
 some other necessary duty, his hands almost instantly sought 
 the neighborhood of his genital organs. He was. sent subse- 
 quently to an asylum as incurable. 
 
 Serrurier reports an interesting but equally painful case, viz., 
 that of a soldier who was the subject of convulsions from sex- 
 ual indulgence and masturbation. In the midst of his most 
 violent paroxysms he endeavored to excite himself and pro- 
 duce an orgasm. This condition lasted six months, when 
 death released him from his sufferings. Zimmerman speaks of 
 a patient under his care who endured an epileptic convulsion 
 whenever he masturbated, or had nocturnal pollutions. Every 
 emission, irrespective of its cause, was invariably accom- 
 panied or followed by a convulsion. Esquirol mentions the 
 case of a young woman of an ardent temperament who became 
 epileptic three days after marriage. It was supposed by her 
 
DISEASES FROM EXCESS AND MASTURBATION. 99 
 
 physician to be a direct result of inordinate indulgence in 
 sexual congress. 
 
 Occurrences like these quoted are numerous. Hospital records 
 are full of them, and they are not exceptional cases either, se- 
 lected to prove a theory for the satisfaction of the originator 
 They make up a very large number of the epileptics in all the 
 hospitals where such cases receive special care and medical 
 supervision. They prove that epilepsy is one of the goals towards 
 which all masturbators and libertines are hastening, and one 
 which is reached in a very short space of time, when the will 
 power to prevent excess is weakened or destroyed. 
 
 CHANGES IN THE CIRCULATORY SYSTEM FROM ONANISM AND 
 SEXUAL EXCESS. 
 
 I have already mentioned that dilatation of the superficial 
 veins of the extremities is a sequence of long indulgence in 
 masturbation and excessive sexual congress. Preceding and 
 during the orgasm the respiratory movements are spasmodic 
 and irregular, and for a moment are completely suppressed. 
 The consequence of this is an obstruction to the current of 
 blood flowing towards the thoracic cavity, and a greater gene- 
 ral fullness of the veins of the extremities. Such repeated dis- 
 tension of the veins as occurs from frequent pollutions becomes 
 more and more marked until the relaxed and venous walls 
 become permanently dilated. The same effect is produced in 
 old age from natural causes, and also from cardiac lesions. 
 
 But it is not the superficial veins only which are thus 
 affected- The right side of the heart likewise takes part in 
 the morbid process. The dilatation may involve the right 
 auricle, and the ventricle of the same side, but generally the 
 auricle alone is affected. The dilatation is soon followed by 
 
lOO DISEASES FROM EXCESS AND MASTURBATION. 
 
 hypertrophy. It has long been remarked that roosters who 
 controlled the barnyard are subject to enlarged heart. The 
 enlargement has a similar origin to that which occurs in man, 
 over action of the heart in sexual intercourse. For like every 
 muscular organ in the body which is called upon to do extra 
 work, it must increase in size. 
 
 Palpitation of the heart is a troublesome symptom in these 
 cases. It must be borne in mind, however, that palpitation may 
 be due to simple weakness and nervous prostration, in the same 
 class of patients. Slight exercise occasions much shortness of 
 breath. Capillary congestion of the extremities especially is 
 well marked. The hands are cold and blue, and the pressure 
 of the fingers on the integument leaves a white mark surrounded 
 by a dark ring which disappears slowly. Acton says : " I have 
 seldom met an instance of sexual excess in which com- 
 plaint of the heart's action has not been made. Patients as- 
 sert that they can make no exertion without suffering under 
 palpitation. In order to satisfy myself that these affections of 
 the heart were not organic, I have met in consultation most of 
 the ablest men in London, and we have come to the conclusion 
 that these patients are suffering from functional disease of the 
 heart, and consequently the prognosis becomes much less 
 serious, provided, as I stated in the preceding, the patients will 
 forego these excesses, and treatment is prescribed calculated to 
 enable them to gain mastery for their will and to exert self 
 control." 
 
 Vertigo is likewise a common symptom. I have noticed 
 frequently that the patients subject to vertigo were also 
 troubled with fainting spells. Females are more liable than 
 males to be affected by syncope. Anemia of the brain from 
 weakened action of the heart may cause both syncope and 
 
DISEASES FROM EXCESS AND MASTURBATION. lOI 
 
 vertigo. (See page 174). Vertigo, however, often arises from 
 other conditions such as an afflux of blood to the brain, and 
 irregular circulation of blood in the cerebral hemispheres. 
 
 PATHOPHOBIA 
 
 Or hypochondriasis, is associated with disorders of digestion 
 in many diseases. Its development, as a result of masturbation 
 or sexual excess, is usually co-incident with stomach and in- 
 testinal troubles, occasioned by the disturbance of the sexual 
 * function. It is rarely absent when the patient has reached 
 middle life. The awakening from a self-complacent course 
 of sexual enjoyment, is the beginning of the pathophobia. 
 Nocturnal pollutions and impotence add to the gloom, and 
 suicide often terminates the wretched victim's misfortune. 
 Even in mild cases of pathophobia, the patient imagines that 
 his disease will certainly terminate in complete destruction of 
 mind and body. He shuns his friends and avoids society. 
 He distrusts those whose honesty and truth he formerly relied 
 on. Business troubles, however slight, haunt his vision sleep- 
 ing or waking. A dread of accident or sudden death adds to 
 his misery. Every little ache or pain is magnified into a fatal 
 affection. He torments his physician with notes of inquiry 
 and visits (Flint). To-day he fears consumption, and his 
 lungs must be examined ; to-morrow he is certain of heart dis- 
 ease, and dissolution is imminent. A headache satisfies him that 
 cerebral inflammation or apoplexy has commenced. The stiff- 
 joint of rheumatism is all the proof he requires that the use- 
 fulness of the limb is forever destroyed. In short, he makes 
 day night, sunshine darkness, and gladness sorrow. There is 
 no light anywhere. The gloom of the grave is over him. 
 And unless relief should come in the shape of judicious advice. 
 
I02 DISEASES FROM EXCESS AND MASTURBATION. 
 
 or systematic treatment, insanity or suicide will terminate his 
 affection. 
 
 INSANITY 
 
 Often follows epilepsy and pathophobia as a result of abuses 
 of the sexual organs. The former is more likely to terminate 
 in insanity than is the latter. Insanity, however, is liable to 
 occur, as a direct result of onanism or sexual excess, without 
 the development of either of the above mentioned affections. 
 Authorities differ as to the percentage of cases of insanity 
 arising from self-abuse. The principal authorities on the 
 subject say that ten per cent, of all cases of insanity are 
 traceable to masturbation and sexual excess. Deslandes 
 states that of two hundred and fifty-six individuals in the 
 asylum for the insane at Charenton, forty-four men and three 
 women owed their diseased mentality to the same source. 
 This statement would indicate that males are affected much 
 oftener than females. But it must be remembered that it is 
 more difficult to obtain a history of self-pollution from the 
 latter than from the former. Much is hidden from the eye of 
 the physician, consequently many cases of feminine insanity 
 due to the secret vice pass through without diagnosis, and are 
 then classed under a different head. Bourgeous, however, errs 
 on the other side. He says that the insane at La Saltpetriere 
 consist of prostitutes whose insanity originated in debauchery. 
 He does not consider that any other elements might enter 
 into the development of the disease. A few, at least, of these 
 unfortunates must have had remembrances of a nobler and 
 purer life. In their better moments the utter hopelessnesss of 
 their condition must impress them. They feel then that they 
 are forever shut out from home, friends and society, and that 
 they are outcasts in every sense of the word. Despair and 
 
DISEASES FROM EXCESS AND MASTURBATION. 103 
 
 mental anxiety must then be counted as factors in some of 
 these cases at La Saltpetriere. Then, again, the effect of al- 
 cohol must be taken into account. All these unfortunates are 
 addicted to the alcohol habit, and of course must suffer from 
 all the mental and physical derangements consequent upon that 
 habit. 
 
 Insanity among masturbators is more apt to develop in those 
 whose intellectual capacity is below the average, and in cases 
 where loss of memory occurs as a prominent feature in the early 
 stages of the vice. Persistent loss of memory is always a 
 precursor of serious mental disease. Maudsley says, " Self- 
 abuse is the cause of a particularly disagreeable form of insanity 
 characterized by intense self-feeling and conceit, and profound 
 moral disturbance in the early stage, and later by failure of 
 intelligence, nocturnal hallucinations and suicidal or homicidal 
 propensities." Dr. Ritchie says that these cases chiefly occur in 
 members of families of strictly religious education, and those 
 who from this cause become insane have generally, to all ap- 
 pearance, been of strictly moral life and recognized as persons 
 who paid much attention to the forms of religion. As will be 
 afterwards more fully stated, it is frequently observed, especially 
 in the acute attacks resulting from this cause, that religion 
 forms a noted subject of conversation or delusion. "The 
 parent, after her son (the only child it may be) is taken to an 
 asylum will tell you that his insanity cannot be accounted for. 
 He has been so well conducted, so quiet and studious, not 
 seeking the company of the gay, the idle and the thoughtless, 
 but remaining quietly at home rather than joining the social 
 amusements of those of his own age. Further inquiry may 
 elicit that he has been of good abilities, and it may be, clever 
 in his occupation, that he had few friends and rather shunned 
 
I04 DISEASES FROM EXCESS AND MASTURBATION. 
 
 « 
 
 the society of the other sex. Had he been other than he was, 
 some cause might have been found in the irregularities of life 
 to cause insanity in one scarcely beyond boyhood's years ; but 
 in such a quiet lad, and so carefully brought up, she is unable 
 to suppose a cause. Then she may tell you that for some time 
 past a gradual alteration has been going on ; he has changed 
 not only in manner but in appearance ; he has become so 
 peevish and irritable, so reserved in his conversation, so apathetic 
 in manner, so slovenly in dress, so contradictory, and so un- 
 certain in his actions, so hesitating, first determining on one 
 thing and before he could execute the course determined on 
 changing to some other, and has such a want of self-reliance. 
 That quite recently, he has grown more and more apathetic, 
 more slovenly in dress, paying less attention to cleanliness, and 
 become slower in his actions ; that he is now not only irritable 
 in his temper, but is at times violent ; that he does things by 
 fits and starts, is impulsive, deliberating long and then suddenly 
 hastens apparently to carry out his intention, and has become 
 so stupid looking and lost, and incapable of taking care of 
 himself or his business, and all this has occurred without any 
 apparent cause, except it may be his studious habits. At last 
 he can be borne with no longer, he is unmanageable in a 
 private house and is obliged to be removed from his home." 
 
 " On entering an asylum for the insane, especially if it be 
 one receiving patients from the middle as well as from the 
 lower class of society, there is one group of inmates which 
 may arrest the attention of the visitor from the contrast pre- 
 sented to the excited persons around him, on the one hand, 
 and to those who are convalescent on the other. Engaged in 
 no social diversion, the patients of this group live alone in the 
 midst of many. In their exercises, they choose the quietest 
 
DISEASES FROM EXCESS AND MASTURBATION. 105 
 
 and most unfrequented parts of the tiring grounds. They join 
 in no social conversation, nor enter with others into any amuse- 
 ment. They walk alone, or they sit alone. If engaged in read- 
 ing, they talk not to others of what they may have read ; their 
 desire, apparently, in the midst of numbers, to be in soHtude. 
 They seek no social joys, nor is any wish for fellowship 
 evinced. 
 
 " The pale complexion, the emaciated form, the slouching 
 gait, the clammy palm, the glassy or leaden eye, and the 
 averted gaze indicate the lunatic victim to this vice. 
 
 " Apathy, loss of memory, abeyance of concentrative power 
 and manifestation of mind generally, combined with loss of 
 self-reliance and an indisposition for or impulsiveness of action, 
 irritability of temper, and incoherence of language are the 
 most characteristic mental phenomena of chronic dementia re- 
 sulting from masturbation in young men. 
 
 " As in diseases of an exhaustive nature, we find that the 
 cutaneous secretion is poured forth abundantly, so in the 
 cases occupying our attention the perspiration breaks forth on 
 the slightest exertion. This relaxed condition of the perspira- 
 tory system is especially marked in the palms, and the exception 
 is to find these dry on a masturbator, for generally a damp, cold 
 clammy perspiration is constantly present, and makes it par- 
 ticularly disagreeable to take the hands of one of these persons. 
 The sub-tegumentary layer is but sparingly supplied with fat, 
 which is remarkable, considering the little exercise these pa- 
 tients, if left to their own guidance, would take. 
 
 ^* In acute or recent dementia, the condition of the patient 
 is most pitiable. His existence is, for a time, merely vegetative, 
 and in well marked cases the obstinacy of disposition is almost 
 the only indication of mental action, and the mental origin 
 
Io6 DISEASES FROM EXCESS AND MASTURBATION. 
 
 of those may be denied. The sufferer becomes quite silent, 
 and is lost and unable to take care of himself. He be- 
 comes statuesque, and extremely obstinate. He resists pas- 
 sively, and occasionally actively. If he be in bed, he will not 
 rise to be washed or dressed. If up, he will not retire at 
 proper time to bed, or allow himself to be undressed. Every- 
 thing requires to be done for him. Cleanliness is neglected, and 
 his dress unattended to. He makes no effort to speak, and, 
 when addressed, although conscious, does not appear to com- 
 prehend what is said. He will not feed himself. Ellis says : 
 * Would that I could take its melancholy victims with me in 
 my daily rounds (at Hanwell Asylum) and could point out to 
 them the awful consequences which they do but little suspect 
 to be the result of its indulgence. I could show them those 
 gifted by nature with high talents, and fitted to be an ornament 
 and a benefit to society, sink into such a state of physical and 
 moral degradation as wrings the heart to witness, and still pre- 
 serving, with the last remnant of mind gradually sinking into 
 fatuity, the consciousness that their hopeless wretchedness is the 
 just reward for their own misconduct.' " 
 
 With regard to the tendency to commit suicide, Dr. Ritchie 
 says : " The greater frequency of this occurs in those whose 
 cases assume a melancholic character with the excitement. 
 Although it will be found that various supposed causes may be 
 alleged, still I believe that in the greater proportion of such 
 cases the immediate exciting cause is the feeling of distrust at, 
 combined with alarm for, the consequences of the patient's 
 criminal conduct. Hence it is that feelings of their own un- 
 worthiness arise in such patients, and under the impression 
 that they have committed the unpardonable sin, have sinned 
 against the Holy Ghost, and that a future world presents no 
 
DISEASES PROM EXCESS AND MASTURBATION. 107 
 
 hope of joy or happiness for them, as they are excluded from 
 it by their own conduct, they frequently make attempts to ter- 
 minate their own existence. Such an act is occasionally in- 
 cited by hallucinations of the aural organs, but I have not 
 found that suicide is so frequently to be traced to this as in 
 other cases of mental aberration depending on other causes." 
 
 Acton says : " In some patients, rash and even criminal acts are 
 the result of the idea that an atonement may thereby be made 
 for the sin committed. The attempt to injure the genitals and 
 similar extravagances often, I believe, arise from such insane 
 fancy while, on the other hand, extravagant masturbation or the 
 tendency to commit rapes or unnatural crimes may be in some 
 cases traced to the not less insane desire the sufferer feels to 
 test and to prove to himself or others that he is not im- 
 potent." Acton thinks that many of the cases of sexual insanity 
 may be cured by appropriate treatment. Dr. Ritchie and other 
 authorities give an unfavorable prognosis in all cases. From 
 my own investigations I am strongly of the opinion that a per- 
 fect cure is impossible, and that when there is an apparent 
 amelioration of the symptoms, lasting perhaps long enough to 
 buoy the hopes of those related to them, they suddenly return 
 to their old condition of hopeless dementia. The cases of 
 sexual insanity that have come under my own observation 
 have been most difficult to manage. The patients usually have 
 lost all moral sense. Their will power has succumbed to the 
 most brutal instincts. The drain on their nervous system is 
 kept up by nocturnal pollutions. They are consequently not 
 amenable to the usual methods of treatment pursued in other 
 forms of the same disease. 
 
 Dr. A. E. McDonald says : " In a general way, I may say 
 that the two causes of insanity named are much less potent (in 
 
lo8 DISEASES FROM EXCESS AND MASTURBATIO!^. 
 
 my experience) than they get credit for. They are far oftener 
 effects, than causes of the insanity. 
 
 " When they are undoubtedly the causes, the insanity resulting 
 (generally Primary Dementia in the case of onanism, and Gen- 
 eral Paresis in the case of sexual excess) is usually incurable 
 under any known system of treatment." 
 
 In reference to the same point, Dr. E. C. Spitzka says : 
 *' Where masturbation is a pronounced feature some writers use 
 the designation ' insanity of masturbation.' In reality the mas- 
 turbation, although a frequent accompaniment, and perhaps a 
 result of hebephrenia, is not its cause, however much this habit 
 may ultimately modify the character of the psychosis. 
 
 " The claim that there is a constant relation of sexual 
 excesses to the development of paretic dementia, as pri- 
 mary causes, contradicted as it has been by high authority, is 
 not supported by these figures. No one will claim that the 
 Anglo-Saxon is more libidinous or less able to endure indul- 
 gences than the other races. If any reflection were to be cast 
 on any race in this respect, it would be the negro race — which 
 shows the least percentage of paretic dementia — to which a li- 
 bidinous character might be assigned. AVhen it is borne in 
 mind, too, that where the negro lives under conditions natural to 
 him, and where he is not compelled to enter into competition 
 with a higher race, paretic dementia is almost unknown.'* 
 
 NYMPHOMANIA, 
 
 Sometimes called furor uterinus, is a disease peculiar to fe- 
 males. It often arises from masturbation, or excessive sexual 
 indulgence. It has also been known to occur from the sudden 
 cessation of such pleasures. Sometimes it manifests itself in 
 healthy young women who have never masturbated, and who 
 
DISEASES FROM EXCESS AND MASTURBATION. I09 
 
 are innocent of any practical knowledge of the sexual relations. 
 Such persons are naturally passionate, and their unsatisfied de- 
 sires, their continence, is the real exciting cause of the affec- 
 tion. 
 
 Nymphomania is apt to occur between the ages of sixteen 
 and twenty-five. Blondes are more frequently subject to it than 
 brunettes. It is characterized by an uncontrollable appetite for 
 lascivious pleasures, exhibited (in its worst forms) in public and 
 private, without regard to time, place, or surroundings. In m.ld 
 cases the patient is nervous, easily excited, subject to hysterical 
 attacks, and is constantly exciting herself in various ways to 
 provoke an orgasm. The mind is full of lascivious ideas which 
 find vent in self-pollution. While there is any modesty left, the 
 patient -deceives every one with regard to the true state of her 
 feelings. She will invent numberless diseases to account for 
 her condition, and for the purpose of being manipulated by the 
 surgeon. Every disease that necessitates an examination of the 
 genitals will in turn be taken up. A curious instance of this 
 nature occurred in my wards, while House Physician in Belle- 
 vue Hospital. A girl aged eighteen was admitted, supposed to 
 be suffering from retention of urine. She was thin, her eyes 
 were deep-set, but bright and staring, and were often filled with 
 tears. Her statement was to the effect that she had passed no 
 water in three days ; that she was subject to these attacks, and 
 was treated by having her water drawn off. I introduced the 
 catheter and found only a few ounces of urine in her bladder, 
 not enough, indeed, to corroborate her history. The next morn- 
 ing, as she had not urinated during the night, I drew off the 
 urine again. While doing so I noticed by a series of peculiar 
 convulsive movements, that she was under the influence of strong 
 excitement. A further examination showed that the labia minora. 
 
tlO DISEASES FROM EXCESS AND MASTURBATION. 
 
 clitoris, and adjacent parts were red and swollen, and bathed in 
 a profuse mucous secretion. I then remembered that on the 
 previous evening she had shown a somewhat similar state of ex- 
 citement, and gave the nurse orders to watch her closely all 
 day. In the evening the nurse informed me that the patient 
 kept up a constant friction of the genitals, when she supposed 
 no one was watching. And even when eyes were on her, en- 
 deavored, by uneasy movements in the bed, to continue the 
 titillation. Knowing, then, what I had to deal with, the pa- 
 tient was given a sedative, and told that she must empty her 
 bladder without assistance. For thirty-six hours subsequently 
 she obstinately insisted on her inability to urinate ; but when 
 she was assured no catheter would be employed again, there 
 was no further retention. Soon after she left the hospital I 
 learned that a friend of mine, a physician, was treating her for 
 uterine disorder ; but he, too, soon found out the true nature 
 of the case, and advised her to get married. What afterwards 
 became of her I do not know. 
 
 Winslow gives an example of the worst form of nymphoma- 
 nia, in the following case : The patient was highly educated, 
 of good family, and with everything about her to make her con- 
 tented and happy. Unfortunately she learned to masturbate. 
 The habit took complete possession of her. At the age of 
 eighteen she threw off all disguise, and masturbated, morning, 
 noon and night. No circumstance prevented her. And even 
 when placed in charge of attendants, and unable to employ her 
 hands, she indulged in the vilest language and filthiest ges- 
 tures to all who came near her. Finally she became a raving 
 maniac, and was sent to an asylum, where death soon released 
 her from her terrible sufferings. 
 
 The only cure for the affection is marriage, or amputation 
 
DISEASES FROM EXCESS AND MASTURBATION. ill 
 
 of the clitoris, according to the plan recommended by Baker 
 Brown, who has reported numerous cures by the operation. 
 In this connection it may be well to mention that Dr. Brown 
 incurred the enmity of his professional brethren for a too 
 free use of the operation in this as well as allied affections, 
 and was, I think, compelled to leave some of the London 
 medical societies, of which he was a prominent member. 
 
 SATYRIASIS 
 
 Is an affection of the male, corresponding, in all its essential 
 features, to nymphomania. It is a rarer form of disease than 
 nymphomania, because the man can gratify his venereal sense 
 with impunity, while a woman is put under a ban, and com- 
 pelled to suppress her passions regardless of consequences to 
 her nervous system. Satyriasis is not so often found among 
 young men as nymphomania is among young women. It is 
 more apt to occur in advanced years. The disease may arise 
 from onanism, excessive sexual intercourse, cerebral affections, 
 or the administration of poisonous doses of cantharides. Oc- 
 casionally, continence is a cause of the disease. The case 
 of Blandet is a good illustration of abstinence from sexual con- 
 gress producing satyriasis. He was a missionary, earnest and 
 full of zeal. His nature was intensely passionate, but he nev- 
 ertheless kept himself free from every sexual vice. Finally, 
 unable to endure the sight of the opposite sex without intense 
 excitement, he secluded himself far from them. But absence 
 only fanned the flame until he became satyriasic to an extraor- 
 dinary degree. He was only cured by indulging his passion in 
 a natural manner. Acton relates the case of a man advanced 
 in years who was so much affected by the disease that he mas- 
 turbated whenever females were in his society. The same au- 
 
112 DISEASES FROM EXCESS AND MASTURBATIOM. 
 
 thor graphically describes another case : " He was young and 
 in good circumstances, but was habitually untidy about his head 
 and hair. His face was flushed, the cheeks and nose especially. 
 His eyes were hollow, and had a haggard expression. The lips 
 were thick and sensuous, the mouth wide. He was short and 
 thick-set, and of a full habit of body. I never saw a case in 
 which the animal was so prominent, although his intellect had 
 not been altogether neglected. I learned that early in life he 
 had masturbated himself, but had left off the practice only to 
 commit excesses with women, of a nature and extent that were 
 shocking to hear of." 
 
 Dr. Hammond relates the following : " This man has a wife 
 and several beautiful children, and within the sanctity 
 of his home, where he is always to be found during the even- 
 ing, his precept and example are so noble and pure and good, 
 that his influence is felt and praised by all of his many friends 
 and admirers. But at stated periods, away from home, he is a 
 holy terror to the biblical standard of those who have the 
 promise of seeing God, an angel of mercy to the fast women 
 whom he patronizes, and an insoluble enigma to all mankind. 
 He has never been known to cohabit with a lewd woman, or to 
 speak an immodest word ; but he is a liberal customer of cer- 
 tain houses of ill repute. His custom is to go early in the 
 afternoon, select two or three of the largest girls in the house, 
 and repair to a private room and lock the door. Here he 
 divests himself of every stitch of clothing from the waist up- 
 wards, but never removes his trowsers or boots. Then, lying 
 prostrate on the floor, with his arms lightly crossed over the 
 abdomen and his hands tightly closed, he commands his com- 
 panions to walk over his naked chest, neck and face, taking 
 care to stop at each step to grind his flesh with the heels of 
 
DISEASES FROM EXCESS AND MASTURBATION. 11;^ 
 
 their boots. After this process has continued for some time, 
 he begins to buy the wine for the girls to drink but religiously 
 abstains from taking a drop himself. 
 
 " About the only noticeable interest he takes in the proceed- 
 ings is an occasional demand for a heavier girl, or for some 
 means by which they can increase the severity of the punish- 
 ment. The tramping process goes on uninterruptedly for two 
 or three hours, at the end of which time he will have ordered a 
 dozen more bottles of wine, besides paying the fair trampers 
 handsomely for their time and trouble. 
 
 ** One of his diversions is to make one of the girls stand on 
 his chest with her entire weight on one boot-heel, and have the 
 other girls spin her around till his flesh is torn and bleeding. 
 He will also frequently direct a girl to place one foot across 
 liis eyes, with the boot-heel resting in one orbit and the other 
 foot resting across his throat. He will keep her in this position 
 for five or ten minutes, thus sustaining a weight of one hundred 
 and fifty pounds or more. It would be impossible to mention 
 all the means of torture that this man has invented and sub- 
 mitted to, but I merely mention these few facts as being sam- 
 ples of dozens which I have heard of. At the conclusion of one of 
 these matinees, our hero puts himself through a course of rub- 
 bing his injured spots with his naked hands ; and a very strange 
 part of the story is the fact that by this simple process his 
 bruises, scars, and ecchymoses will almost entirely disappear 
 within a very few minutes. Having thus rubbed himself back to a 
 state of presentability, he resumes his clothing, pays his bill, 
 and takes himself off to the marts of trade, but only to return 
 and repeat the strange entertainment in about a week." 
 
 "Another case, was a young man, a cigar dealer of this city, 
 who from a very early period of his life had contracted the 
 8 
 
ti4 tilSEASES FROM EXCESS AND MASTURBATION. 
 
 habit of introducing substances into the anus for the purpose 
 of having sexual pleasure. He had been led to the practice 
 by seeing, while yet a very young child, a dog coupled with a 
 bitch, and supposing that the connection was by the anus, he 
 had inserted a wooden lead pencil into the corresponding open- 
 ing of his own body. This had caused him some local pain 
 but it had also produced a singular but voluptuous sensation 
 the exact location of which he was not able to fix. 
 
 " At this time he was about seven years old. In a few days 
 he repeated the operation with a like result, but on this occa- 
 sion with the handle of a toothbrush well oiled. Again he 
 experienced pleasure which was distinctly referable to the penis. 
 After this he often performed this act, using always the same 
 article with which to accomplish his purpose. 
 
 " At about the age of ten he was initiated into masturbation 
 and pederasty by the boys of a boarding-school to which he 
 was sent. Masturbation, however, gave him no pleasure, 
 neither did pederasty when he was the active agent. Indeed 
 he had difficulty in getting an erection sufficiently vigorous for 
 the purpose. His weakness in this respect was soon discovered, 
 and he was relieved from that part of the performance very 
 much in accordance with his wishes,as the role of the passive gave 
 him more pleasure than that of the active agent. Every night, 
 therefore, he took part in these shameful performances and fre- 
 quently to the extent of half a dozen or more times. On each 
 occasion he experienced the voluptuous sensations to obtain 
 which was rapidly becoming one of the chief objects of his 
 life. He remained at the school five years, and then left it to 
 go into a tobacco mercantile establishment to learn the busi- 
 ness, but, as he said, with his health shattered, his nervous 
 system irritable, with almost constant headaches, and with 
 
DISEASES FROM EXCESS AND MASTURBATION. II5 
 
 such a degree of relaxation of the sphincter ani as to sometimes 
 make it impossible for him to hold his feces after they had 
 once reached the rectum. 
 
 " At this time he formed an association for pederastic pur- 
 poses with a young man who was to take the active while he 
 himself was to take the passive part. Articles of agreement 
 were drawn up between them in which each swore eternal 
 fidelity to the other, and in which they were called, respectively, 
 husband and wife. They took a room together and at night 
 slept in the one bed. There were two beds in the room and 
 both were occupied for a few minutes so as not to excite sus- 
 picion, and then the one who was in this disgusting arrange- 
 ment to act the part of the " husband " came to his " wife's " bed 
 and remained there during the night. Generally pederasty 
 was practiced night and morning. 
 
 " Frequently the passive agent would array himself in female 
 attire and would sit up at night waiting for the other to return 
 home — sometimes he was kept out late by business, which was 
 that of a liquor dealer — and he would receive him with every 
 demonstration of affection." 
 
 In the worse cases of satyriasis, the patient is indeed, a 
 maniac. The delirium is of a violent character, and death 
 may occur in a short time from convulsions or from sup- 
 purative inflammation of the genitals, the result of self- 
 inflicted violence. 
 
 If the disease has a cerebral origin it is incurable. The 
 other forms are sometimes amenable to treatment. Cold bath- 
 ing, applications of ice to the sacrum, perineum, and genitals, 
 with the internal administration of aconite, camphor, bromide 
 of potassium, and other sedatives will often give relief. It is 
 well also in these cases or in such cases as are of full habit, to em- 
 
Il6 DISEASES FROM EXCESS AND MASTURBATION. 
 
 ploy severe antiphlogistic measures, even to a point where it 
 reaches the line of danger. Nausea kept up for a few days by 
 administration of a solution of antimony will be of benefit. 
 And I would also recommend in addition to the antimony a 
 few doses of any active cathartic, such as jalap or podophyllin, 
 or elaterium. The application of the actual cautery to the 
 back of the neck as high up as the occiput would be of service; 
 if, as many think, the disease takes its origin in over excitation 
 of the nerve fibres of the cerebellum, or some of the ganglia 
 in the neighborhood, it should be one of the first things tried. 
 Blisters and setons might also be used with benefit. 
 
 ASPERMATISM. 
 
 This affection is characterized by an absence of the orgasm 
 and non-ejaculation of the seminal fluid during sexual inter- 
 course. It is generally the result of masturbation commenced 
 in early life, and discontinued at maturity to commence the 
 more natural act of cohabitation. The inability to cohabit often 
 exists, and the aspermatism comes on when the patient has had 
 a surfeit of enjoyment. The power of erection remains intact, 
 but the patient exerts himself in vain to produce an orgasm. 
 This condition may continue for a couple of weeks, disappear, 
 and then return. It is by no means a permanent condition, but 
 it may lead to sterility and impotence. Some writers say that 
 it is due to spasm of the orifices of the ejaculatory duct, which 
 prevents the passage of the seminal fluid into the urethra ; 
 others, that it is due to a lack of secretion in the various 
 glands. This latter view, however, is not tenable, because 
 patients with aspermatism are subject to nocturnal pollutions 
 as a result of lascivious dreams. 
 
 It is more than probable that there is a temporary paralysis 
 
DISEASES FROM EXCESS AND MASTURBATION. II7 
 
 of sensation existing in the prostatic portion of the urethra, in 
 the ducts, and perhaps in the vesicles. This lack of sensation 
 prevents the reflex muscular action necessary for the propul- 
 sion of the semen. 
 
 Van Buren and Keyes mention cases which have no connec- 
 tion whatever with either sexual excess or masturbation. I 
 have seen cases, in private practice, depending solely on self 
 abuse. None of the patients were impotent. They were able 
 to cohabit, without difficulty, but seldom enjoyed it because of the 
 absence of a natural termination to the act. One of these 
 patients was a married man, who, as a lad, abused himself. He 
 was capable of keeping up connection for three-quarters of an 
 hour at a time without an emission. At intervals, on other 
 occasions, the emissions would take place at the commence- 
 ment of the act. The lack of sensation during intercourse was 
 not permanent. It would continue for three or four months, 
 and at the end of that time the act would be natural and pleas- 
 urable. Electricity relieved this patient, but did not accom- 
 plish a perfect cure. 
 
 Acton terms this condition " non-emission," and thinks the 
 principal cause is stricture of the urethra, and that the best 
 treatment for it is to divide the stricture. But in the same 
 chapter he has the following: "I met with a most singular case 
 of this kind some time ago. The patient was an American. 
 Erection was perfect, but emission did not follow. When erec- 
 tion ceased there was occasionally a slight oozing from the 
 urethra. Strange to say, this patient had emissions at night, 
 once or twice a week. The testicles were small. A short time 
 before, he had been operated on for varicocele, without any 
 good effect. He had also been cauterized. Slight stricture 
 existed, as was ascertained by the bulbed instrument, but a 
 
Il8 DISEASES FROM EXCESS AND MASTURBATION. 
 
 conical bougie passed easily. In this instance there was appar- 
 ently nothing but a want of co-ordinate action between emis- 
 sion and erection, both being perfect at different times. The 
 patient, under proper treatment, ultimately recovered." 
 
 I have obtained the best results from compelling the patient 
 to abstain from intercourse, making daily applications of the 
 Faradic current to the genitals in the method hereinafter 
 described, and giving tonics into the composition of which the 
 alkaloids of nux vomica enter largely. 
 
 Or lack of power to propagate the species, is associated with 
 impotence, although there are many other factors in its pro- 
 duction besides lack of virility. Indeed, inability to copulate 
 does not necessarily make the patient sterile. If the seminal 
 fluid be merely left at the entrance to the vagina by a prema- 
 ture ejaculation, the spermatozoa may find their way to the 
 uterus without much difficulty. As a proof of this, the numer- 
 ous cases of impregnation occurring without intromission or 
 rupture of the hymen are amply sufficient. 
 
 Sterility may also result from inflammatory occlusion of the 
 ejaculatory ducts, arising from cauterization of the prostate 
 portion of the urethra. Lallemand was accused of producing 
 many cases of sterility by his method of cauterizing the urethra 
 for spermatorrhoea, — perhaps, however, with little reason. 
 
 Inflammation of the epididymis will also cause it by occlud- 
 ing the seminal ducts and preventing the passage of the sem- 
 inal fluid through them. Destruction of the testicles will, of 
 course, produce incurable sterility. 
 
 Obesity or corpulence is mentioned by Carpenter as a factor 
 in the production of sterility. " It must be observed that there 
 
DISEASES FROM EXCESS AND MASTURBATION. II9 
 
 is a certain .degree of antagonism between the nutritive and 
 the generative functions, the one set being exercised at the 
 expense of the other. The generative apparatus derives the 
 materials of its operations through the nutritive system and is 
 entirely dependent upon it for the continuance of its activity. 
 If, therefore, the generative activity be excessive, it will neces- 
 sarily draw off some portion of the aliment destined for the 
 maintenance of the fabric at large. It may be universally 
 observed that where the nutritive functions are particularly 
 active in supporting the individual the reproductive system is 
 in a corresponding degree undeveloped, and vice versa'* 
 
 That excessive corpulence tends to generative debility or 
 sterility is brought almost daily under my notice. It is like- 
 wise becoming very well known amongst breeders of the finest 
 stock. At the veterinary college I have had various opportu- 
 nities of seeing this exemplified. It is noticed that sterility in 
 bulls rarely occurs in the commoner sorts. Those that have 
 been sent to the college, in consequence of not getting stock, 
 are found to be the high-bred prize animals. This class is not 
 prolific, the owners caring only to breed animals that produce 
 fat readily. If we had the statistics of these high-bred cattle, 
 we should find that the large prices obtained for them are fully 
 warranted, as the sire and dams are anything but prolific, and 
 the vulgar saying, " a lean dog for a bitch," is a terse but sig- 
 nificant mode of enunciating a prominent fact. 
 
 " I was in conversation with a gentleman, a large farmer in 
 Suffolk. He told me that he is often disappointed when he 
 wishes to breed from cart-mares. This year, out of his own 
 working stock of twenty-eight horses, eleven mares did not 
 stand, greatly to his disappointment and loss, as a yearling colt 
 is worth twenty pounds, and the mare ceases work only during 
 
I20 DISEASES FROM EXCESS AND MASTURBATION. 
 
 one month before and one month after parturition. This sterility- 
 he attributes to the high condition his cattle are kept in by the 
 carters, who, proud of their teams, do not care to see them in 
 foal. To obviate it fresh stallions have been purchased, and 
 with as little success, sterility still prevailing. Among these 
 eleven mares there were young as well as old ones, but none of 
 them proved in foal. 
 
 " The treatment of cases of corpulence has within the last few 
 years excited considerable attention, no doubt through the pam- 
 phlet of Mr. Banting, who, however, is indebted to Mr. Harvey, 
 a member of our profession, for the plan he recommends. I have 
 from the first strongly recommended the chief features of the 
 system as beneficial for the general health, especially in the case 
 of persons of corpulent tendency. No doubt can exist that ab- 
 stinence from or extreme moderation in the use of fat, butter, 
 milk, cream, bread, potatoes, sugar, and beer will in one week 
 considerably diminish the weight, and in fat persons remove 
 many uncomfortable sensations. When a patient is over stout the 
 weight may be fairly and safely reduced one or two pounds 
 weekly. I have often found such treatment assist the recovery 
 of sexual power in persons in whom it has been failing. Absti- 
 nence has been proved to work equally well with animals, and I 
 have heard of several instances of over-fat bulls that had become 
 sterile, recovering their procreative powers after being sent to 
 work on the farm upon less food." 
 
 The treatment of sterility consists in removing the cause and 
 improving the general health. 
 
CHAPTER VII. 
 
 DISEASES OF THE GENITALS THAT ARISE FROM MASTURBATION 
 
 AND SEXUAL EXCESS. 
 
 Causes of Varicocele — General changes in the Spermatic Veins — Effects of 
 the Congestion and Dilatation of the Veins on the Neighboring Tissues — 
 Mental Depression produced by Varicocele — Emissions and Impotence as 
 a result — Ligation of Veins as a means of cure — Caustic Applications — 
 Galvano-Cautery, etc. — Amputation of the Scrotum the only safe Opera- 
 tion — Ecchymosis of Scrotum — Neuralgia of the Testicle — Irritable 
 Testicle — Various Methods of Treatment — Neuralgia of the Neck of the 
 Bladder — Treatment — Spasm of the Muscles at the Neck of the Bladder 
 as a cause of Impotence — Congestion and Inflammation of the Prostate 
 Gland — Treatment. 
 
 Sir Astley Cooper once said : " Varicocele should scarcely 
 receive the title of a disease, for it produces in the greater 
 number of cases no pain, no inconvenience, and no diminution 
 of the virile power." If that eminent surgeon lived at the 
 present day and could see the cases that present themselves for 
 treatment at the city dispensaries and hospitals, as well as 
 those in private practice, he would be compelled to modify, if 
 not change entirely the opinion quoted above. The fact is 
 that while there are cases of the disease which seem to trouble 
 the patient but little, the vast majority are accompanied by 
 more or less general weakness, by relaxation, by nocturnal pol- 
 lutions, and by great mental anxiety. Some of the old writers 
 on the subject state that mental depression is the principal ac- 
 companiment of the disease. This is doubtless true of most 
 cases of fully developed varicocele (cirsocele\ but it is a ques- 
 
122 DISEASES FROM MASTURBATION AND EXCESS. 
 
 tion whether the depression and anxiety are due to the previous 
 bad habits of the patient or to the varicocele. The seminal 
 weakness and the seminal losses, when they are present, suffi- 
 ciently account for the mental trouble ; but these may, of 
 course, be increased by the disease itself. The imagination of 
 the patient is apt to exaggerate every abnormal change which 
 takes place in the genital organs, no matter what importance 
 may be attached to it by the surgeon. 
 
 Varicocele generally occurs on the left side. It consists in 
 a varicose dilatation of the veins in the spermatic cord, and 
 exists independently of varicose enlargement in the veins of 
 the extremities or other parts of the body. Persons of ad- 
 vanced age frequently suffer from varicose veins of the lower 
 extremities, without having any disease of the veins elsewhere. 
 Young adults are particularly susceptible to varicocele, and 
 rarely have any dilatation of the veins of the extremities. There 
 seems to be no connection between the two diseases. 
 
 When varicocele exists in young persons it is a positive sign 
 of some derangement of the genital organs, the result of mas- 
 turbation or of sexual excess, — generally the former. 
 
 The dilatation occurs on the left side from a variety of causes. 
 In the first place, the veins of the spermatic cord empty at 
 right angles, on the left side, into the renal vein ; while on the 
 right side the vein opens obliquely into the ascending vena 
 cava, thus making it easier for the blood to ascend and gain the 
 general circulation. Then, again, the pressure of impacted 
 feces in the sigmoid flexure, which is apt to occur in all cases 
 of constipation, will by the pressure exerted obstruct the cir- 
 culation through the spermatic veins and thus assist in the pro- 
 duction of varicocele, when there is any relaxation of the veins 
 of the cord present. The extra length of the cord on the left 
 
DISEASES FROM MASTURBATION AND EXCESS. I23 
 
 side has not, I think, much to do with the development of the 
 disease. 
 
 As the spermatic veins dilate, they become engorged with 
 blood. The circulation through them is retarded, and as a 
 consequence the venous radicles which supply them are con- 
 gested. The weight of the increased mass of blood, together 
 with the retardation of the circulation of the blood (owing to the 
 stagnation in the vessels) may retard the nutritive processes in 
 the testicle so as to cause atrophy of the organ after a time. The 
 congestion is not confined to the testicles involved, but soon 
 extends to other parts, producing a marked irritability and ex- 
 cessive secretion from the glandular structure of the genitals, 
 which are evidenced by the frequency of the spermatic dis- 
 charges and the impaired virility. The nocturnal pollutions, if 
 they do not appear before, are co-incident with the develop- 
 ment of the varicose condition of the spermatic veins, and as 
 the disease progresses there is more or less impairment of the 
 copulative function. 
 
 Not long since a student of the medical department of the 
 University consulted me about a varicocele, which had de- 
 veloped three years previously. He was a stout, hardy young 
 man of twenty-two, of good habits, comparatively speaking, 
 and one who had rarely been guilty of the habit of mastur- 
 bating. The varicocele was, as is usually the case, on the left 
 side. It was large, and seemed to envelop the testicle. The 
 testicle seemed to be of normal size ; the penis showed no 
 signs of misuse. He had nocturnal emissions as often as four 
 times each week, and he was conscious of some impairment of 
 virile power= These abnormal conditions made him exceedingly 
 unhappy and despondent He slept poorly, his appetite was 
 bad, study was irksome, and he had little hope of any treat- 
 
124 DISEASES FROM MASTURBATION ANt) EXCESS. 
 
 ment effecting a cure, because he had for the two years pre- 
 vious been taking, without benefit, every kind of quack nos- 
 trum he could find as well as orthodox medicine. A few days 
 after I first saw him I made a natural suspensory badge for him 
 by removing the lower and relaxed pendulous portion of 
 the scrotum. The operation proved very beneficial. He 
 improved rapidly after it, and, with other appropriate means, 
 he completely recovered his health. Eighteen months after the 
 operation he was free from his frequent emissions and his men- 
 tal despondency had disappeared. 
 
 Many such cases have come under my notice during the past 
 fifteen years, and in nearly all remarkable amelioration of all 
 the symptoms was produced by amputation of the scrotum. 
 
 Some authorities think that varicocele is more often a cause of 
 the disease, than an effect. The general relaxation of the 
 bloodvessels, and the tendency to dilatation of veins, which exist 
 as a result of masturbation, is likely to be localized in the 
 spermatic veins of the left side, more than anywhere else. 
 
