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+SEXUAL NEUROSES.
+
+CHAPTER I.
+
+_Introductory._――The term sexual presupposes the possibility of two
+distinct and perfect beings, yet one is counterpart of the other,
+distinguished by anatomical features designated male and female; with
+attributes such as passion, love and reciprocal admiration. Sexually
+the two beings become united, constituting plurality in unity.
+
+The sequel of such coalescence of the sexes, or marriage legitimately
+considered, is copulation and reproduction of the species. The
+summit, or peripheral center of venereal sensibility, is found at the
+genitalia, and in the male a concentration of nerve-force conducts,
+as it were, to and unites at the glans penis; and division of the
+terminal nerves at this point will render erection impossible. In both
+man and beast, the only mechanical irritation capable of exciting
+venereal sensibility must be at this point. When the sexual centers
+are physiologically irritated, from peripheral or centric influences,
+contentment is only possible (physiologically speaking) when male
+and female counterparts coalesce, or are in juxtaposition. The sexual
+attributes also constitute an instructive topic for study, as they
+become modified by civilization and the development of reason. The
+procreation of organic life is the sequel of the sexual connection. The
+living universe has been called into existence, and the perpetuation of
+its life-spark is only dependent upon the contact of sexes.
+
+The universe, it is said by one theorist, was evolved; by another,
+who depends upon the Holy Book for a guide, all living creatures were
+thaumaturgically or miraculously, and “in the twinkling of an eye,”
+made to exist in full form and shape. This problem will never be
+settled to the satisfaction of all men as long as theory and faith
+are at war; and small is the prospect of peace while both parties
+are redoubling in their forces annually. Then, we can but accept the
+situation of the human race, as it is, since we have no historical data
+of its origin, that are beyond controversy and that would be accepted
+as evidence in a physiological point of view. But we need no ponderous
+evidence to show the truth of the premise, that animal life is not
+perpetuated except through sexual congress. Not life _only_, but good
+and evil of every degree; vice, folly, crime; love and hate; society,
+social evil and social good: all depend, largely, upon the sexual. It
+is the bond of our existence; it is the wheel of our fortune; it is our
+guiding star; and it may be our loadstone to crime and premature death.
+Passions leading to love, true and gentle, or jealousy, hate, revenge,
+murder and suicide, all hinge on circumstances connected, directly or
+indirectly, with the sexual.
+
+Our schools are conducted upon a foundation entirely sexual; educating
+each of the sexes in the role they are to pursue, with reference to
+exclusiveness in conduct. The girl is taught to pursue only such
+vocations, practices and manners as are becoming to her sex; the boy,
+on the other hand, is instructed not to enact girlish capers, but to
+pursue masculine vocations, from the childish toys to settled, adult
+labors. This all means nothing but distinctive development of the sexes.
+
+The sexual enters our every-day lives, from childhood up; it governs
+our development; it modulates the voice, the build, the dress, the
+hair, the fashion of wearing the dress, and even the gait. In all this
+we can but observe the worship of the sexual; though obscure, yet
+every manifestation of human existence points to it. The good people
+of the earth profit by the grand and noble sexual unity in the marital
+existence, and by the pure, social relations, and chaste affections of
+the unmarried; but these are but a small part of human society. The
+masses express their worship for the sexual by debauch, dissipation,
+vice and crime. The common saying, whenever suicide or murder has been
+committed, that “_woman was at the bottom of it_,” might just as well
+read, “_man was at the bottom of it_;” as without the one, where would
+the other have been?
+
+It is the bad use of noble agencies that often constitutes vice.
+Nothing ignoble, was intended by the Great Designer, should grow out
+of the sexual privileges, and when nobly appreciated, for moral beings
+a greater happiness or pleasure has not been instituted. But by long
+prostitution of these privileges, vices have originated; beliefs have
+been established; customs have been founded; even religions have been
+constructed and modified to suit the wishes of designing “sexualists,”
+“free-thinkers,” Mormons, etc. Occasionally, dissatisfied members of
+one sex will establish an innovation, or a revolutionary commotion,
+demanding rights which they claim have been usurped from them, and
+sometimes thirsting for prerogatives belonging to the opposite sex.
+They agitate their cause until their isolated followers establish
+societies and churches, effecting discord in families, and no good to
+the world in general, and for themselves an unenviable reputation. Such
+individuals are often advocating reforms; temperance, charity, etc.;
+but when good comes out of one, evil grows out of ten. They often take
+a decided stand against the opposite sex, and when their true history
+is known, it will be often found that they have been suffering from
+unrequited love, disappointment in matrimony, deception in society,
+misplaced confidence, illegitimate pregnancy, etc.; or, they are
+phlegmatic and passionless; or, hermaphrodites; or wanting in some of
+the sexual appendages necessary to constitute a perfect man or woman.
+Then, without the complete sexual system, harmoniously balanced, all is
+imperfect.
+
+My purpose in dwelling so much upon these mixed relations and
+disappointments, has been more especially to fully expose the
+predisposing causes of neuroses and more essentially of the sexual
+variety. As I shall labor to show that neurosis is the condition
+throughout our list of sexual diseases, and that all the foregoing
+changes, excesses and defects, depending upon the sexual, are more or
+less influential in predisposing human beings to brain and spinal cord
+disease. No person, so well as the physician, will comprehend, after
+once meditating upon this theme, the necessity for thorough study and
+a more rational understanding of the sexual. Medical writers, with
+one or two exceptions, have only ventured now and then an isolated
+paragraph, and left the physician to draw his own conclusion. Among
+the aboriginal tribes, the sexual appetite is and has always been
+indulged _ad libitum_; not only in the natural manner, but in every
+conceivable way, without noticeable harm to the organs themselves,
+or to the nervous system. In a lesser degree this is true of slaves,
+sailors and peasantry, and the lower orders of civilization. Sexual
+endurance diminishes in proportion to the advancement in civilization
+and intellectual culture. A long-cultured family can not sustain,
+in sexual indulgence, what to the uncivilized would be a matter of
+indifference.
+
+Sexual intercourse, when not contra-indicated, may relieve nervous
+tension and produce sleep in a moderately feeble individual; but on
+the other hand, if carried to excess, it may produce nervous tension,
+wakefulness, headache and exhaustion. There are no definite rules to
+regulate the sexual appetite, more than the stomach for food.
+
+The evils of sexual intemperance are temporary, and if recent, quickly
+recoverable by rest only.
+
+Says Dr. Briggs, of New York, “The sexual system is notoriously the
+seat of excitement and depression from psychical and mental influences.
+It is under the control of the sympathetic nerves, and influenced by
+the solar flexus. Much of the peculiar sensibility experienced in this
+part of the body is directly referable to the mind and imagination:
+the manifestations are controlled by the sympathetic nerves, from the
+impulse given in this manner. But the mind and will, however intense,
+have little power over the sexual functions, except through this
+medium. The emotions are superior.”
+
+_Predisposition._――The innate or uncaused condition, which is so
+commonly found among the young, is quite likely congenital and
+constitutional. There is evidently structural malformation in the
+neuroglia, or nerve cells proper, which predisposes the child to sexual
+excitement. This may not be derived from the immediate parent, but
+far back. In the third or fourth generation, debauchés may be found.
+Licentious parents commonly predispose their children to morbid sexual
+desires; and what evidence have we that structural changes do not exist
+in or about the nerve centres that preside over the sexual functions,
+and that such changes are not constitutional? Then, with this
+structural change as a predisposition, the least cause will set the
+sexual centers into a blaze of excitement. They who are predisposed by
+many generations, show upon their faces the lines of coarse breeding;
+that they are the offspring of debauchés; congenital degradation; not
+but these conditions, under favorable circumstances, may be overcome,
+by rigidly cultivating opposite nerve centers; but such opportunities
+are seldom presented, and when presented seldom embraced.
+
+Circumstances are also to be considered as having a bearing upon the
+sexual “ups and downs” of our human career. With a predisposing sexual
+cause, a downfall may occur under circumstances less seductive in
+character than when no such congenital condition is present.
+
+Listen to the heart-rending stories of girls in the houses of
+prostitution. Each has her story of circumstantial events to relate.
+Circumstances of varied gravity have caused the multitudes of “fallen
+women” to occupy their degraded sphere of shame and debauch. Many of
+these have never been predisposed to a sexual livelihood by an erotic
+disposition, and they only stay by compulsion and fear of reproach that
+must follow if they return to society. The line of social demarkation
+is drawn, and there is no palliation or chance of redemption by
+reform――only secret forgiveness, secret repentance, or a nunnery. There
+are some who follow this life by choice, from the pleasure therein.
+Such are predisposed: they naturally follow this course: they learn it
+on the streets, in mere childhood: their ancestors, or some one of them
+at least, were of this type――mal-constructed――and circumstances are
+meagre that, as is said, lead them astray. They are not led astray: it
+is more natural to them than to pursue the path of rectitude and virtue.
+
+These people are predisposed to evil, and it is only, even if guarded
+from childhood up by constant watching and being kept from every
+possible circumstance, and taught only the good and pure, to adult
+life, that any reasonable assurance may be had of their safety from
+vice. This inheritance is almost indestructible and may crop out after
+the best of culture, with very slight cause, any time in adult life or
+in future generations.
+
+Not only the predisposition to sexual desire is congenital, but the
+enfeebled nervous system that can endure only a limited amount of
+sexual indulgence. They learn to indulge the sexual appetite at a very
+early period, and the males grow up effeminate, or half-sexed. The
+tendency of civilization is toward brain and mental culture. In this
+we have a cause of nervousness which is wonderful. Our ancestors, who
+knew very little of brain-work compared to the cramming of the present
+day――compared to the curriculums of our present school system――were
+not nervous; they were not excitable, but physically strong. They
+labored at a variety of toils without machinery, and they obtained
+physical endurance. Now, the boy is crammed at school and hurried
+through to professional studies, when he has but just begun life; or
+he is placed at business, to find that excitement of competition which
+is the greatest brain-stimulus and the greatest cause of nervousness
+of the present age. The multitude of collateral sciences that a young
+man is compelled to read; the books, scientific and novel, that must
+be perused by every popular student; and the short period of time in
+which he is expected to pass over this entire field: all tend to change
+the young man into a habit of nervousness which would surprise our
+ancestors of one hundred years ago.
+
+The labor that was performed by hand by our ancestors, which was the
+cause of their physical endurance, is now entirely accomplished by
+machinery; and the modern man, instead of patiently doing the labor by
+hand, expends months and years at brain-work, attempting to construct a
+machine that will run by steam, water, or horse-power, that he may save
+physical force, time, and perhaps, in the end, money.
+
+The haste in which Americans live and move, must also become an
+exciting cause of nervousness. The ancients were patient in obtaining
+information; in performing works of art, literature, or agriculture.
+The Greeks did not expect to become proficient in the varied vocations
+until middle life; but an average American is expected to finish
+college at twenty-two; to have invented some kind of a machine for the
+saving of labor, to have made a fortune, married and raised a family of
+children, wasted his father’s fortune, and be prepared to begin life
+anew by the time he is thirty years of age.
+
+Then, to answer the question, “Why are American people so nervous?”
