_Spermatorrhœa._――That special form of sexual neurosis, which has for
its most common phenomenon the premature and involuntary ejaculation
of seminal fluid, has been the great catch-all of fakirs and venders
of popular sexual literature. Not a town of any size in any country is
without an advertising spermatorrhœa doctor, who cries his vocation
and writes up his fraudulent certificates of thousands of cases cured,
and the great danger of millions more sinking into premature decay.
Strange that laws are not made to prohibit this wholesale deception of
a confiding and innocent class of young men. Spermatorrhœa does exist,
but in proportion to the effects of masturbation and sexual debauch,
grave injury is exceedingly uncommon. Not because spermatorrhœa is a
commonly grave disease, do I insert this paragraph; but because of
the unpopularity of the subject, the isolated cases that are really
bad, and the still more isolated ones that fall into the hands of the
legitimate physician.
The term, spermatorrhœa, has been too loosely applied to a class of cases
which the author has chosen to describe under _pseudo-spermatorrhœa_,
and also to a class of cases more properly called sexual neurasthenia;
when the weakness of a nervous character is only noticeable in a minor
degree, or in contradistinction to centric structural changes. But the
term is useful to describe such losses as are involuntary, and of
frequent occurrence; or, as it were, such as occur without intentional
friction of the glans, or without undue nervous shock from accident or
fear of injury. To such emissions should the term be confined. Healthy
young men sometimes have emissions before or soon after the intromission
of the penis, and such occurrences are not uncommon; but with the
individual such an occurrence rarely happens: such should not be called
spermatorrhœa――only a sexual weakness――neurasthenia. Again, after
prolonged sexual excitement, when the organs are simply weak and the
erotic energy intense, an emission is not sufficient to declare such a
diagnosis.
When it is customary for a male to ejaculate immediately after
intromission of the organ, he may have, and quite likely has, a
spermatorrhœa; but this is not in itself diagnostic of anything further
than mere weakness; and he must at other times than these lose semen,
to constitute that real flow which is the true signification of the
term. When a male commonly ejaculates before venereal friction of the
glans has taken place, and in successive attempts at sexual congress
has been baffled, he most certainly has spermatorrhœa, as well as
partial impotence. Whenever an involuntary emission is followed by
weakness, headache, wakefulness, heat of the skin, there is certainly
great sexual neurasthenia; and, if such losses are continuous, the
diagnosis of spermatorrhœa is without a doubt. It is necessary that
these points should be duly understood, in order that our future study
of the disease may not lead to confusion in the study of the conditions
of the nervous system leading to such phenomena.
In common cases of the disease, the losses of semen are as often as two
or three times a week; not uncommonly, every night, for a week or two;
and then an interval of a week, when the nightly ejaculations occur
with a dreamy, erotic pleasure, with the patient half sleeping. The
young man wakes up and finds his linen soiled: he remembers his dream
and is highly disgusted, and soon visits or writes to a traveling or
standing venerealist, who sends him a circular containing the thousands
of cases treated and cured, with a poetical description of the ten
years hence, and perhaps a Marriage Guide, and the price required to
cure such a case. He feels all the many things pictured in the book,
and if the fee is within reach he is sure to send it, and only too
soon finds how badly he is victimized. Not every case is troublesome
enough to visit a specialist; or the young man is wise enough to first
call upon the family doctor, or a friendly physician, when he is sent
home with an opposite kind of discouragement; or he is treated by the
latter M. D. (?), who has not booked himself on such matters, and the
poor fellow is left to himself and the “_specialists_.”
It is a fact, that the common practitioner is so fastidious on this
subject, that he has neglected to obtain the familiarity due his own
patrons; and if he attempts to treat a case, he will be as likely to
fail as to do good. This lack of familiarity is the great cause of such
confusion, and in the application of the term so loosely to conditions.
That the subject may be better understood, I shall arrange my treatment
of it, that view may be had from the several points necessary to
perfect comprehension.
_Causes._――The vice of masturbation is perhaps the most common cause.
In youth, the sexual organs being in an undeveloped state, local
weakness is very commonly produced, and that even before puberty, by
the titilations taught the child by accident or by a designing nurse.
The novel sensation, followed by the profuse flow of semen, commonly
surprises the youth, and through curiosity and a desire to reproduce
the new pleasurable sensation, he continues this very common cause,
masturbation. Ignorant of the consequences that may follow, he pursues
the practice with intense vigor, until the sad effects are wrought, and
too late to repent, he learns the evil of his vice.
Boys of the effeminate type suffer first and most from this vice,
for the reason that they practice the habit more persistently than
phlegmatic children and, it is a fact, that they are willing victims
and their nervous system is much more susceptible to impressions.
Premature development predisposes a child to manipulate the genitals,
as the curiosity is excited in finding such conditions which should
only accompany a more advanced age. Any handling of the genitals may
indirectly give to the child the knowledge of that sexual sensation, or
excite precocity of the genitals.
Boys of a vigorous habit of body are not inclined to play with their
genitals; on the contrary, are often markedly disgusted at an attempt
of a schoolboy to instruct them in the vice. They are therefore not
easily made victims of, and commonly grow up free from, this vice;
but they are the most willing participants in prostitutional debauch,
in a more natural way. With the irritated and excited condition
of the tissues of the genitals at puberty, then passing the first
sexual crisis, what an opportunity for local and general injury must
necessarily be present! The nutrition, so essential to growth and
development, constantly demanded to compensate for the vicarious and
premature waste, great neglect in the natural developments of other
portions must necessarily be a result, which is most likely general in
character.
As the boy grows up, during the years from fourteen to twenty, the
attention he pays to his virile member, and the frequency of his
seminal emissions, would be astonishing to one not acquainted with the
possibilities.
In the above we have the most common cause of spermatorrhœa. I venture
to say that the disease is rare in subjects who never practiced the
vice till after maturity or adult age; but it is nearly as rare to find
an adult male who has not, at some period of his adolescence, practiced
the vice of masturbation.
In addition to the vice of boyhood, the debauch of sexual congress in
the natural way, indulged in to enormous excess, produces a state of
weakness and loss of general health, with actual impairment of the grey
matter of brain and spinal cord, which are reflected upon the genitals
in the form of involuntary seminal losses.