 There can be no doubt that the general relaxation of the 
 bloodvessels with the tendency to a general dilatation of the 
 veins, which exists as a result of excess and onanism, is one of 
 the principal factors in the production of dilatation of the veins 
 of the testicle and spermatic cord. The frequent erections and 
 constant turgescence of the bloodvessels of the genitals must 
 cause, finally, varicose enlargements on the side most readily 
 predisposed to it. The irritability which is thus engendered 
 increases the frequency of the emissions, adds to the mental 
 distress, and may ultimately destroy the already impaired 
 virility of the patient. 
 
 While I believe that a large majority of cases of varicocele 
 result from masturbation and excessive sexual indulgence, yet 
 
t)lSEASES FROM MASTURBATION AND EXCESS. 1 25 
 
 there are cases to which no such history can be attached, and 
 where all the parts are otherwise healthy. These are always 
 amenable to treatment, and are cured in a much shorter time 
 than the others. 
 
 The treatment of varicocele should commence by removing 
 the cause of the disease. If the patient's habits are the basic 
 cause of the trouble, it will be of little use to attempt anything, 
 unless these habits are abandoned. When that is done, he has 
 taken the principal step towards recovery. The general health 
 should first receive attention. The constipation, which is an 
 invariable attendant of the disease, must be gradually removed, 
 without the use of active cathartics (see treatment of sperma- 
 torrhoea and impotence). Cathartic medicines in ordinary 
 use are apt to disorder the stomach and be followed by the 
 same lethargic condition of the bowels which existed before. 
 
 Belladonna is a good remedy to try in all cases of constipa- 
 tion, where the patient cannot stand depletion. It is highly 
 recommended by Bartholow, who advises half a grain of the 
 extract in pill form at bedtime. The following combination, 
 which is recommended by the same authority, and which I have 
 myself employed extensively with excellent results, can be used 
 in all the cases under consideration : R. Ext. belladonna, ext. 
 nucis vomicae, ext. physostigmatis, aa. gr. iij. M. ft. pil. no. 
 vj. Sig. One pill may be given at bed time. If, as sometimes 
 happens with delicate people, this pill acts too severely, half 
 maybe given, or the pill may be given every other night. Some- 
 times the injection of a couple of ounces of sweet oil at night 
 will produce an evacuation in the morning. Injections of cold 
 water will also be of service (see page 225). Another excel- 
 lent combination for the cure of habitual constipation, is a 
 pill made of one quarter of a grain of nux vomica and the 
 
126 DISEASES FROM MASTURBATION AND EXCfeSS. 
 
 same quantity of aloin. This pill, also, is to be taken at bed 
 time. 
 
 Brisk rubbing of the abdomen, in the morning and evening, 
 in addition to the general rubbing will also be of great value in 
 promoting a healthy action of the bowels, and should never be 
 omitted. 
 
 Cold baths stand at the head of the list of palliative 
 measures in the treatment of varicocele. General and local bath- 
 ing are both beneficial. The ordinary Sitz bath is the most 
 efficient bath for local effects (See page 230 for methods of 
 administering the bath). 
 
 Tonics, such as are advised in the treatment of spermator- 
 rhoea and impotence at page 241, are also necessary. 
 
 A well fitting suspensory bandage should be worn constantly, 
 unless the skin becomes much chafed, during walking or other 
 exercise. In such a case it may be dispensed with during the 
 sleeping hours, and a wet towel substituted. The towel should 
 be wet in the center and so arranged that the wet part will 
 envelope both sides or the whole of the scrotum, the dry ends 
 to be carried up on each side, and fastened together, to a band- 
 age under the "waist. When the -yy^t towel is worn in this way, 
 the inflammation of the skin produced by the bandage worn 
 during the day, will be relieved, allowing it to be worn again 
 without much trouble the day following. Besides taking the 
 place of the elastic suspensory at night, the water bandage re- 
 lieves the overloaded veins and the internal congestion pro- 
 duced by them, and brings about a more healthy action in all 
 the neighboring parts. 
 
 In the majority of the cases of varicocele, the palliative 
 measures should be tried before any operative procedures are 
 commenced. With regard to operations many are recommendedj 
 
DISEASES FROM MASTURBATION AND EXCESS. 12;/ 
 
 from which the surgeon may choose, but there is only one op- 
 eration on the list that I regard as free from danger, and that 
 is amputation of the pendulous portion of the scrotum, and 
 making a natural suspensory bandage, which by its regular and 
 even pressure, will diminish the size of the dilated blood- 
 vessels and relieve the congestion permanently. All the other 
 operations are attended with danger ; the patient may lose 
 his life from any one of them, and, in view of the fact that the 
 disease we are endeavoring to cure is never a cause of death, 
 we have no right to perform an operation, attended with danger 
 to life, especially when we have a comparatively simple one, 
 which answers all purposes, and is perhaps more effectual than 
 any of the others. 
 
 The operation for ligation of the veins, for the radical cure 
 of varicocele, is apt to be followed by atrophy of the testicles, and 
 in rare instances by the formation of thrombi, which are often 
 carried to distant organs, producing great and sometimes fatal 
 complications. Deplech, a French surgeon, was assassinated 
 by a patient upon whom he had operated for varicocele, by 
 ligating the veins of both sides. Atrophy of the testicles took 
 place, and the enraged patient avenged himself by murdering 
 the operator (Van Buren and Keyes.) Excision of the veins 
 also has been performed, sometimes with beneficial results, at 
 other times it has been marked by disaster and failure. Gal- 
 vano-cautery, caustics, and injections, have also been tried, 
 but they are open to the same objections as the rest. 
 
 Amputation of the scrotum, first recommended I believe by 
 Sir Astley Cooper, has been performed by all the principal 
 surgeons in this country many times during the past twenty 
 years. It may be done with or without a clamp. It will be 
 well for novices to use a clamp such as is advised by Sayre, 
 
128 DISEASES FROM MASTURBATION AND EXCESS. 
 
 Levis, Henry and others. I have found the index finger and 
 middle fingers of the left hand to answer very well. In using 
 the clamp, care must be taken not to pinch the flaccid scrotum 
 too tightly, as this sometimes retards the healing process, and 
 produces sloughing, owing, I suppose, to the fact that some of 
 the capillary bloodvessels in the flaps are destroyed by the 
 pressure. In using the clamp, or my fingers, I usually draw 
 down a fold of the pendulous scrotum so that the remaining 
 portion of the scrotum is tightly placed over the testicles. It 
 is better to have the covering too tight than too loose. If it is 
 too tight at first, the elastic scrotum will stretch sufficiently to 
 make the pressure right in the course of time. When a satis- 
 factory amount of scrotal tissue has been included in the 
 clamp, I pass a sufficient number of sutures through the scro- 
 tal walls behind and close to the clamp, so as to close the 
 wound perfectly when the redundant tissue is removed. This 
 maneuver saves time, prevents the retraction of the flaps, 
 gives the operator perfect command of the bleeding edges, and 
 greatly facilitates all the subsequent steps of the operation. 
 vVhen the threads are in place the pendulous portion is cut off 
 close to the clamp with a sharp scissors or a scalpel. The clamp 
 is then loosened, all the bleeding vessels secured, and the 
 oozing prevented by the application of a dry towel, before the 
 edges of the wound are drawn together by the sutures. If 
 the bleeding is not stopped the hemorrhage may take place into 
 the scrotal sac, distending it, and giving rise to a great deal of 
 discomfort. To the novice, this effect is alarming. The scro- 
 tum is enormously distended and of a bluish black color, look- 
 ing as if the whole mass were in a state of gangrene. Under 
 such circumstances, the proper thing to do is to cut all the 
 sutures, turn out all the clots, and tie or twist all the bleeding 
 
Diseases from masturbation and excess. 129 
 
 vessels. Cloths dipped in ice water must then be kept on to 
 prevent any capillary oozing or subsequent inflammatory action. 
 
 When the operation is concluded the scrotum should be 
 covered with cloths wet with a cold carbolized solution, and 
 these cloths should be kept constantly wet for the first week. 
 Daily washing of the wounded surface is also necessary until 
 there is perfect union. 
 
 When the patient is able to go about, which is usually at the 
 end of two or three weeks, a suspensory bandage is necessary, 
 and should be worn for several weeks, just as if no operation 
 had been performed. This prevents any accidental stretching 
 of the flaps, and controls the congestion until all the tissues 
 are firm, and fixed, and the veins reduced to their normal size. 
 
 In many cases a period of ten or twelve years may pass 
 before there is any appearance of a relapse, in others, how- 
 ever, the disease may begin again within five or six years. In 
 these cases it will be generally found that the operation has 
 been performed imperfectly, or that the patients have renewed 
 habits, formerly discontinued, which have been destroying their 
 health. Patients who, after the operation, remain temperate 
 and enter the married state, rarely if ever have a return of the 
 disease. Even late in life, in such cases, the veins as well as 
 the scrotum are in a healthy condition. 
 
 NEURALGIA OF THE TESTICLES. 
 
 This distressing affection is frequently caused by onanism 
 and sexual excess, and it is often accompanied by a loss of 
 virility. It may also arise from malaria, rheumatism, strictures 
 of the urethra, prostatic enlargement, and varicocele. In some 
 instances it is a legacy of acute or chronic orchitis. The dis- 
 ease is rare among married men and others who are able to 
 9 
 
130 DISEASES FROM MASTURBATION AND EXCESS. 
 
 fulfill their sexual functions in a temperate or reasonable man- 
 ner. This fact shows the intimate relation which exists between 
 neuralgia of the testicles and bad " sexual hygiene," and that 
 the latter requires special consideration before the other excit- 
 ing and predisposing causes. 
 
 The testicle in these cases is invariably tender on pressure 
 while the attack is on. All muscular movements of the lower 
 parts of the body, walking or climbing, or any exercise which 
 allows contact or pressure of the limbs on the diseased organ 
 will increase the pain. The pain is generally spasmodic in 
 character, either sharp or stinging, or a dull ache. The dura- 
 tion of the attack varies as in other forms of neuralgia, some- 
 times lasting but a few moments, then again continuing for 
 hours with a greater or less degree of severity. During the 
 attack the patient is weak and pallid, perspires profusely, and 
 sometimes vomits. The slightest touch increases the paroxysm. 
 In bad cases the patient's life soon becomes a burden to him, 
 and he will often endeavor to persuade the surgeon to remove 
 the organ without delay, and before any other method of treat- 
 ment has been employed. 
 
 If the testicle is swollen the emissions are generally frequent. 
 Though the patient may be full of erotic fancies, he rarely 
 attempts sexual congress because of the aggravation of the 
 pain usually caused by such attempts. Curling mentions the 
 case of a man, a patient of his, who was unable to cohabit with 
 his wife owing to the excessive pain which came on at the 
 time, and was often so great as to cause fainting. 
 
 IRRITABLE TESTICLE 
 
 Is nothing but a mild form of neuralgia of the testicle. It is 
 seldom accompanied by severe paroxysms. It may affect both 
 
DISEASES FROM MASTURBATION AND EXCESS. I3I 
 
 testicles, and is more apt to affect the testicles of both sides at 
 the same time than one alone. If the testicle is carefully ex- 
 amined, one or more sore spots will be found exquisitely ten- 
 der on pressure. The tenderness is present to a greater or less 
 extent during the continuance of the disease, though with it 
 also there are paroxysms of pain, especially after much excite- 
 ment of the genitals, from masturbating or intercourse. The 
 affection like the preceding one is generally due to bad sexual 
 hygiene, or to excess of one kind or another. " Temporary 
 irritable testis may be produced in a healthy person, at any 
 time, by prolonged sexual excitement, ungratified. Masturba- 
 tors, who have suddenly reformed, and recent widowers, and 
 those who have abused their' sexual power by over use, are 
 liable to the affection." (Van Buren and Keyes.) 
 
 In some instances the disease follows injury and inflamma- 
 tion in anaemic persons. 
 
 Romberg relates the case of a young man who developed 
 an irritable testicle shortly after being engaged to be married, 
 the result of ungratified sexual excitement. He prevailed upon 
 the doctor to remove the diseased testicle. He was relieved for 
 eight days, when the disease attacked the remaining testicle. 
 He concluded to get married, rather than repeat the operation. 
 The marriage cured him completely. 
 
 The general treatment directed in the beginning of the chap- 
 ter to regulate the various secretions and build up the tissue 
 making powers of the patient are all indicated here. When 
 this has been done, and the habits of the patient are mended, 
 local treatment will be found necessary. Indeed it may be 
 commenced first; for the relief of the pain and soreness, either 
 very cold or very hot applications are beneficial. I have found 
 that the cold applications accomplished more than the hot, 
 
132 DISEASES FROM MASTURBATION AND EXCESS. 
 
 though both are serviceable. A bladder filled with ice can be 
 applied over the painful testicle, and retained there until relief 
 is experienced. If the patient is very sensitive to the cold, a 
 towel may be placed between the integument and the ice bag, 
 or cloths dipped in ice water may be used instead of the ice. 
 One of the best things, however, that I have found for neural- 
 gia of the testicle is the cold sitz bath. It should be taken 
 every night, whether the neuralgia is present or not, and also 
 during the time the paroxysm of pain is present. The patient 
 may remain in the bath from five to fifteen minutes, the length 
 of time depending of course on the feelings of the patient, and 
 his general condition. One case of severe neuralgia of the 
 testicle in an impotent middle aged man, was entirely cured by 
 these baths alone. He experienced so much relief from the 
 first bath that he would take no other treatment, and his re- 
 covery was complete as well as rapid. 
 
 During the day a well fitting suspensory bandage should be 
 worn, and the pantaloons should be as loose as possible, so as 
 not to interfere with the circulation through the vessels of the 
 spermatic cord on either side. I am convinced that much 
 harm is often done by the absurd practice of tightening the 
 garment on the " dress " side. The practice not only obstructs 
 the circulation sufficiently to aggravate all diseases of the geni- 
 tals, but I think it is a prominent factor in the causation of 
 varicocele and the various forms of neuralgia incident to a 
 rapid life about town. 
 
 Puncturing the integument over the spermatic cord with 
 needles is sometimes beneficial. It may be advisable, in very 
 bad cases, to rub into the punctures a mixture of equal parts 
 of croton oil and Olive oil. This application must be made 
 over the upper part of the scrotum, and over a surface corres- 
 
DISEASES FROM MASTURBATION AND EXCESS. I33 
 
 ponding to the width of the cord. It should not be continued 
 down over the testicle. 
 
 The Faradic current will also be found of use in many- 
 cases. The positive pole may be applied over the genito- 
 spinal center, at the junction of the last lumbar with the dorsal 
 vertebra, and the negative electrode is then to be passed slowly 
 upwards and downwards over the scrotum on the affected side. 
 I have had no experience with the continuous current in the 
 treatment of these cases, but by many authorities it is said to 
 exercise a curative effect. 
 
 The application of local anodynes and sedatives will be of 
 some service as palliatives. Among the best combinations are 
 the ordinary lead and opium wash (Lotio Plumbi et Opii) the 
 ointment of opium and belladonna, /^//^yf^, belladonna plaster, 
 and the ordinary porous plaster. I have found the following 
 mixture to be among the best : 
 
 5. Tinct. Aconiti . , . . 3i» 
 
 Tinct. Belladonnas . . . • 3 ii. 
 
 Acidi Carbolici . . , . 3i. 
 
 Spt. Vini Rectif. . . • . | iii. 
 
 Wet a cloth with the lotion, and keep constantly moist 
 during the paroxysm. 
 
 Another mixture of the same nature, such as the following is 
 good : 
 
 5. 01. Olivae . . . . .iii. 
 
 Liq. Potassge , . . . 3 ss. 
 
 Tinct. Opii . • . . 3 ii« 
 
 Tinct. Aconiti Rad. . . . 3 ss. 
 
 M. Shake well. 
 
 It is to be rubbed in gently over the scrotum of the inflamed 
 side, two or three times each day. 
 
134 DISEASES FROM MASTURBATION AND EXCESS. 
 
 Quinine in doses of from five to fifteen grains daily is often 
 of benefit, especially if the patient is the subject of any ma- 
 larial tendency. In tonic doses it is good at all times. When 
 the baths, or the ice, or the anodynes fail to relieve the pain, 
 opium or chloral or the bromides must be resorted to. Mor- 
 phia may be given hypodermically or by the mouth. Some 
 advise it to be given endermically, after the skin has been 
 blistered. There is no special objection to this method of ad- 
 ministering the morphia. 
 
 Castration has been recommended by some for inveterate 
 cases, but every other means should have a prolonged trial 
 first. Extreme measures should never be thought of until 
 everything else has failed. 
 
 It is always well to advise marriage when the patient is 
 young and suffering from bad sexual hygiene. This recom- 
 mendation must, of course, be governed by the condition of 
 the general health. He mi st be toned up to a certain point be- 
 fore the marriage can be consummated. (See page 241.) If the 
 patient is full blooded, and his neuralgia is simply the result of 
 unsatisfied longings, then no time need be wasted in pre- 
 paratory treatment. He can be married without delay. 
 
 NEURALGIA OF THE NECK OF THE BLADDER 
 
 Is another affection which very often arises from onanism and 
 excessive venery. It is sometimes also caused by prolonged 
 continence. It occurs also as a result of gout, rheumatism, 
 malaria, and as a sequel to inflammatory conditions of the 
 prostate gland, bladder, and urethra, and from stricture. Even 
 when these disorders are accompanied by irritability of the 
 neck of the bladder, there is probably some bad sexual hygiene 
 at the bottom of it 
 
DISEASES FROM MASTURBATION AND EXCESS. I35 
 
 The constant distension of the prostatic ducts and the semi- 
 nal ducts and the congestion which invariably attends the orgasm, 
 soon produce a chronic congestion in the prostatic urethra, 
 which in nervous subjects, or in persons with a neuralgic ten- 
 dency produces irritability of the neck of the bladder and 
 intense pain. The affection known as irritability of the neck, 
 is like irritability of the testicle, only a modified form of the 
 neuralgia, and by most authorities the terms are synonymous. 
 Whatever may be the cause, the symptoms are characteristic. 
 The patient is frequently seized with a desire to pass water. 
 The evacuation of the bladder is attended with pain of more or 
 less degree of severity. The pain is felt with greatest inten- 
 sity at the neck, but it also extends to the thighs, and radiates 
 over the perineum to the anus, around which part all the 
 muscles seem to be in a state of painful contraction or cramp. 
 The pain on micturition is much aggravated, if the urine con- 
 tains an excess of oxalate of lime, or uric acid. The minute 
 cryitals irritate the nerve filaments and increase the pain. 
 There are cases recorded where the presence of these ingredi- 
 ents in excessive quantity produced the neuralgia or irritabil- 
 ity, and when they were removed by appropriate treatment 
 the pain also disappeared. 
 
 In neuralgia the frequent calls to urinate occur more often 
 during the day than during the night. In inflammation the calls 
 to urinate occur at night as well as by day. This is an import- 
 ant point in diagnosis, though the examination of the urine 
 alone will determine the point. The urine of cystitis always 
 contains pus and triple phosphates, in excess. In simple neu- 
 ralgia these elements are never present in any appreciable quan- 
 tity. 
 
 With the neuralgia, there is more or less hypochondriasiso 
 
136 DISEASES FROM MASTURBATION AND EXCESS. 
 
 Mental depression, deep but not lasting, accompanies all the at- 
 tacks. This arises, undoubtedly, as much from the previous ex- 
 cess as it does from the pain, and is only part of the general 
 weakness which follows all sexual excesses of every kind and 
 nature. 
 
 Impotence and spermatorrhoea are often present and should 
 be considered in all cases. 
 
 The passage of the sound into the bladder in one of these 
 cases is attended with some difficulty on account of the extreme 
 sensibility existing along the whole urethra, but especially at 
 the prostatic part of the urethra. The spasmodic contraction 
 of the muscular fibres around the instrument is often so great 
 as to prevent, for a few moments, the entrance of the sound, 
 and to give the impression that a stricture of an organic nature 
 exists. If the sound is allowed to remain awhile, the spasmodic 
 contraction passes away and with it all the pain, and when the 
 sound is withdrawn great relief is generally experienced by the 
 patient. If the pain arose from inflammation it would be in- 
 tensified by the pressure of the instrument. 
 
 The first object to be attained in the treatment of irritability 
 or neuralgia of the neck of the bladder, is to diminish as much 
 as possible the local causes of irritation. If the urine contains 
 an excess of acids, alkalies should be given-r-if it is too alka- 
 line, acids are indicated. A selection should be made from the 
 various tonics advised in Chapter XIV, and careful and well 
 regulated measures should be taken to keep all the sewerage of 
 the body clear and in perfect working order, so that there shall 
 be no undue accumulation of excrementitious material at any 
 one point, or in any one organ. With the cathartic medicines 
 and the baths spoken of previously this end can be attained. 
 
 The dailv passage of a full sized steel sound is advanta- 
 
DISEASES FROM MASTURBATION AND EXCESS. 137 
 
 geous in almost every case, and should never be omitted except in 
 those rare cases where the neuralgia depends on well developed 
 inflammation. In such cases, of course, much harm might re- 
 sult from the passage of the instrument. If the sound causes 
 pain and fainting, two or three days may be allowed to elapse 
 before it is again introduced. 
 
 Cold sitz baths should never be dispensed with unless there 
 is some special contra-indication for their use. During the par- 
 oxysm a hot sitz bath will sometimes answer better than the 
 cold, but for general treatment the cold bath should be used. 
 When insomnia is present, in connection with great depression, 
 suppositories are beneficial ; both in relieving the irritability and 
 promoting sleep, the following are excellent : 
 
 Ex.^ Belladonnas gr. ii. 
 
 Pulv. Opii gr* iv. 
 
 Quinige Sulph. gr. xx. 
 
 M. 
 
 Make four suppositories, one to be passed into the rectum at 
 bedtime. 
 
 Electricity is another agent of great value in neuralgia of the 
 neck. The negative electrode to be introduced down to the 
 neck of the bladder, and the positive to be applied over the 
 sacrum and perineum. The seance should not last over five 
 minutes at first. In the course of a week or two it may be ex- 
 tended to ten minutes. The Faradic current helps to diminish 
 the pain, and it also diminishes the number of seminal emis- 
 sions, an important point to remember in all these cases ; for 
 while the ejaculations are in excess, the mental condition of the 
 patient will be much disturbed. 
 
 Good food, and exercise out of doors, should, of course, be 
 advised in every case, as well as total abstinence from spiritu- 
 
138 DISEASES FROM MASTURBATION AND EXCESS. 
 
 ous liquors and tobacco. By careful attention to all these 
 points the disease can always be cured. Opium, chloral, and 
 remedies of a like nature, should be given, as in other forms 
 of neuralgia, when milder measures for relieving pain fail. 
 
 I SPASM OF MUSCLES CONNECTED WITH ERECTION. 
 
 During the act of micturition, and the ejacula ion of seminal 
 fluid, there often occurs spasmodic contraction of the com- 
 pressor urethra and accelator urinae, which is very perceptible 
 to the patient, and is often a cause of much annoyance, espec- 
 ially when, as it often does, it interferes with intercourse. The 
 following case illustrates the class of cases to which I refer, and 
 which has not as yet received any notice in any volume that I 
 am acquainted with. « 
 
 A. v., a native of Canada, by occupation a carpenter, applied 
 for treatment at a clinic in the medical department of the Uni- 
 versity of New York, where I was then lecturing. He said that 
 he had been married three months, and had considerable trouble 
 in effecting sexual intercourse. He had perfect erections, but 
 in the midst of the act a severe throbbing of the muscles of the 
 perineum would occur, and cause the erection to cease ; and 
 this would occur often before an ejaculation of semen occurred. 
 At times the spasmodic contraction would bring about prema- 
 ture orgasm, and expulsion of semen, which prevented all 
 further efforts in that direction. This rendered him, for the 
 time being, impotent, and distressed him in every way. He ac- 
 knowledged that in early life he had masturbated considerably, 
 and had also cohabited with women. Before his marriage the 
 difficulty complained of only occurred at rare intervals ; now it 
 was almost a constant attendant of the attempt. Sometimes he 
 was able to diminish the effect of the spasm by pressing with 
 
DlSEASfeS FROM MASTURBATION AND EXCESS. I39 
 
 the fingers of the one hand firmly on the center of the peri- 
 neum, maintaining the pressure until the occurrence of the or- 
 gasm. I passed a full-sized sound and found great tender- 
 ness all along the canal, but especially at the prostatic portion 
 of the bladder. As the sound entered this portion of the canal 
 the spasm again occurred, and the patient said he felt like hav- 
 ing an emission or emptying his bladder. I advised sitz baths 
 and the Faradic current, and abstinence from all sexual pleas- 
 ures, and in a few weeks the act was unattended by the spas- 
 modic contraction. 
 
 I have seen several others who have endured great incon- 
 venience from this form of spasm, but it was entirely uncon- 
 nected with painful symptoms of any kind. Electricity is the 
 best thing for it, but most cases require the full course of 
 treatment for spermatorrhoea and impotence, recommended in 
 another portion of this volume. 
 
 CONGESTION AND INFLAMMATION OF THE PROSTATE. 
 
 The tumefaction in the prostatic region of the urethra, pre- 
 viously spoken of as a result of onanism and excessive venery, 
 if continued when it exists for any great length of time, may 
 sooner or later involve the whole prostate gland. The blood- 
 vessels all through the gland become engorged, the prostatic 
 secretion is for the time being increased, and the organ is 
 larger, more tense and more tender than in health. As a con- 
 sequence there is a feeling of uneasiness at the neck of the 
 bladder and more frequent calls to urinate, and there is also 
 an escape at frequent intervals, after the last drops of water 
 have passed, of a small quantity of prostatic fluid. This secre- 
 tion is sometimes clear, but in many of the cases the secretion 
 is opaque from the admixture of epithelial cells and pus, and 
 
140 DISEASES r?.:M :.:a57 V?.Z All 2 N AND EXCESS. 
 
 in rare insrsnces :v semen. The patier.: experiences an 
 tmpleasaiit sense :: cisrensicn in :'. e ;t:l em. ;ni around the 
 
 
 arge will con: 
 
 /^Ar tTr 
 
 sT/niaii 
 
 sniierin^ :::::. ;: a^ts: t ::A:^_.e. rne resni: of malaria and 
 ccnhnence — mire c: :he ii::e: :hin rne firmer. He did the 
 " : k c: a krge pirisn, ini sizerei : : msirniiir from chills 
 ;.ni :e"er. .-.nd a: '.'3.:::ns Ln:cr»'a.j.5 ne nan SA/ne distress in 
 a: A A^ AAer. Tde a:: of urination vtea af: lAed with 
 powerful ere:rl:ns. painrnl in the extreme aa' a ned 
 l:ng a::er tde bladder vra,s emnried. Ke enpeArnied no 
 relief fr:n: emprdAg :de zlaider, Tde palalal .reAAAs and 
 
 malarial arrack, but they also cccnrrei at varlAas inrer^als 
 when the malaria ~ a s ad s e n r . Tde : e a . . : : d. . e a e : k of the 
 
 blac 
 
 Ider and 
 
 the ;a r 
 
 --- 
 
 - e r e : a : A 5 _ e : :. a: e s : 
 
 
 : that he 
 
 was 
 
 forced 
 
 to c:m 
 
 
 A :Ae cAv ::r aa'die 
 
 ana ar "■ 
 
 e up his 
 
 active parish vrork. 
 
 I 
 
 nii^ht here remark rr 
 
 :a: ne Zt. 
 
 a.ra dav- 
 
 mz 
 
 anv ces: 
 
 .re r : ; : 
 
 a a 
 
 AAr :r anv erana fee 
 
 .mas cr 
 
 a similar 
 
 naA. 
 
 — •- 
 
 ere was 
 
 n: 
 
 e'a aea :e i : an'.' aai 
 
 a :: sdA 
 
 the 
 
 na a 
 
 r-.A: ::-. 
 
 :>ed hi or 
 
 se: 
 
 d m aay ~ay. V/neA 
 
 I raama 
 
 .= _ Aim, 
 
 I :: 
 
 ana aa 
 
 rlAzTlA 
 
 -t- 
 
 sensitive prostatic a 
 
 :re:nra.. s 
 
 :me ten- 
 
 cerr 
 
 ress in :1 
 
 ".e a ermf 
 
 aar 
 
 n. Tde aassaae af tl 
 
 :e sound 
 
 was f ol- 
 
 . - -;-,- - 
 
 ^ a I '•" a 
 
 "A A. a A 
 
 
 -ae ErirTAAZ aaa an 
 
 erection 
 
 . There 
 
 da a 
 
 zren a: 
 
 
 A 1 
 
 aarae : e: : :- :; aa aa 
 
 : --ledge 
 
 except a 
 
 ■Aea 
 
 r :Ae. :: 
 
 ransa are 
 
 irt 
 
 ann SAiny. He vr3.s 
 
 very de: 
 
 jpondenf 
 
Diseases from masturbation and excess. 141 
 
 about his condition, and thought it would be impossible for 
 him ever to perform his regular duties again. He was put to 
 bed, his bowels were freely moved and hot poultices were 
 placed over the perineum, and he was also ordered hot sitz 
 baths by the house surgeon. These measures, to a great 
 extent, relieved the unpleasant sensations in making water, but 
 his erections still continued with great force and frequency, 
 and they were the most annoying part of his disease. He 
 was then ordered large doses of bromide of potassium, and 
 allowed to get up. The hot baths were exchanged for cold 
 ones, and in a short time the erections ceased to be of more 
 than ordinary annoyance. 
 
 This congestion of the prostate may terminate in acute 
 inflammation under increased excitement, or it may run a slow 
 course and terminate in hypertrophy of the gland. A sound 
 introduced into the canal will occasion great pain and a desire 
 to urinate. After the urination the distress still remains to a 
 greater or less degree. The introduction of the finger into the 
 rectum will show that the gland is more sensitive to pressure 
 than it ought to be, and that firm pressure will give pain and at 
 the next urination will produce the expulsion of the prostatic 
 secretion in considerable quantities. 
 
 As before stated, if the congestion of the prostate continues 
 for any great length of time a condition of acute inflammation 
 may arise. This occurs sometimes in the course of an ordi- 
 nary congestion by one night's dissipation with women. The 
 patient may have some chilly sensations preceding the attack, 
 but these are often absent. There is, with or without the 
 chilly sensations, deep-seated pain in the perineum extending 
 towards the anus ; pain on pressure over the pubis and per- 
 ineum, and frequent desire to micturate. Every cime th.e act 
 
t42 Diseases from masturbation and excess. 
 
 is performed there is sharp pain that lasts after the bladder is 
 empty. The aggravation of the pain is due to the fact that 
 muscular fibres of the prostate are thrown into strong contrac- 
 tion in expelling the water during micturition, and the pressure 
 and pulling of these muscular fibres on the inflamed tissue 
 must necessarily give rise to a great deal of pain. The gland 
 becomes very much enlarged, and can be felt to bulge into the 
 rectum. The pressure of the finger in that organ occasions 
 great pain, and with the finger the dimensions of the organ can 
 readily be ascertained. The introduction of the finger will de- 
 termine at once the character of the disease, so that it need 
 not be confounded with cystitis, the only disease it is liable to 
 be mistaken for. There is no tenderness in the rectum over the 
 prostate in cystitis. In prostatitis, as also in cystitis, there is 
 frequent desire to micturate and pain during the act, but in 
 cystitis there is always much more pus and mucus in the 
 urine than there is in prostatitis. Besides this, in cysti- 
 tis there is always a larger quantity of the triple phosphates. 
 Phosphates are never absent in decomposing urine in or out of 
 the bladder, but are not present in prostatitis. 
 
 The swelling of the inflamed prostate may be so great as to 
 produce retention. This is more apt to occur when the disease 
 arises from an extension of gonorrhoeal inflammation or from 
 traumatism. Retention is a very rare occurrence in ordinary 
 prostatitis. With the local symptoms the patient has also 
 more or less febrile excitement. The bowels are apt to be 
 constipated, the stomach is disordered and the skin is dry and 
 hot. The patient is distressed in mind and exceedingly de- 
 spondent. He frets, he worries about his condition more than 
 the severity of the affection would warrant, and this is specially 
 so in those cases which are entirely due to sexual excess or 
 
Diseases from masturbation and excess. 143 
 
 onanism. Prostatitis, whether follicular or parenchymatous 
 (and I think one rarely occurs without the other), will gener- 
 ally terminate favorably under proper treatment. It rarely 
 ends in suppuration. The worst result to be apprehended is a 
 permanent enlargement or hypertrophy of the gland. The 
 inflammation usually lasts from one to three weeks. The dura- 
 tion, of course, depending on the cause of the disease and the 
 general condition of the patient. 
 
 The best way to deplete the vessels of the prostate gland is 
 to apply four or five leeches to the margin of the anus. The 
 branches of the hemorrhoidal plexus are in direct communi- 
 cation with the dense prostatic plexus, and the result of the 
 abstraction of blood there is to diminish in a marked degree 
 the amount of blood in the gland mentioned. Unless the 
 patient is exceedingly sensitive and nervous they should be 
 applied without delay. After the leeches have done their work 
 a saline cathartic in small but often repeated doses should be 
 given. A mixture containing half an ounce of Epsom salts 
 and half an ounce of bi-tartrate of potash, to half a pint of 
 water, can be given in wineglassful doses, every two hours, 
 until free evacuations are produced. Of course, in anaemic 
 persons the cathartic and the leeches may be omitted. Hot 
 linseed meal poultices applied over the perineum and hypo- 
 gastric region, and changed every two or three hours, will 
 afford great relief to the patient. 
 
 Diluents should be given freely. An infusion of the triticum 
 repens, hops, linseed or barley, will answer all purposes and 
 keep the urine in an unirritating state. The triticum repens, 
 or common couch grass, was first recommended by Sir Henry 
 Thompson for cystitis and prostatitis, and it is undoubtedly of 
 great use and value in all painful inflammatory affections of the 
 
144 DISEASES FROM MASTURBATION AND EXCESS. 
 
 genital organs. Dr. Thompson gives its preparation as fol- 
 lows : " Take two ounces of the underground stem, add it to 
 one pint of water and boil for one quarter of an hour, the 
 strained liquor to be taken by the patient in four doses in the 
 twenty-four hours. An infusion of alchimella arve?ists may 
 be given in the same way in doses of from an ounce to an 
 ounce and a half every three or four hours. Liquor potassae 
 and hyoscyamus in combination, though incompatible, often 
 afford great relief to the pain in cystitis. Chloral in ten or 
 fifteen grain doses at bed time will be of service in some cases 
 in relieving pain and producing sleep." 
 
 Hot sitz baths are also employed with benefit in these cases. 
 They may be used twice each day, unless they seem to debili- 
 tate the patient or disagree with him in some other way. 
 
CHAPTER VIII. 
 
 DISEASES OF THE GENITALS ASSOCIATED WITH SPERMATOR- 
 RHCEA AND IMPOTENCE. 
 
 Accumulation of Secretions under a tight Prepuce as a Cause of Sperma- 
 torrhoea and Impotence — Illustrative Cases — Reflex Irritation Produced 
 by Phimosis— Loss of Voice from Phimosis cured by Operation — Sayre's 
 unique Case — General Treatment — Congestion of the Prostate and In- 
 flammation of the Prostate — Cases of Spermatorrhoea and Impotence Pro- 
 duced by Them — Impotence following the Removal of Calculi from the 
 Bladder by the lateral Operation — Spermatorrhoea produced by Hypo- 
 spadias and Epispadias — Curvature of Penis — Large Penis — Prostatic Cal- 
 culi as a cause of Spermatorrhoea. 
 
 PHIMOSIS.^ 
 
 When the prepuce is elongated and contracted in front of 
 the glans-penis, the secretion of the sebaceous follicles ac- 
 cumulates on the glans and behind the corona. At first the 
 secretion is thin and cheesy in character, but after a time the 
 accumulation becomes dry and hard, forming a concrete mass on 
 the sensitive mucous covering of the glans. This mucous mem- 
 brane is perhaps the most sensitive in the human body ; it is 
 certainly the most sensitive portion of the mucous lining 
 of the genitals. Hence any irritation of this membrane is 
 liable to be followed by many varied reflex phenomena, which 
 often baffle the skill of the most experienced. In children this 
 collection of sebaceous matter will produce incontinence of 
 urine, a tendency to handle the parts and to masturbate, and it 
 will sometimes cause paralysis. In adults the reflex irritation 
 
 10 
 
146 SPERMATORRHCEA AND IMPOTENCE. 
 
 is excited in the seminal vesicles and ejaculatory apparatus, 
 and produces numerous losses of seminal fluid. If the con- 
 cretion around the glans has existed long enough to produce 
 inflammation of the mucous covering, the pain will prevent in- 
 tercourse and thus render the patient temporarily impotent. 
 
 But the effects of these accumulations of sebaceous matter 
 resulting from phimosis are not entirely local. The most dis- 
 tant organs are likewise affected by the reflex irritation. Dr. 
 Durant of this city sent me a patient twelve months since, 
 who afforded an excellent illustration of the fact just stated. 
 The patient was a young clergyman of good habits and tem- 
 perate in all things. For several years he had been subject to 
 a troublesome affection of the throat which interfered with his 
 ministerial duties. Some minutes elapsed on entering the pul- 
 pit before he could make his voice heard in distant parts of the 
 church. He had been treated for pharyngitis, laryngitis, etc., 
 without relief. Local applications as well as constitutional 
 remedies failed. For several years he suffered severe pain 
 while cohabiting with his wife. He commenced the act with 
 regret and ended it in agony. The pain was always referred to 
 the head of the penis. Latterly he had ceased intercourse or 
 account of the pain, and he was consequently troubled with 
 seminal emissions three or four times each week. On examin- 
 ing the penis I found the prepuce contracted tightly in 
 front of the glans. It was exceedingly painful on pressure and 
 it was impossible to push it back. 
 
 The next day the patient was placed under the influence of an 
 anaesthetic. I removed the prepuce and exposed the glans. 
 The whole surface of the mucous membrane from the corona 
 glandis to within a quarter of an inch from the meatus, was 
 covered by a hard thick coating of a mortar-like material. 
 
SPERMATORRHOEA AND IMPOTENCE. I47 
 
 which was removed with great difficulty. In some places near 
 the corona it produced ulceration by its pressure. After the 
 removal of this concrete substance the operation was concluded 
 in the usual way. The ulcers were dressed with lint steeped in 
 olive oil. This was the only dressing employed during the 
 whole course of treatment. In ten days the ulcers as well as 
 the wound had completely healed. 
 
 When the patient again entered the pulpit he found, much 
 to his surprise, that the aphonia as well as other disagreeable 
 laryngeal symptoms had disappeared, and that he had full 
 command over his voice. Though more than a year has 
 elapsed since the operation his voice has remained perfectly 
 clear, and there has been no return of the affection. There 
 was also complete relief from pain and other unpleasant sensa- 
 tions during sexual intercourse. 
 
 Dr. Sayre relates the following interesting case occurring in a 
 boy 3^ years old : " Has frequently through the day what the 
 mother terms * spasms of ecstasy,' in which he laughs immod- 
 erately, and his eyes are bright and glistening, but yet he ap- 
 parently sees no object, and the penis is in a state of extreme 
 erection. Cannot see, although eyes have been examined 
 and found sound. Unable to stand ; incapable of voluntar- 
 ily contracting any of his muscles when standing, or rather 
 when being held in the upright posture, as it was impossible for 
 him to stand, but when lying on his back for some time can 
 move his hands and turn over ; but when held upright his legs 
 always spasmodically cross each other, hands close, wrists flex, 
 elbows the same, in fact, all the adductor and flexor muscles 
 act and produce a strange distortion ; the mouth opens, and 
 there is a vacant stare of idiocy with a curious laugh of half 
 intelligence. The penis is in a state of almost constant erec- 
 
148 SPERMATORRHCEA AND IMPOTENCE. 
 
 tion, and greatly excited at the least irritation. The meatus 
 is red and tender. Teeth nearly all destroyed by medicine, and 
 is now nourished on a bottle." Phimosis, firmly adherent pre- 
 puce. Dr. Sayre circumcised him on the spot, and at the next 
 visit the child shook hands with him, which he had never done 
 before in his life. Considerable improvement is said to have 
 followed, but not a cure, as about eight months afterwards " it 
 could not hold its head up with the strength of the normal 
 child, although it could sit down and get up and stand, balanc- 
 ing itself without assistance ; could speak several words, and 
 had acquired the power of eating." 
 
 Lallemand relates several interesting cases of spermatorrhoea 
 which were caused by phimosis and accumulation of seba- 
 ceous matter under the prepuce. They are exceedingly inter- 
 esting : 
 
 " A peasant consulted me for his son aged fifteen, who for 
 two years had experienced a constantly increasing paralysis of 
 the lower extremities. On his sides and loins were marks of 
 numerous ulcers which had been tried during two years. Large 
 excoriations had formed on the sacrum and trochanters. On 
 examining the genital organs, I noticed that the prepuce was 
 very narrow ; and on pressing it to get rid of the sebaceous 
 matter which presented at its orifice, the penis became erect. 
 I learned from the parents thai this boy "had erections at the age 
 of eight, and that at nine years of age, he had been found attempt- 
 ing coitus. The boy himself admitted that the itching with which 
 he was tormented led him to rub the genital organs, and thus 
 induced maneuvers which he has since continued. 
 
 " The first symptom that presented itself was frequent desire 
 of micturition, and this was followed in about a year by com- 
 plete incontinence of urine. In the course of the second vear. 
 
SPERMATORRHCEA AND IMPOTENCE. 149 
 
 the patient's legs grew weak ; he lost his intellectual capacity, 
 digestion became disordered, diarrhoea came on ; and the dis- 
 charge of urine and feces caused excoriation of the skin. 
 Salt and aromatic baths, tonics, excitants, etc., had been just 
 as useless as issues. The cause of the disease was unsuspected. 
 Masturbation had become very rare, but the urine was thick, 
 muddy, and very fetid — so much mucus was passed, that I was 
 unable to make sure of its containing semen — but the patient 
 had constant pollutions at stool. I first performed ablation of 
 the prepuce, and eight days after, I cauterized the bladder and 
 surface of the prostate. A month afterwards, the urine was 
 perfectly transparent, and presented a healthy appearance ; it 
 was no longer passed involuntarily. Sensibility of the skin of 
 the lower extremities had returned. Improvement was here 
 arrested, however, and I lost sight of the patient." 
 
 "Another case, at twenty-three, of nervous temperament, hav- 
 ing enjoyed good health up to the period of puberty, from that 
 time presented a yellow and leaden appearance, with sunken 
 eyes, forehead covered with acne punctata, and timid manners. 
 For a long time he had appeared as if plunged into deep mel- 
 ancholy, and constantly sought solitude. He was restless, but 
 was unable to bear fatigue. Digestion was difficult, and his in- 
 tellect dull. This disorder had lasted four or five years, but 
 
 had increased sensibly during the last year before M. B 
 
 came to consult me. I suspected him of bad habits, but he as- 
 sured me that he had escaped them from want of desire, and 
 that he had never had sexual intercourse. From the period of 
 puberty, however, he had been subject to nocturnal pollutions, 
 the frequency and abundance of which had progressively in- 
 creased, and in spite of the means generally recommended 
 in such cases, pollutions occurred every night, and sometimes 
 
150 SPERMATORRHCEA AND IMPOTENCE. 
 
 two or three times during the night. He had never noticed 
 ascarides in his feces, nor experienced itching at the anus. I 
 was uncertain to what cause to attribute these pollutions, when, 
 on examining the genital organs, I noticed that the opening of 
 the prepuce was very narrow, and that abundance of sebaceous 
 matter escaped. Pressure made from behind forwards pro- 
 duced the discharge of a large quantity of matter of a milky 
 appearance and considerable fetor. I concluded, therefore, 
 that the natural phimosis, by preventing the discharge of the 
 sebaceous secretion, was the cause of involuntary discharges, 
 and in consequence recommended circumcision, which was 
 performed immmediately. I found a large quantity of seba- 
 ceous matter resembling soft cheese in color and consistence, 
 and of a very disagreeable smell, covering the surface of the 
 glans, and especially collected around the corona glandis. 
 
