Produced by Donald Cummings, from images generously made
available by The Internet Archive/American Libraries.









                           SEXUAL NEUROSES.

                                ――BY――

                       J. T. KENT, A. M., M. D.


                            [Illustration]


                              ST. LOUIS:
               MAYNARD & TEDFORD, PRINTERS AND BINDERS.
                                 1879.




      Entered according to Act of Congress, in the year 1879, by
                              J. T. KENT,
      in the Office of the Librarian of Congress, at Washington.




                           LIST OF CHAPTERS


                             CHAPTER I
                             CHAPTER II
                             CHAPTER III
                             CHAPTER IV
                             CHAPTER V
                             CHAPTER VI
                             CHAPTER VII
                             CHAPTER VIII
                             CHAPTER IX
                             CHAPTER X
                             CHAPTER XI




PREFACE.


In presenting this little monograph to the profession, I have no
apologies to offer. My only hope is, that the subject may be as
seriously considered as it deserves. Believing that a superabundance
of modesty has prevented facts from being duly presented to the
profession, and thinking myself endowed with less of that desirable
virtue than others, I can but conclude that my reputation will not
suffer from reverses such as might ensue from elucidating theories,
and maybe fancies, connected with such a delicate topic. But if
professional minds are stimulated to a renewed study of these important
phenomena, my highest anticipations will be reached.




CONTENTS.


                                               PAGE.
 INTRODUCTORY                                      5
 PREDISPOSITION                                   11
 CONTINENCE                                       22
 SODOMY                                           25
 ONANISM                                          27
 MASTURBATION                                 18――31
     Among Females                                33
     As a Cause of Organic Stricture              36
     The Effect of upon the Neural Axis           37
 COPULATION                                       39
     Social Attributes of                         44
 NYMPHOMANIA                                      46
     Causes of                                    47
     Treatment                                    49
 SATYRIASIS                                       56
 SEXUAL NEURASTHENIA                              60
     Treatment of                                 70
 PSEUDO-SPERMATORRHŒA                             71
     Cases of                                     74
     Prostatorrhœa                                76
 SPERMATORRHŒA                                    80
     Cases of                                 81――83
     Moral Effect of                              90
     Symptoms of                                  90
     Spinal Congestion                            92
     Spinal Anæmia                                94
     Cerebral Sexual Neurosis                     97
     Clinical Illustrations                      102
 LOCAL STRUCTURAL CHANGES IN GENITAL ORGANS      109
 SPERMAL CHANGES                                 110
 SEQUELÆ                                         111
 TREATMENT                                       113
     Of Spinal Congestion                        114
     Of Spinal Anæmia                            117
     Cerebral Sexual Neurosis                    120
 DILATATION OF THE ANUS                          123
 ANAL PLUG                                       123
 IMPOTENCE                                       126
     Treatment of                                133
 ASPERMATISM                                     140




SEXUAL NEUROSES.




CHAPTER I.


_Introductory._――The term sexual presupposes the possibility of two
distinct and perfect beings, yet one is counterpart of the other,
distinguished by anatomical features designated male and female; with
attributes such as passion, love and reciprocal admiration. Sexually
the two beings become united, constituting plurality in unity.

The sequel of such coalescence of the sexes, or marriage legitimately
considered, is copulation and reproduction of the species. The
summit, or peripheral center of venereal sensibility, is found at the
genitalia, and in the male a concentration of nerve-force conducts,
as it were, to and unites at the glans penis; and division of the
terminal nerves at this point will render erection impossible. In both
man and beast, the only mechanical irritation capable of exciting
venereal sensibility must be at this point. When the sexual centers
are physiologically irritated, from peripheral or centric influences,
contentment is only possible (physiologically speaking) when male
and female counterparts coalesce, or are in juxtaposition. The sexual
attributes also constitute an instructive topic for study, as they
become modified by civilization and the development of reason. The
procreation of organic life is the sequel of the sexual connection. The
living universe has been called into existence, and the perpetuation of
its life-spark is only dependent upon the contact of sexes.

The universe, it is said by one theorist, was evolved; by another,
who depends upon the Holy Book for a guide, all living creatures were
thaumaturgically or miraculously, and “in the twinkling of an eye,”
made to exist in full form and shape. This problem will never be
settled to the satisfaction of all men as long as theory and faith
are at war; and small is the prospect of peace while both parties
are redoubling in their forces annually. Then, we can but accept the
situation of the human race, as it is, since we have no historical data
of its origin, that are beyond controversy and that would be accepted
as evidence in a physiological point of view. But we need no ponderous
evidence to show the truth of the premise, that animal life is not
perpetuated except through sexual congress. Not life _only_, but good
and evil of every degree; vice, folly, crime; love and hate; society,
social evil and social good: all depend, largely, upon the sexual. It
is the bond of our existence; it is the wheel of our fortune; it is our
guiding star; and it may be our loadstone to crime and premature death.
Passions leading to love, true and gentle, or jealousy, hate, revenge,
murder and suicide, all hinge on circumstances connected, directly or
indirectly, with the sexual.

Our schools are conducted upon a foundation entirely sexual; educating
each of the sexes in the role they are to pursue, with reference to
exclusiveness in conduct. The girl is taught to pursue only such
vocations, practices and manners as are becoming to her sex; the boy,
on the other hand, is instructed not to enact girlish capers, but to
pursue masculine vocations, from the childish toys to settled, adult
labors. This all means nothing but distinctive development of the sexes.