+we have but to compare the present with the past; our country with
+others. The nervousness and mental development of our people, preclude
+anything but moderation in sexual indulgence; and whenever fast living,
+brain-working, nervous people indulge to satiety in sexual pleasure,
+they are in danger of grave consequences, such as our ancestors never
+knew of, as the results of excessive sexual indulgence. They could
+cohabit _ad libitum_, and never notice such consequences as nervous
+people are constantly suffering.
+
+
+
+
+CHAPTER II.
+
+
+_Incidents――Observation――Historical Data, and Sexual Hygiene._――Nature
+furnishes us a vast field for speculation and inquiry, when even
+confined within the domain of certainties; and there is an occult line
+beyond which everything is speculative and imaginary; but there are
+facts enough in common view to enlighten the seeker after knowledge by
+simply collecting commonplace occurrences and gleaning therefrom their
+rich lessons. Observation, by association and comparison, and correct
+judgment will teach us many things not in the least hypothetical――facts.
+
+To comprehend the obscure relations of the sexual function and the
+varieties of morbid changes, we must first systematically inquire into
+a few of nature’s designs, and ascertain thereby the true purpose of
+the sexual organs.
+
+What purpose? is the first point at issue in any observation, and must
+be answered by the physiologist and Physician in this investigation,
+as he _only_ has the results of abuse, or wrong application, to
+investigate and correct.
+
+The production of healthy offspring must be nature’s only design for
+the sexual organs. How to accomplish this end, is the great question of
+scientific observers.
+
+It seems quite axiomatic to remark, that maturity and perfect
+development _only_ can assure perfect reproduction of the species.
+Again, that pleasure should always attend the act of copulation,
+otherwise the pain of parturition and the care of rearing the young
+would always militate against the perpetuation of the race.
+
+With the normal condition of the sexual organs and functions the
+physician has comparatively little to do; but with their abuses he has
+all to do. To comprehend the abnormal, he must be familiar with the
+normal condition of structure and function. Masturbation is a small
+part of the indiscretions and evils of the sexual; and the lesions
+growing out of such evils are too numerous to mention. There is no
+doubt venereal diseases grew out of the evils of repetition of sexual
+congress, with certain unknown violations of nature’s laws, by depraved
+human beings.
+
+I am credibly informed of an occasion: “A prostitute received the
+embraces of eleven men in immediate succession: the ninth and eleventh
+took gonorrhœa, and again gave it; but the prostitute remained free
+from the disease until two months after, when she took the disease from
+one to whom she had given it, on the above-mentioned occasion, after
+which she spread it through a small town in which she lived and also in
+which she was in the habit of plying her vocation. She was free from
+disease before this occasion.”
+
+It is no more doubted that a male will contract a purulent urethritis
+from contact with a woman during her menstrual crisis, or if she be
+afflicted with an infective leucorrhœa; but such a discharge in the
+male is not generally contagious, and he may indulge freely without
+giving the disease.
+
+Uncleanliness may be considered a common cause of sexual disease in
+both sexes.
+
+_Masturbation_, after the age of maturity is no more injurious, aside
+from the degradation it leads to, than the same number of contacts
+in the natural manner; but in the youth the undeveloped organs
+suffer, as well as the nerve-centers which supply these organs with
+nervous energy. The youth is inclined to indulge the habit after once
+initiated, greatly to the detriment of the spinal cord, and through
+this to the general nervous system. He is inclined to practice the
+deplorable vice oftener than he could find opportunity to gratify his
+passion in the natural way. As a rule, to the indiscretions of youth is
+confined the permanent injury to the nervous system. It is at an early
+age, when so much injury is done, that the very common practice occurs
+at schools, when boys club together in squads and go behind embankments
+of stone-wall, or creek-banks; or a boy isolates himself, as it were,
+to “shell out a grist by hand.” With such ample opportunities, and with
+the habit fully established, the acts are repeated with such frequency
+that exhaustion of the nervous power must often attend this wonderful
+deviation from nature’s designs.
+
+With all this supposed nervous weakness, I do not incline to the
+opinion that more injury is done to the sexual organs by this practice,
+in and of itself, than is accomplished through the impressions wrought
+upon the brain from reading spermatorrhœa literature of advertising,
+“private-disease” specialists. I am satisfied that I have seen bad
+cases recover by putting their minds at ease. The carefully worded
+little books, that are sent broadcast to drive in those who have been
+indiscreet, are money-making dodges, and are of great injury to the
+confiding and simple.
+
+When the injury has become very extensive and the condition of habit
+very depraved, a young man becomes so attached to his lothly vice that
+he will refuse the natural way of gratifying the erotic desire. He is
+not in the least influenced by one of the opposite sex, and prefers his
+own company, or isolation.
+
+It is not the mule only that suffers from masturbation, but girls
+as well, though not so commonly, suffer from this peculiar sexual
+neurasthenia and hysteria growing out of sexual abuse. Our opportunities
+for discovering the extent of such practices in the unmarried female are
+very limited; consequently, we remain in ignorance to a great degree.
+
+The married woman furnishes the physician the majority of the practice
+in this class of cases, as she also suffers from a mismanagement of the
+sexual congress; and it is only to the married woman that the practical
+physician will need to devote extensive attention, and only through
+her, in this sphere, can much information be obtained.
+
+In the prostitute, sexual contacts are too promiscuous, and she is
+too unreliable, to afford any very trustworthy information, further
+than may be judged by the aspect of one who has followed the business
+for a decade. It is little to know that her life, as a rule, is short
+and her social redemption next to impossible, and her entailed ills
+irremediable. When the habit of self-pollution is once established by
+a girl, it is worse than in the male; as a female is not so likely
+to yield to any sort of a vice as a male, and she will carry it to a
+greater extreme. Modesty and fear of giving offence will always impede
+the advancement of knowledge in regard to the sexual functions in the
+so-called chaste and unmarried.
+
+The married female’s sexual life and acts are often brought to the
+knowledge of her physician. I have often been asked the question,
+why so many married women become invalids from uterine and ovarian
+diseases? Not referring to child-bearing, abortions, and many
+indirect causes of disease which are numerous, but not enough to
+furnish an etiology for the long category of nervous ailments with
+which the medical man has to contend, my answer is, sexual abuse; a
+misunderstanding of the sexual functions; a non-adaptation of two
+individuals joined in marriage. It is not so commonly excessive
+venery; or too often repeated coition; but unrequited passion. Man is
+too likely to forget his duty to his wife and look first to his own
+gratification. Any sexual embrace not attended with sexual orgasm, is
+very detrimental and causes disease. With the brutal man and phlegmatic
+woman this condition is quite likely to occur, and more especially if
+the man has been a masturbator. Where the latter condition has caused
+a partial impotency, the sexual orgasm very commonly occurs before or
+immediately after the intromission of the penis, in which condition
+beatitude is impossible, and the physician is most likely to be
+consulted by one of the parties.
+
+It will not improve our knowledge to be too modest on this question.
+As medical men we have the diseases of the sexual organs and their
+_sequelæ_ to treat, and we must discuss the causes. My suggestion,
+that a couple should be matched, sexually, seems not out of place;
+and if this condition is not present at first, it must be obtained
+by adaptation. My observation has been supplied with a number of
+instances of once faithful wives, who had forsaken their husbands for
+this seeming little discrepancy or neglect, and associated themselves
+happily with more adaptable mates.
+
+These singular facts confront us, and as teachers and scientific men
+we may, when consulted, if familiar with the causes, suggest remedies.
+I have many times corrected this discrepancy in domestic felicity by
+a little careful instruction, and thereby prevented the impending
+dissolution of the marriage relation.
+
+This might well be termed matrimonial hygiene.
+
+Such grave facts are brought to the knowledge of the family physician,
+and he has but to listen to find out all: he has only a few questions
+to put, and the case is before him. No indecency to be indulged in:
+such cases must be conducted with the strictest sense of honor and
+decorum, or the bond of confidence and trust will be immediately
+forfeited.
+
+_Continence_, while in itself not an abuse, in any manner, of the
+sexual organs, yet is a fruitful source of disease. The erotic male
+may contract troublesome disease, both local and general, by too close
+proximity with a voluptuous female; and why not as much a cause of
+disease in the female? It is the condition so commonly caused by the
+affectionate and chaste embraces of parties “engaged to be married.”
+When this condition exists the marriage ceremony had better be
+consummated as soon as possible, or injury may come to both parties.
+
+The case of a young married couple, lately under observation, is
+instructive. The wife was stricken with paralysis, from which she
+was eight months in recovering. During her illness she became much
+reduced in flesh and will. She recovered in flesh, but remained very
+neurasthenic for many months. I made use of all methods of treatment
+by drugs and electricity. I could detect no organic trouble. When
+interrogating the husband, I ascertained that they had, through fear of
+doing injury to the wife, remained continent, and, being too modest,
+had not consulted the family physician on this very delicate subject.
+I immediately advised sexual congress freely, and the neurasthenia
+gradually disappeared. She has since remained in perfect health. She
+was afflicted, as she supposed, with all manner of diseases. She was
+often too feeble to walk, and required assistance or a cane, to walk
+across the room. She was irritable and fretful, often crying, and
+no reason could be given for any trouble, as she was provided with
+everything asked for. It may seem a venturesome advice to render, yet
+I can but urge the natural use of the sexual organs when there is a
+strong erotic excitement, following a long period of continence, when
+this desire is not a morbid one; which is likely to be the case only in
+the depraved, after long abuses.
+
+Were it not for mistakes so commonly made by individuals in selecting
+such imperfect and inadaptable mates, the very poetical words of the
+old maids and bachelors, “_single blessedness_,” might better read,
+“_single cursedness_.” With the chances as they now are, it is an
+important question, whether it is more advisable for a maiden lady to
+marry or to remain continent and pine.
+
+A loathsome abuse of the sexual organs, not usually recognized by the
+fastidious, exists, in which one of the individuals, taking a part in
+this abnormal sexual act, uses the mouth as a vagina. Some of these
+benighted creatures are males, others females. Houses of prostitution
+of the present day are so accommodating to their patrons that they
+keep females who serve degraded males in this manner. I am credibly
+informed that they prefer this method; that the erotic desire has
+been transferred from the genitals to the tongue. Any person who may
+be inclined to exercise a doubt, may easily convince himself of its
+truthfulness by visiting one of the many low-down “houses of ill fame”
+in any one of our large cities.
+
+From _The Laws of Life_ we extract the language of a clergyman:
+
+    “I have officiated at forty weddings since I came here, and in
+    every case save one, I felt that the bride was running an awful
+    risk. Young men of bad habits and fast tendencies never marry
+    girls of their own sort, but demand a wife above suspicion.
+    So, pure, sweet women, kept from the touch of evil through
+    the years of their girlhood, give themselves, with all their
+    costly dower of womanhood, into the keeping of men who, in
+    base associations, have learned to undervalue all that belong
+    to them, and then find no time for repentance in the sad after
+    years. There is but one way out of this that I can see, and
+    that is for you――the young women of the country――to require,
+    in association and marriage, purity for purity, sobriety for
+    sobriety, and honor for honor. There is no reason why the young
+    men of this Christian land should not be just as virtuous as
+    its young women; and if the loss of your society and love be
+    the price they are forced to pay for vice, they will not pay
+    it. I admit, with sadness, that not all our young women are
+    capable of this high standard for themselves or others, but
+    I believe there are enough earnest, thoughtful girls in the
+    society of our country to work wonders if faithfully aroused.”