 " The glans itself was vividly red, almost entirely deprived of 
 its epithelium, extremely sensitive — the least friction causing a 
 discharge of blood. 
 
 " From this moment he passed a fortnight at a time, and some- 
 times longer without having nocturnal pollutions, which after- 
 wards only arose from spermatic plethora. A rapid change 
 took place in health and habits, so that at the end of a month 
 he was scarcely recognizable." 
 
 "M. J.B., of Amsterdam, of delicate constitution and lympha- 
 tic temperament was subject during childhood to incontinence 
 of urine, and always suffered from frequent desire to make 
 water. About the age of ten, a whitish matter formed, and was 
 discharged from underneath the prepuce, after which erections 
 occurred, and were soon followed by emissions : a very dis- 
 agreeable smell accompanied the preputial discharge. The 
 seminal discharges increased as the patient's passions were 
 
SPERMATORRHOEA AND IMPOTENCE. 151 
 
 roused, and he grew sad, silent, discontented, and constantly 
 occupied with the origin of his disorder. He imagined that the 
 whitish discharges arose from venereal disease, although he had 
 never had connection. His health became much disordered, 
 and at the age of nineteen he mentioned his condition to his 
 medical attendant. Lotions were prescribed, which removed 
 the sebaceous matter and produced considerable improvement 
 in the patient's health. M. B.'s bowels became constipated, 
 however, and he perceived that he passed semen while at stool, 
 in consequence of the effort necessary. The nocturnal pollu- 
 tions diminished in frequency but still occurred occasionally. 
 
 " When M. J. B. consulted me in November, 1836, he presented 
 the following conditions : Small stature, limbs slight and chest 
 narrow, skin fair and soft, hair white and thin, face very pale, 
 manner timid and embarrassed, hesitation, habit of stammering, 
 arising from disorder in the intellect and loss of the memory, 
 genitals remarkably small, penis small and short, hidden among 
 long scanty white hairs, prepuce very long, forming numerous 
 folds in front of the glans, surface of the glans covered by a 
 thin layer of sebaceous matter, notwithstanding the utmost 
 cleanliness on the part of the patient, scrotum compressed and 
 much folded, containing only the right testicle, about the size 
 of an almond, the left being felt in the inguinal canal attached 
 to a portion of omentum. No spinal curvature (which the 
 patient had feared,) his mistake arising from the projection of 
 the hips and pelvis which resembled those of a woman. I re- 
 moved the prepuce entirely in order to put an end to the in- 
 fluence of the sebaceous matter on the glans ; catheterism not 
 giving much pain, I did not consider cauterization necessary ; 
 but in order to give tone to the organs I left a catheter in the 
 bladder for an hour or two at a time once a week, and ordered 
 
152 SPERMATORRHCEA AND IMPOTENCE. 
 
 the free use of cold douches to combat the constipation. The 
 patient's temperament being exceedingly lymphatic, I after- 
 wards prescribed three or four aromatic baths weekly, with the 
 habitual use of spa water. 
 
 " These means lengthened the periods between the pollutions, 
 diminished the constipation, and lessened the involuntary dis- 
 charges that took place when efforts at stool were considerable. 
 Acupuncture of the perineum and prostate produced more 
 rapid and decided effects. After this had been practiced, six- 
 teen days passed without nocturnal pollutions, and the efforts 
 at stool did not cause any seminal discharge. By degrees the 
 patient's face became more healthy looking and animated, 
 and his strength and energy returned ; his character regained 
 its boldness and gayety, erections became frequent and energe- 
 tic, and his health altogether having become as good as could 
 be desired, M. B. returned to his home." 
 
 There can be no possible doubt that a tight elongated 
 prepuce is provocative of masturbation. The irritating secre- 
 tions cause the child to finger his genitals when no persons are 
 observing. That habit once commenced soon culminates in 
 self-pollution. Circumcision is therefore a sanitary operation in all 
 cases when phimosis exists. The earlier the operation is per- 
 formed the better. The child's prospects of remaining free 
 from a debasing and debilitating habit will thus be materially 
 enhanced 
 
 CHRONIC INFLAMMATION OF THE PROSTATE. 
 
 Many cases of chronic prostatitis occur independently of sex- 
 ual excess or masturbation. Prostatitis may run its entire 
 course without loss of virility, or abnormal ejaculations of semen, 
 yet cases are sufficiently numerous where the disease has pro- 
 
SPERMATORRHCEA AND IMPOTENCE. 153 
 
 duced serious forms of spermatorrhoea and impotence to au- 
 thorize a careful examination of them. The irritation which the 
 disease excites in and around the prostate gland and the neck 
 of the bladder, as well as in neighboring tissues, must necessarily 
 affect to a greater or less degree, the seminal apparatus. The 
 irritation, arising from the chronic distension of the blood- 
 vessels of the gland and prostatic urethra as a consequence of 
 the inflammation, acts in a similar way to the irritation excited 
 by sexual excesses or masturbation, and is often followed by 
 the same results, viz: frequent seminal losses, and a subsequent 
 loss of virility. The following case in my own practice illus- 
 trates this point : 
 
 H. G., aet. thirty-five, contracted a gonorrhoea five years pre- 
 vious to admission to the hospital. The discharge lasted six 
 months. Afterwards there was a dull pain felt at the time of 
 micturition, which continued a few moments after making 
 water. At night there was a frequent desire to micturate, accom- 
 panied with constant pain. 
 
 At the end of a year the pain and frequent desire to mictur- 
 ate had diminished somewhat, but he was troubled with noc- 
 turnal emissions. They occurred three or four times each 
 week and weakened him very much. At stool he said he some- 
 times passed semen. This of course is doubtful. It was prob- 
 ably nothing more than the secretion of the inflamed prostate 
 with the addition of the secretion of Cowper's glands. He was 
 less able to have intercourse, to perform the act. The erections 
 were feeble and his ejaculations were premature. An examination 
 of the urine showed the presence of a stringy mucus and a few 
 pus cells. Its odor and reaction were normal. An examina- 
 tion per rectum revealed the fact that the prostate was consider- 
 ably enlarged, and tender on pressure, and some pain was pro- 
 
154 SPERMATORRHCEA AND IMPOTENCE. 
 
 duced by the examination, which continued some time after the 
 removal of the finger. The next act of urination also gave 
 more pain than usual. So far as I could ascertain, there was 
 no inflammation of the bladder. 
 
 He was placed on an infusion of triticum repens, and quinine, 
 and ordered to take two Turkish baths per week. At the end 
 of six weeks I prescribed a weak solution of iodine to be paint- 
 ed over the perineum every other day, and made him empty 
 his bowels every morning by means of a cold water injection. 
 He also took a cold sitz bath just before retiring, and had a 
 brisk rubbing with a flesh brush. At the end of three months 
 though the prostate was still enlarged, there was little or no 
 pain, the frequent acts of micturition had ceased and his erec- 
 tions were as healthy as they were before the inflammation 
 commenced. 
 
 Another case of a similar nature came under my care last 
 winter. The patient was employed as a porter in a dry goods 
 store. He was over forty, and said he had never abused him- 
 self in any way, and only indulged in sexual intercourse at rare 
 intervals. 
 
 Twelve years before coming to consult me he contracted a 
 clap, from which he recovered after six weeks' treatment. A 
 year ago he again contracted the disease, and this time was not 
 so fortunate, for the running continued for three months with 
 little abatement. About a molith after it had ceased, he began 
 to experience unpleasant sensations at the neck of the bladder 
 during and after micturition, and the desire to pass water was 
 frequent and urgent. There was also some discomfort at stool. 
 As the fecal matter passed through the rectum, over the pros- 
 tate, a whitish liquid escaped from the urethra. He consid- 
 ered thi5 to be seminal fluid, because about this time he began 
 
StERMATORRHCEA AND IMPOTENCJE. 1^5 
 
 to have painful erections and nocturnal emissions. The emis- 
 sions occurred about four times each week, though he would 
 sometimes, for a whole week, have one every night. Their 
 effect was very depressing ; he lost appetite, became thin, and 
 had but little sleep at night. 
 
 The passage of the sound into the urethra gave great pain, 
 and a desire to empty the bladder, as in the previous case. He 
 did not attach much importance to the local pain or frequent 
 micturitions. The seminal losses occupied his mind completely, 
 and he felt that he was threatened with every imaginable evil 
 from their occurrence. He improved considerably under treat- 
 ment but he is not yet cured, and I think that the prostate 
 will remain permanently enlarged. 
 
 In all these cases of chronic congestion or chronic inflamma- 
 tion of the prostrate complicated with seminal losses and impo- 
 tence, the patient should be instructed that as soon as the local 
 trouble is relieved he will be able to resume his procreative func- 
 tion without anyfear of failure, and that the seminal losses are 
 not due to any inherent weakness of constitution, or to anything 
 that is likely to leave a permanent impression on his system. 
 Thus re-assured, the remedies applied will have a ten-fold 
 effect. 
 
 If the patient is full-blooded, it will be well to use antiphlo- 
 gistic measures at first. Cathartics in moderate doses may be 
 given daily, for a week, so as to produce one or two extra eva- 
 cuations in the day. Following this the perineum may be 
 painted with iodine, or blistered, the patient of course remain- 
 ing in bed during the time the blister is healing. It is well to 
 follow the blister, when the new skin has formed, by an oint- 
 ment containing mercury. I prefer the ordinary Ung. Hyd., 
 to the others. It is less irritating, and will produce better 
 
t$6 Si»ERMAtORRHCEA AND IMPOTENCE. 
 
 results. If the patient has a very sensitive skin, after the blis- 
 ter ordinary simple cerate may be mixed with the blue oint- 
 ment to make it still less irritating. During the application 
 the gums and teeth should be carefully examined, and at the 
 first symptoms of the constitutional effects of mercury the 
 ointment must be discontinued. 
 
 In addition the cold sitz baths described at page 230 should 
 be taken once a day, at bed-time. The urine should be kept 
 free of all irritating qualities by the remedies mentioned 
 in the first case of prostatitis in this chapter. 
 
 CHRONIC VESICAL CATARRH. 
 
 Chronic vesical catarrh, by keeping up congestion and irri- 
 tation in neighboring parts of the seminal apparatus, will 
 sometimes be attended by frequent and painful emissions (as 
 in prostatitis.) Though these seminal losses are often ignored 
 by the surgeon, they seriously complicate the disease, retarding 
 and perhaps preventing a cure. The cystitis itself produces 
 sufficient pain and discomfort and mental distress, but when 
 the additional weakness and the horror of impotence which 
 every patient feels who is suffering from nocturnal emissions, is 
 added, the case at once assumes a serious aspect, and nothing 
 should be left undone to relieve the spermatorrhoea, while at 
 the same time vigorous measures should be taken to cure the 
 cystitis. The internal remedies recommended in prostatitis 
 are also useful in cystitis, but there are others equally service- 
 able, viz. eucalyptus, triticum repens, pareira brava, buchu, etc. 
 Frequent washing of the bladder should never be omitted 
 unless the operation should produce, as it sometimes does, 
 intense discomfort and aggravation of the pain. After the 
 washing I am in the habit of injecting two or three ounces of 
 
SPERMATORRHCEA AND IMPOTENCE. I57 
 
 linseed oil, allowing the oil to remain in the bladder until the 
 next urination. I have had better results from the use of 
 linseed oil as an injection than from nitrate of silver or any of 
 the numerous remedies used for that purpose. Where all the 
 usual remedies fail to give relief, the operation of cystotomy 
 should be performed. It is an operation attended with very 
 little risk; is easily performed, and invariably gives relief. The 
 pain ceases and the urine dribbles away without causing the 
 patient any inconvenience. The bladder has a respite from 
 the frequent contractions, and the patient has a chance of 
 recovery given him, which he could not have obtained with- 
 out it. 
 
 The operation of lithotomy, especially the lateral one, is 
 sometimes followed by impotence, and sometimes, although the 
 cases are extremely rare, it follows cystotomy. The cause of 
 this impotence I am unable to state. It could hardly arise 
 from cutting the few filaments of nerves in the line of incision. 
 The laceration of the ducts, by dragging out a large stone, may 
 be the main factor. When impotence arises from these opera- 
 tions there is Httle that can be done to cure the patient, who 
 usually remains unable to copulate for the remainder of his 
 days. 
 
 MALFORMATIONS. 
 
 Malformations which prevent sexual intercourse may be 
 either congenital or acquired. They are not usually accom- 
 panied with spermatorrhoea. Spermatorrhoea and impotence 
 combined have been noticed in cases of hypospadias and epi- 
 spadias. Morgagni mentions a case of the former malforma- 
 tion in which there was sufficient irritation existing around the 
 surface of the urethra and on its under surface near the margin 
 
158 SPERM ATORRHCEA AND IMPOTENCE. 
 
 of the opening to cause ejaculations of semen three and four 
 times each week. The constant seminal losses weakened the 
 patient and destroyed his virility. It seems highly probable, 
 however, that in this case there may have been some concealed 
 lascivious habit which the physician failed to discover. Lalle- 
 mand, quoting the same case, thinks there were other causes 
 than the hypospadias at work in producing the pollutions. 
 
 Lallemand says that " hypospadias has never been studied in 
 reference to its connection with weakness of the organs. It is 
 well known that Louis XVI. had hypospadias, and the memoirs 
 of Madame de Campan leave no doubt that his marriage was 
 not consummated for several years. I have met with one case 
 of hypospadias in the hospital of St, Eloi ; it was accompanied 
 with nocturnal and diurnal pollutions, but I only had an oppor- 
 tunity of observing the patient for two or three days, and I 
 cannot say decidedly that these pollutions arose solely from a 
 natural weakness of the organs." * 
 
 When hypospadias is accompanied by curvature of the penis 
 the glans is usually bent downwards on the body. The 
 enlargement consequent upon this altered form is generally 
 sufficient to preclude intromission, and the patient becomes 
 incapacitated for sexual congress. Epispadias may be con- 
 nected with a similar curvature in an upward direction, which 
 likewise occasions impotence. Curving of the penis in various 
 directions sufficient to prevent penetration also arises from 
 injuries and inflammations which destroy tissue. The new 
 material formed to make up for loss of substance contracts 
 like all other cicatricial tissue and the organ is consequently 
 soon curved in the direction of the cicatrix. 
 
 In October last I had a patient in Charity Hospital who had 
 had chancroidal sores on and below the frenum. There was 
 
SPERMATORRHCEA AND IMPOTENCE. t^^ 
 
 considerable loss of tissue by the ulceration, and much new- 
 fibrous tissue in its place. The glans penis was bent down- 
 wards on itself nearly at right angles, and could not be 
 straightened. Erections occasioned great pain. Owing to the 
 curved condition of the organ the patient had been unable to 
 cohabit since the time he contracted the chancroids. I made 
 an incision through the fibrous bands, straightened the organ 
 and kept it in position until the wound healed. The patient 
 was discharged cured. 
 
 Cartilaginous formations in the fibrous septum, between the 
 corpora cavernosa may produce similar changes in the slope 
 of the organ and prevent intercourse. Gross speaks of having 
 met with such cases of degeneration in elderly persons. The 
 cartilage was deposited in patches, and interfered with erec- 
 tions. 
 
 Congenital absence of the penis necessarily involves impo- 
 tence. A very small penis does not prevent either intercourse 
 or procreation. Van Buren relates the case of a patient who 
 had a penis about three-quarters of an inch in length. The 
 man wished to have a child, and his physician advised him to 
 have a glass tube prepared which would accurately fit the 
 end of the penis. With this glass appendage he had inter- 
 course with his wife and secured the wished for results. But 
 artificial means are not necessary ; persons with but the stump 
 of a penis left have been known to enjoy intercourse and 
 impregnate women. All that is needed for conception is an 
 injection of the seminal ^uid into the vagina. Once there it 
 soon fulfills its mission, by finding its way to the ovaries. 
 
 Van Buren and Keyes quote from Aupila the case of a man 
 who was charged with rape by a woman who had conceived 
 from the single intercourse, ^he penis of the man was almost 
 
l6o SPERMATORRHCEA AND IMPOTENCE. 
 
 entirely gone — only a very small stump had been left. Hence 
 it was decided that the concurrence of the woman must have 
 been obtained before the act was consummated, or she would 
 not have become pregnant, and that it was not a case of rape. 
 
 A very large penis may prevent intromission and thus cause 
 impotence. A double penis will do so likewise. 
 
 Elephantiasic tumors of the prepuce, penis or scrotum, will 
 render copulation impossible. Calculi in the urethra may be 
 so large as to prevent intercourse. Gross quotes Sper, of 
 Toulon, as having treated a patient who for upwards of thirty 
 years was debarred from sexual pleasures by large calculi in the 
 foreskin. And Dumeril mentions a case where a calculus 
 weighing nearly six ounces imbedded itself in the urethral 
 canal with like results. 
 
 Extravasations of blood in the erectilQ tissue of the penis may 
 cause impotence. The inflammation which follows the i e- 
 moval of the blood closes the spaces in the erectile tissues, in- 
 terferes with the entrance of blood into them and consequently 
 destroys the erectile power. Gross speaks of a case related by 
 Cullany, in which the patient, after indulging excessively in 
 sexual intercourse, ruptured some portion of the erectile tissue, 
 allowing the blood to escape into the meshes of the organ. The 
 result was an erection which lasted a period of sixteen days. 
 At the end of that time an incision was made, and a large 
 amount of blood coagula burst out. The organ at once re- 
 turned to a flaccid condition, and remained so, — the patient 
 being rendered permanently impotefit by the subsequent in- 
 flammation in the cavernous portions of the penis. 
 
 Absence or atrophy of both testicles cause both impotence 
 and sterility. The patients neither have the power of effecting 
 penetration or of manufacturing semen. Where one testicle 
 
sperMatorrhcea and Impotence. i6t 
 
 is left there is usually power to effect intercourse, and to pro- 
 duce impregnation, though the latter is of rare occurrence. 
 
 Extroversion of the bladder, a congenital condition in which 
 the lower portion of the abdominal wall as well as the anterior 
 wall of the bladder are absent, is necessarily a cause of im- 
 potence and sterility in the male. It is not a cause of sterility 
 in the female, as the functions of the vagina, uterus, and 
 ovaries are not interfered with. 
 
 PISORDERS OF THE RECTUM WHICH AGGRAVATE OR ORIGINATE 
 
 SEMINAL LOSSES OR DISORDERS. 
 
 Many writers on spermatorrhoea believe that certain disorders 
 of the rectum, such as fissure, ulcer, stricture, or hemorrhoids 
 may occasion the disease without the assistance of mastur- 
 bation or sexual excess. The same authorities also attribute 
 spermatorrhoea to the presence of pinworms in the rectum. I 
 have seen in my own practice many cases where these disorders 
 were aggravated by the spermatorrhoea, but I have not seen 
 a case where disease of the rectum was the sole factor. It is 
 reasonable to suppose that the affections in question produce 
 congestion of the vessels connected with the prostate and 
 seminal vesicles, and that the irritation resulting from these 
 abnormal conditions may increase the number of seminal 
 emissions, but I have never seen any cases of spermatorrhoea 
 or impotence which were due solely to disorder of the rectum. 
 They may, however, occur, and Lallemand has given several cases 
 which are of great interest : 
 
 Spermatorrhoea from stricture — " Nicholas G , the guard 
 
 of a diligence, of a strong constitution, at the age of twenty-five 
 contracted chancre, followed by bubo and warts. This attack 
 of syphilis was treated with mercurials, without the patient 
 II 
 
1 62 SPERMATORRHCEA AND IMPOTENCE. 
 
 giving up his employment, and notwithstanding the fatigue 
 consequent upon his frequent journeys, at the expiration of 
 six weeks all the symptoms had disappeared. Shortly after- 
 wards he experienced difficulty in defecation, which slowly in- 
 creased so that in the course of four or five years considerable 
 efforts were necessary to evacuate the rectum. The feces were 
 flattened like a ribband, four or five lines in length and width 
 and about a line in thickness. From this time G.'s health be- 
 came greatly disordered, his appetite diminished, his digestion 
 was impaired, and accompanied with the development of flatus ; 
 he lost flesh and his weakness increased daily ; his memory was 
 impaired, and the genital organs underwent the same changes 
 in their functions. When he first consulted me he had scarcely 
 any venereal desire ; his erections were imperfect, coitus was 
 rarely possible, and ejaculation was long in taking place, — some- 
 times it did not even occur at all, — and it was never accom- 
 panied by any lively sensation. The concurrence of all these 
 symptoms convinced me of the presence of spermatorrhoea. 
 The patient told me that for four years he had been in the 
 habit of passing semen while at stool, and that its discharge 
 in general bore a proportion to the efforts necessary for the 
 expulsion of the feces ; on this account, in order to render 
 them as fluid as possible, he had reduced himself to a vegetable 
 and milk diet. He had often attempted to use enemata, but 
 had been unable to succeed. The abundant spermatic dis- 
 charges had so worn this patient out that at the age of thirty- 
 four he presented the appearance of a man of sixty. On ex- 
 amination, I discovered about two inches from the anus a 
 nearly circular obstruction of about half a line in thickness, 
 having an irregular opening in its center which would barely 
 admit the extremity of the forefinger. This kind of diaphrasjm 
 
SPERMATORRHCEA AND IMPOTENCE. 163 
 
 obstructed the passage of fecal matter ; it was thin and soft, 
 and felt like a cicatrix. I made transverse incisions through 
 the obstruction by means of a straight probe-pointed bistoury 
 passed along the index finger. These incisions were of very 
 trifling depth, and I afterwards dilated the opening by intro- 
 ducing my finger deeply and pressing it forcibly in the direction 
 of each wound until by tearing I reached the walls of the in- 
 testines. 
 
 " Four loose flaps resulted from this operation and I prevented 
 their re-union by the frequent introduction of my finger. The 
 operation was attended with very little pain or loss of blood. 
 Some time afterwards I showed the patient how to introduce a 
 cretum bougie, of sufficient size to dilate the portion of gut 
 which had been operated on ; this I advised him to practice 
 daily for some time. 
 
 " This simple means proved sufficient to procure separate cica- 
 trization of the four flaps, after which the expulsion of the 
 feces took place without difficulty, and the spermatic discharges 
 ceased. All his functions were soon restored to their natural 
 state, and Nicholas G. resumed his former occupation." 
 
 " M , of good constitution, entered the army at the age of 
 
 seventeen, and served for eighteen years, during which he was 
 exposed to considerable hardships. He also committed ex- 
 cesses of all kinds. His health, however, continued excellent. 
 
 In 1 8 14, M , then aged thirty-five, contracted blennorrhagia 
 
 which he neglected ; the discharge diminished, but did not en- 
 tirely cease before 1816, when he quitted the army. In 1820, 
 
 M married, but did not indulge in any excesses. Some 
 
 time afterwards, having been engaged as concierge to a club, 
 he passed many nights almost without lying down. In 1824 he 
 was suddenly seized with violent colic^ which was relieved by 
 
if 4 s?ermator?.h:ea avd ivpcrzvzE. 
 
 means of em:" lient injections, repeated ';:.: .s. ini a severe 
 regimen, bi:: vrh::h did not entirely leave him. Two years af- 
 terwards he hsd a severe heiiirrhage from the rectum, accom- 
 panied with very painfii". :r: r_: . 5 during the violent spasms 
 of which he noticed tha: --e i:£5ti semen. This hemorrhage 
 relieved the colicky p^^ins he ii=d 5 ifered from, but a dysentery 
 remained, which kept up the Tenesmus ar.! — Ith it the involun- 
 tary seminal emissions, and c : u _ t i : t - 5 r : :' several hem- 
 orrhoidal tumors with eversien ci ;he m : ::- mfm-brane of 
 the rectum. From this period M.'s heal:/, i^;. r more and 
 more disordered ; he lost his habitual spirits together with his 
 sexual appetite, and his sirht as ~r e his memory and phjFsi- 
 cal strength became "e.he-ri 5: i??7 he was obliged 
 to give up his occnp 1::; u ; : : : :.::-: ^z I hng the years 1827 
 and 1828, the chronic diaixhit 3. de mease d in severiry, and in 
 1829 it had become much less fre: aen:. A: iermh in 1830, it 
 was replaced by a very ::sTm-:e mmri-mdm \ i:hini:stum 
 also became the cause :: 5 ;: : hit;, aai inireasei the 
 swelling caused by the htm m:h ; i as ana the prolapsed mucous 
 membrane of the rectam. 7.5 ; t iina 'vas irreducible ; it in- 
 creased in hardness as i::m m a : :he :'ri:r*on of his dothes, 
 and at last ass am e a a s irraias mnsismniv. Its presence 
 also formed a considerable obstacle :: aefeiation. On the 28th 
 of March, 1831, M. applied at the Lie ial S:. El. in the fol- 
 lowing condition ; He m fifty-one ears :i ape : extremely 
 pale ; his face p le rii: : skin muda p : hair :la:h : —emaness 
 excessive; sen; : i : erv rreat : prrnana melancholy; 
 habitual hypochondriasis : digestion diniaal:, especially after 
 the nse of animal food ; defecation ren aere a :: : a : les ame by a 
 red hard swelling, five or six lines in di me:e: a::: ss its base, 
 pr; ecaap about an inch, and occupmaa a a: hai: ::.z :i::um- 
 
SPERMATORRHCEA AND IMPOTENCE. 165 
 
 ference of the anus ; involuntary discharges of semen during 
 the efforts necessary to procure a fecal evacuation ; the emis- 
 sion of urine followed by a discharge of a glairy, limpid, and 
 sticky matter ; no erections during a long period ; absence of 
 all sexual impulse ; frequent attacks of vertigo ; dazzling of the 
 eyes ; buzzing in the ears ; attacks of heat towards the head 
 from the sHghtest cause. The tumor of which I have spoken 
 resembled a large cock's comb ; contracted hemorrhoids were 
 situated around it ; and it seemed to have arisen from the pro- 
 lapsus of internal hemorrhoids, which had brought down with 
 them a portion of the mucous membrane of the rectum. The 
 contraction of the sphincter ani had prevented the return of 
 this tumor and had increased its swelling, and the friction of 
 the patient's clothes had caused repeated inflammation and de- 
 generation of its tissue. The base of the tumor occupied more 
 than half the circumference of the anus, and extended above 
 the sphincter ani. It was about six lines in thickness, and its 
 feel was scirrhous ; a sanious discharge exuded from its sur- 
 face, some points of which had even begun to ulcerate. It 
 was, therefore, evident that no time should be lost if it were in- 
 tended to remove this tumor ; the patient was anxious for the 
 operation, and had previously asked several surgeons to perform 
 it ; but the gentlemen had refused on account of the depth to 
 which the diseased tissue extended. By gentle and gradual 
 traction on the tumor I was able to bring it entirely through the 
 sphincter, so as to bring the healthy mucous membrane into 
 view. On the 25th of March, therefore, I comn:.enced its re- 
 moval by an incision in the healthy mucous membrane, and to 
 arrest the severe hemorrhage which ensued, I cauterized the 
 bottom of the wound with a fine heated iron. The tumor was 
 then dissected out, the parts being touched with the actual 
 
1 66 SPERM ATORRHCEA AND IMPOTENCE. 
 
 cautery as they were divided. After the entire removal of the 
 tumor, the greater portion of the wound ascended within the 
 sphincter. Slight inflammatory symptoms supervened, which 
 yielded to bleeding, etc., suppuration was established, and the 
 cicatrization of the wound was completed by degrees. The 
 first few days after the operation the patient was unable to 
 void his urine without the use of the catheter, and for some 
 time afterwards he micturated very frequently. On the first 
 of May, cicatrization was nearly completed, the feces had re- 
 gained their normal consistence and were passed daily without 
 difficulty, their passage no longer giving rise to involuntary 
 spermatic discharge. The patient regained his health and spir- 
 its ; his appetite returned, and his digestion was performed 
 easily ; his strength and stoutness increased daily. About the 
 middle of the month his erections reappeared during the night, 
 and afterwards became more frequent and prolonged ; his 
 cerebral functions followed the same course in their re-estab- 
 lishment ; the dazzling of sight and cerebral congestions dis- 
 appeared ; and M. left the hospital on the 24th of May, per- 
 fectly restored to health. Three years afterwards, when I was 
 summoned to Clermont to preside over a medical inquiry, M. 
 called on me ; I recognized him with difficulty, so much was his 
 countenance changed. It is scarcely necessary for me to say 
 that he had resumed his conjugal duties, and his occupation of 
 concierge. The cicatrix of the anus was thin and soft, and did 
 not interfere with defecation." 
 
 These exceedingly interesting cases are given in detail be- 
 cause I have not had any such cases in my own practice, and 
 other authorities that I have examined fail to give them more 
 than passing mention. Even allowing for the pardonable coloring 
 of an enthusiast Jike Lallemand, it can readily be seen that the 
 
SPERMATORRHCEA AND IMPOTENCE. 167 
 
 rectal troubles described were very important factors in the pro- 
 duction of spermatorrhoea and impotence. 
 
 SPERMATORRHCEA AND IMPOTENCE FROM NARCOTICS AND OTHER 
 
 FORCES. 
 
 Narcotics, such as tobacco, opium, etc., possess a decided 
 influence over the genital function. Tobacco possesses in some 
 cases decidedly irritable qualities and in persons with relaxed 
 genitals may produce increase in the number of pollutions. In- 
 deed in all cases of genital irritation it does an immense deal of 
 harm, but I have never yet met with cases of spermatorrhoea and 
 impotence which were entirely the result of use of this drug. 
 Lallemand gives several. 
 
 " M. S., of Stockholm, short and stout, and of lymphatico-san- 
 guineous temperament, enjoyed excellent health from childhood, 
 until, at the age of sixteen, he entered a tobacco manufactory 
 in May, L835, and was employed in a small room where newly 
 made cigars were dried at a high temperature. At least ten 
 thousand cigars were constantly in the stove. At first M. S. 
 did not suffer any inconvenience, because the doors and win- 
 dows of the drying room were left open; but about the beginning 
 of November he was attacked by headache, which was felt princi- 
 pally behind the ears. This increased by degrees in severity 
 and duration, and by the end of the winter had become con- 
 stant; the patient was neither able to employ himself during the 
 day, nor to sleep by night. Leeches were applied behind the 
 ears, and on the following day he was seized by general indis- 
 position, frequent vomiting, as well before as after meals, dila- 
 tation of the pupils, and constipation. 
 
 " From this time the patient fell into a profound melancholy; 
 
1 68 SPERMATORRHCEA AND IMPOTENCE. 
 
 he became exciteable, timid, and incapable of any serious oc- 
 cupation. A seton was inserted in the nucha and the applica- 
 tion of leeches was repeated. No improvement took place, 
 however, and blisters were applied behind the ears ; these 
 were followed by retention of urine. Soon afterwards, weak- 
 ness of the lower extremities, loss of flesh, and pallidity of the 
 countenance were added to the patient's other symptoms. 
 
 " The mineral springs of Carlsbad and Ems, and the use of 
 sea bathing, with cold douches on the head, relieved the vom- 
 iting, but the other symptoms still continued. In this condi- 
 tion the patient came to consult me in July, 1836. From 
 information received from the medical gentlemen under whose 
 care the patient had been at Stockholm, Paris, etc., I imagined 
 the sea bathing had been the most useful of all means pre- 
 viously tried. 
 
 " I therefore advised M. S. to continue taking salt water 
 baths until the end of the season, and consequently I did not 
 see him again until the beginning of winter, when his weakness 
 was much increased, his headache continued unrelieved, his 
 countenance was pale and livid, his intellect very sluggish, his 
 memory uncertain, his sleep short and broken, with constant 
 drowsiness, the pupils extraordinarily dilated, and vision very 
 imperfect ; in fact the patient seemed to be still laboring under 
 the effects produced by the cigar stove. The pfimary cause of 
 this patient's condition could not be doubted ; but the effects 
 of narcotic poisons usually pass off in a day or two. In this, 
 on the contrary, the headache had been combated by various 
 means for two years. I 'was, therefore, considerably embar- 
 rassed as to what I should advise, when accidentally I saw the 
 patient's urine. I was m.uch surprised to perceive an abundant 
 deposit resembling semen at the bottom of the vessel and on 
 
SPERMATORRHOEA AND IMPOTENCE. 169 
 
 questioning M. S. I learned that although he had never been 
 addicted to masturbation, and had very rarely had sexual in- 
 tercourse, shortly after the symptoms of narcotism first con- 
 fined him to his bed, he had experienced abundant nocturnal 
 pollutions which decreased in frequency, so that he had then 
 only three or four weekly ; he remarked that he was alwavs 
 worse on the following day. At first those pollutions were ac- 
 companied by energetic erections and lascivious dreams ; but 
 these phenomena had greatly diminished and the pollutions 
 were no longer appreciable except by the marks left on the 
 patient's linen. For a long time M. S. had neither exper- 
 ienced venereal desires nor erections, although he was only 
 nineteen years of age. Spa water, iced drinks, cold lotions, 
 etc., having produced no benefit, in the beginning of Decem- 
 ber, I introduced a catheter. The sensibility of the urethra 
 was such that I determined on cauterizing the prostatic sur- 
 face. I had little hope of benefit arising from this operation, 
 but a remarkable effect was produced. From that moment the 
 nocturnal pollutions became more and more distant and the 
 constipation ceased spontaneously. On the tenth day the 
 patient's urine was perfectly transparent, and from that time his 
 headache, which had been unsuccessfully treated for two years, 
 disappeared entirely, his sight became gradually stronger and his 
 pupils contracted, his ideas became clearer, employment was 
 sought and M. S. was soon able to resume his occupation. 
 His virility returned with great energy ; during six months 
 obstinate erections were established every night, and often 
 during the day on the least cause of excitement, but no invol- 
 untary discharges took place. These violent erections arising 
 from the unaccustomed retention of the semen in its reservoirs 
 diminished by degrees, the wants became less imperious and 
 
lyo SPERMATORRHOEA AND IMPOTENCE. 
 
 the functions returned to their normal condition. I have seen 
 M. S. frequently since his recovery, and I am able to state 
 that during two years his health has been perfect. In a letter 
 which I have recently received from him. dated Stockholm, he 
 informs me that the change of climate has not been injurious, 
 that he has never enjoyed better health. He has resumed 
 the habit of smoking, for which he felt insurmountable disgust 
 during his illness." 
 
 *' I have a young man of very nervous temperament at present 
 under my care, in whom nocturnal and diurnal pollutions have 
 brought on pain in the loins, palpitation, difficulty of breathing, 
 etc., symptoms which were supposed to arise from disease oi 
 the spinal cord, cardiac affection, and commencing phthisis. 
 Among the exciting causes of these involuntary discharges, the 
 effects of smoking occupy the chief place. The following is 
 the patient's statement : * At twenty years of age I wished to 
 accustom myself to smoking, but a day never passed without 
 my experiencing complete intoxication, attended with vomiting, 
 vertigo and trembling of the limbs. I continued the habit, 
 however, and I soon began to perceive that my sight became 
 weak and that I lost my memory, my hands shook, and my di- 
 gestion became much disordered. I noticed, also, great de- 
 bility of the genital organs, my erections ceased and at the age 
 of twenty-two I found myself completely impotent.' 
 
 " This patient had rarely practiced masturbation, and had 
 never committed any excesses when he first began to smoke : 
 his health had, previously, been excellent. It is, therefore, 
 evident that the impotence as well as the other symptoms 
 arose from the action of tobacco. Impotence at the age of 
 twenty-two can only be produced by involuntary seminal dis- 
 charges, provided there be no physical disability. In the 
 
SPfeRMAtORRHCEA AND IMPOTENCE. 17I 
 
 present case there was no doubt on the point, the patient hav- 
 ing discovered diurnal and nocturnal pollutions.** 
 
 *' A professor, ^t, thirty, engaged in a new method of tui- 
 tion, had recourse to very strong coffee to keep himself awake, 
 and took eight or ten cups every night. A large quantity of 
 urine was secreted, and micturition was much increased in 
 frequency. After a few weeks the desire to empty the bladder 
 became so frequent and imperious that the patient was obliged 
 to leave his class several times during their meeting. Soon 
 after he suffered from constipation and disordered digestion, 
 attended with great discharge of flatus. His intellect and 
 memory declined, so that he became unable to finish his course 
 of instruction, and sleep had left him entirely, although he had 
 for some time given up taking coffee. 
 
 " On his consulting me, he confessed that he had become 
 completely impotent, after having experienced frequent and 
 abundant nocturnal pollutions, which diminished by degrees, and 
 had not appeared for three months. I found his urine per- 
 fectly transparent, — almost colorless, — and very abundant. 
 There was not the least cloud perceptible, but at the bottom of 
 the vessel there were numerous transparent granules, which 
 left no doubt as to the existence of diurnal pollutions. Cathe- 
 terism showed excessive sensibility of the urethra, especially 
 near the neck of the bladder ; and on this account I performed 
 cauterization. The operation was followed by rapid improve- 
 ment, and a few months afterward the cure was effected by the 
 use of sulphuretted springs.** 
 
 The same author reports cases of spermatorrhoea arising from 
 the use of camphor, ergot, cantharides, iodide of potassium, etc. 
 If these drugs are capable of inducing this disease it must be 
 merely temporary, and a healthy state would be recovered when 
 
1^2 SPERMAtORRHCEA AND IMPOTENCE. 
 
 the effects of the poison had passed away. In my own prac* 
 tice I have not found any such cases. 
 
 CALCULI IN THE PROSTATE GLAND. 
 
 Small concretions occurring in the prostatic ducts excite a 
 degree of irritation sufficient to produce in persons of average 
 health frequent nocturnal, and even diurnal, emissions. The 
 irritation may be even so great as that which exists in com- 
 firmed masturbators. After the concretion has been removed, 
 it may leave behind inflammation and ulceration in the ducts 
 which will keep up, for a length of time, the emissions of sem- 
 inal fluid. 
 
 I know a married man who treated himself for gonorrhoea 
 with a strong solution of acetate of lead. He forced the solu- 
 tion, by injection and pressure with his fingers, to the neck of 
 the bladder. A few moments subsequently he had a curious 
 feeling of distension in the prostatic portion of the urethra. 
 The feeling of distension then changed to a sensation which 
 he said was like a moderate orgasm accompanied with pain. 
 The irritation which this peculiar feeling occasioned was so 
 great that he could not sit still one minute. At night he was 
 troubled with emissions, which were always painful. Micturi- 
 tion was frequent, and at its termination there were violent 
 expulsive movements of the muscles and straining at the 
 neck of the bladder. Two weeks from the time the injection 
 of lead was used, he got up at night to empty his bladder, and 
 after great straining forced out a half-teaspoonful of a material 
 which was hard and gritty and about the consistency of plas- 
 ter. With the passage of the calcareous mass the irritability 
 and pain and emissions ceased. The patient thought that the 
 lead had occasioned a precipitation of calcareous salts in the 
 
SPERMATORRHCEA AND IMPOTENCE. I73 
 
 prostate or ejaculatory ducts, or sinus pocularis, and that this 
 was the whole cause of the trouble. The concretion came 
 undoubtedly from some portion of the prostate. Whether it 
 had anything to do or not with the injection of acetate of lead I 
 am unable to say. 
 
CHAPTER IX. 
 
 DISEASES THAT RESULT FROM SEXUAL EXCESS AND MASTURBA- 
 TION. 
 
 Cerebral Anaemia — Symptoms and Course — Peculiarities of Cerebral Anaemia 
 in connection with Excess — Spasmodic Contraction of Voluntary Muscles 
 in Connection with Anaemia — Termination in White Softening — Signifi- 
 cance of Loss of Memory — Local Paralysis — Effects of Hemorrhage into 
 the Cerebellum — Sclerosis of Nerv^e-Fibres of Cerebellum — Hanging — 
 Concussion of the Spinal Cord — Softening of Spinal Cord — Impotence 
 from Sunstroke. 
 
 CEREBRAL ANAEMIA 
 
 Is of common occurrence among those addicted to masturba- 
 tion and sexual excess. It is more likely to occur in such per- 
 sons when the digestive organs are. out of order and the power 
 of assimilation feeble. Add to these a condition of impover- 
 ished blood and we have all the necessary elements for attacks 
 of cerebral ansemia, which, in such cases, may occur suddenly 
 when the stomach and intestines are distended with gas. 
 
 It is ushered in with vertigo and dimness of vision. The 
 patient may drop suddenly on the floor in a " fainting fit," and 
 become partially or completely insensible. The face is deathly 
 pale, the pupils are dilated, and the pulse thready or altogether 
 absent. In some cases there may be spasmodic contraction for 
 a short duration, — of the voluntary muscles. I have seen these 
 spasms in those who had cerebral anaemia from protracted hem- 
 orrhages. In some cases the patients have what they call a 
 '' lost feeling," which appears with a dazed expression of coun- 
 
SEXUAL EXCESS AND MASTURBATION. l^^ 
 
 tenance, with pallor, and though able to retain the erect or sit- 
 ting position, they are partially unconscious. The effect soon 
 passes off, and the patient seems to be as well as before the 
 attack took place. 
 
 With reference to cerebral anaemia, Jones has the following : 
 " The diagnosis of cerebral anaemia is evidently a point of the 
 highest importance, and one which may, by no means, be always 
 easy. When the face is pale, the scalp cool, the eyes uninjected, 
 the general circulation quiet, when there is no appearance of 
 cerebral excitement but rather of failing power, when the 
 recumbent position affords relief, and the distressing sensations 
 in the head are described as a weight at the vertex, or a feeling 
 of opening and shutting, and as if the top of the head were 
 being lifted off, — the nature of the case is clear. But there 
 may be conditions of the most marked general anaemia or span- 
 semia, in which, of course, the cerebral circulation participates, 
 and yet in which there may arise terapprarily a state of cerebral 
 hyperaemia. By this I mean that though the blood is evidently 
 of very imperfect quality, deficient in solids and in red cells, 
 and that an excess of this blood is sent to the brain above what 
 it ought, under the circumstances, to receive. Nothing is more 
 common than to find anaemic patients complaining of headache 
 from the administration of necessary tonics, because their ner- 
 vous centres have been brought into such a state of hyper- 
 aesthesia by their impaired nutrition that they can hardly toler- 
 ate anything of a stimulant nature. A little excess, therefore, 
 even of spanaemic blood, may cause distress to a feeble brain, 
 which, after it has regained more healthy tone, will bear and be 
 benefited by a larger amount of much better blood. The case 
 is similar to that of the starved man, whose very preservation 
 depends on his being fed most sparingly for some time. 
 
I*j6 SEXUAL EXCESS AND MASTURBATION. 
 