Spermatorrhœa is only a symptom of a disease, and must be studied as a
neurosis. This diseased condition is generally wrought by frequently
repeated erotic crises and sexual orgasms, for a long period of time,
in conjunction with habitual spermal losses, during the period of
development. The frequent repetition of sexual orgasm so completely
destroys the erotic sensorii, that the long practice of masturbation
destroys the venereal orgasm, and an emission is produced without even
a pleasurable sensation; and even the glans penis becomes so anæsthetic
in venereal sensibility that the mental effort _only_ produces a
venereal excitability enough to bring about an erection. In copulation,
such persons do not enjoy a venereal thrill, only by fresh novelties
and different females. The subsidence of the venereal thrill, and the
loss of erotic sensibility and intensity of enjoyment at sexual crisis,
or during sexual orgasm, is evidence that structural changes have
occurred and that the disease has become located.
Not until structural changes are wrought in the nervous system, is it
probable that involuntary seminal losses will continue, or should be
corrected as a disease.
Sexual congress may, under favorable circumstances, when indulged
in to great excess, become a cause of such organic changes in the
nerve-centers as are followed by spermal losses. A few such cases have
come under my observation, that were of an unmistakable character. The
report of one case, which is a typical one, will suffice.
_Case._――Chas. B., a rather gentlemanly fellow, consulted me for
spermatorrhœa, with the following history: When he was a small boy,
some twelve years of age, a servant girl was his room-mate, with other
small children; his parents thinking him too small to interfere with
the servant girl, and did not change his room until a year or more
after she taught him the significance of his erect genital organ, by
coaxing him to an attitude favorable to her own gratification. Thus she
cultivated her new-found pleasure, as he grew up and developed. After
his room was changed, he found no impediment to nightly visits to the
servant’s bed. He was soon able to comply with all demands, and nightly
they indulged in sexual congress to satiety, and grew up together. She,
being much older than he and knowing all the probabilities, exercised
her vigilance and precaution, and all went well until he was twenty-two
years of age; when he found that, upon leaving home and undergoing a
few weeks’ deprivation from sexual contact, an involuntary discharge of
semen occurred two or three times per week, in his sleep, accompanied
by a lascivious dream. The constant and profuse discharge of semen and
prostatic fluid had passed from his glans penis, for which he had often
sought advice in vain. These cases are not very uncommon, although
many a young man has passed through similar experiences with unimpaired
virile powers. I opine that, if a young man passes to the age of twenty
without much sexual excitement, he will not be likely to suffer with
any form of sexual weakness; but if he has the predisposition spoken of
elsewhere, he will not be likely to pass to the age of eighteen without
being fully aware of his sexual instinct, and the pleasure that may be
derived from sexual indulgence or masturbation.
The great author, Lallemand, has given as causes a list of organic
troubles, a great portion of which are, instead of causes, produced
by the genital irritation and spermatorrhœa. He overlooks the general
phenomena which point directly to neurine pathology. As causes,
Lallemand gives, among various organic troubles, prolonged erections,
excited by erotic ideas or lascivious publications; the use of
diuretics, of ergot, of cantharides, etc.; the abuse of alcoholic
drinks, coffee and tea; constipation; ascarides in the rectum;
hemorrhoids, fissures of the anus; heating and irritation of the anal
and perineal regions by habitual sitting, or prolonged horseback riding.
Notwithstanding the eminent authority, it must appear quite impossible
for any of the above conditions to cause spermatorrhœa as a disease.
The few seminal emissions that may occur from such causes are in
isolated cases, and of short duration. Even when spermal losses have
seemed to arise from such causes, I should think grave reasons present
for the suspicion of self-pollution or sexual excess. The simple denial
would not be reason to attribute so permanent a disease to such trivial
causes.
It cannot be disputed with tangible evidence, that Lallemand’s causes
may develop a morbid sexual instinct, by reflex excitation, and act
as a predisposition by exciting sexual desire and self-pollution, and
thereby spermatorrhœa; but the innate condition must be present also in
every case.
While it is well known that various morbid anatomical changes are
found in the genital organs, on careful dissection, yet scarce any can
be said to act as a cause, but rather as a result of long debauch by
pollution and venereal diseases; and as commonly, such changes have
been found in the genito-urinary organs, when spermatorrhœa never had
been suspected.
Roberts Bartholow, in opposition to the views of Lallemand as to
causes, says:
“To place this question beyond controversy, I have lately made
a most careful dissection of the sexual apparatus of a young
man, dead of double pneumonia, who was known to have practiced
masturbation in an extreme degree for many years. Besides a
catarrhal condition of the mucous membrane of the seminal and
prostatic ducts and of the _vesiculæ seminales_, there were
literally no lesions of these organs. I therefore reject this
position of Lallemand as untenable, and as leading to improper
methods of treatment.”
I can but conclude the cause of spermatorrhœa with one definite remark:
That the frequently repeated sexual orgasm, continued for a long time,
causing to be evolved so rapidly the great amount of nerve-force which
must each time be lost forever, must be the only direct cause of that
obscure neurosis upon which spermatorrhœa invariably depends.
_Moral Effect._――There is a moral effect wrought upon the mind of every
person suffering from an inflamed imagination. The constant dwelling
of the mind upon the sexual organs, or the imagination of a future
cohabitation, must stimulate the free flow of seminal fluid to the
overflowing of the _vesiculæ seminales_. Old debauchés frequently feast
upon the virgin countenances that pass street corners, and constantly
stand in wait for an expected girl, to be secured by a procuress,
that they may feast upon her ruin. The cultivation of such morbid
imaginations is an effect, rather than a cause, of long-practiced
sexual debauch, and grows out of a cultivated or congenital grossness
of the sexual instinct.
Elsewhere, the effects of unrequited passion have been fully
elucidated, as cause and effect of local neurasthenia.
_Symptoms._――The physiognomy of a spermatorrhœa patient is often
very striking; especially one who has been an extensive masturbator,
and has been led to think that any physician has but to behold his
countenance to judge of his entire condition and its cause. He bears
the aspect of one who has been convicted of a shameful vice. This
is the picture of an advanced case, yet not beyond the threshold of
reason. As he realizes his condition, he is embarrassed that he is
compelled to converse on the subject and confess his shame. The face
is commonly pallid: the eyes are sunken, with dark lines beneath: the
lips are anæmic: the corners of the mouth are drawn down, and haggard
lines are deep-cut about the face. He looks much older than he is, and
his beard is tardy, isolated and of a dirty color. The general aspect
of hunger is marked upon his entire figure: he is often lean and wan.