+
+_Sodomy_, or sexual contact of a human being with an animal, is an
+ancient practice and but little indulged in at the present day; as our
+laws are very rigid against such _degraded and inhuman treatment of
+animals_. There has been a civilizing influence, since human beings
+have organized societies for the “Prevention of Cruelty to Animals.”
+But it will nevertheless be remarked, that this elevating tendency
+came about entirely through the respect for animals, and not for human
+beings. Were it not for love of animal property and legal watch-care
+over our animals, and plenty of opportunity to gratify the sexual
+desire in other ways, the habits of the people would be no better
+than in ancient times, when sodomy so extensively prevailed. This
+beastiality may have been a cause of venereal disease――syphilis――which
+can be traced back to ancient times, without a doubt.
+
+In addition to such abuses, there were worships quite as degrading.
+Phallus was a figure of the virile member, which was carried about
+at the festival of _Bacchus_ as a symbol of the generative powers of
+nature. The _Athenians_, who refused to show proper respect to Phallus,
+were punished by Bacchus with a severe disease of the penis. Such may
+be concluded from the “_History of the Phallus in Greece_.” Priapus
+is now supposed to have been a venereal specialist, differing in no
+respect from such modern specialists, to whom, it is said, votive
+offerings were donated, and his great skill caused him to be worshipped
+and deified; hence the term priapismus, which is commonly applied to
+morbid erections, so frequently occurring in gonorrhœa and paralysis
+of the insane, and which is also applied to the active stage of the
+condition otherwise known as satyriasis.
+
+
+
+
+CHAPTER III.
+
+
+_Onanism._――I have adopted the term Onanism, more especially to
+illustrate a class of conjugal sins, and shall not use it, as generally
+applied, as a synonym for masturbation, but will define the term as it
+should be used. That the meaning of the word may be fully understood I
+will quote the two verses from _Genesis_ xxxviii, 8, 9:
+
+    “And Judah said unto Onan, go in unto thy brother’s wife, and
+    marry her, and raise up seed to thy brother.
+
+    “And Onan knew that the seed should not be his. And it came to
+    pass, when he went in unto his brother’s wife, that he spilled
+    _it_ on the ground, lest that he should give seed to his
+    brother.”
+
+It must not be supposed that Onan used his hand to facilitate an
+emission, but that he simply withdrew his penis and allowed the semen
+to be lost on the ground, to prevent conception. Onanism is practised
+more at the present day by married males than may at first be imagined.
+It is the commonest of all means used as a preventive of conception.
+The majority of so-called society women are wives of men who practice
+Onanism. The word has come to signify masturbation, or any intentional
+process of wasting the seminal fluid. But I have preferred its use
+here as it explains a practice which I have no other word for. The very
+common practice of withdrawing the organ before ejaculation is often
+a very hurtful one, as the orgasm is often incomplete, and there are
+more satisfactory ways of accomplishing what is intended by such a
+practice. Under the strict signification of the term, a child cannot
+be an Onanist, until after puberty, but he may be a masturbator. A
+woman cannot properly be called an Onaness, but she may masturbate
+nevertheless. To present, in a true light, this conjugal vice, I
+excerpt, from the _Ohio Med. and Surg. Reporter_, the following most
+excellent paragraph, which illustrates in the pithy and elegant style
+that speaks volumes of argument, and should be a lasting hint to
+cultured and scientific students in the learned profession of medicine:
+
+    “The sexual instinct has been given to man for the perpetuation
+    of his species; but in order to refine this gift and set
+    limits to its abuse, it has been wisely ordered that a purely
+    intellectual quality――that of love――should find its most
+    passionate expression in the gratification of this instinct.
+    Dissociate the one from the other, and man sinks below the
+    level of a brute. Destroy the reciprocity of the union, and
+    marriage is no longer an equal partnership, but a sensual
+    usurpation on the one side and a loathsome submission on the
+    other. Consider the moral effects of such shameful manœuvres:
+    wedlock lapses into licentiousness; the wife is degraded
+    into a mistress; love and affection change into aversion and
+    hate. Without suffering some penalty, man cannot disturb
+    the conditions of his well-being or trespass beyond its
+    limitations. Let him traverse her physical laws and Nature
+    exacts a forfeit: dare he violate his moral obligations, an
+    offended Deity stands ready to avenge them. That this law
+    is immutable, witness, from the history read to you, the
+    estrangement between the husband and wife; witness his ill
+    health and ill temper, and the wreck of body and mind to which
+    she has been reduced.”
+
+Again, from the _Medical Advance_ for 1876, we find the following
+language written by Dr. Arnalt:
+
+    “There is one phase of sexual depravity to which I would, in
+    passing, call your attention.
+
+    “We are fully aware of the many devices used to avoid
+    impregnation. It may be well to remember that such desires may,
+    under certain circumstances, be excusable; but let us never
+    forget the fact that generally they are conceived in iniquity.
+
+    “Of the many ways of avoiding possible conception, there is one
+    so filthy, mean and degrading, and fraught with such fearfully
+    disastrous consequences to health, that I make special mention
+    of it. I have reference to the practice of withdrawing the male
+    organ from the vagina before the completion of the embrace.
+
+    “But when man brings to the marriage-bed so foul a nature that
+    he can repeatedly and constantly perpetrate such an outrage
+    upon nature’s most precious gifts, he places himself at once
+    beyond the desert of human sympathy.
+
+    “Just imagine, if you please, man and woman in the act of
+    cohabitation; their brain reeling under the powerful stimulus
+    of that all-pervading passion; the heart’s action increased
+    to a high state of intensity; the whole system, with all the
+    energy it is capable of exciting, getting ready for that
+    great act of reproduction; and just as the act is about to be
+    completed, when the soul of the man can almost feel and grasp
+    that of the woman, the evil genius of lust, being more of a
+    fool than a knave, must dash to the ground the chalice filled
+    with ambrosia of purest bliss, if tasted with a pure lip; must
+    turn into the vilest poison the sweetest and holiest gift of
+    nature to man.
+
+    “Why, I have wondered, long and often, that man could sink so
+    low, be so foolish. Just conceive of the intensity of such a
+    shock upon the system, and then have this repeated time after
+    time, year after year. Why there are married people who never
+    once, in all their married life, completely and unreservedly
+    finished the act of cohabitation.
+
+    “No wonder that nervousness, peevishness, and all kinds of
+    distempers show themselves. No wonder we get spermatorrhœa and
+    impotence in the male, and a perfect host of troubles, insanity
+    included, in the woman. No wonder homes are broken up and human
+    lives made desolate.”
+
+
+
+
+CHAPTER IV.
+
+
+_Masturbation._――Under this caption will I proceed with the topic of
+self-abuse; as this term more properly covers the vice of both sexes,
+as well as of childhood.
+
+The small boy, only four years of age, will often titilate his genitals
+until the prepuce has become inflamed and swollen. In this undeveloped
+and delicate condition of the genitalia, more harm may be accomplished
+than could be imagined. Nurse-girls, sometimes, for the purpose of
+quieting a child, will titilate its genital organs; which is quite
+sufficient to lead the child to manipulate its own organs as it goes on
+in age and development. Often a feeble state of health in the child,
+will cause the mother to consult a physician; and the genitalia will
+show signs of irritation; and when the true nature of the difficulty
+is revealed to the mother, it will be much to her surprise, and
+often, disgust; and she will not be convinced beyond a doubt until by
+constantly watching, she has observed actions more convincing than the
+doctor’s hints.
+
+Boys at school teach each other to perform this manual pollution; and
+vile servants initiate small boys at a surprisingly early period. I
+have often gained the confidence of these little ones, and learned
+things more astounding than amusing. Not long since a boy only eight
+years of age convinced me, by his confidential description of his
+little vice, that he realized passion, erection, and as he called
+it the “goodie feeling” (orgasm); which was evidently the sensation
+without emission of semen. No small amount of injury is done to the
+nervous system by the constant titilation of the undeveloped genitalia;
+and as the habit passes on to the puberty-stage of adolescence, the
+novelty of the first ejaculation affords great and frequent amusement
+to the child, and he pursues it as often as he can obtain an obscure
+corner. This must be the time that the greatest harm is wrought upon
+the brain and spinal cord. The first five years succeeding puberty, the
+vice is carried on with great energy in a vigorous youth. Doubtless,
+the majority of boys have practiced masturbation, to some extent, some
+time during adolescence, but as they arrive at the age of discretion,
+become disgusted; or some influential person frightens them, and they
+quit the practice. Where it has only been an occasional indulgence, no
+lasting injury has occurred.
+
+Masturbation is practiced among men, not so much to the injury of their
+physical structure, but it is nevertheless a common vice. Miserly
+bachelors, hermits, and often widowers resort to self-pollution
+when financial affairs prevent their visiting houses of ill fame. I
+am credibly informed that the vice of self-pollution, by the hand,
+prevails largely among soldiers, as well as in convents, and public
+schools.
+
+_Pollution Among Females._――This is less common in childhood than in
+the male. Small girls are naturally more modest than small boys: they
+will not so readily fall into such vices, as they do not readily submit
+to having their genital organs manipulated; they therefore remain
+comparatively free until puberty, and often later; and then the habit
+is not common, but occasionally exists. With the limited opportunities
+for finding out such things, it will undoubtedly be long before an
+estimate, as to the extent that it prevails, can be made. I cannot
+better continue this subject, than by giving a case which is typical
+of many adult cases that I have observed in this peculiar and delicate
+role of physician; and it is not a “cooked” case, but one in actual
+life, which cannot be fully portrayed by type or word:
+
+Mrs. X. visited me professionally; aged 28; mother of three children;
+been married nine years; spare, dark hair and eyes, rather brilliant;
+small of stature; retiring and confiding of disposition. She was very
+neurasthenic and excitable; never hysterical; bowels constipated. I
+prescribed all kinds of treatment for her during the first six weeks,
+after which time, as I had failed to find out anything that might be a
+cause for such a peculiar nervousness, I suggested an examination _per
+vaginam_. As soon as my finger reached the orifice of the vagina, I
+was convinced that my case was a sexual one, as a nervous, passionate
+shiver ran over her; but she soon controlled herself, and I proceeded
+with my examination, with the discovery of only slight general
+irritation. She then gave me the following account of her married life
+and condition. She was married at nineteen, a robust, vigorous girl.
+Her husband was amorous and ignorant of her requirements; would soon
+satisfy his desires and go to sleep, when she had but just become
+excited; but when her erotic excitement was aroused she had no control
+of it: would remain wakeful during the entire night, with the husband
+sleeping, regardless of her condition. She finally learned to use a
+clothes-pin, by which means she could appease her burning and bring
+about an orgasm. She says that she could then sleep. She of late had
+consented to the advancements of a prominent lawyer; but she was
+conscience-stricken and desired, if possible, to be a “good woman;” but
+was satisfied that, to be a virtuous woman, she must remain away from
+her husband, so that her passion never would be beyond her control. I
+immediately, after her departure, sent for the husband, and informed
+him how to perform the marital connection, and that, if he desired that
+his wife should become a well woman, he must adhere to my instructions.
+He was glad of the information, and was successful in his efforts. She
+was soon free from her troublesome neurasthenia, and beatitude prevails
+to this day; and, I believe, she is as virtuous and worthy a woman as a
+man deserves.