 Cerebral anaemia may terminate in chronic softening of the 
 brain, usually denominated white softening. The affection 
 may commence without any marked attacks of cerebral 
 anaemia. When it arises as a concurrence of venereal excess 
 or masturbation it is usually insidious in its onset. Though I 
 have not seen any cases where the cause was directly attribut- 
 able to these malpractices, there are enough of them on record 
 to make the matter certain. The softening is probably the result 
 (as it is the* cause) of general mal-nutrition, which, owing to 
 the excessive waste of nerve force consequent upon the vice, is 
 first felt in the nerve fibres before it has established itself else- 
 where. One of the first symptoms is a failure of memory. The 
 patient drops in the middle of a sentence and forgets the bal- 
 ance. There is a mental blank for the time being, and only by 
 an immense effort can the conversation be resumed. But it must 
 be remembered that forgetfulness and spasmodic mental blanks 
 are often occasioned by "brain fag" from overtaxed brain, 
 from mental worry, and also from various forms of dyspepsia. 
 It is not safe therefore to attribute the failing mentality in all 
 cases, nor indeed in the majority of cases, to white or chronic 
 softening unless there are other corroborative signs. If there 
 is a diminished sensibility and loss of power in the extremities, 
 together with loss of memory, then we may conclude that the 
 disease is present. Chronic softening of the brain and of the 
 cord are both curable if taken in the early stages. The treat- 
 ment will be described in its proper place further on. 
 
 In addition to the general tonic treatment recommended in 
 chapter XIV patients suffering from anaemia of the brain and 
 cord or softening of a portion of either, arising from excess or 
 masturbation, should receive hypodermic injections of strych- 
 nine -^ff of grain daily unless unpleasant effects are produced 
 
SEXUAL EXCESS AND MASTURBATION. I77 
 
 by the drug. Even when they make the patient uncomfortable 
 a day or two's abatement from the drug may enable him to bear 
 it better afterwards. Small doses of opium have also been 
 recommended, but I should dread the effect on the stomach. 
 Vigorous massage is beneficial in all cases. 
 
 HEMORRHAGE IN THE CEREBELLUM — SCLEROSIS — SOFTENING 
 
 AND CONCUSSION OF THE CORD, ETC. EFFECTS OF 
 
 HANGING, ETC. 
 
 Other diseases of the brain and cord are ushered in and 
 accompanied by frequent ejaculations of seminal fluid. Many 
 of the cases are accompanied by impotence, others develop 
 erotic desires, satyriasis and priapism. Diseases of the cere- 
 bellum are peculiarly liable to induce derangement of the gen- 
 ital functions. Sclerosis of the nerve fibres of the cerebellum 
 is sometimes marked by nocturnal and diurnal emissions and 
 severe cephalalgia referred to the occiput. In one case of par- 
 tial cerebral sclerosis which involved a small portion of the 
 cerebelliim the patient suffered from frequent emissions before 
 any symptoms of cerebral trouble manifested themselves. Co- 
 incident with manifestations of the sclerosis, the pollutions 
 were increased in frequency, and as the disease progressed 
 were of daily and nightly occurrence. The erectile power was 
 good in the early stages and an erection accompanied each 
 emission, but as the disease progressed the patient gradually 
 became impotent, and all power of cohabitation was com- 
 pletely lost. 
 
 Hemorrhage into the cerebellum may produce a similar con- 
 dition ; usually, however, hemorrhage into that portion of the 
 brain causes priapism, a condition which is characterized by 
 constant erection with little or no desire. Serres gives the his- 
 12 
 
178 SEXUAL EXCESS AND MASTURBATIOisf. 
 
 tory of eleven cases of hemorrhage, six of which were affected 
 with priapism. Tumors in the same region have been known 
 to cause priapism in some and in others spermatorrhoea and 
 impotence. 
 
 It is well known that persons who have died from hanging 
 have had seminal emissions during the death struggle. And 
 cases are recorded and well authenticated also, in which tem- 
 porary suspension of the body by means of a rope around the 
 neck has been resorted to by masturbators to produce the 
 orgasm and ejaculation of semen. 
 
 Concussion of the spinal cord has been known to produce 
 persistent priapism in some cases and spermatorrhoea and 
 impotence in others. When the principal seat of injury is 
 located near the genito-spinal center of the cord the latter con- 
 dition will probably prevail. Lallemand relates the case of a 
 French soldier who, while attempting to climb to the room of 
 his mistress, fell a considerable distance to the ground striking 
 on his sacrum. Paralysis of the lower half of the body soon 
 showed itself, and afterwards there was a priapism. His erec- 
 tions were constant. He endeavored by masturbation to 
 relieve the painful distension of the penis, but without avail. 
 He then went to his mistress and thought to relieve himself by 
 intercourse. Though he tired the woman out he obtained no 
 relief. His efforts in every instance failed. He had neither 
 discharge of seminal fluid nor an orgasm while in her com- 
 pany. Still, strange to say, when alone and asleep in his own 
 apartments he had both emissions and pleasurable sensations. 
 
 Acton mentions the case of a young clergyman who was sub- 
 ject to priapism from the slightest irritation. Walking, riding, 
 even the friction of the trowsers would produce erection. Dr. 
 Acton found that the trouble was partly due to a very tight pre- 
 
SEXUAL EXCESS AND MASTURBATION. 1 79 
 
 puce, and by stripping the glans and frequent ablutions the 
 patient was very quickly improved. I have seen a similar case 
 in a clergyman suffering from malaria and slight prostatitis. 
 Whenever he had occasion to make water he had powerful 
 erections which were not relieved by emptying the bladder, but 
 continued for two or three hours afterwards. By a judicious 
 use of bromide of potassium and hot sitz baths he was very 
 much relieved, and when the malaria was cured the priapism 
 ceased. I have also noticed in two cases, where the patients 
 had been indulging their venereal appetites to excess, that a 
 priapism lasting several hours at a time was the commencement 
 of their impotence, but in this variety of priapism there seems 
 to be no loss of desire while the condition lasts, and they 
 indulge themselves at every favorable opportunity. In one of 
 these cases there was no recovery. Progressive locomotor 
 ataxia was at one time supposed to arise from inordinate 
 sexual congress and onanism, but that belief has to a 
 great extent been abandoned. Many cases of the affection 
 occur in persons who have lived temperate lives, and who have 
 shunned excess in every form. However a majority of the 
 patients suffering from locomotor ataxia have spermatorrhoea 
 of a troublesome nature. In the latter stages of the disease 
 there is complete loss of the virile power. In the cases which 
 are preceded by spermatorrhoea the disease is of a more serious 
 nature, is more apt to run a rapid course and reach a fatal 
 termination. 
 
 Other diseases of the spinal cord, such as white softening, 
 tumors, and injuries, such as dislocations and fractures of the 
 vertebrae, implicating the cord, are all accompanied by some 
 disarrangement of the genital functions. In some instances, 
 they are characterized by frequent ejaculations of semen and 
 
l8o SEXUAL EXCESS AND MASTURBATION. 
 
 loss of virility, in others priapism and aspermatism are present. 
 In injuries which produce a certain amount of irritation and 
 inflammation the latter conditions are more likely to be present, 
 while in anaemic conditions, or chronic softening, seminal emis- 
 sions and impotence are usual. Chronic or white softening of 
 the spinal cord may arise as a result of masturbation and sex- 
 ual excess. The nerve fibres of the part affected show first a 
 coagulation of the white substance of Schwann, then segmenta- 
 tion of the nerve fibre, and finally granular degeneration and 
 breaking up of the nerve fibres and softening of the whole part 
 affected. The disease is apt to pass unnoticed until there is 
 more or less loss of power, and some loss of sensation in the 
 lower extremities. In its inception there is diminished sen- 
 sibility in the different portions of the extremities, usually, the 
 toe. The patient feels that the spot is numb, and that the toe, 
 or the spot afi'ected, is not so moveable as it was before the 
 disease. The paralysis becomes more and more marked as the 
 months go by, for it must be borne in mind that the disease 
 runs a very slow course until the paraplegia is complete, and 
 the patient is unable to move his lower extremities or feel any 
 sensation to any extent in them. He is then confined t-o bed. 
 There is retention of urine, and the urine must be drawn off 
 with a catheter two or three times each day. With all possible 
 care exercised in keeping the bladder clean by frequent wash- 
 ings, cystitis is soon developed by the irritating urine, which 
 adds much to the pain and general discomfort of the patient. 
 I had a patient in Charity Hospital a few years ago, who had 
 softening of the cord supposed to be due to excess of one kind 
 or another, who suffered very great pain from his cystitis, 
 which was increased by every washing. Even large doses of 
 morphia failed to relieve him, given by the mouth and hypo^ 
 
SEXUAL EXCESS AND MASTURBATION. l8l 
 
 dermically. I was finally compelled to resort to cystotomy, 
 which afforded a free outlet to the urine, and allowed his blad- 
 der to be washed without causing any special inconvenience. 
 The operation relieved him completely of the pain and dimin- 
 ished the amount of his cystitis to a very appreciable degree. 
 
 SUNSTROKE. 
 
 Sunstroke i« frequently a cause of spermatorrhoea and im- 
 potence. These disorders are more likely to appear in the 
 congestive forms of sunstroke than in that variety character- 
 ized by exhaustion or syncope. The genital derangement 
 shows itself when the headache, vertigo, dimness of vision and 
 other accompaniments of the disease disappear. Soon after 
 the patient begins to exercise, frequent emissions occur which 
 aggravate to a great degree the already existing mental depres- 
 sion. With the emissions there is always a loss of virile power, 
 though the loss is not complete till a later period. In these 
 cases there must be some organic change in the encephalon, 
 the direct result of the coup de soliel, which interferes with the 
 genital functions. This is shown by the persistence of the local 
 affection in spite of all treatment. 
 
 In my own practice I have only met with one case of impo- 
 tence from sunstroke. I have heard, however, of three other 
 cases which were under the care of other physicians. The 
 patient referred to was a man in robust health, full blooded 
 and muscular, a free eater and drinker, and previous to his 
 attack had indulged very freely in sexual intercourse. From 
 his boyhood to the age of thirty-nine (at which time he was in- 
 jured), he had never had the slightest inconvenience or illness 
 from it. At the time the sunstroke occurred his genital func- 
 tions were perfect in their action. Three weeks subsequently, 
 
t82 sexual excess and masturbation. 
 
 when he seemed to have completely recovered from the injury, 
 he attempted cohabitation with his wife, but was not success- 
 ful. Consecutive trials soon convinced him of his complete 
 incapacity for sexual intercourse. When I saw him twelve 
 months afterwards he seemed to be in perfect health, but he 
 had no control over his genitals. Desire was present, just as 
 much as ever, but there was no attempt at erection, and the 
 ordinary methods of treatment availed him but little. 
 
CHAPTER X. 
 
 CONTINENCE. 
 
 Fulfillment of Function Necessary to a Healthy Organization — Impairment 
 of Function as a result of Disease, or Inaction — Results of Suspending 
 the Function of Joints, Muscles, Eyes, etc. — Loss of Sight in Animals 
 Secluded from the Light — Changes in Genital Organs from Continence — 
 Reasons Why Continence is Likely to Cause Spermatorrhoea and Impo- 
 tence — Cases where Impotence Existed Independently of Spermatorrhoea 
 and Latter without Impotence — Where Continence Produces these Dis- 
 eases, and Marriage is not Attainable what Advice Should be Given by 
 the Physician — Responsibility of the Medical Adviser — Novel Aspect of 
 the Case — Views of Clergymen on the Subject and their Advice — Opin- 
 ions of Acton and Others. 
 
 Nature intended that every organ in the human body should 
 perform some special physiological duty. To each atom a task 
 is assigned. The normal action of one part is necessary for 
 the healthy action of another. Though independent in func- 
 tion, the mutual performance of nature's task is necessary for 
 the harmony of the whole. Fulfillment of function is indis- 
 pensable to development, and to the maintainance of a healthy 
 standard. There is no exemption from this law. 
 
 Whenever, through disease or neglect, an organ fails to ac- 
 complish the object for which it was intended, its functions be- 
 come impaired, and may even be altogether destroyed. When 
 the movement of a joint is interfered with by splints, or other 
 surgical appliances, for any great length of time, the synovial 
 fluid diminishes, the smooth surface of the synovial membrane 
 becomes dryer and rougher, and the ligaments become thicker. 
 
184 CONTINENCE. 
 
 The movements of the joint are very much impaired by these 
 changes,and if the immovable condition should be continued for 
 too long a period permanent anchylosis of the joint surface 
 would take place, with entire loss of movement. When m^us- 
 cles are maintained in a quiescent state by paralysis or by me- 
 chanical appliances, the muscular fibriilse undergo fatty degen- 
 eration. Atrophy of the muscle soon follows, with complete 
 loss of the power of contraction. If the eyes are not employed, 
 diminished ocular perception and even total blindness will 
 occur. This is often witnessed in young animals confined in 
 darkened places, or where there is an entire seclusion from 
 light. Fishes living in caves where no light enters lose their 
 sight rapidly. In the tanks of the New York aquarium many 
 of the fishes were rendered blind from the same cause. Most 
 of the old ones had very large opacities of the cornea. 
 
 The genital organs are not exempted from the general law, 
 viz : that the neglect to fulfill a function may be followed by a 
 loss of power to perform that function in a natural manner. It 
 is true that a man may go for years without intercourse, may 
 then marry, and be able to copulate with success ; but such 
 cases are exceptional. The organs of generation were intended 
 for the propagation of the species during adult life, and the 
 performance of their functions in the married state conduces to 
 a healthy condition of mind and body. Every man with a 
 healthy organization should be married before the age of 
 twenty-four. 
 
 Sexual debility is far more frequent among men who marry 
 after the age of thirty-five than it is among those who marry young, 
 and failure occurs earlier. I think it is not advisable for a 
 marriage contract to be made before the age of twenty-four un- 
 less there should exist some special disorder of the genitals 
 
CONTINENCE. 185 
 
 which may be benefited by such a course. The questions may 
 be asked, why define as a limit the age of twenty- four ? Are 
 the genitals not active and ready to fulfill their physiological pur- 
 poses soon after the age of puberty ? It is true that the age of 
 puberty is the commencement of entirely new conditions, and 
 it would be possible for the organs to be employed in the fulfill- 
 ment of their natural function ; but I believe that while the 
 development from youth to young manhood is going on^ 
 while the tissues are in process of development for the more 
 active life of maturer years, sexual intercourse would probably 
 retard that growth and development. When the youth has 
 reached his full growth, then, is the time for him to indulge in 
 legitimate sexual intercourse ;' then the nervous impressions due 
 to repeated orgasms will do little or no harm, unless there is 
 great excess. 
 
 With the boy who has been free from bad habits and who is 
 thoroughly educated as to the necessity of holding the sexual 
 appetite in abeyance up to a certain age, so that he may become 
 a perfect man, there will be little difficulty in preventing im- 
 proper intercourse or legitimate intercourse before the time 
 stated. 
 
 Acton says : " An almost infinite variety of opinion exists 
 on this subject, between the extreme proposition on the one 
 hand, that a young man has, or need have, no sexual desire, at 
 least to any troublesome degree, and consequently need neither 
 take precautions, nor be warned against the danger of exciting 
 his sexual feeHngs ; and the equally extreme doctrine on the 
 other hand, that the sufferings of chastity are such as to justify, 
 or at least to excuse, incontinence. My own opinion is, that 
 where, as is the case with a very large number, a young man's 
 education has been properly watched, and his mind has not 
 
1 86 CONTINENCE. 
 
 been debased by vile practices, it is usually a comparatively 
 easy task to be continent, and requires no great or extraordi- 
 nary effort ; and every year of voluntary effort at chastity 
 renders the task easier by force of habit. That it is an easy 
 task to be continent is only true of those who have been com- 
 paratively pure, in thought, word and deed. How very few of 
 these exist is best known by the priest and physician. The fact 
 is that even with the rarest opportunities for observation in these 
 cases it is almost impossible to define any universal law or ab- 
 solute rule to which every case is amenable. We must at all 
 times be ready to meet, and to change our practice for, the ex- 
 ceptional case, and to give advice which perhaps may be en- 
 tirely opposed to the formulated maxims used in a preceding 
 case. The attempt to make any rule entirely absolute is an ab- 
 surdity which in our practice too many of us commit." 
 
 Lallemand, speaking of continence, says : " There is a con- 
 stant state of orgasm and erotic preoccupation, accompanied 
 with agitation, disquiet, and malaise, an indefinable derange- 
 ment of the functions. This state of distress is seen particu- 
 larly in all young men who have arrived at puberty, and whose 
 innocence has been preserved from any unfortunate initiation. 
 Their disposition becomes soured, impatient and sad. They fall 
 into a state of melancholy, or misanthropy, sometimes become 
 disgusted with life, and are disposed to shed tears without any 
 cause. They seek solitude without any cause in order to dream 
 about the great mystery which absorbs them, about those great 
 unknown passions which cause their blood to boil. They are 
 at the same time apathetic, restless, agitated, and drowsy. Their 
 head is in a state of fermentation, and nevertheless weighed 
 down by a sort of habitual headache. A spontaneous emis- 
 sion or escape which causes this state of plethora to cease, is a 
 
CONTINENCE. 1^7 
 
 true and salutary crisis which, for the moment, re-establishes 
 the equilibrium of the economy." In another chapter the same 
 author continues : " The effects produced by complete pri- 
 vation afford the most certain evidence of the original strength 
 or debility of the genital organs. If they are powerful, such 
 privation proves a kind of torture which may induce the most 
 serious abuses or disorders in all the functions ; if irritable, pro- 
 longed abstinence causes abundant and frequent nocturnal pol- 
 lutions ; if weak, and little developed, such privation is not 
 painful ; the pollutions are rare and in small quantity at first, 
 but still they produce serious effect, and after a time they be- 
 come more and more severe and difficult of cure. 
 
 " These signs of energy, irritability, or weakness in the genital 
 organs, are more certain than those drawn from their external 
 appearance. 
 
 " The patients of whom I am about to speak are all remark- 
 able for the facility with which they support privation from 
 sexual intercourse. 
 
 " Their lives are exemplary in all respects ; not only have they 
 never committed excesses or practiced abuse^ but for the most 
 part they have never had any relations with the opposite sex. 
 In these cases the temptation is " so slight " that to conquer it 
 is not any great merit. Such constant and easy continence 
 is an unfavorable sign when considered in reference to 
 the powers of the genital organs ; and we should much de- 
 ceive ourselves if we adopted, without examination, the ex- 
 planation the patients give of their conduct. They generally 
 attribute their continence to strict morality, to religious princi- 
 ples inculcated in early infancy, or to the effects of good ex- 
 ample ; they omit altogether to mention the little desire they 
 have had to combat. But when such patients wish to break 
 
iBS CONTINENCE. 
 
 their long and easy continence they find themselves completely 
 unable ; not on one occasion only, but habitually ; not under 
 unfavorable circumstances, but during many years of marriage. 
 Such a state of things during the period of the greatest virility 
 completely explains the ease with which they maintained their 
 former long continence. Most of these patients, too, feel a 
 strange presentiment of the catastrophe which awaits them. 
 They have a suspicion of their weakness, and hence they mani- 
 fest an instinctive repugnance to marriage, and hesitate long 
 before they make up their minds to enter that state. 
 
 *'A great facility, then, of supporting absolute continence ought 
 to lead us to suspect want of power in the genital organs as well 
 as diurnal pollutions when nocturnal ones do not occur, because 
 the continued presence of semen will stimulate the least power- 
 ful organs into occasional actiono 
 
 " Let us now see what are the effects of such long continence, 
 especially in these weak individualSo If fatigue be hurt- 
 ful to all organs, so moderate exercise is necessary to them 
 as soon as they are in a condition to act. The generative 
 organs are not beyond the influence of this general law. All 
 surgeons admit that prolonged inaction produces the same effects 
 on the genital organs as on any other ; that is to say, that it 
 diminishes their activity. The inactivity of these organs in 
 children and eunuchs arises from the non-secretion of semen ; 
 no pollutions can therefore arise in such cases, and the health 
 does not become disordered. On the contrary, in the un- 
 mutilated adult want of power can only be attributed to very 
 serious diurnal pollutions, often very difficult of cure. As 
 soon as the evolution of the genitals commences, the testicles 
 begin to act; if their structure be not accidentally injured, they 
 continue to secrete until a very advanced age. This secretion, 
 
COI^TINENCE. I§9 
 
 it is true, may be diminished by the absence of all excitement, 
 direct or indirect, or by momentary weakening of the system, 
 or by the special action of certain medicines ; but it never 
 ceases entirely from the age of puberty to the commencement of 
 old age. Hence results an evident deduction, viz. : that in the 
 absence of all voluntary evacuation the seminal vesicles must 
 become filled more or less rapidly, and after a time must be- 
 come distended ; so that if the secretion be not evacuated in 
 quantity in an open and sudden manner, it must escape by de- 
 grees at periods more or less close and under circumstances 
 which render this evacuation difficult to be ascertained ; in 
 other words, if nocturnal pollutions do not occasionally occur 
 it is because diurnal ones exist. 
 
 " From the numerous cases I have related, it is evident how 
 slow and insidious the progress of this disease may be, and it 
 is remarkable that those who have fallen into the most deplor- 
 able condition, and whose cure has been most difficult, have 
 been precisely such as had supported the disease longest with- 
 out suffering much. In studying the cases attentively it be- 
 comes evident that the disease commences by nocturnal pollu- 
 tions, accompanied by lascivious dreams, energetic erections, 
 and a lively sense of pleasure. But this orgasm diminishes by 
 degrees, and the emissions at last take place without erection 
 or sensation ; such nocturnal pollutions become more rare and 
 sometimes cease entirely, and then the health of the patients 
 becomes seriously and rapidly affected, much to their astonish- 
 ment, as they have no suspicion that diurnal pollutions have 
 been added to the nocturnal ones, and at last have entirely 
 taken their place. By reflecting on the succession of the 
 phenomena in individuals who have done nothing to aggra- 
 vate their condition, and taking into consideration the salutary 
 
tpb CONTINENCE. 
 
 effects which sexual intercourse produced in many of the cases 
 that have come under my notice, it is impossible not to admit 
 that prolonged inaction of the genital organs diminishes the 
 tonic resistance of the ejaculatory ducts, disorders their sensi- 
 bility, and perverts their functions, without being able to pre- 
 vent the formation of semen by the testicles, or its passage 
 into the seminal vesicles. Absolute continence, therefore, ren- 
 ders the expulsion of semen more and more easy in these cases 
 without diminishing its secretion in an equal proportion." 
 
 There is some truth in the above description, but, I think 
 with Acton that it is exaggerated. He says (and his opinion 
 only repeats the opinion of all who have had much to do with 
 the cases) : " It is a matter of every day experience to hear 
 patients complaining that a state of continence after a certain 
 time produces a most irritable condition of the nervous system, 
 so that the individual is unable to settle his mind to anything ; 
 study becomes impossible, the student cannot sit still, sedentary 
 occupations are unbearable, and sexual ideas intrude perpetu- 
 ally on the patient's thoughts. When I listen to this complaint 
 I have little doubt of the confession that is to follow ; a confes- 
 sion that at once explains the symptoms. Of course in such 
 cases I am prepared to learn that the self-prescribed remedy 
 has been most effective, that sexual intercourse has enabled the 
 student to at once recommence his labors, the poet his verses, 
 and the faded imagination of the painter to resume its fervor 
 and brilliancy ; while the writer, who for days has not been 
 able to construct two phrases that he considered readable, has 
 found himself, after relief of the seminal vesicles, in a con- 
 dition to dictate his best performances. In the individuals con- 
 stituted as these are, continence is sure to induce this state of 
 irritability. Still no such symptoms, however feelingly described. 
 
CONti^TENCfe. t^t 
 
 should ever induce a medical man to even seem to sanction his 
 patient's continuing the fatal remedy, which is only perpetuat- 
 ing the disease. In all solemn earnestness I protest against a 
 medical man countenancing such a remedy. It is better for 
 such a youth to live a continent life. The strictly continent 
 suffer little or none of this irritability ; but the incontinent, 
 as soon as seminal plethora occurs, are sure to be troubled in 
 one or other of the modes above spoken of, while the remedy 
 of indulgence, if effective, requires repetition as often as the 
 inconvenience returns. If, instead of gratifying his inclination 
 the young patient should consult a conscientious medical man, 
 he would probably be told and the result would soon prove the 
 correctness of the advice given, that low diet, partial abstinence 
 from meat and stimulants, aperient medicine if necessary, 
 gymnastic exercises, and self control will most effectively re- 
 lieve the symptoms. The truth is that most people, and es- 
 pecially the young, are often only too glad to indulge to find 
 an excuse for indulging their animal propensities, instead of 
 endeavoring to regulate or control them. I have not a doubt 
 that this sexual suffering is often much exaggerated, if not in- 
 vented, for this purpose." 
 
 Van Buren & Keyes on this point also agree that the nervous 
 hypochondria, with despondency, " the excited and suspicious 
 tendencies so marked and remarkable in nearly all men at any 
 time of life in connection with functional or organic trouble in 
 the genito-urinary tracts, are only explicable by recognizing 
 that nature has implanted in man a sexual want which controls 
 many actions of his life, impels him to continue his species, 
 and cries out in distress whenever it is trifled with, ungratified, 
 or: over-stimulated, or whenever its existence seems to be 
 menacedo A man will feel more depressed at seeing a little 
 
■HI 
 
 102 CdNtliSTENCE. 
 
 excess of phosphate in his urine which he thinks, in spite of all 
 proof to the contrary, indicates a " local weakness," than he 
 will at loss of memory or mental incapacity, w^hich he can 
 recognize himself and be fully conscious of. There are few 
 men who would not rather lose a leg or an eye, than a testicle ; 
 while functional or organic disease of the bladder, testicles, or 
 penis, cause more mental inquietude and distress to its pos- 
 sessor than does a cavity in a lung. Why should this be, 
 except that nature has endowed man with an instinct of terror 
 at the idea of losing his sexual capacity, and has established a 
 law for the regular and judicious performance of the sexual 
 ^ct, which he must obey or else suffer in some way the penalty ? 
 This suffering may not be evinced by symptoms in the organs 
 of generation themselves, and probably will not be unless 
 through excitement of those organs by abuse or irregular use, 
 or unless through their stimulation by erotic fancies, the patient 
 attract the morbid nervous tendency to a local explosion. A 
 man perfectly pure in thought and deed would not suffer from 
 vesical neuralgia, unless, of course, some physical lesion of the 
 parts should first occur to excite local congestion. Old maids and 
 priests suffer from sexual distress as much as young and old 
 bachelors and widov»^ers, but they very rarely give any local signs 
 of trouble. Their symptoms may be scattered over all the 
 organs, and may impair any or all of the functions." 
 
 In consideration of subjects of this kind, a medical man 
 must look at facts as they really are, without bias or pre- 
 conception, not as he thinks they ought to be, and while on the 
 main points I believe as Acton does, there are unfortunate 
 cases, where it is impossible to regulate the matter by simply 
 giving advice. We must ascertain first, if the advice can be 
 followed, and if experience teaches that it will not be followed, 
 
CONtiNENCE. 2$3 
 
 then it is our duty to regulate and diminish the amount of 
 immorality indulged in. Many men are by nature polygamous, 
 they will indulge in the gratification of their passions, regard- 
 less of consequences ; when this is the case then proper means 
 should be taken for their guidance, in order that they may not 
 rush into excess, or abuse themselves in a way detrimental to 
 their physical welfare. It is not advisable to say to the unfor- 
 unate possessor of these feelings " you must not indulge at all no 
 matter what the consequences may be," but it is possible to keep 
 the patient controlled by a healthy sexual relation, in the mar- 
 ried state if possible. If that condition cannot be attained, 
 then it is the physician's unpleasant duty to accept the fact and 
 to regulate his illicit intercourse, which he certainly will indulge 
 in, no matter at what risk or consequence. 
 
 If a robust, full blooded man, with a fully developed venereal 
 sense, becomes continent, nocturnal and perhaps diurnal pollu- 
 tions will precede the impotence. Erotic impulses, sometimes 
 amounting almost to satyriasis, may also occur before the 
 virile power is extinguished. The spermatorrhoea is occasioned 
 because the secretion of the testicles, prostate and other 
 glands is manufactured rapidly, and has no natural cause for 
 expulsion. 
 
 The loss of virility may or may not be followed by dimin- 
 ished secretion, and there are cases where the ejaculations of 
 seminal fluid will not occur oftener than once or twice a year. 
 Such cases are exceedingly hard to manage. 
 
 When a man of small animalism is continent for a number 
 of years, what little desire he may have formerly possessed is 
 likely to disappear completely, and the emissions will be 
 infrequent in both classes of patients, with or without sperma- 
 torrhoea, the genital apparatus will ultimately show the relaxation 
 13 
 
194 CONtiNENCfi. 
 
 and other changes that occur as the result of masturbation. In 
 a few instances there is atrophy of the testicles, but it is most 
 unusual in persons under forty-five. 
 
 In this connection the following cases will be of interest, as 
 showing some of the varied results of continence : In the 
 winter of 1876, an undertaker of this city was admitted to St. 
 Francis Hospital, suffering from prolapse of the rectum. He 
 was forty-five years old, and his general health was good. After 
 recovering from the prolapse he informed me that he was 
 impotent, and likewise was subject to nocturnal emissions. 
 During the whole course of his life he had refrained from any 
 gratification of his passions, and had never even attempted 
 sexual intercourse, until within the past year. Twelve months 
 previous to his admission, he had married a lady, thirty-eight 
 years old, and without expecting anything of the kind found 
 himself impotent and unable to consummate the marriage. Every 
 attempt at intromission failed, through weak erections, and 
 rapid emissions of semen. He denied having practiced mastur- 
 bation, and the condition of his genitals seemed to confirm his 
 statement. From the age of twenty-five he had emissions once 
 a fortnight, and frequent erections, but the erections were 
 feeble, and lasted only for a few moments. Since his marriage 
 the emissions had increased in frequency, and there seemed 
 to be much relaxation and apparent elongation of the penis. 
 The patient did not seem to be depressed by the fact of his 
 impotence. He attributed it all to total abstinence, and hoped 
 that, in the course of time, nature would effect a cure. 
 
 I am aware that there are a few cases recorded by Lallemand 
 and others where diseases of the rectum were a cause of 
 temporary impotence, but the patients were not continent, and 
 they recovered from the spermatorrhoea and impotence when 
 
CONTINENCE. I95 
 
 the prolapse was cured. In the patient whose history I 
 have just given, the prolapse of the rectum may have just 
 added to his genital weakness, but I am satisfied that it was 
 not the cause of it. 
 
 A second interesting case of impotence from continence, un- 
 accompanied by spermatorrhoea, came under my care during 
 the winter of 1881. The patient was thirty-eight years old, and 
 a broker by occupation. His general health was excellent, and 
 he was constantly and actively employed in a flourishing busi- 
 ness. He stated that he commenced to masturbate a little when 
 a boy of twelve, and occasionally was guilty of the habit until 
 he reached the age of sixteen, at which time he discontinued it 
 altogether. At twenty he had intercourse in a natural way, and 
 without any difficulty whatever. For six months subsequently, 
 he cohabited at intervals of two weeks, and never at any time 
 indulged to excess. A period of eight years then elapsed with- 
 out any opportunity for sexual congress. At the termination 
 of that period he again attempted to renew his sexual relations 
 with his former partner, but to his great annoyance failed. 
 Though he subsequently made frequent trials, the result was 
 the same. He finally gave up all hope, firmly believing that his 
 impotence was beyond the reach of therapeutical agents. He 
 attributed his loss of virility to continence, and not to any dissi- 
 pation or bad habits in early life. A period of ten years elapsed, 
 during which interval he tried sexual congress but once, and 
 was unsuccessful. He had a few emissions, and few erections, 
 and for twelve months previous to calling at my office, he had 
 had only three emissions, and no erections of any degree of per- 
 manency. He thought his desire for sexual pleasures had not 
 diminished, but the knowledge of his impotence being ever 
 present, would prevent him from attempting it again. Thi? 
 
IBMi 
 
 196 CONTINENCE. 
 
 mental state necessarily complicated his case, and added 
 to the difficulty of a cure. On making an examination of his 
 genital organs, I found the penis and testicles somewhat smaller 
 than natural. The left testicle was smaller than the right, and 
 more than ordinarily sensitive to pressure. Otherwise the parts 
 were unchanged. Knowing that the patient's habits were ex- 
 cellent, and that his general health was good, I made a favor- 
 able prognosis, and put him under treatment. He continued 
 under treatment for three months, improving slowly. His erec- 
 tions were more frequent and natural, and his hopes of final 
 recovery revived. He suddenly, without any notification, ceased 
 his visits at the office, and I saw nothing more of him until the 
 summer following, when he came in as I was about leaving for 
 the country, and with a broad smile on his face said, " Doctor, 
 I have the clap." He then went on to inform me that a few 
 days after he had ceased calling, he renewed his attempt at in- 
 tercourse, and had succeeded, and had kept well in that respect 
 ever since. His gonorrhoea was the result of leaving his mis- 
 tress, and assuming relations with a less reliable woman. These 
 two cases are very good examples of the varieties of impotence 
 by continence, viz : that which is characterized by activity of the 
 secreting organs, and resulting in spermatorrhoea, and that which 
 is accompanied by loss of erection and diminished secretion. 
 Now, the most difficult problem to solve, as already stated, is 
 the best line to follow in the way of treatment. Of course, if 
 the spermatorrhoea and impotence and great nervousness and 
 mental distress which usually attend such cases is the result of 
 continence, then one of the principal things to advise is sexual 
 intercourse, whenever the patient's physical weakness is re- 
 moved and the organs able to fulfill their function. Here the 
 physician is brought face to face with the great moral law, which 
 
CONTINENCE. I97 
 
 is supposed to govern, but which really does not govern civilized 
 Christians. Marriage is in many cases impossible, from lack of 
 means, or inclination, or the presence of an acceptable woman 
 willing to enter into the partnership. It is a difficult matter to 
 determine, while we all acknowledge that a pure life is the best 
 under all circumstances. Here is a man who cannot be cured 
 by legitimate moral means, but can be relieved by 
 breaking a moral law. Acton seems to have been troubled by 
 the same vexatious problem. He says : " It was far from my in- 
 tention when I commenced this work to put myself forward 
 as a religious teacher, but I so frequently receive letters from 
 young men, seeking advice how to cure the lusts of the flesh, 
 that I was induced to inquire as to the views entertained upon 
 the subject by the modern executive of the church of England. 
 I found, on application to competent persons, that it is not 
 deemed expedient to be very diffuse upon the observance of the 
 Seventh Commandment. I was referred, indeed, by one worthy 
 divine to the heads of " Fasts and Vigils," in our offices, but 
 after careful perusal, I was unable to discover much that could 
 be of assistance to the earnest layman desirous of arming liim- 
 self against the promptings of nature and imagination. All the 
 help that one excellent clergyman can give to tempted clergy- 
 men brethren, is this : "Another man is tempted by evil 
 thoughts at night. Let him be directed to cross his arm upon 
 his breast, and extend himself as if he were lying in his coffin. 
 Let him endeavor to think of himself as he will be one day 
 stretched in death. If such solemn thoughts do not drive 
 away evil imaginings, let him r;se from his bed and lie on the 
 floor." 
 
 Going further into the religious aspect of the case, he says : 
 " The Church of Rome, with that practical wisdom which so 
 
■!^ 
 
 198 CONTINENCE. 
 
 often characterizes her, and which no Protestant prejudices 
 should lead us to deny, has in many of her arrangements and 
 in much of her authorized teaching, fully and sympathizingly 
 recognized the great facts of the existence and intensity of 
 sexual misery and temptation, and of the absolute necessity of 
 sexual purity, for those who would reap the blessings of conti- 
 nence." 
 
 The following extracts from the instructions on the com- 
 mandments and sacraments, by St. Alphonsus M. Liguori, 
 are teachings referred to above : " In every sin of thought 
 there are three things, the suggestion, the delectation, and the 
 consent. The suggestion is the first thought of doing an evil 
 action which is presented to the mind. This is no sin; on the 
 contrary, when the will rejects, we merit the reward. Even 
 the saints have been troubled by bad thoughts. To conquer a 
 temptation against chastity, St. Benedict threw himself amongst 
 thorns, St. Peter of Alcantara cast himself into a frozen pool. 
 Even St. Paul writes that he was tempted against purity. 
 After the suggestion comes the delectation, when if the person 
 is not careful to banish the temptation immediately, but stops 
 to reason with it, the thought instantly begins to delight, and 
 thus continues to gain consent of the will. As long as the 
 will withholds the consent, the sin is only venial, and not 
 mortal. But if the soul does not return to God, and make an 
 effort to resist the delectation, the consent will be easily 
 obtained. The soul loses the grace of God, and is con- 
 demned to hell, the instant a person consents to the de- 
 sire of committing sin, or delights to think of the immodest 
 action as if he were committing it. This is called morose 
 delectation, which is different from the sin of desire. He who 
 contract? the h^bit of consenting to bad thoughts, exposes 
 
CONTINENCE. I99 
 
 himself to great danger of dying in sin — first because it is very- 
 easy to commit sins of thought. In a quarter of an hour a 
 person may entertain a thousand bad thoughts. My brother, 
 do not say, as men do, that the sins against chastity are light 
 sins, and that God has compassion on such sins. What I do 
 say is that ' No fornicator hath inheritance in the kingdom of 
 Jesus Christ, and of God.' (Eph. v, 5.) Even the pagans held 
 impurity to be the worst of vices, on account of the bad effects 
 which it produces. Seneca says : * Impurity is the foremost of 
 the world's wickedness,* and Cicero writes : * There is no more 
 heinous pest than the indulgence of uncleanliness.* St. Isodore 
 has written : * Whatsoever sin you name you shall find nothing 
 equal to this crime.' For those who are unable to abstain from 
 impurity, or who are in great danger of falling into it, God has, 
 as St. Paul says, instituted matrimony as a remedy. * But if they 
 do not contain themselves, let them marry, for it is better to 
 marry than to be burnt.' (I. Cor. vii, 9.) But, some may say, 
 father, marriage is a great burden. Who denies it ? But have 
 you heard the words of the apostle : It is better to marry, and 
 to bear this great burden than to burn forever in hell. But do 
 not imagine that, for those who are unwilling or unable to 
 marry, there is no other means but marriage by which they 
 preserve chastity. By the grace of God, and by commending 
 themselves to him, they can conquer all the temptations of hell." 
 " The fifth remedy, which is the most necessary for avoiding 
 sins against chastity, is to fly from sins against chastity, fly 
 from dangerous occasions. Generally speaking, the first of all 
 the means of preserving yourself chaste, is to avoid the occa- 
 sion of sin. According to St. Bernardine, it is a greater miracle 
 not to fall into the occasion of sin than to resuscitate the dead. 
 It is necessary to abstain from reading bad books, and not only 
 
200 CONTINENCE. 
 
 those that are positively obscene, but also of those that treat 
 of profane love. O, fathers ! be careful not to allow your 
 children to read romances. These sometimes do more harm 
 than even obscene books ; they infuse into young persons cer- 
 tain malignant affections which destroy devotion, and after- 
 wards impel them to give themselves up to sin. And here I 
 repeat, do not allow your daughters to be taught letters by a 
 man, though he be a St. Paul or a St. Francis of Assisium." 
 
 So much for the religious aspect of the case. There can be 
 little doubt of the correctness of the advice given, but it does 
 not answer the original question. I presume that it is the duty of 
 the conscientious physician to say to the patients suffering 
 from continence, or the result of continence, that marriage is 
 the only remedy — not promiscuous intercourse — and leave the 
 rest to the patients. My experience is that they have acted as 
 they pleased so soon as they learned that intercourse was one 
 of the essentials to perfect health — while a few get married, the 
 large majority indulge their natural instincts without the for- 
 mality of marriage, and dispense with further advice on the 
 matter. Besides spermatorrhoea and impotence, prolonged 
 continence may give rise to affections of the prostate and 
 bladder. It is at times a cause of the worst forms of satyriasis, 
 and pathophobia. These affections are considered in another 
 chapter. 
 
 Prolonged continence sometimes developes in females all 
 the series of nervous manifestations classed under the head of 
 hysteria. It is also a common cause of nymphomania, (see 
 Chapter VIII.) and of ovarian neuralgia. 
 
 Women do not suffer so much as men do from continence. 
 Indeed the majority of healthy women are not much injured by 
 total abstinence after the age of thirty, and to very many 
 
CONTINENCE. 20I 
 
 sexual intercourse is a source of pain and mortification instead 
 of pleasure. They are not compelled to suffer as men are 
 from the distension of a highly organized set of organs, with a 
 constant secretion, which creates in most men an irritation 
 that certainly injures unless relieved by nocturnal emission or 
 intercourse. The congestion accompanying the menses creates 
 only a temporary excitement and desire, which is relieved at 
 once by the flow of blood. 
 
 The treatment of these cases will be considered in connec- 
 tion with the treatment of spermatorrhoea and impotence. 
 
CHAPTER XI. 
 
 CLASSIFICATION OF CASES FOR TREATMENT, 
 
 Universal Rules which should not be Universal — The Danger of Advising a 
 Single Method of Treatment for all Cases of Spermatorrhoea and Impo- 
 tence without a Special Study of Each Case — Errors in Treatment — Bro- 
 mide of Potassium as a Remedial Agent — Its Effects on the Vascular and 
 Nervous Systems — How it Affects the Digestive Function — Injurious 
 Effects Arising from the Indiscriminate Use of the Drug — Bromide of 
 Potassium as a Cause of Impotence — Cauterization of the Prostatic 
 Portion of the Urethra — Its Universal Use in the Treatment of Sperma- 
 torrhoea — Why a Division of Cases is Necessary — Four Varieties of Sper- 
 matorrhoea and Impotence — Peculiarities Exhibited by Cases of the 1st 
 Class — Cases which are Incurable — Second Variety— Distinguishing 
 Features — Patients Amenable to Treatment — Peculiarities of Third and 
 Fourth Class of Cases — Greater Frequency of the Milder Forms of Sper- 
 matorrhoea and Impotence. 
 
 There is a growing tendency in the modern mind to " make 
 laws as well as to break them." In every department of medi- 
 cine stringent rules are formulated to guide all persons irre- 
 spective of age, sex, hereditary tendencies, idiosyncrasies, occu- 
 pations, sympathies or surroundings. The pathology of a 
 disease is scientifically described. Each symptom pointed out. 
 But just there the discrimination is apt to terminate. A stereo- 
 typed set of remedial agents is recommended for every patient 
 suffering from the disease spoken of. No iraportance seems to 
 be attached to the fact, that " wnatis one man's me^t is another 
 man's poison." It is a general though a fallacious idea that an 
 agent which is beneficial in one case, must necessarily be of 
 utility in every other case of the same nature. It is this which 
 occasions the cry of humbug in medicine. The young prac- 
 
CLASSIFICATION OF CASES FOR TREATMENT. 20^ 
 
 titioner with his first case, follows the prescribed rules — gives 
 his patient the orthodox medicine, and is unsuccessful. His 
 faith is shaken in the authority once revered, and he turns in 
 another direction for a more reliable guide. His second case 
 may, in its results, be a mere repetition of the first, unless that 
 failure has taught him to examine for himself the phenomenal 
 symptoms or characteristics which belong to the individual under 
 treatment. The fault is not in the medicine prescribed, in its 
 quantity or quality. The mistake lies wholly in the neglect of 
 a systematic classification of different forms of the same disease, 
 founded, to some extent, on the peculiar developments and 
 idiosyncrasies of the patient. There are so many remarkable 
 differences in the habits, occupations, and vitality of people, 
 that the treatment successful in one instance may be absolutely 
 injurious in another. Each case demands special study. Each 
 peculiar tendency and sympathy should be contrasted and 
 studied. Occupations and their varied results on the economy 
 should be examined. Previous effects of treatment are always 
 to be considered. Medicines which before failed, or which 
 have produced unpleasant effects on the economy, or for which 
 the patient had a disgust, should never again be repeated. 
 