He trembles with slight exertion, and complains of fatigue: his muscles
feel doughy, and an unpleasant odor is emitted from his body, strong,
like a goat or a pig, and his voice is feeble. He speaks low, as if he
desired to be very quiet and secret, even when his subject has nothing
in it of a secret character. In common conversation, his voice is
reduced almost to a whisper. He often has pustules on his face――acne.
A young man may have spermatorrhœa with very few of these symptoms
present; but when he has advanced far in the disease――in the nervous
lesions――the above symptoms are only the common manifestations noted
by close observation. Yet all these symptoms may exist from other
causes, and the patient may be free from spermatorrhœa or pollution.
Then, only by the history and physical signs connected with the general
aspect, can we hope to effect an exclusive and conclusive diagnosis.
He relates his history, which is only a confession of his vice and
the story of his spermal losses nightly, with languor, bad digestion,
pains and aches too numerous to mention. His tongue is coated, breath
fœtid, appetite poor, circulation feeble, and heart-sounds feeble and
irregular. Often, a dull aching is located in his back-head, forehead
and eyes, with asthenopia, anthropophobia, agoraphobia, astrophobia,
monophobia, syphilophobia, nocturnal ephidrosis, palmar hyperidrosis,
and neuralgia of different localities and of varied intensity.
_Spinal Congestion._――This is one of the varieties of disease-pictures
that call for a deviation in management, and is, perhaps, as common
as any of the special types, and may be recognized by the following
symptoms: pain in the back, as if from long stooping, not increased
by pressure; also a dull, aching sensation, as after prolonged
exercise. This pain is aggravated by the recumbent posture; hence the
sleeplessness so common in many of these cases. Fainting sensations are
produced by standing long upon the feet: a misstep, or a sudden jolt
in a wagon or car, causes much suffering. Intense burning is often
felt along the cord and base of the brain, which is not influenced
by pressure; hyperæsthesia of the skin of one or both legs and feet,
and the scrotum; testes and penis are often too sensitive to touch;
at times, neuralgic pains in the genitals, with herpes præputialis,
periodically appearing; great tenderness of the anus, with herpetic
eruptions _ab margine ani_. Again, anæsthesia may take the place of
exalted sensibility, with formication――or tingling, or sensation of
“pins and needles”――of the feet and legs. Sometimes they complain of a
sensation of fullness of tissue, as if they were swollen, with no signs
of any puffy or œdemic condition present. I have often observed both
anæsthesia and hyperæsthesia at the same time, in different localities,
upon the same patient. Shooting, neuralgic, or knife-cutting pains
often emanate from the spinal cord and pass into the limbs, testes or
penis. Sometimes a tight belt is felt constricting the limbs, thorax
or abdomen; again a choking sensation, as in globus hystericus, with
a sensation of drawing in the spermatic cord and testes; pain in the
heart, lungs, abdominal viscera and genitals, is of common occurrence.
Irregularities in cardiac movements are not uncommon, with troublesome
erections of the penis in the morning, even when erections were
impossible at night. Such erections are commonly without erotic desire,
and with the bladder empty. They are more troublesome after lying upon
the back during the night, which seems to aggravate the engorged spinal
cord. As these cases advance paralysis may intervene, more or less
profound, generally in the form of paraplegia.
The above, under treatment, will be referred to as the congestive
type of spinal cord disease, where the direct adaptation of agents to
conditions will be pointed out, founded on the only principle that
can lead to ultimate satisfaction――“specific medicine and specific
diagnosis.”
_Spinal Anæmia._――That form of spinal anæmia caused by the sexual
differs from spinal irritation of other causes only in the more
usual beginning at the lower portion of the spinal cord――sacral and
lumbar regions. In this we have a group of symptoms of spermatorrhœa
that is not by any means rare; not always diagnostic yet, coupled
with the necessary history, they afford a condition to which too
little attention has been given. Spinal tenderness is always present,
increased by pressure, relieved by the incumbent position and
aggravated by walking. Unless these symptoms be present, no case is to
be considered anæmia of the cord.
Where spermatorrhœa and spinal anæmia are associated, and sexual
debauch has evidently been the cause of the latter directly, it will
be observed that sexual excesses have existed a long time before the
latter, or before constitutional disturbance had in any way manifested
itself. Spermatorrhœa, when associated with spinal anæmia, appears only
secondarily, as a phenomenon of the disease thus caused.
As spinal anæmia advances and other tender points appear in the cord,
the eccentric symptoms also change and the phenomena are various
in accordance with the location and symptoms coincident with such
phenomena when the causes have been other than sexual.
The lumbar tenderness is generally accompanied by neuralgic pains in
the lower limbs, back, abdomen and rectum, cramps in the bladder, with
difficulty in urinating; at other times incontinence.
In one case, which was under my care two years without any benefit,
the whole spinal cord was tender to the touch, and the patient was
epileptic and very feeble in mind.
When the dorsal region is involved and tender, as might be supposed,
there will appear gastric troubles; acidity, pyrosis, nausea and
vomiting, gastrodynia; again intercostal neuralgia and rheumatism,
cough and dyspnœa, palpitation, fits of fainting and epileptiform
convulsions.
_Case._――Mrs. P., in addition to unmistakable symptoms of spinal
anæmia, with dorsal tenderness would, at the sudden closure of a
door, complain of great pain in her abdomen, stomach and uterus. On
several occasions she had had involuntary evacuation of fœces and
urine during a thunderstorm. Her skin would be covered with cold sweat
(hyperidrosis). Medicine had very little influence in this case;
but electricity applied daily for three months――a mild current of
Faradisation――effected a very satisfactory improvement. This was a case
of sexual origin and a result of fifteen years’ sexual excess in her
early life; after which she married well to enjoy the remainder of her
life in wedlock under the care of a physician constantly.
The cervical region is not uncommonly affected and may be very tender,
which may produce pain in the stomach and nausea, rejecting everything
swallowed, at times. Sleep is nearly always deranged: sometimes
sleeplessness, and again, in the same patient, profound coma of long
duration is observed, and somnambulism is also likely to occur in
such cases. Twitching of muscles, contraction of flexor tendons,
hiccough, aphonia, vertigo, head-pain through the top, tinnitus aurium,
disturbance of vision, asthenopia, and mental derangements, as the last
stage of the disease, when the brain and entire nervous system are in a
feeble condition: all follow, in rare occurrence, the sexual debauch,
and are symptoms of the entailed conditions, viz., sexual neurosis, of
which spermatorrhœa is only one of the numerous symptoms, yet perhaps
the most attractive.