+
+Women use tallow candles, clothes-pins, and other commodious means,
+such as friction over the pubes, titilations of the clitoris, etc., for
+the purpose of exciting erotic energy and sexual orgasm. The nervous
+excitement which is wrought, is not unlike shock, from general causes;
+yet, when frequently brought about, may produce an over-stimulation,
+followed by relaxation and general weakness of the nervous system, or a
+neurasthenia, advancing to hysteria and organic disease of the nervous
+system. Various devices have been resorted to to overcome the habit of
+masturbation. Such things may be of service in children, but in adults
+moral treatment alone is of any value; and as to any appliances and
+devices I have nothing new to offer. The old means of blistering, tying
+the hands, etc., may be resorted to with children, by those who have
+confidence in their efficacy. In adults, matrimony will often do good,
+when the habit is in its incipiency; but in an advanced stage it is of
+little benefit.
+
+The great variety of unnatural ways of gratifying the sexual passion
+is only an evidence of human depravity; and the entailed diseases must
+be unreservedly studied, that, as much as possible, these abominable
+conditions may be confined within a certain limit, which should be
+legally set apart and licensed, that the chaste and elevated portions
+of society may find protection.
+
+These conditions all exist: there is no remedy to abort or expunge
+them; and the numerous diseases, growing out of this great depravity
+and mismanagement of the sexual, must all be duly considered, by the
+medical man, as predisposing and exciting causes of neurine maladies.
+To prevent the spread of disease, should be the chief aim of every
+humane citizen, and more especially the physician. Much is said in
+regard to means and legislation to prohibit the spread of venereal
+disease; but the nervous diseases caused by sexual debauch and
+mismanagement are of equal importance and as devastating to the race.
+
+If we can give credence to what Dr. S. W. Gross says, in the May
+number, 1877, _Medical and Surgical Reporter_, of Philadelphia,
+masturbation has, in his cases, caused fifteen out of nineteen cases
+of urethral stricture, while four were caused by gonorrhœa. I am not
+aware of any such proportions reported by any other authority, yet I am
+thoroughly convinced that masturbation has existed in a great majority
+of cases of urethral stricture, and in many such cases has been a
+cause, primarily or secondarily. It is not far from true to say, that
+a large proportion of masturbators, of advanced age, have a general
+contraction of the entire urethral canal and a diminished dilatability.
+Purulent discharges and abscesses are not uncommon along the course of
+the urethra and prostate gland, followed by folicular disintegration
+and perforation.
+
+_The Effect of Sexual Excesses upon the Neural Axis as a Cause of
+Organic Disease._――“_Sexual excesses_ and _Onanism_ are certainly of no
+slight significance, at least in the development of a predisposition
+to tabes.” (Erb.) Again, in speaking of causes in general of spinal
+disease, the same author says: (P. 147, Ziemssen’s Cyclopœdia, vol.
+XIII.)
+
+    “Of these (causes) _sexual excesses_ and _irregularities_
+    occupy the first place. * * * * I believe we may say that
+    _any gratification of the sexual passions, whether natural or
+    unnatural, indulged in to an excess and for a long time, forms
+    for many men――not for all――a circumstance that powerfully
+    depresses the spinal cord and predisposes it to disease_.” * *
+    * *
+
+    “_Excessive natural coitus_, in many persons, certainly
+    produces symptoms which point to a weakness and a diminished
+    functional capacity on the part of the spinal cord; weakness of
+    the legs, inability to stand for a long time, trembling when
+    forcible movements are made, pains in the back, shooting pains
+    in the legs, sleeplessness, etc. This may often be noticed in
+    the newly married, or in persons who have indulged in great
+    excess for a short time. If the cause of these symptoms soon
+    disappears, the injury may in most cases be quickly repaired;
+    but if the excesses are continued, further injury, or even
+    positive disease, occurs. Any external injury, exposure to
+    cold, excessive walking, etc., may then bring on the worst
+    results.”
+
+
+
+
+CHAPTER V.
+
+
+_Copulation――Physiology and Social Attributes._――With the male, the
+condition essential to coition is erection of the penis; which is
+physiologically accomplished by fostering amative thoughts, and by
+attitudes favorable to the stimulation of the erotic desire; as in
+close proximity with one of the opposite sex. A voluptuous female
+figure may excite the erotic instinct of an amative male in vigorous
+health, even though he be chaste in his intentions and habits.
+Individuals are isolated whose amative passions are entirely under
+the will, when in perfect health, of either sex. The act of coition
+is entirely under the will, in all healthy, well-organized human
+beings; but it is not uncommon that a man or woman is observed who is
+not responsible for acts during erotic excitement. Such are either
+victims of mal-organization or a sexual delirium. Many an act has been
+committed during such delirium or excitement, on account of which an
+individual has grieved her life away, or sought the only refuge that
+could hide her life from shame; the victim’s grave, the river: yes,
+a victim to sexual delirium or uncontrollable sexual passion. This
+innate desire is the usual instigation of copulation, and has been said
+to be the index to the presence of spermatozoa within the vesiculæ
+seminales.
+
+Copulation may take place in the female before puberty or after
+the climacteric period; but in neither will the sexual congress
+be fruitful. Then, if the signification be confined to fruitful
+contact, there would seem to be a marital discrepancy between the
+male and female; as in the female we observe only thirty years of her
+existence in which it is possible for sexual congress to be followed
+by conception; while the male, from puberty to very old age, may be
+fruitful, if placed in conjunction with a female at the proper age.
+Nature, being rather wise in this respect, has not deprived the female
+of her sexual passion and pleasure at the limit of her fructification
+period.
+
+Perfect coitus is not essential to impregnation; as many authenticated
+cases are on record in which intromission had not taken place, as
+evidenced by an unruptured hymen, where only it was possible for the
+semen to come in contact with the sphincter vaginæ; and impregnation
+and conception followed. Only by contrasting natural with abnormal
+coition, is it possible for us to comprehend how much one subject
+has to do in causing nervous diseases; and not to advocate that
+normal coition――which refers to time as much as manner――produces many
+permanent morbid changes.
+
+_Copulation, practiced in moderation, is conducive to domestic felicity
+only when both parties to the marriage contract are in a state of
+health sexually._ This excludes sexual contact in too close proximity
+to the menstrual crisis, and whenever the female is not in a condition
+to appreciate the act, and that her condition and will should be
+considered and respected, and man at all times should consult her
+pleasure.
+
+For further information on the physiology of copulation, I must refer
+the reader to _Flint’s Human Physiology_, where it is treated of in an
+exhaustive manner. But there are many points of interest that are not
+alone physiological, that may well be discussed and belong especially
+to our subject.
+
+There seems to be a chosen time for fruitful coition with all
+animals. With the human race this is only partially true. The female,
+it is said, begins her period of breeding usually at fourteen and
+discontinues at forty-five; yet there are intermediate periods
+when copulation will not usually prove fruitful, viz., that period
+beginning the fourteenth day after menstruation, and ending with the
+next menstrual flow. This rule is not valid; as many times, in my own
+observation, have I known women to conceive at any and all times during
+her period of breeding. Even cases have occurred where the period
+of menstruation was not confined to the usual time of life; or the
+“second life” may appear, as in the following case which came under my
+observation some years since:
+
+A Mrs. H. ceased menstruating at 52, was free from menstrual flow
+until 71 years of age, and then menstruated regularly (a perfect
+menstrual flow), every 40 days, until she died at the age of 76. She
+possessed the erotic desire and enjoyed coition. Her husband died two
+years before she did. She became confused in religious doctrines after
+her husband’s death; was melancholy and fond of isolation; committed
+suicide by hanging herself to her bedpost. I assisted in cutting the
+scarf and learned all particulars of her past life from friends and her
+physician.
+
+Many cases are on record of females menstruating at very early periods.
+As to these discharges being indicative of the reproductive stage, much
+doubt may be expressed. It is very common for the male to retain his
+virility to a very advanced age. I am acquainted with an octogenarian,
+who married a young girl of nineteen, whose copulation was fruitful
+and the child healthy. This is doubtless not so very uncommon, in
+proportion to the circumstances offered for a test.
+
+We would naturally conclude that, on account of prostitution and
+debauch, it was necessary that marriage become a legally organized
+institution. There is no evidence that in early history marriage
+was any more than a choice, the consummation of which was simply the
+invocation of a superhuman or divine watch-care; that they were bound
+in wedlock, not by statute law, but by a superstitious belief and
+natural selection. Natural selection was more cultivated and was a
+better guidance than in modern times, when law governs the joining and
+casting asunder. Copulation is the key to morality and society. So
+certain bonds of restriction and moral government of a social character
+exist, and they are made to restrain human beings and to control
+and limit copulation to a legitimate sphere; viz., man and wife.
+Any deviation from this legitimate course has long been denominated
+prostitution, which exists in public and private.
+
+The vice of changing partners has become so open and for such trivial
+causes that laws have been enacted, of the most rigid character, and
+then divorcing and remarrying are carried on to an alarming extent.
+These are only the attributes of copulation and erotic desire.
+
+Natural copulative affinity constitutes the bond of chaste affection
+that holds together a man and wife in harmony and love. Parties, male
+and female, have existed just as happily during life, when marriage
+vows had never been solemnized and legalized by other than natural
+copulative affinity. This sexual affinity constitutes more than
+mere admiration, or transient passion or erotic anxiety: everlasting
+contentment and felicity will follow such natural adaptation. Some are
+contented in wedlock, as they possess submissive dispositions, who are
+not adapted by copulative affinity.
+
+Society is partial in her endowments and liberties bestowed upon the
+sexes. The male enjoys favors at the hands of society not permitted the
+female. For this, on account of her innate propensities, the female
+is responsible. She will expunge a female from her circle of society
+for that for which she will sustain the male. She will encourage
+insults from man, and cry for woman’s rights, and against masculine
+maltreatment. She will receive, with open arms, the young father of a
+prospective bastard, and commit the equal participant, and prospective,
+victimized mother, whose sins can only be equal to those of the father,
+to a dungeon, or permit her to accept a life of shame by refusing her
+entrance at the threshold.
+
+If these are the privileges of modern society _now_, what would women
+do with the fallen ones of their sex had they things as they so much
+desire, in “woman’s rights” circles? Every female who had made a
+mistake (that should become known) would be tortured at the rack, or
+murdered; and few would there be left to tell the tale. The moral
+beginning must be with woman. She must not offer premiums for male
+licentiousness, and must encourage her fallen sisters to “sin no
+more.” She must protect her own sex by showing forgiveness, as well
+as censuring. So far as effecting any change, moral teaching is of
+the greatest vanity. But these things are not looked upon in their
+true light. Sexualists discuss these subjects, who do not appreciate
+the first principles of sexual physiology; who do not comprehend that
+the sexual relation in itself is the very essence of deception, as of
+secrecy. The cunning devices of both male and female are exhausted by
+efforts at assignation and debauch. The greater the legal restriction
+the greater the deception. The more common, open and generous our
+society becomes, the better will be its constituents.
+
+
+
+
+CHAPTER VI.
+
+
+_Nymphomania._――The most deplorable condition of all, to which the
+female is subject, is the uncontrollable, maniacal, erotic desire,
+called nymphomania. The disease is fortunately rare, and commonly
+makes its appearance at, or soon after puberty, but has been observed
+in adult and married women. Of the six cases that have come under my
+observation, one was a married woman, the mother of children, four were
+girls at puberty and one, which will be hereafter reported, aged 19
+years.
