LIBRARY OF CONGRFSS. Gljap. ;:i|ng{!i Shelf... P 64- 5 UNITED STATE* -ERICA. L THE NEW METHOD. AN INTERESTING THESIS ON GENERAL DEBILITY AND Nervous Exhaustion; WITH A FULL DESCRIPTION OF THE GENERATIVE ORGANS OF MAN, AND THEIR PECULIAR DISEASES. ALSO, THE NEW METHOD OP TEEATING NEEYOUS EXHAUSTION. / By EDWIN D. SMITH, A.M., M.D., Professor of the Principles and Practice of Surgery, Diseases of the Geniio** Urinary System, and Clinical Surgery; Professor of Pathological Anatomy and Histology, Diseases of the Nervous System, and Clinical Medicine; Attending Physician at the Clinics for Venereal and Skin Diseases; Operating Surgeon for Diseases of Genito-Urinary System of Women; A uthor of Medical Works on Special Diseases of the J (y Genito-Urinary Organs of both Male and Female, etc. Office Hours— 8 a.m. to 1 p.m., and 5 to 8 p.m. yo.I± I OFFICE ; ioo East Twenty-ninth Street, cor. Fourth Avenue, New-York. ) 9- Entered, according to Act of Congress, in the year 1880, by EDWIN D. SMITH, A.M., M.D. In the Office of the Librarian of Congress, at Washington. TABLE OF CONTENTS. Introduction, . . .5 Anatomy and Physiology of the Generative Or- gans, 13 General Debility, 31 Spermatorrhoea, Impotence, Sterility, ... 58 Treatment of Spermatorrhoea, etc., . .75 Marriage, and Diseases of Women, . . . .82 Gonorrhoea, or Local Diseases of Generative Or- gans, 97 Syphilis, or Special Diseases of Generative Or- gans, in Surgical Diseases of the Generative Organs, . 128 Self-Diagnosis, 140 Notes of Cases, 145 Special Notice to Patients, 167 INTRODUCTION. Some years ago it occurred to me that it would be beneficial to mankind to issue a small and popular work, which would be acceptable to all without as much as possible using the many tech- nical terms so prolific with writers on medical sub- jects, that would be plain and intelligent to the many readers and to those suffering from the mal- treatment, neglect, and ignorance of self-styled phy- sicians ; but circumstances prevented the consum- mation of my desires until the present moment, when I determined to issue this work, that it may serve as a " beacon light " to warn off the many suf- ferers from the rocky coast that would lead them to destruction through the so-called doctors that attempt to foist their pretensions of skill on a too- willing and deluded public ; and should this little work, with its plain and unvarnished truths, lead and instruct any sufferers to a true and intelligent account of their ailments, I shall be well rewarded for my time and labor. It is with this object in view, and for the true benefit of mankind, that I shall endeavor to 6 Introduction. demonstrate clearly, and succinctly, the damaging re- sults that may occur from neglect of those warning symptoms, that disease in its many forms shows itself to the practiced eye of a physician, and to point them out and impress them upon the mind of my readers, that they may be warned thereby and so seek proper and skillful medical aid. With the above object in view, and with a sincere desire to help and aid our fellow-man in his hour of distress and despondency — those hours when all the world seems dark and forlorn to his excited imagina- tion from the result of his over-indulgence by forcing nature on too early to do the work of adult life be- fore those organs God has endowed man with, that he may " increase and multiply after his kind," have at- tained their full development — and man rendered in- capable of procreation, and giving everlasting shame, misery, and unhappiness to the human race. Now, we have been endowed with certain procrea- tive organs so delicate and elaborate in their minute anatomy, that secrete an important fluid — the liquor seminalis, or seminal liquid — the richest and most elaborate and complex of all the secretions of the human body; truly the very essence and foundation of life that strengthens the body, invigorates the mind, renders the nervous system powerful, that we may exercise our memory and judgment for our fu- ture happiness, and those of others near and dear to Introduction. 7 us. So, if we waste this precious fluid, so important in all its relations to our well-being, in a manner never intended or ordained by nature, but too com- mon among most young men of the present day, we sap the foundation of our being, overwhelm the nerv- ous system in its powerful functions, and then must suffer the many disorders always resulting from this over-indulgence, and causing the nervous system to deteriorate, the brain and all the important organs to become impaired, and giving us as an unwelcome leg- acy — melancholy, impotency, nervousness, and a gen- eral decay of all the faculties. And when the sufferer becomes in this condition, and realizes, perhaps too late, the wretchedness of his situation, and he is no longer able to enjoy the society he may be so well fitted to adorn ; that he is incapable of sexual inter- course ; by form a man, but not in truth ; without the healthy power of mind and body — and so becom- ing morbidly affected with distrust of his fellow-man, extremely sensitive, and perhaps leading on to acute mania or melancholia. The nervous system is very important in its power over life, and on all human happiness has a most direct bearing ; therefore its uses, and the danger of being overtaxed by any cause, should be fully appre- ciated by the public ; and if by constant mental work, or an over-indulgence