_Sexual Neurasthenia._――Another and more general aspect of the results
of the sexual mismanagement will be studied under the above heading.
The general weakness, nervousness, general debility, general nervous
exhaustion, proceeding from sexual excesses, will be considered from
another stand-point than those, subsequently, which are considered
and named, more from the more attractive phenomena, than from an
understanding of their pathological anatomy. A generalization of signs,
symptoms, and conditions of sexual weakness, covers a multitude of
manifestations found under other names, but calculated more especially
to assist in the study of a weakness not depending upon observable
organic disease.
Sexual neurasthenia differs from neurasthenia of other origin, in that
the former is always coupled with weakness of the genital organs, which
is not necessarily the case in neurasthenia of mental origin. Again,
the genital weakness is always traceable to sexual excesses or juvenile
pollution.
The most troublesome form of neurasthenia is the sexual. There are but
few symptoms in common with neurasthenia from any cause that do not
appear in this variety.
The diagnosis, or line of demarkation between sexual neurasthenia and
the variety of actual organic diseases, is not always well defined. It
undoubtedly forms a stage beyond which is structural disease of sexual
excess, or the cause is perpetuated. I cannot admit that true impotence
and spermatorrhœa are concomitants of neurasthenia, as they are
phenomena of structural changes; but a threatened condition may exist.
In this, I believe, I am at variance with some modern writers high in
authority.
For the most satisfactory description of this disease, and the
application of the term, neurasthenia, the profession is indebted
to Geo. M. Beard, who has given the subject a most thorough review
in periodicals and in Beard and Rockwell’s _Medical and Surgical
Electricity_. In 1869, Beard published an article in the _Boston
Medical and Surgical Journal_, giving illustrations of thirty
cases treated principally by electricity; and again, with a better
understanding of the cerebral and spinal forms, he presented a paper
before the _New York Neurological Society_, in 1877, which was
published in the _New York Medical Journal_. Other papers, by the
same author, have appeared, which evince a careful study of nervous
weakness. Erb has given also a very excellent treatise in vol. XIII of
Ziemssen’s “Cyclopœdia.” Authors have not, thus far, given due credit
to the sexual organs as a cause of neurasthenia. Erb treats of the
disease in a confused manner, in portions of his treatise, compared
to his clearness on other subjects, evincing more book theories than
facts from clinical observation. In generalizing he is clear, but in
classifying, he is not particular enough in pointing out the different
signs of neurasthenia originating from the brain, from that form
belonging to the spinal cord.
The most common form of nervous manifestations is such as would lead
one to think of exhaustion of the forces usually attributed to the
structures of the cord: the nervous energies are very much depleted.
They seem, at times, to be duly supplied, but the forces may as quickly
depart and leave the system languid and depressed, without power to
coordinate the muscles. This more especially applies to a certain class
of cases which assimilate organic trouble in the nervous structure. No
change observable takes place in the circulation, yet it must stand to
reason that the replenishing power of the nerve-matter is deficient.
This must be impaired nutrition, and a lower order of nerve-structure
organized, not capable of evolving so perfect a function or
force――nervous energy. This suspension of nervous energies is only
transitory when a fair degree of activity is established. This would
seem to be caused by depriving the nerve-tissues of elements demanded
to supply natural waste; which is, in all probability, the true nature
of this exhaustion.
We have neither spermatorrhœa nor impotency, in the strict sense of
these terms. They perform the sexual function well, but lack power to
repeat the act as often as healthy people are wont to do. Sometimes
they cannot control their ejaculation during various conditions of
excitement, fear, or fright. It is in this condition that a lack
of confidence in the sexual ability is had at certain times when
copulation would be the most desired. It is in such cases that a young
man complains of chagrin and embarrassment. Many a time have young men
described their afflictions in the language more forcible than elegant,
describing such opportunities with voluptuous “sylphs,” saying, “he
went back on me.” This is a weakness of the genital organ, having lost
its innate power to become erect, in which all the powers of mind and
will, concentrated upon the act, are required to establish the erect
posture. Whenever any great mental effort is required to procure an
erection, either there is local weakness, or there has been too often
repeated sexual contact, which has not been followed by proper rest; or
the female has not a fascinating influence over the male.
