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- SEXUAL NEUROSES.
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-
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- CHAPTER I.
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-
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- _Introductory._――The term sexual presupposes the possibility of two
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- distinct and perfect beings, yet one is counterpart of the other,
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- distinguished by anatomical features designated male and female; with
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- attributes such as passion, love and reciprocal admiration. Sexually
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- the two beings become united, constituting plurality in unity.
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-
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- The sequel of such coalescence of the sexes, or marriage legitimately
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- considered, is copulation and reproduction of the species. The
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- summit, or peripheral center of venereal sensibility, is found at the
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- genitalia, and in the male a concentration of nerve-force conducts,
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- as it were, to and unites at the glans penis; and division of the
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- terminal nerves at this point will render erection impossible. In both
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- man and beast, the only mechanical irritation capable of exciting
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- venereal sensibility must be at this point. When the sexual centers
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- are physiologically irritated, from peripheral or centric influences,
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- contentment is only possible (physiologically speaking) when male
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- and female counterparts coalesce, or are in juxtaposition. The sexual
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- attributes also constitute an instructive topic for study, as they
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- become modified by civilization and the development of reason. The
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- procreation of organic life is the sequel of the sexual connection. The
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- living universe has been called into existence, and the perpetuation of
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- its life-spark is only dependent upon the contact of sexes.
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-
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- The universe, it is said by one theorist, was evolved; by another,
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- who depends upon the Holy Book for a guide, all living creatures were
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- thaumaturgically or miraculously, and “in the twinkling of an eye,”
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- made to exist in full form and shape. This problem will never be
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- settled to the satisfaction of all men as long as theory and faith
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- are at war; and small is the prospect of peace while both parties
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- are redoubling in their forces annually. Then, we can but accept the
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- situation of the human race, as it is, since we have no historical data
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- of its origin, that are beyond controversy and that would be accepted
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- as evidence in a physiological point of view. But we need no ponderous
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- evidence to show the truth of the premise, that animal life is not
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- perpetuated except through sexual congress. Not life _only_, but good
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- and evil of every degree; vice, folly, crime; love and hate; society,
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- social evil and social good: all depend, largely, upon the sexual. It
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- is the bond of our existence; it is the wheel of our fortune; it is our
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- guiding star; and it may be our loadstone to crime and premature death.
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- Passions leading to love, true and gentle, or jealousy, hate, revenge,
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- murder and suicide, all hinge on circumstances connected, directly or
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- indirectly, with the sexual.
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-
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- Our schools are conducted upon a foundation entirely sexual; educating
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- each of the sexes in the role they are to pursue, with reference to
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- exclusiveness in conduct. The girl is taught to pursue only such
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- vocations, practices and manners as are becoming to her sex; the boy,
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- on the other hand, is instructed not to enact girlish capers, but to
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- pursue masculine vocations, from the childish toys to settled, adult
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- labors. This all means nothing but distinctive development of the sexes.
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-
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- The sexual enters our every-day lives, from childhood up; it governs
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- our development; it modulates the voice, the build, the dress, the
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- hair, the fashion of wearing the dress, and even the gait. In all this
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- we can but observe the worship of the sexual; though obscure, yet
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- every manifestation of human existence points to it. The good people
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- of the earth profit by the grand and noble sexual unity in the marital
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- existence, and by the pure, social relations, and chaste affections of
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- the unmarried; but these are but a small part of human society. The
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- masses express their worship for the sexual by debauch, dissipation,
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- vice and crime. The common saying, whenever suicide or murder has been
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- committed, that “_woman was at the bottom of it_,” might just as well
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- read, “_man was at the bottom of it_;” as without the one, where would
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- the other have been?
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-
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- It is the bad use of noble agencies that often constitutes vice.
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- Nothing ignoble, was intended by the Great Designer, should grow out
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- of the sexual privileges, and when nobly appreciated, for moral beings
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- a greater happiness or pleasure has not been instituted. But by long
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- prostitution of these privileges, vices have originated; beliefs have
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- been established; customs have been founded; even religions have been
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- constructed and modified to suit the wishes of designing “sexualists,”
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- “free-thinkers,” Mormons, etc. Occasionally, dissatisfied members of
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- one sex will establish an innovation, or a revolutionary commotion,
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- demanding rights which they claim have been usurped from them, and
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- sometimes thirsting for prerogatives belonging to the opposite sex.
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- They agitate their cause until their isolated followers establish
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- societies and churches, effecting discord in families, and no good to
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- the world in general, and for themselves an unenviable reputation. Such
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- individuals are often advocating reforms; temperance, charity, etc.;
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- but when good comes out of one, evil grows out of ten. They often take
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- a decided stand against the opposite sex, and when their true history
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- is known, it will be often found that they have been suffering from
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- unrequited love, disappointment in matrimony, deception in society,
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- misplaced confidence, illegitimate pregnancy, etc.; or, they are
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- phlegmatic and passionless; or, hermaphrodites; or wanting in some of
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- the sexual appendages necessary to constitute a perfect man or woman.
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- Then, without the complete sexual system, harmoniously balanced, all is
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- imperfect.
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-
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- My purpose in dwelling so much upon these mixed relations and
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- disappointments, has been more especially to fully expose the
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- predisposing causes of neuroses and more essentially of the sexual
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- variety. As I shall labor to show that neurosis is the condition
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- throughout our list of sexual diseases, and that all the foregoing
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- changes, excesses and defects, depending upon the sexual, are more or
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- less influential in predisposing human beings to brain and spinal cord
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- disease. No person, so well as the physician, will comprehend, after
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- once meditating upon this theme, the necessity for thorough study and
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- a more rational understanding of the sexual. Medical writers, with
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- one or two exceptions, have only ventured now and then an isolated
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- paragraph, and left the physician to draw his own conclusion. Among
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- the aboriginal tribes, the sexual appetite is and has always been
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- indulged _ad libitum_; not only in the natural manner, but in every
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- conceivable way, without noticeable harm to the organs themselves,
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- or to the nervous system. In a lesser degree this is true of slaves,
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- sailors and peasantry, and the lower orders of civilization. Sexual
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- endurance diminishes in proportion to the advancement in civilization
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- and intellectual culture. A long-cultured family can not sustain,
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- in sexual indulgence, what to the uncivilized would be a matter of
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- indifference.
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-
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- Sexual intercourse, when not contra-indicated, may relieve nervous
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- tension and produce sleep in a moderately feeble individual; but on
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- the other hand, if carried to excess, it may produce nervous tension,
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- wakefulness, headache and exhaustion. There are no definite rules to
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- regulate the sexual appetite, more than the stomach for food.
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-
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- The evils of sexual intemperance are temporary, and if recent, quickly
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- recoverable by rest only.
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-
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- Says Dr. Briggs, of New York, “The sexual system is notoriously the
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- seat of excitement and depression from psychical and mental influences.
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- It is under the control of the sympathetic nerves, and influenced by
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- the solar flexus. Much of the peculiar sensibility experienced in this
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- part of the body is directly referable to the mind and imagination:
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- the manifestations are controlled by the sympathetic nerves, from the
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- impulse given in this manner. But the mind and will, however intense,
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- have little power over the sexual functions, except through this
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- medium. The emotions are superior.”
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-
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- _Predisposition._――The innate or uncaused condition, which is so
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- commonly found among the young, is quite likely congenital and
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- constitutional. There is evidently structural malformation in the
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- neuroglia, or nerve cells proper, which predisposes the child to sexual
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- excitement. This may not be derived from the immediate parent, but
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- far back. In the third or fourth generation, debauchés may be found.
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- Licentious parents commonly predispose their children to morbid sexual
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- desires; and what evidence have we that structural changes do not exist
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- in or about the nerve centres that preside over the sexual functions,
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- and that such changes are not constitutional? Then, with this
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- structural change as a predisposition, the least cause will set the
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- sexual centers into a blaze of excitement. They who are predisposed by
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- many generations, show upon their faces the lines of coarse breeding;
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- that they are the offspring of debauchés; congenital degradation; not
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- but these conditions, under favorable circumstances, may be overcome,
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- by rigidly cultivating opposite nerve centers; but such opportunities
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- are seldom presented, and when presented seldom embraced.
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-
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- Circumstances are also to be considered as having a bearing upon the
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- sexual “ups and downs” of our human career. With a predisposing sexual
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- cause, a downfall may occur under circumstances less seductive in
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- character than when no such congenital condition is present.
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-
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- Listen to the heart-rending stories of girls in the houses of
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- prostitution. Each has her story of circumstantial events to relate.
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- Circumstances of varied gravity have caused the multitudes of “fallen
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- women” to occupy their degraded sphere of shame and debauch. Many of
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- these have never been predisposed to a sexual livelihood by an erotic
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- disposition, and they only stay by compulsion and fear of reproach that
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- must follow if they return to society. The line of social demarkation
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- is drawn, and there is no palliation or chance of redemption by
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- reform――only secret forgiveness, secret repentance, or a nunnery. There
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- are some who follow this life by choice, from the pleasure therein.
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- Such are predisposed: they naturally follow this course: they learn it
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- on the streets, in mere childhood: their ancestors, or some one of them
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- at least, were of this type――mal-constructed――and circumstances are
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- meagre that, as is said, lead them astray. They are not led astray: it
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- is more natural to them than to pursue the path of rectitude and virtue.
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-
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- These people are predisposed to evil, and it is only, even if guarded
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- from childhood up by constant watching and being kept from every
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- possible circumstance, and taught only the good and pure, to adult
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- life, that any reasonable assurance may be had of their safety from
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- vice. This inheritance is almost indestructible and may crop out after
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- the best of culture, with very slight cause, any time in adult life or
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- in future generations.
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-
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- Not only the predisposition to sexual desire is congenital, but the
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- enfeebled nervous system that can endure only a limited amount of
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- sexual indulgence. They learn to indulge the sexual appetite at a very
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- early period, and the males grow up effeminate, or half-sexed. The
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- tendency of civilization is toward brain and mental culture. In this
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- we have a cause of nervousness which is wonderful. Our ancestors, who
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- knew very little of brain-work compared to the cramming of the present
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- day――compared to the curriculums of our present school system――were
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- not nervous; they were not excitable, but physically strong. They
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- labored at a variety of toils without machinery, and they obtained
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- physical endurance. Now, the boy is crammed at school and hurried
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- through to professional studies, when he has but just begun life; or
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- he is placed at business, to find that excitement of competition which
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- is the greatest brain-stimulus and the greatest cause of nervousness
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- of the present age. The multitude of collateral sciences that a young
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- man is compelled to read; the books, scientific and novel, that must
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- be perused by every popular student; and the short period of time in
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- which he is expected to pass over this entire field: all tend to change
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- the young man into a habit of nervousness which would surprise our
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- ancestors of one hundred years ago.
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-
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- The labor that was performed by hand by our ancestors, which was the
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- cause of their physical endurance, is now entirely accomplished by
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- machinery; and the modern man, instead of patiently doing the labor by
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- hand, expends months and years at brain-work, attempting to construct a
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- machine that will run by steam, water, or horse-power, that he may save
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- physical force, time, and perhaps, in the end, money.
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-
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- The haste in which Americans live and move, must also become an
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- exciting cause of nervousness. The ancients were patient in obtaining
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- information; in performing works of art, literature, or agriculture.
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- The Greeks did not expect to become proficient in the varied vocations
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- until middle life; but an average American is expected to finish
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- college at twenty-two; to have invented some kind of a machine for the
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- saving of labor, to have made a fortune, married and raised a family of
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- children, wasted his father’s fortune, and be prepared to begin life
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- anew by the time he is thirty years of age.
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-
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- Then, to answer the question, “Why are American people so nervous?”
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- we have but to compare the present with the past; our country with
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- others. The nervousness and mental development of our people, preclude
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- anything but moderation in sexual indulgence; and whenever fast living,
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- brain-working, nervous people indulge to satiety in sexual pleasure,
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- they are in danger of grave consequences, such as our ancestors never
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- knew of, as the results of excessive sexual indulgence. They could
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- cohabit _ad libitum_, and never notice such consequences as nervous
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- people are constantly suffering.
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-
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-
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-
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-
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- CHAPTER II.
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-
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-
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- _Incidents――Observation――Historical Data, and Sexual Hygiene._――Nature
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- furnishes us a vast field for speculation and inquiry, when even
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- confined within the domain of certainties; and there is an occult line
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- beyond which everything is speculative and imaginary; but there are
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- facts enough in common view to enlighten the seeker after knowledge by
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- simply collecting commonplace occurrences and gleaning therefrom their
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- rich lessons. Observation, by association and comparison, and correct
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- judgment will teach us many things not in the least hypothetical――facts.
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-
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- To comprehend the obscure relations of the sexual function and the
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- varieties of morbid changes, we must first systematically inquire into
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- a few of nature’s designs, and ascertain thereby the true purpose of
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- the sexual organs.
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-
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- What purpose? is the first point at issue in any observation, and must
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- be answered by the physiologist and Physician in this investigation,
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- as he _only_ has the results of abuse, or wrong application, to
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- investigate and correct.
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-
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- The production of healthy offspring must be nature’s only design for
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- the sexual organs. How to accomplish this end, is the great question of
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- scientific observers.
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-
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- It seems quite axiomatic to remark, that maturity and perfect
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- development _only_ can assure perfect reproduction of the species.
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- Again, that pleasure should always attend the act of copulation,
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- otherwise the pain of parturition and the care of rearing the young
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- would always militate against the perpetuation of the race.
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-
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- With the normal condition of the sexual organs and functions the
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- physician has comparatively little to do; but with their abuses he has
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- all to do. To comprehend the abnormal, he must be familiar with the
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- normal condition of structure and function. Masturbation is a small
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- part of the indiscretions and evils of the sexual; and the lesions
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- growing out of such evils are too numerous to mention. There is no
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- doubt venereal diseases grew out of the evils of repetition of sexual
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- congress, with certain unknown violations of nature’s laws, by depraved
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- human beings.
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-
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- I am credibly informed of an occasion: “A prostitute received the
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- embraces of eleven men in immediate succession: the ninth and eleventh
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- took gonorrhœa, and again gave it; but the prostitute remained free
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- from the disease until two months after, when she took the disease from
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- one to whom she had given it, on the above-mentioned occasion, after
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- which she spread it through a small town in which she lived and also in
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- which she was in the habit of plying her vocation. She was free from
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- disease before this occasion.”
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-
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- It is no more doubted that a male will contract a purulent urethritis
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- from contact with a woman during her menstrual crisis, or if she be
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- afflicted with an infective leucorrhœa; but such a discharge in the
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- male is not generally contagious, and he may indulge freely without
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- giving the disease.
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-
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- Uncleanliness may be considered a common cause of sexual disease in
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- both sexes.
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-
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- _Masturbation_, after the age of maturity is no more injurious, aside
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- from the degradation it leads to, than the same number of contacts
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- in the natural manner; but in the youth the undeveloped organs
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- suffer, as well as the nerve-centers which supply these organs with
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- nervous energy. The youth is inclined to indulge the habit after once
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- initiated, greatly to the detriment of the spinal cord, and through
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- this to the general nervous system. He is inclined to practice the
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- deplorable vice oftener than he could find opportunity to gratify his
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- passion in the natural way. As a rule, to the indiscretions of youth is
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- confined the permanent injury to the nervous system. It is at an early
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- age, when so much injury is done, that the very common practice occurs
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- at schools, when boys club together in squads and go behind embankments
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- of stone-wall, or creek-banks; or a boy isolates himself, as it were,
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- to “shell out a grist by hand.” With such ample opportunities, and with
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- the habit fully established, the acts are repeated with such frequency
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- that exhaustion of the nervous power must often attend this wonderful
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- deviation from nature’s designs.
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-
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- With all this supposed nervous weakness, I do not incline to the
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- opinion that more injury is done to the sexual organs by this practice,
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- in and of itself, than is accomplished through the impressions wrought
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- upon the brain from reading spermatorrhœa literature of advertising,
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- “private-disease” specialists. I am satisfied that I have seen bad
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- cases recover by putting their minds at ease. The carefully worded
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- little books, that are sent broadcast to drive in those who have been
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- indiscreet, are money-making dodges, and are of great injury to the
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- confiding and simple.
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-
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- When the injury has become very extensive and the condition of habit
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- very depraved, a young man becomes so attached to his lothly vice that
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- he will refuse the natural way of gratifying the erotic desire. He is
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- not in the least influenced by one of the opposite sex, and prefers his
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- own company, or isolation.
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-
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- It is not the mule only that suffers from masturbation, but girls
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- as well, though not so commonly, suffer from this peculiar sexual
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- neurasthenia and hysteria growing out of sexual abuse. Our opportunities
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- for discovering the extent of such practices in the unmarried female are
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- very limited; consequently, we remain in ignorance to a great degree.
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-
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- The married woman furnishes the physician the majority of the practice
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- in this class of cases, as she also suffers from a mismanagement of the
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- sexual congress; and it is only to the married woman that the practical
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- physician will need to devote extensive attention, and only through
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- her, in this sphere, can much information be obtained.
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-
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- In the prostitute, sexual contacts are too promiscuous, and she is
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- too unreliable, to afford any very trustworthy information, further
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- than may be judged by the aspect of one who has followed the business
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- for a decade. It is little to know that her life, as a rule, is short
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- and her social redemption next to impossible, and her entailed ills
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- irremediable. When the habit of self-pollution is once established by
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- a girl, it is worse than in the male; as a female is not so likely
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- to yield to any sort of a vice as a male, and she will carry it to a
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- greater extreme. Modesty and fear of giving offence will always impede
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- the advancement of knowledge in regard to the sexual functions in the
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- so-called chaste and unmarried.
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-
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- The married female’s sexual life and acts are often brought to the
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- knowledge of her physician. I have often been asked the question,
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- why so many married women become invalids from uterine and ovarian
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- diseases? Not referring to child-bearing, abortions, and many
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- indirect causes of disease which are numerous, but not enough to
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- furnish an etiology for the long category of nervous ailments with
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- which the medical man has to contend, my answer is, sexual abuse; a
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- misunderstanding of the sexual functions; a non-adaptation of two
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- individuals joined in marriage. It is not so commonly excessive
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- venery; or too often repeated coition; but unrequited passion. Man is
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- too likely to forget his duty to his wife and look first to his own
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- gratification. Any sexual embrace not attended with sexual orgasm, is
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- very detrimental and causes disease. With the brutal man and phlegmatic
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- woman this condition is quite likely to occur, and more especially if
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- the man has been a masturbator. Where the latter condition has caused
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- a partial impotency, the sexual orgasm very commonly occurs before or
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- immediately after the intromission of the penis, in which condition
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- beatitude is impossible, and the physician is most likely to be
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- consulted by one of the parties.
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-
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- It will not improve our knowledge to be too modest on this question.
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- As medical men we have the diseases of the sexual organs and their
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- _sequelæ_ to treat, and we must discuss the causes. My suggestion,
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- that a couple should be matched, sexually, seems not out of place;
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- and if this condition is not present at first, it must be obtained
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- by adaptation. My observation has been supplied with a number of
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- instances of once faithful wives, who had forsaken their husbands for
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- this seeming little discrepancy or neglect, and associated themselves
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- happily with more adaptable mates.
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-
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- These singular facts confront us, and as teachers and scientific men
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- we may, when consulted, if familiar with the causes, suggest remedies.
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- I have many times corrected this discrepancy in domestic felicity by
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- a little careful instruction, and thereby prevented the impending
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- dissolution of the marriage relation.
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-
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- This might well be termed matrimonial hygiene.
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-
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- Such grave facts are brought to the knowledge of the family physician,
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- and he has but to listen to find out all: he has only a few questions
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- to put, and the case is before him. No indecency to be indulged in:
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- such cases must be conducted with the strictest sense of honor and
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- decorum, or the bond of confidence and trust will be immediately
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- forfeited.
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-
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- _Continence_, while in itself not an abuse, in any manner, of the
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- sexual organs, yet is a fruitful source of disease. The erotic male
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- may contract troublesome disease, both local and general, by too close
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- proximity with a voluptuous female; and why not as much a cause of
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- disease in the female? It is the condition so commonly caused by the
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- affectionate and chaste embraces of parties “engaged to be married.”
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- When this condition exists the marriage ceremony had better be
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- consummated as soon as possible, or injury may come to both parties.
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-
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- The case of a young married couple, lately under observation, is
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- instructive. The wife was stricken with paralysis, from which she
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- was eight months in recovering. During her illness she became much
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- reduced in flesh and will. She recovered in flesh, but remained very
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- neurasthenic for many months. I made use of all methods of treatment
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- by drugs and electricity. I could detect no organic trouble. When
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- interrogating the husband, I ascertained that they had, through fear of
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- doing injury to the wife, remained continent, and, being too modest,
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- had not consulted the family physician on this very delicate subject.
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- I immediately advised sexual congress freely, and the neurasthenia
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- gradually disappeared. She has since remained in perfect health. She
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- was afflicted, as she supposed, with all manner of diseases. She was
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- often too feeble to walk, and required assistance or a cane, to walk
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- across the room. She was irritable and fretful, often crying, and
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- no reason could be given for any trouble, as she was provided with
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- everything asked for. It may seem a venturesome advice to render, yet
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- I can but urge the natural use of the sexual organs when there is a
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- strong erotic excitement, following a long period of continence, when
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- this desire is not a morbid one; which is likely to be the case only in
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- the depraved, after long abuses.
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-
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- Were it not for mistakes so commonly made by individuals in selecting
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- such imperfect and inadaptable mates, the very poetical words of the
429
- old maids and bachelors, “_single blessedness_,” might better read,
430
- “_single cursedness_.” With the chances as they now are, it is an
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- important question, whether it is more advisable for a maiden lady to
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- marry or to remain continent and pine.