As these foregoing types or conditions advance, they become complicated
and even change in essential features; but if not remedied, the result
must be toward paralysis, insanity, tabes dorsalis, epilepsy and
imbecility; all of which can best be studied as special diseases in
numerous volumes on diseases of the nervous system.
_Cerebral Sexual Neurosis._――That form of neurosis, brought on by
masturbation in adolescence and sexual excesses, does not exist
independently of other portions of the nervous system, and only as the
spinal cord becomes impaired by excessive sexual shocks and evolution
of nerve-force, which is expended in orgasms during sexual excitement,
does the brain become involved, and its tissues fail, by feeble
perpetuative force, to evolve healthy intellect. When the formative
forces fail to construct as perfect a brain-structure as has existed,
renewal is required more and more often, which cannot be brought
about by the impaired nerve-forces, and softening must, necessarily,
follow or, at least, a mal-renewal and mal-construction of cells and
neuroglia, too unnatural to evolve the elements of healthy mind.
That there is a connecting link between the intellectual and the sexual
there can be no doubt, and that for the sexual to be appreciated,
without the assistance of the intellectual, would be only animal and
should not be considered advisable for human beings, but that the
intellectual should not only predominate, but preside over, all sexual
conditions.
Thomas would have us believe that the cerebellum is the seat of
amative desire, and that that organ presides over the sexual function.
Again, an opposite claim has attempted to overthrow such doctrines, by
experiments to prove that the cerebellum presides over coôrdination of
muscular movements.
I am not prepared to accept the doctrine of either as true, but only
can see evidence that both may be disturbed or lost for a time by
pressure upon, or section of, a part of the cerebellum, and that this
organ perhaps tends to effect an equilibrium of the nervous forces
between the cerebrum and cord, and also as a generator of nerve-force.
We do know that coôrdination of muscular movements is interfered with
by any structural changes in this organ; but it would seem that, if the
sexual was so much depending upon the cerebellum for force, or there
was such an intimate relation between these organs, muscular movement
would be oftener impaired or disturbed by reflex irritation, owing to
the frequency of impotence and other genital diseases, through the
close relations supposed to exist between the genitalia and cerebellum.
The coôrdination of muscles is seldom interfered with by sexual
diseases directly, but only as a secondary issue, by first producing
chronic impairment of the nutritive forces, and thereby effecting the
changes in nerve-cells.
The sensitive nervous organizations are of themselves predisposed to
morbid changes, from too often repeated shocks of pleasure or grief;
such persons are first to suffer mentally through shame, from having
indulged in such vices, and secondly, from actual structural changes
that have occurred.
The vice, commenced at puberty or before, interferes greatly with the
development of the brain, and only a feeble intellect is possible as a
product of such feeble brain-structure. The mental powers often yield,
as it were, when the genital organs possess the power to copulate _ad
libitum_. This is not an uncommon occurrence. Lunatics frequently
possess such genital vigor, when their lunacy has been produced by
masturbation and other sexual debauch.
Roberts Bartholow has, in his monograph, recorded a paragraph worthy of
mention:
“It is to be remarked that the mental phenomena of
spermatorrhœa are not always in proportion to seminal losses.
In the cerebral form, in addition to those lesions of the
sexual spinal system, of the digestive apparatus and of the
circulation, described under the genital form, there are
certain disorders of the mind. That spermatorrhœa will produce,
in one class of cases, mental disorders, and not in another,
indicates either that some predisposition to these disorders
existed, or that the habit of self-pollution was merely an
expression of mental alienation. The lascivious images which
pervade the minds of boys, possessed of the highly developed
nervous organization of masturbators, are those of delusional
insanity. In one case the spermatorrhœa is a symptom of mental
disorder; in the other, the spermatorrhœa is an exciting
cause――the predisposition already existing.”
The general anæmia that so often occurs in spermatorrhœa, caused by
impaired digestion and spermal losses, is secondarily the cause of the
cerebral anæmia, and tertiarily of softening. The digestive powers,
so much impaired by frequent draughts on the vegetative centers, must
be a cause for a great disturbance in the nutritive supply of the
brain. The vicarious expenditure of nerve-force upon the exaggerated
secretory power of the testicles must be a source of great waste, as
well as the actual loss of elements, necessary to the structures of a
body losing annually by decay. The tendency of local spasm is of no
little importance as a cause of local anæmias. Centric irritations,
such as influence the _vaso-motor_ centers, without a doubt, cause
local spasms of the _vasa vasorum_, capillaries and supplying arterial
trunks of organs; and the vessels of the brain are the most likely to
be influenced in such a manner, and the tissues of the brain the most
likely, of all tissues, to suffer from such a condition.
The brain-symptoms do not end with feeble intellection or insanity,
but impairment of the special senses and motility is not unfrequently
present, as a phenomenon evolved from structural changes in the
brain. Asthenopia amblyopia, diplopia, dilatation of the pupil and
hyperæsthesia alternated with anæsthesia of the visionary apparatus,
aphonia, perversion of the sense of taste, with loss of smell and
deafness, are rare yet occasional complications.
The usual catalogue of symptoms bears closely to one of two forms, the
hyperæmic or anæmic, local or general, of the cerebral substance.
The profound impressions wrought upon the minds of these patients
by popular sexual literature must greatly exaggerate the structural
changes, but are not sufficient of themselves, as a rule, to produce
anything but morbid emotions until after enfeeblement has first been
organized.
The records of the State Asylum, at Utica, N. Y., show five hundred and
twenty-one cases admitted directly attributable to this vice; and Dr.
Jno. P. Gray, the able superintendent, thinks this greatly understated.
Sexual excesses, pollution, and other mismanagements of the sexual
functions have received too little attention, and are too seldom
mentioned in the etiology of nervous and brain lesions. Too little
effort has been put forth to ascertain the proportion of mental
diseases caused by the sexual and reproductive organs. A greater
number of brain-lesions occurs, in which the sexual function has been
a remote cause, than any author, as yet, has ventured to affirm.
Statistics of any degree of accuracy are impossible to obtain; but
supposition, imagination, and guess-work only can be found to assist in
making up a statement of the most important of all causes of disease.