+
+In the commencement the sufferer is a prey to perpetual contest between
+feelings of modesty and impetuous desires. At an after period she
+abandons herself to the latter, seeking no longer to restrain them. In
+the last stage the obscenity is disgusting; and the mental alienation,
+for such it is, becomes complete. The cause is often obscure, but when
+known has been undue irritation, by titilation of the genitals, or
+anything that would cause turgescence. The disease is apparently local
+in the beginning, but seems to affect the entire nervous organization,
+through reflex excitation.
+
+The clitoris, by some, is supposed to be the seat of irritation, and
+has been amputated or cauterized, but without generally effecting
+any relief. The disease is not generally confined to any particular
+locality of the genitals. If allowed, the patient will take the hand of
+the male and place it upon the _mons veneris_, and it is only by force
+that she will allow it to be taken away. She cannot locate the seat
+of pleasure, but will say that the entire surface touched contributes
+to the venereal excitement. Another peculiar feature is, that she
+obtains no satisfaction from venereal orgasm; but on the contrary it
+adds to her maniacal conduct and obscenity. She is not in any manner
+responsible for her conduct, and no punishment will cause her to
+desist. Everything is sacrificed that is feminine, for that which is
+disgusting and vulgar. The more modest she has been in health, the
+more obscene she is likely to become in her venereal frenzy. What the
+final result would be, without treatment, I have never witnessed, but
+must conclude that lunacy would soon be prominent and probably suicide.
+There is no tendency to recovery, but to continue from bad to worse,
+until publicity is no restraint to the obscenity and indecent conduct
+of the victim.
+
+_Case._――Nymphomania, with nocturnal involuntary orgasm. Miss U.――She
+was aged 19, very small in stature, only weighing 90 pounds, of very
+respectable family and herself perfectly respectable. She was refused
+by her probable “intended,” who had discovered signs entirely unnatural
+for her, in whom he had placed implicit trust. When the condition was
+first manifested in her, the intended, not thinking of anything wrong
+on her part, attempted to gratify her morbid erotic desire by coition,
+which only made her, as he said, “nearly crazy.” She had heretofore
+been modest and distant, but now she was on his lap, and all over him
+or leading him to a place of decumbiture. When she visited my office,
+and imparted to me her whole confidence, my first treatment toward
+her was so rigid and distant that my examination revealed the parts
+before orgasm had taken place; but as soon as I touched the nymphæ;
+they became lubricated with a thin viscid fluid which was profuse. At
+first the clitoris and nymphæ were red, dry and hot; but as my digit
+came in contact with the soft parts, she forgot the rough treatment
+and my cold conduct toward her, which I had assumed to prevent, if
+possible, her venereal crisis, and she became unmanageable for the
+time, until she had passed three or four orgasms, as I supposed, one
+immediately following the other, when she became more governable. To
+carefully portray in words what she said and did would be shocking to
+a fastidious doctor. With a speculum in the vagina the os uteri would
+contract and dilate in alternation, and undergo orgasms in rapid
+succession, with only a few seconds interval. She begged of me not to
+withdraw the instrument, but when I had completed my examination she
+was partially exhausted and docile. I could discover a mucoid fluid
+emitting from the os uteri which evolved a strong venereal odor.
+
+She informed me that she had voluptuous dreams nightly――as many as
+three in a night. Her figure is small and round, eyes black, hair coal
+black, countenance very sallow and chlorotic. She seemed to know that
+this condition was not right, but her modesty was entirely gone, when
+in company with a male. The presence of a woman restrained her. Her
+own mother had not determined the true nature of her difficulty, only
+noticed that something was peculiar with her daughter. The patient had
+judgment enough left to go out of the room and isolate herself when a
+man would come about. The advent of this disease she says was first
+known by a peculiar thrill at the sight of a male, which became more
+aggravated from day to day. Now, one year has she suffered from this
+intolerable mania.
+
+To pass over and not give the treatment would leave the case quite
+incomplete.
+
+_Treatment._――I directed monobromated camph., in two gr. pills, one
+every 4 hours, with formula No. 1, as directed; ice-water to the vulva
+nights, with daily applications of Faradisation by placing a wetted
+sponge upon a chair with the patient seated upon it, to which the
+negative pole is attached; used the positive in my left hand, with my
+right hand applied to the head and down the spine. Improvement took
+place from the beginning, and in forty days she was quite herself.
+She was improved in flesh, color and strength. In two months she was
+so modest that I could scarce gather courage to ask her if she was
+yet troubled with any signs of her old affliction. I could not obtain
+consent to make another physical examination, and she remains well,
+but is continuing to take the medicine, from formula No. 1. She has
+strength of will, I am informed by her “intended,” to refuse any degree
+of proximity. He says, “It seems like a dream. I am learning to court
+her over again, and succeed very slowly. She is so distant.”
+
+The two cases reported by Prof. S. H. Potter in the April number of
+_Am. Med. Journal_, 1876, do not overdraw the picture, any one will
+testify who has had a few of these perplexing patients to manage.
+
+    “Miss M. T., age 18 years, of sanguine temperament, quite
+    corpulent for her age, a wealthy farmer’s daughter,
+    distinguished for her modesty, intelligence, prudence and good
+    social qualities.
+
+    “_History._――In the hot weather of August, the writer was
+    called 15 miles to consult with Dr. A., the family physician of
+    Mr. T. About three weeks prior to this, Miss T. had suddenly
+    exhibited paroxysms of uncontrollable desire for coition.
+    When any young gentleman chanced to call upon the family, she
+    would elevate her apparel under her arms, approach and attempt
+    an embrace in the most lascivious manner, until forced to
+    desist by the interference of the overpowering strength of the
+    persons present. At first these scenes were at intervals, with
+    intervening times of great dejection, gloominess and silence.
+    The father being of rather a superstitious nature, thought her
+    ‘possessed of the devil,’ and resorted to repeated and severe
+    flagellations without effecting any perceptible reform. During
+    the last week her excitement had been almost continuous, and
+    she had been confined to and locked in her room. It may well be
+    supposed that the case had excited the entire neighborhood to
+    wonder and amazement, and in some of the more thoughtful, deep
+    sympathy, and through their advice the physician was called.
+
+    “Examination with a glass speculum showed an irritating fluid
+    oozing from the os uteri; the whole surface of the vagina,
+    the nymphæ clitoris and the vulva were suffering from active
+    congestion. Exalted general sensation was apparent, and the
+    slightest touch of the internal labia or clitoris produced the
+    most exquisite amorous excitement――an uncontrollable mania.
+
+    “_Case II._――Was called to see Mrs. F., of this city, September
+    last, age 30, a grass widow by third marriage. Found her in
+    violent hysterical spasms, with usual accompanying symptoms.
+    Her aunt, with whom she was then visiting, gave the following:
+
+    “_History of the Case._――For some time past she had exhibited
+    lasciviousness; had to be kept under surveillance; to-day
+    the aunt had ‘been out shopping;’ on coming home she found
+    her niece in a sequestered place with exposed nudity quite
+    shocking, and using persistent artifice to effect coition with
+    a canine Newfoundlander. The aunt so rashly interposed, that
+    the niece ‘went into alarming and persistent spasms.’”
+
+Dr. Potter further says that examination showed this case to be one of
+nymphomania, relying upon the turgescence of the clitoris and nymphæ
+and ichorous discharge from the os uteri as diagnostic.
+
+It may be remarked that such turgescence not uncommonly produces an
+exalted erotic desire which is analogous to turgescence of the urethra
+in the male, manifested in gonorrhœal priapism.
+
+Such irritations are not always peripheral in origin, as may be
+supposed, but more commonly a general neurasthenia, or at times a
+spinal turgescence, which qualifies the genitals for any disturbing
+titilations that come along. This may seem more evident, when it is
+once considered, that a hyperæmia of the nymphæ and clitoris may and
+has often existed and no nymphomania; and if the peculiar centric
+condition does not first exist, there will be no local venereal
+turgescence of the genitalia.
+
+Ovarian and uterine disease may produce first, a determination of
+blood to the cord, and then, by slight irritation of the vulva, the
+condition, nymphomania, may be established. Such is perhaps the most
+common cause; and the more have we reason to conclude so, from the
+fact, that the majority of these cases appear soon after puberty, when
+the first crisis of femininity has wrought its effect upon the uterus
+and ovaries. At such times is self-pollution most likely to produce a
+striking impression upon those organs, and most likely to bring about
+nervous shock by calling a superabundance of liquor-sanguinis to the
+developing genitalia and reproductive organs. This shock is sometimes
+so apparent that fainting results and alarming symptoms follow. To
+relate a case will the better illustrate what may sometimes occur.
+
+_Case._――Miss E. H., under the following peculiar circumstances, I
+was informed, needed my services, as it was known that I was the
+physician of her family. A young man, whom I well knew, came after me
+and returned with me to the house, and during our ride, he related the
+following story, to which I had reason to give entire credit:
+
+The young man and the patient were “sitting up” with a sick lady.
+During the night, when all was quiet, the young man had taken the
+liberty to place his hand upon the genitalia of Miss H., when he
+noticed that she rolled her eyes in rather a peculiar manner which he
+considered only submission, as she leaned toward him in a very passive
+manner. He took her in his arms and placed her on a couch, replaced his
+hand, introducing his finger into the vagina, when he became alarmed at
+seeing her froth at the mouth, with slight muscular twitchings of the
+eyes and mouth. He attempted to arouse her, but failed and, becoming
+still more frightened, called the family, and hastened to my office.
+
+I found the patient, Miss H., who was aged 18, fleshy (her weight was
+150 pounds), had been a very healthy girl, of an excellent family, and
+rather pleasant in disposition. She had always been very modest and
+retiring; had rosy cheeks, black hair and eyes. She was then in a very
+delirious state, with pupils contracted, face flushed, no cramping,
+feet cold; head very hot, with occasional epileptiform movements of the
+eyes and mouth; biting the tongue and frothing at the mouth; twitching
+of the facial muscles and sphincters. I informed an old lady that I
+suspected some private trouble and invited her _only_, to remain in
+the room while I made an external inspection, which only gave me the
+satisfaction of knowing that nothing was the matter with her genitals,
+and that the young man had not deceived me and effected intromission,
+as the hymen was perfect.
+
+A large dose of chloral hydrate produced quietude for the night, and I
+ordered her to be taken home as soon as she was rested by sleep.
+
+I visited her the next morning at her own home. She was conscious, with
+pulse at 120; temperature, 102; pupils contracted, and face flushed;
+skin dry; tongue dry and red; asking for water often; head drawn back;
+throbbing of the carotids, with spasms of the dorsal and posterior
+cervical muscles.
+
+She had never been sick, and she had never been of a nervous habit; and
+such a condition was entirely unexpected. There was no epidemic of such
+a character, and no accountable cause except that given. Her case was
+of an inflammatory type and lasted twenty-one days.
+
+Treated by large doses of gelseminum, veratrum viride, and quinine when
+safe. The case was a sthenic one throughout, a meningitis without a
+doubt, and no cause but venereal shock.
+
+When she recovered I asked her if she remembered what occurred during
+the night of her falling sick, and she flushed, but finally confessed
+knowing when he put his hand upon her genitalia, when she thought she
+fainted; but casually remarked, “I don’t understand it, but I had no
+power to prevent him doing so.”