The general weakness, so much the cause of alarm in young men, and
yet not of the least danger, is the typical case of neurasthenia. The
young man consults a doctor, with a long discourse of his symptoms: he
has read a book on indiscretions of youth; feels badly; has had erotic
dreams once a month; is “nervous,” feels languid, and apprehends danger.
Medical students, when listening to lectures graphically picturing
disease of the genital organs from sexual debauch, all have each and
every form, with the rare and peculiar sequelæ. They consult the
professor in whom they repose the most confidence, only to receive the
assurance that nothing is the matter, only a little weakness which will
soon of itself subside.
In treating of sexual neurasthenia I can but confine myself to that
functional derangement caused, directly or indirectly, by the supposed
lack of endurance of the genital organs and the coëxisting nervous
weakness.
The fact that nearly all young men have at some period polluted, gives
them a cause to fear that any nervous debility discovered may be
caused by their early indiscretions. In this they are deceived, and
only putting their minds at ease will dispel, often, the cause of this
perpetuation. I am often consulted by literary men, who only need rest
to be free from this languor. A zealous divine consulted me, with the
impression that he was afflicted with some organic nervous disease or
brain disease. After examining him closely, and assuring him that he
had only a nervous weakness of a functional character, he thought best
to confess all by saying that he had been “wild” in his youth, and he
was laboring under great fear that he was beginning to feel its latent
influence upon his brain. I again assured him that it was entirety
impossible for him to become in any manner afflicted with a brain
disease.
The transitory character of all neurasthenic symptoms is quite
sufficient to distinguish this from organic disease. On one day the
patient feels badly, with some signs of organic neurosis; but the next
day he has forgotten that group of symptoms, and another is complained
of; or he may be free and light, and in bright spirits; but whenever
he feels weak and languid, the first thing he thinks of is his early
indiscretion.
_Neurasthenia Caused by Sexual Excess and Domestic Infelicity_――_Case._――Mrs.
M., the mother of two children, passed through four abortions, came
lately from Chicago to this city and, perchance, became my patient, when
I learned her history. She had sustained a fracture of the left parietal
bone and suffered some from compression. The specula was removed in
Chicago. The injury was caused by a heavy glass, hurled by her husband
in a fit of jealous rage. She is fleshy, weighing 135 pounds, and rather
short; has some time been given to drink, to cover domestic infelicity;
her face is florid, and on the least excitement becomes purple and
ecchymosed in spots; she feels, sometimes, as if she would faint; often
has vertigo, tingling in feet and hands, sickness at the stomach; she
never cramps, but often cries, feels languid all the time, and lies in
bed the most of the day; pulse normal, sometimes a little intermittent;
tongue natural and bowels regular; no belt sensation; no tenderness in
the cord; no bladder trouble.
Her husband compelled her to submit to his embraces three or four
times on Sunday and every night during the week; and this had been
practiced, with only menstrual intervals and when too sick to submit,
for six years. She is peevish and fretful, and suffering from general
exhaustion.
There are many manifestations of neurasthenia, when the cause has been
from the sexual; prominent among which is irritability, exhaustion, and
sleeplessness following sexual congress; nervous headache with black
line under both eyes the next day; creeping sensation and itching of
the skin, without any abnormal appearance to cause it; formication,
numbness of the hands and feet, flushed face, tenderness and pains
that are transitory: all without any detection of organic disease;
not but what such symptoms exist in organic disease, but they are
more permanent, when they do exist, and can be associated with some
assurance. I have had my mind on the point of naming and searching for
numerous organic and spinal and cerebral affections, when the patient
would multiply antagonistic symptoms so rapidly that I have often
concluded that my patient had a new and serious combination of lesions.
Organic disease generally has a set of signs and phenomena entirely in
accordance with structures involved; but neurasthenic symptoms are most
commonly such as are antagonistic to any two forms of neurosis.
A greater variety of symptoms exists in neurasthenia than any organic
disease. Symptoms of one organic disease are common one day, and of
another the next day; and though the two organic manifestations were
wholly different, the patient on the third day will perceive them all
combined and aggravated.
Not all cases of neurasthenia can be attributed to the genital organs.
In my experience cases, arising from sexual irritation and other
causes, are very evenly divided. I have often been convinced of genital
irritation being caused from neurasthenia; but as I have intended the
more to discuss sexual neurasthenia, in Neurasthenia from Genital
Irritation, I shall be compelled to leave the subject with only having
mentioned its bearing on sexual irritation as a cause.