_Clinical Illustrations――Case._――Mr. X. came from the South with his
brother to consult a physician in St. Louis. I found the patient, who
was aged 24 years, feeble and wan. He wore a thin, scraggy beard, about
an inch long, over his chin and under his maxilla, but the side of his
face contained only a little furze. When I entered the room it was not
necessary to inquire which one of the young men had come to consult me,
as his general aspect told me that he was a sick man. He was cadaverous
in looks, staggering in gait, anæmic and haggard. He had been a
masturbator, and practiced it as long as he could obtain erection,
which had been until within a year; although I learned that for five
years previous his erections had been only occasional and feeble. His
semen was wasting nocturnally and his genitals flabby, cold and damp:
his scrotum especially was relaxed and pendant. The spinal cord was
very tender to the touch, giving great pain upon examination, over the
lumbar, dorsal and cervical vertebræ. He complained of a sensation of
constriction (girdle) around the body, painful digestion, constipation
of the bowels, and talked incoherently. His mind wandered: he had no
wishes to go home, or to stay, or to live, and became quite passive.
He failed fast, and I soon lost sight of him, as he was placed in an
insane asylum. All treatment failed to benefit him.
I might enumerate scores of similar cases, in which it is impossible to
see any cause but abuse of the sexual function, in which spermatorrhœa
and impotence blend in a very obscure manner, but combined with other
phenomena prove, beyond a doubt, the existence of a sexual neurosis,
peculiar to itself, which needs study as to pathological anatomy; when
it will be discovered that more than mere cause for general neurosis is
found in the sexual abuse so lightly spoken of by authors in treatises
on diseases of the nervous system. It will not require an accurate
observer to discover signs of myelitis and softening in the above case;
but his symptoms had been, long before, markedly those of anæmia, as
related to me by his brother. Many cases selected for this section are
in the advanced stage that I may the better show the termination of
some of these cases. The majority of the cases that I have observed
have been wanting in these distinctly organic features, _only_ for the
reason that they were not so far advanced, and their indulgences had
been limited to a more careful habit of pollution and sexual congress.
The usual course of lesions appears in the following order after
sexual excesses and pollution: Nervous weakness (neurasthenia), anæmia
or congestion, myelitis, and softening. These may point either to
the brain or spinal cord, or both associated, in any given case, in
accordance with compatibility of lesions and conditions.
A most striking condition of sexual neurosis is not uncommonly
observed, that is not confined strictly to a locality, but shows a
general breaking down of the conductors of nerve-force, both motor and
sensory, as well as the nerve-cells, with a tendency to softening of
both brain and spinal cord.
_Case._――A marked case of impaired conductivity is now under my
observation. The patient is a masturbator, and I have thus far failed
to disrupt the vice.
In addition to many symptoms, not of general interest, is the impaired
condition of the sensory conductors. When he is touched, it is a
second before he feels. He sees the finger placed upon his hand or
foot, but does not feel it for one or two seconds: sometimes it is
quicker than at other times. When he is spoken to, he does not receive
the idea for ten or fifteen seconds after he has heard the sound. He
comprehends that such is the condition. He says he does not desire to
practice self-pollution, but simply performs the act because he can’t
help it. He is sensible and strong-minded on some things, and very
feeble on others. He is agoraphobic, but has no pathophobia. He is not
anthropophobic, but even foolish after female society, and still has
no inclination to copulate. He prefers to masturbate, rather than to
accept of coition when accessible.
The motor nerves and centers are rarely, but sometimes, involved
directly. When paralysis does occur, it is from advanced complications
and need not be mentioned here; but sometimes an unnatural class of
movements is produced by this variety of neurosis, generally of a
spasmodic character and located in the involuntary sphere. I wish only
to record, in this place, the fact that such is a lesion of sexual
neurosis, and take it up elsewhere with greater precision.
Tabes dorsalis has not been uncommonly caused by sexual abuse, in
proportion to the frequency of the disease. Loss of sensibility is also
exceedingly rare, but impairment is not uncommon. The loss of venereal
sensation is a very common consequence and will be spoken of elsewhere.
Paralysis of some of the muscles of the genitals and bladder is of
frequent occurrence, especially those connected with urination; the
bladder is often paretic and micturition is frequent, and the quantity
very small: often the natural warning as to time is wanting. The
mental symptoms are often very prominent: loss of memory; conversation
difficult; language incoherent and ideation very imperfect; insanity,
idiocy, imbecility and epilepsy.
Hitzig says, under _Etiology of Paralysis of the Insane_, “Probably
the combination of excessive labor with excesses _in Baccho et Venere_
is the most common cause. The influence of sexual excesses can be
recognized in females also.”
_Case._――An epileptic gentleman, æt. 24, consulted me for his fits. He
had practiced masturbation from childhood to twenty years of age; was
losing semen nightly; often without erection; had been epileptic four
years. At first the fits were as frequent as every four months, but now
they are weekly. His face was of a venous color, as if a venous stasis
was the constant condition. His eyes and hair were black. His face was
expressionless and covered with acne; memory very poor. He was a fine
penman, and had been a book-keeper. He had felt no _aura_, and always
had his fits during the day-time. All treatment failed in this case
to produce any impression upon the fits. The bromides at first could
not be used, as dangerous symptoms followed three successive attempts.
Electricity, if any thing, aggravated his general condition. I cast
lots for general treatment, in an empirical manner, but very little
benefit followed: his general condition was downward, and the epilepsy
continued to grow more frequent. Large doses of bromides benefited him
and increased the interim, but finally four drachms a day failed to
control or to modify them. Galvanization and Faradisation, both singly
and conjointly, were tried in vain. Ergot also was tried, and many
agents of lesser prospects, as he staid with me three years, growing
feebler in body and mind constantly, until he is now nearly imbecile.
Four cases so nearly alike have come under my observation, that the one
will answer as a typical case of them all; not a single one recovering:
two have ended up in the insane asylum: the other two I have lost sight
of, but not until they had passed into a state of dementia.
_Case._――Jno. W. My attention was called to this patient by Dr. M.,
who was the attending physician. The patient was in bed, very much
emaciated and feeble; form originally tall, bony and muscular; dark
hair and eyes. The Doctor informed me that he had passed through
the hands of a number of physicians, without relief. His pulse was
feeble and averaging 100: his venous circulation was feeble; a livid
appearance of the skin: the redness would disappear upon pressure and
return very slowly. There was profuse nocturnal hyperidrosis, with
great morning prostration and general coldness. He was exceedingly
irritable and profane; appetite poor, and what little was eaten
was digested with pain; bowels constipated; urine high-colored and
of high specific gravity, containing blood and pus. The spinal cord
was so tender, during its whole extent, that the slightest pressure
produced intense pain. His rectum was indurated and very tender to the
touch. The urethra was diminished in calibre to a No. 8 catheter, and
that was passed with great pain. The prostate gland was enlarged and
hyperæsthetic. He complained much of the girdle sensation, which placed
the diagnosis beyond a doubt as chronic myelitis of the posterior
columns. There were no lesions of motility, but lesions of sensibility
were present throughout the body and lower limbs; anæsthesia of the
skin and hyperæsthesia of the mucous membranes of the rectum, urethra
and bladder. All treatment proved futile, and he died after a year of
most distressed suffering.