+
+The young man again informed me that his hand was upon the vulva,
+perhaps a minute, when he noticed a strange expression on her
+countenance.
+
+The shock did not occur at or near her menstrual period, and she
+menstruated during convalescence, which her mother informed me was a
+period six weeks from her previous time. She never entirely recovered
+her mental vigor, and remained single till three years ago, when she
+married, and all has gone well.
+
+The shock can only be attributed to that susceptibility to nervous
+impressions so common to the female reproductive organs in the stage of
+development. There is a strong probability that had this nervous shock
+been less impressive in character and more prolonged, a nymphomania
+might have occurred.
+
+
+
+
+CHAPTER VII.
+
+
+_Satyriasis._――Not the female _only_, suffers from an ungovernable
+venereal desire, but the male also is, at times, the subject of a
+disease, analogous to nymphomania of the female. Such is the disease
+termed satyriasis. A young married man says to me, in the following
+forcible language, “My penis is stiff all night. I can’t let my wife
+rest, and she is nearly dead, and I am tired out myself; but as soon as
+I see a woman, my penis rears up like the proud standard of Wellington.
+What shall I do?” His penis became erect while I was examining it. I
+could not see anything unnatural, only it was enormously large. He
+had not been a debauché, neither had he masturbated to any degree
+of injury. There was no spermatorrhœa. He said that it required a
+more than ordinarily long time to bring about venereal orgasm, after
+which erection would remain in situ until he went to the hydrant and
+drenched his penis in cold water; but as soon as he went back to bed
+with his wife his penis would become erect immediately. He had suffered
+a month in this manner. He had not been a very amorous man before
+this, but confessed having obtained and enjoyed a usually temperate
+allowance previous to marriage. This patient had always been of a
+robust appearance, but when he consulted me was beginning to look worn
+and anxious, with sunken eyes from want of sleep and mental unrest. He
+suffered from pain in his back, head and through his lumbar spine. Deep
+pressure revealed tenderness over sacrum and last lumbar vertebra. His
+general symptoms were those of spinal hyperæmia.
+
+_Treatment._――Bromide potassium, grs. xx, 3 times a day, with general
+Faradisation and central galvanization (after the method of Beard &
+Rockwell), soon gave him relief, and after ten applications no more
+difficulty was experienced; but a number of months was required before
+his general health was restored.
+
+The symptoms of spinal hyperæmia were very prominent in this case,
+viz., pain in the cord, not affected by digital pressure, increased
+by lying down and diminished by sitting. His erections were not
+troublesome, only when he was in bed lying on his back: this point it
+will be well to remember. Many of the symptoms so commonly existing in
+spinal hyperæmia are absent.
+
+Many cases occur of a peripheral origin, from inflammation of the
+mucous membrane of the urethra or prepuce. Gonorrhœa commonly causes
+a peripheral satyriasis; but this soon passes away and is of minor
+importance compared to the disease which is intended as the premise
+of this chapter. Morbid erections appear without erotic desire, and
+peripheral causes commonly give rise to this condition. It may not
+be properly considered a disease, as it is so commonly symptomatic
+of spinal hyperæmia. And never, as yet, have I observed this morbid
+exaltation of the amative desire without spinal symptoms, with the
+usual diagnostic signs of spinal hyperæmia of the posterior columns.
+The treatment, to be followed by success, must be of such a character
+as will relieve any centric local hyperæmia, and as such treatment
+seems to give relief is additional evidence of centric turgescence.
+As a treatment for the disease, bromide of potass and ergot must be
+administered in large doses, with the addition of galvanism alternated
+with Faradisation. Cleanliness of the genitalia is indispensable, as
+well as the removal of any morbid condition or irritating influence.
+
+Satyriasis may exist as a very troublesome reflex condition in many
+painful affections of proximate regions; indurations, hæmorrhoids and
+cancer of the rectum, irritation of the bladder or prostate gland, or
+by caluli in either bladder or pelvis of the kidney.
+
+_Case._――Jno. C. consulted me on numerous occasions for troublesome
+erections. His kidneys were painful under a mild Faradic current;
+his water was high-colored and urethra contracted in calibre, with
+folicular inflammation periodically appearing, and giving great
+annoyance by the discharge produced. Dilatation of the urethra to full
+size has finally given permanent relief from the most troublesome
+morbid erections, and other reflex nervous manifestations.
+
+In such cases, no agent controls reflex irritations like bromide
+potassium; but it must be given in large doses. When causes cannot
+be removed, the satyriasis may or may not pass away by appropriate
+management, or it may be controlled temporarily and return again. I
+have more than once known this condition to appear and reappear in
+cancer of the rectum and testes, which was a troublesome feature, with
+intervals, during the existence of the patient.
+
+The local causes, if possible, must be removed.
+
+For the treatment of spinal congestion, see page 92.
+
+
+
+
+CHAPTER VIII.
+
+
+_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.
+
+
+
+
+CHAPTER IX.
+
+
+_Pseudo-Spermatorrhœa._――A male, enjoying the best of health may,
+under certain influences, have an involuntary discharge of seminal
+or prostatic fluid; but as the latter will be treated in full
+below, I shall first consider accidental discharges of semen as a
+pseudo-spermatorrhœa. Impressions are wrought upon the nervous system,
+sometimes of a stimulant character――other times like a shock――that are
+followed by involuntary losses of semen. It is not uncommon for semen
+to be found in the clothing of criminals hanged by the neck; or for
+soldiers to ejaculate semen at the time of entering an expected battle.
+Involuntary discharges as often occur from the bowels under similar
+influences.
+
+But mental shock is not essential to the production of such relaxation
+of sphincters. I have on numerous occasions produced an ejaculation of
+seminal fluid by the strong currents of electricity passed through the
+genitals, localized.
+
+A cold bath has not been uncommonly the cause of such losses, in
+perfectly healthy subjects. I was once riding, in company with a
+friend, through the country on horseback. My friend had suffered some
+rheumatic pains, for which I gave him opium and quinine in large doses
+which, under the influence of the friction of the saddle, caused an
+ejaculation of semen without erection or erotic thoughts. He was a
+robust fellow, and knew nothing of sexual weakness of any kind.
+
+Young men sometimes, and married men that have been continent a long
+time, and bachelors commonly, are subject to spermatic ejaculations
+involuntary, without genital debility. It has been stated by authors,
+high in authority, that seminal losses two or three times a week
+were only physiological. From this I must dissent. I do not wish to
+be understood as saying that occasional seminal losses are always
+injurious, but I do not on the other hand believe, as do some, that
+even occasional losses are really and always physiological.
+
+To think that the disease exists entirely in the act of involuntary
+emission, is as great an error; as it would seem only rational that,
+if a larger quantity of semen was manufactured than the vesiculæ
+seminales could hold, the natural result would be an evacuation. Again,
+I have known males to live continent and have involuntary losses for
+ten years, as often as weekly, and no evidence of any general or local
+debility. Yet I believe this to be an exception worthy of note. It is
+quite useless to attempt to effect a cure in some of these cases of
+pseudo-spermatorrhœa, as no real disease exists. Some of them will
+continue: others are only transitory, and need only to be assured that
+no wrong exists. Even if it is not physiological or desirable that such
+things should exist, yet it is not actually pathological.
+
+Again, so-called mental spermatorrhœa partakes partly of this
+character; especially when a young man is so pathophobic, from mere
+book-reading fright, derived from specialists and impostors, whose main
+business is to scare a young man to pay out his money and be humbugged.
+If he has not had emissions oftener than monthly, and he is of a
+confiding turn of mind, a troublesome mental disease may be founded.
+If no marked physical disturbance follows these occasional losses, I
+generally inform the young man that he has been mistaken as to the
+gravity of his troubles; thus putting his mind at ease, and the patient
+in a position for self-recovery.
+
+_Case._――Not long since, a young man was under my care who was
+pathophobic; his mind constantly dwelling upon what he had read; and
+the occurrence to his mind, that he had losses of semen as often as
+once in six weeks――although he was a vigorous blacksmith――caused him
+to imagine himself suffering with all the usual bad feelings of an
+advanced case of nightly seminal losses. He appeared in good health;
+was able to do a day’s work, and to work well; but, nevertheless, he
+was neurasthenic, and at times very feeble; or, at least, he thought
+he was. When once he could be made to forget his imagination, he would
+be as strong as ever. The simple assurance that he would recover with
+simple treatment was unavailing; but when persuaded to think much was
+being done, and that his medicine was very potent, he soon ceased to
+be troubled with his worry and was quite well, although he had taken
+only a simple bitter. He finally became afflicted with a sore upon
+his prepuce, which was of a herpetic nature _only_, and for which
+he consulted a score of doctors, as the sore would appear from time
+to time. All informed him of the harmless nature of the eruption,
+but he had faith in no one until a venereal specialist reduced his
+purse to vacuity, when he returned to me for advice. He was simply
+syphilophobic, and demanded only a deceptive treatment, with assurance
+that his trouble was of a local character and never could grow upon
+him; but shortly his herpetic trouble ceased to appear, and something
+else victimized his imagination. Such is the mental predisposition of
+the nervous, imaginative class who _only_ suffer, to any extent, with
+what to them appears to be disease.
+
+Such a case of pseudo-spermatorrhœa would not irritate, in body or
+mind, any person of good reasoning capacity; but, unfortunately, such
+persons are not as common as may be supposed; hence, the deceiving
+specialist has many willing victims.
+
+_Prostatorrhœa_, may exist as an independent, uncomplicated and local
+disease, or in conjunction with spermatorrhœa. My experience leads me
+to remark, that the latter seldom exists without the former, but that
+prostatorrhœa commonly exists as an independent disease; and when the
+flow of semen does not amount to sufficient, in frequency, to consider
+it a cause or a consequence of disease. In my judgment, this flow of
+glary, viscid fluid is most commonly observed while straining at stool
+from constipation. Young men very commonly apply to specialists and
+exhaust their funds and return to the less pretentious family doctor
+for a more satisfactory and truthful statement. Even with this little
+discharge of prostatic fluid, and when no sign of spermatorrhœa existed
+with it, the young man may experience all the phenomena of true and
+long-standing spermatorrhœa. His mind suffers, as well as his body,
+with imaginary nervous phenomena too numerous to mention. But in
+these conditions it is not uncommon to find very troublesome disease
+of the prostate gland, brought on by gonorrhœa, sexual excesses or
+masturbation, existing alone or with true spermatorrhœa.
+
+An examination will reveal enlargement and tenderness of the gland,
+commonly irritation of the neck of the bladder. If we make inquiry, the
+history of prostatic inflammation will be obtained, and gonorrhœa or
+venereal excesses. Pressure upon the prostate, through the rectum, will
+not uncommonly cause a discharge of prostatic liquid, which is followed
+by a smarting sensation. Copulation and ejaculation are sometimes
+followed by a burning pain in the prostate gland, which lasts sometimes
+a few hours――commonly a few moments. Prolonged erection is followed
+by a discharge of viscid fluid, not ejaculated, but simply flowing
+away. When the bowels are constipated, as scybala pass the gland, a
+viscid fluid is pressed out and drips from the end of the penis with
+a smarting soreness, prolonged in the gland. The fluid is not hurled
+forth, or ejaculated in jets, like semen, but a thin glary fluid. The
+disease is commonly only local, and needs very little constitutional
+treatment.