 Such a classification is particularly necessary in cases of 
 spermatorrhoea and impotence and the special study of each case 
 before treatment is commenced is an imperative necessity. 
 Usually in these cases little or no differentiation is attempted. 
 Any one who takes the trouble to peruse the various text-books 
 and monographs on the subject, will find an arbitrary system of 
 medication adopted. For instance bromide of potassium is 
 recommended to the majority of patients suffering from 
 seminal emissions. Its use is general. But I think the experi- 
 ence of those who have looked beyond the temporary and per- 
 
204 <^MSS1F1CAT10N OP CASES FOR TREATMENT. 
 
 haps only apparent beneficial effects of the drug, will agree with 
 mine. I have no hesitation in saying that its administration in 
 spermatorrhoea and impotence is a source of incalculable injury 
 to the patient. To understand this statement more thoroughly, 
 let us for a moment examine the local and constitutional effects 
 of the drug. 
 
 When given in full medicinal doses for two or three weeks it 
 has a depressing effect on the nerve centers. This is evidenced 
 by the defective memory, dullness of sight and hearing, ten- 
 dency to sleep and weight and fullness about the head. It is 
 known to diminish the supply of blood to the brain and cord and 
 thus aggravate the symptoms mentioned. It is known to im- 
 poverish the blood and prevent assimilation. Few persons can 
 use bromide of potassium for any great length of time without 
 suffering from nausea, and other signs of defective digestion. 
 It impairs, and may altogether destroy, the virility of the patient. 
 Hensle says it produces insensibility of the fauces and torpidity 
 of the genital organs. Many other authorities agree with him. 
 
 Bartholow says with reference to the action of the bromides : 
 " A very notable action of the bromides — chiefly bromide of 
 potassium — is the diminution of the sexual feeling and of the 
 power of the erections produced by it. This fact has been es- 
 tablished by abundant clinical evidence The pallor 
 
 and anaemia of bromism are due to several causes: to the dimin- 
 ished action of the heart, slowness of the capillary circulation, 
 a consequent interference in the metamorphosis of tissue, de- 
 rangement of digestion and assimilation in consequence of gas- 
 tric catarrh, and diminished blood supply to the cerebro-spinal 
 axis, the disorders of voluntary movement, the uncertain gait, 
 the apparent defects of co-ordination, are variously explained, 
 but they are doubtless made up of several factors of which 
 
CLASSiFiCATiON OF CASES FOR TREATMENT. 20^ 
 
 cutaneous anaesthesia is the most influential. The bromides 
 possess the power to destroy or impair the irritability of the 
 motor and sensory nerves, and the contractility of muscle, and 
 to these effects must be attributed in part the disorders of vol- 
 untary motion noted above It is very evident that 
 
 the bromides depress certain organic functions : they diminish 
 the action of the heart, lower the animal temperature, and lessen 
 the blood supply to various organs. These results can only be 
 accomplished by a sedative influence on the sympathetic nervous 
 system. Some observers have maintained that in this action 
 lies all the physiological power of the bromides." 
 
 Little argument is needed to show that the administration of 
 a medicine which in nearly all persons produces the effects men- 
 tioned must necessarily be injurious to patients suffering from 
 the effects of masturbation or sexual excesses. A patient whose 
 nervous system is already anaemic from bad habits and frequent 
 seminal losses certainly does not need a medicine which still more 
 diminishes the quantity of blood going to his brain and spinal 
 cord. When the digestive function is disturbed and the powers 
 of nutrition enfeebled, it is worse than useless to prescribe a drug 
 which causes nausea and vomiting and prevents absorption. 
 If the genital organs are weakened and virile power unequal 
 to the demands upon it, it will not conduce to the benefit of 
 the patient to administer a medicine which has the power of 
 destroying erections. The nerve power, the vitality of all per- 
 sons suffering from spermatorrhoea is much below the normal 
 standard. The bromides by diminishing this force can do no 
 possible good unless indeed on the principle of similia similibus 
 curantur. The reason for the indiscriminate and careless use of 
 this drug is simply because it has the power of diminishing the 
 sensibility of the mucous lining of the urethra, especially of that 
 
2o6 CLASSIFICATION OF CASES FOR TREATMENT. 
 
 portion contained in the prostate gland. In this way it dimin- 
 ishes for a time the number of seminal losses. This temporary 
 improvement in the eyes of the ignorant patient is a positive 
 sign of a permanent curative action. And for the sake solely 
 of this apparent benefit much evil is done and a disturbed 
 and diseased system brought still lower in the scale. 
 
 There are only a very few cases where the administration of 
 the bromides is admissible, and these will be pointed out in 
 another chapter. 
 
 The tendency to pursue a stereotyped course of treatment is 
 also witnessed in the local management of spermatorrhoea. 
 Many years ago Lallemand recommended caustic applications 
 to the prostatic portion of the urethra to diminish the irritabil- 
 ity of the orifices of the ducts which open in this portion of the 
 canal. Since his time caustic applications, both in liquid and 
 solid form, are unusually recommended as the principal local 
 remedies. In the cure of the affection, there can be no doubt 
 that the use of caustic in certain cases is followed by benefi- 
 cial results, and I have myself used them with great benefit. 
 But the majority of patients only receive a temporary relief, 
 which is dearly paid for by the intense suffering from caustic 
 application which invariably ensues. And the discharge of 
 blood and purulent exudation, independently of the pain, 
 add very much to the mental depression of the patient. 
 
 CLASSIFICATION OF CASES. 
 
 A systematic division of all cases of spermatorrhoea can 
 always be made. Each class affords some special indication 
 for treatment which, if employed in another class, would be 
 exceedingly injurious. Not only is this distinction between 
 each class a necessity, but each special case must be studied 
 
CLASSIFICATION Ot* CASES FOR tREATMENt. 207 
 
 thoroughly by itself, without respect to any other case of the 
 same class. Each patient usually presents some peculiarity 
 which requires the physician to vary his treatment in one or two 
 important particulars upon which the permanent relief of the 
 patient may depend. 
 
 The various cases of spermatorrhoea may be divided into 
 four different classes. Though each class will be found to 
 have many symptoms in common, yet there are variations so 
 marked that there will be little difficulty in placing each patient 
 in his proper class for treatment. When this division is made 
 and the characters peculiar to each described, it will be well to 
 give the various local and constitutional measures which have 
 been found useful in all — therapeutical agents which are indi- 
 cated in all, and then point out the special indications which 
 belong to each particular class. 
 
 In the first class the mental derangement is greater than the 
 physical. The mental status approximates more nearly to that 
 of the lower animals than in any other affection short of com- 
 plete insanity. These cases are happily of rare occurrence. 
 
 Patients of this class are found usually between the ages of 
 sixteen and twenty-five. The habit of masturbation commenced 
 in early childhood and was indulged in to excess for many years. 
 The patient does not seek medical advice himself. His parents 
 or friends generally compel him to submit to treatment. He 
 has been warned and instructed carefully as to the evils which 
 surely accompany a persistence in the vile habit. The best 
 directed efforts to show him that the path he is following will 
 eventually terminate in complete destruction of mind and 
 body, give negative results. And though he is fully aware of 
 his debased, hardened condition he persists in self-pol- 
 lution. 
 
2oS CLASSIFICATION OF CASES FOR TREATMENT. 
 
 He accomplishes the act at every opportunity. Alone and in 
 company of friends or strangers he gives rein to his propensi- 
 ties. Every vestige of moral sense seems to have disappeared 
 and he cares only for the sensual gratification which mastur- 
 bation produces. 
 
 This class of patients may or may not be emaciated. I have 
 seen two cases where there was very little loss of flesh. The 
 face has usually a yellowish pallor, and is often covered with 
 pimples. The eyes are restless and wander from one object 
 to another, studiously avoiding the gaze of the examiner. The 
 head hangs down and rests on the chest. He is restless and 
 unable to remain long in one position. He '* slouches" around 
 from one corner to another, dragging his feet slowly along 
 after him as if they were too heavy for his body. When the 
 countenance is at rest he has all the appearance of an imbecile. 
 The hands are placed between the thighs, or are held in the 
 pockets of the pantaloons in close proximity to the genital or- 
 gans. The answers which he gives may have no special bear- 
 ing on the subject under examination. He prefers to answer 
 in monosyllables. "Yes" and "No" are all that can be 
 obtained from him in the way of information. He 
 cannot or will not pronounce a sentence of any length. 
 To get more of his history some harshness is necessary. 
 In fact his mentality is so much below par — so sluggish in 
 its action, that only by great labor can he speak connectively. 
 He may be seen even while undergoing the physician's exami- 
 nation to twist his hands about and so endeavor to bring on an 
 orgasm. Sometimes his public attempts at masturbation seem 
 to be done unconsciously. The mind losing sight of the fact 
 that persons are around him, is occupied by the one controlling 
 desire, a desire which absorbs every faculty of his being. 
 
CLASSIFICATION OF CASES FOR TREATMENT. 20^ 
 
 In all such cases there is no will-power left to assist the 
 efforts of the physician in promoting a cure. A favorable 
 termination of the disease is almost impossible. An unfavor- 
 able prognosis should always be given. If, however, the patient 
 is less than eighteen when brought under observation, the treat- 
 ment may not be altogether without favorable results. The 
 young have great power of reaction, and if means are employed 
 to keep the act of masturbation from being committed for a few 
 months, and efforts made to build up the patient, a cure may 
 be effected. The close and constant supervision which is 
 necessary for this result, however, is rarely attainable. To show 
 this, I will relate the case of a young man, a resident of New 
 York, and the son of a wealthy citizen, who masturbated him- 
 self into insanity, and into an early grave. His nurse taught 
 him to masturbate when he was but five years of age. He fol- 
 lowed the vicious instructions of his teacher until he was six- 
 teen years old, at which time the whole household became 
 horrified at his public attempts at self-pollution. He titillated 
 his genital organs in the presence of both male and female 
 members of his family. Prayers and threats were equally un- 
 availing in changing the current of his thoughts or suppressing 
 the habit. He was watched night and day by faithful servants, 
 but he still managed to masturbate by means of bedclothes and 
 peculiar twisting motions of his body and limbs. His hands 
 were tied and his genitals blistered, but yet he twisted and con- 
 torted until he produced emissions. Finally he was placed in 
 a warm room without clothing and with little bed furniture, and 
 made to lie with his hands and feet fastened. He was fed and 
 washed by the servants who never left him alone for a moment. 
 Under this harsh treatment he was prevented for a few weeks 
 from indulging his vicious propensities. The physician then 
 14 
 
2i6 CLASSIFICATION OF CASES FOR TREATMENT. 
 
 thought that by placing him in a room with a prepossessing 
 female, he might be led to turn his sensual devices into their 
 natural channel. The questionable advice was followed, a hand- 
 some nyjnph du pave was obtained and placed by his side. 
 Every restraint was removed and developments awaited. It is 
 hardly necessary to say that the experiment failed ; for at the 
 very moment the patient's hands were freed he commenced 
 masturbating with redoubled energy. He paid no attention 
 whatever to the female by his side. 
 
 A few months subsequently epilepsy and insanity supervened, 
 and death finally relieved him of his malady. 
 
 Patients of the second class are generally found between the 
 ages of eighteen and twenty-five. The habit begins a short time 
 before the development of puberty, and continues until years 
 of discretion are reached. The patient will tell you that every 
 night he has emissions which are seldom accompanied by pleas- 
 urable sensations. Under the influence of strong excitement, he 
 may have in the daytime emissions without erections. He is un- 
 able to complete sexual congress, intromission being prevented 
 by feeble erections and premature expulsion of seminal fluid. 
 
 His mind continually dwells on his affliction, and he is un- 
 able to concentrate his attention on any other subject. All the 
 minutiae of the dreams are continually before him. He suffers 
 from vertigo, dimness of vision, backache, headache, loss of 
 appetite, constipation, palpitation of the heart and great de- 
 pression of spirits. He is restless at night and troubled with 
 frequent nightmares. His sleep is broken, and when he rises 
 in the morning he feels unrefreshed and tired out. His condi- 
 tion is made worse by exaggerating the symptoms, and continu- 
 ally dwelling upon them. His countenance is indicative of 
 anxiety and physical weakness. There is a haggard look about 
 
CLASSIFICATION OF CASES FOR TREATMENT. 211 
 
 him which expresses the mental anguish in a striking manner. 
 Sometimes patients of this class have a phthisical appearance 
 without phthisis being present. If the genital organs are ex- 
 amined they will be found to have decreased in size. The penis 
 is bent laterally. The veins are enlarged and appear prominently 
 through the integumental covering of the organ. The scrotum 
 is relaxed and cold. The testicles are small and hang much 
 lower than they do in a healthy state. They are soft and ten- 
 der on slight pressure. A varicose condition of the sper- 
 matic cord is almost always present. A sound introduced into 
 the urethal canal will not give rise to any special unpleasant 
 sensations until the prostatic portion is reached. At this point 
 the patient will complain of intense pain, and a desire to uri- 
 nate. The pain may be so severe as to make him cry out, and 
 he will beg to be excused from any further examination. I 
 regard this sign as indicative of excessive masturbation or of pro- 
 longed or inordinate sexual indulgence. Even when patients 
 deny m tne most emphatic manner that they have been guilty 
 of the vice, the pain excited in the prostatic portion of the 
 urethra by the sound assures me that they have spoken falsely. 
 Occasionally the removal of the sound will be followed by a few 
 drops of a viscid fluid, opaque in character which the patient 
 calls semen. It is not semen^ but merely the secretion from 
 the gland pressed out by the contraction of the muscular fibres 
 as the sound is withdrawn. Following the passage of the sound 
 there is a scalding sensation during and after micturition, and 
 frequent desire to micturate. At the termination of the act 
 more of the secretion previously mentioned appears at the 
 meatus. It is also present from straining at stool, horseback 
 exercise, or other acts which cause the muscular fibres around 
 the neck of the bladder to contract. 
 
212 CLASSIFICATION OF CASES FOR TREATMENT. 
 
 Though the health of the patient is impaired, and the will 
 power weakened, there is usually enough intelligence and man- 
 hood left to appreciate the situation, and sufficient firmness left 
 to make him cease from onanistic exercise, and the careful 
 practitioner can generally promise a positive cure if the habit 
 has been abandoned and all the hygienic and medicinal mea- 
 sures carried out as he has directed. 
 
 Patients of the third class are more numerous than either 
 of the preceding. Every practitioner has met with numbers of 
 such cases. There is nothing alarming in their condition, yet 
 their mental distress calls for the same judicious care and man- 
 agement demanded by patients of the second class. Patients 
 of this class commence masturbating at an early age, and con- 
 tinue it at greater or lesser intervals for five or six years. At 
 sixteen or seventeen they are awakened to the dangers of the 
 course they are pursuing, and they discontinue the habit at once, 
 or indulge in it at much longer intervals of time, as little harm 
 harm results. Two or three months subsequent to the cessation 
 of the habit, involuntary seminal losses commence. At first 
 they occur perhaps once in a week, but as the patient grows older 
 and the sexual organs become the seat of increased excitement 
 from associations with women, the emissions increase in 
 number, while at the age of twenty, or thereabout, they occur 
 three or four times each week ; or, as is sometimes the case, 
 two or even three emissions may occur in a single night, and 
 then not again for seven or eight days, when the double emis- 
 sions again appear. He is sometimes able to have sexual inter- 
 course, but the intercourse is rarely satisfactory from sudden 
 ejaculation. The involuntary emissions cease while the passions 
 are indulged in a natural manner, but they re-appear when 
 the intercourse has ceased. The patient soon becomes very 
 
CLASSIFICATION OF CASES FOR TREATMENT. 213 
 
 nervous about his health. Every trouble is magnified. Every 
 little nervous sensation about the genitals is magnified into some- 
 thing fatal to his virility. His desires are stronger than ever, 
 he is easily excited by the presence of a pretty woman, and he 
 can scarcely help showing the lust of his mind. ■ The genital 
 organs are' relaxed, but the penis and testicles are of a normal 
 size. The passage of the sound produces a little pain, not 
 nearly so intense, however, as in the cases previously mentioned. 
 There is nothing in the countenance of the person to show that 
 he has ever indulged in any self-pollution, or was subject to 
 involuntary seminal losses. In light-complexioned persons 
 there may be a dark ring around the eyes, but as this is also a 
 sign accompanying over-indulgence in sexual intercourse, it has 
 no special significance. 
 
 These patients are active, but they are often troubled with 
 palpitation of the heart. They are also apt to be short- 
 winded after exercise of an active nature. 
 
 The mental distress is the worst symptom they exhibit, and 
 the hardest to get rid of. All the evils that it is possible to be- 
 fall them are constantly talked about. They read everything 
 written on the subject of spermatorrhoea and impotence and 
 have found in themselves every symptom of the worst cases 
 mentioned. Partial, and even complete, loss of virility may 
 finally ensue. 
 
 All cases of this class can be cured in a short space of time, 
 and with very little trouble. In fact many of them recover 
 without any medical treatment whatever. 
 
 Patients belonging to the fourth class are found more fre- 
 quently among married than among single men. I will take the 
 case first of the single man : He has not indulged to excess 
 in sexual intercourse, nor has he ever masturbated. His habits 
 
214 CLASSIFICATION OF CASES FOR TREATMENT. 
 
 are usually regular. He has a highly developed nervous or- 
 ganization, but usually enjoys excellent health. When his gen- 
 ital organs are matured and his venereal sense fully developed, 
 seminal emissions occur once, or perhaps twice in a fortnight. 
 He becomes intensely excited when he thinks of sexual inter- 
 course, and when his desires culminate he finds that his great 
 nervous excitement prevents the accomplishment of the act. 
 The depression of mind that follows the first failure makes 
 failure certain in the second attempt. He becomes the victim 
 of mental impotence, and in a state of great depression consults 
 his physician. His first visit to the physician will either help to 
 fix the disease upon him for months or will secure him from any 
 further anxiety. 
 
 The married patient, like the preceding, has not been guilty 
 of excesses. He has a highly developed nervous organization. 
 During the occurrence of some trouble which depresses his ner- 
 vous system, he fails in the performance of his sexual function. 
 The first failure is the progenitor of a series of failures. He 
 imagines that continence will do him good. The only result 
 from this procedure is the development of seminal emissions 
 which, in the course of time, may be so frequent as to under- 
 mine the patient's health. 
 
 It is only in rare instances that the physician can obtain 
 from patients of this class any history of masturbation or sex- 
 ual excess. Local and general examinations would give nega- 
 tive results on that point. Yet their condition is very bad. 
 Their mental anxiety is great ; indeed, it may be as distressing 
 as in patients of the second class. The mind alone is at fault, 
 and mental influence brought to bear upon them in a judicious 
 manner is the essential part of the treatment. With judicious 
 management they usually recover. 
 
CHAPTER XII. 
 
 CONSTITUTIONAL TREATMENT OF SPERMATORRHOEA, IMPO- 
 TENCE, AND ALLIED DISEASES. 
 
 General Debility, a Leading Feature in the Majority of cases — A Special 
 diet necessary for each patient — How to select a suitable diet — Cases in 
 which the number of meals should be increased — Condition of the Genital 
 Organs not to be considered in selecting food — Nutritious Articles not to 
 be set aside because they have a tendency to excite the Genitals — Eggs, 
 Oysters, Clams, Raw Beef, Broths, Gluten, Cracked Wheat, Cream, Milk, 
 etc., Essential Articles — Digestible Salads — Method of preparing Raw 
 Beef — Quantity of food for each meal — Incompatible mixtures of food in 
 the stomach, and their effects — Rules for the selection of compatibles — 
 Food that should be eaten — Food that should be excluded from the bill of 
 fare — Meat not to be eaten with milk — Other Incompatibles — No lard or 
 pork to be used in cooking — Mild wines permitted in the treatment. 
 
 Nearly every case of spermatorrhoea and impotence exhibits 
 marked evidence of depraved nutrition. Constitutional treat- 
 ment is consequently as much of a necessity as local treatment. 
 Indeed many cases may be cured by constitutional treatment 
 alone, by strict attention to all the known hygienic rules, by a 
 nutritious regimen, and moderate use of tonic medicines. 
 When the organs which regulate absorption and assimilation 
 are brought to a healthy working standard, then, and only 
 then is there a prospect of a favorable issue. Therapeutical 
 agents which regulate the action of the alimentary canal, skin 
 and kidneys, and give tone to the system, are of much value in 
 the treatment of spermatorrhoea and impotence, but they too 
 can sometimes be dispensed with, if nutritious food is carefully 
 and judiciously selected. A suitable diet regulated by the 
 
2l6 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 wants of the patient will always do more towards accomplishing 
 a cure than will the best selected medicinal agent, without such 
 attention to diet. 
 
 A few questions from the physician will soon determine the 
 variety of food which will agree or disagree with the patient. 
 Having obtained this important information as the first regular 
 step in the course of treatment, it will be well to exclude from 
 the mind any anxiety respecting the morbid condition of the 
 genital organs, or the effects which the food will have on the 
 secretions of these organs, or the changes it may excite in their 
 working capacity. The aim should be to build up the patient 
 irrespective of every other object. I am particular in impress- 
 ing this point because some authorities condemn articles of food 
 on account of their supposed tendency to increase seminal 
 emissions. They believe in excluding everything which dis- 
 plays a tendency to stimulate the secretion of the testicles or 
 promote erections. Now the most nutritious elements of food 
 effect this result. In fact everything that increases the vitality 
 of the patient stimulates and gives tone to the genital organs. 
 The stimulation is not abnormal. It is not an increase in the 
 already existing irritation. It is a development of a normal 
 power, a renewal of strength and functional activity, which is 
 the end and aim of all methods of treatment. And it is of lit- 
 tle consequence that a few additional emissions occur 
 at the commencement. As the case progresses and approaches 
 a favorable termination the number of emissions will be much 
 diminished. No greater mistake has ever been made in the treat- 
 ment of spermatorrhoea and impotence than to recommend a 
 diet or a medicine which will not stimulate or give tone to the 
 organs of procreation. Such depleting diet is ordered for the 
 same reason that bromide of potassium is given, viz., to diminish 
 
CONSTITUTIONAL TREATMENT OF IMPOTENCE. 217 
 
 the ejaculations of semen, to relieve a symptom at the expense 
 of the vitality of the patient. 
 
 Eggs, oysters, milk, cream, raw beef, chicken, strong broths, 
 thickened with barley, cracked wheat, oat meal, etc., should 
 be ordered to be taken frequently and in such quantities as 
 will suit the digestive force of the patient. One person can 
 assimilate a much larger quantity of food than another, and it 
 is safe to assume that whenever uncomfortable sensations are 
 excited in the stomach by a meal that either the quantity of 
 food is too great or that it is not the kind of food which is 
 suitable for the patient. In cases where the vitality is much 
 impaired, as in the first two classes mentioned in the previous 
 chapter, it will not do to confine the patient to the ordinary 
 system of three meals each day. The stomach will not prepare 
 such an amount for absorption, and much of the food taken 
 will pass out undigested or unchanged. Instead of three large 
 meals in twenty-four hours, the patient should have six or 
 seven small ones. Dividing the eating hours in this way the 
 stomach will be enabled to take up far more of the nutritive 
 elements of the food than in any other way. 
 
 For several years I have pursued about the same plan of 
 treatment in these cases as I do in phthisis, giving only that 
 variety of food which can best be assimilated. There are 
 many different articles of diet taken into the stomach which 
 are entirely incompatible, and which, by the peculiar changes 
 produced in each other by the digestive reagents, and their own 
 peculiar ingredients, retard, rather than assist, digestion and 
 assimilation. With a little care, both the quality and quantity 
 of food best suited to the peculiar needs of the patient are 
 easily ascertained, and the patient is then put in the best possi- 
 ble condition to begin his fight for restoration to health. L^t 
 
2l8 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 US see first what kind of food should not be eaten, and what 
 ingredients employed in cooking should be left out. 
 
 Neither lard nor pork should be used in cooking. Fresh 
 beef suet, or melted butter, should be employed instead. Of 
 the two, the beef suet is preferable to the butter. Smoked food 
 of all kinds is injurious. Fresh bread, pastries, hot puddings, 
 are also to be left from the bill of fare. Fried oysters should 
 be avoided. Any fried food is objectionable. Salt fish and 
 meats, pickles, olives, cheese, and bananas should not be eaten. 
 Milk and flesh food should never be taken at the same time. 
 Two hours should elapse after a meal where meat of any kind 
 is served, before milk is taken. When fresh meat is served, 
 butter on bread or otherwise is prohibited. No oily substance 
 of any kind should be employed in cooking a steak, or in mak- 
 ing a gravy for it. It should be broiled only. All soups should 
 be cooked the day before they are used, and all the fat skimmed 
 off before serving. All fruit eaten should be cooked, with the 
 exception of oranges and grapes. 
 
 Mustard may be used ad libitum with all kinds of meats. 
 
 Salads may be eaten at any meal. Among the salads which, 
 curiously enough, agree with delicate stomachs, is a salad made 
 from the inner leaves of red cabbage, dressed with oil, salt, 
 pepper, and vinegar if desired. The oil must be absolutely 
 pure olive oil, and should be put on the leaves first. Ordinary 
 field lettuce, carefully dressed, is also a desirable article of 
 diet. Potato salad may be eaten with lunch. If the onions 
 in it are objectionable they may be left out, and celery salt 
 substituted. Another salad that suits some may be made of 
 good Florida oranges. Take good oranges, peel and slice and 
 free from seeds. Add oil and salt and a quantity of cayenne 
 pepper. 
 
dONStltUtlONAL TREATMENT Of IMPOTENCE. :^I9 
 
 The best bread to use is Graham bread, and it should be at 
 least one day old before being eaten. Pumpernikle bread is 
 also good for a change. 
 
 Jellies contain very little that is nourishing, and as a rule 
 should not be used. There is one exception, however, to this 
 rule, and that is cranberry jelly ; this is both nutritious and 
 palatable, and assists the digestive process. 
 
 Boiled cereals of all varieties may be eaten cold or warm, 
 with sweet cream, or syrups that are made of melted cane, or 
 maple sugar. 
 
 Beef and mutton are preferable to lamb or veal — the latter 
 may be left out of the bill of fare. 
 
 Fresh fish of all varieties eaten with rice or other boiled 
 cereals, can be generally easily digested by the most delicate 
 stomach. 
 
 As a sample of the method by which some ordinary forms of 
 solid food may be prepared so as to suit the digestive apparatus 
 of a person much debilitated by excess or disease, I give the 
 following : If mutton or lamb chops or chicken is desirable, 
 the chops or the chicken should be put in the pan, with just 
 enough water to cover them. Cook thoroughly, in the meantime 
 sprinkle a little salt and pepper. Take out the chops, and add 
 to the liquid, butter, and a little flour, and curry powder. Boil 
 some rice in salted water, and add to this the gravy in the dish. 
 Chops cooked in this manner form a most savory, palatable, 
 and digestible dish. 
 
 I am accustomed to order the first meal to be taken in the 
 morning as early as half-past six or seven o'clock, even if the 
 patient does not rise to eat it, but takes it in bed. I do this 
 because the second sleep in the early morning, if allowed to 
 run on to eight or nine without disturbance, is liable to make a 
 
226 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 marked difference in the feeling of congestion which most of 
 these patients experience about their genitals, at that time, 
 especially if they have not had an emission during the night. 
 If they wake early, and get a reasonably good meal, and their 
 circulation is equalized, there is less tendency to local con- 
 gestion. The morning meal may consist of clam stew, a very 
 palatable article for weak stomachs, and a couple of soft boiled 
 eggs, with a plate of wheaten grits and cream, or oatmeal and 
 cream, and a pint of milk, fresh from the cow. The watered 
 milk will not answer in these cases. Sometimes I order a raw 
 egg dropped in iced water, or iced milk, before the cereals, 
 with perhaps a cup of weak coffee, or English breakfast tea. 
 If chops are desirable, I order them as above, to be preceded 
 by oranges or other suitable fruits. Let the patient take tea or 
 coffee instead of milk or plain water. 
 
 After breakfast a brisk walk should be taken for about half 
 an hour. If the weather is bad the walking can be done in- 
 doors. If much fatigue is experienced from half an hour's 
 walk, the time may be shortened. 
 
 At eleven a. m. the patient can have one or two raw beef 
 sandwiches, with a cup of weak tea or hot milk. The raw 
 beef should be carefully prepared by taking a tender steak, 
 freeing it from fat, and then scraping it with a knife until the 
 red pulp of the meat is separated from its cellular tissue. This 
 pulp includes all the nutritious elements of the beef, and con- 
 tains nothing that is not easily digested. Indeed it is the most 
 nutritious and most easily digested article of diet that I am 
 acquainted with. When prepared with a little salt it is exceed- 
 ingly palatable. There is nothing in its taste then, to remind 
 the patient of unprepared raw beef. There is some of the taste 
 of raw beef in badly cooked meat, none in the really raw 
 
CONSTITUTIONAL TREATMENT OF IMPOTENCE. 22 1 
 
 meat. I have given it to infants suffering from cholera 
 infantum, with good effect. It is often retained in these cases 
 when food in any other form is vomited. 
 
 If the patient cannot take this meat in the form of a sandwich, 
 it can be given in teaspoonful doses five or six times each day. 
 
 At two o'clock the heaviest meal of the day is to be taken. 
 A full meal in the evening is not admissible. The dinner may 
 consist of mutton broth, thickened with barley or pea-soup, 
 with some of the marrow of the beef bones mixed with it, fol- 
 lowed by chops or broiled chicken or beef. Broiled meats are 
 always to be preferred. Fried fish maybe substituted for meat 
 or added to the bill of fare. Vegetables, such as potatoes, 
 beans, peas and spinach, are generally beneficial. Asparagus, 
 beets, onions and carrots are not to be used unless the patient 
 has some special desire for them. For dessert, rice or tapioca 
 pudding will be necessary. All the ordinary forms of pastry 
 should be excluded. Fruit, such as apples, pears and peaches 
 are to be indulged in sparingly. When the stomach has regained 
 some of its lost tone, they may be given in greater quantities. 
 
 With the dinner, a small bottle of claret or a glass of sherry 
 may be taken. I am aware that in prescribing any form of 
 of alcoholic stimulus, I am running counter to the advice of 
 many in the profession, who consider total abstinence from all 
 stimulants a desideratum in the treatment of every form of 
 spermatorrhoea. They oppose the use of stimulants for the 
 same reason that they object to oysters and other articles of 
 diet which are said to increase the activity of the genital ap- 
 paratus. My experience, however, has taught me that a mild 
 stimulant in the form of claret, taken at dinner or at intervals 
 during the afternoon, is an indispensable adjuvant in the treat- 
 ment of the patients belonging to the first two classes of cases. 
 
222 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 It assists digestion, gives tone to the stomach, and limits the 
 nervous depression ; and owing to its astringency it must have 
 some effect in diminishing the secretion of the glands connected 
 with the genitals. I have never seen it display a tendency to 
 increase either the nocturnal or diurnal pollutions. Even if 
 the emissions were temporarily increased by its use I should 
 not hesitate to give it, for I regard its assistance in strengthen- 
 ing the patient as more than compensating for any seminal 
 losses which its general stimulating action might produce. 
 There are other drinks which may be used with benefit besides 
 claret. Pilsner lager is often relished and readily digested. 
 ApoUinaris and imported seltzers may also be employed in- 
 stead of plain water. Sweet cider is not objectionable. Beef 
 tea made in a bottle, bouillion, and hot milk are both pleasant 
 and nutritious. 
 
 The lightest meal of the day should be taken in the evening. 
 Nothing in the shape of food should be taken after that meal 
 unless the patient is in a very low state. The meal should be 
 served at six, in order that the principal part of the digestive 
 process may be completed before the patient retires to bed. 
 
 For supper the patient may eat a few raw oysters, stewed 
 clams, a little cold chicken or boiled rice. A cup of tea and 
 toast will suffice for many, and will be much better than a 
 heavier meal. Some get along very well with bread and a glass 
 of milk for the evening meal. If the milk seems to disagree 
 with the stomach, a tablespoonful or two of lime water should 
 be added to the goblet of it before using. It makes no differ- 
 ence whether the sensation of hunger ceases or not from the 
 food taken into the stomach. The quantity of food must be 
 less than that taken at any other period of the day. A patient 
 will sleep better with the stomach comparatively empty, than 
 
CONSTITUTIONAL tREATMENT OF IMPOTENCE. i2^ 
 
 with a full meal. A hearty meal in the evening makes the di- 
 gestive function active and continues it into the hours neces- 
 sary for sleep, and is consequently provocative of unpleasant 
 dreams, restlessness, insomnia, and seminal emissions. 
 
 Liquids of all kinds should be abstained from after the six 
 o'clock meal, unless the patient be very feverish and thirsty. 
 The less water the bladder has to throw off during the night 
 the better. When the bladder is distended the congestion about 
 the prostate and other parts is increased, and emissions are 
 more Hable to take place. If a drink is necessary, a cup of hot 
 milk or hot water will be found to answer. It excites the action 
 of the perspiratory glands, takes some of the work away from 
 the bladder, and assists in relieving congestion. 
 
 All spices or spiced food is apt to exert an injurious effect in 
 spermatorrhoea. Spices of all kinds stimulate the genital 
 organs, without giving any nourishment to the system. 
 
 Coffee is more injurious than tea. In many cases coffee 
 may have to be dispensed with altogether, but, as before stated, 
 it may be given largely diluted. When there is a choice the 
 preference should be given to tea. 
 
CHAPTER XIII. 
 
 TENCE, AND ALLIED DISEASES. 
 
 Condition of the Bowels in Spermatorrhoea — Scanty Secretion — Diminished 
 Peristaltic Action — Why Cathartics are Contra-indicated — Effects of 
 Constipation in Increasing the Number of Seminal Emissions — Semen 
 Evacuated at Stool — Cases in which Small Doses of Calomel may be 
 Employed — Action of Belladonna and Physostigma on the Bowels — Injec- 
 tions of Oil into the Rectum — Cold Water Enemata the Best Remedy for 
 Constipation in Spermatorrhoea — Local Effects of the Injection — Cold 
 Water Bathing — Various Methods of Employing Cold Water in the 
 Treatment of Spermatorrhoea and Impotence — Cold Sponge Bath — Sitz 
 Bath— Shower Bath— Rubbing Bath— Cold Douche Bath— Sea Bath- 
 ing — Temperature of Bath for Weak and Nervous Patients — Local and 
 General Effects of the Bath — Sleep and Exercise. 
 
 All patients suffering from spermatorrhoea and impotence are 
 likewise subject to constipation. The disease is characterized 
 by a lack of secretion in the intestinal glands and by diminished 
 peristaltic action of the intestinal muscular fibres. As a conse- 
 quence the fecal evacuations are extremely hard and infrequent. 
 They are usually accompanied by violent straining efforts which 
 cause great distress. In many instances the fecal matter 
 accumulates in large quantities in the rectum, presses upon the 
 vesiculge seminales and prostate gland, occasioning consid- 
 erable irritation. This irritation invariably increases the fre- 
 quency of the seminal emissions. 
 
 This fecal mass must be removed, and the lethargic condition 
 of the bowels changed to an active and normal one, at the 
 beginning of the treatment. Healthy and regular fecal evacua- 
 
CONSTiTUTiONAL TREATMENT OF iMPOtENC£. 225 
 
 tions must be promoted, or the remedies for the cure of the 
 original disease will be almost useless. For patients belonging 
 to the first and second classes, cathartics are not 
 admissible. For patients belonging to the third 
 and fourth classes, mild cathartics are generally 
 beneficial. When cathartics are administered to debilitated 
 patients, they increase the relaxation which already obtains, and 
 diminish the strength. To persons who can bear the medicine, 
 and who are subject to bilious attacks, I usually prescribe 
 eight grains of calomel or double doses of two grains. Each 
 two grain powder may be taken at intervals of five hours. The 
 morning after, a glass or two of Kissengen (or any other 
 cathartic water) may be taken, the Kissengen, however, being 
 the most effective and desirable. The mineral water should be 
 continued for three or four weeks, in sufficient quantities to 
 produce regular evacuations from the alimentary canal. It is 
 essential to establish the habit of moving the bowels every 
 morning. And the patient should attempt to evacuate the con- 
 tents of the intestines every day at a certain hour, whether the 
 inclination to do so is present or not. If this plan is continued, 
 good results will certainly follow. 
 
 In some cases, I found compound rhubarb pills to act with 
 excellent effect, being useful for patients belonging to the 
 third and fourth classes. It is not necessary to give a full 
 cathartic dose of these pills. One pill each night, or every 
 other night, will gradually bring about the desired effect. If 
 one pill at night should produce more than one evacuation 
 in the morning, half a pill may be administered instead. A pill 
 composed of belladonna, physostigma and nux vomica may be 
 employed with great advantage. (See page 244.) 
 
 Another excellent method of increasing the alvine evacua- 
 15 
 
±26 CONSTItUTIOiJAL TREATMENT OF IMPOTENCE. 
 
 tions, is to inject before retiring an ounce or two ounces of 
 sweet oil. The oil generally remains in the rectum all night, 
 without producing any unpleasant sensations. The bowels are 
 usually emptied in the morning. The most satisfactory method 
 of emptying the bowels in all cases where there is general 
 debility, is to administer an enema of cold water every morn- 
 ing after breakfast. From one to two pints will be sufficient. 
 The nozzle of the syringe should be warmed and oiled, and the 
 water injected slowly and carefully ; the injections should be 
 continued until the bowels acquire the habit of moving daily. 
 
 The cold water injection may occasion unpleasant sensations to 
 the patient unaccustomed to its use, and it may even cause 
 considerable pain in the perineum and around the base 
 of the bladder. This, however, should not deter the patient 
 from a faithful trial of the remedy. For, usually, after the 
 fourth or fifth injection all disagreeable feelings cease. 
 
 A twofold effect is usually obtained from these injections of 
 cold water. The bowels are emptied in a natural manner 
 without any resulting weakness, and the congestion around the 
 vesiculae seminales and neck of the bladder is immediately dimin- 
 ished. The stream of cold water thrown from the syringe 
 impinges on the parts mentioned, the dilated bloodvessels con- 
 tract, thereby relieving the engorgement, and producing a more 
 natural circulation in all the tissues of the parts concerned. 
 Coincident with this decreased congestion there is necessarily 
 less irritability of the nerves and a diminution in the secretions of 
 the glands which furnish materials for the seminal fluid. The 
 emissions in consequence become less frequent. Besides this, 
 the muscular fibres connected with the prostate derive more 
 tone from the cold water. And as muscular contraction has 
 much to do with the erectile power, this added tonicity develops 
 
CONSTITUTIONAL TREATMENT OF IMPOTENCE. 227 
 
 greater permanency in the erection. I have known these in- 
 jections in three cases to produce natural erections without the 
 employment of any other remedial agent. 
 
 All these agents are assisted by friction over the bowels, with 
 the hand or with a brush. If the hand is employed the move- 
 ment is made from the caecum upwards to the ribs, then across 
 over the transverse colon and then down in the course of the 
 descending colon and sigmoid flexure. The amount of pres- 
 sure made must depend on the sensitiveness of the patient ; as 
 a rule it should be very firm. These movements may be re- 
 peated for half an hour at a time, in the morning and evening, 
 and may be supplemented by a general rubbing of the whole 
 body. 
 
 COLD WATER BATHING. 
 
 The use of water as a remedial agent has of late years become 
 universal. The indiscriminate use resulting from the first hy- 
 dropathic fever has been replaced by systematic and scientific 
 methods of application which have been obtained by a prac- 
 tical study of its local and constitutional effects on the 
 economy. The therapeutical action of cold water is well un- 
 derstood, and its efiicacy in many disorders satisfactorily es- 
 tablished. Especially in the treatment of spermatorrhoea and 
 impotence it has been found to be a valuable and indispensable 
 adjuvant. It may be employed in these affections both locally 
 and generally in the form of 
 
 Cold sponge baths. 
 
 " Sitz baths. 
 
 ** Shower baths. 
 
 " Douches. 
 
 " Hubbing. 
 
■■■ 
 
 228 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 I usually commence treatment with the cold sponge bath. It 
 should be taken in the morning upon getting out of bed. If the 
 patient is very weak, the bath is not admissible. Re-action is 
 slow in debilitated persons. They feel chilly and uncomfort- 
 able, because much of their animal heat is abstracted by 
 the cold water, and their heat-making power is not sufficient 
 to make up for the loss. Much discrimination therefore is 
 necessary in prescribing the bath. The majority, however, of 
 patients suffering from spermatorrhoea react remarkably well 
 after the bath. 
 
 The water of the first bath should have a temperature of about 
 sixty degrees, and should be of a three minutes' duration. Sub- 
 sequently, baths may be taken in water below sixty, of five 
 minutes' duration. The patient prepared for the bath stands 
 by the side of the tub on a warm rug and after dipping the 
 sponge in the cold water, rubs it rapidly over the face and 
 neck, drenching the parts thoroughly four or five times. Then 
 the arms from the shoulders down receive the same applica- 
 tion. When the arms are finished the patient should get into 
 the bath-tub and while standing up apply the sponge to every 
 part of the lower extremities. The next step is to sit down in 
 the water and thoroughly sponge the surface of the chest, abdo- 
 men and spinal column. By pressing the wet sponge on the 
 back of the neck, the whole back is reached by the water. 
 There or four repetitions of this process will be sufficient to com- 
 plete the bath. 
 
 After the patient leaves the bath he should be rubbed with a 
 dry coarse towel until the integument is dry and red. The 
 patient should himself apply the surface friction, as this ne- 
 cessitates considerable action of the muscles, conduces to the 
 development of caloric, and ensures reaction. Even where 
 
CONSTITUTIONAL TREATMENT OF IMPOTENCE. 229 
 
 there is a tendency to chilliness the brisk rubbing by the patient 
 will prevent any unpleasant termination to the bath. 
 
 In case the patient's debility prevents him from taking the 
 bath as directed, the sponging may be done in bed, or a towel 
 may be used instead of the sponge. The sponge or towel is first 
 applied to the face and neck. When these parts are dried, each 
 arm should be washed and dried. Then the lower extremities, 
 abdomen, throat and back receive the same application and 
 rubbing as the head and neck. Sometimes, when the circula- 
 tion is very bad and the hands and feet are cold, I am in the 
 habit of applying a flannel saturated with alcohol to the whole 
 integument as soon as the water bath has terminated and the 
 skin is dry. 
 
 These applications of cold water at first produce contrac- 
 tion of the capillary bloodvessels and more rapid circulation of 
 the blood. When reaction takes place, there is a determination 
 of blood to the integument which increases the secreting and 
 excreting functions of the skin and assists in relieving internal 
 congestions. The muscular tone is increased and nervous 
 irritability removed. The patient feels stronger and his mind 
 is clearer after the bath than before it, and he is better fitted 
 in every way to attend to daily work. 
 
 The sitz bath likewise is productive of excellent results 
 when properly employed in the treatment of spermatorrhoea 
 and impotence. The bath is taken in a zinc tub shaped 
 somewhat like an arm-chair without legs and having a large 
 back for the patient to rest against while he sits in the water, 
 with his lower limbs resting on the floor outside of the bath. 
 The water at sixty degrees should fill one-third of the tub, 
 and the patient's shoulders, arms and legs are covered with 
 blankets or other material which will keep the body comfortably 
 
230 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 warm. The water covers the upper half of the thighs, the geni- 
 tal organs and the lower half of the abdomen. 
 