The sexual enters our every-day lives, from childhood up; it governs
our development; it modulates the voice, the build, the dress, the
hair, the fashion of wearing the dress, and even the gait. In all this
we can but observe the worship of the sexual; though obscure, yet
every manifestation of human existence points to it. The good people
of the earth profit by the grand and noble sexual unity in the marital
existence, and by the pure, social relations, and chaste affections of
the unmarried; but these are but a small part of human society. The
masses express their worship for the sexual by debauch, dissipation,
vice and crime. The common saying, whenever suicide or murder has been
committed, that “_woman was at the bottom of it_,” might just as well
read, “_man was at the bottom of it_;” as without the one, where would
the other have been?

It is the bad use of noble agencies that often constitutes vice.
Nothing ignoble, was intended by the Great Designer, should grow out
of the sexual privileges, and when nobly appreciated, for moral beings
a greater happiness or pleasure has not been instituted. But by long
prostitution of these privileges, vices have originated; beliefs have
been established; customs have been founded; even religions have been
constructed and modified to suit the wishes of designing “sexualists,”
“free-thinkers,” Mormons, etc. Occasionally, dissatisfied members of
one sex will establish an innovation, or a revolutionary commotion,
demanding rights which they claim have been usurped from them, and
sometimes thirsting for prerogatives belonging to the opposite sex.
They agitate their cause until their isolated followers establish
societies and churches, effecting discord in families, and no good to
the world in general, and for themselves an unenviable reputation. Such
individuals are often advocating reforms; temperance, charity, etc.;
but when good comes out of one, evil grows out of ten. They often take
a decided stand against the opposite sex, and when their true history
is known, it will be often found that they have been suffering from
unrequited love, disappointment in matrimony, deception in society,
misplaced confidence, illegitimate pregnancy, etc.; or, they are
phlegmatic and passionless; or, hermaphrodites; or wanting in some of
the sexual appendages necessary to constitute a perfect man or woman.
Then, without the complete sexual system, harmoniously balanced, all is
imperfect.

My purpose in dwelling so much upon these mixed relations and
disappointments, has been more especially to fully expose the
predisposing causes of neuroses and more essentially of the sexual
variety. As I shall labor to show that neurosis is the condition
throughout our list of sexual diseases, and that all the foregoing
changes, excesses and defects, depending upon the sexual, are more or
less influential in predisposing human beings to brain and spinal cord
disease. No person, so well as the physician, will comprehend, after
once meditating upon this theme, the necessity for thorough study and
a more rational understanding of the sexual. Medical writers, with
one or two exceptions, have only ventured now and then an isolated
paragraph, and left the physician to draw his own conclusion. Among
the aboriginal tribes, the sexual appetite is and has always been
indulged _ad libitum_; not only in the natural manner, but in every
conceivable way, without noticeable harm to the organs themselves,
or to the nervous system. In a lesser degree this is true of slaves,
sailors and peasantry, and the lower orders of civilization. Sexual
endurance diminishes in proportion to the advancement in civilization
and intellectual culture. A long-cultured family can not sustain,
in sexual indulgence, what to the uncivilized would be a matter of
indifference.

Sexual intercourse, when not contra-indicated, may relieve nervous
tension and produce sleep in a moderately feeble individual; but on
the other hand, if carried to excess, it may produce nervous tension,
wakefulness, headache and exhaustion. There are no definite rules to
regulate the sexual appetite, more than the stomach for food.

The evils of sexual intemperance are temporary, and if recent, quickly
recoverable by rest only.

Says Dr. Briggs, of New York, “The sexual system is notoriously the
seat of excitement and depression from psychical and mental influences.
It is under the control of the sympathetic nerves, and influenced by
the solar flexus. Much of the peculiar sensibility experienced in this
part of the body is directly referable to the mind and imagination:
the manifestations are controlled by the sympathetic nerves, from the
impulse given in this manner. But the mind and will, however intense,
have little power over the sexual functions, except through this
medium. The emotions are superior.”

_Predisposition._――The innate or uncaused condition, which is so
commonly found among the young, is quite likely congenital and
constitutional. There is evidently structural malformation in the
neuroglia, or nerve cells proper, which predisposes the child to sexual
excitement. This may not be derived from the immediate parent, but
far back. In the third or fourth generation, debauchés may be found.
Licentious parents commonly predispose their children to morbid sexual
desires; and what evidence have we that structural changes do not exist
in or about the nerve centres that preside over the sexual functions,
and that such changes are not constitutional? Then, with this
structural change as a predisposition, the least cause will set the
sexual centers into a blaze of excitement. They who are predisposed by
many generations, show upon their faces the lines of coarse breeding;
that they are the offspring of debauchés; congenital degradation; not
but these conditions, under favorable circumstances, may be overcome,
by rigidly cultivating opposite nerve centers; but such opportunities
are seldom presented, and when presented seldom embraced.

Circumstances are also to be considered as having a bearing upon the
sexual “ups and downs” of our human career. With a predisposing sexual
cause, a downfall may occur under circumstances less seductive in
character than when no such congenital condition is present.

Listen to the heart-rending stories of girls in the houses of
prostitution. Each has her story of circumstantial events to relate.
Circumstances of varied gravity have caused the multitudes of “fallen
women” to occupy their degraded sphere of shame and debauch. Many of
these have never been predisposed to a sexual livelihood by an erotic
disposition, and they only stay by compulsion and fear of reproach that
must follow if they return to society. The line of social demarkation
is drawn, and there is no palliation or chance of redemption by
reform――only secret forgiveness, secret repentance, or a nunnery. There
are some who follow this life by choice, from the pleasure therein.
Such are predisposed: they naturally follow this course: they learn it
on the streets, in mere childhood: their ancestors, or some one of them
at least, were of this type――mal-constructed――and circumstances are
meagre that, as is said, lead them astray. They are not led astray: it
is more natural to them than to pursue the path of rectitude and virtue.