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-
434
- A loathsome abuse of the sexual organs, not usually recognized by the
435
- fastidious, exists, in which one of the individuals, taking a part in
436
- this abnormal sexual act, uses the mouth as a vagina. Some of these
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- benighted creatures are males, others females. Houses of prostitution
438
- of the present day are so accommodating to their patrons that they
439
- keep females who serve degraded males in this manner. I am credibly
440
- informed that they prefer this method; that the erotic desire has
441
- been transferred from the genitals to the tongue. Any person who may
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- be inclined to exercise a doubt, may easily convince himself of its
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- truthfulness by visiting one of the many low-down “houses of ill fame”
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- in any one of our large cities.
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-
446
- From _The Laws of Life_ we extract the language of a clergyman:
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-
448
- “I have officiated at forty weddings since I came here, and in
449
- every case save one, I felt that the bride was running an awful
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- risk. Young men of bad habits and fast tendencies never marry
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- girls of their own sort, but demand a wife above suspicion.
452
- So, pure, sweet women, kept from the touch of evil through
453
- the years of their girlhood, give themselves, with all their
454
- costly dower of womanhood, into the keeping of men who, in
455
- base associations, have learned to undervalue all that belong
456
- to them, and then find no time for repentance in the sad after
457
- years. There is but one way out of this that I can see, and
458
- that is for you――the young women of the country――to require,
459
- in association and marriage, purity for purity, sobriety for
460
- sobriety, and honor for honor. There is no reason why the young
461
- men of this Christian land should not be just as virtuous as
462
- its young women; and if the loss of your society and love be
463
- the price they are forced to pay for vice, they will not pay
464
- it. I admit, with sadness, that not all our young women are
465
- capable of this high standard for themselves or others, but
466
- I believe there are enough earnest, thoughtful girls in the
467
- society of our country to work wonders if faithfully aroused.”
468
-
469
- _Sodomy_, or sexual contact of a human being with an animal, is an
470
- ancient practice and but little indulged in at the present day; as our
471
- laws are very rigid against such _degraded and inhuman treatment of
472
- animals_. There has been a civilizing influence, since human beings
473
- have organized societies for the “Prevention of Cruelty to Animals.”
474
- But it will nevertheless be remarked, that this elevating tendency
475
- came about entirely through the respect for animals, and not for human
476
- beings. Were it not for love of animal property and legal watch-care
477
- over our animals, and plenty of opportunity to gratify the sexual
478
- desire in other ways, the habits of the people would be no better
479
- than in ancient times, when sodomy so extensively prevailed. This
480
- beastiality may have been a cause of venereal disease――syphilis――which
481
- can be traced back to ancient times, without a doubt.
482
-
483
- In addition to such abuses, there were worships quite as degrading.
484
- Phallus was a figure of the virile member, which was carried about
485
- at the festival of _Bacchus_ as a symbol of the generative powers of
486
- nature. The _Athenians_, who refused to show proper respect to Phallus,
487
- were punished by Bacchus with a severe disease of the penis. Such may
488
- be concluded from the “_History of the Phallus in Greece_.” Priapus
489
- is now supposed to have been a venereal specialist, differing in no
490
- respect from such modern specialists, to whom, it is said, votive
491
- offerings were donated, and his great skill caused him to be worshipped
492
- and deified; hence the term priapismus, which is commonly applied to
493
- morbid erections, so frequently occurring in gonorrhœa and paralysis
494
- of the insane, and which is also applied to the active stage of the
495
- condition otherwise known as satyriasis.
496
-
497
-
498
-
499
-
500
- CHAPTER III.
501
-
502
-
503
- _Onanism._――I have adopted the term Onanism, more especially to
504
- illustrate a class of conjugal sins, and shall not use it, as generally
505
- applied, as a synonym for masturbation, but will define the term as it
506
- should be used. That the meaning of the word may be fully understood I
507
- will quote the two verses from _Genesis_ xxxviii, 8, 9:
508
-
509
- “And Judah said unto Onan, go in unto thy brother’s wife, and
510
- marry her, and raise up seed to thy brother.
511
-
512
- “And Onan knew that the seed should not be his. And it came to
513
- pass, when he went in unto his brother’s wife, that he spilled
514
- _it_ on the ground, lest that he should give seed to his
515
- brother.”
516
-
517
- It must not be supposed that Onan used his hand to facilitate an
518
- emission, but that he simply withdrew his penis and allowed the semen
519
- to be lost on the ground, to prevent conception. Onanism is practised
520
- more at the present day by married males than may at first be imagined.
521
- It is the commonest of all means used as a preventive of conception.
522
- The majority of so-called society women are wives of men who practice
523
- Onanism. The word has come to signify masturbation, or any intentional
524
- process of wasting the seminal fluid. But I have preferred its use
525
- here as it explains a practice which I have no other word for. The very
526
- common practice of withdrawing the organ before ejaculation is often
527
- a very hurtful one, as the orgasm is often incomplete, and there are
528
- more satisfactory ways of accomplishing what is intended by such a
529
- practice. Under the strict signification of the term, a child cannot
530
- be an Onanist, until after puberty, but he may be a masturbator. A
531
- woman cannot properly be called an Onaness, but she may masturbate
532
- nevertheless. To present, in a true light, this conjugal vice, I
533
- excerpt, from the _Ohio Med. and Surg. Reporter_, the following most
534
- excellent paragraph, which illustrates in the pithy and elegant style
535
- that speaks volumes of argument, and should be a lasting hint to
536
- cultured and scientific students in the learned profession of medicine:
537
-
538
- “The sexual instinct has been given to man for the perpetuation
539
- of his species; but in order to refine this gift and set
540
- limits to its abuse, it has been wisely ordered that a purely
541
- intellectual quality――that of love――should find its most
542
- passionate expression in the gratification of this instinct.
543
- Dissociate the one from the other, and man sinks below the
544
- level of a brute. Destroy the reciprocity of the union, and
545
- marriage is no longer an equal partnership, but a sensual
546
- usurpation on the one side and a loathsome submission on the
547
- other. Consider the moral effects of such shameful manœuvres:
548
- wedlock lapses into licentiousness; the wife is degraded
549
- into a mistress; love and affection change into aversion and
550
- hate. Without suffering some penalty, man cannot disturb
551
- the conditions of his well-being or trespass beyond its
552
- limitations. Let him traverse her physical laws and Nature
553
- exacts a forfeit: dare he violate his moral obligations, an
554
- offended Deity stands ready to avenge them. That this law
555
- is immutable, witness, from the history read to you, the
556
- estrangement between the husband and wife; witness his ill
557
- health and ill temper, and the wreck of body and mind to which
558
- she has been reduced.”
559
-
560
- Again, from the _Medical Advance_ for 1876, we find the following
561
- language written by Dr. Arnalt:
562
-
563
- “There is one phase of sexual depravity to which I would, in
564
- passing, call your attention.
565
-
566
- “We are fully aware of the many devices used to avoid
567
- impregnation. It may be well to remember that such desires may,
568
- under certain circumstances, be excusable; but let us never
569
- forget the fact that generally they are conceived in iniquity.
570
-
571
- “Of the many ways of avoiding possible conception, there is one
572
- so filthy, mean and degrading, and fraught with such fearfully
573
- disastrous consequences to health, that I make special mention
574
- of it. I have reference to the practice of withdrawing the male
575
- organ from the vagina before the completion of the embrace.
576
-
577
- “But when man brings to the marriage-bed so foul a nature that
578
- he can repeatedly and constantly perpetrate such an outrage
579
- upon nature’s most precious gifts, he places himself at once
580
- beyond the desert of human sympathy.
581
-
582
- “Just imagine, if you please, man and woman in the act of
583
- cohabitation; their brain reeling under the powerful stimulus
584
- of that all-pervading passion; the heart’s action increased
585
- to a high state of intensity; the whole system, with all the
586
- energy it is capable of exciting, getting ready for that
587
- great act of reproduction; and just as the act is about to be
588
- completed, when the soul of the man can almost feel and grasp
589
- that of the woman, the evil genius of lust, being more of a
590
- fool than a knave, must dash to the ground the chalice filled
591
- with ambrosia of purest bliss, if tasted with a pure lip; must
592
- turn into the vilest poison the sweetest and holiest gift of
593
- nature to man.
594
-
595
- “Why, I have wondered, long and often, that man could sink so
596
- low, be so foolish. Just conceive of the intensity of such a
597
- shock upon the system, and then have this repeated time after
598
- time, year after year. Why there are married people who never
599
- once, in all their married life, completely and unreservedly
600
- finished the act of cohabitation.
601
-
602
- “No wonder that nervousness, peevishness, and all kinds of
603
- distempers show themselves. No wonder we get spermatorrhœa and
604
- impotence in the male, and a perfect host of troubles, insanity
605
- included, in the woman. No wonder homes are broken up and human
606
- lives made desolate.”
607
-
608
-
609
-
610
-
611
- CHAPTER IV.
612
-
613
-
614
- _Masturbation._――Under this caption will I proceed with the topic of
615
- self-abuse; as this term more properly covers the vice of both sexes,
616
- as well as of childhood.
617
-
618
- The small boy, only four years of age, will often titilate his genitals
619
- until the prepuce has become inflamed and swollen. In this undeveloped
620
- and delicate condition of the genitalia, more harm may be accomplished
621
- than could be imagined. Nurse-girls, sometimes, for the purpose of
622
- quieting a child, will titilate its genital organs; which is quite
623
- sufficient to lead the child to manipulate its own organs as it goes on
624
- in age and development. Often a feeble state of health in the child,
625
- will cause the mother to consult a physician; and the genitalia will
626
- show signs of irritation; and when the true nature of the difficulty
627
- is revealed to the mother, it will be much to her surprise, and
628
- often, disgust; and she will not be convinced beyond a doubt until by
629
- constantly watching, she has observed actions more convincing than the
630
- doctor’s hints.
631
-
632
- Boys at school teach each other to perform this manual pollution; and
633
- vile servants initiate small boys at a surprisingly early period. I
634
- have often gained the confidence of these little ones, and learned
635
- things more astounding than amusing. Not long since a boy only eight
636
- years of age convinced me, by his confidential description of his
637
- little vice, that he realized passion, erection, and as he called
638
- it the “goodie feeling” (orgasm); which was evidently the sensation
639
- without emission of semen. No small amount of injury is done to the
640
- nervous system by the constant titilation of the undeveloped genitalia;
641
- and as the habit passes on to the puberty-stage of adolescence, the
642
- novelty of the first ejaculation affords great and frequent amusement
643
- to the child, and he pursues it as often as he can obtain an obscure
644
- corner. This must be the time that the greatest harm is wrought upon
645
- the brain and spinal cord. The first five years succeeding puberty, the
646
- vice is carried on with great energy in a vigorous youth. Doubtless,
647
- the majority of boys have practiced masturbation, to some extent, some
648
- time during adolescence, but as they arrive at the age of discretion,
649
- become disgusted; or some influential person frightens them, and they
650
- quit the practice. Where it has only been an occasional indulgence, no
651
- lasting injury has occurred.
652
-
653
- Masturbation is practiced among men, not so much to the injury of their
654
- physical structure, but it is nevertheless a common vice. Miserly
655
- bachelors, hermits, and often widowers resort to self-pollution
656
- when financial affairs prevent their visiting houses of ill fame. I
657
- am credibly informed that the vice of self-pollution, by the hand,
658
- prevails largely among soldiers, as well as in convents, and public
659
- schools.
660
-
661
- _Pollution Among Females._――This is less common in childhood than in
662
- the male. Small girls are naturally more modest than small boys: they
663
- will not so readily fall into such vices, as they do not readily submit
664
- to having their genital organs manipulated; they therefore remain
665
- comparatively free until puberty, and often later; and then the habit
666
- is not common, but occasionally exists. With the limited opportunities
667
- for finding out such things, it will undoubtedly be long before an
668
- estimate, as to the extent that it prevails, can be made. I cannot
669
- better continue this subject, than by giving a case which is typical
670
- of many adult cases that I have observed in this peculiar and delicate
671
- role of physician; and it is not a “cooked” case, but one in actual
672
- life, which cannot be fully portrayed by type or word:
673
-
674
- Mrs. X. visited me professionally; aged 28; mother of three children;
675
- been married nine years; spare, dark hair and eyes, rather brilliant;
676
- small of stature; retiring and confiding of disposition. She was very
677
- neurasthenic and excitable; never hysterical; bowels constipated. I
678
- prescribed all kinds of treatment for her during the first six weeks,
679
- after which time, as I had failed to find out anything that might be a
680
- cause for such a peculiar nervousness, I suggested an examination _per
681
- vaginam_. As soon as my finger reached the orifice of the vagina, I
682
- was convinced that my case was a sexual one, as a nervous, passionate
683
- shiver ran over her; but she soon controlled herself, and I proceeded
684
- with my examination, with the discovery of only slight general
685
- irritation. She then gave me the following account of her married life
686
- and condition. She was married at nineteen, a robust, vigorous girl.
687
- Her husband was amorous and ignorant of her requirements; would soon
688
- satisfy his desires and go to sleep, when she had but just become
689
- excited; but when her erotic excitement was aroused she had no control
690
- of it: would remain wakeful during the entire night, with the husband
691
- sleeping, regardless of her condition. She finally learned to use a
692
- clothes-pin, by which means she could appease her burning and bring
693
- about an orgasm. She says that she could then sleep. She of late had
694
- consented to the advancements of a prominent lawyer; but she was
695
- conscience-stricken and desired, if possible, to be a “good woman;” but
696
- was satisfied that, to be a virtuous woman, she must remain away from
697
- her husband, so that her passion never would be beyond her control. I
698
- immediately, after her departure, sent for the husband, and informed
699
- him how to perform the marital connection, and that, if he desired that
700
- his wife should become a well woman, he must adhere to my instructions.
701
- He was glad of the information, and was successful in his efforts. She
702
- was soon free from her troublesome neurasthenia, and beatitude prevails
703
- to this day; and, I believe, she is as virtuous and worthy a woman as a
704
- man deserves.
705
-
706
- Women use tallow candles, clothes-pins, and other commodious means,
707
- such as friction over the pubes, titilations of the clitoris, etc., for
708
- the purpose of exciting erotic energy and sexual orgasm. The nervous
709
- excitement which is wrought, is not unlike shock, from general causes;
710
- yet, when frequently brought about, may produce an over-stimulation,
711
- followed by relaxation and general weakness of the nervous system, or a
712
- neurasthenia, advancing to hysteria and organic disease of the nervous
713
- system. Various devices have been resorted to to overcome the habit of
714
- masturbation. Such things may be of service in children, but in adults
715
- moral treatment alone is of any value; and as to any appliances and
716
- devices I have nothing new to offer. The old means of blistering, tying
717
- the hands, etc., may be resorted to with children, by those who have
718
- confidence in their efficacy. In adults, matrimony will often do good,
719
- when the habit is in its incipiency; but in an advanced stage it is of
720
- little benefit.
721
-
722
- The great variety of unnatural ways of gratifying the sexual passion
723
- is only an evidence of human depravity; and the entailed diseases must
724
- be unreservedly studied, that, as much as possible, these abominable
725
- conditions may be confined within a certain limit, which should be
726
- legally set apart and licensed, that the chaste and elevated portions
727
- of society may find protection.
728
-
729
- These conditions all exist: there is no remedy to abort or expunge
730
- them; and the numerous diseases, growing out of this great depravity
731
- and mismanagement of the sexual, must all be duly considered, by the
732
- medical man, as predisposing and exciting causes of neurine maladies.
733
- To prevent the spread of disease, should be the chief aim of every
734
- humane citizen, and more especially the physician. Much is said in
735
- regard to means and legislation to prohibit the spread of venereal
736
- disease; but the nervous diseases caused by sexual debauch and
737
- mismanagement are of equal importance and as devastating to the race.
738
-
739
- If we can give credence to what Dr. S. W. Gross says, in the May
740
- number, 1877, _Medical and Surgical Reporter_, of Philadelphia,
741
- masturbation has, in his cases, caused fifteen out of nineteen cases
742
- of urethral stricture, while four were caused by gonorrhœa. I am not
743
- aware of any such proportions reported by any other authority, yet I am
744
- thoroughly convinced that masturbation has existed in a great majority
745
- of cases of urethral stricture, and in many such cases has been a
746
- cause, primarily or secondarily. It is not far from true to say, that
747
- a large proportion of masturbators, of advanced age, have a general
748
- contraction of the entire urethral canal and a diminished dilatability.
749
- Purulent discharges and abscesses are not uncommon along the course of
750
- the urethra and prostate gland, followed by folicular disintegration
751
- and perforation.
752
-
753
- _The Effect of Sexual Excesses upon the Neural Axis as a Cause of
754
- Organic Disease._――“_Sexual excesses_ and _Onanism_ are certainly of no
755
- slight significance, at least in the development of a predisposition
756
- to tabes.” (Erb.) Again, in speaking of causes in general of spinal
757
- disease, the same author says: (P. 147, Ziemssen’s Cyclopœdia, vol.
758
- XIII.)
759
-
760
- “Of these (causes) _sexual excesses_ and _irregularities_
761
- occupy the first place. * * * * I believe we may say that
762
- _any gratification of the sexual passions, whether natural or
763
- unnatural, indulged in to an excess and for a long time, forms
764
- for many men――not for all――a circumstance that powerfully
765
- depresses the spinal cord and predisposes it to disease_.” * *
766
- * *
767
-
768
- “_Excessive natural coitus_, in many persons, certainly
769
- produces symptoms which point to a weakness and a diminished
770
- functional capacity on the part of the spinal cord; weakness of
771
- the legs, inability to stand for a long time, trembling when
772
- forcible movements are made, pains in the back, shooting pains
773
- in the legs, sleeplessness, etc. This may often be noticed in
774
- the newly married, or in persons who have indulged in great
775
- excess for a short time. If the cause of these symptoms soon
776
- disappears, the injury may in most cases be quickly repaired;
777
- but if the excesses are continued, further injury, or even
778
- positive disease, occurs. Any external injury, exposure to
779
- cold, excessive walking, etc., may then bring on the worst
780
- results.”
781
-
782
-
783
-
784
-
785
- CHAPTER V.
786
-
787
-
788
- _Copulation――Physiology and Social Attributes._――With the male, the
789
- condition essential to coition is erection of the penis; which is
790
- physiologically accomplished by fostering amative thoughts, and by
791
- attitudes favorable to the stimulation of the erotic desire; as in
792
- close proximity with one of the opposite sex. A voluptuous female
793
- figure may excite the erotic instinct of an amative male in vigorous
794
- health, even though he be chaste in his intentions and habits.
795
- Individuals are isolated whose amative passions are entirely under
796
- the will, when in perfect health, of either sex. The act of coition
797
- is entirely under the will, in all healthy, well-organized human
798
- beings; but it is not uncommon that a man or woman is observed who is
799
- not responsible for acts during erotic excitement. Such are either
800
- victims of mal-organization or a sexual delirium. Many an act has been
801
- committed during such delirium or excitement, on account of which an
802
- individual has grieved her life away, or sought the only refuge that
803
- could hide her life from shame; the victim’s grave, the river: yes,
804
- a victim to sexual delirium or uncontrollable sexual passion. This
805
- innate desire is the usual instigation of copulation, and has been said
806
- to be the index to the presence of spermatozoa within the vesiculæ
807
- seminales.
808
-
809
- Copulation may take place in the female before puberty or after
810
- the climacteric period; but in neither will the sexual congress
811
- be fruitful. Then, if the signification be confined to fruitful
812
- contact, there would seem to be a marital discrepancy between the
813
- male and female; as in the female we observe only thirty years of her
814
- existence in which it is possible for sexual congress to be followed
815
- by conception; while the male, from puberty to very old age, may be
816
- fruitful, if placed in conjunction with a female at the proper age.
817
- Nature, being rather wise in this respect, has not deprived the female
818
- of her sexual passion and pleasure at the limit of her fructification
819
- period.
820
-
821
- Perfect coitus is not essential to impregnation; as many authenticated
822
- cases are on record in which intromission had not taken place, as
823
- evidenced by an unruptured hymen, where only it was possible for the
824
- semen to come in contact with the sphincter vaginæ; and impregnation
825
- and conception followed. Only by contrasting natural with abnormal
826
- coition, is it possible for us to comprehend how much one subject
827
- has to do in causing nervous diseases; and not to advocate that
828
- normal coition――which refers to time as much as manner――produces many
829
- permanent morbid changes.
830
-
831
- _Copulation, practiced in moderation, is conducive to domestic felicity
832
- only when both parties to the marriage contract are in a state of
833
- health sexually._ This excludes sexual contact in too close proximity
834
- to the menstrual crisis, and whenever the female is not in a condition
835
- to appreciate the act, and that her condition and will should be
836
- considered and respected, and man at all times should consult her
837
- pleasure.
838
-
839
- For further information on the physiology of copulation, I must refer
840
- the reader to _Flint’s Human Physiology_, where it is treated of in an
841
- exhaustive manner. But there are many points of interest that are not
842
- alone physiological, that may well be discussed and belong especially
843
- to our subject.
844
-
845
- There seems to be a chosen time for fruitful coition with all
846
- animals. With the human race this is only partially true. The female,
847
- it is said, begins her period of breeding usually at fourteen and
848
- discontinues at forty-five; yet there are intermediate periods
849
- when copulation will not usually prove fruitful, viz., that period
850
- beginning the fourteenth day after menstruation, and ending with the
851
- next menstrual flow. This rule is not valid; as many times, in my own
852
- observation, have I known women to conceive at any and all times during
853
- her period of breeding. Even cases have occurred where the period
854
- of menstruation was not confined to the usual time of life; or the
855
- “second life” may appear, as in the following case which came under my
856
- observation some years since:
857
-
858
- A Mrs. H. ceased menstruating at 52, was free from menstrual flow
859
- until 71 years of age, and then menstruated regularly (a perfect
860
- menstrual flow), every 40 days, until she died at the age of 76. She
861
- possessed the erotic desire and enjoyed coition. Her husband died two
862
- years before she did. She became confused in religious doctrines after
863
- her husband’s death; was melancholy and fond of isolation; committed
864
- suicide by hanging herself to her bedpost. I assisted in cutting the
865
- scarf and learned all particulars of her past life from friends and her
866
- physician.