+
+The tinct. staphisagria, so highly recommended by many, will often
+act very kindly as an adjunct, but will not cure the disease. Cascara
+sagrada must be used for a long time, to regulate the bowels and
+digestion. Faradisation, localized and general, is the only agency that
+may at nearly all times be relied on for permanent relief.
+
+When the disease exists with true spermatorrhœa the above treatment is
+none the less essential, and only needs modification to meet special
+indications.
+
+The manner of using electricity for the relief of prostatic disease
+is very simple. My experience has led me into the habit of placing
+the positive pole as closely in contact as possible with the gland. I
+sometimes introduce an electrode into the urethra――other times into the
+rectum――connecting the anode, and with the cathode and large wetted
+sponge stroking the lumbar and sacral regions, especially over the
+origin of the hypogastric nerve and plexus. If there be tenderness over
+any part of the spinal cord, I change the poles and apply the anode to
+the spinal tenderness. Such tenderness is very common over the sacral
+plexus. Again, it is important in the way of ascertaining causes, to
+know which antedates the other, the prostatic tenderness or the spinal
+tenderness; and the anode should be applied to that irritation which is
+found to be the most ancient; as, commonly, upon the spinal tenderness
+the prostatic irritation depends. But this rule is not always tenable,
+yet will answer very well in a new case until an electric test, as it
+were, is obtained.
+
+Whenever unrest, pain or fulness follows the use of one pole to the
+gland, it is safe to change; as such is not the desired effect. There
+is no one thing so needful in the use of electricity as familiarity
+with the physiological effects wrought. Every electrician has marked
+out the management of a patient, and the course proper to pursue, only
+to find an entire change necessary, after the first application. Many
+cases are plain, but many more are wonderfully obscure; and only after
+repeated practical tests, do we find the proper current, intensity and
+quantity adapted to a given case.
+
+
+
+
+CHAPTER X.
+
+
+_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.
+
+
+
+
+CHAPTER XI.
+
+
+_Impotence._――Some misapprehension as to the signification of this
+term is prevalent, owing to the extent of weakness and the morbid
+conditions to which it has been applied. The wrong application has been
+very common; _i. e._, in using it to describe a condition of sexual
+neurasthenia and temporary suspension of the sexual powers, from moral
+shock. A young man who exercises a doubt as to his ability to copulate
+may, upon the occasion, be unable to procure an erection; and yet he
+may, after a time, secure his own confidence; or, when he the least is
+thinking of it, be in full possession of his potence. The first attempt
+at coition, after matrimony, may be unavailing for this reason, and no
+trouble occur at any time afterwards.
+
+The penis may be erect at first, and become flaccid before intromission
+can be effected. Even this does not constitute, but may be only a
+result of, nervous shock or impression produced upon the mind and
+sexual instinct, from embarrassment, that may occur to any young man
+who is not self-confident, and is no evidence of any permanent disease.
+
+Impotence, as it should be defined and considered, is the
+manifestation of a disease in which there is permanent and actual
+impairment of the nerve-centres and, as a phenomenon of such centric
+changes, inability to procure an erection of the penis, at any and all
+times, sufficient to perform the act of coition. This is a chronic
+malady, of slow advent, and when once established there is very little
+tendency to recovery. The chagrin manifested in a man who is impotent
+is at all times striking. He feels that to be impotent is to be worse
+than dead. Men pride themselves on their ability to perform coition,
+and feel the loss of sexual power more than mind. Money and time are,
+therefore, expended exorbitantly to recover this lost power, that they
+may feel themselves men once more.
+
+The flabby organ is the centre of attraction. He handles it, and dotes
+upon what has been in by-gone years, and mourns over his misspent
+fortune only for the possibility of his obtaining relief from his
+genital affliction through its influence.
+
+The disease is complicated with spermatorrhœa at nearly all times, and
+may be considered only an advanced period of the same neurosis. The
+same conditions and types of diseased manifestations are to be studied
+in impotence as in spermatorrhœa. Then, to spermatorrhœa we add the
+phenomenon, impotence, and the accompanying changes, and we quickly
+comprehend the position.
+
+The condition is a loss of excitation-power of the nerve of Eckhard,
+whereby all physiological irritation becomes impossible. This nerve
+arises from the sacral plexus, any irritation of which, in a healthy
+state, causes a flow of blood to the corpus cavernosa and spongiosa
+of the penis; but the constant stimulation of this nerve produces a
+loss of irritability and paralysis of the parietes of the arterioles
+of the erectile bodies of the penis, and no relaxation of their valves
+occurs at any time: a perfect vascular inactivity is the result. These
+arterioles anastomose with corporal venules which are very tortuous
+and sacculated and supplied with very large openings and very small
+outlets compared with the magnitude of their calibres; but the often
+turgesced condition of these venules causes a dilated condition of
+the outlets, and any blood that may be conveyed into the corpora
+through the arterioles will flow out so fast through the dilated
+venule outlets, that the turgescence necessary to produce erection is
+impossible. Again, the innate contractility of the trabecular substance
+must antagonize, to a considerable extent, the erectile tendency of
+surrounding tissue.
+
+Then there is another condition so closely connected with impotence
+that a mention of it will not be out of place. Impotence consists in
+a lack of power to effect an erection; but there is a condition, not
+always impotence, where the person has lost all desire for copulation,
+and will not make an effort to obtain an erection. He does not attempt
+to concentrate his will-power, and does not desire any relation
+whatever with the opposite sex, although he may have been a debauché in
+his early life. When such a condition has been congenital, there would
+be reason to suspect deformity or congenital defect. Such person may
+not be impotent, and if the desire returns it manifests itself in the
+genitals as soon as the mind is allowed to dwell upon erotic thoughts;
+and if erection does not occur impotence is present.
+
+The loss of semen often subsides in the aged, and atrophy of the testes
+is not an uncommon result; but some people live to be very old, and are
+never troubled with senile-impotence.
+
+The penis is at all times flaccid, if impotence be complete. Often
+partial impotence will reveal itself, deviating peculiarly in its
+character. Sometimes a man will, while entertaining erotic thoughts,
+have an erection of the penis which is perfect in all appearance, and
+when brought in contact with a female cannot sustain or even procure
+the erection, and yet the erotic desire be just as intense as if he be
+able to perform the act in a proper manner. These cases are practically
+impotent, but the disease has all to do with the mind; and as soon as
+the mind can be so corrected that self-control may be exercised as
+well as self-confidence, just so soon will the impotence disappear;
+and once the act is performed normally, the trouble will be at an end.
+But there is a condition in which all the powers of mind and body,
+exercised to control, will not impart either the power of erection or
+the erotic desire――only a longing for that once felt erotic desire
+exists. The condition often exists in which the patient cannot control
+the mental impressions, so as to effect that peculiar concentration
+of the nervous force which gives energy to the sexual organs; and yet
+there may be no disease of such nerves themselves. It is the same
+condition that will cause the mental operations to fail during any
+course of anxiety, or turbulence of the emotions. A speech-maker may
+fail in his efforts at first, even after he considered himself prepared
+for every emergency; but as soon as allowed to collect his scattered
+mental evolutions, he may compose himself.
+
+Inability to perform the sexual act while suffering from any mental
+derangement, or misunderstanding one’s own mental elaborations, is
+not impotence; but there must be impairment of the integrity of the
+nerve-substance that evolves the force that sustains the sexual organ
+in its erect attitude, and also supplies the so-called physiological
+irritation. If we attempt to name this peculiar disease from other
+stand-points, we shall become confused; as it would only demonstrate a
+function-disease, which is an impossibility and leads to confusion.
+
+I have seen cases of so-called impotence from intestinal worms: while
+impotence is not generally considered a symptom of worms, yet this is a
+case which recovered as soon as the worms were expelled. I have known
+two cases that supposed they were permanently impotent, both of which
+obtained relief after the expulsion of a tænia solium.
+
+These were cases of symptomatic impotence; which only means phenomena
+that may exist in remote structural disease, or by mechanical pressure,
+as from foreign bodies, lumbricoide, tapeworms, etc., pressing or
+directly or indirectly infringing upon the nervous track that conveys
+the force which supplies the erectile tissue of the penis. This is a
+paralysis of the vaso-motor variety, in which the impotence is only a
+symptom: the disease must be studied under nervous diseases.
+
+To comprehend and study true impotence, the student will be attracted
+to the brain and spinal cord; as there only can the pathology be
+carefully comprehended.
+
+Nearly all the descriptions of this perplexing malady have been
+confined principally to the chronic flaccid penis and the general
+nervous phenomena most likely to co-exist. I must say that our
+knowledge is very limited beyond the superficial sources of
+information; and we have to content ourselves with simply describing
+the appearance, for the real disease itself; not but what structural
+changes exist in the sexual organs, worthy of note, but such changes
+are only secondary.
+
+Depending upon organic disorganization of the nerve-substance, we have
+all grades of loss of sexual power, from the simple chronic premature
+ejaculation to advanced and perfect paralysis of the organ. Any male
+who, from exhaustion of nervous force, cannot perform the act of
+copulation in a normal manner, may be said to be in a degree impotent.
+If he be able to effect intromission and then unable to complete
+the act, from premature ejaculation――providing this is a common
+occurrence――he may be said to be impotent. The continent may undergo
+premature ejaculation and not be impotent. Neither is flaccidity likely
+to follow ejaculation from such cause.
+
+The more advanced cases of impotence are not even capable of procuring
+erections; and often semen is discharged in the flaccid condition
+without the knowledge of the patient: such may be the result of
+spermatorrhœa and impotence combined.
+
+The long-continued and frequent indulgence of masturbation must be
+a most frequent cause of impotence. I have only observed a very few
+whom I knew to have brought upon themselves this condition without the
+habit of masturbation; and even then I am not positive in knowledge.
+Yet they were rare debauchés, with money to squander and appetites so
+salacious that the almost constant contact with women was their custom.
+On the other hand, it seems that a male human being is constructed for
+endurance of his sexual organs. A notorious polygamist in practice,
+once living in the city of Elmira, New York, was known to lavish his
+smiles on his “kept women,” whom he numbered by scores, and still he
+was potent till he died in advanced life. We must have a most excellent
+example in the famous President Young whose wives, we are inclined to
+believe, must have kept him on the _qui vive_, as his children bear
+evidence, as well as the fascination and attractiveness of his young
+wives.
+
+The exciting cause of impotence must combine a constant and
+long-continued sexual debauch with the depraved chain of thought that
+must necessarily accompany such degradation; and the practice of
+self-pollution must be the most fruitful of all causes.
+
+_Treatment._――In the management of impotence, the patient’s persuasive
+influence must not in any way change the intentions of the physician,
+or the fast hold of his mind, which is so indispensable to a cure,
+will be lost. The patient is always in great haste, and constantly
+urging the physician to make rapid progress. Too great firmness cannot
+be exercised, and promises of speedy cure will invariably fail.
+Time is one of the most important of all elements in the treatment,
+as opportunity is afforded for the recuperative powers of nature or
+physical forces to become poised.