These people are predisposed to evil, and it is only, even if guarded
from childhood up by constant watching and being kept from every
possible circumstance, and taught only the good and pure, to adult
life, that any reasonable assurance may be had of their safety from
vice. This inheritance is almost indestructible and may crop out after
the best of culture, with very slight cause, any time in adult life or
in future generations.

Not only the predisposition to sexual desire is congenital, but the
enfeebled nervous system that can endure only a limited amount of
sexual indulgence. They learn to indulge the sexual appetite at a very
early period, and the males grow up effeminate, or half-sexed. The
tendency of civilization is toward brain and mental culture. In this
we have a cause of nervousness which is wonderful. Our ancestors, who
knew very little of brain-work compared to the cramming of the present
day――compared to the curriculums of our present school system――were
not nervous; they were not excitable, but physically strong. They
labored at a variety of toils without machinery, and they obtained
physical endurance. Now, the boy is crammed at school and hurried
through to professional studies, when he has but just begun life; or
he is placed at business, to find that excitement of competition which
is the greatest brain-stimulus and the greatest cause of nervousness
of the present age. The multitude of collateral sciences that a young
man is compelled to read; the books, scientific and novel, that must
be perused by every popular student; and the short period of time in
which he is expected to pass over this entire field: all tend to change
the young man into a habit of nervousness which would surprise our
ancestors of one hundred years ago.

The labor that was performed by hand by our ancestors, which was the
cause of their physical endurance, is now entirely accomplished by
machinery; and the modern man, instead of patiently doing the labor by
hand, expends months and years at brain-work, attempting to construct a
machine that will run by steam, water, or horse-power, that he may save
physical force, time, and perhaps, in the end, money.

The haste in which Americans live and move, must also become an
exciting cause of nervousness. The ancients were patient in obtaining
information; in performing works of art, literature, or agriculture.
The Greeks did not expect to become proficient in the varied vocations
until middle life; but an average American is expected to finish
college at twenty-two; to have invented some kind of a machine for the
saving of labor, to have made a fortune, married and raised a family of
children, wasted his father’s fortune, and be prepared to begin life
anew by the time he is thirty years of age.

Then, to answer the question, “Why are American people so nervous?”
we have but to compare the present with the past; our country with
others. The nervousness and mental development of our people, preclude
anything but moderation in sexual indulgence; and whenever fast living,
brain-working, nervous people indulge to satiety in sexual pleasure,
they are in danger of grave consequences, such as our ancestors never
knew of, as the results of excessive sexual indulgence. They could
cohabit _ad libitum_, and never notice such consequences as nervous
people are constantly suffering.




CHAPTER II.


_Incidents――Observation――Historical Data, and Sexual Hygiene._――Nature
furnishes us a vast field for speculation and inquiry, when even
confined within the domain of certainties; and there is an occult line
beyond which everything is speculative and imaginary; but there are
facts enough in common view to enlighten the seeker after knowledge by
simply collecting commonplace occurrences and gleaning therefrom their
rich lessons. Observation, by association and comparison, and correct
judgment will teach us many things not in the least hypothetical――facts.

To comprehend the obscure relations of the sexual function and the
varieties of morbid changes, we must first systematically inquire into
a few of nature’s designs, and ascertain thereby the true purpose of
the sexual organs.

What purpose? is the first point at issue in any observation, and must
be answered by the physiologist and Physician in this investigation,
as he _only_ has the results of abuse, or wrong application, to
investigate and correct.

The production of healthy offspring must be nature’s only design for
the sexual organs. How to accomplish this end, is the great question of
scientific observers.

It seems quite axiomatic to remark, that maturity and perfect
development _only_ can assure perfect reproduction of the species.
Again, that pleasure should always attend the act of copulation,
otherwise the pain of parturition and the care of rearing the young
would always militate against the perpetuation of the race.

With the normal condition of the sexual organs and functions the
physician has comparatively little to do; but with their abuses he has
all to do. To comprehend the abnormal, he must be familiar with the
normal condition of structure and function. Masturbation is a small
part of the indiscretions and evils of the sexual; and the lesions
growing out of such evils are too numerous to mention. There is no
doubt venereal diseases grew out of the evils of repetition of sexual
congress, with certain unknown violations of nature’s laws, by depraved
human beings.

I am credibly informed of an occasion: “A prostitute received the
embraces of eleven men in immediate succession: the ninth and eleventh
took gonorrhœa, and again gave it; but the prostitute remained free
from the disease until two months after, when she took the disease from
one to whom she had given it, on the above-mentioned occasion, after
which she spread it through a small town in which she lived and also in
which she was in the habit of plying her vocation. She was free from
disease before this occasion.”

It is no more doubted that a male will contract a purulent urethritis
from contact with a woman during her menstrual crisis, or if she be
afflicted with an infective leucorrhœa; but such a discharge in the
male is not generally contagious, and he may indulge freely without
giving the disease.

Uncleanliness may be considered a common cause of sexual disease in
both sexes.