867
-
868
- Many cases are on record of females menstruating at very early periods.
869
- As to these discharges being indicative of the reproductive stage, much
870
- doubt may be expressed. It is very common for the male to retain his
871
- virility to a very advanced age. I am acquainted with an octogenarian,
872
- who married a young girl of nineteen, whose copulation was fruitful
873
- and the child healthy. This is doubtless not so very uncommon, in
874
- proportion to the circumstances offered for a test.
875
-
876
- We would naturally conclude that, on account of prostitution and
877
- debauch, it was necessary that marriage become a legally organized
878
- institution. There is no evidence that in early history marriage
879
- was any more than a choice, the consummation of which was simply the
880
- invocation of a superhuman or divine watch-care; that they were bound
881
- in wedlock, not by statute law, but by a superstitious belief and
882
- natural selection. Natural selection was more cultivated and was a
883
- better guidance than in modern times, when law governs the joining and
884
- casting asunder. Copulation is the key to morality and society. So
885
- certain bonds of restriction and moral government of a social character
886
- exist, and they are made to restrain human beings and to control
887
- and limit copulation to a legitimate sphere; viz., man and wife.
888
- Any deviation from this legitimate course has long been denominated
889
- prostitution, which exists in public and private.
890
-
891
- The vice of changing partners has become so open and for such trivial
892
- causes that laws have been enacted, of the most rigid character, and
893
- then divorcing and remarrying are carried on to an alarming extent.
894
- These are only the attributes of copulation and erotic desire.
895
-
896
- Natural copulative affinity constitutes the bond of chaste affection
897
- that holds together a man and wife in harmony and love. Parties, male
898
- and female, have existed just as happily during life, when marriage
899
- vows had never been solemnized and legalized by other than natural
900
- copulative affinity. This sexual affinity constitutes more than
901
- mere admiration, or transient passion or erotic anxiety: everlasting
902
- contentment and felicity will follow such natural adaptation. Some are
903
- contented in wedlock, as they possess submissive dispositions, who are
904
- not adapted by copulative affinity.
905
-
906
- Society is partial in her endowments and liberties bestowed upon the
907
- sexes. The male enjoys favors at the hands of society not permitted the
908
- female. For this, on account of her innate propensities, the female
909
- is responsible. She will expunge a female from her circle of society
910
- for that for which she will sustain the male. She will encourage
911
- insults from man, and cry for woman’s rights, and against masculine
912
- maltreatment. She will receive, with open arms, the young father of a
913
- prospective bastard, and commit the equal participant, and prospective,
914
- victimized mother, whose sins can only be equal to those of the father,
915
- to a dungeon, or permit her to accept a life of shame by refusing her
916
- entrance at the threshold.
917
-
918
- If these are the privileges of modern society _now_, what would women
919
- do with the fallen ones of their sex had they things as they so much
920
- desire, in “woman’s rights” circles? Every female who had made a
921
- mistake (that should become known) would be tortured at the rack, or
922
- murdered; and few would there be left to tell the tale. The moral
923
- beginning must be with woman. She must not offer premiums for male
924
- licentiousness, and must encourage her fallen sisters to “sin no
925
- more.” She must protect her own sex by showing forgiveness, as well
926
- as censuring. So far as effecting any change, moral teaching is of
927
- the greatest vanity. But these things are not looked upon in their
928
- true light. Sexualists discuss these subjects, who do not appreciate
929
- the first principles of sexual physiology; who do not comprehend that
930
- the sexual relation in itself is the very essence of deception, as of
931
- secrecy. The cunning devices of both male and female are exhausted by
932
- efforts at assignation and debauch. The greater the legal restriction
933
- the greater the deception. The more common, open and generous our
934
- society becomes, the better will be its constituents.
935
-
936
-
937
-
938
-
939
- CHAPTER VI.
940
-
941
-
942
- _Nymphomania._――The most deplorable condition of all, to which the
943
- female is subject, is the uncontrollable, maniacal, erotic desire,
944
- called nymphomania. The disease is fortunately rare, and commonly
945
- makes its appearance at, or soon after puberty, but has been observed
946
- in adult and married women. Of the six cases that have come under my
947
- observation, one was a married woman, the mother of children, four were
948
- girls at puberty and one, which will be hereafter reported, aged 19
949
- years.
950
-
951
- In the commencement the sufferer is a prey to perpetual contest between
952
- feelings of modesty and impetuous desires. At an after period she
953
- abandons herself to the latter, seeking no longer to restrain them. In
954
- the last stage the obscenity is disgusting; and the mental alienation,
955
- for such it is, becomes complete. The cause is often obscure, but when
956
- known has been undue irritation, by titilation of the genitals, or
957
- anything that would cause turgescence. The disease is apparently local
958
- in the beginning, but seems to affect the entire nervous organization,
959
- through reflex excitation.
960
-
961
- The clitoris, by some, is supposed to be the seat of irritation, and
962
- has been amputated or cauterized, but without generally effecting
963
- any relief. The disease is not generally confined to any particular
964
- locality of the genitals. If allowed, the patient will take the hand of
965
- the male and place it upon the _mons veneris_, and it is only by force
966
- that she will allow it to be taken away. She cannot locate the seat
967
- of pleasure, but will say that the entire surface touched contributes
968
- to the venereal excitement. Another peculiar feature is, that she
969
- obtains no satisfaction from venereal orgasm; but on the contrary it
970
- adds to her maniacal conduct and obscenity. She is not in any manner
971
- responsible for her conduct, and no punishment will cause her to
972
- desist. Everything is sacrificed that is feminine, for that which is
973
- disgusting and vulgar. The more modest she has been in health, the
974
- more obscene she is likely to become in her venereal frenzy. What the
975
- final result would be, without treatment, I have never witnessed, but
976
- must conclude that lunacy would soon be prominent and probably suicide.
977
- There is no tendency to recovery, but to continue from bad to worse,
978
- until publicity is no restraint to the obscenity and indecent conduct
979
- of the victim.
980
-
981
- _Case._――Nymphomania, with nocturnal involuntary orgasm. Miss U.――She
982
- was aged 19, very small in stature, only weighing 90 pounds, of very
983
- respectable family and herself perfectly respectable. She was refused
984
- by her probable “intended,” who had discovered signs entirely unnatural
985
- for her, in whom he had placed implicit trust. When the condition was
986
- first manifested in her, the intended, not thinking of anything wrong
987
- on her part, attempted to gratify her morbid erotic desire by coition,
988
- which only made her, as he said, “nearly crazy.” She had heretofore
989
- been modest and distant, but now she was on his lap, and all over him
990
- or leading him to a place of decumbiture. When she visited my office,
991
- and imparted to me her whole confidence, my first treatment toward
992
- her was so rigid and distant that my examination revealed the parts
993
- before orgasm had taken place; but as soon as I touched the nymphæ;
994
- they became lubricated with a thin viscid fluid which was profuse. At
995
- first the clitoris and nymphæ were red, dry and hot; but as my digit
996
- came in contact with the soft parts, she forgot the rough treatment
997
- and my cold conduct toward her, which I had assumed to prevent, if
998
- possible, her venereal crisis, and she became unmanageable for the
999
- time, until she had passed three or four orgasms, as I supposed, one
1000
- immediately following the other, when she became more governable. To
1001
- carefully portray in words what she said and did would be shocking to
1002
- a fastidious doctor. With a speculum in the vagina the os uteri would
1003
- contract and dilate in alternation, and undergo orgasms in rapid
1004
- succession, with only a few seconds interval. She begged of me not to
1005
- withdraw the instrument, but when I had completed my examination she
1006
- was partially exhausted and docile. I could discover a mucoid fluid
1007
- emitting from the os uteri which evolved a strong venereal odor.
1008
-
1009
- She informed me that she had voluptuous dreams nightly――as many as
1010
- three in a night. Her figure is small and round, eyes black, hair coal
1011
- black, countenance very sallow and chlorotic. She seemed to know that
1012
- this condition was not right, but her modesty was entirely gone, when
1013
- in company with a male. The presence of a woman restrained her. Her
1014
- own mother had not determined the true nature of her difficulty, only
1015
- noticed that something was peculiar with her daughter. The patient had
1016
- judgment enough left to go out of the room and isolate herself when a
1017
- man would come about. The advent of this disease she says was first
1018
- known by a peculiar thrill at the sight of a male, which became more
1019
- aggravated from day to day. Now, one year has she suffered from this
1020
- intolerable mania.
1021
-
1022
- To pass over and not give the treatment would leave the case quite
1023
- incomplete.
1024
-
1025
- _Treatment._――I directed monobromated camph., in two gr. pills, one
1026
- every 4 hours, with formula No. 1, as directed; ice-water to the vulva
1027
- nights, with daily applications of Faradisation by placing a wetted
1028
- sponge upon a chair with the patient seated upon it, to which the
1029
- negative pole is attached; used the positive in my left hand, with my
1030
- right hand applied to the head and down the spine. Improvement took
1031
- place from the beginning, and in forty days she was quite herself.
1032
- She was improved in flesh, color and strength. In two months she was
1033
- so modest that I could scarce gather courage to ask her if she was
1034
- yet troubled with any signs of her old affliction. I could not obtain
1035
- consent to make another physical examination, and she remains well,
1036
- but is continuing to take the medicine, from formula No. 1. She has
1037
- strength of will, I am informed by her “intended,” to refuse any degree
1038
- of proximity. He says, “It seems like a dream. I am learning to court
1039
- her over again, and succeed very slowly. She is so distant.”
1040
-
1041
- The two cases reported by Prof. S. H. Potter in the April number of
1042
- _Am. Med. Journal_, 1876, do not overdraw the picture, any one will
1043
- testify who has had a few of these perplexing patients to manage.
1044
-
1045
- “Miss M. T., age 18 years, of sanguine temperament, quite
1046
- corpulent for her age, a wealthy farmer’s daughter,
1047
- distinguished for her modesty, intelligence, prudence and good
1048
- social qualities.
1049
-
1050
- “_History._――In the hot weather of August, the writer was
1051
- called 15 miles to consult with Dr. A., the family physician of
1052
- Mr. T. About three weeks prior to this, Miss T. had suddenly
1053
- exhibited paroxysms of uncontrollable desire for coition.
1054
- When any young gentleman chanced to call upon the family, she
1055
- would elevate her apparel under her arms, approach and attempt
1056
- an embrace in the most lascivious manner, until forced to
1057
- desist by the interference of the overpowering strength of the
1058
- persons present. At first these scenes were at intervals, with
1059
- intervening times of great dejection, gloominess and silence.
1060
- The father being of rather a superstitious nature, thought her
1061
- ‘possessed of the devil,’ and resorted to repeated and severe
1062
- flagellations without effecting any perceptible reform. During
1063
- the last week her excitement had been almost continuous, and
1064
- she had been confined to and locked in her room. It may well be
1065
- supposed that the case had excited the entire neighborhood to
1066
- wonder and amazement, and in some of the more thoughtful, deep
1067
- sympathy, and through their advice the physician was called.
1068
-
1069
- “Examination with a glass speculum showed an irritating fluid
1070
- oozing from the os uteri; the whole surface of the vagina,
1071
- the nymphæ clitoris and the vulva were suffering from active
1072
- congestion. Exalted general sensation was apparent, and the
1073
- slightest touch of the internal labia or clitoris produced the
1074
- most exquisite amorous excitement――an uncontrollable mania.
1075
-
1076
- “_Case II._――Was called to see Mrs. F., of this city, September
1077
- last, age 30, a grass widow by third marriage. Found her in
1078
- violent hysterical spasms, with usual accompanying symptoms.
1079
- Her aunt, with whom she was then visiting, gave the following:
1080
-
1081
- “_History of the Case._――For some time past she had exhibited
1082
- lasciviousness; had to be kept under surveillance; to-day
1083
- the aunt had ‘been out shopping;’ on coming home she found
1084
- her niece in a sequestered place with exposed nudity quite
1085
- shocking, and using persistent artifice to effect coition with
1086
- a canine Newfoundlander. The aunt so rashly interposed, that
1087
- the niece ‘went into alarming and persistent spasms.’”
1088
-
1089
- Dr. Potter further says that examination showed this case to be one of
1090
- nymphomania, relying upon the turgescence of the clitoris and nymphæ
1091
- and ichorous discharge from the os uteri as diagnostic.
1092
-
1093
- It may be remarked that such turgescence not uncommonly produces an
1094
- exalted erotic desire which is analogous to turgescence of the urethra
1095
- in the male, manifested in gonorrhœal priapism.
1096
-
1097
- Such irritations are not always peripheral in origin, as may be
1098
- supposed, but more commonly a general neurasthenia, or at times a
1099
- spinal turgescence, which qualifies the genitals for any disturbing
1100
- titilations that come along. This may seem more evident, when it is
1101
- once considered, that a hyperæmia of the nymphæ and clitoris may and
1102
- has often existed and no nymphomania; and if the peculiar centric
1103
- condition does not first exist, there will be no local venereal
1104
- turgescence of the genitalia.
1105
-
1106
- Ovarian and uterine disease may produce first, a determination of
1107
- blood to the cord, and then, by slight irritation of the vulva, the
1108
- condition, nymphomania, may be established. Such is perhaps the most
1109
- common cause; and the more have we reason to conclude so, from the
1110
- fact, that the majority of these cases appear soon after puberty, when
1111
- the first crisis of femininity has wrought its effect upon the uterus
1112
- and ovaries. At such times is self-pollution most likely to produce a
1113
- striking impression upon those organs, and most likely to bring about
1114
- nervous shock by calling a superabundance of liquor-sanguinis to the
1115
- developing genitalia and reproductive organs. This shock is sometimes
1116
- so apparent that fainting results and alarming symptoms follow. To
1117
- relate a case will the better illustrate what may sometimes occur.
1118
-
1119
- _Case._――Miss E. H., under the following peculiar circumstances, I
1120
- was informed, needed my services, as it was known that I was the
1121
- physician of her family. A young man, whom I well knew, came after me
1122
- and returned with me to the house, and during our ride, he related the
1123
- following story, to which I had reason to give entire credit:
1124
-
1125
- The young man and the patient were “sitting up” with a sick lady.
1126
- During the night, when all was quiet, the young man had taken the
1127
- liberty to place his hand upon the genitalia of Miss H., when he
1128
- noticed that she rolled her eyes in rather a peculiar manner which he
1129
- considered only submission, as she leaned toward him in a very passive
1130
- manner. He took her in his arms and placed her on a couch, replaced his
1131
- hand, introducing his finger into the vagina, when he became alarmed at
1132
- seeing her froth at the mouth, with slight muscular twitchings of the
1133
- eyes and mouth. He attempted to arouse her, but failed and, becoming
1134
- still more frightened, called the family, and hastened to my office.
1135
-
1136
- I found the patient, Miss H., who was aged 18, fleshy (her weight was
1137
- 150 pounds), had been a very healthy girl, of an excellent family, and
1138
- rather pleasant in disposition. She had always been very modest and
1139
- retiring; had rosy cheeks, black hair and eyes. She was then in a very
1140
- delirious state, with pupils contracted, face flushed, no cramping,
1141
- feet cold; head very hot, with occasional epileptiform movements of the
1142
- eyes and mouth; biting the tongue and frothing at the mouth; twitching
1143
- of the facial muscles and sphincters. I informed an old lady that I
1144
- suspected some private trouble and invited her _only_, to remain in
1145
- the room while I made an external inspection, which only gave me the
1146
- satisfaction of knowing that nothing was the matter with her genitals,
1147
- and that the young man had not deceived me and effected intromission,
1148
- as the hymen was perfect.
1149
-
1150
- A large dose of chloral hydrate produced quietude for the night, and I
1151
- ordered her to be taken home as soon as she was rested by sleep.
1152
-
1153
- I visited her the next morning at her own home. She was conscious, with
1154
- pulse at 120; temperature, 102; pupils contracted, and face flushed;
1155
- skin dry; tongue dry and red; asking for water often; head drawn back;
1156
- throbbing of the carotids, with spasms of the dorsal and posterior
1157
- cervical muscles.
1158
-
1159
- She had never been sick, and she had never been of a nervous habit; and
1160
- such a condition was entirely unexpected. There was no epidemic of such
1161
- a character, and no accountable cause except that given. Her case was
1162
- of an inflammatory type and lasted twenty-one days.
1163
-
1164
- Treated by large doses of gelseminum, veratrum viride, and quinine when
1165
- safe. The case was a sthenic one throughout, a meningitis without a
1166
- doubt, and no cause but venereal shock.
1167
-
1168
- When she recovered I asked her if she remembered what occurred during
1169
- the night of her falling sick, and she flushed, but finally confessed
1170
- knowing when he put his hand upon her genitalia, when she thought she
1171
- fainted; but casually remarked, “I don’t understand it, but I had no
1172
- power to prevent him doing so.”
1173
-
1174
- The young man again informed me that his hand was upon the vulva,
1175
- perhaps a minute, when he noticed a strange expression on her
1176
- countenance.
1177
-
1178
- The shock did not occur at or near her menstrual period, and she
1179
- menstruated during convalescence, which her mother informed me was a
1180
- period six weeks from her previous time. She never entirely recovered
1181
- her mental vigor, and remained single till three years ago, when she
1182
- married, and all has gone well.
1183
-
1184
- The shock can only be attributed to that susceptibility to nervous
1185
- impressions so common to the female reproductive organs in the stage of
1186
- development. There is a strong probability that had this nervous shock
1187
- been less impressive in character and more prolonged, a nymphomania
1188
- might have occurred.
1189
-
1190
-
1191
-
1192
-
1193
- CHAPTER VII.
1194
-
1195
-
1196
- _Satyriasis._――Not the female _only_, suffers from an ungovernable
1197
- venereal desire, but the male also is, at times, the subject of a
1198
- disease, analogous to nymphomania of the female. Such is the disease
1199
- termed satyriasis. A young married man says to me, in the following
1200
- forcible language, “My penis is stiff all night. I can’t let my wife
1201
- rest, and she is nearly dead, and I am tired out myself; but as soon as
1202
- I see a woman, my penis rears up like the proud standard of Wellington.
1203
- What shall I do?” His penis became erect while I was examining it. I
1204
- could not see anything unnatural, only it was enormously large. He
1205
- had not been a debauché, neither had he masturbated to any degree
1206
- of injury. There was no spermatorrhœa. He said that it required a
1207
- more than ordinarily long time to bring about venereal orgasm, after
1208
- which erection would remain in situ until he went to the hydrant and
1209
- drenched his penis in cold water; but as soon as he went back to bed
1210
- with his wife his penis would become erect immediately. He had suffered
1211
- a month in this manner. He had not been a very amorous man before
1212
- this, but confessed having obtained and enjoyed a usually temperate
1213
- allowance previous to marriage. This patient had always been of a
1214
- robust appearance, but when he consulted me was beginning to look worn
1215
- and anxious, with sunken eyes from want of sleep and mental unrest. He
1216
- suffered from pain in his back, head and through his lumbar spine. Deep
1217
- pressure revealed tenderness over sacrum and last lumbar vertebra. His
1218
- general symptoms were those of spinal hyperæmia.
1219
-
1220
- _Treatment._――Bromide potassium, grs. xx, 3 times a day, with general
1221
- Faradisation and central galvanization (after the method of Beard &
1222
- Rockwell), soon gave him relief, and after ten applications no more
1223
- difficulty was experienced; but a number of months was required before
1224
- his general health was restored.
1225
-
1226
- The symptoms of spinal hyperæmia were very prominent in this case,
1227
- viz., pain in the cord, not affected by digital pressure, increased
1228
- by lying down and diminished by sitting. His erections were not
1229
- troublesome, only when he was in bed lying on his back: this point it
1230
- will be well to remember. Many of the symptoms so commonly existing in
1231
- spinal hyperæmia are absent.
1232
-
1233
- Many cases occur of a peripheral origin, from inflammation of the
1234
- mucous membrane of the urethra or prepuce. Gonorrhœa commonly causes
1235
- a peripheral satyriasis; but this soon passes away and is of minor
1236
- importance compared to the disease which is intended as the premise
1237
- of this chapter. Morbid erections appear without erotic desire, and
1238
- peripheral causes commonly give rise to this condition. It may not
1239
- be properly considered a disease, as it is so commonly symptomatic
1240
- of spinal hyperæmia. And never, as yet, have I observed this morbid
1241
- exaltation of the amative desire without spinal symptoms, with the
1242
- usual diagnostic signs of spinal hyperæmia of the posterior columns.
1243
- The treatment, to be followed by success, must be of such a character
1244
- as will relieve any centric local hyperæmia, and as such treatment
1245
- seems to give relief is additional evidence of centric turgescence.
1246
- As a treatment for the disease, bromide of potass and ergot must be
1247
- administered in large doses, with the addition of galvanism alternated
1248
- with Faradisation. Cleanliness of the genitalia is indispensable, as
1249
- well as the removal of any morbid condition or irritating influence.
1250
-
1251
- Satyriasis may exist as a very troublesome reflex condition in many
1252
- painful affections of proximate regions; indurations, hæmorrhoids and
1253
- cancer of the rectum, irritation of the bladder or prostate gland, or
1254
- by caluli in either bladder or pelvis of the kidney.
1255
-
1256
- _Case._――Jno. C. consulted me on numerous occasions for troublesome
1257
- erections. His kidneys were painful under a mild Faradic current;
1258
- his water was high-colored and urethra contracted in calibre, with
1259
- folicular inflammation periodically appearing, and giving great
1260
- annoyance by the discharge produced. Dilatation of the urethra to full
1261
- size has finally given permanent relief from the most troublesome
1262
- morbid erections, and other reflex nervous manifestations.