Neurasthenia does not differ, when of a genital origin, from the same
disease of other origin; only that the genital irritation antedates the
neurasthenia.
It has been said that neurasthenia usually confines itself to the
nervous diathesis. If we only had a definite condition, known as the
nervous diathesis, that could be relied on, much would be gained. Some
of the most troublesome cases of neurasthenia have appeared in persons
whom no one would point out as possessing a nervous diathesis. Beard
says, “Among the chief signs of a nervous diathesis are fine, soft
skin, fine hair, delicately cut features and tapering extremities.”
These are often marked features in nervous women, but neurasthenia has
existed in persons coarse, dark, thick-skinned, clump-fingered, and
very uncomely in shape; often large and fleshy.
In attempting to show the relation of neurasthenia to the genitals in
both male and female, it will lend information to relate a few cases:
_Case._――Jno. B. wishes to know what makes him so “fidgety and
good-for-nothing.” He says he has visited his intended, to whom he
is “engaged to be married,” twice a week for nearly two years. “We
are very intimate and kiss and embrace: I think too much of her to
do anything wrong. My penis is up all the time I am with her; and
when I go home my testicles are sore, and I lie awake all night.”
This is typical, as a cause from continuance; and if the female is as
amorous as the male, she will also become nervous and irritable. The
restlessness, following the protracted turgescence of the genitals,
is a fruitful cause of neurasthenia. Yet all will gradually pass away
after marriage, which should be advised speedily. With nymphomania,
there commonly exists a neurasthenia that long remains after all signs
of any organic disease have disappeared.
Mrs. M., aged 26; the mother of one healthy child; rather adipose;
short and firm of organization; flushed face; weight, 140 pounds;
apparently a very vigorous woman. She cannot endure any muscular
effort of any kind, as she becomes exhausted; dizziness, formication,
sickness at the stomach, one day; coldness of feet and hands, with
paresis of first one side then the other, tingling of the tongue; no
hysterical manifestations, cramping or fainting, at any time. Uterus
is normal; no tenderness along the spine. Sometimes a local hyperæmia
of the brain exists, but only lasts a short time. Her heart-sounds
are normal, and pulse regular; bowels perfectly regular at all times,
and menses regular. Within a period of two years’ time, she produced
four abortions upon herself. Each time at third month, and each time
did so well that no physician was called. She informed me that she
became more and more nervous after each abortion. I have not benefitted
this case by any manner of treatment, as yet, and still there is no
manifestation of any organic disease.
If ever a physician is perplexed, it is when he is called on to advise
a patient whom he calls “nervous.” This is more commonly the case with
the general practitioner, as he is looking for something to be the
matter, and finds nothing but phenomena which he illy comprehends.
These cases are of vast interest to the neurologist, as he is in an
expansive field for study, and he feels a pleasure with his work; not
as to the rapidity with which he expects to see these manifestations
pass away, but in the assurance that these most troublesome phenomena
are harmless.
_Treatment._――In the management of these peculiar nervous appearances,
many agents may become necessary; but to obtain rest is the
all-important consideration. To aid nutrition is the next in importance,
and thereby build up the structure of the nervous system, improving tone
by assimilation. All causes, of course, must be removed. The medical
treatment will consist of agents that stimulate evolution of
nerve-forces. Tinct. pulsatilla, bromide ammonia, dil. phos. acid, are
agents which act excellently, given one after the other, changed in a
manner to perpetuate their influence. With determination of blood to
the face and head, small doses of gelseminum or bromide potassium, for
temporary relief, and ergotine continued in grain doses.
When the hands and feet are inclined to become cold, the hypophosphites
should be given.
As a tonic in these conditions, and especially when the patient is not
often seen, formula No. 1 will act in a majority of cases very kindly.
Electricity must be resorted to for the permanent relief of nearly all
cases. General Faradisation will be the most generally useful, used
often and by short sittings.
The general bathing, resorted to in bath-houses, is often very
injurious; as no selection of cases as to the peculiar necessities,
and no adaptation, is made; but proper douching is a most excellent
remedial measure, and must be conducted with special care and judgment,
as regards the adaptation of kinds to each and every condition and
temperament.