 The length of time the patient should remain in the bath 
 must be governed entirely by the stage of the disease and the 
 general condition of the patient. As sound judgment must be 
 exercised in the employment of this bath as in the use of any 
 other therapeutical agent. For the first class of patients one 
 bath at uight before retiring will be sufficient if the cold sponge 
 bath was taken in the morning. If not, two baths, with an 
 interval of two hours between will be necessary. Each bath 
 must not exceed five minutes in duration. For patients of the 
 second class one sitz bath of eight minutes duration will be 
 necessary every four hours ; the last bath should be taken at 
 bed-time. These frequent sitz baths have a remarkable effect 
 in removing chronic distension of the bloodvessels within and 
 without the pelvic cavity. A direct tonic and stimulating 
 effect is exerted upon the genital organs, which is soon felt by 
 the patient, and the frequent employment of the bath continues 
 these effects. Each one assists in keeping up the contraction 
 of the bloodvessels, prevents further engorgement, so that in 
 the course of time they resume their natural caliber and no 
 more blood circulates in the organs than is needed for their 
 functional activity. 
 
 For patients belonging to the third and fourth class a sitz 
 bath each night of fifteen minutes' duration, in water at the 
 same temperature as previously is advised. Sitz baths continued 
 this length of time have more of a sedative and derivative action 
 than the five-minute baths. Their action extends to remote 
 organs ; they relieve congestion of the brain to some extent, 
 and promote sleep. They generally relieve the insomnia 
 of patients suffering from spermatorrhoea when other remedies 
 
CONSTITUTIONAL TREATMENT OF IMPOTENCE. 2$l 
 
 fail. The alimentary canal also is affected by the bath. The 
 constipation is removed and healthy and regular evacuations 
 are the result. 
 
 Gully, who has made a specialty of the water treatment, 
 and who has had an immense experience says : " The sitz 
 bath is admirably adapted to the treatment of active 
 irritations, as well as conditions of obstruction, so that it 
 is applicable in almost all cases of chronic, as it is in very 
 many acute, diseases. The sitz bath is used either as a tonic 
 or a derivative. In the former case it is taken cold and for a 
 time varying from five to fifteen minutes, seldom exceeding the 
 latter period. The rationale of its operation in this character 
 is sufficiently simple. The stimulus of the cold causes the 
 bloodvessels of the parts and neighborhood to which the 
 water is applied to contract, and thereby rid themselves of any 
 excess of blood, and as this stimulus has not been carried to 
 any great extent, there is very little subsequent return of 
 relaxation in those vessels ; still there is some, and it is for this 
 reason that it becomes necessary to apply the stimulus again 
 after short intervals ; short sitz baths always require frequent 
 repetition, sometimes as often as six or seven times in the 
 twenty-four hours. It will appear from the above that the 
 short or tonic sitz bath is applicable in all cases where 
 there is an enfeebled or congested state of the parts 
 contained within the hips, for instance, in excessive menstrua- 
 tion, leucorrhoea, loss of muscular tone and protrusion of the 
 lower gut. 
 
 " The temperature at which it is fit to take the sitz bath is 
 important. Its tonic effect is best, and indeed only obtained 
 by the cold degrees ; that is under sixty degrees. . . . Patients 
 in a very low condition of vital activity, but in whom it is d^- 
 
232 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 sirable to produce derivation of blood to the lower organs 01 
 digestion, should in the first instance be submitted to water of 
 a tepid temperature or nearly so, and the degree should be 
 lowered as the strength increases. The amount of derivation 
 in such an event is not so great nor permanent as when water 
 at forty or fifty degrees is used ; but a judicious practitioner 
 will suit his remedies to his patients' power and not go by blind 
 rules. In applying the sitz bath in its tonic character it is de- 
 sirable to use it often and this because the relaxed bloodvessels 
 of the viscera of the pelvis may not have time to fall again 
 into an exhausted state and re-admit fresh blood. It is chiefly 
 in its derivative action that it produces a lowering effect, and 
 is, therefore, adapted for certain states of active irritation of 
 the digestive viscera and head. By such a bath the pulse is 
 reduced in rapidity and hardness to an extent that many would 
 scarcely credit. . . . Both the long and the short sitz baths 
 have the effect of quieting the brain and nervous system. In 
 sleepless nights the best opiate that can be taken is a cold sitz 
 bath of four or five minutes' duration, and the sound sleep that 
 certainly follows is well worth the exertion of the resolution to 
 get up and take it. I have repeatedly known patients to fall 
 asleep in a cold sitz bath of long duration, and they always 
 pronounced it a refreshing sleep. Both the long and the short 
 sitz bath are beneficial in removing headaches of a nervous or 
 bihous kind, in staying vomiting, flatulent spasms, etc. When 
 used to open the bowels it is well to rub the abdomen with the 
 wet hand during the last eight or ten minutes of the bath." 
 
 The sitz bath exercises a good effect on the erectile tissues 
 of the genitals. After the first dozen baths the erections last 
 longer and approximate more nearly to a healthy standard. 
 The emissions are diminished and the uneasy sensations 
 
CONSTITUTIONAL TREATMENT OF IMPOTENCE. 233 
 
 in the perineum and urethral canal may completely pass 
 away. 
 
 The only contra-indication to the use of the bath is the con- 
 tinuance of chilly sensations after the patient retires to bed, 
 and the occurrence of a pain over the sacral region which is 
 aggravated by walking. These abnormal symptoms are due to 
 excessive use of the cold water. In such cases the number of 
 baths may be reduced to three in the week, and the temperature 
 of the water may be increased to seventy degrees. As soon as the 
 patient bears this without uneasiness the temperature may be 
 lowered two or three degrees at a time until sixty is again 
 reached. 
 
 Shower Baths are only useful in a few cases. In previous 
 years I prescribed them in almost every case of spermatorrhoea 
 that came under my care. But I soon found that the over 
 excitation of the nervous system produced by them more than 
 counterbalanced their tonic effect. Some of these patients 
 after taking the bath could not sit still or rest in one position 
 for more than three minutes at a time. And this restlessness 
 often lasted during the entire forenoon. They complained of 
 uncomfortable sensations on the spinal column, described by 
 some of them as a creeping feeling, by others as a pricking or 
 tingling sensation. One case in particular maybe mentioned as 
 exhibiting this peculiar effect. The patient had suffered from 
 spermatorrhoea for four years. He was not particularly 
 nervous or frightened as to his condition. The first shower 
 bath was administered in the evening and lasted three minutes. 
 Almost as soon as he had retired to bed he felt as if myriads 
 of ants were crawling up and down the spinal column. Ice 
 cold spots the size of a pea were felt on the lower extremities. 
 He became very much frightened and passed an uncomfortable 
 
234 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 and sleepless night. Next evening the same results followed 
 the bath. He then allowed an interval of three days to pass 
 before he repeated the bath. This one was taken in the morn- 
 ing upon getting out of bed. An hour afterwards the same 
 creeping sensations came on accompanied by great restlessness 
 and inability to remain long in one position. The bath was 
 finally discontinued and the cold sponge and sitz bath em- 
 ployed. With these he suffered no discomfort whatever. 
 
 In consequence of these peculiar results and also because of 
 the fact that reaction is very much protracted after these baths 
 I have discontinued them in all cases belonging to the first 
 three classes. With patients belonging to the fourth class we 
 get better results. These persons are often full-blooded and 
 in the enjoyment of average good health with the one excep- 
 tion of marked impotence. The " stirring up " which the 
 cold shower occasions gives the patient renewed energy, 
 awakens him for a time from his listlessnsss and depression 
 and conduces to a healthy mencal action, which is an impor- 
 tant result for the physician to secure. 
 
 The cold douche is recommended by hydropaths as an effi- 
 cient remedy in spermatorrhoea. I have had but little experience 
 with this variety of bath, because I have found the others pre- 
 viously spoken of to answer all purposes. The cold douche may 
 be either general or local. In using the former, the patient sits 
 in the bath tub while an assistant pours cold water on his body 
 from a pitcher held some distance above the patient. Some 
 prefer a steady stream from a rubber tube or pipe to the inter- 
 rupted stream from the pitcher. This bath is similar in its 
 effects to the shower bath. 
 
 The local douche is often beneficial in diminishing the num- 
 ber of emissions and giving tone to the genitals. The simplest 
 
CONSTITUTIONAL TREATMENT OF IMPOTENCE. 235 
 
 way to give this bath is for the patient to sit on the edge of the 
 bath tub with his limbs inside, and, by means of a rubber pipe 
 with a suitable nozzle, he directs the stream of water to the 
 perineum and genital organs. This local bath is best taken .at 
 bed-time or before indulging in sexual intercourse. 
 
 Some authorities speak highly of the rubbing or dripping 
 sheet bath in the diseases under consideration. Gully says 
 with reference to it: — " The dripping sheet is generally used as a 
 preparative process for the skin, if that organ has been hitherto 
 unaccustomed to the impression of water below its own tem- 
 perature, and the shock is considerably modified by the attend- 
 ant friction. The bloodvessels of the skin contract in the 
 first instance, and subsequently relax, admitting more blood 
 into their calibre, — a double action, which is reiterated by the 
 friction, until a good amount of blood is fixed in the skin, to 
 be maintained by subsequent exercise. But besides this, the 
 stimulating impression made upon the myriads of nerves of ani- 
 mal life spread over the skin, and derived from the brain and 
 spinal cord, modifies the circulation in these last, and, through 
 them, affects the vital energies of the viscera. It is in this 
 manner that it takes off languor, gives alacrity to mind and 
 limb, clears away intellectual and moral cloudiness, at the same 
 time that it generates appetite, removes thirst, causes expulsion 
 of flatulence, etc. More than this, its repeated and frequent 
 use will reduce some of the symptoms of very intense derange- 
 ment of the animal nervous system, such as attacks of tic and 
 violent spasms of the limbs and trunk. 
 
 " When speaking of the wet-sheet packing, I have alluded to 
 the favorable condition in which it placed the skin and viscera 
 for the best reaction on the subsequent process of the dripping 
 sheet. Were the patient to remain just as he comes from the 
 
2$6 COXSTITUTIOXAL TREATMENT OF IMPOTENCE. 
 
 packing, his skin would be liable to take cold from the opera- 
 tion of the air, the stimulus of which is not strong enough to 
 ensure sufficient reaction. But when the dripping sheet, with 
 the friction, comes to play upon the skin with its organic energy 
 accumulated in the packing, the reaction is great, the blood 
 remains in the skin, and its presence prevents the taking of 
 cold. Hence it, or some cognate process, is indispensable 
 after the wet-sheet packing. For this purpose, it is sometimes 
 prudent, in cases of great organic feebleness, to commence with 
 a tepid sheet, and only gradually reach the cold temperature. 
 But when it is used alone, for the purpose of refreshing the 
 animal nerves and the brain, or for reducing their painful or 
 spasmodic affections, it should always be cold, and the accom- 
 panying friction long and continued. Six or eight sheets in 
 succession are sometimes thus administered. To ver}- delicate 
 persons I often apply, in the first instance, only friction of the 
 trunk and arms with a wet towel, dry and dress those parts, and 
 then have the lesrs rubbed in like manner. Reaction and com- 
 fortable sensation may thus be obtained, which would be want- 
 ing were an entire sheet thrown at once over the entire body. 
 In persons with apoplectic heads, such a commencement is 
 likewise advisable. As the dripping sheet, although less stim- 
 ulant, answers in some degree the objects of the shallow bath 
 presently to be mentioned, it is a good substitute for it when 
 that bsth is difficult to obtain, as in traveling. If there be 
 feverish pulse and heat, the dripping sheet taken at bed-time in- 
 duces sleep, by relieving the brain from the irritation of the skin. 
 But if there be no signs of feverishness, it will rather prevent 
 sleep by exciting the skin, which then exckes the brain." 
 
COisrSTITUTIONAL TREATMENT OF IMPOTENCE. 237 
 
 EXERCISE. 
 
 Active exercise is an indispensable adjunct in the treatment 
 of all forms of genital weakness. It promotes digestion, and 
 assists in relieving the congested condition of all the viscera. 
 Whatever exercise is advised for the patient should be taken at 
 various intervals during the day, and should not be crowded on 
 the patient at one time. From two to three hours after each 
 meal is the best time for exercise. The amount of it must be 
 determined by the strength of the patient. If he should be 
 too weak to walk or ride, manipulation and friction of the sur- 
 face of the body should be given twice each day by a compe- 
 tent manipulator engaged for the purpose. This passive exer- 
 cise will answer all purposes until the patient regains sufficient 
 strength to exercise himself. 
 
 Boxing is an excellent indoor exercise. It brings into play 
 every muscle of the body. It keeps the mind active as well 
 as the muscles. It stimulates the circulation in every part and 
 increases the strength of the patient. Exercise in boxing, even 
 if carried to the extent of fatiguing the patient, is nevertheless 
 beneficial. 
 
 Dumb bells and indian clubs are also serviceable means of 
 exercise. They may be used four or five times each day, for 
 about fifteen minutes, without injury. The benefit derived 
 from this employment is not, however, so great as that derived 
 from boxing. 
 
 Outdoor exercise should never be omitted. Walking, run- 
 ning, rowing, riding are all excellent in their proper time and 
 place. Two hours after breakfast is an excellent time to walk ; 
 and a brisk walk of from half an Jiour to an hour, even if the 
 patient is fatigued by it, will produce good results. 
 
 I 
 
2^8 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 
 
 Horseback exercise is good when there is not too much irri- 
 tation of the genital organs. In irritable cases I have known 
 the exercise to increase the number of seminal losses. The 
 cases that are benefited by it are those whose trouble is chiefly- 
 mental, as it is in the fourth class of cases. Indeed, in all per- 
 sons in whom the mental trouble preponderates over the local 
 trouble in the genitals, horseback exercise will do a vast amount 
 of good. 
 
 SLEEP. 
 
 The sleeping apartment of a patient suffering from sperma- 
 torrhoea should be large and well ventilated. The windows of 
 the room should be kept open night and day. The free cir- 
 culation of air is always to be continued without respect to 
 the peculiar opinions on the subject entertained by the patient 
 or his friends. The windows should be closed only when the 
 baths are taken. 
 
 A feather bed is not so good to sleep on as a hard hair 
 mattress. The covering of the bed should be sufficient to pre- 
 vent the patient from taking cold, but not enough to induce 
 perspiration. Linen sheets are preferable to cotton in summer 
 and winter. Ten o'clock is a good hour for retiring. The 
 patient should rise at six o'clock in the morning or earlier, even 
 if he has passed a sleepless night. It is best to rise and bathe 
 and eat. If further sleep is necessary, it can be obtained after 
 the exercise prescribed by the physician has been taken. 
 
 It is always advisable to sleep on the right or left side. The 
 former is the best. When the patient lies on the back, emis- 
 sions are more apt to occur. To obviate the tendency to lie 
 on the back, an ordinary wooden reel maintained in place over 
 the lumbar region by a cord* can be used to good purpose. 
 
CHAPTER XIV. 
 
 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE AND 
 ALLIED DISORDERS (CONTINUED.) 
 
 Indications for the use of Tonic Medicines — Cases in which they are benefi- 
 cial — Reasons for their Discontinuance — Effects of Strychnia on the 
 Spinal Cord — Combination of Strychnia, Iron, Quinia and Glycerine — 
 Tonics and Nerve Stimulants in Nervous Depression — Preparations to be 
 employed when there is obstinate Constipation, Palpitation of the Heart, 
 Vertigo, etc. — Employment of Arsenic, Iron, Nux Vomica, Ergot and 
 Quinia — Aphrodisiacs — Special Indications for their Employment — Classes 
 of Patients benefited by their use — When they should be discontinued — 
 Peculiar effects of Phosphorus on the Nervous System and Genital 
 Organs — Dangers connected with its administration — Compound phos- 
 phorus Pills — Cantharides as an Aphrodisiac — Best mode of administra- 
 tion — Combination of Ergot, Nux Vomica and Capsicum — Effect of Can- 
 nabis Indica, Ergot, Nux Vomica, Quinia — Sanguinaria, Stillingia, Water 
 Pepper, Damiana, etc. — Homoeopathic Remedies. 
 
 Tonic medicines are indispensable in nearly all cases of 
 spermatorrhoea and impotence. Tonics which combine a stimu- 
 lating effect on the genital organs with a general restorative in- 
 fluence, can be more advantageously employed than the simple 
 tonics ; or, simple tonics may be combined with medicines 
 whose action is specially exerted upon the genital functions. 
 All medicinal agents lose their effect when continued for any 
 great length of time. It is well, therefore, to change from one 
 preparation to another as soon as improvement ceases. Five 
 weeks is a sufficient length of time for the employment of any 
 one medicine or combination of medicines. 
 
 Again, certain preparations act beneficially in one case and 
 obtain negative results in another. They may suit the stomach 
 
^40 TREATMENT OF IMPOTENCE, ETC. 
 
 of one patient and disorder the digestive functions of another. 
 Hence, the necessity for a careful discriminating selection in 
 all cases. When medicines disagree with a patient for more 
 than a couple of days they should be discontinued and another 
 set of remedies substituted. Nothing is gained by persevering 
 in the use of a drug obnoxious to the patient, or failing to do 
 its work within a reasonable period. 
 
 One of the best tonic combinations for cases of spermator- 
 rhoea and impotence is the following : — 
 
 ]^ . Strychniae Sulphas. . , . gr. i, 
 
 Quiniae Sulphas. , , . | ss. 
 
 Tinct. Ferri Chloridi • . . | ss. 
 
 Glycerinae . • . . | iv. 
 
 Misce. 
 
 Half teaspoonful in a wine-glass of water four times each 
 day. To be taken before meals if it does not disorder the 
 stomach. 
 
 This combination has a local as well as a general effect. The 
 strychnia, by sending a greater amount of blood to the spinal 
 cord, stimulates the action of the nerves given off to the genital 
 organs, and gives tone to the muscular fibres concerned in 
 erection. The preparation of iron increases the quantity of 
 red globules in the blood and exerts a special tonic action on 
 the genito-urinary apparatus. The quinine is a general tonic 
 and stimulant, and the glycerine, besides being a pleasant 
 vehicle for the bitter drugs, assists the stomach digestion. 
 
 When there is general nervousness and depression of spirits, 
 a nervous stimulant should be added to the tonic remedies. The 
 following combination containing phosphorus in connection 
 with the iron and chloric ether, will be found to produce good 
 results •— 
 
TREATMENT OF IMPOTENCE, ETC. 
 
 241 
 
 5. Strychniae Sulphas. • . . gri. 
 
 Quinine Sulphas. • . . 3 ss. 
 
 Ferri Pyrophosphat. . • . 3 ii. 
 
 Spts Chloroformi ... 3 iii. 
 
 Glycerinae . . . • § iv. 
 
 Misce. 
 
 One teaspoonful in a wine-glass of water four times each day. 
 In cases where flatulence is a common and painful symptom 
 the following preparation will often answer : — 
 
 5. Tinct. Nucis Vomicae . . . 3 ii. 
 
 Tinct. Capsici 
 
 Tinct. Hydropiper. . . . aa 3 iii. 
 
 Tinct. Cinchonae Comp. . . . | ii. 
 
 Spts. Lavend. Comp. ... § iii. 
 
 Misce. 
 
 A dessertspoonful in water four times each day. 
 This combination, through the water pepper it contains, ex- 
 erts a stimulating effect on the genital organs. If the number 
 of emissions are increased by its use the drug may be omitted. 
 Or the following combination may be used for the same pur- 
 pose if the capsicum, as it sometimes does, disagrees with the 
 stomach : 
 
 ;^. Bismuth. Subnitratis . . . . 3 ii. 
 
 Pulv, Zingiberis | ss. 
 
 Tinct. Hydropiper § i. 
 
 Spts. Lavend Comp. ,,.... | iii. 
 
 M. 
 
 One teaspoonful four or five times each day. 
 
 Two drops of nux vomica may be given in a wineglass of 
 
 water before each meal, and the above preparation may be 
 
 given after each meal. 
 t6 
 
242 TREATMENT OF IMPOTENCE, EtC. 
 
 In cases where the patients are subject to bilious attacks the 
 bowels should be thoroughly cleansed with the following 
 simple combination of cream of tartar and Epsom salts and 
 afterwards nux vom. may be administered in two or three drop 
 doses in water before meals, and nitro-muriatic acid in five drop 
 doses after each meal. 
 
 ]^. Magnesias Sulph. 
 
 Potassii Bitartras. aa | i. 
 
 Aquae Oi. 
 
 M. 
 
 One or two wineglassfuls before breakfast. 
 
 If the patient has been in the habit of drinking he may be 
 given a wineglassful every hour till four or five doses have 
 been taken, and afterward take the medicine before breakfast 
 in the small dose. 
 
 The passages produced by this medicine are unattended with 
 pain, and great relief is usually experienced in all cases where 
 the medicine is indicated. 
 
 In some patients insomnia is a prominent as well as a most 
 obstinate symptom. These cases in addition to their baths 
 (see p. 227) need sedatives that will not disorder the stomach or 
 retard the assimilation of food in any way. The following I 
 have found beneficial : 
 
 ]^. Tinct. Lupuline . • • • . 
 
 Tinct. Hyoscyami , . . • * S,S. %u 
 
 Tinct. Valerianae . . • • 
 
 Tinct. Gentianae 
 
 Spts. Vini Rectif. . . • . aa | ii. 
 
 One dessertspoonful in a wineglass of water three or four 
 times each day. A double dose may be taken at bedtime. 
 The action of this medicine may be accelerated by placing 
 
TREATMENT OF IMPOTENCE, ETC. 243 
 
 over the stomach and praecordlum a muslin handkerchief wet with 
 tinct. of capsicum diluted with alcohol sufficiently to prevent 
 pain. I have found it useful in many cases. I have also used in 
 addition to tonics in cases of insomnia parvules of morphia and 
 atropia at bedtime (morphia g^o? atropia jio), with good re- 
 sults, but I do not advise their continuous use. They should be 
 employed only in cases of emergency, when it is absolutely nec- 
 essary for the patient to get a good night's sleep. 
 
 When there is weakness of the heart and a tendency to 
 syncope, as there often is, especially in females, the following 
 may be used : 
 
 5 . Tinct. Digitalis • . . . • 3 iii. 
 Tinct. Ergotse .... . |i. 
 
 Spts. Ammonise Aromat. . . . | ss. 
 
 Tinct. Valerian | iiL 
 
 M. 
 
 One teaspoonful every two or three hours. 
 
 Or as a temporary stimulant : 
 
 ^5 . Spts. Ammonise Aromat | ss. 
 
 Spts. Vini Gallici | ii. 
 
 M. 
 
 Half teaspoonful in a wineglass of water every half hour or 
 hour until the faintness has passed away. Not more than six 
 consecutive doses should be given. 
 
 Some patients prefer medicine in the solid state. The fol- 
 lowing is an excellent combination : 
 
 ^. Ferri Arseniatis 
 
 Ext. Nucis Vomicae . . . . aa grs. v. 
 
 Ergotinae . . . ; . 
 
 Quinise Sulphas. . . . . . aa 3 ss. 
 
 M. Ft. pil. No xxx. div. 
 
244 TREATMENT OF IMPOTENCE, ETC. 
 
 One pill four times each day. 
 
 The ergotine and nux stimulate the circulation of blood in 
 the genital organs. The former is supposed to reduce the 
 calibre of the bloodvessels, thus diminishing the congestion 
 which exists in these parts. 
 
 When constipation is a prominent symptom the combination 
 of aloes and nux in the tonic preparation will exert a beneficial 
 effect. 
 
 5. Ferri. Sulph. Exsiccata . , . . 3 ss. 
 
 Ext. Nucis Vomicae .... grs. v. 
 
 Pulv. Aloes Soc * grs. xv. 
 
 Ext. Gentianse . ... • . grs. xx. 
 
 M. Ft. pil. No. XXX. div. 
 
 One pill three times each day. 
 
 Sometimes palpitation of the heart and vertigo are trouble- 
 some symptoms. When such is the case the following pre- 
 paration may be employed with benefit : 
 
 B. Ex. Digitalis 
 
 Ex. Belladonnas . . . . . aa grs. 
 
 Quiniae Sulph. 
 
 Ferri Phosphas aa 3 ss. 
 
 M. Ft. pil. No. XXX. div. 
 
 One pill four times each day. 
 
 As soon as the palpitation and vertigo are relieved this pre- 
 paration should be discontinued and one of the other tonics 
 prescribed. 
 
 Physostigma is a useful addition to the tonic or other medicines. 
 T have employed it successfully in combination with belladonna 
 as a laxative in torpid conditions of the intestinal canal depend- 
 ent upon sexual excess and masturbation. It is also useful in 
 any other condition where it is essential to secure a natural 
 
 i 
 
TREATMENT OF IMPOTENCE, ETC. 245 
 
 movement of the bowels, without depleting the patient. 
 Bartholow recommends a combination of physostigma, bella- 
 donna and nux vomica in the following formulse : 
 5. Tinct. Physostigmatis .... 
 Tinct. Nucis Vomicae .... 
 Tinct. Belladonnas . . . . aa 3 ii. 
 M. Sig. Twenty drops in water morning and evening. 
 I have had better results from the solid combination than the 
 liquid. 
 
 B. Ext. Physostigmatis .... 
 
 Ext. Belladonnse 
 
 Ext. Nucis Vomicas . . . aa grs. v. 
 
 M. Ft. pil. No. X. div. One pill at bedtime. 
 Aloin may sometimes be added to the above with benefit. 
 
 APHRODISIACS. 
 
 When tonic medicines have been employed for two or three 
 weeks, aphrodisiacs may be given to increase the frequency 
 and permanency of the erections. While the genital organs are 
 irritable, relaxed, and the emissions frequent, they should not 
 be employed. But when all irritability has been removed by 
 the local and general treatment, and the patient about to ex- 
 ercise his genital functions, their use will be beneficial. 
 
 Aphrodisiacs are of little use in patients of the third class, 
 or those whose genital organs are in a state of constant excite- 
 ment, whether that excitement is, or is not connected with par- 
 tial or complete impotence. They increase the congestion 
 and cause a vast amount of trouble. 
 
 When the impotence depends on mental emotion they can 
 be administered at the commencement of the treatment. In no 
 other instance can this be done. Even in these cases electricity 
 
^46 TREATMENT OF IMPOTENCE, ETC. 
 
 should be first used. Applications of electricity, hereafter to be 
 described, rarely fail to cure the impotence. There is no abso- 
 lute necessity to use aphrodisiacs in mental impotence at the 
 onset. But I have found that if some positive excitement is 
 produced at the beginning of the treatment by medicinal agents 
 that recovery took place rapidly. For these patients usually 
 lose all hope at the first failure, and are only relieved of these 
 depressions when there is a perceptible improvement in their 
 virile power. 
 
 All aphrodisiacs cause a determination of blood to the geni- 
 tal organs. Some do this by acting as a local irritant — others 
 by stimulating the cerebro-spinal center. They all exert an 
 injurious influence on the stomach when continued for any 
 great length of time ; when they disturb the digestive functions ; 
 or cause trouble in any other way they should be discon- 
 tinued. 
 
 Phosphorus is one of the best aphrodisiacs in the list. It is 
 a powerful stimulant to the genital organs. It increases the 
 desire for sexual intercourse without producing any local irri- 
 tation in the genital apparatus. It also diminishes the anaemic 
 condition of the brain and furnishes it with material that has 
 been lost through excess. Bartholow says, " We have no remedy 
 at present more effective in the treatment of impotence than 
 phosphorus." The great objection to its use is its unvarying 
 tendency to disorder the stomach. In consequence of this it 
 must be given in very minute doses, and its effects carefully 
 watched. It should not be administered on an empty stomach. 
 The drug may be given in solution or in pill form. Half a 
 grain of phosphorus may be dissolved in an ounce of cod-liver 
 oil, and half a teaspoonful of the mixture administered after 
 meals until there is a manifest increase in the frequency 
 
TREATMENT OF IMPOTENCE, ETC. 247 
 
 and power of the erections. It may be given combined with 
 nux vomica as in the compound phosphorus pills. Each pill 
 contains ^ of a grain of nux and i J o of phosphorus. One 
 pill may be given twice each day, until the desired result is at- 
 tained. As soon as symptoms of disordered digestion appear, 
 the administration should be discontinued for a few days and 
 then resumed. If the medicine still disorders the stomach, it 
 may be stopped permanently and another aphrodisiac substi- 
 tuted. 
 
 Cantharides is second only to phosphorus as a stimulant to 
 the genital organs. It produces an increased flow of blood to 
 the whole genito-urinary tract without exaggerating the desire 
 for sexual pleasures. In over doses it causes priapism, strang- 
 ury and inflammation of the genitals. Its effects, therefore, 
 should be carefully watched. 
 
 The tincture may be given in ten drop doses four or five 
 times daily until it produces its specific physiological effects. 
 Better results are obtained, however, by combining it with other 
 drugs such as ergot, nux vomica, cannabis indica, or cap- 
 sicum. 
 
 The root of petroselinum sativum is possessed of qualities 
 which entitle it to rank as an excellent aphrodisiac as well as 
 emenagogue. The active principle apiol may be given in five or 
 fifteen grain doses, two or three times each day. It is especially 
 indicated if there is any malarial complication. Water pepper or 
 polygonun hydropiperoides is also a useful and at the same 
 time harmless aphrodisiac. In mild doses it stimulates the circu- 
 lation, promotes digestion and increases the menstrual flow, and 
 promotes erection. Eberle believed it to be a specific in amen- 
 orrhcea. Bartholow says, *' it is a remedy of considerable 
 power in functional impotence. When the erections are feeble, 
 
248 
 
 TREATMENT OF IMPOTENCE, ETC. 
 
 the seminal fluid watery, and the testes soft, great results will be 
 obtained from this remedy, provided no structural alterations hin- 
 der or prevent improvement. When hydropepper is administered 
 in these disorders of the sexual system, it causes a feeling of weight 
 and tension, and dragging of the pelvic viscera. As it tends to 
 increase the blood supply to these organs, it is inadmissible 
 when a state of congestion or inflammation exists." 
 
 The leaves of ruta graveolans also increase the flow of blood 
 to the genital organs. Hence, it is useful as an aphrodisi- 
 ac though most frequently employed as an emenagogue. The 
 oil is principally used in doses of from one drop to five after 
 meals. 
 
 Stillingia, sanguinaria and other remedies are used much 
 for the same purpose. The following combination can always 
 be relied on to do excellent work : 
 
 5t. Tinct. Hydropiper. .... § iss. 
 
 Tinct. Nucis Vomicae 
 
 Tinct. Ergotae 
 Tinct. Rutae 
 Spts. Vini Galilei. 
 Spts. Lavend. Comp. 
 
 3ii. 
 
 aa I ss. 
 
 aa |ii. 
 
 M. One teaspoonful in water four or five times each day, 
 or the following : — 
 
 ^. Tinct. Cantharidis. .... 
 
 Ext. Ergotae, fl aa 3 1 
 
 Tinct. Nucis Vomicae .... 
 
 Tinct. Capsici aa § ii. 
 
 Mix. 
 
 Dose, half teaspoonful In a wineglass of water four times 
 each day. To be discontinued on the manifestation of any un- 
 pleasant symptoms. 
 
TREATMENT OF IMPOTENCE, ETC. 249 
 
 Bartholow recommends a preparation containing : — 
 
 5. Tine. Sanguinarise, 3 iii. 
 
 Ext. Stillingiae, 3 v. 
 
 M, Fifteen to twenty drops in water three times a day. 
 If solid preparations are preferred, the following combina- 
 tion will be found exceedingly useful : — 
 
 5. Ext. Cannabis Indicse .... grs. x. 
 
 Ext. Ergotse ...... 3i 
 
 Ext. Nucis Vomicae .... grs. iv. 
 
 Pulv. Capsici grs. xv. 
 
 M. Ft. Pil. No. XXX, div. 
 One pill four times each day. 
 
 Damiana is the latest aphrodisiac medicine. It has been 
 largely advertised, and is said to have an excellent effect in 
 promoting erections. Not having used it I can express no 
 opinion concerning its medicinal or physiological effects. 
 
 In many cases of impotence it will be found necessary to 
 continue the ordinary tonic medicine during the day and give 
 an aphrodisiac at bed time. A simple and at the same time a 
 valuable mixture, is the following : 
 
 5. Pulv. Capsici ..... grs. x. 
 
 Quinise Sulph. . . • . , grs. v. 
 
 Spts. Vini Gallic! . . • • | ss. 
 
 Aqu3e. ..... I ii.^ 
 
 M. 
 
 To be taken in two doses, one hour apart. 
 The administration of stimulants at bed time, uncombined 
 with drugs, are often necessary for patients whose impotence re- 
 sults from fear. Brandy or champagne are about the best 
 stimulants for the purpose. 
 
 In this connection it will be well for the benefit of those who 
 
250 TREATMENT OF IMPOTENCE, ETC. 
 
 are curious on the subject to mention the peculiar remedies ad- 
 vised by the homoeopaths. Gillman says : " Aconite is indi- 
 cated by great nervous derangement ; sudden starting at the 
 least noise, fitful mood, apprehensions for the future, dizziness, 
 frontal headache, dryness of the tongue, distress in the pit of 
 the stomach, smarting of the egesta, wakefulness at night, 
 drowsiness in the day time, nightmare, copious emissions. This 
 agent will be found of no use in this disease unless it is ad- 
 ministered in the form of tincture in a tumbler of water, a tea- 
 spoonful every three or four hours until a decided improvement 
 sets in. 
 
 *' Nux vomica may be given, one dose of the 6th att. every 
 other night, if the patient complains of costiveness, bad taste 
 in the mouth, soreness of the stomach, constipation. 
 
 " Mercurius vivus is adapted to the following symptoms : 
 pappy mouth, thinly coated tongue, altered taste, sallow com- 
 plexion, chilliness, great sensitiveness to air, costiveness. The 
 alvine evacuations being composed of hard balls or lumps hav- 
 ing a dark color. Give a powder of the third trituration every 
 night. 
 
 " Carho vegit. will be found adapted to constipation, with 
 heartburn, acidity of the stomach, distress after eating, disten- 
 sion of the bowels. If the agent should not relieve the patient, 
 phosphorus may be substituted, especially if the nervous system 
 is very much shattered and the patient complains of oppres- 
 sion on the chest, tendency to cough, pains in the chest. This 
 medicine should be used alternately with China if the patient 
 is very weak. 
 
 " Acidum muriaticum in complete impotence, relaxation of the 
 penis, complete absence of all erections and a sense of weak- 
 ness in the parts, 
 
"Agnus castus, for frequent emissions, aversion or indiffer- 
 ence to sexual intercourse, deficient erections. 
 
 " Argentum nitricum : Deficient sexual desire, shriveling of 
 the genital organs. 
 
 " Camphora : Weakness of the parts, want of sexual desire 
 and erections, coldness of the parts. 
 
 " Cannabis : Aversion to sexual intercourse, with coldness of 
 the genital organs. 
 
 ** Colocynthis : Complete impotence, complete loss of sexual 
 desire. 
 
 " Conium maculatum : Impotence, deficient erections, im- 
 perfect or short lasting erections. 
 
 " Ignatia amara : Impotence with a feeling of weakness in 
 the hips. 
 
 " Lycopodium : Aversion to intercourse of several years 
 standing, with impotence. 
 
 " Magnesia carb. : Deficient erections, loss of sexual desire, 
 aversion to intercourse, no erection even when dallying with 
 a female. 
 
 " Selenium : Impotence with desire for coitus. 
 
 " Sulphur : Impotence with amorous fancies. 
 
 " Stramoniu?n : Complete impotence. 
 
 " Sabadilla : Relaxed penis with amorous fancies, insensi- 
 bility to sexual excitement, aversion to dallying with females, 
 diminished sexual desire. 
 
 " Thuja : Indifference to female society." 
 
 It is interesting to remark that Dr. Gillman assists the action 
 of these remedies by the persistent use of electricity. 
 
CHAPTER XV. 
 
 LOCAL TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 
 
 Electricity the principal remedial agent in impotence — Effects of the induced 
 or Faradic current — The continuous current — Electro magnetic batteries — 
 Cases illustrating the effects of electricity — Various methods of using the 
 electrodes — Position of the patient — Urethral and rectal electrodes — Wire- 
 brush cauterization as a means of cure — Solid and liquid caustics — Lalle- 
 mand's porte caustique — Precautionary measures to be adopted — Usual re- 
 sults of the operation — Caustic solutions safer — Instruments for introducing 
 caustic solutions to the prostatic portion of the urethra — Acupuncture — 
 Introduction of the needles — Regions in which the needles are inserted — 
 Results of acupuncture — Use of astringent and anodyne applications — 
 Medicated bougies — Spermatorrhoea rings — Electric rings — Rectal pes- 
 saries. 
 
 Hippocrates treated cases of spermatorrhoea and impotence, 
 by first giving an emetic, and then confining the patient to milk 
 and decoctions of barley and leaves. Since his time the majority 
 of practitioners have depended mainly on local treatment to 
 promote a cure. IMany cases, indeed, can be cured by local 
 remedies alone. The list of mechanical appliances and medici- 
 nal agents employed in or upon various portions of the genera- 
 tive apparatus is a long one. The majority of them I have 
 never used, nor do I intend to use them, while there are other 
 and better means of accomplishing the desired end. But, as 
 they are recommended by many in the profession, v»^hose experi- 
 ence is worthy of consideration, they are given in the following 
 list in their order of value, and as recommended by others : 
 
 Electricity, 
 
 Cauterization, 
 
 Astringent and anodyne applications, 
 
Local treatment of spermatorrhcea & impotence. 253 
 
 Introduction of medicated bougies, 
 
 (t 
 
 " Steel sounds, 
 
 Acupuncture, 
 
 Application 
 
 of electric rings, 
 
 (( 
 
 " Spermatorrhoea rings, 
 
 u 
 
 " Rectal pessaries. 
 
 
 ELECTRICITY. 
 
 Electricity is the most useful of these remedial agents. There 
 is no other agent which is capable of exerting such a beneficial 
 influence on a// cases of spermatorrhoea and impotence. In fact, 
 it should supersede, as it has in my hands, all other forms of 
 local treatment. I have used it invariably in every case which 
 has come under my care during the past ten years, and have 
 rarely found it to fail in accomplishing all that is claimed for it. 
 Electricity, when judiciously employed, removes in a short time 
 the irritability of the mucous membrane in the prostatic urethra 
 and seminal ducts, upon which the frequent nocturnal and diur- 
 nal pollutions generally depend. It restores the bloodvessels to 
 their normal calibre, and stimulates the circulation through 
 them, thus removing the congestion which always obtains in the 
 relaxed tissues of the masturbator. It increases the nervous 
 force, and gives tone to the muscular fibres connected with the 
 genital organs. 
 
 Either the induced or continuous current may be employed. 
 Having found the induced or Faradic current to answer every 
 purpose, I do not employ the continuous, though in many 
 hands the latter has done excellent service. The induced 
 current is recognized by most authorities as more beneficial 
 than the continuous in cases of spermatorrhoea and impotence. 
 
254 LOCAL T^EATMENt OF SPERMATORRHCEA & IMPOTENCE. 
 
 Meyer's general conclusions as to the cases in which induced 
 electricity is indicated, point at once to its applicability in the 
 diseases under consideration. He says : — *' The induced cur- 
 rent is applicable in those cases in which we want — 
 
 " a — To excite the muscles, the nerves of sense, the sensory 
 or the motor nerves." 
 
 "^ — To produce contractions of the blood or lymphatic 
 vessels." 
 
 " c — Or to affect organs supplied from the sympathetic." 
 
 There are many varieties of batteries in the market. Among 
 the best are those manufactured by Kidder, Fleming, of Phila- 
 delphia, and the Galvano-Faradic Co. 
 
 The applications of electricity are best made when the patient 
 is in a recumbent posture, though they can readily be given 
 while the patient is sitting or standing. When the battery is 
 ready for use and the patient's hips, back and genitals exposed, 
 the urethral electrode insulated to within an inch of its point 
 is attached to the negative pole of the battery. The other 
 electrode with a moistened sponge on its extremity is attached 
 to the positive pole. The urethral electrode well oiled and 
 warmed is slowly introduced through the urethral canal to the 
 neck of the bladder, while the sponge covered electrode is 
 placed over the genito-spinal center at the junction of the 
 dorsal with the lumbar vertebrse, and moved up and down over 
 the vertebral column as far as the tip of the coccyx. While 
 the sponge is being moved over these parts the urethral elec- 
 trode is slowly withdrawn until its point reaches the bulbous 
 portion of the urethra. There it is allowed to remain until the 
 termination of the se'ance. When the sponge covered elec- 
 trode has been applied posteriorly about five minutes, it can 
 be carried around to the perineum, and moved slowly up 
 
tOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. ^$^ 
 
 and down from the line of the scrotum to the anus until the 
 sitting is ended. 
 
 The first stance should not exceed seven or eight minutes, 
 and the current should be very mild. If the application is 
 protracted, and the current intense enough to produce pain, too 
 great a sedative action may be produced which may have to 
 be counteracted by stimulating medicines. Besides this the 
 urethral electrode, by mechanical irritation alone, may cause 
 local inflammation if it remains too great a length of time in 
 the canal. 
 
 At the second stance the day following a wire brush may be 
 substituted for the urethral electrode. This is passed slowly 
 over the inner side of the thighs, perineum and scrotum at the 
 same time that the sponge covered electrode is passed over the 
 lumbar, sacral and ischio-rectal regions. The second stance 
 should last for ten minutes. On the third day the urethral 
 electrode may be employed again. And this alternation of the 
 latter with the wire brush may be continued until the close of 
 treatment. If the urethral canal of the patient is not too sensi- 
 tive, the urethral electrode may be employed every day, 
 alternating at the same sitting with the wire brush. 
 
 When there are large quantities of prostatic fluid poured out 
 or squeezed out during defecation or where there is enlargement 
 of the gland, it will be well to use the rectal electrode. This 
 instrument when warmed and oiled is introduced into the rec- 
 tum, slowly and gently until it reaches the posterior border of 
 the prostatic gland, when the current is passed through from 
 the urethra to the rectum. 
 
 When the nocturnal emissions are reduced to one a week, 
 and the erections are still feeble and infrequent a greater 
 stimulating effect on the erectile tissues may be effected bv 
 
256 LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 
 
 changing the direction of the current ten or fifteen times dur- 
 ing the seance. This method usually increases the frequency 
 and permanency of the erections. 
 
 If the impotence is complete, this method should be employed 
 from the commencement of the treatment. 
 
 In this connection one or two instances of the peculiar effects 
 of electricity in spermatorrhoea and impotence will be of 
 interest. 
 
 Four years since a teacher in one of the public schools ap- 
 plied to me for relief. He was twenty-two years old, of good 
 habits and capable of performing his business duties with satis- 
 faction. He commenced masturbating when a boy of nine and 
 continued the habit until the age of nineteen. Thereafter 
 seminal emissions occurred with varying frequency. Some 
 months they occurred as often as five times a week. He had 
 essayed sexual congress on different occasions with bad results. 
 At the time he came under my care he had from three to five 
 emissions in the week. He was running down rapidly and in 
 great distress of mind concerning his condition. He intended 
 taking a vacation in the country the day after his visit. I gave 
 him but one application of electricity in the manner previously 
 described, and prescribed a tonic medicine, containing 
 strychnia, iron, quinine and glycerine. Four weeks subse- 
 quently he returned from his vacation and, much to my surprise, 
 informed me that only one seminal loss had taken place during 
 the interval, and that occurred the morning of his return to 
 town. As his former trips to the country had made no special 
 difference in his condition, I was compelled to ascribe the 
 principal part of healthy change to the application of electricity 
 made on his first visit. This, of course, is an exceptional case. 
 The majority of patients feel the effects of electricity in dimin- 
 
LOCAL TREATMENT OF SPERMATORRHOEA & IMPOTENCE. ^5^ 
 
 ishing the number of emissions very gradually, yet the results 
 in this instance indicate the curative power which electricity 
 possesses in spermatorrhoea and impotence. 
 