1263
-
1264
- In such cases, no agent controls reflex irritations like bromide
1265
- potassium; but it must be given in large doses. When causes cannot
1266
- be removed, the satyriasis may or may not pass away by appropriate
1267
- management, or it may be controlled temporarily and return again. I
1268
- have more than once known this condition to appear and reappear in
1269
- cancer of the rectum and testes, which was a troublesome feature, with
1270
- intervals, during the existence of the patient.
1271
-
1272
- The local causes, if possible, must be removed.
1273
-
1274
- For the treatment of spinal congestion, see page 92.
1275
-
1276
-
1277
-
1278
-
1279
- CHAPTER VIII.
1280
-
1281
-
1282
- _Sexual Neurasthenia._――Another and more general aspect of the results
1283
- of the sexual mismanagement will be studied under the above heading.
1284
- The general weakness, nervousness, general debility, general nervous
1285
- exhaustion, proceeding from sexual excesses, will be considered from
1286
- another stand-point than those, subsequently, which are considered
1287
- and named, more from the more attractive phenomena, than from an
1288
- understanding of their pathological anatomy. A generalization of signs,
1289
- symptoms, and conditions of sexual weakness, covers a multitude of
1290
- manifestations found under other names, but calculated more especially
1291
- to assist in the study of a weakness not depending upon observable
1292
- organic disease.
1293
-
1294
- Sexual neurasthenia differs from neurasthenia of other origin, in that
1295
- the former is always coupled with weakness of the genital organs, which
1296
- is not necessarily the case in neurasthenia of mental origin. Again,
1297
- the genital weakness is always traceable to sexual excesses or juvenile
1298
- pollution.
1299
-
1300
- The most troublesome form of neurasthenia is the sexual. There are but
1301
- few symptoms in common with neurasthenia from any cause that do not
1302
- appear in this variety.
1303
-
1304
- The diagnosis, or line of demarkation between sexual neurasthenia and
1305
- the variety of actual organic diseases, is not always well defined. It
1306
- undoubtedly forms a stage beyond which is structural disease of sexual
1307
- excess, or the cause is perpetuated. I cannot admit that true impotence
1308
- and spermatorrhœa are concomitants of neurasthenia, as they are
1309
- phenomena of structural changes; but a threatened condition may exist.
1310
- In this, I believe, I am at variance with some modern writers high in
1311
- authority.
1312
-
1313
- For the most satisfactory description of this disease, and the
1314
- application of the term, neurasthenia, the profession is indebted
1315
- to Geo. M. Beard, who has given the subject a most thorough review
1316
- in periodicals and in Beard and Rockwell’s _Medical and Surgical
1317
- Electricity_. In 1869, Beard published an article in the _Boston
1318
- Medical and Surgical Journal_, giving illustrations of thirty
1319
- cases treated principally by electricity; and again, with a better
1320
- understanding of the cerebral and spinal forms, he presented a paper
1321
- before the _New York Neurological Society_, in 1877, which was
1322
- published in the _New York Medical Journal_. Other papers, by the
1323
- same author, have appeared, which evince a careful study of nervous
1324
- weakness. Erb has given also a very excellent treatise in vol. XIII of
1325
- Ziemssen’s “Cyclopœdia.” Authors have not, thus far, given due credit
1326
- to the sexual organs as a cause of neurasthenia. Erb treats of the
1327
- disease in a confused manner, in portions of his treatise, compared
1328
- to his clearness on other subjects, evincing more book theories than
1329
- facts from clinical observation. In generalizing he is clear, but in
1330
- classifying, he is not particular enough in pointing out the different
1331
- signs of neurasthenia originating from the brain, from that form
1332
- belonging to the spinal cord.
1333
-
1334
- The most common form of nervous manifestations is such as would lead
1335
- one to think of exhaustion of the forces usually attributed to the
1336
- structures of the cord: the nervous energies are very much depleted.
1337
- They seem, at times, to be duly supplied, but the forces may as quickly
1338
- depart and leave the system languid and depressed, without power to
1339
- coordinate the muscles. This more especially applies to a certain class
1340
- of cases which assimilate organic trouble in the nervous structure. No
1341
- change observable takes place in the circulation, yet it must stand to
1342
- reason that the replenishing power of the nerve-matter is deficient.
1343
- This must be impaired nutrition, and a lower order of nerve-structure
1344
- organized, not capable of evolving so perfect a function or
1345
- force――nervous energy. This suspension of nervous energies is only
1346
- transitory when a fair degree of activity is established. This would
1347
- seem to be caused by depriving the nerve-tissues of elements demanded
1348
- to supply natural waste; which is, in all probability, the true nature
1349
- of this exhaustion.
1350
-
1351
- We have neither spermatorrhœa nor impotency, in the strict sense of
1352
- these terms. They perform the sexual function well, but lack power to
1353
- repeat the act as often as healthy people are wont to do. Sometimes
1354
- they cannot control their ejaculation during various conditions of
1355
- excitement, fear, or fright. It is in this condition that a lack
1356
- of confidence in the sexual ability is had at certain times when
1357
- copulation would be the most desired. It is in such cases that a young
1358
- man complains of chagrin and embarrassment. Many a time have young men
1359
- described their afflictions in the language more forcible than elegant,
1360
- describing such opportunities with voluptuous “sylphs,” saying, “he
1361
- went back on me.” This is a weakness of the genital organ, having lost
1362
- its innate power to become erect, in which all the powers of mind and
1363
- will, concentrated upon the act, are required to establish the erect
1364
- posture. Whenever any great mental effort is required to procure an
1365
- erection, either there is local weakness, or there has been too often
1366
- repeated sexual contact, which has not been followed by proper rest; or
1367
- the female has not a fascinating influence over the male.
1368
-
1369
- The general weakness, so much the cause of alarm in young men, and
1370
- yet not of the least danger, is the typical case of neurasthenia. The
1371
- young man consults a doctor, with a long discourse of his symptoms: he
1372
- has read a book on indiscretions of youth; feels badly; has had erotic
1373
- dreams once a month; is “nervous,” feels languid, and apprehends danger.
1374
-
1375
- Medical students, when listening to lectures graphically picturing
1376
- disease of the genital organs from sexual debauch, all have each and
1377
- every form, with the rare and peculiar sequelæ. They consult the
1378
- professor in whom they repose the most confidence, only to receive the
1379
- assurance that nothing is the matter, only a little weakness which will
1380
- soon of itself subside.
1381
-
1382
- In treating of sexual neurasthenia I can but confine myself to that
1383
- functional derangement caused, directly or indirectly, by the supposed
1384
- lack of endurance of the genital organs and the coëxisting nervous
1385
- weakness.
1386
-
1387
- The fact that nearly all young men have at some period polluted, gives
1388
- them a cause to fear that any nervous debility discovered may be
1389
- caused by their early indiscretions. In this they are deceived, and
1390
- only putting their minds at ease will dispel, often, the cause of this
1391
- perpetuation. I am often consulted by literary men, who only need rest
1392
- to be free from this languor. A zealous divine consulted me, with the
1393
- impression that he was afflicted with some organic nervous disease or
1394
- brain disease. After examining him closely, and assuring him that he
1395
- had only a nervous weakness of a functional character, he thought best
1396
- to confess all by saying that he had been “wild” in his youth, and he
1397
- was laboring under great fear that he was beginning to feel its latent
1398
- influence upon his brain. I again assured him that it was entirety
1399
- impossible for him to become in any manner afflicted with a brain
1400
- disease.
1401
-
1402
- The transitory character of all neurasthenic symptoms is quite
1403
- sufficient to distinguish this from organic disease. On one day the
1404
- patient feels badly, with some signs of organic neurosis; but the next
1405
- day he has forgotten that group of symptoms, and another is complained
1406
- of; or he may be free and light, and in bright spirits; but whenever
1407
- he feels weak and languid, the first thing he thinks of is his early
1408
- indiscretion.
1409
-
1410
- _Neurasthenia Caused by Sexual Excess and Domestic Infelicity_――_Case._――Mrs.
1411
- M., the mother of two children, passed through four abortions, came
1412
- lately from Chicago to this city and, perchance, became my patient, when
1413
- I learned her history. She had sustained a fracture of the left parietal
1414
- bone and suffered some from compression. The specula was removed in
1415
- Chicago. The injury was caused by a heavy glass, hurled by her husband
1416
- in a fit of jealous rage. She is fleshy, weighing 135 pounds, and rather
1417
- short; has some time been given to drink, to cover domestic infelicity;
1418
- her face is florid, and on the least excitement becomes purple and
1419
- ecchymosed in spots; she feels, sometimes, as if she would faint; often
1420
- has vertigo, tingling in feet and hands, sickness at the stomach; she
1421
- never cramps, but often cries, feels languid all the time, and lies in
1422
- bed the most of the day; pulse normal, sometimes a little intermittent;
1423
- tongue natural and bowels regular; no belt sensation; no tenderness in
1424
- the cord; no bladder trouble.
1425
-
1426
- Her husband compelled her to submit to his embraces three or four
1427
- times on Sunday and every night during the week; and this had been
1428
- practiced, with only menstrual intervals and when too sick to submit,
1429
- for six years. She is peevish and fretful, and suffering from general
1430
- exhaustion.
1431
-
1432
- There are many manifestations of neurasthenia, when the cause has been
1433
- from the sexual; prominent among which is irritability, exhaustion, and
1434
- sleeplessness following sexual congress; nervous headache with black
1435
- line under both eyes the next day; creeping sensation and itching of
1436
- the skin, without any abnormal appearance to cause it; formication,
1437
- numbness of the hands and feet, flushed face, tenderness and pains
1438
- that are transitory: all without any detection of organic disease;
1439
- not but what such symptoms exist in organic disease, but they are
1440
- more permanent, when they do exist, and can be associated with some
1441
- assurance. I have had my mind on the point of naming and searching for
1442
- numerous organic and spinal and cerebral affections, when the patient
1443
- would multiply antagonistic symptoms so rapidly that I have often
1444
- concluded that my patient had a new and serious combination of lesions.
1445
-
1446
- Organic disease generally has a set of signs and phenomena entirely in
1447
- accordance with structures involved; but neurasthenic symptoms are most
1448
- commonly such as are antagonistic to any two forms of neurosis.
1449
-
1450
- A greater variety of symptoms exists in neurasthenia than any organic
1451
- disease. Symptoms of one organic disease are common one day, and of
1452
- another the next day; and though the two organic manifestations were
1453
- wholly different, the patient on the third day will perceive them all
1454
- combined and aggravated.
1455
-
1456
- Not all cases of neurasthenia can be attributed to the genital organs.
1457
- In my experience cases, arising from sexual irritation and other
1458
- causes, are very evenly divided. I have often been convinced of genital
1459
- irritation being caused from neurasthenia; but as I have intended the
1460
- more to discuss sexual neurasthenia, in Neurasthenia from Genital
1461
- Irritation, I shall be compelled to leave the subject with only having
1462
- mentioned its bearing on sexual irritation as a cause.
1463
-
1464
- Neurasthenia does not differ, when of a genital origin, from the same
1465
- disease of other origin; only that the genital irritation antedates the
1466
- neurasthenia.
1467
-
1468
- It has been said that neurasthenia usually confines itself to the
1469
- nervous diathesis. If we only had a definite condition, known as the
1470
- nervous diathesis, that could be relied on, much would be gained. Some
1471
- of the most troublesome cases of neurasthenia have appeared in persons
1472
- whom no one would point out as possessing a nervous diathesis. Beard
1473
- says, “Among the chief signs of a nervous diathesis are fine, soft
1474
- skin, fine hair, delicately cut features and tapering extremities.”
1475
-
1476
- These are often marked features in nervous women, but neurasthenia has
1477
- existed in persons coarse, dark, thick-skinned, clump-fingered, and
1478
- very uncomely in shape; often large and fleshy.
1479
-
1480
- In attempting to show the relation of neurasthenia to the genitals in
1481
- both male and female, it will lend information to relate a few cases:
1482
-
1483
- _Case._――Jno. B. wishes to know what makes him so “fidgety and
1484
- good-for-nothing.” He says he has visited his intended, to whom he
1485
- is “engaged to be married,” twice a week for nearly two years. “We
1486
- are very intimate and kiss and embrace: I think too much of her to
1487
- do anything wrong. My penis is up all the time I am with her; and
1488
- when I go home my testicles are sore, and I lie awake all night.”
1489
- This is typical, as a cause from continuance; and if the female is as
1490
- amorous as the male, she will also become nervous and irritable. The
1491
- restlessness, following the protracted turgescence of the genitals,
1492
- is a fruitful cause of neurasthenia. Yet all will gradually pass away
1493
- after marriage, which should be advised speedily. With nymphomania,
1494
- there commonly exists a neurasthenia that long remains after all signs
1495
- of any organic disease have disappeared.
1496
-
1497
- Mrs. M., aged 26; the mother of one healthy child; rather adipose;
1498
- short and firm of organization; flushed face; weight, 140 pounds;
1499
- apparently a very vigorous woman. She cannot endure any muscular
1500
- effort of any kind, as she becomes exhausted; dizziness, formication,
1501
- sickness at the stomach, one day; coldness of feet and hands, with
1502
- paresis of first one side then the other, tingling of the tongue; no
1503
- hysterical manifestations, cramping or fainting, at any time. Uterus
1504
- is normal; no tenderness along the spine. Sometimes a local hyperæmia
1505
- of the brain exists, but only lasts a short time. Her heart-sounds
1506
- are normal, and pulse regular; bowels perfectly regular at all times,
1507
- and menses regular. Within a period of two years’ time, she produced
1508
- four abortions upon herself. Each time at third month, and each time
1509
- did so well that no physician was called. She informed me that she
1510
- became more and more nervous after each abortion. I have not benefitted
1511
- this case by any manner of treatment, as yet, and still there is no
1512
- manifestation of any organic disease.
1513
-
1514
- If ever a physician is perplexed, it is when he is called on to advise
1515
- a patient whom he calls “nervous.” This is more commonly the case with
1516
- the general practitioner, as he is looking for something to be the
1517
- matter, and finds nothing but phenomena which he illy comprehends.
1518
-
1519
- These cases are of vast interest to the neurologist, as he is in an
1520
- expansive field for study, and he feels a pleasure with his work; not
1521
- as to the rapidity with which he expects to see these manifestations
1522
- pass away, but in the assurance that these most troublesome phenomena
1523
- are harmless.
1524
-
1525
- _Treatment._――In the management of these peculiar nervous appearances,
1526
- many agents may become necessary; but to obtain rest is the
1527
- all-important consideration. To aid nutrition is the next in importance,
1528
- and thereby build up the structure of the nervous system, improving tone
1529
- by assimilation. All causes, of course, must be removed. The medical
1530
- treatment will consist of agents that stimulate evolution of
1531
- nerve-forces. Tinct. pulsatilla, bromide ammonia, dil. phos. acid, are
1532
- agents which act excellently, given one after the other, changed in a
1533
- manner to perpetuate their influence. With determination of blood to
1534
- the face and head, small doses of gelseminum or bromide potassium, for
1535
- temporary relief, and ergotine continued in grain doses.
1536
-
1537
- When the hands and feet are inclined to become cold, the hypophosphites
1538
- should be given.
1539
-
1540
- As a tonic in these conditions, and especially when the patient is not
1541
- often seen, formula No. 1 will act in a majority of cases very kindly.
1542
-
1543
- Electricity must be resorted to for the permanent relief of nearly all
1544
- cases. General Faradisation will be the most generally useful, used
1545
- often and by short sittings.
1546
-
1547
- The general bathing, resorted to in bath-houses, is often very
1548
- injurious; as no selection of cases as to the peculiar necessities,
1549
- and no adaptation, is made; but proper douching is a most excellent
1550
- remedial measure, and must be conducted with special care and judgment,
1551
- as regards the adaptation of kinds to each and every condition and
1552
- temperament.
1553
-
1554
-
1555
-
1556
-
1557
- CHAPTER IX.
1558
-
1559
-
1560
- _Pseudo-Spermatorrhœa._――A male, enjoying the best of health may,
1561
- under certain influences, have an involuntary discharge of seminal
1562
- or prostatic fluid; but as the latter will be treated in full
1563
- below, I shall first consider accidental discharges of semen as a
1564
- pseudo-spermatorrhœa. Impressions are wrought upon the nervous system,
1565
- sometimes of a stimulant character――other times like a shock――that are
1566
- followed by involuntary losses of semen. It is not uncommon for semen
1567
- to be found in the clothing of criminals hanged by the neck; or for
1568
- soldiers to ejaculate semen at the time of entering an expected battle.
1569
- Involuntary discharges as often occur from the bowels under similar
1570
- influences.
1571
-
1572
- But mental shock is not essential to the production of such relaxation
1573
- of sphincters. I have on numerous occasions produced an ejaculation of
1574
- seminal fluid by the strong currents of electricity passed through the
1575
- genitals, localized.
1576
-
1577
- A cold bath has not been uncommonly the cause of such losses, in
1578
- perfectly healthy subjects. I was once riding, in company with a
1579
- friend, through the country on horseback. My friend had suffered some
1580
- rheumatic pains, for which I gave him opium and quinine in large doses
1581
- which, under the influence of the friction of the saddle, caused an
1582
- ejaculation of semen without erection or erotic thoughts. He was a
1583
- robust fellow, and knew nothing of sexual weakness of any kind.
1584
-
1585
- Young men sometimes, and married men that have been continent a long
1586
- time, and bachelors commonly, are subject to spermatic ejaculations
1587
- involuntary, without genital debility. It has been stated by authors,
1588
- high in authority, that seminal losses two or three times a week
1589
- were only physiological. From this I must dissent. I do not wish to
1590
- be understood as saying that occasional seminal losses are always
1591
- injurious, but I do not on the other hand believe, as do some, that
1592
- even occasional losses are really and always physiological.
1593
-
1594
- To think that the disease exists entirely in the act of involuntary
1595
- emission, is as great an error; as it would seem only rational that,
1596
- if a larger quantity of semen was manufactured than the vesiculæ
1597
- seminales could hold, the natural result would be an evacuation. Again,
1598
- I have known males to live continent and have involuntary losses for
1599
- ten years, as often as weekly, and no evidence of any general or local
1600
- debility. Yet I believe this to be an exception worthy of note. It is
1601
- quite useless to attempt to effect a cure in some of these cases of
1602
- pseudo-spermatorrhœa, as no real disease exists. Some of them will
1603
- continue: others are only transitory, and need only to be assured that
1604
- no wrong exists. Even if it is not physiological or desirable that such
1605
- things should exist, yet it is not actually pathological.
1606
-
1607
- Again, so-called mental spermatorrhœa partakes partly of this
1608
- character; especially when a young man is so pathophobic, from mere
1609
- book-reading fright, derived from specialists and impostors, whose main
1610
- business is to scare a young man to pay out his money and be humbugged.
1611
- If he has not had emissions oftener than monthly, and he is of a
1612
- confiding turn of mind, a troublesome mental disease may be founded.
1613
- If no marked physical disturbance follows these occasional losses, I
1614
- generally inform the young man that he has been mistaken as to the
1615
- gravity of his troubles; thus putting his mind at ease, and the patient
1616
- in a position for self-recovery.
1617
-
1618
- _Case._――Not long since, a young man was under my care who was
1619
- pathophobic; his mind constantly dwelling upon what he had read; and
1620
- the occurrence to his mind, that he had losses of semen as often as
1621
- once in six weeks――although he was a vigorous blacksmith――caused him
1622
- to imagine himself suffering with all the usual bad feelings of an
1623
- advanced case of nightly seminal losses. He appeared in good health;
1624
- was able to do a day’s work, and to work well; but, nevertheless, he
1625
- was neurasthenic, and at times very feeble; or, at least, he thought
1626
- he was. When once he could be made to forget his imagination, he would
1627
- be as strong as ever. The simple assurance that he would recover with
1628
- simple treatment was unavailing; but when persuaded to think much was
1629
- being done, and that his medicine was very potent, he soon ceased to
1630
- be troubled with his worry and was quite well, although he had taken
1631
- only a simple bitter. He finally became afflicted with a sore upon
1632
- his prepuce, which was of a herpetic nature _only_, and for which
1633
- he consulted a score of doctors, as the sore would appear from time
1634
- to time. All informed him of the harmless nature of the eruption,
1635
- but he had faith in no one until a venereal specialist reduced his
1636
- purse to vacuity, when he returned to me for advice. He was simply
1637
- syphilophobic, and demanded only a deceptive treatment, with assurance
1638
- that his trouble was of a local character and never could grow upon
1639
- him; but shortly his herpetic trouble ceased to appear, and something
1640
- else victimized his imagination. Such is the mental predisposition of
1641
- the nervous, imaginative class who _only_ suffer, to any extent, with
1642
- what to them appears to be disease.
1643
-
1644
- Such a case of pseudo-spermatorrhœa would not irritate, in body or
1645
- mind, any person of good reasoning capacity; but, unfortunately, such
1646
- persons are not as common as may be supposed; hence, the deceiving
1647
- specialist has many willing victims.
1648
-
1649
- _Prostatorrhœa_, may exist as an independent, uncomplicated and local
1650
- disease, or in conjunction with spermatorrhœa. My experience leads me
1651
- to remark, that the latter seldom exists without the former, but that
1652
- prostatorrhœa commonly exists as an independent disease; and when the
1653
- flow of semen does not amount to sufficient, in frequency, to consider
1654
- it a cause or a consequence of disease. In my judgment, this flow of
1655
- glary, viscid fluid is most commonly observed while straining at stool
1656
- from constipation. Young men very commonly apply to specialists and
1657
- exhaust their funds and return to the less pretentious family doctor
1658
- for a more satisfactory and truthful statement. Even with this little
1659
- discharge of prostatic fluid, and when no sign of spermatorrhœa existed
1660
- with it, the young man may experience all the phenomena of true and
1661
- long-standing spermatorrhœa. His mind suffers, as well as his body,
1662
- with imaginary nervous phenomena too numerous to mention. But in
1663
- these conditions it is not uncommon to find very troublesome disease
1664
- of the prostate gland, brought on by gonorrhœa, sexual excesses or
1665
- masturbation, existing alone or with true spermatorrhœa.