He was a debauché, given to extreme sexual indulgence and wine; was a
victim of early indiscretions, and to a great excess: spermatorrhœa was
present up to six months of his death; but was only impotent after he
took his bed from general exhaustion. He was thirty-three years of age
when he died.
Gull’s case of paralysis reported must be quite exceptional, as
paralysis generally found, which has been caused from a sexual
neurosis, has not differed in any manner from the same paralysis
from other causes; and I can only see the sexual neurosis as a cause
of paralysis, and not as a special variety. The same may be said
of an anæsthesia of the skin, or a hyperæsthesia; that the sensory
nerve-roots are influenced by either anæmia or turgescence, and the
phenomena are manifested at the periphera. The phenomena do not
differ, when these conditions are caused by the sexual, from phenomena
when conditions are wrought by other causes; and conditions causing
identical phenomena are in themselves identical, but not as to their
cause; hence so many forms of sexual neurosis, and so many conditions.
_Local Structural Changes._――Structural changes in the genital organs,
in a chronic case of spermatorrhœa, are not a little interesting to the
student of pathology. The scrotum is pendant, baggy and relaxed. The
penis is flabby, cold and pallid. The veins are dilated and tortuous,
and the organs are in a condition of anæsthesia or hyperæsthesia;
and as irritability often exists, causing unnatural attention of the
patient, and he finds much difficulty in dressing to suit his genitals.
The spermatic cord is hypertrophied, and the epididymis enlarged and
baggy. If the examination can be obtained when there is an erection,
tenderness will be observed, along the entire course of the urethra.
The urethral mucous membrane is thickened, and the canal is strictured
throughout its length. The prostate gland is changed and tender to
touch, congested, and its ducts relaxed. (See Prostatorrhœa.) The
anus is sore to manipulate, and at stool, when scybala pass over the
prostate gland, a sensation of pain is felt, and fluid is forced out
of the ducts into the canal and drips from the end of the penis. The
veins of the spermatic cord are varicose, the erections are deficient
in power (see Impotence), and seminal fluid is thin and watery. The
spermatozoa are deficient in size, shape, and amœboid movements. The
urine is of a low specific gravity and contains a superabundance
of urates. The orgasms are feeble and often imperceptible, and the
proportion of spermatozoa to fluid is not great.
_Spermal Changes._――The only known detection of spermzoons is by the
microscope, which only can detect the seminal from the prostatic fluid
in this stage of disease. The reason that spermatozoa have not been
detected oftener in the urine of spermatorrhœa patients, is simply from
the fact that the urine was not examined more than once, perhaps twice.
When I have watched for ten days, making daily observations, before
discovering spermatozoa, I have then found them daily for as many days.
The first object to be determined is, is the patient strictured, or
has he a general narrowing of the calibre of his urethra? If so, then
this is a good reason to suppose there may be spermatozoa in his urine,
providing that he is losing semen; as the fluid is thin, and the walls
of the canal are clumsy in performing those wave movements which are so
essential in ejaculating semen or expelling the last drops of urine;
therefore regurgitation may take place, and semen be found in the next
discharge of urine. When nocturnal losses occur, a large portion may
be expected in the urine at the next micturition. This is commonly the
case in aspermatism, and may act as a cause of sterility.
The married, as well as the unmarried, have involuntary discharges of
semen when every possible opportunity is present for an emission to
take place in the natural way. The newly married, after the novelty
period has subsided may, from excessive indulgence, have an involuntary
emission, which occurred during a lascivious dream, when no desire for
cohabitation preceded his going to sleep. When the cause producing
these involuntary emissions is not transitory, the young man must have
indulged extensively in his boyhood. Such a discharge, if followed by
the usual depressing effects, is invariably pathological; yet with
proper rest, self-recovery is probable when the cause is transitory.
_Sequelæ._――The common results of spermatorrhœa and sexual excesses
become noticeable, either shortly before or soon after marriage.
The young man well knows his defects, and he consults a physician to
ascertain the magnitude of what may occur to him on account of his
indiscretions. He informs us that sexual orgasm occurs very soon after
intromission, on account of which he is grieved, and fears that his
buxom, voluptuous bride will not be satisfied with such tantalizing as
he may be able to afford. A few months’ tonic treatment encourages him,
and he makes a trial of his condition before entering wedlock, that
he may be sure not to disappoint his fresh, true and virtuous maiden.
Again, the matrimonial rites have been consummated, and the young man
fails to reach the expected goal of marital adaptation and aptitude:
the wife is of course unsophisticated, and thinks there is nothing
wrong; but the husband is well satisfied that he is not what will be
expected, or what is necessary to promote marital felicity; and he
consults his physician. Perhaps he was not a little disgusted, upon the
first attempt at intromission, at ejaculating his semen either upon her
linen, thighs, or vulva; she of course being innocent and not knowing
the why such was not the natural procedure, he could excuse himself and
thereby palliate his embarrassment.
Others, less sensitive in organic construction, do not understand these
shortcomings, and are not _quantum sufficit_ for a healthy female, as
ejaculation follows a moment’s rapid copulative movement, leaving
the female aflamed with erotic passion, and physiological turgescence
of the sexual apparatus. These are only the _sequelæ_ of seminal
weakness, such as pertain to the neurotic origin and character of this
disease. The grave and less common results are, as the symptomatology
illustrates, spinal anæmia and congestion, cerebral anæmia and
hyperæmia, insanity, epilepsy, tabes dorsalis (progressive locomotor
ataxia), paralysis, impotence and structural disease of the heart and
blood-vessels.