in any of the passions, the nervous system becomes impaired, it should receive 8 Introduction. prompt and immediate attention by seeking the ad- vice of one who has given these peculiar disorders his time and especial study for many years, and from whose experience and practice can discover the cause, and as promptly apply the proper means for a speedy and permanent cure ; so that the nervous power be- coming exhausted, the brain disordered, and the sys- tem at fault generally, they should be corrected, and a new impulse given to life by the application of those methods, new to the practice of medicine, that I have perfected and brought to the acme of science and skill ; and from my large experience, I am able to command success, and the heartfelt thanks of the many patients who have committed their cases to my care and judgment. There are many cases, also, in which the cause of many troubles are due to malformation, arrest of de- velopment, and of congenital origin ; and that can only be relieved by means of a surgeon's skill. To all such, we would advise a prompt consultation, in which they may be assured of the utmost considera- tion in the skillful treatment of their case. Many of these cases that require surgical interfer- ence have their direct influence on the happiness of married life ; and as the perfection of offspring and rightful succession of estates depends on the physical perfection of those about to enter the married state, it should not be consummated while there is any Introductic :. 9 doubt that through weakness, malformation, or dis- ease its object would be useless, and the contracting parties rendered miserable for life, when, by a careful perusal of this instructive work, and a consultation with one who has made this department of medicine his special study, may afford the certain relief and cure. And to the many who, through the example of designing or indiscreet persons, have given the pas- sions free sway in many ways, and so have impaired their health, feel that they are in danger of premature decay ; let him, ere it is too late, look for those means that are now at his disposal, and so gain back his wasted strength and vigor, and feel that he is " once again a man ; " and that he may continue on to a ripe old age and happy end, surrounded by a bright and happy family. How many, without number, of both sexes, may be laboring under mental troubles and physical pecul- iarities connected with their generative systems, and which are the greatest importance of their lives ; and yet it is only their own secret, locked in their inner- most thought, and fearing to speak about it to their most intimate friends, because they will not be un- derstood or their motives appreciated ; and so they conceal their secret, and carry it on a heavy burden to the grave, a constant bane to their lives, and per- haps cause an early death, when by a little boldness, and a proper trust and confidence in their physician, 10 Introduction. they might be relieved of so much worry and unhap- piness, and live to enjoy old age and honor. Therefore, in the following pages of this work, we will as briefly as possible give a description, first of the anatomy and physiology of the generative organs, that they may be readily understood, and their general importance in the human economy fully appreciated, and we will then endeavor to give to the intelligent reader the causes, variety, symptoms, etc., of the diseases and peculiarities that may affect the generative organs, that may cause them wholly or in part to fail in those important functions for which they were ordained ; and upon a proper discharge of which, depends and rests the entire happiness in the future of many individuals and families, as well as the prosperity of the country : for it is an unquestioned fact, that according to the perfection and vigor of these organs and their healthy action, depend, in a great measure, the health and perfection of the off- spring of man, as is taught to us in our daily expe- rience. In all respects we wish it distinctly understood that we stand second to none ; that we will always keep in the advance of practical medicine, that our patients may have the benefits of the progress of the times, and the advantages of all new remedies and new methods that may be advanced, and will be faith- fully tried and proved ; and I would call particular hitroduction. 1 1 attention to my new method, approved by the faculty in the treatment of Spermatorrhoea, or seminal weak- ness, and which will be fully spoken of in our article on that pernicious bane, to most young men of the present day, and in all cases of any discovery, I do not adopt it or employ it in my practice, until fully tried, calmly and without prejudice, in its chemical and therapeutical effects, and then finally testing it by intelligent experiments on proper cases; by so doing, we keep step with the advance in physics, and have at our command all the best and most ap- proved remedies and instruments for the relief of many of those depressing " ills that flesh is heir to ; " nor shall I spare any expense, to obtain all those rem- edies and appliances that may be of benefit to my many patients. This is one of the many reasons that has induced me to issue this work at the present time, that I may bring before my readers a full and clear account of their troubles, at the same time offer them a means of speedy and complete