 An average result of the electrical treatment is illustrated by 
 the following case : — 
 
 J. S., aet 29, occupation book-keeper, came under treatment in 
 March 1877. He had indulged in onanistic exercises during 
 his school-boy days. At the age of eighteen he cohabited with 
 a servant at varying intervals for a period of two years. Subse- 
 quently circumstances compelled him to refrain from any in- 
 dulgence for six years, during which time he had emissions two 
 and three times each week. He was then (March '77) contem- 
 plating matrimony, but his state of health was such that he 
 feared he would be unable to fulfill his engagement, or perform 
 his matrimonial duties with satisfaction. His memory was not 
 so good as in former years, and his ability to endure mental and 
 physical labor comparatively small. 
 
 He received applications of electricity every other day for 
 two months ; took cold water sponge baths and tonics during 
 the same period. At the end of the first month an interval of 
 ten days had elapsed between the last emission and the present 
 one, and his virile power was increased, as evidenced by 
 the character of the erections. He was discharged at the end 
 of the period mentioned and entered the marriage state, feeling 
 well and competent to perform all his functions properly. He 
 has been married eight months and has suffered no incon- 
 venience from his previous disorder in any particular ; he con- 
 siders himself perfectly well. 
 
 In all cases where the nocturnal emissions have been re- 
 duced to one in a week or ten days, and the erections occur 
 Hightly, the patient is in a fit condition to marry. Marriage 
 17 
 
25^ LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCil. 
 
 should take place as soon as the patient leaves the hands of the 
 physician, in order that the healthy condition commenced by 
 the treatment may continue without interruption. Wedlock in 
 itself and independently of everything else, is a means of 
 cure which should never be lost sight of. The patient even 
 when diffident and fearful, may rest assured that at the end of 
 a few weeks at the most his virile power developing strength 
 from a natural source will supply all normal demands made 
 upon it. 
 
 CAUTERIZATION. 
 
 This operation may be performed with either solid or liquid 
 caustic preparations. Applications of solid caustics are usually 
 made with Lallemand's porte caustiques. I do not advocate 
 cauterization of the prostatic urethra when electricity is avail- 
 able, but there is no doubt it is the next best thing, and is pro- 
 ductive of excellent results. The method of employing Lalle- 
 mand's instrument may best be described in his own words : 
 
 "Before proceeding to cauterization it is indispensably 
 necessary to introduce a catheter for the double purpose of 
 taking the exact length of the urethra and of completely 
 emptying the bladder. On slowly withdrawing the instrument 
 during the escape of the urine, the stream is arrested as soon as 
 the eye of the catheter enters the canal, and recommences 
 again when it is again pushed into the bladder. The penis 
 being then moderately stretched the thumb and forefinger 
 should be applied to the instrument at the point of the glass, 
 when the catheter is withdrawn. The distance between the 
 finger and thumb and its eyes give the exact length of the 
 urethra, and this must be immediately marked on the porte 
 caustique, the eyes of the olivary instrument and the position 
 
LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 259 
 
 of the fingers indicated by fixing a little slide on the stem of 
 the instrument. When the porte caustique has penetrated so 
 far into the urethra that this slide touches the front of the 
 glans, the penis being exactly in the same state of elongation 
 in which it was when the catheter was introduced, it is clear 
 that its extremity will be in precisely the spot previously 
 occupied by the eyes of the catheter when the length of the 
 canal was taken, that is to say at the commencement of the 
 neck of the bladder, a position which it is highly important to 
 the operator to be assured of. 
 
 " The bladder must be completely emptied in order that no 
 urine may penetrate into the tube of the porte caustique, and 
 that none may enter the urethra during cauterization. When 
 the caustic is wetted by the urine it acts much less energeti- 
 cally than if it were dry, and its action extends to parts where 
 it is not required. 
 
 " As the olivary extremity of the porte caustique approaches 
 the neck of the bladder the irritability of the passages increase 
 and the patient's agitation often becomes so great as to incon- 
 venience the operator. The instrument should now be allowed 
 to pass on by its own gravity, attention being paid to detect the 
 moment when the olivary extremity passes the neck of the blad- 
 der. As soon as this happens the instrument should be gently 
 withdrawn, so as to bring its olivary extremity slightly within 
 the neck of the bladder, and firmly held while the outer tube is 
 a little drawn back and the curette very rapidly passed over the 
 inferior surface of the prostate by slightly turning the stem 
 attached to it. The instrument then should be entirely closed 
 and slowly withdrawn from the urethra." 
 
 Lallemand claims a large number of cures by this process. It 
 15 readily seen that if the operation is properly performed^ the 
 
26o LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 
 
 granulations which exist in the prostatic urethra will be dis- 
 troyed and the irritability lessened. This being the case, a 
 diminution in the number of the seminal emissions must neces- 
 sarily result. The great objection to the operation, however, is 
 that great pain is produced by it, and severe inflammation of 
 the urethra and bladder is liable to follow it. In the only case 
 it was employed by me considerable bleeding followed the 
 withdrawal of the caustic. * 
 
 ACUPUNCTURE 
 
 Is one of the most ancient operations for the cure of sperma- 
 torrhoea and impotence ; Lallemand and other surgeons of his 
 time employed it successfully. 
 
 Needles from two to three inches in length are passed through 
 the perineum into the prostate gland and neck of the bladder. 
 Before the operation is performed the patient's bowels should 
 be emptied and the urine drawn off. The first needle is intro- 
 duced in the median line midway between the anus and 
 scrotum. The second is inserted into the prostate half an inch 
 below the first, and the third needle is introduced half an inch 
 above the first one. They are kept in position half or three 
 quarters of an hour. In no instance should they be allowed to 
 remain over an hour. If much pain is caused by the operation 
 an opiate may be administered. 
 
 Some surgeons recommend the introduction of needles into 
 the testicles and spermatic cord for the same purpose. The 
 operation is a barbarous one and should not be attempted. 
 
 With regard to the effects of acupuncture, Lallemand says : 
 " The patients experience, immediately after removal of the 
 
 * Since the above was written I have employed the porte caustique in 
 three other cases without producing much bleeding. 
 
LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 26 1 
 
 needles, a sense of comfort and suppleness which extends from 
 the perineum to neighboring parts, and remarkable improvement 
 in all the phenomena caused by disordered innervation of the 
 genital organs usually results. Sometimes, indeed, such dis- 
 orders do not i:e-appear. 
 
 COUNTER-IRRITATION. 
 
 Counter-irritation, to cause a determination of blood to the 
 surface, is often used to relieve the irritability of the genitals 
 which occasions the emissions, and also to prevent the confirmed 
 masturbator from handling the parts. Counter-irritants are 
 seldom if ever necessary except for the latter purpose. Any 
 diminution in the congestion produced by them is merely 
 temporary. In case it is found necessary to employ them can- 
 tharadal collodion or a fly blister may be used. Painting 
 the parts with tincture of iodine will answer where mild 
 measures are necessary. Croton oil is a dangerous counter- 
 irritant and should never be applied to the genitals, as 
 it is apt to produce a severe degree of inflammation and 
 sloughing. 
 
 Astringent and anodyne injections have long been used in 
 the treatment of spermatorrhoea and impotence. At best they 
 are only palliative. They merely diminish for a time such un- 
 pleasant accompaniments of the disease, as prostatorrhoea, cow- 
 peritis, and allay the irritability existing at the orifice of the 
 seminal and prostatic ducts. 
 
 Syringes, with nozzles six or seven inches in length, and 
 having several perforations at their extremities, injection 
 catheters, etc., are employed for these deep urethal injections. 
 Dr. Bumstead's syringes are the best for the purpose. The in- 
 jection may be made with an ordinary urethral syringe if the 
 
262 LOCAL TREATMENT OF SPERMATORRHOEA & IMPOTENCE. 
 
 Others cannot be had, by pressing the fluid in the urethra back- 
 wards with the finger after the syringe is withdrawn. When it 
 has reached the neck of the bladder, by relaxing the sphincter 
 as at the commencement of micturition the liquid can be 
 pressed into the bladder. 
 
 One of the simpler astringent remedies is the following : 
 
 ^ . Acidi Gallici 3 iii. 
 
 Glycerinae | i. 
 
 Aquae liv. 
 
 Misce. 
 
 One syringeful of this solution may be injected at bed 
 lime. 
 
 In some cases alum is useful in the proportion of one drachm 
 to four ounces of distilled water. One injection each night. 
 If there is much smarting at the neck of the bladder it must be 
 discontinued. 
 
 When a sedative as well as an astringent effect is required 
 the following combination will be found of benefit : 
 
 5. Ext. Hyoscyami 3 ii. 
 
 Vini opii 3 i. 
 
 Acidi Gallici 3L 
 
 Glycerinae | iv. 
 
 Misce. 
 
 One tablespoonful of this mixture added to an equal quantity 
 of water may be injected twice each day for one week, unless 
 pain at the neck of the bladder is excited by its use. In such 
 a case the number of injections may be limited to one each 
 night or every other night. If the injections are employed 
 twice a day for one week, thereafter they should be used every 
 other day. 
 
 Injections containing ergot are often used, such as : 
 
LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 263 
 
 5 
 
 3i. 
 3ii. 
 
 Ext. Ergots fl. . 
 Ext. Uva Ursi fl. 
 Aquae 
 Misce. 
 
 One teaspoonful in a wineglassful of water ; inject once each 
 day. 
 
 A number of unguents are used for medicated bougies. The 
 ordinary ung. gallae combined with ung. opii is a useful 
 one. The ointment is smeared thoroughly over the extremity 
 of the bougie or sound. The instrument is then passed down 
 to the neck of the bladder and allowed to remain there for ten 
 minutes. 
 
 The following combination is as good as any that can be 
 used : 
 
 5 
 
 Ext. Belladonnse 
 
 
 
 Ext. Hyoscyam. , 
 
 
 aa grs. v. 
 
 Pulv. Opii • 
 
 
 grs. ii. 
 
 Acidi Gallici 
 
 
 grs. X. 
 
 Cerat. Simpl. 
 
 
 3ii. 
 
 M. 
 
 A thick layer of the ointment is placed on the bougie for 
 about two inches from its extremity. When introduced to 
 the neck of the bladder it may be allowed to remain for five 
 minutes. This preparation may be introduced daily. 
 
 INTRODUCTION OF SOUNDS. 
 
 The daily introduction of steel sounds has been advocated 
 by many surgeons. They claim that the presence of the sound 
 in the prostatic portion of the urethra, empties the congested 
 and dilated bloodvessels, promotes absorption of inflamma- 
 
264 LOCAL TREATMENT OF SPERMATORRHOEA & IMPOTENCE. 
 
 tory products and gradually removes the irritability of the sem- 
 inal passages, thereby diminishing the number of pollutions. 
 
 My experience with sounds has taught me that but little 
 benefit can be expected from their employment, except in neu- 
 ralgia of the neck of the bladder. 
 
 ELECTRIC RINGS. 
 
 The electric ring is an ingenious contrivance for awakening 
 the patient before an emission occurs. The ring is placed around 
 the penis at night and connected with an electric belt which is* 
 placed around the abdomen, the latter being attached to the 
 poles of a battery. When there is a determination of blood 
 to the genital organs during sleep, the whole tissue of the penis 
 becomes distended, the ring expands and separates the wires 
 which prevent the patient from feeling the electric current 
 while the organ is quiescent. As soon as the separation takes 
 place a violent shock is experienced which awakens the sleeper 
 in time to prevent an emission. This instrument was invented 
 by Johnson of New York. He calls it an electric monitor. 
 
 Steel rings armed with sharp teeth on the inner surface are 
 also employed for the same purpose. The ring is placed on 
 the penis before going to bed ; when erection takes place the 
 sharp points pierce the integument and the pain arouses the 
 sleeper. Leather rings furnished with teeth or pins are also 
 recommended for a like purpose. 
 
 In some cases when the patient cannot get intelligent ad- 
 vice or treatment such devices may be employed for tempo- 
 rary relief ; otherwise, they should never be advised. 
 
 RECTAL PESSARIES. 
 
 Pessaries shaped like an egg and inserted into the rectum 
 so as to press on the ejaculatory ducts and prevent the semen 
 
 i 
 
LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 265 
 
 from entering the urethra have also been recommended. No bene- 
 fit can arise from their employment. It would be better for the 
 patient to put up with an emission than to have an egg pessary- 
 introduced into his rectum every night. 
 
 RECAPITULATION. 
 
 Patients belonging to the first class (see page 207) are ex- 
 tremely rare. They are nearly always beyond the reach of 
 moral or medical treatment. The will power not being suffi- 
 cient to control the habit, ordinary treatment is wasted. It 
 may be well to exercise strict supervision over the patient, and 
 use the baths, tonics and electricity for a few weeks, and then if 
 there is no good result, the patient should be castrated without 
 delay, and the penis, pubes and perineum covered with canthara- 
 dal collodion. Simple castration will not at once stop ejacula- 
 tions through the urethral canal, so it is consequently necessary 
 to place the parts in such a condition as to prevent them from 
 being handled. If these measures fail, I see no objection to 
 removing the whole of the external genital apparatus. 
 
 Patients of the second class (see page 208) are always curable. 
 Though very much broken down, their will power is sufficient to 
 enable them to discontinue the habit completely. Let the 
 patient understand that he can be cured by following up sys- 
 tematically every order given him. He should take from three 
 to six sitz baths daily for the first ten days or a fortnight. After 
 that period one or two will be sufficient. If the baths cause 
 much aching about the loins and difficulty in locomotion, they 
 should not be used so frequently. The pain and stiffness do 
 not often occur, but when present, contra-indicate the frequent 
 use of the bath. Every morning after breakfast an injection of 
 one pint of cold water should be taken. This can be con- 
 
: 66 LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 
 
 tinued daily, until the evacuations from the bowels are normal 
 in character. Three or four weeks is generally long enough to 
 accomplish this end. If the patient is not strong enough to 
 take a sponge bath in the morning he should be bathed while 
 in bed, and after the bath have a brisk rubbing. Instead of 
 eating three meals per day, he should have six or seven as de- 
 scribed (page 221). Exercise in the open air is indispensable. 
 
 The applications of electricity may be made every day or 
 every other day in the manner described (page 255), with this 
 difference that the current should be reversed often during the 
 sitting, in order to get the stimulating effect of the application. 
 Nothing tends so much to a cure as an increase in the erections. 
 The moral effect of this upon the patient cannot be over- 
 estimated. As the increase in the virile power is not attended 
 by more frequent emissions, there is nothing to add to the anxiety 
 of the patient. If ordinary aphrodisiacs were used to accom- 
 plish the same purpose, an increased number of emissions 
 would at once result. Therefore, the use of aphrodisiacs at 
 this stage is inadmissible. The only medicines to be employed 
 from the commencement of the treatment are those which give 
 tone to the system (see page 241). 
 
 When the emissions are brought down to one or two in a 
 week and the erections occur every night, it is well to advise 
 legitimate sexual intercourse. No fear need be entertained of 
 failure if the patient is willing to follow the advice of his phy- 
 sician. If necessary the patient may take a few doses of some 
 of the aphrodisiac combinations previously mentioned, before 
 testing his powers in sexual congress, and he may be allowed 
 to continue them for a couple of weeks after marriage. 
 
 Bromide of potassium and all medicines of a like nature 
 should be strictly prohibited to all patients of this class. 
 
LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 267 
 
 Patients of the third class (see page 209) make up a large 
 majority of the subjects who present themselves for treatment. 
 The undue excitement of the genital organs evidenced by fre- 
 quent but feeble erections and frequent emissions, re-acts on 
 the circulation and their mental excitement and fears form the 
 principal features in the case. They require judicious advice 
 more than they do medication. If they could be induced to 
 marry, and wait for a week or two before becoming disheartened 
 at temporary failures, they would need no other cure. But 
 their fears are so urgent that a systematic course of treatment 
 is necessary to get them in a proper frame of mind for 
 marriage. 
 
 A sponge bath in the morning and a sitz bath at night of 
 fifteen minutes* duration are always necessary. The cold water 
 enema may also be employed, but some of the mild cathartics 
 will answer as well. When the genital excitement is very great 
 a few doses of bromide of potassium given at bed-time for the 
 space of one week will do good. It should never be continued 
 longer than a week. Applications of electricity may be made 
 every day, with the negative electrode in the urethra and the 
 positive electrode over the spine (see page 255). The current 
 need not be reversed until the patient has been under treat- 
 ment five or six weeks. 
 
 Aphrodisiacs are never necessary for patients belonging to 
 this class unless failure should occur after marriage. 
 
 Patients of the fourth class (see page 210) should cease from 
 all attempts at sexual intercourse for several weeks, or months, if 
 necessary, and make a short or long trip into the country with en- 
 joyable company. Take in all the change of air and surroundings 
 as will keep the mind away from all sexual matters. They should 
 exercise actively in the open air and bathe freely, according to the 
 
268 LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 
 
 directions in a previous chapter. Upon returning home they 
 should make up their minds not to attempt sexual intercourse 
 for three or four nights at least, and not then until they have 
 perfect control of themselves in every way. 
 
 Female masturbators can only be cured by marriage. The 
 general health must receive the same attention as in the case of 
 the male masturbator. The tonics, baths and other remedial 
 agents described are all necessary, but marriage itself is the 
 only positive cure. If circumstances are such as to prevent 
 the patient from entering the married state and the will power 
 is not strong enough to prevent her indulging in the vice, then 
 amputation of the clitoris may be considered. Indeed, I think 
 it would be a perfectly justifiable operation in all bad cases. 
 
 It is well also to make liberal use of bromide of potassium in 
 these cases so long as it does not materially disorder the stomach. 
 For obvious reasons the bromides may be more freely used in 
 cases of female onanism than in cases occurring in the other 
 sex. 
 
 Cold sitz-baths should be given freely. 
 
CHAPTER XVI. 
 
 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE, 
 
 Methods of Treatment used by Gross, Van Buren and Keyes, Post, Bar- 
 tholow, Hutchinson, McGraw, Gant, Acton, Humphrey and others. 
 
 In order to make this volume complete as a book of refer- 
 ence, I have collected the opinions of some of our principal 
 surgeons, and given their various methods of treatment. Their 
 peculiar views can be compared and an intelligent opinion 
 formed as to the respective merits of each mode of treatment. 
 
 Prof. Samuel D. Gross, of Philadelphia, in speaking of the 
 treatment of spermatorrhoea says : " The milder cases after 
 riddance of the exciting cause, often recover spontaneously, 
 or under the use of very mild means, as a proper regulation of 
 the diet and bowels, exercise in the open air, cold bathing, 
 sleeping upon a hard mattress. Circumcision will be necessary 
 when there is hyperaesthesia of the head of the penis from the 
 irritation of retained sebaceous matter consequent upon elonga- 
 tion and contraction of the prepuce. When the parts are 
 morbidly sensitive leeches may be applied to the perineum, and 
 use made, twice daily, of some astringent and anodyne injec- 
 tion, as a solution of acetate of lead and opium, in the propor- 
 tion of three grains of each to the ounce of water. But a very- 
 different mode of management will be required when the 
 disease is fully established, especially when it is dependent 
 upon habitual onanism. The best local treatment then, at least 
 in many cases, is cauterization, but before resorting to this 
 expedient, the urethra should be well explored with a bougie 
 
270 TREATMENT OP SPERMATORRHCEA AND IMPOTENCE. 
 
 or silver catheter, to ascertain the precise seat of the irritation. 
 This will sometimes be found in front of the membranous 
 portion of the urethra, but generally it is further back, at the 
 neck of the bladder, or, more correctly speaking, at the orifices 
 of the ejaculatory ducts and the anterior extremity of the 
 gallinagenous crest, where it is often so great that the patient will 
 shrink from the mere contact with the instrument. Occasion- 
 ally the morbid sensibility is diffused over the whole surface of 
 the urethra, from one end to the other, and then the passage of 
 the bougie is liable to be followed by excessive pain and even 
 syncope." [Dr. Gross then describes the process of cauteriza- 
 tion which has been given in a previous chapter.] 
 
 " Instead of the solid nitrate of silver, a solution of the salt 
 may often be advantageously employed, in the proportion of 
 ten to twenty grains to the ounce of water. The fluid is con- 
 veyed directly to the prostatic portion of the urethra by means 
 of a syringe shaped like an ordinary catheter, and perforated 
 with numerous openings at the distal extremity. The injection 
 should not be repeated oftener than once in six, eight, or ten 
 days. 
 
 " Cold bathing, general and local, is often highly beneficial ; 
 dashing cold water against the perineum, scrotum, penis, and 
 inside of the thighs is useful. Some persons, especially such as 
 are of a nervous, irritable temperament, experience greater 
 advantage from warm bathing than from cold. Occasionally 
 marked relief arises from cold enemas repeated twice in the 
 twenty-four hours. When the patient is plethoric, as is some- 
 times the case in the early stage of the disease, leeches may be 
 applied to the perineum, followed, if the local excitement is 
 unusually great, by a blister, a small seton, or an issue. When 
 the morbid sensibility of the urethra is -very extensive, obsti- 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 271 
 
 nate or persistent, the treatment should be aided by the injec- 
 tion, twice a day, of a weak solution of nitrate of silver 
 and opium in the proportions of about two grains of the former 
 and five of the latter to the ounce of water. Sulphate of zinc, 
 Goulard's extract and acetate of lead also answer extremely 
 well in cases of this kind. ... In some cases the irritability of 
 the urethra promptly yields to the daily use of a full sized 
 bougie retained for half an hour at a time. The morbid erec- 
 tions so often present in spermatorrhoea are generally easily 
 controlled by anodyne enemas, or by opium, belladonna and 
 tartar-emetic given by the mouth at bed time. 
 
 " The patient must sleep upon a hard mattress and every- 
 thing stimulating, whether in the form of food, drink or medicine 
 must be carefully avoided. The bowels must be kept soluble 
 by mild aperients. Exercise in the open air is an important 
 auxiliary. Riding on horseback is injurious, as it has a ten- 
 dency to create undue excitement in the genital apparatus. 
 Sometimes an entire change of occupation affords more relief 
 than anything else. 
 
 " Where there is great prostration of the system, with restless- 
 ness and loss of sleep, the use of tonics, as quinine and tincture 
 of iron with hyoscyamus or opium is indicated. Dilute 
 phosphoric acid sometimes exerts a powerful restorative in- 
 fluence. In such cases a change of air, and the daily use of 
 the shower bath, greatly promote recovery. The diet should 
 be light, but nutritious, and a glass of German wine should be 
 allowed at dinner. Should there be reason to believe that the 
 emissions are dependent upon cerebellar irritation, the chief re- 
 liance must be upon leeches and blisters to the nape of the 
 neck, cold shower baths and other soothing measures. Much 
 has lately been written in favor of lupulin as a sedative in this 
 
272 TR^ATMEXT OF SPERMATCRJvH ^A AXD IZlPOTESCt. 
 
 disease, but :l::urh I ':; r :rr:\:t":! e v : tii: i: hrs ::ever 
 done any gcc i ::: my 'mnis ' mii s:ica a remedy is required the 
 best article rha: I k-o~ ;: is :r:niideof potassium given three 
 rimes a day, in d^ses rar.rir.r from twenty to thirty grains or 
 under with a few drops of tincture of aconite, in half an ounce 
 of camphor water. I have also used with excellent effect, in a 
 number of cases, bromide of ammonium in conjunction with 
 tincture of cypropedium. The action cf these medicines is 
 powerfully sedative, and they are worthy of much greater at- 
 tention than has hitherto been accorded to them in this parti- 
 cular class of affections. 
 
 "V.lien, by the a::--e me :..-:. res, :'r.z system has re^-aiied its 
 natural tone and the sesna: anpararas its accustomed vigor, the 
 best guarantee again s: rei: :t is m:::i m, L'pon this point, 
 however, it is impossi: it m ; t : : : : as, " 
 
 Van Buren and iKieyes, cm nam: :ia_ amn :'ae sa':;ec:. say: 
 "When a man comes complaining cf the results of masturba- 
 tion, an attentive study of his symptoms wiQ not infrequently 
 disclose his disease to be hypochondria, and his malady ungrati- 
 fied sexual desire with often some neuralgia of the vesical neck. 
 Hi's training should consist in encouragement and continence, 
 with absolute purity of thought, and subsequently marriage, to 
 regulate his sexual hygiene. After marriage it is rare to hear 
 any further complaint from these cases, always provided there 
 is really nothing more than functional derangemen: ; : :im mt- 
 tom of the patient's complaint, as is the case in :he vast 
 majority of instances. 
 
 " As for medicines, they are of little or no value ; camphor, 
 bromide of potassium or lupulin might be given as placebos, but 
 it is doubtful if they are of any efficacy. = Cold sponge baths, 
 out-door sports, physical fatirae. sleeping in a coo! room cyi a 
 
TREATMENT OF SPERMATORRttCEA ANB IMPOTENCE. 2^3 
 
 hard bed with a light covering are all useful ; eating lightly 
 at night, not retiring until very sleepy and rising immediately 
 on waking in the morning are powerful assistants in breaking 
 up the habit, but all will be of no avail unless the morale of the 
 patient be elevated, unless he keeps his thoughts pure, and 
 desires, for the manliness of it alone, to be rid of his bad 
 habit. 
 
 " The treatment of diurnal pollution is by steel sounds and 
 local astringents to the prostate together with most of the 
 means detailed for nocturnal emission. Circumcision should be 
 performed if the glans penis is sensitive. . . . 
 
 " The use of the steel sound and electricity helps to give tone 
 to the parts. The use of local astringents to the prostatic 
 sinus is often of marked advantage. The best agent for 
 effecting this is tannin, and the cupped sound, the most 
 convenient method of applying it The ap- 
 plications are to be repeated once or twice weekly, according 
 to the effect, and often in a short time a change in the symptoms 
 for the better is usually manifested in mild cases. Should these 
 simple means fail recourse may be had to prostatic injections 
 with deep-urethral syringes ; a solution of nitrate of silver not 
 stronger than five or ten grains to the ounce being used. 
 Failing with this, hope must be based upon the continuance 
 of general and local tonic hygienic measures. The use of the 
 fluid nitrate of silver with Lallemand's instrument is not 
 justifiable, for fear of including the orifices of the ejaculatory 
 ducts in an eschar and obliterating them by cicatrization.'* 
 
 Professor Roberts Bartholow recommends cauterization with 
 
 solid or liquid caustics, injection of astringents for relief of the 
 
 local symptoms. In discussing general medication under the 
 
 head of " Anaphrodisiacs " he says* "One of the oldest of 
 
 i8 
 
274 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 
 
 these remedies is camphor. . . . It is not, however, a very val- 
 uable remedy. To produce the desired anaphrodisiac effects 
 large doses are necessary ; it frequently fails, and its action 
 upon the stomach is unpleasant, giving rise to a sense of heat 
 and burning, and followed by disagreeable eructations. 
 
 " Lupulin has considerable efficacy as an anaphrodisiac, but 
 like camphor it is uncertain. Conium and belladonna are 
 quite as efficient if given in sufficient doses, and are considera- 
 bly more certain. Conium, particularly, is not given in doses 
 sufficient to produce its peculiar effects upon the genital organs, 
 as ordinarily prescribed. Five to fifteen grains of the extract, 
 according to its freshness and activity, may be administered at 
 
 a single dose Conium and belladonna are, 
 
 however, chiefly valuable when administered with bromide of 
 potassium or other true anaphrodisiacs. 
 
 *' The most important agent of this class, the most efficient 
 and certain, and the least distressing in its immediate and re- 
 mote effects, when purely administered, is the bromide of po- 
 tassium. The anaphrodisiac property of this drug is now al- 
 most universally acknowledged, but the condition of its success 
 and failure have not been as definitely determined as is desira- 
 ble. There are yet some skeptics who disbelieve in this prop- 
 erty of the bromide of potassium. 
 
 ** Aphrodisiacs. — These are indicated under certain circum- 
 stances. The tincture of cantharides is sometimes beneficial in 
 in cases of great atony and relaxation. Those characterized 
 by profuse mucous discharge, so-called diurnal pollutions, very 
 feeble power of erection, and absence of sexual desire. It is 
 contra-indicated when much hypersesthesia of the prostatic por- 
 tion of the urethra exists. To prevent its irritant effects, or at 
 least to reduce them to the minimum, opium, or cannabis indica, 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 275 
 
 or chlorodyne, may be advantageously combined with it. The 
 red or amorphous phosphorus may be given in the same class 
 of cases as suggested for the tincture of cantharides. Nux 
 vomica is adapted to those cases in which it is desired to restore 
 the functional activity of the sexual organs after the state of 
 quiescence induced by the prolonged administration of ana- 
 phrodisiacs. Cimicifuga (actea racemosa) has seemed to me to 
 possess considerable aphrodisiac power, and has proved useful 
 in cases of long standing spermatorrhoea, accompanied by ner- 
 vousness and anxiety, and diminished sexual desire. 
 
 " Galvanism, especially the direct current, and static electric- 
 ity, are often decidedly aphrodisiac, and are probably applica- 
 ble to more numerous cases than any other remedy of the class. 
 The moral effect of galvanism is too important to be disregarded. 
 
 " Ergot has been much extolled in those cases in which 
 emission takes place quickly with feeble erections. 
 
 " Iron, quinine, the vegetable bitters, the mineral acids, are in- 
 dicated in anaemic cases. The hygienica^ exercise, bathing, 
 travel, etc., are valuable adjuncts to the remedial measures." 
 
 In his work on therapeutics, Dr. Bartholow also advocates 
 the injection of a solution of ergotin near the dorsal vein of 
 the penis, in order to compress it and promote erections. 
 
 Prof. Frank H. Hamilton says : — " If the emissions are only 
 occasional, and do not affect the general health, no treatment 
 is required and these constitute a majority of those cases 
 which are brought under the notice of the surgeon. If on the 
 other hand, both the general health and the mental functions 
 are sensibly impaired as is sometimes the case, a careful inquiry 
 must first be made to ascertain the cause and the proper 
 measures must be adopted for its removal. In nearly all of 
 these latter examples there is evidence of a loss of tone in th?> 
 
2-6 TREATMENT OF SPERMATORRHCEA AND IMFOTEXCE. 
 
 entire nervous system and it will be proper to recommend plain 
 but nutritious diet, mineral tonics, cold bathing with frictions, 
 and out-door exercise. All stimulating liquors and tobacco 
 are hurtful. The emissions take place usually at night or 
 towards morning, when the patient has become warm in bed, 
 and is sleeping soundly. In such cases the patient must be 
 enjoined not to eat a hearty meal within four or five hours of 
 retiring ; he must empty his bladder before getting into bed ; 
 the bed should be rather hard and the coverings light, so that 
 his sleep shall be less profound ; he must lie upon his side, 
 never upon his back and if possible he should rise a little past 
 midnight, or when he has been in bed about four hours, and, 
 stepping upon the cold floor, empt}' his bladder again. A strict 
 adherence to these rules seldom fails to prevent nocturnal 
 emissions, and if the habit can be interrupted by these or any 
 other measures for several weeks, the patient is on a fair way for 
 ^ecove^\^ The object in requiring the patient not to rest upon 
 his back and to empty the bladder often is to prevent an ac- 
 cumulation of urine upon the trigone and neck of the bladder 
 where its presence is liable in children to cause involuntary 
 discharges of urine and in those who are older involuntary 
 discharges of semen. 
 
 ''As a direct means of recover}- from the morbid irritability 
 of the neck of the bladder no plan is more successful than the 
 application of nitrate of silver first suggested and practiced by 
 Lallemand, but the instrument invented by Lallemand and em- 
 ployed by most surgeons up to a very recent date, has proved 
 ver}- unsuccessful and ought to be wholly laid aside. In addi- 
 tion to the numerous accidents which have attended its use, 
 and which have from time to time been recorded by surgeons, 
 it has happened under my own observation also, that a young 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 277 
 
 physician who had borrowed my instrument, turned the style 
 in the wrong direction, and broke it, leaving the cut, contain- 
 ing the caustic and several inches of the cord in the urethra, 
 from which it was with great difficulty removed by a narrow 
 urethral forceps. Since then I have ceased to use Lallemand's 
 instrument myself, and have never recommended its use to 
 others, but I have employed instead a method similar to that 
 which I have seen more recently recommended by Mr. Erich- 
 sen. A silver catheter furnished with a large number of small 
 holes instead of the usual long fenestra at its vesical extremity, 
 is introduced to the neck of the bladder, when a piece of 
 sponge fastened to the end of the wire stylet, and saturated 
 with a solution of nitrate of silver, is carried forcibly to the 
 vesical extremity of the catheter driving the caustic solution 
 out upon the mucous membranes. In the first experiment 
 the strength of the solution is not to exceed five grains to the 
 ounce. If this fails after the lapse of two or three weeks ten 
 or twenty grains to the ounce may be employed. Latterly I 
 have obtained in a few cases benefit from the daily introduc- 
 tion of a steel sound of moderate size. 
 
 " Beyond these measures, all of which it must be acknowl- 
 edged are liable to fail, nothing but wedlock can hold out much 
 promise of a cure, and this has proved successful in my obser- 
 vation almost without an exception, not always immediately, 
 but the improvement is generally manifest within a few weeks 
 or months, and a complete cure can in most cases be assured 
 after a year or two at most ; nor, in general, need any fear be 
 entertained that the results on the patient will be found to have 
 been injurious. Beyond a temporary incapacity resulting from 
 a lack of confidence, no failure of the virile powers is generally 
 experienced. 
 
278 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 
 
 " I have omitted to speak of ligature of the spermatic arteries, 
 ligature of the vas deferens and castration, all of which 
 methods have occasionally been practiced in extreme cases of 
 onanism or entire mania. When practiced for the cure of 
 onanism these measures have in most cases been successful, 
 but the relief has not generally been immediate." 
 
 Prof. Alfred C. Post sends me the following brief summary 
 of his method in the treatment of spermatorrhoea and impotence : 
 " I have regard to the constitutional condition of the patient 
 and to the local irritation or congestion of the parts specially 
 involved in the disease. As to the general condition of the 
 patient, I combat debility as indicated by feeble pulse, pale 
 complexion and muscular inertia, by tonic medicines, as iron 
 and quinine, by cold bathing, local and general, especially salt 
 water bathing, by regular moderate exercise in the open air, by 
 nutritious diet, cheerful recreation and other appropriate 
 hygienic means. When the prostatic part of the urethra is in 
 a congested and irritated condition, I make gentle pressure 
 upon it by the careful introduction of steel sounds, of as large 
 a size as can be introduced without giving much pain to the 
 patient. I repeat the introduction at intervals of two or three 
 days. If the irritability be not relieved in this way, I make an 
 occasional application of nitrate of silver to the prostatic portion 
 of the urethra by means of Lallemand's porte caustique or other 
 suitable instrument. I sometimes derived benefit from the use 
 of ergot, giving 30 minims of Squibb's fluid extract three times 
 a day in water, and continuing its use for several weeks. It is 
 always important to guard against constipation of the bowels. 
 Good effects are sometimes derived from stimulating diuretics 
 such as diosma crenata, uva ursi, copaiba, cubebs, oil of san- 
 dal wood, oil of turpentine. 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 279 
 
 Dr. Joseph C. Hutchinson, of Brooklyn, says : '* In cases of 
 spermatorrhoea requiring treatment, that is to say when the 
 emissions occur two or three times a week and affect the gen- 
 eral health, the cause of the trouble should be ascertained 
 and the means for its removal adopted at once. The usual 
 cause is self-pollution. The patient should be directed 
 to avoid stimulants and tobacco (the latter direction is 
 specially important), to have plenty of out-door exercise, 
 to use mineral tonics, cold bathing, etc. He should sleep 
 on a hard bed with light covering, avoid fluids as far as 
 possible during the evening, empty his bladder before retir- 
 ing and at any time he may awake during the night, and 
 never sleep upon his back. This may be avoided by tying a 
 handkerchief around the body with a knot in the center behind. 
 These directions strictly adhered to will overcome the tendency 
 to excessive nocturnal emissions in many cases. In the more 
 obstinate cases I know of no remedy so generally useful as 
 ergot. I advise 5 grs. of Squibb's extract, representing 20 grs. 
 of the best ergot, three times a day. In most cases the 
 hypersesthesia which exists in the neighborhood of the ejacu- 
 latory ducts requires for its removal the application of altera- 
 tive and astringent unguents to the affected parts. That which 
 has been the most satisfactory to me is an ointment containing 
 one-fourth of a grain of sulphate of copper to the ounce, 
 applied once or twice a week by means of a number twelve 
 cupped steel sound, to the prostatic urethra. In this way we 
 obtain the benefits not only of the medicinal agent, but also of 
 the sound itself, which is by no means unimportant. The 
 cupped sound I have used for the last twenty years formerly 
 belonged to and was used by the late Dr. Isaacs. The oint- 
 ment may also be employed by means of a long pipe urethral 
 
28o TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 
 
 syringe devised by myself and made by Tiemann. I have 
 used with advantage urethral suppositories of butter of cocoa 
 containing one-quarter of a grain of carbolic acid pushed 
 down to the prostatic urethra by a steel sound and allowed to 
 dissolve there. Patients may be instructed to use these instru- 
 ments themselves when it is not convenient to attend in person 
 as often as necessary. I formerly used Lallemand's instrument 
 for applying solid nitrate of silver to the orifice of the ejacula- 
 tory ducts, but abandoned it because of unpleasant effects 
 which sometimes followed its use. Should these measures fail 
 to promote a cure, the patient ought to be married. Wedlock 
 is often successful when everything else fails. 
 
 " In cases where impotence is the principal feature of the 
 case, I have found nothing as efficient as fifteen minims each of 
 the tinct. ferri chlor. and tinct. cantharides with one twenty-fifth 
 of a grain of strychnia. The iron may be omitted when not 
 indicated. In conjunction with the above mixture, phosphorus 
 in one-fiftieth of a grain dose may be used. Very often phos- 
 phorus alone is relied upon. The use of the cupped sound and 
 the unguents recommended in the treatment of spermatorrhoea 
 have a marked beneficial influence." 
 
 Prof. Theo. A. McGraw, of Detroit, says : "I do not 
 believe that even a daily emission of semen will do serious 
 damage to a healthy vigorous man. In view of the fact that 
 multitudes of men after marriage have connection with their 
 wives more than once every night without suffering injury, it 
 seems to me an absurdity to ascribe so much evil to seminal 
 losses as is usually done by authors. Lallemand especially 
 confounded the effects of long dissipations and other diseases 
 affecting the genital organs with those of seminal losses. 
 
 ''' 2d. My experience teaches that young men who do not 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 281 
 
 suffer from involuntary emissions once or twice a month or week, 
 are rarely to be found in civilized society. This is a physiolo- 
 gical necessity and it seems to me just as absurd and useless 
 to order medicines and apply treatment to cure moderate 
 seminal losses as it would to try to prevent a man from passing 
 water. When the seminal vessels become full they will contract 
 and empty themselves. 
 
 " 3d. Young men who read trashy pamphlets on spermator- 
 rhoea may brood over their fancied disease until they cause 
 serious and often irreparable damage to the nerves supplying 
 the genital organs. This causes loss of sexual power, increased 
 irritability of the organs, and eventually an impotence which is 
 not always susceptible of cure. I regard this as the result of 
 the mental despondency and perverted attention, kept up as it 
 often is through a long series of years. I do not believe that it 
 is ever caused by the occurrence of emissions alone. 
 
 " 4th. As regards treatment, the sine qua non seems to me to 
 be, to get out of the patient's head that a seminal emission is in 
 itself hurtful. He may then get his mind in healthier channels 
 and get well. He will always, however, continue to have more 
 or less frequent involuntary emissions until cured in marriage." 
 
 Acton of London, says : " The first consideration on dealing 
 with any case of spermatorrhoea, is to ascertain from which of 
 its many causes the affection may have more especially arisen. 
 Each patient may complain of some particular or well marked 
 symptom to the exclusion of all others, though the affection 
 itself may consist of a lesion of more than one function. It is 
 therefore of great importance that this distinction should be 
 clearly understood. According as one or other of the functions 
 (e. g. erection, emission, or the character of the emitted semen) 
 is in fault, so must the treatment vary : what may be good in one 
 
282 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 
 
 case may not be applicable in another. Having learned what 
 particular symptom the patient complains of, he should be 
 desired to make water into a glass which should be deposited 
 at once on a stand, to be examined at leisure. It is well at the 
 same time to pass an oblong bougie in order to ascertain the 
 susceptibility of the urethra ... In order to cure the affection 
 it is of more consequence to ascertain the i77imediate existing or 
 local cause than the primary cause which may have impaired 
 the function or congested the brain. 
 
 o 
 
 "Before attempting the curative treatment "Out preventive on^ 
 should be commenced. It should be ascertained if bad habits 
 exist, and if so, the patient should be told at once that unless 
 they are left off it is useless for the surgeon to attempt to heal 
 him. It should, however, not be concealed from the patient 
 that the means about to be employed will speedily impart such 
 power to the will, that by his own volition he will be capable 
 of correcting habits which were previously beyond his control. 
 Moderation in sexual indulgence, if not abstinence, should 
 be enjoined on the married, and a promise to that effect ob- 
 tained. It should be next ascertained whether constipation 
 exists, whether ascarides excite the secretion, or if the pa- 
 tient suffers from varicocele. If the latter complication be 
 present a suspensory bandage must be worn, or what is still 
 better, a varicocele ring, which the surgeon should teach the 
 patient how to put on . . . 
 
 " The patient must do his utmost to prevent emissions taking 
 place, and to effect this should have recourse to all the means 
 spoken of." . . . [Mr. Acton employs the measures pre- 
 viously mentioned, page 224.] " In the slighter cases of sperma- 
 torrhoea, these remedies may alone suffice, and as stated 
 above the occasional passage of a large bougie or the glass 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 2^^ 
 
 tube of the instrument hereafter to be described will suffice to 
 cure the patient. If, however, these plans do not succeed, and 
 if the emissions occur I have no hesitation in at once em- 
 ploying cauterization." [Mr. Acton injects a ten grain solution 
 of nitrate of silver with a large glass syringe,] With regard to 
 its efficacy he says : " The advantages of injecting a solution 
 of nitrate of silver are so manifest that I now never employ 
 any other plan, and yet I have occasionally to treat some of the 
 most obstinate forms that others have failed in curing. , . . 
 ** Remedial treatment comprises both constitutional and local 
 measures. Constitutional treatment consists in the administra- 
 tion of tonics to restore a healthy state of both the muscular 
 and nervous systems, and in the use of sedatives to allay irri- 
 tability. Of tonics, the preparations of iron are most effica- 
 cious ; and particularly the sesquichloride of iron, in doses of 
 from fifteen to thirty drops in half a wineglassful of water 
 thrice daily. Strychnia, in doses of one-twelfth of a grain, 
 made into a pill, with or without the sulphate of iron, forms a 
 tonic anti-spasmodic preparation of great value. Sedatives are 
 less beneficial than tonics ; yet, in spasmodic spermatorrhoea, 
 a night pill of belladonna or of hyoscyamus and camphor, may 
 perhaps be advantageously given to subdue the local irritability 
 which favors the seminal emissions. Suppositories of pil. sap- 
 onis, ten grains, are, according to my experience, preferable as 
 acting topically. The cold hip-bath, or sluicing the perineum 
 with cold water night and morning, is a most serviceable local 
 tonic. Hygienic measures must also be carefully attended to 
 as part of the constitutional treatment. A plain, unstimulat- 
 ing, nutritious diet is essentially requisite, rigorously excluding 
 peppers and other condiments, which are apt to irritate the 
 rectum and provoke seminal emissions during defecation. 
 