1666
-
1667
- An examination will reveal enlargement and tenderness of the gland,
1668
- commonly irritation of the neck of the bladder. If we make inquiry, the
1669
- history of prostatic inflammation will be obtained, and gonorrhœa or
1670
- venereal excesses. Pressure upon the prostate, through the rectum, will
1671
- not uncommonly cause a discharge of prostatic liquid, which is followed
1672
- by a smarting sensation. Copulation and ejaculation are sometimes
1673
- followed by a burning pain in the prostate gland, which lasts sometimes
1674
- a few hours――commonly a few moments. Prolonged erection is followed
1675
- by a discharge of viscid fluid, not ejaculated, but simply flowing
1676
- away. When the bowels are constipated, as scybala pass the gland, a
1677
- viscid fluid is pressed out and drips from the end of the penis with
1678
- a smarting soreness, prolonged in the gland. The fluid is not hurled
1679
- forth, or ejaculated in jets, like semen, but a thin glary fluid. The
1680
- disease is commonly only local, and needs very little constitutional
1681
- treatment.
1682
-
1683
- The tinct. staphisagria, so highly recommended by many, will often
1684
- act very kindly as an adjunct, but will not cure the disease. Cascara
1685
- sagrada must be used for a long time, to regulate the bowels and
1686
- digestion. Faradisation, localized and general, is the only agency that
1687
- may at nearly all times be relied on for permanent relief.
1688
-
1689
- When the disease exists with true spermatorrhœa the above treatment is
1690
- none the less essential, and only needs modification to meet special
1691
- indications.
1692
-
1693
- The manner of using electricity for the relief of prostatic disease
1694
- is very simple. My experience has led me into the habit of placing
1695
- the positive pole as closely in contact as possible with the gland. I
1696
- sometimes introduce an electrode into the urethra――other times into the
1697
- rectum――connecting the anode, and with the cathode and large wetted
1698
- sponge stroking the lumbar and sacral regions, especially over the
1699
- origin of the hypogastric nerve and plexus. If there be tenderness over
1700
- any part of the spinal cord, I change the poles and apply the anode to
1701
- the spinal tenderness. Such tenderness is very common over the sacral
1702
- plexus. Again, it is important in the way of ascertaining causes, to
1703
- know which antedates the other, the prostatic tenderness or the spinal
1704
- tenderness; and the anode should be applied to that irritation which is
1705
- found to be the most ancient; as, commonly, upon the spinal tenderness
1706
- the prostatic irritation depends. But this rule is not always tenable,
1707
- yet will answer very well in a new case until an electric test, as it
1708
- were, is obtained.
1709
-
1710
- Whenever unrest, pain or fulness follows the use of one pole to the
1711
- gland, it is safe to change; as such is not the desired effect. There
1712
- is no one thing so needful in the use of electricity as familiarity
1713
- with the physiological effects wrought. Every electrician has marked
1714
- out the management of a patient, and the course proper to pursue, only
1715
- to find an entire change necessary, after the first application. Many
1716
- cases are plain, but many more are wonderfully obscure; and only after
1717
- repeated practical tests, do we find the proper current, intensity and
1718
- quantity adapted to a given case.
1719
-
1720
-
1721
-
1722
-
1723
- CHAPTER X.
1724
-
1725
-
1726
- _Spermatorrhœa._――That special form of sexual neurosis, which has for
1727
- its most common phenomenon the premature and involuntary ejaculation
1728
- of seminal fluid, has been the great catch-all of fakirs and venders
1729
- of popular sexual literature. Not a town of any size in any country is
1730
- without an advertising spermatorrhœa doctor, who cries his vocation
1731
- and writes up his fraudulent certificates of thousands of cases cured,
1732
- and the great danger of millions more sinking into premature decay.
1733
- Strange that laws are not made to prohibit this wholesale deception of
1734
- a confiding and innocent class of young men. Spermatorrhœa does exist,
1735
- but in proportion to the effects of masturbation and sexual debauch,
1736
- grave injury is exceedingly uncommon. Not because spermatorrhœa is a
1737
- commonly grave disease, do I insert this paragraph; but because of
1738
- the unpopularity of the subject, the isolated cases that are really
1739
- bad, and the still more isolated ones that fall into the hands of the
1740
- legitimate physician.
1741
-
1742
- The term, spermatorrhœa, has been too loosely applied to a class of cases
1743
- which the author has chosen to describe under _pseudo-spermatorrhœa_,
1744
- and also to a class of cases more properly called sexual neurasthenia;
1745
- when the weakness of a nervous character is only noticeable in a minor
1746
- degree, or in contradistinction to centric structural changes. But the
1747
- term is useful to describe such losses as are involuntary, and of
1748
- frequent occurrence; or, as it were, such as occur without intentional
1749
- friction of the glans, or without undue nervous shock from accident or
1750
- fear of injury. To such emissions should the term be confined. Healthy
1751
- young men sometimes have emissions before or soon after the intromission
1752
- of the penis, and such occurrences are not uncommon; but with the
1753
- individual such an occurrence rarely happens: such should not be called
1754
- spermatorrhœa――only a sexual weakness――neurasthenia. Again, after
1755
- prolonged sexual excitement, when the organs are simply weak and the
1756
- erotic energy intense, an emission is not sufficient to declare such a
1757
- diagnosis.
1758
-
1759
- When it is customary for a male to ejaculate immediately after
1760
- intromission of the organ, he may have, and quite likely has, a
1761
- spermatorrhœa; but this is not in itself diagnostic of anything further
1762
- than mere weakness; and he must at other times than these lose semen,
1763
- to constitute that real flow which is the true signification of the
1764
- term. When a male commonly ejaculates before venereal friction of the
1765
- glans has taken place, and in successive attempts at sexual congress
1766
- has been baffled, he most certainly has spermatorrhœa, as well as
1767
- partial impotence. Whenever an involuntary emission is followed by
1768
- weakness, headache, wakefulness, heat of the skin, there is certainly
1769
- great sexual neurasthenia; and, if such losses are continuous, the
1770
- diagnosis of spermatorrhœa is without a doubt. It is necessary that
1771
- these points should be duly understood, in order that our future study
1772
- of the disease may not lead to confusion in the study of the conditions
1773
- of the nervous system leading to such phenomena.
1774
-
1775
- In common cases of the disease, the losses of semen are as often as two
1776
- or three times a week; not uncommonly, every night, for a week or two;
1777
- and then an interval of a week, when the nightly ejaculations occur
1778
- with a dreamy, erotic pleasure, with the patient half sleeping. The
1779
- young man wakes up and finds his linen soiled: he remembers his dream
1780
- and is highly disgusted, and soon visits or writes to a traveling or
1781
- standing venerealist, who sends him a circular containing the thousands
1782
- of cases treated and cured, with a poetical description of the ten
1783
- years hence, and perhaps a Marriage Guide, and the price required to
1784
- cure such a case. He feels all the many things pictured in the book,
1785
- and if the fee is within reach he is sure to send it, and only too
1786
- soon finds how badly he is victimized. Not every case is troublesome
1787
- enough to visit a specialist; or the young man is wise enough to first
1788
- call upon the family doctor, or a friendly physician, when he is sent
1789
- home with an opposite kind of discouragement; or he is treated by the
1790
- latter M. D. (?), who has not booked himself on such matters, and the
1791
- poor fellow is left to himself and the “_specialists_.”
1792
-
1793
- It is a fact, that the common practitioner is so fastidious on this
1794
- subject, that he has neglected to obtain the familiarity due his own
1795
- patrons; and if he attempts to treat a case, he will be as likely to
1796
- fail as to do good. This lack of familiarity is the great cause of such
1797
- confusion, and in the application of the term so loosely to conditions.
1798
-
1799
- That the subject may be better understood, I shall arrange my treatment
1800
- of it, that view may be had from the several points necessary to
1801
- perfect comprehension.
1802
-
1803
- _Causes._――The vice of masturbation is perhaps the most common cause.
1804
- In youth, the sexual organs being in an undeveloped state, local
1805
- weakness is very commonly produced, and that even before puberty, by
1806
- the titilations taught the child by accident or by a designing nurse.
1807
- The novel sensation, followed by the profuse flow of semen, commonly
1808
- surprises the youth, and through curiosity and a desire to reproduce
1809
- the new pleasurable sensation, he continues this very common cause,
1810
- masturbation. Ignorant of the consequences that may follow, he pursues
1811
- the practice with intense vigor, until the sad effects are wrought, and
1812
- too late to repent, he learns the evil of his vice.
1813
-
1814
- Boys of the effeminate type suffer first and most from this vice,
1815
- for the reason that they practice the habit more persistently than
1816
- phlegmatic children and, it is a fact, that they are willing victims
1817
- and their nervous system is much more susceptible to impressions.
1818
- Premature development predisposes a child to manipulate the genitals,
1819
- as the curiosity is excited in finding such conditions which should
1820
- only accompany a more advanced age. Any handling of the genitals may
1821
- indirectly give to the child the knowledge of that sexual sensation, or
1822
- excite precocity of the genitals.
1823
-
1824
- Boys of a vigorous habit of body are not inclined to play with their
1825
- genitals; on the contrary, are often markedly disgusted at an attempt
1826
- of a schoolboy to instruct them in the vice. They are therefore not
1827
- easily made victims of, and commonly grow up free from, this vice;
1828
- but they are the most willing participants in prostitutional debauch,
1829
- in a more natural way. With the irritated and excited condition
1830
- of the tissues of the genitals at puberty, then passing the first
1831
- sexual crisis, what an opportunity for local and general injury must
1832
- necessarily be present! The nutrition, so essential to growth and
1833
- development, constantly demanded to compensate for the vicarious and
1834
- premature waste, great neglect in the natural developments of other
1835
- portions must necessarily be a result, which is most likely general in
1836
- character.
1837
-
1838
- As the boy grows up, during the years from fourteen to twenty, the
1839
- attention he pays to his virile member, and the frequency of his
1840
- seminal emissions, would be astonishing to one not acquainted with the
1841
- possibilities.
1842
-
1843
- In the above we have the most common cause of spermatorrhœa. I venture
1844
- to say that the disease is rare in subjects who never practiced the
1845
- vice till after maturity or adult age; but it is nearly as rare to find
1846
- an adult male who has not, at some period of his adolescence, practiced
1847
- the vice of masturbation.
1848
-
1849
- In addition to the vice of boyhood, the debauch of sexual congress in
1850
- the natural way, indulged in to enormous excess, produces a state of
1851
- weakness and loss of general health, with actual impairment of the grey
1852
- matter of brain and spinal cord, which are reflected upon the genitals
1853
- in the form of involuntary seminal losses.
1854
-
1855
- Spermatorrhœa is only a symptom of a disease, and must be studied as a
1856
- neurosis. This diseased condition is generally wrought by frequently
1857
- repeated erotic crises and sexual orgasms, for a long period of time,
1858
- in conjunction with habitual spermal losses, during the period of
1859
- development. The frequent repetition of sexual orgasm so completely
1860
- destroys the erotic sensorii, that the long practice of masturbation
1861
- destroys the venereal orgasm, and an emission is produced without even
1862
- a pleasurable sensation; and even the glans penis becomes so anæsthetic
1863
- in venereal sensibility that the mental effort _only_ produces a
1864
- venereal excitability enough to bring about an erection. In copulation,
1865
- such persons do not enjoy a venereal thrill, only by fresh novelties
1866
- and different females. The subsidence of the venereal thrill, and the
1867
- loss of erotic sensibility and intensity of enjoyment at sexual crisis,
1868
- or during sexual orgasm, is evidence that structural changes have
1869
- occurred and that the disease has become located.
1870
-
1871
- Not until structural changes are wrought in the nervous system, is it
1872
- probable that involuntary seminal losses will continue, or should be
1873
- corrected as a disease.
1874
-
1875
- Sexual congress may, under favorable circumstances, when indulged
1876
- in to great excess, become a cause of such organic changes in the
1877
- nerve-centers as are followed by spermal losses. A few such cases have
1878
- come under my observation, that were of an unmistakable character. The
1879
- report of one case, which is a typical one, will suffice.
1880
-
1881
- _Case._――Chas. B., a rather gentlemanly fellow, consulted me for
1882
- spermatorrhœa, with the following history: When he was a small boy,
1883
- some twelve years of age, a servant girl was his room-mate, with other
1884
- small children; his parents thinking him too small to interfere with
1885
- the servant girl, and did not change his room until a year or more
1886
- after she taught him the significance of his erect genital organ, by
1887
- coaxing him to an attitude favorable to her own gratification. Thus she
1888
- cultivated her new-found pleasure, as he grew up and developed. After
1889
- his room was changed, he found no impediment to nightly visits to the
1890
- servant’s bed. He was soon able to comply with all demands, and nightly
1891
- they indulged in sexual congress to satiety, and grew up together. She,
1892
- being much older than he and knowing all the probabilities, exercised
1893
- her vigilance and precaution, and all went well until he was twenty-two
1894
- years of age; when he found that, upon leaving home and undergoing a
1895
- few weeks’ deprivation from sexual contact, an involuntary discharge of
1896
- semen occurred two or three times per week, in his sleep, accompanied
1897
- by a lascivious dream. The constant and profuse discharge of semen and
1898
- prostatic fluid had passed from his glans penis, for which he had often
1899
- sought advice in vain. These cases are not very uncommon, although
1900
- many a young man has passed through similar experiences with unimpaired
1901
- virile powers. I opine that, if a young man passes to the age of twenty
1902
- without much sexual excitement, he will not be likely to suffer with
1903
- any form of sexual weakness; but if he has the predisposition spoken of
1904
- elsewhere, he will not be likely to pass to the age of eighteen without
1905
- being fully aware of his sexual instinct, and the pleasure that may be
1906
- derived from sexual indulgence or masturbation.
1907
-
1908
- The great author, Lallemand, has given as causes a list of organic
1909
- troubles, a great portion of which are, instead of causes, produced
1910
- by the genital irritation and spermatorrhœa. He overlooks the general
1911
- phenomena which point directly to neurine pathology. As causes,
1912
- Lallemand gives, among various organic troubles, prolonged erections,
1913
- excited by erotic ideas or lascivious publications; the use of
1914
- diuretics, of ergot, of cantharides, etc.; the abuse of alcoholic
1915
- drinks, coffee and tea; constipation; ascarides in the rectum;
1916
- hemorrhoids, fissures of the anus; heating and irritation of the anal
1917
- and perineal regions by habitual sitting, or prolonged horseback riding.
1918
-
1919
- Notwithstanding the eminent authority, it must appear quite impossible
1920
- for any of the above conditions to cause spermatorrhœa as a disease.
1921
- The few seminal emissions that may occur from such causes are in
1922
- isolated cases, and of short duration. Even when spermal losses have
1923
- seemed to arise from such causes, I should think grave reasons present
1924
- for the suspicion of self-pollution or sexual excess. The simple denial
1925
- would not be reason to attribute so permanent a disease to such trivial
1926
- causes.
1927
-
1928
- It cannot be disputed with tangible evidence, that Lallemand’s causes
1929
- may develop a morbid sexual instinct, by reflex excitation, and act
1930
- as a predisposition by exciting sexual desire and self-pollution, and
1931
- thereby spermatorrhœa; but the innate condition must be present also in
1932
- every case.
1933
-
1934
- While it is well known that various morbid anatomical changes are
1935
- found in the genital organs, on careful dissection, yet scarce any can
1936
- be said to act as a cause, but rather as a result of long debauch by
1937
- pollution and venereal diseases; and as commonly, such changes have
1938
- been found in the genito-urinary organs, when spermatorrhœa never had
1939
- been suspected.
1940
-
1941
- Roberts Bartholow, in opposition to the views of Lallemand as to
1942
- causes, says:
1943
-
1944
- “To place this question beyond controversy, I have lately made
1945
- a most careful dissection of the sexual apparatus of a young
1946
- man, dead of double pneumonia, who was known to have practiced
1947
- masturbation in an extreme degree for many years. Besides a
1948
- catarrhal condition of the mucous membrane of the seminal and
1949
- prostatic ducts and of the _vesiculæ seminales_, there were
1950
- literally no lesions of these organs. I therefore reject this
1951
- position of Lallemand as untenable, and as leading to improper
1952
- methods of treatment.”
1953
-
1954
- I can but conclude the cause of spermatorrhœa with one definite remark:
1955
- That the frequently repeated sexual orgasm, continued for a long time,
1956
- causing to be evolved so rapidly the great amount of nerve-force which
1957
- must each time be lost forever, must be the only direct cause of that
1958
- obscure neurosis upon which spermatorrhœa invariably depends.
1959
-
1960
- _Moral Effect._――There is a moral effect wrought upon the mind of every
1961
- person suffering from an inflamed imagination. The constant dwelling
1962
- of the mind upon the sexual organs, or the imagination of a future
1963
- cohabitation, must stimulate the free flow of seminal fluid to the
1964
- overflowing of the _vesiculæ seminales_. Old debauchés frequently feast
1965
- upon the virgin countenances that pass street corners, and constantly
1966
- stand in wait for an expected girl, to be secured by a procuress,
1967
- that they may feast upon her ruin. The cultivation of such morbid
1968
- imaginations is an effect, rather than a cause, of long-practiced
1969
- sexual debauch, and grows out of a cultivated or congenital grossness
1970
- of the sexual instinct.
1971
-
1972
- Elsewhere, the effects of unrequited passion have been fully
1973
- elucidated, as cause and effect of local neurasthenia.
1974
-
1975
- _Symptoms._――The physiognomy of a spermatorrhœa patient is often
1976
- very striking; especially one who has been an extensive masturbator,
1977
- and has been led to think that any physician has but to behold his
1978
- countenance to judge of his entire condition and its cause. He bears
1979
- the aspect of one who has been convicted of a shameful vice. This
1980
- is the picture of an advanced case, yet not beyond the threshold of
1981
- reason. As he realizes his condition, he is embarrassed that he is
1982
- compelled to converse on the subject and confess his shame. The face
1983
- is commonly pallid: the eyes are sunken, with dark lines beneath: the
1984
- lips are anæmic: the corners of the mouth are drawn down, and haggard
1985
- lines are deep-cut about the face. He looks much older than he is, and
1986
- his beard is tardy, isolated and of a dirty color. The general aspect
1987
- of hunger is marked upon his entire figure: he is often lean and wan.
1988
- He trembles with slight exertion, and complains of fatigue: his muscles
1989
- feel doughy, and an unpleasant odor is emitted from his body, strong,
1990
- like a goat or a pig, and his voice is feeble. He speaks low, as if he
1991
- desired to be very quiet and secret, even when his subject has nothing
1992
- in it of a secret character. In common conversation, his voice is
1993
- reduced almost to a whisper. He often has pustules on his face――acne.
1994
- A young man may have spermatorrhœa with very few of these symptoms
1995
- present; but when he has advanced far in the disease――in the nervous
1996
- lesions――the above symptoms are only the common manifestations noted
1997
- by close observation. Yet all these symptoms may exist from other
1998
- causes, and the patient may be free from spermatorrhœa or pollution.
1999
- Then, only by the history and physical signs connected with the general
2000
- aspect, can we hope to effect an exclusive and conclusive diagnosis.
2001
- He relates his history, which is only a confession of his vice and
2002
- the story of his spermal losses nightly, with languor, bad digestion,
2003
- pains and aches too numerous to mention. His tongue is coated, breath
2004
- fœtid, appetite poor, circulation feeble, and heart-sounds feeble and
2005
- irregular. Often, a dull aching is located in his back-head, forehead
2006
- and eyes, with asthenopia, anthropophobia, agoraphobia, astrophobia,
2007
- monophobia, syphilophobia, nocturnal ephidrosis, palmar hyperidrosis,
2008
- and neuralgia of different localities and of varied intensity.
2009
-
2010
- _Spinal Congestion._――This is one of the varieties of disease-pictures
2011
- that call for a deviation in management, and is, perhaps, as common
2012
- as any of the special types, and may be recognized by the following
2013
- symptoms: pain in the back, as if from long stooping, not increased
2014
- by pressure; also a dull, aching sensation, as after prolonged
2015
- exercise. This pain is aggravated by the recumbent posture; hence the
2016
- sleeplessness so common in many of these cases. Fainting sensations are
2017
- produced by standing long upon the feet: a misstep, or a sudden jolt
2018
- in a wagon or car, causes much suffering. Intense burning is often
2019
- felt along the cord and base of the brain, which is not influenced
2020
- by pressure; hyperæsthesia of the skin of one or both legs and feet,
2021
- and the scrotum; testes and penis are often too sensitive to touch;
2022
- at times, neuralgic pains in the genitals, with herpes præputialis,
2023
- periodically appearing; great tenderness of the anus, with herpetic
2024
- eruptions _ab margine ani_. Again, anæsthesia may take the place of
2025
- exalted sensibility, with formication――or tingling, or sensation of
2026
- “pins and needles”――of the feet and legs. Sometimes they complain of a
2027
- sensation of fullness of tissue, as if they were swollen, with no signs
2028
- of any puffy or œdemic condition present. I have often observed both
2029
- anæsthesia and hyperæsthesia at the same time, in different localities,
2030
- upon the same patient. Shooting, neuralgic, or knife-cutting pains
2031
- often emanate from the spinal cord and pass into the limbs, testes or
2032
- penis. Sometimes a tight belt is felt constricting the limbs, thorax
2033
- or abdomen; again a choking sensation, as in globus hystericus, with
2034
- a sensation of drawing in the spermatic cord and testes; pain in the
2035
- heart, lungs, abdominal viscera and genitals, is of common occurrence.