cure, and so I have consid- ered it my duty, through this book, to bring the results of experience and practice before an intelli- gent public, both for them and our mutual advantage. As it would be interesting and instructive to our readers, I insert also some of the most peculiar and striking cases from my case-book, as they may be useful and give a correct notion to many in regard to their com- 12 Introduction. plaints, and to show the treatment they have received that all future patients may see that their troubles are fully understood and appreciated ; that they, too, with many others, may look for speedy relief and sympathy. It will also be noticed that all these cases are so arranged that the author and patient may not be known to any one personally, though many of my patients, feeling truly grateful for the relief afforded at my office, have given me permission to refer all those who may apply personally to me. In conclusion I would say, after careful perusal of this work, that the human organs of genera- tion, in their deep and complex nature, require the most careful and cautious treatment, and as this has been my special study for the past years, and the treatment of all cases of nervous debility, venereal infection, loss of sexual power, malformations, and all complaints arising from a disorganization of the reproductive organs, whether constitutional or ac- quired, will be faithfully carried out in all its details, and that all those who may apply to me for advice or assistance may be assured of not only intelligent treatment, but the most inviolable secrecy, sympathy? and skillful attention. E. D. Smith, M.D., Physician and Surgeon, No. ioo East 29th st., cor. 4th ave., New York City. CHAPTER I. ANATOMY AND PHYSIOLOGY OF THE GENERATIVE ORGANS. THESE organs, so very important in their relations to the happiness of mankind and for the proper pro- creation of his species, are so varied and complex in their nature and minute anatomy, that in a work of this kind we can not give a full account, but will give their anatomical and physiological relations in such a manner that the intelligent reader may fully understand them, and so be better able to judge of the nature and seriousness of his malady; that he may realize how important all these structures are in keeping the mind and body in a healthy condition, that it may perform the many functions and condi- tions it is so eminently fitted for. This work is only intended for the consideration of special maladies, with their causes, prevention, and treatment, and all those depending upon the organs of generation in the human species, in which a proper performance of their functions, with which they are endowed, has ever been considered so neces- sary and essential to our health and well-being, both mental and physical. They have always excited the (13) 14 The Generative Organs. admiration of all anatomists, physiologists, and mi- croscopists in their beautiful arrangements and com- plex nature ; so perfect in all their many forms, and so well adapted by nature to perform that work she has set for them to do ; and, when we realize the delicate structure — so minute that it is not visible to the naked eye — and their peculiar fitness for the functions required of them, we understand how easily they may be impaired and their utility destroyed by any abuse or maltreatment that they may be sub- jected to through our passions and desires. In our classification of the organs of generation we w T ould divide them into — first, those lying within the abdominal cavity ; second, those lying within the pel- vis ; and third, those lying external to the body. Of the first w r e have the kidneys with a portion of the ureters, and the blood-vessels supplying them, and the nerves controlling their action ; and in the sec- ond, or those within the pelvis, we have the urinary portions of the urethra, the tubes coming from the testicles that convey the liquor seminalis, or seminal fluid containing the procreative seed, the seminal vesicles, the prostate gland, bladder, and the impor- tant portions of the urethra; and in the third, or those lying external to the body, the penis and urethra, with the scrotum, testicles, and appendages (Fig. i). The KIDNEYS are two true glandular organs, solely intended for the secretion of the urine, and are situ- The Generative Organs. 15 Fig. i. —Vertical Section of the Kidney.— Flint. *i *. '1 2, 3. 3, 3, 4, 4 , 4, 4 , pyramids of malpighi ; 5, 5, 5, 5, Sl 5 , apices of the pyramids surrounded by the calices ; 6, 6, columns of Bertin; 7 , pelvis of the kidney; 8, upper extremity of the ureter. 1 6 The Generative Organs. ated in the back part of the abdominal cavity, behind the peritoneum ; one lying in each lumbar region, on each side of the spinal column, and extending down- ward from the eleventh rib to the crest of the ilium — the right being somewhat lower than the left on account of the liver being above it ; the left having the spleen above. The kidneys are capped by two small ductless glands — the suprarenal capsules — and are retained in their position by the vessels which en- ter them, and are surrounded by cellular tissue and fat. Each one is about four inches in length, and in shape resembles the kidney-bean. They are invested by a fibrous capsule, thin and smooth and easily removed from the surface. On section the kidneys present two portions to us — the cortical and the pyr- amids — both consisting of blood-vessels and the urinary tubes that lead down to the hilum, and carry the urine, after its abstraction from the blood, to the pelvis, and from that to the ureters. Now, as the kidneys secrete the urine from the rich supply of blood passing in by the renal artery, we can readily see how these important organs may be affected and influenced by the passions — as instance the effect of suddenly increasing the flow of urine, and a desire to void it from the effect of fear on infants and ani- mals, and also in those patients laboring under the effects of organic structure, with difficulty in passing the urine. The mind worried and harassed from th ; s The Generative Organs. 