284 TREATMENT OF SPER:iIAtORRHCEA AND IMPOTENCE. 
 
 The stomach should never be overloaded by a heavy meal ; 
 and a daily action of the bowels should be secured by gentle 
 aperients when necessary. A dinner pill consisting of the 
 compound rhubarb pill with hyoscyamus, will answer this pur- 
 pose far better than colocynth or any other irritant purgative. 
 The invigorating influence of daily exercise in the open air and 
 of outdoor amusements, with perhaps change to a bracing 
 climate, can scarcely be overlooked ; but relaxation from study 
 or the excitement of business, and freedom if possible from 
 the pressure of anxiety are no less restorative, while every 
 encouragement must be given to cheerfulness and hope. All 
 this constitutional treatment not unfrequently fails to cure the 
 spermatorrhoea ; the local irritability of the prostatic urethra 
 still remaining. Recourse must be had to the application of 
 nitrate of silver along the under surface of this portion of the 
 urethra, to the orifices of the ejaculatory ducts." — Gant. 
 
 Humphrey thinks that when the emissions return, " more than 
 once in a fortnight, and especially if they amount to two, three 
 or more in a week, as is sometimes the case, they should receive 
 attention." With regard to treatment he says : "The attention 
 to these sensations, real and imaginary, and the constant dwell- 
 ing upon the matter, tends, unquestionably, to aggravate the 
 malady. My first effort, therefore — having requested the patient 
 to burn any book or pamphlet he may have upon the subject — 
 is to restore a calm and less anxious frame of mind, by assuring 
 him that a great part of his apprehensions are groundless, 
 giving him good hope of recovery, in great measure at least, 
 recommending him to engage in out-door amusements and to 
 enjoy the cheerful society of his friends, not to relinquish his 
 reading, but to work less hard at it, especially towards night, 
 to go to L>d early and rise early. I am unwilling to keep up 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 285 
 
 the idea of invalidism by prescribing medicine or particular 
 diet, and simply warn him against overloading his stomach, as 
 that is likely to induce the discharges. These assurances and 
 simple directions are often sufficient, and many have told me of 
 the relief and happiness they have derived from them. This 
 failing, and in worse cases, more particular attention must be 
 paid to the digestive organs and their secretions, especially 
 when the urine is turbid ; mild aperients may be required to 
 prevent accumulations in the intestines, and a light diet must 
 be enforced. In those who are robust, an alkali may be given 
 at night, and in those who are weak, quinine or steel. Better 
 than all medicines are relaxation from work, with change of 
 air, traveling, and sea-side residence. Often, however, these 
 cannot be carried out, or are available only for a time ; and 
 under the medicinal treatment the discharges are sometimes not 
 sufficiently diminished. Perhaps the intervals between them 
 are lengthened, and they return two or three nights in suc- 
 cession, instead of being more frequent and with more regular 
 intervals. I have not found cold ablutions do much good, 
 though washing the exterior of the glans penis, and keeping it 
 clear of secretion, is of some service by lessening the irrita- 
 bility of that part. The application of nitrate of silver by 
 means of the porte-caustique to the inner surface of the prosta- 
 tic portion of the urethra, where the ejaculatory ducts open, is 
 unquestionably, in some cases, an efficient adjuvant to the means 
 just described for checking or moderating this malady. It has 
 been employed by many persons since it was brought promi- 
 nently into notice by Lallemand ; and I do not know that 
 mischievous results have attended its use in competent hands. 
 Care should be taken that the instrument is sound, for the 
 solder connecting the part which carries the caustic is liable to 
 
286 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 
 
 be decomposed. This once gave way, leaving the end of the in- 
 strument and the caustic in the prostate of a gentleman whose 
 urethra I was cauterizing. It was voided with the urine in the 
 course of the following day, and, though he suffered more than 
 was intended, no evil resulted. The caustic may be applied 
 pretty freely, the instrument being known to be in the prostatic 
 region by the distance to which it has been passed, and by the 
 sensitiveness of the part, or, more certainly, by feeling with the 
 finger in the rectum. A good deal of irritation, pain, with fre- 
 quent bloody micturition and some discharge follow the opera- 
 tion, with, perhaps, seminal emissions at night. These subside 
 in a few days, and the good effect is at once shown by a ces- 
 sation of the emissions. In many cases, however, they return 
 after a period, requiring a repetition of the remedy, perhaps 
 two or three times ; and in some cases no good results from it. 
 I am aware that this proceeding is objected to by some whose 
 opinions deserve attention as unsafe, by others as empirical, 
 and by others as unphysiological and unpathological. It can 
 scarcely be regarded as unphysiological, when we observe the 
 effect which is produced on the whole length of a tube or a 
 series of tubes by irritation at any one part of the lining mem- 
 brane, especially if that part be near an orifice, how titillation 
 of the fauces will cause vomiting, or of the larynx coughing, 
 or of the rectum diarrhoea and tenesmus. It cannot be very 
 unsafe or even injurious, or we should ere this have heard of 
 more ill-effects produced by it. Neither do I think it so em- 
 pirical and unpathological as some seem to regard it, mistaking, 
 as I cannot help fancying, the real seat of the malady, which 
 appears to me to be in the prostatic part of the urethra more 
 distinctly than in any other portion of the generative apparatus. 
 I judge this to be so, because there is usually a preternatural 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 287 
 
 sensitiveness of that part elicited by the passage of instru- 
 ments or by pressure with the finger. Frequently there is un- 
 easiness or actual pain there, especially after the emissions ; 
 and an irritation of this part by any cause is likely to induce 
 the emissions. It is the only part in which anything distinctly 
 abnormal in the sensations is experienced ; the testes, vasa 
 deferentia, vesiculae seminales, show little or no tenderness or 
 other sign of disturbance. We are, therefore, warranted in 
 considering this part to be at fault, and in applying to it that 
 salt which is often found to allay irritability or a chronic in- 
 flammatory condition in other mucous membranes. Above all, 
 there is the more cogent argument that good frequently results 
 from its use. We must not, however, be too sanguine in our 
 expectations, for, as has been already said, the benefit is some- 
 times only temporary, and in some cases the treatment fails 
 altogether. In some slight cases benefit is derived from the 
 occasional passage of a metallic instrument into the bladder 
 and allowing it to remain there ten or twenty minutes. It is 
 commonly well to try this before resorting to cauterization. 
 Accompanying this malady or independent of it, there is some- 
 times a discharge from the urethra of tenacious fluid, like white 
 of egg, in small quantity, following the urine, or expelled during 
 the evacuation of the feces, especially when straining is re- 
 quired for that purpose. This symptom causes great alarm to 
 the patient, as he conceives that he is suffering from a con- 
 tinual escape of the semen. Such, however, is not the case. 
 I have examined this fluid passed by several persons, and have 
 never found any spermal elements in it. It proceeds appa- 
 rently from the prostate gland, and its presence in sufficient 
 quantity to issue from the urethra is an indication of a relaxed 
 condition of the ducts of the gland, permitting the secretion to 
 
288 TREATMENT OF SPERMATORRHGEA AND IMPOTENCE. 
 
 be expressed during the voiding of the urine or feces. It 
 generally ceases or diminishes under a tonic regimen and atten- 
 tion to the state of the bowels. The commonly received 
 opinion that the debility and other symptoms experienced in 
 these cases is due chiefly to the loss of spermatic fluid, is a 
 mistaken one, inasmuch as the exhaustion consequent on the 
 emission bears very little relation to the quantity of the fluid 
 discharged, or the amount of spermatic elements contained in 
 the fluid. As the disorder progresses, and the emissions are 
 more frequent, the proportion, indeed the actual quantity, of 
 the spermatozoa decreases, the discharge consisting chiefly of 
 the secretions of the vesiculse seminales and the prostate gland. 
 The drain upon the system is rather through the nervous sys- 
 tem than through the testicle, and the exhaustion experienced 
 after each occasion is consequent upon a loss of nervous force 
 
 rather than upon a loss of the secretion of the generative 
 
 « 
 organ. 
 
 " The question of impotence, with its contingent, — the unad- 
 visability of matrimony — is one on which it is difficult to write, 
 inasmuch as there is not much very definite to be written. In 
 deciding it, it is usually necessary to allow a considerable 
 margin for the nervousness of the patient. A quiescent state 
 of the organs, consequent on long control of the passions, is 
 not to be regarded as an obstacle, because they may be roused 
 into activity when appropriate circumstances arise ; and after 
 a long continuance and frequent repetition of nocturnal emis- 
 sions, the organs usually retain sufficient vigor to admit of im- 
 provement under the influence of matrimony. It has happened 
 to me often to be consulted on this subject, and I have very 
 rarely felt it necessary to give a discouraging opinion. In the 
 case of one gentleman, who from early life had been subject to 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 289 
 
 very frequent emissions, who had long ceased to have erections 
 or desire, and whom a variety of treatment, including cauteri- 
 zation of the urethra, conducted by different persons, had 
 failed to give relief, my advice was that he should remain a 
 bachelor. Very soon afterwards he married and had a family. 
 " It has been recommended that in doubtful cases the experi- 
 mentum should be made in corpore vili. This appears to me 
 to be useless as well as wrong, for the experiment thus made as 
 a test is no real test, and, as might be expected, has ended in 
 disappointment. I know a gentleman, in every respect, as I 
 believe, well qualified to be a husband, and at one time anxious 
 to be so, who has been prevented from marrying by the failure 
 of this test, to which he, most reluctantly and needlessly, as- 
 sented, in deference to the advice of an eminent surgeon whom 
 he consulted. The indications derivable from external appear- 
 ance are of little value ; and suspicions based upon them have 
 repeatedly proved to be groundless. There are certain obvious 
 disqualifications, such as imperfect formations or diseased con- 
 ditions of the necessary organs, and an entire absence of erec- 
 tions or desire. Where such disqualifications exist, matrimony 
 is rarely contemplated. Where they are absent the surgeon is 
 seldom justified in giving an unfavorable verdict, the instances 
 being few in which, by judicious treatment, the patient may not 
 be fitted for matrimony. To the encouragement to matrimony 
 it is well to add the hint that though, for various reasons, the 
 rite may not be at first consummated, yet that, in all proba- 
 bility, it will be so before long. This may prevent unnecessary 
 disappointment or despair. I have known premature separation 
 carried out, indeed hurried on by the medical man, when there 
 is reason to think that a little management and patience might 
 have resulted in a happy union. The whole of this question is 
 19 
 
2g6 Treatment of spermatorrhcea and Impotence. 
 
 fraught with so much anxiety and excitement to the person 
 concerned, that the mind is liable to be thrown off its balance, 
 and the most deplorable consequences to ensue. In some 
 cases, doubtless, there is cause for the anxiety, but in many the 
 apprehensions are groundless, and happy is it if a man when 
 thus racked with doubts can bring himself to make a confidant 
 of, and disburden himself freely to, some judicious medical 
 adviser, who will assure him that such cases are not uncommon, 
 and will, perhaps, give him the often-quoted recommendation 
 of Hunter, to make up his mind to abstain for a time. In all 
 such cases it is necessary to take the general state of health 
 into account, for any debilitating cause, such as dyspepsia, 
 diarrhoea, mental anxiety, etc., especially when there are phos- 
 phates or oxalate of lime in the urine — is liable to be attended 
 with inability, which may be only of a temporary nature, and 
 will yield to appropriate treatment. As a general rule, in the 
 healthy person, the recurrence of desire and power, more par- 
 ticularly the former, decreases gradually with advancing years. 
 Sometimes it does not cease till a late period. This, however, 
 varies much. In those who have abused the organs, or in- 
 dulged their amorous propensities to excess in early life, the 
 cessation takes place sooner than in others. We learn that the 
 lords of the harem are not unfrequently impotent at thirty or 
 forty ; and in this country the same occurs to persons who have 
 been addicted to excite the organs preternaturally by giving 
 way to lascivious thoughts, and in other ways. Any debili- 
 tating influence, whether it be mental depression or enervating 
 bodily disease, indigestion, phthisis, diabetes, etc., produces 
 more or less of the same effect, and it has been remarked by 
 Mr. Curling that * the testes of persons who die of chronic 
 lingermg diseases are almost invariably soft and inelastic. 
 
TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 29I 
 
 When incised, their internal structure seems to contain but 
 few bloodvessels, is pale, apparently shrunk and dry, and the 
 little fluid that can be squeezed from it is destitute of sperma- 
 tozoa.' 
 
 " It seems also that long-continued continence induces an 
 earlier cessation of the capability of function than does mod- 
 erate indulgence. And after long disuse the attempt to rouse 
 these organs into activity at a late period of life, even if suc- 
 cessful, is not altogether without risk to the general health. 
 The excitement consequent on it, is liable to induce much pros- 
 tration, which may be followed by paralysis, amaurosis, affec- 
 tions of the heart, or other disorders. I suspect there is foun- 
 dation for the remark that these ill-effects are more likely to 
 occur in the case of widowers marrying after a considerable 
 interval, than in those who have not been before married." 
 
INDEX. 
 
 Absence of testicles, i6o 
 Acne in masturbation, 73 
 Acton on aspermatism, 117 
 
 — on condition of vesiculae semi- 
 nales, 45 
 
 — on continence, 185 
 
 — on education of youth, 23 
 
 — on the effect of sexual excess on 
 the heart, 100 
 
 — on frequency of sexual inter- 
 course, 78 
 
 — on priapism, 178 
 
 — on satyriasis, in 
 
 — on sexual insanity, 107 
 
 — on spermatorrhoea, 60 
 
 — on the the treatment of impo- 
 tence produced by continence, 
 197 
 
 — on the treatment of spermator- 
 rhoea and impotence, 281 
 
 Acupuncture in the treatment of 
 spermatorrhoea and impotence, 
 260 
 
 Advertisements, quack, 21 
 
 Age for marriage, 184 
 
 Alimentary canal in masturbation, 
 
 73 
 Anaemia, cerebral, 174 
 Anatomy of corpora cavernosa, 29 
 
 — of corpus spongiosum, 29 
 
 — of genital apparatus, 28 
 
 — of glans penis, 30 
 
 — of penis, 29 
 
 — of prostate gland, 34 
 
 — of the testicles, 37 
 Anodyne injections, 261 
 Aphrodisiacs, 245 
 
 Araetius on spermatorrhoea, 59 
 Arteries of the penis, 33 
 Aspermatism, 116 
 
 — treatment of, 118 
 Astringent injections, 261 
 Ataxia, locomotor, 179 
 Atrophy of testicles, 160 
 
 Baker on epilepsy produced by 
 
 masturbation, 97 
 Bartholin's glands, 41 
 Bartholow on the bromides, 204 
 
 — on spermatorrhoea, 61 
 
 — on the treatment of spermator- 
 rhoea and impotence, 273 
 
 Bathing in the treatment of sper- 
 matorrhoea and impotence, 227 
 Bilious attacks, treatment of, 242 
 Bladder, chronic catarrh of, 156 
 — , extroversion of, 161 
 — , irritability of neck of, 135 
 — , neuralgia of neck of, 134 
 Blandet's case of satyriasis, ill 
 Blood, extravasations of, 160 
 Bromide of potassium, 203 
 Bourgeons on insanity from mas- 
 turbation, etc., 102 
 Bowels in spermatorrhoea and im- 
 potence, 224 
 Brown, Baker, on amputation of 
 the clitoris, in 
 
 Calculi, prostatic, 172 
 
 — in urethra or foreskin, 160 
 Cantharides as an aphrodisiac, 247 
 
 — producing satyriasis, III 
 Caput gallinaginous, 32 
 Carpenter on obesity as a cause of 
 
 sterility, 118 
 
 Castration for neuralgia of the tes- 
 ticle, 134 
 
 Catarrh, chronic vesical, 156 
 
 Cauterization in the treatment of 
 spermatorrhoea and impotence, 
 258 
 
 Celsus on spermatorrhoea, 59 
 
 Cerebral anaemia, 174 
 
 Cerebellum, connection of with 
 sexual instinct, 51, 52 
 
 — , function of, 51 
 
 — , hemorrhage into the, 177 
 
 Chastity, 23 
 
294 
 
 INDEX. 
 
 Chylous urine, differentiation from 
 seminal fluid, 50 
 
 Classification of cases for treat- 
 ment, 206 
 
 Clitoris, amputation of, iii 
 
 — , anatomy of, 40 
 
 Clothing, night, 21 
 
 Coitus, sensation in, in the female, 
 
 41 
 
 — , sensations terminating, 32 
 
 Compressor urethrae muscle, 31 
 
 Constipation, 224 
 
 — , treatment of, 244 
 
 Constitutional changes in mastur- 
 bation, 72 
 
 — treatment of spermatorrhoea, 
 etc., 215 
 
 Consumptives, erotic tendency of, 
 
 95 
 
 Consumption, traceable to mastur- 
 bation, 93 
 
 Continence, 183 
 
 — , productive of impotence, 194 
 
 Convulsions following the orgasm, 
 78. 
 
 Cooper, Sir Astley on varicocele, 
 121 
 
 Cord, spinal, concussion of, 178 
 
 — , softening of, 180 
 
 Corpora cavernosa, 29 
 
 — , cartilaginous formations in, 159 
 
 Corpus spongiosum, 29 
 
 Cowper's glands, 31 
 
 — , fluid from, differentiation from 
 seminal fluid, 49 
 
 Counter-irritation in the treatment 
 of spermatorrhoea and impo- 
 tence, 261 
 
 Curling on neuralgia of the testi- 
 cles, 130 
 
 Cystitis, discharge in. differentia- 
 tion of from seminal fluid, 50 
 
 Cystotomy as a cause of impotence, 
 157 
 
 Damiana as an aphrodisiac, 249 
 Damerel on urethral calculus, 160 
 Deslandes on insanity from mas- 
 turbation, etc., 102 
 Diet in the treatment of sperma- 
 torrhoea and impotence, 216 
 Diseases which arise from sexual 
 
 excess and masturbation, 92 
 Dreams, lascivious, 47 
 
 Ducts, ejaculatory, 32 
 
 — from prostate gland, 32 
 
 Education of youth, Acton on, 23 
 
 — of youthful mind, 20 
 
 — of sexual instincts, objections to, 
 22 
 
 Ejaculatory ducts, 32 
 
 — condition of, in masturbation, 
 70 
 
 — effect of masturbation on, 32 
 Electric rings in the treatment of 
 
 spermatorrhoea and impotence, 
 264 
 
 Electricity in the treatment of sper- 
 matorrhoea and impotence, 253 
 
 Elephantiasis, 160 
 
 Ellis on insanity from masturba- 
 tion, 106 
 
 Emission before puberty, 63 
 
 — , frequency of, 47 
 
 — , nocturnal, 47 
 
 — produced by shampooing of oc- 
 ciput, 51 
 
 — seminal, 74 
 
 — in women, 47 
 
 Emotions, effects of certain, on 
 erection, 53 
 
 — , mental; see mental emotions. 
 
 Epididymitis as a cause of sterility, 
 118 
 
 Epilepsy produced by masturba- 
 tion, 96 
 
 — terminating in insanity, 102 
 Epileptiform convulsions following 
 
 the orgasm, 78 
 Epispadias as a cause of sperma- 
 
 torrhsea and impotence, 157 
 Erectile tissues, 29 
 Erection, Kobelt on, 55 
 — , mechanism of, 51 
 — , partial, 56 
 — , permanency of, 54 
 
 — produced by certain emotions, 
 
 53 
 — , Rouget on, 56 
 — , spasm of muscles connected 
 
 with, 138 
 Erector penis muscle, 29 
 Erotic tendency of consumptives, 
 
 95 
 Esquirol on epilepsy produced by 
 
 excessive indulgence, 98 
 Eyes in masturbation, 73 
 
INDEX. 
 
 295 
 
 Excess, sexual; see Sexual Excess. 
 Exercise in the treatment of sper- 
 matorrhoea and impotence, 237 
 Extroversion of bladder, i6i 
 
 Face in masturbation, 67-73 
 
 False impotence, 91 
 
 Fear as a cause of impotence, 85 
 
 — as an educational agent, 20-22 
 
 — producing impotence, case of, 85 
 Female, masturbation in, 40-41 
 
 — organs concerned in masturba- 
 tion, 39 
 
 — , sensation in coitus in, 41 
 Flatulence, treatment of, 241 
 Flint on epilepsy produced by mas- 
 turbation, 97 
 Flourens on the cerebellum and 
 
 sexual passions, 52 
 Fluid, seminal, 43 
 Function of prostate gland, 35 
 Functions, sexual, knowledge of, 
 
 17 
 Furor uterinus; see Nymphomania. 
 
 Gait in masturbation, 73 
 Galen on spermatorrhoea, 60 
 Gall on a case of excessive sexual 
 indulgence, 95 
 
 — on sexual instincts, 51 
 Generative organs in female, effect 
 
 of masturbation on, 41, 72 
 
 Genital apparatus, anatomy of, 28 
 
 Glands, Bartholin's, 41 
 
 — , Cowper's, 31 
 
 Glans penis, anatomy of, 30 
 
 — , changes in mucous covering 
 caused by masturbation, 30 
 
 Gland, prostate ; see Prostate 
 Gland. 
 
 Gleet, differentiation of discharge 
 in, from seminal fluid, 49 
 
 Grimaud de Caux on mental impo- 
 tence, 89 
 
 Gross on calculi beneath prepuce, 
 160 
 
 — on cartilaginous formations in 
 corpora cavernosa, 159 
 
 — on rupture of erectile tissue, 160 
 
 — on spermatorrhoea, 61 
 
 Gross, S. D., treatment of sperma- 
 torrhoea and impotence, 269 
 
 Gymnastic exercises causing mas- 
 turbation, 65 
 
 Ham, John, on spermatozoa, 44 
 Hamilton, F. H., on the treatment 
 of spermatorrhoea and impo- 
 tence, 275 
 Hammond on mental impotence, 
 86 
 
 — on satyriasis, 112 
 
 Hands, condition of, in masturba- 
 tion, 73-105 
 Heart, hypertrophy of, from sexual 
 
 excess, 100 
 — , treatment of palpitation of, 244 
 — , treatment of weakness of, 243 
 Hemorrhage into the cerebellum, 
 
 177 
 Hensle on the bromides, 204 
 Hippocrates on spermatorrhoea, 59 
 
 — treatment of spermatorrhoea and 
 impotence, 252 
 
 Homoeopathic treatment of sper- 
 matorrhoea and impotence, 250 
 
 Humphrey on the treatment of 
 spermatorrhoea and impotence, 
 284 
 
 Hutchinson, J, C, on the treat- 
 ment of spermatorrhoea and im- 
 potence, 279 
 
 Hypertrophy of heart from sexual 
 excess, 100 
 
 Hygiene, sexual, ignorance of, 17 
 
 Hypochondriasis, loi 
 
 Hypospadias as a cause of sperma- 
 torrhoea and impotence, 157 
 
 Ignorance of sexual hygiene, 17 
 Injections, astringent and anodyne, 
 
 261 
 Immorality in schools, 25 
 Impotence, 58 
 — , cause of, 62 
 
 — , constitutional treatment of, 215 
 — , diseases of the sexual organs 
 
 associated with, 145 
 — , first signs of, 79 
 
 — from continence, 194 
 
 — from excess, 79 
 
 — from excess, prognosis in 
 of, 80 
 
 — , false, 91 
 
 — from fear, 85 
 
 — from fear, case of, 85 
 
 — from mental emotions, 84 
 — , local treatment of, 252 
 — , mental, cases of, 86 et seq. 
 
^9^ 
 
 INDEX. 
 
 Impotence precedes spermator- 
 rhoea, 79 
 
 — in stallions caused by putting 
 dorsal nerves of penis, 53 
 
 Insanity as a result of abuse of 
 
 sexual organs, 102 
 Insomnia, treatment of, 73, 242 
 Integument, changes in, in mastur- 
 bation, 72 
 
 — of penis, 33 
 
 — of penis, effect of masturbation 
 on, 33 
 
 Intercourse, sexual, capacity for, 77 
 — , sexual, frequency of, 77 
 Irritable testicle, 130 
 Irritability of neck of bladder, 135 
 
 Jones on cerebral anaemia, 175 
 
 KoBELT on erection of the penis, 55 
 Kolliker on spermatozoa, 44 
 
 — on the nerves of the penis, 34 
 
 Labia majora, anatomy of, 40 
 Lallemand's cauterization as a 
 cause of sterility, 118 
 
 — on continence, 186 
 
 — on frequency of sexual inter- 
 course, 77 
 
 — on hypospadias, 157 
 
 — on masturbation caused by cer- 
 tain gymnastic exercises, 66 
 
 — on persistent priapism, 178 
 
 — on rectal troubles, 161 
 
 — on spermatorrhoea, 60 
 
 — on spermatorrhoea caused by 
 phymosis, 148 
 
 — on the condition of the ejacula- 
 tory ducts in masturbation, 70 
 
 — on tobacco as a cause of sper- 
 matorrhoea, 167 
 
 — method of examining for semen, 
 74 
 
 — porte caustique, 258 
 
 Langer on the arteries of the penis, 
 
 33 
 Leaming on the cause of phthisis,* 
 
 95 
 Leucorrhoea, 64 
 Lithotomy as a cause of impotence, 
 
 157 
 Local treatment of spermatorrhoea 
 
 and impotence, 252 
 Locomotor ataxia, 179 
 
 MacDonald on sexual insanity, 
 
 107 
 McGraw on spermatorrhoea, 61 
 
 — on the treatment of spermator- 
 rhoea and impotence, 280 
 
 Malformations of genitals, 157 
 Marriage, age for, 184 
 
 — as a cure for nymphomania, no 
 Masturbating period. 63 
 Masturbation a cause of epilepsy, 
 
 96 
 — , acne in, 73 
 — , age at which it is commenced, 
 
 63 
 — , alimentary canal in, 73 
 
 — as a cause of hypochondriasis, 
 loi 
 
 — as a cause of spermatorrhoea and 
 impotence, 62 
 
 — as a cause of varicocele, 122 
 
 — as a result of varicocele, 124 
 
 — as a vice of civilization, 62 
 
 — caused by phymosis, 19 
 
 — caused by certain gymnastic ex- 
 ercises, 65 
 
 — caused by warm or tight cloth- 
 ing, 21 
 
 — causing insanity, 102 
 
 — , changes in the integument in, 
 
 72 
 — , characteristic face of, 67-73 
 — , condition of hands in, 73 
 — , condition of mind in, 73 
 — , condition of muscles in, 73 
 — , condition of penis in, 68 
 — , condition of prostate gland in, 
 
 71 
 — , condition of scrotum in, 69 
 
 — , condition of testicles in, 69 
 — , condition of ejaculatory ducts 
 
 in, 70 
 — , condition of urethra in, 69 
 — , condition of veru montanum in, 
 
 69 
 — , constitutional changes in, 72 
 — , diseases arising from, 121 
 — , diseases which arise from, 92 
 — , effect of on ejaculatory ducts, 
 
 32 
 — , effect of on glans penis, 30 
 — , effect of on integument of penis, 
 
 33 
 — , effect on offspring, 93 
 — , eyes in, 73 
 
INDEX. 
 
 297 
 
 Masturbation, female organs con- 
 cerned in, 39 
 — , gait in, 73 
 — , hypertrophy of heart from, 100 
 
 — in female, effect of, on genera- 
 tive organs, 41, 72 
 
 — in nursing infants, 63 
 
 — in the female, 40-41 
 
 — ^Jess injurious to females than 
 
 males, 67 
 — , local effects of, 68 
 
 — not confined to the human fam- 
 ily, 62 
 
 — , occupations predisposing to, 66 
 — , posture in, 73 
 
 — producing consumption directly, 
 
 94 . . . ^ 
 
 — producmg consumption in oflf- 
 
 spring, 93 
 — , prophylaxis of, 65 
 — , seminal fluid in, 92 
 — , signs of in early life, 64 
 — , spermatozoa in, 92 
 — , symptoms of, 208 et seq. 
 
 — taught by nurses and domestics, 
 64 
 
 — , vertigo from, 100 
 — , vertigo in, 73 
 
 — vs. sexual excess, 77 
 — , hands of, 105 
 
 Maudsley on insanity produced by 
 
 self-abuse, 103 
 Mental emotions, 81 
 — , impotence from, 84 
 Mechanism of erection, 51 
 Mental impotence, cases of, 86 
 Mental influences as a cause of 
 
 spermatorrhoea, 85 
 Membranous portion of urethra, 31 
 Mind, condition of in sexual ex- 
 cesses and masturbation, 73 
 Mons Veneris, anatomy of, 39 
 Morals, school, 25 
 Morgagni on hypospadias, 157 
 Moschon on spermatorrhaea, 60 
 Muscles, condition of, in mastur- 
 bation, 73 
 
 Narcotics, 167 
 
 Neuralgia of neck of bladder, 134 
 Nerves of the penis, 34 
 Neuralgia of the testicles, 129 
 Nocturnal emissions; see Emis- 
 sions, nocturnal. 
 
 " Non-Emission" of Acton, 117 
 Nurses as teachers of masturbation, 
 
 64 
 Nutrition, depraved, 215 
 Nux vomica in the treatment of 
 
 spermatorrhoea and impotence, 
 
 241 
 Nymphomania, 108 
 
 — produced by tumor of cerebel- 
 lum, 51 
 
 Obesity as a cause of sterility, ii8 
 
 Occupations predisposing to mas- 
 turbation, 66 
 
 Offspring, effect of masturbation 
 on, 93 
 
 Onanism; see Masturbation. 
 
 Orgasm, 53-78 
 
 — , absence of, 116 
 
 Palpitation of heart from sexual 
 excess, 100 
 
 — , treatment of, 244 
 
 Par6 on spermatorrhoea, 60 
 
 Parent's advice at puberty, 18 
 
 Pathophobia, loi 
 
 Penis, anatomy of, 29 
 
 — , arteries of, 33 
 
 — , condition of in masturbation, 
 68 
 
 — , congenital absence of, 159 
 
 — , double, 160 
 
 — , erector muscle of, 29 
 
 — , integument of, 33 
 
 — , nerves of, 34 
 
 — , very large, 160 
 
 — , very small, 159 
 
 Perineum, 28 
 
 Petroselinum sativum as an aphro- 
 disiac, 247 
 
 Phymosis, 145 
 
 — as a cause of njasturbation, 19 
 Phosphorus as an aphrodisiac, 246 
 
 — in the treatment of spermator- 
 rhoea and impotence, 241 
 
 Phthisis; see Consumption. 
 Physician's advice at puberty, 17, 
 
 18 
 Platonic attachments between boys, 
 
 26 
 Post, A. C, on the treatment of 
 
 spermatorrhoea and impotence, 
 
 278 
 Posture in masturbation, 73 
 
298 
 
 INDEX. 
 
 Prepuce, the, 30 
 Priapism, persistent, 178 
 Prostate, chronic inflammation of, 
 
 152 
 — , congestion and inflammation 
 
 of, 139 
 — , anatomy of, 34 
 — , condition of, in masturbation, 
 
 71 
 
 — , ducts from, 32 
 
 — , examination of, 36 
 
 — , function of, 35 
 
 Prostatic calculi, 172 
 
 Prostatitis, discharge in, differen- 
 tiation of from seminal fluid, 50 
 
 Prostatic portion of urethra, 32 
 
 Puberty, advice of parent or guar- 
 dian at, 18 
 
 — , emissions before, 63 
 
 — , physician's advice at, 17, 18 
 
 Quack advertisements, 21 
 Quinia in the treatment of sperma- 
 torrhoea and impotence, 240 
 
 Rectal pessaries in the treatment 
 of spermatorrhoea and impotence, 
 264 
 
 Rectum, disorders of, 161 
 
 Regimen in the treatment of sper- 
 matorrhoea and impotence, 219 
 
 Ritchie on insanity from self-abuse, 
 103 
 
 — on sexual insanity, 107 
 
 — on suicide from masturbation, 
 106 
 
 Roland on a case of mental impo- 
 tence, 86 
 Romberg on irritable testicle, 131 
 Rouget on erection of the penis, 56 
 
 — on the arteries of the penis, 33 
 Rufus, of Ephesus, on nocturnal 
 
 emissions, etc., 60 
 
 Saissaigne on abolition of the sex- 
 ual passion, 52 
 Sanguinaria as an aphrodisiac, 248 
 Sartorius on spermatorrhoea, 60 
 Satyriasis, in 
 
 — produced by tumor of cerebel- 
 lum, 51 
 
 — treatment of, 115 
 Sayre on phymosis, 147 
 School morals, 25 
 
 Sclerosis, 177 
 
 Scrotum, amputation of, 127 
 
 — , condition of in masturbation, 
 69 
 
 Sedatives in the treatment of sper- 
 matorrhoea and impotence, 242 
 
 Sensation in coitus in the female, 41 
 
 Sensations terminating coitus, 32 
 
 Semen, see Seminal Fluid. 
 
 Seminal emissions, 74 
 
 Seminal fluid, 43 
 
 — , diagnosis of, 48 
 
 — , differentiation from chylous 
 urine, 50 
 j — , differentiation of discharge in, 
 I ■ from seminal fluid, 49 
 j — , differentiation of, from dis- 
 1 charge in cystitis, 50 
 
 — , differentiation of from dis- 
 charge in prostatitis, 50 
 
 — , differentiation from that of 
 Cowper's glands, 49 
 
 — , differentiation of, from urethral 
 secretion, 49 
 
 — , in masturbators, 92 
 
 — , involuntary discharge of, 58 
 
 — , Lallemand's method of examin- 
 ing for, 74 
 
 — , quantity discharged during an 
 emission, 47 
 
 — , secretions mistaken for. 48 
 
 Serrurieron epilepsy from mastur- 
 bation, 98 
 
 Sexual intercourse, capacity for. 77 
 
 Sexual excess, diseases which ari.-e 
 from, 92 
 
 — , case of, 95 
 
 — , diseases arising from. 121 
 
 — , hypertrophy of heart from, ir o 
 
 — not as injurious as self polluiioii, 
 76 
 
 — producing impotence, 79 
 — , results of, 76 
 
 — , vertigo from, 100 
 Sexual functions, knowledge of, 17 
 Sexual hygiene, ignorance of, 17 
 Sexual indulgence, excessive, diag- 
 nosis of, 32 
 Sexual intercourse, frequency of, 77 
 Sexual instinct, connection of the 
 
 cerebellum with, 51, 52 
 — , connection of the spinal cord 
 
 with, 52 
 — , location of, §l 
 
INDEX. 
 
 299 
 
 Sexual relations, husband and wife 
 both ignorant of, 18 
 
 Sleep in the treatment of sperma- 
 torrhoea and impotence, 238 
 
 Sleeplessness, see Insomnia. 
 
 Sounds, introduction of in the treat- 
 ment of spermatorrhoea and im- 
 potence, 263 
 ^pasm of muscles connected with 
 erection, 138 
 
 Spermatic fluid, see Seminal Fluid. 
 
 Spermatic veins, ligation of, 127 
 
 Spermatorrhoea, 58 
 
 — , local treatment of, 252 
 
 — as the result of mental influ- 
 ences, 85 
 
 — , causes of, 62 
 
 — , constitutional treatment of, 215 
 
 — , diseases of the genital organs 
 
 associated with, 145 
 — , from stricture of rectum, 161 
 Spermatozoa, 44 
 
 — in masturbators, 92 
 Spermatozemla, see Spermator- 
 rhoea. 
 
 Spinal cord, connection of with sex- 
 ual instinct, 52 
 
 Spitzka on sexual insanity, 108 
 
 Sterility, 118 
 
 Stillingia as an aphrodisiac, 248 
 
 Stimulants in the treatment of sper- 
 matorrhoea and impotence, 221 
 
 Strieker on spermatozoa, 44 
 
 Strychnia in the treatment of sper- 
 matorrhoea and impotence, 240 
 
 Suicide, 101-106 
 
 Sunstroke, 181 
 
 Testicle, irritable, 130 
 Testicles, absence or atrophy of, 
 
 160 
 — , anatomy of, 37 
 — , condition of in masturbation, 69 
 — , neuralgia of the, 129 
 Thompson, Sir H. on treatment of 
 
 inflammation of prostate, 143 
 
 Tight clothing, 21 
 
 Tissues, erectile, 29 
 
 Tobacco as a cause of spermator- 
 rhoea and impotence, 167 
 
 Tonics in the treatment of sper- 
 matorrhoea and impotence, 239 
 
 Treatment of spermatorrhoea and 
 impotence, recapitulation of, 265 
 
 Urethra, condition of in mastur- 
 bation, 69 
 — , female, anatomy of, 40 
 — , membranous portion of, 31 
 — , prostatic portion of, 32 
 Urethral secretion, differentiation 
 
 of, from seminal fluid, 49 
 Urine, chylous, see Chylous Urine. 
 
 Vagina, anatomy of. 41 
 Van Buren on small penis, 159 
 Van Buren and Keyes on asperma- 
 tism, 117 
 
 — on continence, 191 
 
 — on irritable testicle, 131 
 
 — on spermatorrhoea, 61 
 
 — , treatment of spermatorrhoea 
 
 and impotence, 272 
 Vandeveer on spermatorrhoea, 61 
 Varicocele as a cause of masturba- 
 tion, 124 
 
 — as a result of masturbation, 122 
 — , treatment of, 125 
 
 Vertigo in masturbation, 73 
 
 — produced by sexual excess, 100 
 — , treatment of, 244 
 
 Veru montanum, 32, 53 
 — , condition of in masturbation, 69 
 Vesical catarrh, chronic, 156 
 Vesiculse scminales, Acton on con- 
 dition of, 45 
 Vestibule, anatomy of, 40 
 
 WiNSLOW on nymphomania, no 
 
 Zimmerman on epilepsy produced 
 by a seminal emission, 98 
 
SEXUAL NEURASTHENIA 
 
 ^^ BiB M^k. ^^ m^ ■■§ (NERVOUS EXHAUSTION.) 
 
 Its Hygiene, Causes, Symptoms and Treatment, 
 
 WITH A CHAPTER ON 
 
 By Oeorge M. Beard^ A.M., M.D>, 
 
 Formtxly Lecturer on Kervous Diseases in the University of the City of Newr York; 
 
 fellow of the New York Academy of Medicine; Author of "On* 
 
 Home Physician," *' Hay Fever;" one of the Authors of 
 
 *' Medical and Surgical Electricity," etc. 
 
 [posthumous manuscript.] 
 
 Edited by A. D. Rockwell, A.M.. M.D. 
 
 fWUovr of the New York Academy of Medicine, and Electro-Therapeutiit to tke 
 
 N» Y. State Woman's Hospital; one of the Authors of ' Medical 
 
 and Surgical Electricity," etc. 
 
 The philosophy of this work is based on the theory that there is 
 a special and very important and very frequent clinical variety of neuras- 
 thenia (nervous exhaustion) to which the term sexual neurasthenia 
 (seZUal exhaustion) may properly be applied. 
 
 While this \ariety may be and often is involved as cause or effect 
 ©r coincident with other varieties — exhaustion of the brain, of the spine, 
 of the stomach and digestive system — yet in its full development it can 
 be and should be differentiated from hysteria, simple hypochondria, in- 
 sanity, and various organic diseases of the nervous system, with all of 
 which it had until lately been confounded. 
 
 The long familiar local conditions of genital dehility in the malo 
 — impotence and spermatorrhoea, prostatorrhoea, irritable prostate — 
 which have hitherto been almost universally described as diseases by 
 themselves, are philosophically jtnd clinically analyzed. These symp- 
 toms, as such, do not usually exist alone, but are associated with other 
 local or general symptoms of sexual neurasthenia herein described. 
 
 ThO causes of sexual neurasthenia are not single or simple but 
 complex; evil habits, excesses, tobacco, alcohol, worry and special ex- 
 citements, even climate itself, are the great predisposing causes. 
 
 The subject is restricted mainly to sexual exhaustion aS it CXistS in 
 th© male, for the reason that the symptoms of neurasthenia, as it exists 
 in females, are, and for a long time have been, understood and recog- 
 nized. Cases analogous to those in females are dismissed as hypochon- 
 driacs, just as females suffering from now clearly explained uterine and 
 ovarian disorders were formerly dismissed as hysterics. 
 
 This view of the relation of the reproductive System to nervous 
 diseases is in accordance with facts that are verifiable and abundant ; 
 that in men as in women, a large group of nervous symptoms, which are 
 very common indeed, would not exist but for morbid states of the re- 
 productive system. — [J^rom Dr. Beard's Introduction. 
 
 The Causes and Symptoms of forty-three cases are given, fol- 
 lowed by a chapter on treatment. — [-S"^^ Revieio of St. Louis Naiional 
 Druggist and others. 
 
 In One Volume. Crown 8vo, Neartu 300 pa^es. $2« 
 
 IgADtS lantei E. B. TREAT, Pub., 771 Broadway, N. Y. 
 
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 "'OUR HOME: PHYSICIAN' has an established reputation for 
 accuracy, learning and sagacity. 1 keep it on a prominent shelf in my 
 library, and find it a kind of Guardian Angel of the household in matters 
 sanitary and hygienic."— Rev. Joseph Cook. 
 
 "'Our Home Physician' is, in our opinion, the best work 
 upon the subject that has ever been published. It is full, from beginning 
 to end, of intelligible, judicious and conscientious advice." 
 
 —New York Medical Record. 
 
 " It abounds In valuable hints and suggestions of a practical kind, which 
 make it a valuable companion in the family. Dr. Beard has the genius 
 and ability which fit a man to be an educator."—!.. J, Sanford, M.D,| 
 Professor of Anatomy and Physiology in Yale College. 
 
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 fied contents of this remarkable combination of all that laymen need to 
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 family in the land." —The Scientific AmeHcan (New York). 
 
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 I really admire the degree of intelligence, and fairness, and sound good 
 sense exhibited throughout."— Samuel Hen'y DlckSOn, M.D., Profes- 
 sor in the Jefferson Medical College, Philadelphia, Pa. 
 
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 book is a comprehensive and trustworthy vade tnecutn. As a compend of 
 the theory and practice of medicine, it is the best that we know." 
 
 -New York Tribune. 
 
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 that he has performed his task so well. I take great pleasure in recom- 
 mending the work as the best extant, and fully up to the times" — J, P, 
 Ross, M.D., Professor in the Rush Medical College, Chicago, 111. 
 
 " There is no ill that flesh is heir to that is not plainly described in its 
 pages, and its appropriate treatment prescribed." 
 
 -New Orleans Picayune. 
 
 " Its general views on physiology and hygene are so sound, and it< 
 directions what to do in emergencies so clear and concise, that I am convinced 
 is will be found exceedingly useful by all." — J, L. CraWCOUr, M.D., 
 Professor of Medicine, New Orleans School of Medicine. 
 
 "Dr. Beard has been assisted in this work by a number of eminent 
 men, and has succeeded in making a popular treatise on the science of 
 medicine very far superior to any other in existence." 
 
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