2036
- Irregularities in cardiac movements are not uncommon, with troublesome
2037
- erections of the penis in the morning, even when erections were
2038
- impossible at night. Such erections are commonly without erotic desire,
2039
- and with the bladder empty. They are more troublesome after lying upon
2040
- the back during the night, which seems to aggravate the engorged spinal
2041
- cord. As these cases advance paralysis may intervene, more or less
2042
- profound, generally in the form of paraplegia.
2043
-
2044
- The above, under treatment, will be referred to as the congestive
2045
- type of spinal cord disease, where the direct adaptation of agents to
2046
- conditions will be pointed out, founded on the only principle that
2047
- can lead to ultimate satisfaction――“specific medicine and specific
2048
- diagnosis.”
2049
-
2050
- _Spinal Anæmia._――That form of spinal anæmia caused by the sexual
2051
- differs from spinal irritation of other causes only in the more
2052
- usual beginning at the lower portion of the spinal cord――sacral and
2053
- lumbar regions. In this we have a group of symptoms of spermatorrhœa
2054
- that is not by any means rare; not always diagnostic yet, coupled
2055
- with the necessary history, they afford a condition to which too
2056
- little attention has been given. Spinal tenderness is always present,
2057
- increased by pressure, relieved by the incumbent position and
2058
- aggravated by walking. Unless these symptoms be present, no case is to
2059
- be considered anæmia of the cord.
2060
-
2061
- Where spermatorrhœa and spinal anæmia are associated, and sexual
2062
- debauch has evidently been the cause of the latter directly, it will
2063
- be observed that sexual excesses have existed a long time before the
2064
- latter, or before constitutional disturbance had in any way manifested
2065
- itself. Spermatorrhœa, when associated with spinal anæmia, appears only
2066
- secondarily, as a phenomenon of the disease thus caused.
2067
-
2068
- As spinal anæmia advances and other tender points appear in the cord,
2069
- the eccentric symptoms also change and the phenomena are various
2070
- in accordance with the location and symptoms coincident with such
2071
- phenomena when the causes have been other than sexual.
2072
-
2073
- The lumbar tenderness is generally accompanied by neuralgic pains in
2074
- the lower limbs, back, abdomen and rectum, cramps in the bladder, with
2075
- difficulty in urinating; at other times incontinence.
2076
-
2077
- In one case, which was under my care two years without any benefit,
2078
- the whole spinal cord was tender to the touch, and the patient was
2079
- epileptic and very feeble in mind.
2080
-
2081
- When the dorsal region is involved and tender, as might be supposed,
2082
- there will appear gastric troubles; acidity, pyrosis, nausea and
2083
- vomiting, gastrodynia; again intercostal neuralgia and rheumatism,
2084
- cough and dyspnœa, palpitation, fits of fainting and epileptiform
2085
- convulsions.
2086
-
2087
- _Case._――Mrs. P., in addition to unmistakable symptoms of spinal
2088
- anæmia, with dorsal tenderness would, at the sudden closure of a
2089
- door, complain of great pain in her abdomen, stomach and uterus. On
2090
- several occasions she had had involuntary evacuation of fœces and
2091
- urine during a thunderstorm. Her skin would be covered with cold sweat
2092
- (hyperidrosis). Medicine had very little influence in this case;
2093
- but electricity applied daily for three months――a mild current of
2094
- Faradisation――effected a very satisfactory improvement. This was a case
2095
- of sexual origin and a result of fifteen years’ sexual excess in her
2096
- early life; after which she married well to enjoy the remainder of her
2097
- life in wedlock under the care of a physician constantly.
2098
-
2099
- The cervical region is not uncommonly affected and may be very tender,
2100
- which may produce pain in the stomach and nausea, rejecting everything
2101
- swallowed, at times. Sleep is nearly always deranged: sometimes
2102
- sleeplessness, and again, in the same patient, profound coma of long
2103
- duration is observed, and somnambulism is also likely to occur in
2104
- such cases. Twitching of muscles, contraction of flexor tendons,
2105
- hiccough, aphonia, vertigo, head-pain through the top, tinnitus aurium,
2106
- disturbance of vision, asthenopia, and mental derangements, as the last
2107
- stage of the disease, when the brain and entire nervous system are in a
2108
- feeble condition: all follow, in rare occurrence, the sexual debauch,
2109
- and are symptoms of the entailed conditions, viz., sexual neurosis, of
2110
- which spermatorrhœa is only one of the numerous symptoms, yet perhaps
2111
- the most attractive.
2112
-
2113
- As these foregoing types or conditions advance, they become complicated
2114
- and even change in essential features; but if not remedied, the result
2115
- must be toward paralysis, insanity, tabes dorsalis, epilepsy and
2116
- imbecility; all of which can best be studied as special diseases in
2117
- numerous volumes on diseases of the nervous system.
2118
-
2119
- _Cerebral Sexual Neurosis._――That form of neurosis, brought on by
2120
- masturbation in adolescence and sexual excesses, does not exist
2121
- independently of other portions of the nervous system, and only as the
2122
- spinal cord becomes impaired by excessive sexual shocks and evolution
2123
- of nerve-force, which is expended in orgasms during sexual excitement,
2124
- does the brain become involved, and its tissues fail, by feeble
2125
- perpetuative force, to evolve healthy intellect. When the formative
2126
- forces fail to construct as perfect a brain-structure as has existed,
2127
- renewal is required more and more often, which cannot be brought
2128
- about by the impaired nerve-forces, and softening must, necessarily,
2129
- follow or, at least, a mal-renewal and mal-construction of cells and
2130
- neuroglia, too unnatural to evolve the elements of healthy mind.
2131
-
2132
- That there is a connecting link between the intellectual and the sexual
2133
- there can be no doubt, and that for the sexual to be appreciated,
2134
- without the assistance of the intellectual, would be only animal and
2135
- should not be considered advisable for human beings, but that the
2136
- intellectual should not only predominate, but preside over, all sexual
2137
- conditions.
2138
-
2139
- Thomas would have us believe that the cerebellum is the seat of
2140
- amative desire, and that that organ presides over the sexual function.
2141
- Again, an opposite claim has attempted to overthrow such doctrines, by
2142
- experiments to prove that the cerebellum presides over coôrdination of
2143
- muscular movements.
2144
-
2145
- I am not prepared to accept the doctrine of either as true, but only
2146
- can see evidence that both may be disturbed or lost for a time by
2147
- pressure upon, or section of, a part of the cerebellum, and that this
2148
- organ perhaps tends to effect an equilibrium of the nervous forces
2149
- between the cerebrum and cord, and also as a generator of nerve-force.
2150
- We do know that coôrdination of muscular movements is interfered with
2151
- by any structural changes in this organ; but it would seem that, if the
2152
- sexual was so much depending upon the cerebellum for force, or there
2153
- was such an intimate relation between these organs, muscular movement
2154
- would be oftener impaired or disturbed by reflex irritation, owing to
2155
- the frequency of impotence and other genital diseases, through the
2156
- close relations supposed to exist between the genitalia and cerebellum.
2157
- The coôrdination of muscles is seldom interfered with by sexual
2158
- diseases directly, but only as a secondary issue, by first producing
2159
- chronic impairment of the nutritive forces, and thereby effecting the
2160
- changes in nerve-cells.
2161
-
2162
- The sensitive nervous organizations are of themselves predisposed to
2163
- morbid changes, from too often repeated shocks of pleasure or grief;
2164
- such persons are first to suffer mentally through shame, from having
2165
- indulged in such vices, and secondly, from actual structural changes
2166
- that have occurred.
2167
-
2168
- The vice, commenced at puberty or before, interferes greatly with the
2169
- development of the brain, and only a feeble intellect is possible as a
2170
- product of such feeble brain-structure. The mental powers often yield,
2171
- as it were, when the genital organs possess the power to copulate _ad
2172
- libitum_. This is not an uncommon occurrence. Lunatics frequently
2173
- possess such genital vigor, when their lunacy has been produced by
2174
- masturbation and other sexual debauch.
2175
-
2176
- Roberts Bartholow has, in his monograph, recorded a paragraph worthy of
2177
- mention:
2178
-
2179
- “It is to be remarked that the mental phenomena of
2180
- spermatorrhœa are not always in proportion to seminal losses.
2181
- In the cerebral form, in addition to those lesions of the
2182
- sexual spinal system, of the digestive apparatus and of the
2183
- circulation, described under the genital form, there are
2184
- certain disorders of the mind. That spermatorrhœa will produce,
2185
- in one class of cases, mental disorders, and not in another,
2186
- indicates either that some predisposition to these disorders
2187
- existed, or that the habit of self-pollution was merely an
2188
- expression of mental alienation. The lascivious images which
2189
- pervade the minds of boys, possessed of the highly developed
2190
- nervous organization of masturbators, are those of delusional
2191
- insanity. In one case the spermatorrhœa is a symptom of mental
2192
- disorder; in the other, the spermatorrhœa is an exciting
2193
- cause――the predisposition already existing.”
2194
-
2195
- The general anæmia that so often occurs in spermatorrhœa, caused by
2196
- impaired digestion and spermal losses, is secondarily the cause of the
2197
- cerebral anæmia, and tertiarily of softening. The digestive powers,
2198
- so much impaired by frequent draughts on the vegetative centers, must
2199
- be a cause for a great disturbance in the nutritive supply of the
2200
- brain. The vicarious expenditure of nerve-force upon the exaggerated
2201
- secretory power of the testicles must be a source of great waste, as
2202
- well as the actual loss of elements, necessary to the structures of a
2203
- body losing annually by decay. The tendency of local spasm is of no
2204
- little importance as a cause of local anæmias. Centric irritations,
2205
- such as influence the _vaso-motor_ centers, without a doubt, cause
2206
- local spasms of the _vasa vasorum_, capillaries and supplying arterial
2207
- trunks of organs; and the vessels of the brain are the most likely to
2208
- be influenced in such a manner, and the tissues of the brain the most
2209
- likely, of all tissues, to suffer from such a condition.
2210
-
2211
- The brain-symptoms do not end with feeble intellection or insanity,
2212
- but impairment of the special senses and motility is not unfrequently
2213
- present, as a phenomenon evolved from structural changes in the
2214
- brain. Asthenopia amblyopia, diplopia, dilatation of the pupil and
2215
- hyperæsthesia alternated with anæsthesia of the visionary apparatus,
2216
- aphonia, perversion of the sense of taste, with loss of smell and
2217
- deafness, are rare yet occasional complications.
2218
-
2219
- The usual catalogue of symptoms bears closely to one of two forms, the
2220
- hyperæmic or anæmic, local or general, of the cerebral substance.
2221
-
2222
- The profound impressions wrought upon the minds of these patients
2223
- by popular sexual literature must greatly exaggerate the structural
2224
- changes, but are not sufficient of themselves, as a rule, to produce
2225
- anything but morbid emotions until after enfeeblement has first been
2226
- organized.
2227
-
2228
- The records of the State Asylum, at Utica, N. Y., show five hundred and
2229
- twenty-one cases admitted directly attributable to this vice; and Dr.
2230
- Jno. P. Gray, the able superintendent, thinks this greatly understated.
2231
-
2232
- Sexual excesses, pollution, and other mismanagements of the sexual
2233
- functions have received too little attention, and are too seldom
2234
- mentioned in the etiology of nervous and brain lesions. Too little
2235
- effort has been put forth to ascertain the proportion of mental
2236
- diseases caused by the sexual and reproductive organs. A greater
2237
- number of brain-lesions occurs, in which the sexual function has been
2238
- a remote cause, than any author, as yet, has ventured to affirm.
2239
- Statistics of any degree of accuracy are impossible to obtain; but
2240
- supposition, imagination, and guess-work only can be found to assist in
2241
- making up a statement of the most important of all causes of disease.
2242
-
2243
- _Clinical Illustrations――Case._――Mr. X. came from the South with his
2244
- brother to consult a physician in St. Louis. I found the patient, who
2245
- was aged 24 years, feeble and wan. He wore a thin, scraggy beard, about
2246
- an inch long, over his chin and under his maxilla, but the side of his
2247
- face contained only a little furze. When I entered the room it was not
2248
- necessary to inquire which one of the young men had come to consult me,
2249
- as his general aspect told me that he was a sick man. He was cadaverous
2250
- in looks, staggering in gait, anæmic and haggard. He had been a
2251
- masturbator, and practiced it as long as he could obtain erection,
2252
- which had been until within a year; although I learned that for five
2253
- years previous his erections had been only occasional and feeble. His
2254
- semen was wasting nocturnally and his genitals flabby, cold and damp:
2255
- his scrotum especially was relaxed and pendant. The spinal cord was
2256
- very tender to the touch, giving great pain upon examination, over the
2257
- lumbar, dorsal and cervical vertebræ. He complained of a sensation of
2258
- constriction (girdle) around the body, painful digestion, constipation
2259
- of the bowels, and talked incoherently. His mind wandered: he had no
2260
- wishes to go home, or to stay, or to live, and became quite passive.
2261
- He failed fast, and I soon lost sight of him, as he was placed in an
2262
- insane asylum. All treatment failed to benefit him.
2263
-
2264
- I might enumerate scores of similar cases, in which it is impossible to
2265
- see any cause but abuse of the sexual function, in which spermatorrhœa
2266
- and impotence blend in a very obscure manner, but combined with other
2267
- phenomena prove, beyond a doubt, the existence of a sexual neurosis,
2268
- peculiar to itself, which needs study as to pathological anatomy; when
2269
- it will be discovered that more than mere cause for general neurosis is
2270
- found in the sexual abuse so lightly spoken of by authors in treatises
2271
- on diseases of the nervous system. It will not require an accurate
2272
- observer to discover signs of myelitis and softening in the above case;
2273
- but his symptoms had been, long before, markedly those of anæmia, as
2274
- related to me by his brother. Many cases selected for this section are
2275
- in the advanced stage that I may the better show the termination of
2276
- some of these cases. The majority of the cases that I have observed
2277
- have been wanting in these distinctly organic features, _only_ for the
2278
- reason that they were not so far advanced, and their indulgences had
2279
- been limited to a more careful habit of pollution and sexual congress.
2280
-
2281
- The usual course of lesions appears in the following order after
2282
- sexual excesses and pollution: Nervous weakness (neurasthenia), anæmia
2283
- or congestion, myelitis, and softening. These may point either to
2284
- the brain or spinal cord, or both associated, in any given case, in
2285
- accordance with compatibility of lesions and conditions.
2286
-
2287
- A most striking condition of sexual neurosis is not uncommonly
2288
- observed, that is not confined strictly to a locality, but shows a
2289
- general breaking down of the conductors of nerve-force, both motor and
2290
- sensory, as well as the nerve-cells, with a tendency to softening of
2291
- both brain and spinal cord.
2292
-
2293
- _Case._――A marked case of impaired conductivity is now under my
2294
- observation. The patient is a masturbator, and I have thus far failed
2295
- to disrupt the vice.
2296
-
2297
- In addition to many symptoms, not of general interest, is the impaired
2298
- condition of the sensory conductors. When he is touched, it is a
2299
- second before he feels. He sees the finger placed upon his hand or
2300
- foot, but does not feel it for one or two seconds: sometimes it is
2301
- quicker than at other times. When he is spoken to, he does not receive
2302
- the idea for ten or fifteen seconds after he has heard the sound. He
2303
- comprehends that such is the condition. He says he does not desire to
2304
- practice self-pollution, but simply performs the act because he can’t
2305
- help it. He is sensible and strong-minded on some things, and very
2306
- feeble on others. He is agoraphobic, but has no pathophobia. He is not
2307
- anthropophobic, but even foolish after female society, and still has
2308
- no inclination to copulate. He prefers to masturbate, rather than to
2309
- accept of coition when accessible.
2310
-
2311
- The motor nerves and centers are rarely, but sometimes, involved
2312
- directly. When paralysis does occur, it is from advanced complications
2313
- and need not be mentioned here; but sometimes an unnatural class of
2314
- movements is produced by this variety of neurosis, generally of a
2315
- spasmodic character and located in the involuntary sphere. I wish only
2316
- to record, in this place, the fact that such is a lesion of sexual
2317
- neurosis, and take it up elsewhere with greater precision.
2318
-
2319
- Tabes dorsalis has not been uncommonly caused by sexual abuse, in
2320
- proportion to the frequency of the disease. Loss of sensibility is also
2321
- exceedingly rare, but impairment is not uncommon. The loss of venereal
2322
- sensation is a very common consequence and will be spoken of elsewhere.
2323
-
2324
- Paralysis of some of the muscles of the genitals and bladder is of
2325
- frequent occurrence, especially those connected with urination; the
2326
- bladder is often paretic and micturition is frequent, and the quantity
2327
- very small: often the natural warning as to time is wanting. The
2328
- mental symptoms are often very prominent: loss of memory; conversation
2329
- difficult; language incoherent and ideation very imperfect; insanity,
2330
- idiocy, imbecility and epilepsy.
2331
-
2332
- Hitzig says, under _Etiology of Paralysis of the Insane_, “Probably
2333
- the combination of excessive labor with excesses _in Baccho et Venere_
2334
- is the most common cause. The influence of sexual excesses can be
2335
- recognized in females also.”
2336
-
2337
- _Case._――An epileptic gentleman, æt. 24, consulted me for his fits. He
2338
- had practiced masturbation from childhood to twenty years of age; was
2339
- losing semen nightly; often without erection; had been epileptic four
2340
- years. At first the fits were as frequent as every four months, but now
2341
- they are weekly. His face was of a venous color, as if a venous stasis
2342
- was the constant condition. His eyes and hair were black. His face was
2343
- expressionless and covered with acne; memory very poor. He was a fine
2344
- penman, and had been a book-keeper. He had felt no _aura_, and always
2345
- had his fits during the day-time. All treatment failed in this case
2346
- to produce any impression upon the fits. The bromides at first could
2347
- not be used, as dangerous symptoms followed three successive attempts.
2348
- Electricity, if any thing, aggravated his general condition. I cast
2349
- lots for general treatment, in an empirical manner, but very little
2350
- benefit followed: his general condition was downward, and the epilepsy
2351
- continued to grow more frequent. Large doses of bromides benefited him
2352
- and increased the interim, but finally four drachms a day failed to
2353
- control or to modify them. Galvanization and Faradisation, both singly
2354
- and conjointly, were tried in vain. Ergot also was tried, and many
2355
- agents of lesser prospects, as he staid with me three years, growing
2356
- feebler in body and mind constantly, until he is now nearly imbecile.
2357
- Four cases so nearly alike have come under my observation, that the one
2358
- will answer as a typical case of them all; not a single one recovering:
2359
- two have ended up in the insane asylum: the other two I have lost sight
2360
- of, but not until they had passed into a state of dementia.
2361
-
2362
- _Case._――Jno. W. My attention was called to this patient by Dr. M.,
2363
- who was the attending physician. The patient was in bed, very much
2364
- emaciated and feeble; form originally tall, bony and muscular; dark
2365
- hair and eyes. The Doctor informed me that he had passed through
2366
- the hands of a number of physicians, without relief. His pulse was
2367
- feeble and averaging 100: his venous circulation was feeble; a livid
2368
- appearance of the skin: the redness would disappear upon pressure and
2369
- return very slowly. There was profuse nocturnal hyperidrosis, with
2370
- great morning prostration and general coldness. He was exceedingly
2371
- irritable and profane; appetite poor, and what little was eaten
2372
- was digested with pain; bowels constipated; urine high-colored and
2373
- of high specific gravity, containing blood and pus. The spinal cord
2374
- was so tender, during its whole extent, that the slightest pressure
2375
- produced intense pain. His rectum was indurated and very tender to the
2376
- touch. The urethra was diminished in calibre to a No. 8 catheter, and
2377
- that was passed with great pain. The prostate gland was enlarged and
2378
- hyperæsthetic. He complained much of the girdle sensation, which placed
2379
- the diagnosis beyond a doubt as chronic myelitis of the posterior
2380
- columns. There were no lesions of motility, but lesions of sensibility
2381
- were present throughout the body and lower limbs; anæsthesia of the
2382
- skin and hyperæsthesia of the mucous membranes of the rectum, urethra
2383
- and bladder. All treatment proved futile, and he died after a year of
2384
- most distressed suffering.
2385
-
2386
- He was a debauché, given to extreme sexual indulgence and wine; was a
2387
- victim of early indiscretions, and to a great excess: spermatorrhœa was
2388
- present up to six months of his death; but was only impotent after he
2389
- took his bed from general exhaustion. He was thirty-three years of age
2390
- when he died.
2391
-
2392
- Gull’s case of paralysis reported must be quite exceptional, as
2393
- paralysis generally found, which has been caused from a sexual
2394
- neurosis, has not differed in any manner from the same paralysis
2395
- from other causes; and I can only see the sexual neurosis as a cause
2396
- of paralysis, and not as a special variety. The same may be said
2397
- of an anæsthesia of the skin, or a hyperæsthesia; that the sensory
2398
- nerve-roots are influenced by either anæmia or turgescence, and the
2399
- phenomena are manifested at the periphera. The phenomena do not
2400
- differ, when these conditions are caused by the sexual, from phenomena
2401
- when conditions are wrought by other causes; and conditions causing
2402
- identical phenomena are in themselves identical, but not as to their
2403
- cause; hence so many forms of sexual neurosis, and so many conditions.
2404
-
2405
- _Local Structural Changes._――Structural changes in the genital organs,
2406
- in a chronic case of spermatorrhœa, are not a little interesting to the
2407
- student of pathology. The scrotum is pendant, baggy and relaxed. The
2408
- penis is flabby, cold and pallid. The veins are dilated and tortuous,
2409
- and the organs are in a condition of anæsthesia or hyperæsthesia;
2410
- and as irritability often exists, causing unnatural attention of the
2411
- patient, and he finds much difficulty in dressing to suit his genitals.
2412
- The spermatic cord is hypertrophied, and the epididymis enlarged and
2413
- baggy. If the examination can be obtained when there is an erection,
2414
- tenderness will be observed, along the entire course of the urethra.