17 complaint will cause great increase in the secretion of this fluid, and so greatly add to his already exist- ing irritation by the frequent calls to empty the blad- der, and might be very serious from retention of urine. The Ureters, these tubes lined by mucous membrane, commence at the pelvis of the kidney, and convey the urine to the bladder, and are called the " excre- tory duct of the kidney ;" they are about the size of a goose-quill, and from sixteen to eighteen inches long, and they pass down, one on each side of the body, to the back and lower'part of the bladder, and enter that organ by passing obliquely between its muscular and mucous coats, for about an inch, and terminate by a constricted orifice, thereby preventing regurgitation of urine. The Bladder (see Fig. 2) is a muscular mem- branous sac, situated in the pelvis at the lowest part of the body, behind the pubes and in front of the rectum in the male, and the uterus in the female ; this organ is the reservoir of the urine, and admits of great distension, so much so that when fully distended it rises out of the pelvis into the abdominal cavity ; it is oval in shape, and usually contains about a pint of urine, and has four coats, a serous, muscular, cellular, and mucous, named from without inwards ; the muscular coat acting by its contractions to expel the urine, and is held in its position by the various liga- ments that connect the bladder to the different por- 18 The Generative Organs. Fig. 2.— Vertical Section of Bladder, Penis, and Urethra. The Generative Organs. 19 tions of the pelvis. Upon the inner surface of the base or fundus of the bladder, and behind the ori- fice of fhe urethra, is the trigone vesicate. The Urethra commences at the apex of the trigone at the neck of the bladder, and extends the entire length of the penis, to the meates urinarius, and presents a double curve in the flaccid state ; its. length is about eight to nine inches, and consists of three portions, the prostatic, membranous, and spongy por- tions ; the prostatic portions pass through the pros- tate gland, and upon its floor we have the verumon- tannm or caput gallinaginis, an elevation of the mucous membrane lining the canal, and serves to prevent the semen passing back to the bladder, on the floor of which on each side are the prostatic sinuses containing numerous openings, the orifices of the ducts of the prostate gland, and in front of which are the mouths of the ejaculatory ducts, and the seat of trouble in seminal emissions ; the urethra is very vascular, has some elasticity, and is lined by mucous membrane, very thin, and without any muscular fibers, and its lower part surrounded by muscles, the accelerator urince, and compresses urethra to assist in expelling the urine. We have two glands opening into the urethra : first, the prostate gland at the mouth of the bladder, and in shape and size somewhat like a horse-chestnut ; it is a pale, firm body surrounding the neck of the 20 The Generative Organs. bladder, and consists of three lobes — two lateral, and a middle lobe — and secretes the prostatic fluid — a milky fluid of acid reaction, consisting of columnar epithelium and granular nuclei — and placed beneath and on each side of the membranous portion of the urethra, we have Compers glands about the size of peas, with their excretory ducts opening in the urethra. The Penis (see Fig. 2), " the organ of copula- tion/' consists of the cavernous portions or bodies (corpora cavernosa), and the spongy portion or body (corpus spongiosum), this latter extending the whole length of the penis, from its bulb to its termination in the glands which overlap the anterior portion or ends of the corpora cavernosa. These bodies are covered by integument or skin, very thin, and continuous with the mucous membrane, which covers the glands of the penis, and contains numerous small and highly-sensi- tive papillae, slightly raised, and supposed to be the seat of pleasure or of pain in the parts ; and upon the glands we have numerous small, lenticular, sebaceous glands, that secrete a matter of very peculiar odor, becoming easily decomposed. We will now turn our attention to the anatomy of those parts — the scrotum with its contents, the tes- ticles and appendages, as these are the most important organs concerned solely in the secretion of the most important fluid — the liquor seminalis. The scrotum The Generative Organs. 