_Masturbation_, after the age of maturity is no more injurious, aside
from the degradation it leads to, than the same number of contacts
in the natural manner; but in the youth the undeveloped organs
suffer, as well as the nerve-centers which supply these organs with
nervous energy. The youth is inclined to indulge the habit after once
initiated, greatly to the detriment of the spinal cord, and through
this to the general nervous system. He is inclined to practice the
deplorable vice oftener than he could find opportunity to gratify his
passion in the natural way. As a rule, to the indiscretions of youth is
confined the permanent injury to the nervous system. It is at an early
age, when so much injury is done, that the very common practice occurs
at schools, when boys club together in squads and go behind embankments
of stone-wall, or creek-banks; or a boy isolates himself, as it were,
to “shell out a grist by hand.” With such ample opportunities, and with
the habit fully established, the acts are repeated with such frequency
that exhaustion of the nervous power must often attend this wonderful
deviation from nature’s designs.

With all this supposed nervous weakness, I do not incline to the
opinion that more injury is done to the sexual organs by this practice,
in and of itself, than is accomplished through the impressions wrought
upon the brain from reading spermatorrhœa literature of advertising,
“private-disease” specialists. I am satisfied that I have seen bad
cases recover by putting their minds at ease. The carefully worded
little books, that are sent broadcast to drive in those who have been
indiscreet, are money-making dodges, and are of great injury to the
confiding and simple.

When the injury has become very extensive and the condition of habit
very depraved, a young man becomes so attached to his lothly vice that
he will refuse the natural way of gratifying the erotic desire. He is
not in the least influenced by one of the opposite sex, and prefers his
own company, or isolation.

It is not the mule only that suffers from masturbation, but girls
as well, though not so commonly, suffer from this peculiar sexual
neurasthenia and hysteria growing out of sexual abuse. Our opportunities
for discovering the extent of such practices in the unmarried female are
very limited; consequently, we remain in ignorance to a great degree.

The married woman furnishes the physician the majority of the practice
in this class of cases, as she also suffers from a mismanagement of the
sexual congress; and it is only to the married woman that the practical
physician will need to devote extensive attention, and only through
her, in this sphere, can much information be obtained.

In the prostitute, sexual contacts are too promiscuous, and she is
too unreliable, to afford any very trustworthy information, further
than may be judged by the aspect of one who has followed the business
for a decade. It is little to know that her life, as a rule, is short
and her social redemption next to impossible, and her entailed ills
irremediable. When the habit of self-pollution is once established by
a girl, it is worse than in the male; as a female is not so likely
to yield to any sort of a vice as a male, and she will carry it to a
greater extreme. Modesty and fear of giving offence will always impede
the advancement of knowledge in regard to the sexual functions in the
so-called chaste and unmarried.

The married female’s sexual life and acts are often brought to the
knowledge of her physician. I have often been asked the question,
why so many married women become invalids from uterine and ovarian
diseases? Not referring to child-bearing, abortions, and many
indirect causes of disease which are numerous, but not enough to
furnish an etiology for the long category of nervous ailments with
which the medical man has to contend, my answer is, sexual abuse; a
misunderstanding of the sexual functions; a non-adaptation of two
individuals joined in marriage. It is not so commonly excessive
venery; or too often repeated coition; but unrequited passion. Man is
too likely to forget his duty to his wife and look first to his own
gratification. Any sexual embrace not attended with sexual orgasm, is
very detrimental and causes disease. With the brutal man and phlegmatic
woman this condition is quite likely to occur, and more especially if
the man has been a masturbator. Where the latter condition has caused
a partial impotency, the sexual orgasm very commonly occurs before or
immediately after the intromission of the penis, in which condition
beatitude is impossible, and the physician is most likely to be
consulted by one of the parties.

It will not improve our knowledge to be too modest on this question.
As medical men we have the diseases of the sexual organs and their
_sequelæ_ to treat, and we must discuss the causes. My suggestion,
that a couple should be matched, sexually, seems not out of place;
and if this condition is not present at first, it must be obtained
by adaptation. My observation has been supplied with a number of
instances of once faithful wives, who had forsaken their husbands for
this seeming little discrepancy or neglect, and associated themselves
happily with more adaptable mates.

These singular facts confront us, and as teachers and scientific men
we may, when consulted, if familiar with the causes, suggest remedies.
I have many times corrected this discrepancy in domestic felicity by
a little careful instruction, and thereby prevented the impending
dissolution of the marriage relation.

This might well be termed matrimonial hygiene.

Such grave facts are brought to the knowledge of the family physician,
and he has but to listen to find out all: he has only a few questions
to put, and the case is before him. No indecency to be indulged in:
such cases must be conducted with the strictest sense of honor and
decorum, or the bond of confidence and trust will be immediately
forfeited.

_Continence_, while in itself not an abuse, in any manner, of the
sexual organs, yet is a fruitful source of disease. The erotic male
may contract troublesome disease, both local and general, by too close
proximity with a voluptuous female; and why not as much a cause of
disease in the female? It is the condition so commonly caused by the
affectionate and chaste embraces of parties “engaged to be married.”
When this condition exists the marriage ceremony had better be
consummated as soon as possible, or injury may come to both parties.

The case of a young married couple, lately under observation, is
instructive. The wife was stricken with paralysis, from which she
was eight months in recovering. During her illness she became much
reduced in flesh and will. She recovered in flesh, but remained very
neurasthenic for many months. I made use of all methods of treatment
by drugs and electricity. I could detect no organic trouble. When
interrogating the husband, I ascertained that they had, through fear of
doing injury to the wife, remained continent, and, being too modest,
had not consulted the family physician on this very delicate subject.
I immediately advised sexual congress freely, and the neurasthenia
gradually disappeared. She has since remained in perfect health. She
was afflicted, as she supposed, with all manner of diseases. She was
often too feeble to walk, and required assistance or a cane, to walk
across the room. She was irritable and fretful, often crying, and
no reason could be given for any trouble, as she was provided with
everything asked for. It may seem a venturesome advice to render, yet
I can but urge the natural use of the sexual organs when there is a
strong erotic excitement, following a long period of continence, when
this desire is not a morbid one; which is likely to be the case only in
the depraved, after long abuses.