_Treatment._――The treatment of spermatorrhœa, with its associate
phenomena, demands careful investigation of the lesions and conditions
of every case. The results and character of lesions are so varied that
often a diagnosis as to condition is not an easy task. To know that
spermatorrhœa exists is but a small part of the diagnosis necessary to
arrange a treatment that may rationally result in benefit. As has been
shown, seminal losses may exist when opposite conditions are present;
and only can benefit be rationally expected from equally opposite
methods of treatment. Any physician of experience has, and always will
have, much difficulty in treating and controlling these cases, as they
are hard to manage when even doing well, and only an intelligent and
positive course can succeed in managing them during any great length of
time.
A positive code of government, rigidly followed, is indispensable; as
well as perfect confidence in the managing physician.
The nasty drugs of our old-fashioned materia medica will not cure these
cases The bringing about so-called tonicity, by tonics and nervines,
only needs to be tested for a short period to convince any practical
physician how useless is such a procedure, and how soon his patient
will find another attendant. Drugs are often useful but bad ones,
selected for a tonic principle _only_, will as often do harm. Only
with a definite object in view, should we expect to accomplish such
changes as can result in positive relief. The list of nasty tonics for
indefinite purposes, or such as “have been used in such cases,” the
author has resolved not to, in any manner, refer to, and at no time
will he direct an agent or combination of drugs on so-called “general
principles,” but with definite expectations only.
_Spinal Congestion._――The group of manifestations pointing to spinal
congestion will first receive attention. The remedies are bromide
potassium, bromide ammonium, ergot and belladonna, with electricity.
These are selected also with reference to conditions only; yet the
reader can evidently see that their ultimate effects are aimed at,
as all of this list of agents affect the calibres of capillary
blood-vessels; therefore, the engorged spinal vessels are unloaded by
contraction, perhaps, of capillary _parietes_.
By this effect of drugs we aim at relief of the long compression of
the cord, and liberation of nervous energies and forces supplying the
organs of nutrition and assimilation.
It is pre-supposed that all sexual excesses and vices are under
control; otherwise, all treatment will be useless.
Numerous are the contrivances to control or prevent seminal emissions.
They have all failed, and nothing is lost; as only the effect is
looked upon in their construction, and not the true nature of the
disease; therefore, to prevent spermal losses is not the first object
to accomplish, but to relieve the nerve-centers, which preside over
the manufacture of semen, of these abnormal structural changes; and
the loss of semen will abate. No instrument will then be required; and
if this centric improvement cannot be effected, the patient is beyond
help. No mechanical contrivance will relieve the centric lesions;
therefore, such appliances are useless. The loss of semen is not a
disease, only a manifestation or a phenomenon of centric lesions; and
as we have said heretofore that spermatorrhœa is not even a cause of
such lesions; but sexual shocks, often repeated for a long time, are
the cause of the neurosis through which we have spermal losses――true
spermatorrhœa. This reiteration is made that no mistake may be made in
interpreting the means of relief, which are all aimed at the lesions
instead of their phenomena.
When the patient is not too much debilitated, chloral may be
administered to produce sleep; but very commonly the ergot or ergotine
will allay all nervous irritation and bring on perfect rest. Large
doses are demanded, as much as two grains of Beaujon’s extract three
times per day, or one drachm of Squibb’s fld. ext. or an ext. of equal
strength should be used. Belladonna should be used by commencing with
small doses and gradually increasing until asthenopia is produced, when
small doses should again be used: by this means the extent of tolerance
may be ascertained, and that dose should be continued which does not
affect the eye. When the bladder is involved and urine is voided with
a lack of expulsive energy, or the urine dribbles away, ergot and
belladonna are the remedies. Where there is extensive hyperæsthesia the
bromides are better agents, and also to overcome any reflex irritations.
Hot applications to the spine are often followed by very excellent
effects, as the relief of pain and other troublesome symptoms.
Cold water to the hands, feet and genitals is often followed by
surprising results, and should be used night and morning for a long
period of time――many months. Tonics do great injury in this class of
cases. Quinia, strychnia, phosphorus and iron should never be used in
any form.
_Electricity._――The downward, constant current, alternated with
Faradisation, is indispensable to satisfactory results in the majority
of the cases of the congestive type; using the galvanic one day, and
the induced the next day, with general Faradisation, if it be followed
by pleasant effects and relief of unpleasant nervous symptoms.
Stimulating food, as well as alcoholic and malt liquors, should be
proscribed; yet a generous diet is at all times indispensable. Opiates
should not be administered, even for the relief of pain.
_The Anæmic Form._――When this type of spermatorrhœa is satisfactorily
diagnosed, the treatment is plain and the agents quite positive in
their course of action, when the case is not so far gone that relief
could not reasonably be expected. But if there be a doubt as to
diagnosis, on account of mixed symptoms――and such is not unfrequently
the case――if we are not well satisfied whether there is anæmia or
congestion of the cord, the administration of 1/60 of a grain of
sulph. strychnia will decide the matter, which will produce some of
its physiological effects if there be congestion; but if anæmia exist,
there will be no noticeable change, at least no unpleasant effects.
With this point clear, we then direct a treatment which is intended to
stimulate a free circulation of blood in the cord――_spinal stimulants_.
Strychnia, phosphide zinc, cantharides, pulsatilla, phosphoric acid and
collinsonia, are such agents.
Cold spinal and genital douche, with hot foot and hand bathing morning
and night, are highly important agents, with strychnia 1/60 gr., three
times a day. The author has for many years almost entirely depended
upon formula No. 1, not on “general principles,” but as a combination
that applies directly to the anæmic condition of the cord and its
consequence; and knowing its effects, as he has, so long, could not
well do without it in the treatment of these complicated cases. If
there be general anæmia, as well as local, chalybeates may be of
service, but not until the patient is eating and digesting moderately
well: then we prefer the citrate in port wine. Stimulants in moderate
quantity are admissible, especially wine and malt liquors. Opium may be
administered to allay pain, but chloral is better.
Any agents, used for their stimulating effect upon the cord, must not
be expected to act too rapidly. Patience is the all-important motto
after the diagnosis is well made.
Counter-irritation will always be of great service, and the cantharidal
plaster is the most desirable form. The seaton has in a few instances
been of service, but we prefer the emplastrum canth.
Electricity is indispensable, and should be applied daily. The anode
should be applied to the tender spots in the cord, and the cathode to
the genitals, in the form of a large sponge placed in contact with
the perineum, scrotum and penis. Faradisation may be alternated with
the constant current daily. General Faradisation may be applied best
by a large foot-plate covered with a wetted sponge, and the operator,
holding the anode, may place his other hand on the patient’s head, back
of his neck and along his spine: the hair of the patient will of course
be moistened as the dry hair is a non-conductor of electricity.