21 or purse is a loose bag of skin just below the root of the penis, and divided into two lateral halves by a me- dian line or raphe ; the left is somewhat longer than the right, due to greater length of the spermatic cord on that side, and consists of the integument and dar- tos ; the latter is a thin layer of connective tissue inclosing the testes, and divides the scrotum into two cavities, forming in tmmtMbf T''^ the center the septum m ^ scroti. The Testicles, those most important organs of the human economy, are two glands having an ex- cretory duct, and are sit- uated in the scrotum, one in each of its cavities, and their secretion consists of the true semen, the pro- creating fluid which en- dows the ovum or human egg with its vital power • they are suspended by the spermatic cord, which consists of the excretory duct or vas-deferens, vessels, and nerves. During early foetal life they lie in the abdominal cavity, be- Fig. 3. — Vertical Section of the Testicle, to show the arrangement of the Ducts. 22 The Generative Organs. hind the peritoneum, and before birth they descend along the inguinal canal, and emerging at the external abdominal ring, pass down to the scrotum, carrying with it the spermatic cord and vessels, surrounded by a fold of peritoneum, which forms the serous covering of the testes, and its upper portion becoming obliter- ated, forms a distinct sac. They are supplied by the spermatic arteries which arise from the main arterial trunk, the aorta. Each testicle is of an oval form, flattened laterally, and on each outer edge lies the epididymis, consisting of a body (Fig. 3), head (glo- bus major), and tail (globus minor), and they are in- vested with the testicle with tunics or coats (the tuni- ca vaginalis, tunica albuginea, and tunica vasculosa), the first being most important ; we have spoken of it above. The minute anatomy of these important or- gans is too complex to give one a perfect idea how vast and wonderful they are, as when we consider that each testicle consists of three or four hundred lobules, each of which is a long, coiled tube, said to be several feet in length, and only visible under the microscope. It is in these minute tubes that the semen is secreted from the rich supply of blood passing over them ; and they therefore serve for the secretion and elimination of the seed, as it passes along these minute tubes to the head of the epididymis, and in the vas-deferens or seminal duct, and by that tube is conveyed to the vesicular seminalis or seminal vesicles (Fig. 4) situated The Generative Organs, 23 at the base, and underneath the bladder, and serves as a storehouse for the semen until required for use, when it passes out through the ejaculatory duct to empty into the urethra. I have dealt thus far with the anatomy of these ducB Fig. 4. — Base of the Bladder, with the Vasa Deferentiaand Vesiculae Seminales. organs that my readers may fully appreciate their importance, and to show that being so minute in their structure, and elaborate in their formation, that they can not be forced on in their functions by self- abuse, without their most complete disorganization. 24 The Generative Organs. This important fluid, the secretion from these glands, in its physiological structure, consists of the true semen, a thick, whitish fluid, having a peculiar odor, and the liquor seminalis, with solid particles, the seminal granules and spermatozoa ; this liquor sem- inalis being a transparent, colorless fluid, of an albu- minous composition, and the seminal granules round, Fig. 5. — Human Spermatozoids ; magnified 800 diameters. very fine granular corpuscles, only T oVo °f an i nc h * n diameter, and the spermatozoa, or spermatic fila- ments, the only and true essential element in pro- ducing fecundation. These are minute elongated particles, consisting of a flattened oval extremity or body, and a long slender caudal filament. A small circular spot is seen in the center of the body, and The Generative Organs. 25 their movements, which are constant and remarkable, being a lashing or undulatory motion of the tail ; these animalcules are always present in healthy semen, and were discovered many years ago, but only lately have their true nature and object been fully studied ; but with the high power now obtained by the microscope, they have been fully and patiently studied, and all their movements tracked, and they are found to exist in all animals, but each has a pe- culiar form, and are supposed to be developed from the seminal granules, that finally open and allow the animacules to escape. The size of these minute beings is only -^Vo" P art °f an inch, and their num- bers are immense, while they are in constant mo- tion, except when in contact with acid or cold, but the movements will return on the application of al- kaline fluids or warmth, and while at the temperature of the body will continue for several days in motion, always going straight forward ; they do not exist in the seminal fluid until after puberty, and seldom in old age, though in some rare cases they have been found in the semen of very old men. And in all cases where they are absent, from whatever cause, the semen can not impregnate, though in every other respect it may be perfect, and the patient in his full health ; this has been many times proven, by separating them in animals. The great importance of these facts will be fully appreciated by our readers, when we treat of the 26 The Generative Organs. subject of impotence or seminal weakness, and that they give me a correct knowledge of their nature and the proper and scientific treatment of these organs when in a state of disease, or disorganization from Fig. 6. — Development of "£he Spermatozoids. — Flint.