Were it not for mistakes so commonly made by individuals in selecting
such imperfect and inadaptable mates, the very poetical words of the
old maids and bachelors, “_single blessedness_,” might better read,
“_single cursedness_.” With the chances as they now are, it is an
important question, whether it is more advisable for a maiden lady to
marry or to remain continent and pine.

A loathsome abuse of the sexual organs, not usually recognized by the
fastidious, exists, in which one of the individuals, taking a part in
this abnormal sexual act, uses the mouth as a vagina. Some of these
benighted creatures are males, others females. Houses of prostitution
of the present day are so accommodating to their patrons that they
keep females who serve degraded males in this manner. I am credibly
informed that they prefer this method; that the erotic desire has
been transferred from the genitals to the tongue. Any person who may
be inclined to exercise a doubt, may easily convince himself of its
truthfulness by visiting one of the many low-down “houses of ill fame”
in any one of our large cities.

From _The Laws of Life_ we extract the language of a clergyman:

    “I have officiated at forty weddings since I came here, and in
    every case save one, I felt that the bride was running an awful
    risk. Young men of bad habits and fast tendencies never marry
    girls of their own sort, but demand a wife above suspicion.
    So, pure, sweet women, kept from the touch of evil through
    the years of their girlhood, give themselves, with all their
    costly dower of womanhood, into the keeping of men who, in
    base associations, have learned to undervalue all that belong
    to them, and then find no time for repentance in the sad after
    years. There is but one way out of this that I can see, and
    that is for you――the young women of the country――to require,
    in association and marriage, purity for purity, sobriety for
    sobriety, and honor for honor. There is no reason why the young
    men of this Christian land should not be just as virtuous as
    its young women; and if the loss of your society and love be
    the price they are forced to pay for vice, they will not pay
    it. I admit, with sadness, that not all our young women are
    capable of this high standard for themselves or others, but
    I believe there are enough earnest, thoughtful girls in the
    society of our country to work wonders if faithfully aroused.”

_Sodomy_, or sexual contact of a human being with an animal, is an
ancient practice and but little indulged in at the present day; as our
laws are very rigid against such _degraded and inhuman treatment of
animals_. There has been a civilizing influence, since human beings
have organized societies for the “Prevention of Cruelty to Animals.”
But it will nevertheless be remarked, that this elevating tendency
came about entirely through the respect for animals, and not for human
beings. Were it not for love of animal property and legal watch-care
over our animals, and plenty of opportunity to gratify the sexual
desire in other ways, the habits of the people would be no better
than in ancient times, when sodomy so extensively prevailed. This
beastiality may have been a cause of venereal disease――syphilis――which
can be traced back to ancient times, without a doubt.

In addition to such abuses, there were worships quite as degrading.
Phallus was a figure of the virile member, which was carried about
at the festival of _Bacchus_ as a symbol of the generative powers of
nature. The _Athenians_, who refused to show proper respect to Phallus,
were punished by Bacchus with a severe disease of the penis. Such may
be concluded from the “_History of the Phallus in Greece_.” Priapus
is now supposed to have been a venereal specialist, differing in no
respect from such modern specialists, to whom, it is said, votive
offerings were donated, and his great skill caused him to be worshipped
and deified; hence the term priapismus, which is commonly applied to
morbid erections, so frequently occurring in gonorrhœa and paralysis
of the insane, and which is also applied to the active stage of the
condition otherwise known as satyriasis.




CHAPTER III.


_Onanism._――I have adopted the term Onanism, more especially to
illustrate a class of conjugal sins, and shall not use it, as generally
applied, as a synonym for masturbation, but will define the term as it
should be used. That the meaning of the word may be fully understood I
will quote the two verses from _Genesis_ xxxviii, 8, 9:

    “And Judah said unto Onan, go in unto thy brother’s wife, and
    marry her, and raise up seed to thy brother.

    “And Onan knew that the seed should not be his. And it came to
    pass, when he went in unto his brother’s wife, that he spilled
    _it_ on the ground, lest that he should give seed to his
    brother.”

It must not be supposed that Onan used his hand to facilitate an
emission, but that he simply withdrew his penis and allowed the semen
to be lost on the ground, to prevent conception. Onanism is practised
more at the present day by married males than may at first be imagined.
It is the commonest of all means used as a preventive of conception.
The majority of so-called society women are wives of men who practice
Onanism. The word has come to signify masturbation, or any intentional
process of wasting the seminal fluid. But I have preferred its use
here as it explains a practice which I have no other word for. The very
common practice of withdrawing the organ before ejaculation is often
a very hurtful one, as the orgasm is often incomplete, and there are
more satisfactory ways of accomplishing what is intended by such a
practice. Under the strict signification of the term, a child cannot
be an Onanist, until after puberty, but he may be a masturbator. A
woman cannot properly be called an Onaness, but she may masturbate
nevertheless. To present, in a true light, this conjugal vice, I
excerpt, from the _Ohio Med. and Surg. Reporter_, the following most
excellent paragraph, which illustrates in the pithy and elegant style
that speaks volumes of argument, and should be a lasting hint to
cultured and scientific students in the learned profession of medicine:

    “The sexual instinct has been given to man for the perpetuation
    of his species; but in order to refine this gift and set
    limits to its abuse, it has been wisely ordered that a purely
    intellectual quality――that of love――should find its most
    passionate expression in the gratification of this instinct.
    Dissociate the one from the other, and man sinks below the
    level of a brute. Destroy the reciprocity of the union, and
    marriage is no longer an equal partnership, but a sensual
    usurpation on the one side and a loathsome submission on the
    other. Consider the moral effects of such shameful manœuvres:
    wedlock lapses into licentiousness; the wife is degraded
    into a mistress; love and affection change into aversion and
    hate. Without suffering some penalty, man cannot disturb
    the conditions of his well-being or trespass beyond its
    limitations. Let him traverse her physical laws and Nature
    exacts a forfeit: dare he violate his moral obligations, an
    offended Deity stands ready to avenge them. That this law
    is immutable, witness, from the history read to you, the
    estrangement between the husband and wife; witness his ill
    health and ill temper, and the wreck of body and mind to which
    she has been reduced.”

Again, from the _Medical Advance_ for 1876, we find the following
language written by Dr. Arnalt:

    “There is one phase of sexual depravity to which I would, in
    passing, call your attention.

    “We are fully aware of the many devices used to avoid
    impregnation. It may be well to remember that such desires may,
    under certain circumstances, be excusable; but let us never
    forget the fact that generally they are conceived in iniquity.

    “Of the many ways of avoiding possible conception, there is one
    so filthy, mean and degrading, and fraught with such fearfully
    disastrous consequences to health, that I make special mention
    of it. I have reference to the practice of withdrawing the male
    organ from the vagina before the completion of the embrace.

    “But when man brings to the marriage-bed so foul a nature that
    he can repeatedly and constantly perpetrate such an outrage
    upon nature’s most precious gifts, he places himself at once
    beyond the desert of human sympathy.

    “Just imagine, if you please, man and woman in the act of
    cohabitation; their brain reeling under the powerful stimulus
    of that all-pervading passion; the heart’s action increased
    to a high state of intensity; the whole system, with all the
    energy it is capable of exciting, getting ready for that
    great act of reproduction; and just as the act is about to be
    completed, when the soul of the man can almost feel and grasp
    that of the woman, the evil genius of lust, being more of a
    fool than a knave, must dash to the ground the chalice filled
    with ambrosia of purest bliss, if tasted with a pure lip; must
    turn into the vilest poison the sweetest and holiest gift of
    nature to man.

    “Why, I have wondered, long and often, that man could sink so
    low, be so foolish. Just conceive of the intensity of such a
    shock upon the system, and then have this repeated time after
    time, year after year. Why there are married people who never
    once, in all their married life, completely and unreservedly
    finished the act of cohabitation.

    “No wonder that nervousness, peevishness, and all kinds of
    distempers show themselves. No wonder we get spermatorrhœa and
    impotence in the male, and a perfect host of troubles, insanity
    included, in the woman. No wonder homes are broken up and human
    lives made desolate.”




CHAPTER IV.


_Masturbation._――Under this caption will I proceed with the topic of
self-abuse; as this term more properly covers the vice of both sexes,
as well as of childhood.

The small boy, only four years of age, will often titilate his genitals
until the prepuce has become inflamed and swollen. In this undeveloped
and delicate condition of the genitalia, more harm may be accomplished
than could be imagined. Nurse-girls, sometimes, for the purpose of
quieting a child, will titilate its genital organs; which is quite
sufficient to lead the child to manipulate its own organs as it goes on
in age and development. Often a feeble state of health in the child,
will cause the mother to consult a physician; and the genitalia will
show signs of irritation; and when the true nature of the difficulty
is revealed to the mother, it will be much to her surprise, and
often, disgust; and she will not be convinced beyond a doubt until by
constantly watching, she has observed actions more convincing than the
doctor’s hints.

Boys at school teach each other to perform this manual pollution; and
vile servants initiate small boys at a surprisingly early period. I
have often gained the confidence of these little ones, and learned
things more astounding than amusing. Not long since a boy only eight
years of age convinced me, by his confidential description of his
little vice, that he realized passion, erection, and as he called
it the “goodie feeling” (orgasm); which was evidently the sensation
without emission of semen. No small amount of injury is done to the
nervous system by the constant titilation of the undeveloped genitalia;
and as the habit passes on to the puberty-stage of adolescence, the
novelty of the first ejaculation affords great and frequent amusement
to the child, and he pursues it as often as he can obtain an obscure
corner. This must be the time that the greatest harm is wrought upon
the brain and spinal cord. The first five years succeeding puberty, the
vice is carried on with great energy in a vigorous youth. Doubtless,
the majority of boys have practiced masturbation, to some extent, some
time during adolescence, but as they arrive at the age of discretion,
become disgusted; or some influential person frightens them, and they
quit the practice. Where it has only been an occasional indulgence, no
lasting injury has occurred.

Masturbation is practiced among men, not so much to the injury of their
physical structure, but it is nevertheless a common vice. Miserly
bachelors, hermits, and often widowers resort to self-pollution
when financial affairs prevent their visiting houses of ill fame. I
am credibly informed that the vice of self-pollution, by the hand,
prevails largely among soldiers, as well as in convents, and public
schools.