2415
- The urethral mucous membrane is thickened, and the canal is strictured
2416
- throughout its length. The prostate gland is changed and tender to
2417
- touch, congested, and its ducts relaxed. (See Prostatorrhœa.) The
2418
- anus is sore to manipulate, and at stool, when scybala pass over the
2419
- prostate gland, a sensation of pain is felt, and fluid is forced out
2420
- of the ducts into the canal and drips from the end of the penis. The
2421
- veins of the spermatic cord are varicose, the erections are deficient
2422
- in power (see Impotence), and seminal fluid is thin and watery. The
2423
- spermatozoa are deficient in size, shape, and amœboid movements. The
2424
- urine is of a low specific gravity and contains a superabundance
2425
- of urates. The orgasms are feeble and often imperceptible, and the
2426
- proportion of spermatozoa to fluid is not great.
2427
-
2428
- _Spermal Changes._――The only known detection of spermzoons is by the
2429
- microscope, which only can detect the seminal from the prostatic fluid
2430
- in this stage of disease. The reason that spermatozoa have not been
2431
- detected oftener in the urine of spermatorrhœa patients, is simply from
2432
- the fact that the urine was not examined more than once, perhaps twice.
2433
- When I have watched for ten days, making daily observations, before
2434
- discovering spermatozoa, I have then found them daily for as many days.
2435
- The first object to be determined is, is the patient strictured, or
2436
- has he a general narrowing of the calibre of his urethra? If so, then
2437
- this is a good reason to suppose there may be spermatozoa in his urine,
2438
- providing that he is losing semen; as the fluid is thin, and the walls
2439
- of the canal are clumsy in performing those wave movements which are so
2440
- essential in ejaculating semen or expelling the last drops of urine;
2441
- therefore regurgitation may take place, and semen be found in the next
2442
- discharge of urine. When nocturnal losses occur, a large portion may
2443
- be expected in the urine at the next micturition. This is commonly the
2444
- case in aspermatism, and may act as a cause of sterility.
2445
-
2446
- The married, as well as the unmarried, have involuntary discharges of
2447
- semen when every possible opportunity is present for an emission to
2448
- take place in the natural way. The newly married, after the novelty
2449
- period has subsided may, from excessive indulgence, have an involuntary
2450
- emission, which occurred during a lascivious dream, when no desire for
2451
- cohabitation preceded his going to sleep. When the cause producing
2452
- these involuntary emissions is not transitory, the young man must have
2453
- indulged extensively in his boyhood. Such a discharge, if followed by
2454
- the usual depressing effects, is invariably pathological; yet with
2455
- proper rest, self-recovery is probable when the cause is transitory.
2456
-
2457
- _Sequelæ._――The common results of spermatorrhœa and sexual excesses
2458
- become noticeable, either shortly before or soon after marriage.
2459
- The young man well knows his defects, and he consults a physician to
2460
- ascertain the magnitude of what may occur to him on account of his
2461
- indiscretions. He informs us that sexual orgasm occurs very soon after
2462
- intromission, on account of which he is grieved, and fears that his
2463
- buxom, voluptuous bride will not be satisfied with such tantalizing as
2464
- he may be able to afford. A few months’ tonic treatment encourages him,
2465
- and he makes a trial of his condition before entering wedlock, that
2466
- he may be sure not to disappoint his fresh, true and virtuous maiden.
2467
- Again, the matrimonial rites have been consummated, and the young man
2468
- fails to reach the expected goal of marital adaptation and aptitude:
2469
- the wife is of course unsophisticated, and thinks there is nothing
2470
- wrong; but the husband is well satisfied that he is not what will be
2471
- expected, or what is necessary to promote marital felicity; and he
2472
- consults his physician. Perhaps he was not a little disgusted, upon the
2473
- first attempt at intromission, at ejaculating his semen either upon her
2474
- linen, thighs, or vulva; she of course being innocent and not knowing
2475
- the why such was not the natural procedure, he could excuse himself and
2476
- thereby palliate his embarrassment.
2477
-
2478
- Others, less sensitive in organic construction, do not understand these
2479
- shortcomings, and are not _quantum sufficit_ for a healthy female, as
2480
- ejaculation follows a moment’s rapid copulative movement, leaving
2481
- the female aflamed with erotic passion, and physiological turgescence
2482
- of the sexual apparatus. These are only the _sequelæ_ of seminal
2483
- weakness, such as pertain to the neurotic origin and character of this
2484
- disease. The grave and less common results are, as the symptomatology
2485
- illustrates, spinal anæmia and congestion, cerebral anæmia and
2486
- hyperæmia, insanity, epilepsy, tabes dorsalis (progressive locomotor
2487
- ataxia), paralysis, impotence and structural disease of the heart and
2488
- blood-vessels.
2489
-
2490
- _Treatment._――The treatment of spermatorrhœa, with its associate
2491
- phenomena, demands careful investigation of the lesions and conditions
2492
- of every case. The results and character of lesions are so varied that
2493
- often a diagnosis as to condition is not an easy task. To know that
2494
- spermatorrhœa exists is but a small part of the diagnosis necessary to
2495
- arrange a treatment that may rationally result in benefit. As has been
2496
- shown, seminal losses may exist when opposite conditions are present;
2497
- and only can benefit be rationally expected from equally opposite
2498
- methods of treatment. Any physician of experience has, and always will
2499
- have, much difficulty in treating and controlling these cases, as they
2500
- are hard to manage when even doing well, and only an intelligent and
2501
- positive course can succeed in managing them during any great length of
2502
- time.
2503
-
2504
- A positive code of government, rigidly followed, is indispensable; as
2505
- well as perfect confidence in the managing physician.
2506
-
2507
- The nasty drugs of our old-fashioned materia medica will not cure these
2508
- cases The bringing about so-called tonicity, by tonics and nervines,
2509
- only needs to be tested for a short period to convince any practical
2510
- physician how useless is such a procedure, and how soon his patient
2511
- will find another attendant. Drugs are often useful but bad ones,
2512
- selected for a tonic principle _only_, will as often do harm. Only
2513
- with a definite object in view, should we expect to accomplish such
2514
- changes as can result in positive relief. The list of nasty tonics for
2515
- indefinite purposes, or such as “have been used in such cases,” the
2516
- author has resolved not to, in any manner, refer to, and at no time
2517
- will he direct an agent or combination of drugs on so-called “general
2518
- principles,” but with definite expectations only.
2519
-
2520
- _Spinal Congestion._――The group of manifestations pointing to spinal
2521
- congestion will first receive attention. The remedies are bromide
2522
- potassium, bromide ammonium, ergot and belladonna, with electricity.
2523
-
2524
- These are selected also with reference to conditions only; yet the
2525
- reader can evidently see that their ultimate effects are aimed at,
2526
- as all of this list of agents affect the calibres of capillary
2527
- blood-vessels; therefore, the engorged spinal vessels are unloaded by
2528
- contraction, perhaps, of capillary _parietes_.
2529
-
2530
- By this effect of drugs we aim at relief of the long compression of
2531
- the cord, and liberation of nervous energies and forces supplying the
2532
- organs of nutrition and assimilation.
2533
-
2534
- It is pre-supposed that all sexual excesses and vices are under
2535
- control; otherwise, all treatment will be useless.
2536
-
2537
- Numerous are the contrivances to control or prevent seminal emissions.
2538
- They have all failed, and nothing is lost; as only the effect is
2539
- looked upon in their construction, and not the true nature of the
2540
- disease; therefore, to prevent spermal losses is not the first object
2541
- to accomplish, but to relieve the nerve-centers, which preside over
2542
- the manufacture of semen, of these abnormal structural changes; and
2543
- the loss of semen will abate. No instrument will then be required; and
2544
- if this centric improvement cannot be effected, the patient is beyond
2545
- help. No mechanical contrivance will relieve the centric lesions;
2546
- therefore, such appliances are useless. The loss of semen is not a
2547
- disease, only a manifestation or a phenomenon of centric lesions; and
2548
- as we have said heretofore that spermatorrhœa is not even a cause of
2549
- such lesions; but sexual shocks, often repeated for a long time, are
2550
- the cause of the neurosis through which we have spermal losses――true
2551
- spermatorrhœa. This reiteration is made that no mistake may be made in
2552
- interpreting the means of relief, which are all aimed at the lesions
2553
- instead of their phenomena.
2554
-
2555
- When the patient is not too much debilitated, chloral may be
2556
- administered to produce sleep; but very commonly the ergot or ergotine
2557
- will allay all nervous irritation and bring on perfect rest. Large
2558
- doses are demanded, as much as two grains of Beaujon’s extract three
2559
- times per day, or one drachm of Squibb’s fld. ext. or an ext. of equal
2560
- strength should be used. Belladonna should be used by commencing with
2561
- small doses and gradually increasing until asthenopia is produced, when
2562
- small doses should again be used: by this means the extent of tolerance
2563
- may be ascertained, and that dose should be continued which does not
2564
- affect the eye. When the bladder is involved and urine is voided with
2565
- a lack of expulsive energy, or the urine dribbles away, ergot and
2566
- belladonna are the remedies. Where there is extensive hyperæsthesia the
2567
- bromides are better agents, and also to overcome any reflex irritations.
2568
-
2569
- Hot applications to the spine are often followed by very excellent
2570
- effects, as the relief of pain and other troublesome symptoms.
2571
-
2572
- Cold water to the hands, feet and genitals is often followed by
2573
- surprising results, and should be used night and morning for a long
2574
- period of time――many months. Tonics do great injury in this class of
2575
- cases. Quinia, strychnia, phosphorus and iron should never be used in
2576
- any form.
2577
-
2578
- _Electricity._――The downward, constant current, alternated with
2579
- Faradisation, is indispensable to satisfactory results in the majority
2580
- of the cases of the congestive type; using the galvanic one day, and
2581
- the induced the next day, with general Faradisation, if it be followed
2582
- by pleasant effects and relief of unpleasant nervous symptoms.
2583
-
2584
- Stimulating food, as well as alcoholic and malt liquors, should be
2585
- proscribed; yet a generous diet is at all times indispensable. Opiates
2586
- should not be administered, even for the relief of pain.
2587
-
2588
- _The Anæmic Form._――When this type of spermatorrhœa is satisfactorily
2589
- diagnosed, the treatment is plain and the agents quite positive in
2590
- their course of action, when the case is not so far gone that relief
2591
- could not reasonably be expected. But if there be a doubt as to
2592
- diagnosis, on account of mixed symptoms――and such is not unfrequently
2593
- the case――if we are not well satisfied whether there is anæmia or
2594
- congestion of the cord, the administration of 1/60 of a grain of
2595
- sulph. strychnia will decide the matter, which will produce some of
2596
- its physiological effects if there be congestion; but if anæmia exist,
2597
- there will be no noticeable change, at least no unpleasant effects.
2598
- With this point clear, we then direct a treatment which is intended to
2599
- stimulate a free circulation of blood in the cord――_spinal stimulants_.
2600
- Strychnia, phosphide zinc, cantharides, pulsatilla, phosphoric acid and
2601
- collinsonia, are such agents.
2602
-
2603
- Cold spinal and genital douche, with hot foot and hand bathing morning
2604
- and night, are highly important agents, with strychnia 1/60 gr., three
2605
- times a day. The author has for many years almost entirely depended
2606
- upon formula No. 1, not on “general principles,” but as a combination
2607
- that applies directly to the anæmic condition of the cord and its
2608
- consequence; and knowing its effects, as he has, so long, could not
2609
- well do without it in the treatment of these complicated cases. If
2610
- there be general anæmia, as well as local, chalybeates may be of
2611
- service, but not until the patient is eating and digesting moderately
2612
- well: then we prefer the citrate in port wine. Stimulants in moderate
2613
- quantity are admissible, especially wine and malt liquors. Opium may be
2614
- administered to allay pain, but chloral is better.
2615
-
2616
- Any agents, used for their stimulating effect upon the cord, must not
2617
- be expected to act too rapidly. Patience is the all-important motto
2618
- after the diagnosis is well made.
2619
-
2620
- Counter-irritation will always be of great service, and the cantharidal
2621
- plaster is the most desirable form. The seaton has in a few instances
2622
- been of service, but we prefer the emplastrum canth.
2623
-
2624
- Electricity is indispensable, and should be applied daily. The anode
2625
- should be applied to the tender spots in the cord, and the cathode to
2626
- the genitals, in the form of a large sponge placed in contact with
2627
- the perineum, scrotum and penis. Faradisation may be alternated with
2628
- the constant current daily. General Faradisation may be applied best
2629
- by a large foot-plate covered with a wetted sponge, and the operator,
2630
- holding the anode, may place his other hand on the patient’s head, back
2631
- of his neck and along his spine: the hair of the patient will of course
2632
- be moistened as the dry hair is a non-conductor of electricity.
2633
-
2634
- A highly nutritious diet should be always advised, and plenty of
2635
- open-air exercise, even to fatigue; as the mind is thereby employed,
2636
- and not so much time is found to brood over these physical conditions.
2637
- The very common and exceedingly troublesome constipation may be
2638
- overcome by rhamnus purshiana, in teaspoonful doses of the fluid
2639
- extract, morning and night.
2640
-
2641
- When extreme sleeplessness prevails, grain doses of svapnia have acted
2642
- excellently; also ten-grain doses of chloral hydrate.
2643
-
2644
- I do not prescribe for seminal losses under any consideration: I
2645
- simply ignore them during the whole course of treatment. Where the
2646
- general health improves, and with that the nerve-symptoms, the seminal
2647
- losses become less frequent and finally cease. As the involuntary
2648
- discharges diminish, we may conclude the central lesions are improving.
2649
-
2650
- _Cerebral Sexual Neurosis――Treatment._――The most prominent feature of
2651
- the cerebral manifestation is mental asthenia, or feeble-mindedness,
2652
- from real exhaustion of all the forces; a general lack of power.
2653
-
2654
- To impart vigor to the general nervous system must be the first
2655
- indication. For this purpose dil. phos. acid may be administered. If
2656
- the extremities are cold the hypophosphites are of positive benefit,
2657
- and must be continued for a month or more. Tinct. nux vomica imparts
2658
- tone to the nerve-centres. When active symptoms are present the
2659
- bromides act very kindly, and may be combined with ergot, or the latter
2660
- may be used separately with most excellent results. But the physician
2661
- must be certain that he has a case of hyperæmia, before such agents are
2662
- resorted to, and then they should be given in large doses.
2663
-
2664
- Electricity, in the form of general Faradisation, seems to be of the
2665
- most service, and must be applied daily for several months. Only a
2666
- feeble current should be used.
2667
-
2668
- The structural changes that have occurred in the genitals always demand
2669
- attention.
2670
-
2671
- Chronic turgescence of the prostate gland will best be treated by
2672
- the internal use of tinct. staphisagria, large doses of bromide of
2673
- potassium, and the introduction of catheters increasing in size until
2674
- the urethra is fully dilated.
2675
-
2676
- Electricity should be used as recommended under Prostatorrhœa. The
2677
- organic stricture, which is so commonly present, should be treated by
2678
- dilatation with suitable bougies or catheters. The bougie must be used
2679
- as often as twice a week, until the full size and elasticity of the
2680
- urethra are obtained.
2681
-
2682
- Injections are sometimes useful. A solution of nitrate of silver,
2683
- ten grains to the ounce of water, used only once, and followed by a
2684
- solution of brown sugar (sacch. communis), morphine and rose-water,
2685
- will answer a most excellent purpose. After the acute inflammation has
2686
- subsided the bougies must always be resorted to, and used persistently
2687
- until the object for which they are used is accomplished. Any
2688
- ulceration may be relieved by injections of permanganate of pot., not
2689
- stronger than one-half grain to the ounce.
2690
-
2691
- The glans and prepuce should be closely scrutinized from time to
2692
- time, and if the prepuce be of undue proportions, or if the patient
2693
- is filthy, permitting accumulations to form beneath the folds and
2694
- creating a local irritation, circumcision should be performed without
2695
- hesitation.
2696
-
2697
- Reflex irritations have often prevented recovery, and even produced
2698
- grave manifestations. Cases of epilepsy have been reported from such
2699
- peripheral causes, and cured by relieving the cause, or circumcision.
2700
- The division of the sensitive nerves, which occurs in the operation
2701
- of circumcision, often prevents involuntary spermal losses, and
2702
- even permits such patients to perform normal copulation as had even
2703
- ejaculated previous to intromission. Such little causes must not be
2704
- overlooked. It is often in attending to little things that great
2705
- results are accomplished; and in this we have no exception to the rule.
2706
-
2707
- There is no room for a doubt in my mind that the Jewish rite was first
2708
- established from hygienic motives _only_; and as “cleanliness is,” and
2709
- always has been, “next to godliness,” circumcision would seem a very
2710
- natural sacred rite for any religious sect to adopt.
2711
-
2712
- We have no history of anything more ancient than the operation of
2713
- circumcision. The Egyptian priests were practicing circumcision nearly
2714
- 5,000 years ago. A translation of Herodotus informs us that such
2715
- hygienic measures were in existence amongst the Egyptians in the most
2716
- ancient of periods; and it is quite reasonable to suppose that the Jews
2717
- obtained this rite from the Egyptians.
2718
-
2719
- _Dilatation of the Anus――Anal Plug._――A very troublesome complication
2720
- of the genital structural changes occurring in spermatorrhœa is
2721
- induration of the mucous membrane and sub-mucous tissues. Where such a
2722
- condition is present, little benefit should be expected until relief is
2723
- obtained from the local difficulty.
2724
-
2725
- The dilatation should be accomplished by suitable means; such as by
2726
- bougies, or a bi-valve rectal speculum. An anal plug may be constructed
2727
- that is self-sustaining, polypoid in shape, which will be of more
2728
- service than compression of the anal surfaces. The troublesome
2729
- pruritus, and hemorrhoidal tumors, and indurated anal tumors, will
2730
- gradually subside under such management. Suppositories of iodoform are
2731
- also of invaluable service in reducing indurated conditions of the
2732
- anus and rectum, as well as enlargement of the prostate gland. The
2733
- old-fashioned stretching of the sphincter ani for spermatorrhœa, so
2734
- highly recommended by Trousseau in his clinic on this subject, from
2735
- indiscriminate use, is neglected, when it is really a most important
2736
- means, deviating the reflex current from the genitals as well as
2737
- relieving actual structural change in the anus. Roberts Bartholow has
2738
- dwelt upon this subject without pointing out definitely such cases as
2739
- it has actually relieved, leaving the reader to guess or find out for
2740
- himself. The failures from its use have been so numerous, and the
2741
- cases in which benefit has followed so few, that it is no wonder that
2742
- it is not in better repute as a remedial means.
2743
-
2744
- Whenever this dilating process is restricted to thickening and
2745
- induration of the mucous membranes of the anus and rectum, much benefit
2746
- will follow its use.
2747
-
2748
- Many peculiar means have been recommended and are resorted to, many of
2749
- which only need a condemnatory mention, which seems the more necessary
2750
- that they are in almost general use. The most prominent is _the porte
2751
- caustique_, which was probably introduced by Ambrose Paré, and improved
2752
- and so highly recommended by Lallemand. Other prominent supporters of
2753
- this manner of medicating the urethra and prostate gland were Wiseman,
2754
- Hunter, Amussat, and Everard Home. The supporters of this manner of
2755
- cauterizing the openings of the vesiculæ seminales were under the
2756
- impression that spermal losses constituted the essential cause of
2757
- the disease, instead of the habit the testicles had taken on by a
2758
- hyper-supply or vicarious evolution of nerve-force.
2759
-
2760
- We do not hesitate to say that this method is seldom followed by
2761
- beneficial effects, and often by irreparable injury.
2762
-
2763
- Bartholow advises its use in exceptional cases; “those in which,”
2764
- he says, “the moral effect of the application is desirable.” From
2765
- this I must dissent; as any superabundance of attention demanded may
2766
- be bestowed by cauterizing or vesicating the perineum, obtaining
2767
- an excellent moral effect and even accomplishing, by way of
2768
- counter-irritation, physical improvement.
2769
-
2770
- We might suppose that these harsh means of treatment, owing to the
2771
- elevated character of their supporters, were in good repute; and that a
2772
- work on this subject would be incomplete without a full detail of them;
2773
- but a better success without than with them has led me to discontinue
2774
- their use, and conscientiously speaking of the treatment, I can but
2775
- manifest my disapprobation of all caustic applications to the urethra
2776
- or prostatic ducts.
2777
-
2778
-
2779
-
2780
-
2781
- CHAPTER XI.
2782
-
2783
-
2784
- _Impotence._――Some misapprehension as to the signification of this
2785
- term is prevalent, owing to the extent of weakness and the morbid
2786
- conditions to which it has been applied. The wrong application has been
2787
- very common; _i. e._, in using it to describe a condition of sexual
2788
- neurasthenia and temporary suspension of the sexual powers, from moral
2789
- shock. A young man who exercises a doubt as to his ability to copulate
2790
- may, upon the occasion, be unable to procure an erection; and yet he
2791
- may, after a time, secure his own confidence; or, when he the least is
2792
- thinking of it, be in full possession of his potence. The first attempt
2793
- at coition, after matrimony, may be unavailing for this reason, and no
2794
- trouble occur at any time afterwards.
2795
-
2796
- The penis may be erect at first, and become flaccid before intromission
2797
- can be effected. Even this does not constitute, but may be only a
2798
- result of, nervous shock or impression produced upon the mind and
2799
- sexual instinct, from embarrassment, that may occur to any young man
2800
- who is not self-confident, and is no evidence of any permanent disease.
2801
-
2802
- Impotence, as it should be defined and considered, is the
2803
- manifestation of a disease in which there is permanent and actual
2804
- impairment of the nerve-centres and, as a phenomenon of such centric
2805
- changes, inability to procure an erection of the penis, at any and all
2806
- times, sufficient to perform the act of coition. This is a chronic
2807
- malady, of slow advent, and when once established there is very little
2808
- tendency to recovery. The chagrin manifested in a man who is impotent
2809
- is at all times striking. He feels that to be impotent is to be worse
2810
- than dead. Men pride themselves on their ability to perform coition,
2811
- and feel the loss of sexual power more than mind. Money and time are,
2812
- therefore, expended exorbitantly to recover this lost power, that they
2813
- may feel themselves men once more.