A highly nutritious diet should be always advised, and plenty of
open-air exercise, even to fatigue; as the mind is thereby employed,
and not so much time is found to brood over these physical conditions.
The very common and exceedingly troublesome constipation may be
overcome by rhamnus purshiana, in teaspoonful doses of the fluid
extract, morning and night.
When extreme sleeplessness prevails, grain doses of svapnia have acted
excellently; also ten-grain doses of chloral hydrate.
I do not prescribe for seminal losses under any consideration: I
simply ignore them during the whole course of treatment. Where the
general health improves, and with that the nerve-symptoms, the seminal
losses become less frequent and finally cease. As the involuntary
discharges diminish, we may conclude the central lesions are improving.
_Cerebral Sexual Neurosis――Treatment._――The most prominent feature of
the cerebral manifestation is mental asthenia, or feeble-mindedness,
from real exhaustion of all the forces; a general lack of power.
To impart vigor to the general nervous system must be the first
indication. For this purpose dil. phos. acid may be administered. If
the extremities are cold the hypophosphites are of positive benefit,
and must be continued for a month or more. Tinct. nux vomica imparts
tone to the nerve-centres. When active symptoms are present the
bromides act very kindly, and may be combined with ergot, or the latter
may be used separately with most excellent results. But the physician
must be certain that he has a case of hyperæmia, before such agents are
resorted to, and then they should be given in large doses.
Electricity, in the form of general Faradisation, seems to be of the
most service, and must be applied daily for several months. Only a
feeble current should be used.
The structural changes that have occurred in the genitals always demand
attention.
Chronic turgescence of the prostate gland will best be treated by
the internal use of tinct. staphisagria, large doses of bromide of
potassium, and the introduction of catheters increasing in size until
the urethra is fully dilated.
Electricity should be used as recommended under Prostatorrhœa. The
organic stricture, which is so commonly present, should be treated by
dilatation with suitable bougies or catheters. The bougie must be used
as often as twice a week, until the full size and elasticity of the
urethra are obtained.
Injections are sometimes useful. A solution of nitrate of silver,
ten grains to the ounce of water, used only once, and followed by a
solution of brown sugar (sacch. communis), morphine and rose-water,
will answer a most excellent purpose. After the acute inflammation has
subsided the bougies must always be resorted to, and used persistently
until the object for which they are used is accomplished. Any
ulceration may be relieved by injections of permanganate of pot., not
stronger than one-half grain to the ounce.
The glans and prepuce should be closely scrutinized from time to
time, and if the prepuce be of undue proportions, or if the patient
is filthy, permitting accumulations to form beneath the folds and
creating a local irritation, circumcision should be performed without
hesitation.
Reflex irritations have often prevented recovery, and even produced
grave manifestations. Cases of epilepsy have been reported from such
peripheral causes, and cured by relieving the cause, or circumcision.
The division of the sensitive nerves, which occurs in the operation
of circumcision, often prevents involuntary spermal losses, and
even permits such patients to perform normal copulation as had even
ejaculated previous to intromission. Such little causes must not be
overlooked. It is often in attending to little things that great
results are accomplished; and in this we have no exception to the rule.
There is no room for a doubt in my mind that the Jewish rite was first
established from hygienic motives _only_; and as “cleanliness is,” and
always has been, “next to godliness,” circumcision would seem a very
natural sacred rite for any religious sect to adopt.
We have no history of anything more ancient than the operation of
circumcision. The Egyptian priests were practicing circumcision nearly
5,000 years ago. A translation of Herodotus informs us that such
hygienic measures were in existence amongst the Egyptians in the most
ancient of periods; and it is quite reasonable to suppose that the Jews
obtained this rite from the Egyptians.
_Dilatation of the Anus――Anal Plug._――A very troublesome complication
of the genital structural changes occurring in spermatorrhœa is
induration of the mucous membrane and sub-mucous tissues. Where such a
condition is present, little benefit should be expected until relief is
obtained from the local difficulty.
The dilatation should be accomplished by suitable means; such as by
bougies, or a bi-valve rectal speculum. An anal plug may be constructed
that is self-sustaining, polypoid in shape, which will be of more
service than compression of the anal surfaces. The troublesome
pruritus, and hemorrhoidal tumors, and indurated anal tumors, will
gradually subside under such management. Suppositories of iodoform are
also of invaluable service in reducing indurated conditions of the
anus and rectum, as well as enlargement of the prostate gland. The
old-fashioned stretching of the sphincter ani for spermatorrhœa, so
highly recommended by Trousseau in his clinic on this subject, from
indiscriminate use, is neglected, when it is really a most important
means, deviating the reflex current from the genitals as well as
relieving actual structural change in the anus. Roberts Bartholow has
dwelt upon this subject without pointing out definitely such cases as
it has actually relieved, leaving the reader to guess or find out for
himself. The failures from its use have been so numerous, and the
cases in which benefit has followed so few, that it is no wonder that
it is not in better repute as a remedial means.
Whenever this dilating process is restricted to thickening and
induration of the mucous membranes of the anus and rectum, much benefit
will follow its use.
Many peculiar means have been recommended and are resorted to, many of
which only need a condemnatory mention, which seems the more necessary
that they are in almost general use. The most prominent is _the porte
caustique_, which was probably introduced by Ambrose Paré, and improved
and so highly recommended by Lallemand. Other prominent supporters of
this manner of medicating the urethra and prostate gland were Wiseman,
Hunter, Amussat, and Everard Home. The supporters of this manner of
cauterizing the openings of the vesiculæ seminales were under the
impression that spermal losses constituted the essential cause of
the disease, instead of the habit the testicles had taken on by a
hyper-supply or vicarious evolution of nerve-force.
We do not hesitate to say that this method is seldom followed by
beneficial effects, and often by irreparable injury.
Bartholow advises its use in exceptional cases; “those in which,”
he says, “the moral effect of the application is desirable.” From
this I must dissent; as any superabundance of attention demanded may
be bestowed by cauterizing or vesicating the perineum, obtaining
an excellent moral effect and even accomplishing, by way of
counter-irritation, physical improvement.
We might suppose that these harsh means of treatment, owing to the
elevated character of their supporters, were in good repute; and that a
work on this subject would be incomplete without a full detail of them;
but a better success without than with them has led me to discontinue
their use, and conscientiously speaking of the treatment, I can but
manifest my disapprobation of all caustic applications to the urethra
or prostatic ducts.