_Pollution Among Females._――This is less common in childhood than in
the male. Small girls are naturally more modest than small boys: they
will not so readily fall into such vices, as they do not readily submit
to having their genital organs manipulated; they therefore remain
comparatively free until puberty, and often later; and then the habit
is not common, but occasionally exists. With the limited opportunities
for finding out such things, it will undoubtedly be long before an
estimate, as to the extent that it prevails, can be made. I cannot
better continue this subject, than by giving a case which is typical
of many adult cases that I have observed in this peculiar and delicate
role of physician; and it is not a “cooked” case, but one in actual
life, which cannot be fully portrayed by type or word:

Mrs. X. visited me professionally; aged 28; mother of three children;
been married nine years; spare, dark hair and eyes, rather brilliant;
small of stature; retiring and confiding of disposition. She was very
neurasthenic and excitable; never hysterical; bowels constipated. I
prescribed all kinds of treatment for her during the first six weeks,
after which time, as I had failed to find out anything that might be a
cause for such a peculiar nervousness, I suggested an examination _per
vaginam_. As soon as my finger reached the orifice of the vagina, I
was convinced that my case was a sexual one, as a nervous, passionate
shiver ran over her; but she soon controlled herself, and I proceeded
with my examination, with the discovery of only slight general
irritation. She then gave me the following account of her married life
and condition. She was married at nineteen, a robust, vigorous girl.
Her husband was amorous and ignorant of her requirements; would soon
satisfy his desires and go to sleep, when she had but just become
excited; but when her erotic excitement was aroused she had no control
of it: would remain wakeful during the entire night, with the husband
sleeping, regardless of her condition. She finally learned to use a
clothes-pin, by which means she could appease her burning and bring
about an orgasm. She says that she could then sleep. She of late had
consented to the advancements of a prominent lawyer; but she was
conscience-stricken and desired, if possible, to be a “good woman;” but
was satisfied that, to be a virtuous woman, she must remain away from
her husband, so that her passion never would be beyond her control. I
immediately, after her departure, sent for the husband, and informed
him how to perform the marital connection, and that, if he desired that
his wife should become a well woman, he must adhere to my instructions.
He was glad of the information, and was successful in his efforts. She
was soon free from her troublesome neurasthenia, and beatitude prevails
to this day; and, I believe, she is as virtuous and worthy a woman as a
man deserves.

Women use tallow candles, clothes-pins, and other commodious means,
such as friction over the pubes, titilations of the clitoris, etc., for
the purpose of exciting erotic energy and sexual orgasm. The nervous
excitement which is wrought, is not unlike shock, from general causes;
yet, when frequently brought about, may produce an over-stimulation,
followed by relaxation and general weakness of the nervous system, or a
neurasthenia, advancing to hysteria and organic disease of the nervous
system. Various devices have been resorted to to overcome the habit of
masturbation. Such things may be of service in children, but in adults
moral treatment alone is of any value; and as to any appliances and
devices I have nothing new to offer. The old means of blistering, tying
the hands, etc., may be resorted to with children, by those who have
confidence in their efficacy. In adults, matrimony will often do good,
when the habit is in its incipiency; but in an advanced stage it is of
little benefit.

The great variety of unnatural ways of gratifying the sexual passion
is only an evidence of human depravity; and the entailed diseases must
be unreservedly studied, that, as much as possible, these abominable
conditions may be confined within a certain limit, which should be
legally set apart and licensed, that the chaste and elevated portions
of society may find protection.

These conditions all exist: there is no remedy to abort or expunge
them; and the numerous diseases, growing out of this great depravity
and mismanagement of the sexual, must all be duly considered, by the
medical man, as predisposing and exciting causes of neurine maladies.
To prevent the spread of disease, should be the chief aim of every
humane citizen, and more especially the physician. Much is said in
regard to means and legislation to prohibit the spread of venereal
disease; but the nervous diseases caused by sexual debauch and
mismanagement are of equal importance and as devastating to the race.

If we can give credence to what Dr. S. W. Gross says, in the May
number, 1877, _Medical and Surgical Reporter_, of Philadelphia,
masturbation has, in his cases, caused fifteen out of nineteen cases
of urethral stricture, while four were caused by gonorrhœa. I am not
aware of any such proportions reported by any other authority, yet I am
thoroughly convinced that masturbation has existed in a great majority
of cases of urethral stricture, and in many such cases has been a
cause, primarily or secondarily. It is not far from true to say, that
a large proportion of masturbators, of advanced age, have a general
contraction of the entire urethral canal and a diminished dilatability.
Purulent discharges and abscesses are not uncommon along the course of
the urethra and prostate gland, followed by folicular disintegration
and perforation.

_The Effect of Sexual Excesses upon the Neural Axis as a Cause of
Organic Disease._――“_Sexual excesses_ and _Onanism_ are certainly of no
slight significance, at least in the development of a predisposition
to tabes.” (Erb.) Again, in speaking of causes in general of spinal
disease, the same author says: (P. 147, Ziemssen’s Cyclopœdia, vol.
XIII.)

    “Of these (causes) _sexual excesses_ and _irregularities_
    occupy the first place. * * * * I believe we may say that
    _any gratification of the sexual passions, whether natural or
    unnatural, indulged in to an excess and for a long time, forms
    for many men――not for all――a circumstance that powerfully
    depresses the spinal cord and predisposes it to disease_.” * *
    * *

    “_Excessive natural coitus_, in many persons, certainly
    produces symptoms which point to a weakness and a diminished
    functional capacity on the part of the spinal cord; weakness of
    the legs, inability to stand for a long time, trembling when
    forcible movements are made, pains in the back, shooting pains
    in the legs, sleeplessness, etc. This may often be noticed in
    the newly married, or in persons who have indulged in great
    excess for a short time. If the cause of these symptoms soon
    disappears, the injury may in most cases be quickly repaired;
    but if the excesses are continued, further injury, or even
    positive disease, occurs. Any external injury, exposure to
    cold, excessive walking, etc., may then bring on the worst
    results.”




CHAPTER V.