+
+Perfect confidence in the medical adviser is prerequisite to success,
+as by this alone can the patient’s mind be manipulated, and his hope
+constantly stimulated. If he has been much exercised in mind about his
+case, from reading “self-abuse” literature, moral treatment will be
+required to dispel from his mind the pictures there wrought. Not always
+can the virile organ be restored to its normal vigor, but elevating the
+general health should be first considered, and the patient’s mind kept
+constantly thinking about his improving physical condition, instead of
+watching for the first erection as he will most naturally do.
+
+When the foregoing conditions cannot be secured, no benefit will result
+to the patient. In no disease has mental influence so much to do with
+recovery, as in impotence; and I do not hesitate to say, where I can
+control my patient’s mind, that I can always effect a very satisfactory
+relief. Employment is indispensable, and must be persisted in. The
+patient should have no time to play, or brood over his disease, but
+must be engaged so constantly that he will be even fatigued after he
+has finished his day’s toil, and will sleep long and soundly from
+his exhaustion. The most nutritious diet should be selected: meat,
+eggs, oysters, milk, etc. Cold bathing at night, before retiring, is
+a very important measure; as, first, it washes the parts of a cold,
+clammy sweat, and the chill from the water after reaction, produces
+a naturally warm feeling, and his attention is not attracted to the
+parts by their otherwise doughy, unnatural feeling; and secondly, the
+tonic properties of cold are of lasting benefit. The bathing should
+extend to the back, perineum, scrotum, penis, and down the thighs. Such
+constitutional measures should be resorted to as will favor any of the
+imperfect processes in the body. The means should favor assimilation of
+food and normal excretion, and the avoidance of stimulating diet and
+alcoholic liquors.
+
+For the neurosis upon which impotence depends, I have accomplished
+very much by a single combination of medicine (see formula No. 1),
+that this preparation has been, as it were, a “stand-by” for many
+years; the patient gradually improving under its use, in nearly every
+case. I can affirm that it has been tested in hundreds of cases, in a
+great majority of which marked improvement has taken place, and many
+have been permanently cured. Many were cured before I became familiar
+with the importance of electricity in the treatment of such cases; but
+since having extensive experience with the various methods of applying
+electricity I confess I could not do well without it.
+
+As to the beneficial results following galvanism and Faradisation,
+there can be no question; but as to which of these forms should be
+applied, I am not always able to say. I have used galvanism without
+benefit, a certain length of time, and changed to Faradism with
+immediate improvement; and _vice versa_.
+
+I do not opine that either form, if used mildly, will often do harm;
+and where improvement does not follow after a reasonable length
+of time, I would advise a change. When the patient is wakeful and
+restless, a pleasant effect is produced by Faradisation, which is often
+a favorable sign, and may be continued with exalted expectations. In
+very advanced cases, the galvanic current will oftener establish an
+improvement, when a change to the Faradic current will continue the
+improvement. I consider no means of the physician demanding so much
+judgment and experience as electricity; and in the skilled operator’s
+hand much good may be realized from its use.
+
+A very natural manner of applying Faradisation in impotence, as well
+as other forms of sexual neurosis, is to seat the patient upon a large
+wet sponge, to which the negative is connected, bringing the scrotum
+and perineum well in contact with the sponge, and stroking the spinal
+column well with the positive, also using a wet sponge. The operator
+will be governed by the patient’s sensibilities, as to time of sitting
+and strength of current. The current should not be painful or very
+unpleasant; and if twenty minutes produces any uneasy sensation, the
+next application should not be continued longer than ten minutes.
+
+The galvanic current may be used in a similar manner.
+
+Beard & Rockwell’s method of general Faradisation is a most excellent
+one for alternate applications.
+
+A troublesome complication is often constipation of the bowels, which
+may be overcome by the judicious use of rhamnus purshiana. Not too much
+general bathing, but local bathing, as directed above, with stimulant
+friction, is always beneficial.
+
+Turkish baths, so often ordered, must be avoided, as great general
+debility and languor often follow their use. No undue warmth can be
+made use of, either in dressing or bathing, as the neurosis, upon which
+all these unnatural phenomena depend, is aggravated.
+
+The general treatment of neurosis, in impotency, differs very little
+from that in the neurosis of spermatorrhœa, as the conditions are
+very similar if not identical; only degrees of the same organic
+cerebro-spinal changes. The beginning is perhaps only a neurasthenia,
+but gradually increasing in intensity to spinal anæmia, or congestion,
+finally softening.
+
+Any changes of the genitals must be treated according to principles
+mentioned under treatment of structural changes of the genitals.
+
+_Clinical Illustrations._――It must not be expected that all cases
+will be confined to one definite condition, or to one combination of
+phenomena that may be grouped together and named. No one will so fully
+comprehend this as the practical physician. Cases are constantly under
+the care of the medical man, suffering with conditions too numerous
+to mention, complicated with many strange lesions. Every case must
+necessarily be studied from its own merits, in and of itself, or
+success will not follow.
+
+It is not uncommon to come in contact with spermatorrhœa and impotence,
+both together, also complicated with organic disease of testicles,
+prostate gland, and anus or rectum. At the same time the brain and
+spinal cord may be drawn upon by a variety of organic lesions. By this
+we shall see that a report of clinical cases will bear more upon the
+practical than the theoretical, as regards adapting doses to nosology.
+
+_Case._――J. S. consulted me in ’74. He was suffering from spermatorrhœa
+and partial impotence. He had tenderness over last lumbar vertebra and
+sacrum, anæsthesia of the genitals, dyspepsia, bowels constipated,
+and at times very languid; was brooding over his loss of power and
+involuntary discharges of semen, which were nocturnal, generally
+accompanied by lascivious dreams. The urethral sound revealed
+tenderness along the urethra and extreme soreness of the prostate
+gland. His semen was thin and spermatozoa scanty and imperfect. He
+was thin in flesh, and anæmic. His erections were imperfect, and he
+could not perform the act of coitus. He was a masturbator. I directed
+pills, formula No. 2, and continued until bowels became regular; also
+No. 1, which was continued one year without change, with cold local
+bathing and brisk friction over bowels, back, perineum and scrotum. His
+recovery has been very satisfactory.
+
+_Case._――J. W., when he first visited my office for examination
+and advice, was emaciated, pallid, with his eyes sunken. He was
+careworn and haggard in his expression, suffering from pain in his
+back and limbs, almost constant pain through the top of his head;
+palpitation, with accelerated pulse; formications over his back and in
+his finger-ends; bowels constipated, and urine smelled strong like a
+horse’s; tender spots along the spinal cord. The testicles and scrotum
+were doughy and constantly moist and cold. His scrotum was long and
+pendant: his penis was blue and flabby. He could only obtain partial
+erections, very occasional. He lost semen often. His urethra was very
+tender, also the prostate gland. He was restless and wakeful during the
+night. I directed local cold bathing, Faradisation, formula No. 1, for
+his general neurotic condition; pills――formula No. 2――for constipation.
+He took chloral every night, to produce sleep, for 3 months; tr.
+staphisagria, small doses, for prostatic irritation, and occasional
+opium suppository. I discharged him after sixteen months, when he
+married, and now has a healthy child.
+
+_Case._――R. confided to me his history, which was, he had been a
+debauché and masturbator. He was tall, slender, anæmic, beard thin;
+was suffering from too much medicine, which he had received from
+unprincipled specialists, as he had been three years in their hands.
+There was spinal anæmia, judging from the spinal soreness, and
+formication at times. He thought he would become paralyzed, as his
+hands and feet often became numbed. He was impotent, and often lost
+semen. His urine contained spermatozoa. As soon as his mind could
+be put at ease he began to improve, under formula No. 1, with cold
+local bathing, as directed, with Faradisation. I discharged him after
+thirteen months.
+
+_Aspermatism._――Since Roubaud’s description of this condition, and
+especially the application of the above term, much has been said in
+regard to the causation and true nature of this peculiar deficiency.
+Whenever sexual orgasm occurs in the male, after puberty, without
+ejaculation, the condition known as aspermatism may be said to exist,
+and may be considered as a symptom of disease. This may be partial or
+complete. I have known a number of individuals who failed to ejaculate
+semen at the time of sexual orgasm, and the semen would pass away in
+jets some time after the penis had become flaccid. These cases exist
+where there is no sign of organic stricture of the urethra, or any
+other organic trouble within the prostate gland or ejaculatory ducts.
+
+Dr. Van Buren is the author of a paper which appeared in the _New York
+Med. Journal_, November, 1868, in which he attempts to establish the
+cause as a spasmodic condition of the urethra, forcing the seminal
+fluid, by reflux action, into the bladder. I can not, at present, think
+that this is always the case. Only a little attention to physiology
+will familiarize any person with the calibre-contractions that follow
+a column of urine from the bladder to the meatus. This same muscular
+contraction exists in the veins, and is what constitutes the venous
+wave. The same wave exists in the ejaculation of semen; and where the
+muscles that perform accelerating movements are paralyzed, the natural
+consequence must be, that the fluid will remain in its reservoir until
+its place is supplied by new, and a portion is forced out along the
+urethra, which drips away when the penis returns to flaccidity. Then, I
+can but regard this condition, often, as one of paralysis, in which are
+affected the muscles of ejaculation and acceleration. This condition
+often exists where the genitals are not impaired as to potence. That
+such a condition is present, should not be declared until after bougies
+have proven, to entire satisfaction, the absence of organic stricture
+or spasmodic contraction.
+
+When such a lesion has come on gradually and is of long standing,
+the prognosis is very unfavorable; as relapses will most generally
+occur with the slightest indulgence. But when the condition has made
+its advent suddenly, from inflammatory causes, the prognosis is very
+favorable. A gonorrhœal orchitis will often produce this condition,
+which is only transitory, or of a few months’ duration. This is only
+symptomatic, and very much unlike the true aspermatism of a neurotic
+origin.
+
+A very extraordinary case has of late engaged my attention and
+curiosity. No case of the kind have I been able to discover, in medical
+literature or in the practice of my medical friends.
+
+_Case._――A young married man consulted me with an affliction (as it
+were), much to the discomfort of himself and to the great injury of
+his wife. He never had passed the sexual orgasm, nor ejaculated semen
+during coition. He is very erotic, and has no difficulty in performing
+the marital act, but it is followed without the slightest satisfaction.
+He continues in the act of coition until exhausted, and retires with
+the wife very much in the same condition after repeated sexual orgasms.
+He informs me that one hour is not an uncommon length of time for him
+to occupy in the act of coition, participating in the sexual beatitude
+during the entire period, until gradually becoming exhausted, when
+the pleasure dwindles away, but his penis remains erect for some time
+after. He says that he has often applied cold water to facilitate
+flaccidity.
+
+After the organ has been reduced he sometimes can detect semen, or
+prostatic fluid, on the glans and meatus, and he is very soon ready
+to perform the act again. I have often discovered spermatozoa in his
+urine. His testicles are well formed, and his penis is normal in
+appearance. He has never had a venereal disease, and has no stricture.
+Treatment has given no relief as yet. It will be observed that
+satyriasis is prominent in this case.
+
+Galvanism will often be found of great service as a paliative measure,
+with phosphide zinc and nux vomica. If a few years’ continence can be
+obtained, a better prospect for recovery may obtain. When galvanism is
+used, an insulated electrode should be passed to the orifices of the
+ejaculatory ducts, with the anode attached, and the cathode applied to
+the cord with wet sponge. I have derived some benefit from localized
+and general Faradisation, after the manner heretofore mentioned.