2814
-
2815
- The flabby organ is the centre of attraction. He handles it, and dotes
2816
- upon what has been in by-gone years, and mourns over his misspent
2817
- fortune only for the possibility of his obtaining relief from his
2818
- genital affliction through its influence.
2819
-
2820
- The disease is complicated with spermatorrhœa at nearly all times, and
2821
- may be considered only an advanced period of the same neurosis. The
2822
- same conditions and types of diseased manifestations are to be studied
2823
- in impotence as in spermatorrhœa. Then, to spermatorrhœa we add the
2824
- phenomenon, impotence, and the accompanying changes, and we quickly
2825
- comprehend the position.
2826
-
2827
- The condition is a loss of excitation-power of the nerve of Eckhard,
2828
- whereby all physiological irritation becomes impossible. This nerve
2829
- arises from the sacral plexus, any irritation of which, in a healthy
2830
- state, causes a flow of blood to the corpus cavernosa and spongiosa
2831
- of the penis; but the constant stimulation of this nerve produces a
2832
- loss of irritability and paralysis of the parietes of the arterioles
2833
- of the erectile bodies of the penis, and no relaxation of their valves
2834
- occurs at any time: a perfect vascular inactivity is the result. These
2835
- arterioles anastomose with corporal venules which are very tortuous
2836
- and sacculated and supplied with very large openings and very small
2837
- outlets compared with the magnitude of their calibres; but the often
2838
- turgesced condition of these venules causes a dilated condition of
2839
- the outlets, and any blood that may be conveyed into the corpora
2840
- through the arterioles will flow out so fast through the dilated
2841
- venule outlets, that the turgescence necessary to produce erection is
2842
- impossible. Again, the innate contractility of the trabecular substance
2843
- must antagonize, to a considerable extent, the erectile tendency of
2844
- surrounding tissue.
2845
-
2846
- Then there is another condition so closely connected with impotence
2847
- that a mention of it will not be out of place. Impotence consists in
2848
- a lack of power to effect an erection; but there is a condition, not
2849
- always impotence, where the person has lost all desire for copulation,
2850
- and will not make an effort to obtain an erection. He does not attempt
2851
- to concentrate his will-power, and does not desire any relation
2852
- whatever with the opposite sex, although he may have been a debauché in
2853
- his early life. When such a condition has been congenital, there would
2854
- be reason to suspect deformity or congenital defect. Such person may
2855
- not be impotent, and if the desire returns it manifests itself in the
2856
- genitals as soon as the mind is allowed to dwell upon erotic thoughts;
2857
- and if erection does not occur impotence is present.
2858
-
2859
- The loss of semen often subsides in the aged, and atrophy of the testes
2860
- is not an uncommon result; but some people live to be very old, and are
2861
- never troubled with senile-impotence.
2862
-
2863
- The penis is at all times flaccid, if impotence be complete. Often
2864
- partial impotence will reveal itself, deviating peculiarly in its
2865
- character. Sometimes a man will, while entertaining erotic thoughts,
2866
- have an erection of the penis which is perfect in all appearance, and
2867
- when brought in contact with a female cannot sustain or even procure
2868
- the erection, and yet the erotic desire be just as intense as if he be
2869
- able to perform the act in a proper manner. These cases are practically
2870
- impotent, but the disease has all to do with the mind; and as soon as
2871
- the mind can be so corrected that self-control may be exercised as
2872
- well as self-confidence, just so soon will the impotence disappear;
2873
- and once the act is performed normally, the trouble will be at an end.
2874
- But there is a condition in which all the powers of mind and body,
2875
- exercised to control, will not impart either the power of erection or
2876
- the erotic desire――only a longing for that once felt erotic desire
2877
- exists. The condition often exists in which the patient cannot control
2878
- the mental impressions, so as to effect that peculiar concentration
2879
- of the nervous force which gives energy to the sexual organs; and yet
2880
- there may be no disease of such nerves themselves. It is the same
2881
- condition that will cause the mental operations to fail during any
2882
- course of anxiety, or turbulence of the emotions. A speech-maker may
2883
- fail in his efforts at first, even after he considered himself prepared
2884
- for every emergency; but as soon as allowed to collect his scattered
2885
- mental evolutions, he may compose himself.
2886
-
2887
- Inability to perform the sexual act while suffering from any mental
2888
- derangement, or misunderstanding one’s own mental elaborations, is
2889
- not impotence; but there must be impairment of the integrity of the
2890
- nerve-substance that evolves the force that sustains the sexual organ
2891
- in its erect attitude, and also supplies the so-called physiological
2892
- irritation. If we attempt to name this peculiar disease from other
2893
- stand-points, we shall become confused; as it would only demonstrate a
2894
- function-disease, which is an impossibility and leads to confusion.
2895
-
2896
- I have seen cases of so-called impotence from intestinal worms: while
2897
- impotence is not generally considered a symptom of worms, yet this is a
2898
- case which recovered as soon as the worms were expelled. I have known
2899
- two cases that supposed they were permanently impotent, both of which
2900
- obtained relief after the expulsion of a tænia solium.
2901
-
2902
- These were cases of symptomatic impotence; which only means phenomena
2903
- that may exist in remote structural disease, or by mechanical pressure,
2904
- as from foreign bodies, lumbricoide, tapeworms, etc., pressing or
2905
- directly or indirectly infringing upon the nervous track that conveys
2906
- the force which supplies the erectile tissue of the penis. This is a
2907
- paralysis of the vaso-motor variety, in which the impotence is only a
2908
- symptom: the disease must be studied under nervous diseases.
2909
-
2910
- To comprehend and study true impotence, the student will be attracted
2911
- to the brain and spinal cord; as there only can the pathology be
2912
- carefully comprehended.
2913
-
2914
- Nearly all the descriptions of this perplexing malady have been
2915
- confined principally to the chronic flaccid penis and the general
2916
- nervous phenomena most likely to co-exist. I must say that our
2917
- knowledge is very limited beyond the superficial sources of
2918
- information; and we have to content ourselves with simply describing
2919
- the appearance, for the real disease itself; not but what structural
2920
- changes exist in the sexual organs, worthy of note, but such changes
2921
- are only secondary.
2922
-
2923
- Depending upon organic disorganization of the nerve-substance, we have
2924
- all grades of loss of sexual power, from the simple chronic premature
2925
- ejaculation to advanced and perfect paralysis of the organ. Any male
2926
- who, from exhaustion of nervous force, cannot perform the act of
2927
- copulation in a normal manner, may be said to be in a degree impotent.
2928
- If he be able to effect intromission and then unable to complete
2929
- the act, from premature ejaculation――providing this is a common
2930
- occurrence――he may be said to be impotent. The continent may undergo
2931
- premature ejaculation and not be impotent. Neither is flaccidity likely
2932
- to follow ejaculation from such cause.
2933
-
2934
- The more advanced cases of impotence are not even capable of procuring
2935
- erections; and often semen is discharged in the flaccid condition
2936
- without the knowledge of the patient: such may be the result of
2937
- spermatorrhœa and impotence combined.
2938
-
2939
- The long-continued and frequent indulgence of masturbation must be
2940
- a most frequent cause of impotence. I have only observed a very few
2941
- whom I knew to have brought upon themselves this condition without the
2942
- habit of masturbation; and even then I am not positive in knowledge.
2943
- Yet they were rare debauchés, with money to squander and appetites so
2944
- salacious that the almost constant contact with women was their custom.
2945
- On the other hand, it seems that a male human being is constructed for
2946
- endurance of his sexual organs. A notorious polygamist in practice,
2947
- once living in the city of Elmira, New York, was known to lavish his
2948
- smiles on his “kept women,” whom he numbered by scores, and still he
2949
- was potent till he died in advanced life. We must have a most excellent
2950
- example in the famous President Young whose wives, we are inclined to
2951
- believe, must have kept him on the _qui vive_, as his children bear
2952
- evidence, as well as the fascination and attractiveness of his young
2953
- wives.
2954
-
2955
- The exciting cause of impotence must combine a constant and
2956
- long-continued sexual debauch with the depraved chain of thought that
2957
- must necessarily accompany such degradation; and the practice of
2958
- self-pollution must be the most fruitful of all causes.
2959
-
2960
- _Treatment._――In the management of impotence, the patient’s persuasive
2961
- influence must not in any way change the intentions of the physician,
2962
- or the fast hold of his mind, which is so indispensable to a cure,
2963
- will be lost. The patient is always in great haste, and constantly
2964
- urging the physician to make rapid progress. Too great firmness cannot
2965
- be exercised, and promises of speedy cure will invariably fail.
2966
- Time is one of the most important of all elements in the treatment,
2967
- as opportunity is afforded for the recuperative powers of nature or
2968
- physical forces to become poised.
2969
-
2970
- Perfect confidence in the medical adviser is prerequisite to success,
2971
- as by this alone can the patient’s mind be manipulated, and his hope
2972
- constantly stimulated. If he has been much exercised in mind about his
2973
- case, from reading “self-abuse” literature, moral treatment will be
2974
- required to dispel from his mind the pictures there wrought. Not always
2975
- can the virile organ be restored to its normal vigor, but elevating the
2976
- general health should be first considered, and the patient’s mind kept
2977
- constantly thinking about his improving physical condition, instead of
2978
- watching for the first erection as he will most naturally do.
2979
-
2980
- When the foregoing conditions cannot be secured, no benefit will result
2981
- to the patient. In no disease has mental influence so much to do with
2982
- recovery, as in impotence; and I do not hesitate to say, where I can
2983
- control my patient’s mind, that I can always effect a very satisfactory
2984
- relief. Employment is indispensable, and must be persisted in. The
2985
- patient should have no time to play, or brood over his disease, but
2986
- must be engaged so constantly that he will be even fatigued after he
2987
- has finished his day’s toil, and will sleep long and soundly from
2988
- his exhaustion. The most nutritious diet should be selected: meat,
2989
- eggs, oysters, milk, etc. Cold bathing at night, before retiring, is
2990
- a very important measure; as, first, it washes the parts of a cold,
2991
- clammy sweat, and the chill from the water after reaction, produces
2992
- a naturally warm feeling, and his attention is not attracted to the
2993
- parts by their otherwise doughy, unnatural feeling; and secondly, the
2994
- tonic properties of cold are of lasting benefit. The bathing should
2995
- extend to the back, perineum, scrotum, penis, and down the thighs. Such
2996
- constitutional measures should be resorted to as will favor any of the
2997
- imperfect processes in the body. The means should favor assimilation of
2998
- food and normal excretion, and the avoidance of stimulating diet and
2999
- alcoholic liquors.
3000
-
3001
- For the neurosis upon which impotence depends, I have accomplished
3002
- very much by a single combination of medicine (see formula No. 1),
3003
- that this preparation has been, as it were, a “stand-by” for many
3004
- years; the patient gradually improving under its use, in nearly every
3005
- case. I can affirm that it has been tested in hundreds of cases, in a
3006
- great majority of which marked improvement has taken place, and many
3007
- have been permanently cured. Many were cured before I became familiar
3008
- with the importance of electricity in the treatment of such cases; but
3009
- since having extensive experience with the various methods of applying
3010
- electricity I confess I could not do well without it.
3011
-
3012
- As to the beneficial results following galvanism and Faradisation,
3013
- there can be no question; but as to which of these forms should be
3014
- applied, I am not always able to say. I have used galvanism without
3015
- benefit, a certain length of time, and changed to Faradism with
3016
- immediate improvement; and _vice versa_.
3017
-
3018
- I do not opine that either form, if used mildly, will often do harm;
3019
- and where improvement does not follow after a reasonable length
3020
- of time, I would advise a change. When the patient is wakeful and
3021
- restless, a pleasant effect is produced by Faradisation, which is often
3022
- a favorable sign, and may be continued with exalted expectations. In
3023
- very advanced cases, the galvanic current will oftener establish an
3024
- improvement, when a change to the Faradic current will continue the
3025
- improvement. I consider no means of the physician demanding so much
3026
- judgment and experience as electricity; and in the skilled operator’s
3027
- hand much good may be realized from its use.
3028
-
3029
- A very natural manner of applying Faradisation in impotence, as well
3030
- as other forms of sexual neurosis, is to seat the patient upon a large
3031
- wet sponge, to which the negative is connected, bringing the scrotum
3032
- and perineum well in contact with the sponge, and stroking the spinal
3033
- column well with the positive, also using a wet sponge. The operator
3034
- will be governed by the patient’s sensibilities, as to time of sitting
3035
- and strength of current. The current should not be painful or very
3036
- unpleasant; and if twenty minutes produces any uneasy sensation, the
3037
- next application should not be continued longer than ten minutes.
3038
-
3039
- The galvanic current may be used in a similar manner.
3040
-
3041
- Beard & Rockwell’s method of general Faradisation is a most excellent
3042
- one for alternate applications.
3043
-
3044
- A troublesome complication is often constipation of the bowels, which
3045
- may be overcome by the judicious use of rhamnus purshiana. Not too much
3046
- general bathing, but local bathing, as directed above, with stimulant
3047
- friction, is always beneficial.
3048
-
3049
- Turkish baths, so often ordered, must be avoided, as great general
3050
- debility and languor often follow their use. No undue warmth can be
3051
- made use of, either in dressing or bathing, as the neurosis, upon which
3052
- all these unnatural phenomena depend, is aggravated.
3053
-
3054
- The general treatment of neurosis, in impotency, differs very little
3055
- from that in the neurosis of spermatorrhœa, as the conditions are
3056
- very similar if not identical; only degrees of the same organic
3057
- cerebro-spinal changes. The beginning is perhaps only a neurasthenia,
3058
- but gradually increasing in intensity to spinal anæmia, or congestion,
3059
- finally softening.
3060
-
3061
- Any changes of the genitals must be treated according to principles
3062
- mentioned under treatment of structural changes of the genitals.
3063
-
3064
- _Clinical Illustrations._――It must not be expected that all cases
3065
- will be confined to one definite condition, or to one combination of
3066
- phenomena that may be grouped together and named. No one will so fully
3067
- comprehend this as the practical physician. Cases are constantly under
3068
- the care of the medical man, suffering with conditions too numerous
3069
- to mention, complicated with many strange lesions. Every case must
3070
- necessarily be studied from its own merits, in and of itself, or
3071
- success will not follow.
3072
-
3073
- It is not uncommon to come in contact with spermatorrhœa and impotence,
3074
- both together, also complicated with organic disease of testicles,
3075
- prostate gland, and anus or rectum. At the same time the brain and
3076
- spinal cord may be drawn upon by a variety of organic lesions. By this
3077
- we shall see that a report of clinical cases will bear more upon the
3078
- practical than the theoretical, as regards adapting doses to nosology.
3079
-
3080
- _Case._――J. S. consulted me in ’74. He was suffering from spermatorrhœa
3081
- and partial impotence. He had tenderness over last lumbar vertebra and
3082
- sacrum, anæsthesia of the genitals, dyspepsia, bowels constipated,
3083
- and at times very languid; was brooding over his loss of power and
3084
- involuntary discharges of semen, which were nocturnal, generally
3085
- accompanied by lascivious dreams. The urethral sound revealed
3086
- tenderness along the urethra and extreme soreness of the prostate
3087
- gland. His semen was thin and spermatozoa scanty and imperfect. He
3088
- was thin in flesh, and anæmic. His erections were imperfect, and he
3089
- could not perform the act of coitus. He was a masturbator. I directed
3090
- pills, formula No. 2, and continued until bowels became regular; also
3091
- No. 1, which was continued one year without change, with cold local
3092
- bathing and brisk friction over bowels, back, perineum and scrotum. His
3093
- recovery has been very satisfactory.
3094
-
3095
- _Case._――J. W., when he first visited my office for examination
3096
- and advice, was emaciated, pallid, with his eyes sunken. He was
3097
- careworn and haggard in his expression, suffering from pain in his
3098
- back and limbs, almost constant pain through the top of his head;
3099
- palpitation, with accelerated pulse; formications over his back and in
3100
- his finger-ends; bowels constipated, and urine smelled strong like a
3101
- horse’s; tender spots along the spinal cord. The testicles and scrotum
3102
- were doughy and constantly moist and cold. His scrotum was long and
3103
- pendant: his penis was blue and flabby. He could only obtain partial
3104
- erections, very occasional. He lost semen often. His urethra was very
3105
- tender, also the prostate gland. He was restless and wakeful during the
3106
- night. I directed local cold bathing, Faradisation, formula No. 1, for
3107
- his general neurotic condition; pills――formula No. 2――for constipation.
3108
- He took chloral every night, to produce sleep, for 3 months; tr.
3109
- staphisagria, small doses, for prostatic irritation, and occasional
3110
- opium suppository. I discharged him after sixteen months, when he
3111
- married, and now has a healthy child.
3112
-
3113
- _Case._――R. confided to me his history, which was, he had been a
3114
- debauché and masturbator. He was tall, slender, anæmic, beard thin;
3115
- was suffering from too much medicine, which he had received from
3116
- unprincipled specialists, as he had been three years in their hands.
3117
- There was spinal anæmia, judging from the spinal soreness, and
3118
- formication at times. He thought he would become paralyzed, as his
3119
- hands and feet often became numbed. He was impotent, and often lost
3120
- semen. His urine contained spermatozoa. As soon as his mind could
3121
- be put at ease he began to improve, under formula No. 1, with cold
3122
- local bathing, as directed, with Faradisation. I discharged him after
3123
- thirteen months.
3124
-
3125
- _Aspermatism._――Since Roubaud’s description of this condition, and
3126
- especially the application of the above term, much has been said in
3127
- regard to the causation and true nature of this peculiar deficiency.
3128
- Whenever sexual orgasm occurs in the male, after puberty, without
3129
- ejaculation, the condition known as aspermatism may be said to exist,
3130
- and may be considered as a symptom of disease. This may be partial or
3131
- complete. I have known a number of individuals who failed to ejaculate
3132
- semen at the time of sexual orgasm, and the semen would pass away in
3133
- jets some time after the penis had become flaccid. These cases exist
3134
- where there is no sign of organic stricture of the urethra, or any
3135
- other organic trouble within the prostate gland or ejaculatory ducts.
3136
-
3137
- Dr. Van Buren is the author of a paper which appeared in the _New York
3138
- Med. Journal_, November, 1868, in which he attempts to establish the
3139
- cause as a spasmodic condition of the urethra, forcing the seminal
3140
- fluid, by reflux action, into the bladder. I can not, at present, think
3141
- that this is always the case. Only a little attention to physiology
3142
- will familiarize any person with the calibre-contractions that follow
3143
- a column of urine from the bladder to the meatus. This same muscular
3144
- contraction exists in the veins, and is what constitutes the venous
3145
- wave. The same wave exists in the ejaculation of semen; and where the
3146
- muscles that perform accelerating movements are paralyzed, the natural
3147
- consequence must be, that the fluid will remain in its reservoir until
3148
- its place is supplied by new, and a portion is forced out along the
3149
- urethra, which drips away when the penis returns to flaccidity. Then, I
3150
- can but regard this condition, often, as one of paralysis, in which are
3151
- affected the muscles of ejaculation and acceleration. This condition
3152
- often exists where the genitals are not impaired as to potence. That
3153
- such a condition is present, should not be declared until after bougies
3154
- have proven, to entire satisfaction, the absence of organic stricture
3155
- or spasmodic contraction.
3156
-
3157
- When such a lesion has come on gradually and is of long standing,
3158
- the prognosis is very unfavorable; as relapses will most generally
3159
- occur with the slightest indulgence. But when the condition has made
3160
- its advent suddenly, from inflammatory causes, the prognosis is very
3161
- favorable. A gonorrhœal orchitis will often produce this condition,
3162
- which is only transitory, or of a few months’ duration. This is only
3163
- symptomatic, and very much unlike the true aspermatism of a neurotic
3164
- origin.
3165
-
3166
- A very extraordinary case has of late engaged my attention and
3167
- curiosity. No case of the kind have I been able to discover, in medical
3168
- literature or in the practice of my medical friends.
3169
-
3170
- _Case._――A young married man consulted me with an affliction (as it
3171
- were), much to the discomfort of himself and to the great injury of
3172
- his wife. He never had passed the sexual orgasm, nor ejaculated semen
3173
- during coition. He is very erotic, and has no difficulty in performing
3174
- the marital act, but it is followed without the slightest satisfaction.
3175
- He continues in the act of coition until exhausted, and retires with
3176
- the wife very much in the same condition after repeated sexual orgasms.
3177
- He informs me that one hour is not an uncommon length of time for him
3178
- to occupy in the act of coition, participating in the sexual beatitude
3179
- during the entire period, until gradually becoming exhausted, when
3180
- the pleasure dwindles away, but his penis remains erect for some time
3181
- after. He says that he has often applied cold water to facilitate
3182
- flaccidity.
3183
-
3184
- After the organ has been reduced he sometimes can detect semen, or
3185
- prostatic fluid, on the glans and meatus, and he is very soon ready
3186
- to perform the act again. I have often discovered spermatozoa in his
3187
- urine. His testicles are well formed, and his penis is normal in
3188
- appearance. He has never had a venereal disease, and has no stricture.
3189
- Treatment has given no relief as yet. It will be observed that
3190
- satyriasis is prominent in this case.
3191
-
3192
- Galvanism will often be found of great service as a paliative measure,
3193
- with phosphide zinc and nux vomica. If a few years’ continence can be
3194
- obtained, a better prospect for recovery may obtain. When galvanism is
3195
- used, an insulated electrode should be passed to the orifices of the
3196
- ejaculatory ducts, with the anode attached, and the cathode applied to
3197
- the cord with wet sponge. I have derived some benefit from localized
3198
- and general Faradisation, after the manner heretofore mentioned.