_Copulation――Physiology and Social Attributes._――With the male, the
condition essential to coition is erection of the penis; which is
physiologically accomplished by fostering amative thoughts, and by
attitudes favorable to the stimulation of the erotic desire; as in
close proximity with one of the opposite sex. A voluptuous female
figure may excite the erotic instinct of an amative male in vigorous
health, even though he be chaste in his intentions and habits.
Individuals are isolated whose amative passions are entirely under
the will, when in perfect health, of either sex. The act of coition
is entirely under the will, in all healthy, well-organized human
beings; but it is not uncommon that a man or woman is observed who is
not responsible for acts during erotic excitement. Such are either
victims of mal-organization or a sexual delirium. Many an act has been
committed during such delirium or excitement, on account of which an
individual has grieved her life away, or sought the only refuge that
could hide her life from shame; the victim’s grave, the river: yes,
a victim to sexual delirium or uncontrollable sexual passion. This
innate desire is the usual instigation of copulation, and has been said
to be the index to the presence of spermatozoa within the vesiculæ
seminales.

Copulation may take place in the female before puberty or after
the climacteric period; but in neither will the sexual congress
be fruitful. Then, if the signification be confined to fruitful
contact, there would seem to be a marital discrepancy between the
male and female; as in the female we observe only thirty years of her
existence in which it is possible for sexual congress to be followed
by conception; while the male, from puberty to very old age, may be
fruitful, if placed in conjunction with a female at the proper age.
Nature, being rather wise in this respect, has not deprived the female
of her sexual passion and pleasure at the limit of her fructification
period.

Perfect coitus is not essential to impregnation; as many authenticated
cases are on record in which intromission had not taken place, as
evidenced by an unruptured hymen, where only it was possible for the
semen to come in contact with the sphincter vaginæ; and impregnation
and conception followed. Only by contrasting natural with abnormal
coition, is it possible for us to comprehend how much one subject
has to do in causing nervous diseases; and not to advocate that
normal coition――which refers to time as much as manner――produces many
permanent morbid changes.

_Copulation, practiced in moderation, is conducive to domestic felicity
only when both parties to the marriage contract are in a state of
health sexually._ This excludes sexual contact in too close proximity
to the menstrual crisis, and whenever the female is not in a condition
to appreciate the act, and that her condition and will should be
considered and respected, and man at all times should consult her
pleasure.

For further information on the physiology of copulation, I must refer
the reader to _Flint’s Human Physiology_, where it is treated of in an
exhaustive manner. But there are many points of interest that are not
alone physiological, that may well be discussed and belong especially
to our subject.

There seems to be a chosen time for fruitful coition with all
animals. With the human race this is only partially true. The female,
it is said, begins her period of breeding usually at fourteen and
discontinues at forty-five; yet there are intermediate periods
when copulation will not usually prove fruitful, viz., that period
beginning the fourteenth day after menstruation, and ending with the
next menstrual flow. This rule is not valid; as many times, in my own
observation, have I known women to conceive at any and all times during
her period of breeding. Even cases have occurred where the period
of menstruation was not confined to the usual time of life; or the
“second life” may appear, as in the following case which came under my
observation some years since:

A Mrs. H. ceased menstruating at 52, was free from menstrual flow
until 71 years of age, and then menstruated regularly (a perfect
menstrual flow), every 40 days, until she died at the age of 76. She
possessed the erotic desire and enjoyed coition. Her husband died two
years before she did. She became confused in religious doctrines after
her husband’s death; was melancholy and fond of isolation; committed
suicide by hanging herself to her bedpost. I assisted in cutting the
scarf and learned all particulars of her past life from friends and her
physician.

Many cases are on record of females menstruating at very early periods.
As to these discharges being indicative of the reproductive stage, much
doubt may be expressed. It is very common for the male to retain his
virility to a very advanced age. I am acquainted with an octogenarian,
who married a young girl of nineteen, whose copulation was fruitful
and the child healthy. This is doubtless not so very uncommon, in
proportion to the circumstances offered for a test.

We would naturally conclude that, on account of prostitution and
debauch, it was necessary that marriage become a legally organized
institution. There is no evidence that in early history marriage
was any more than a choice, the consummation of which was simply the
invocation of a superhuman or divine watch-care; that they were bound
in wedlock, not by statute law, but by a superstitious belief and
natural selection. Natural selection was more cultivated and was a
better guidance than in modern times, when law governs the joining and
casting asunder. Copulation is the key to morality and society. So
certain bonds of restriction and moral government of a social character
exist, and they are made to restrain human beings and to control
and limit copulation to a legitimate sphere; viz., man and wife.
Any deviation from this legitimate course has long been denominated
prostitution, which exists in public and private.

The vice of changing partners has become so open and for such trivial
causes that laws have been enacted, of the most rigid character, and
then divorcing and remarrying are carried on to an alarming extent.
These are only the attributes of copulation and erotic desire.

Natural copulative affinity constitutes the bond of chaste affection
that holds together a man and wife in harmony and love. Parties, male
and female, have existed just as happily during life, when marriage
vows had never been solemnized and legalized by other than natural
copulative affinity. This sexual affinity constitutes more than
mere admiration, or transient passion or erotic anxiety: everlasting
contentment and felicity will follow such natural adaptation. Some are
contented in wedlock, as they possess submissive dispositions, who are
not adapted by copulative affinity.

Society is partial in her endowments and liberties bestowed upon the
sexes. The male enjoys favors at the hands of society not permitted the
female. For this, on account of her innate propensities, the female
is responsible. She will expunge a female from her circle of society
for that for which she will sustain the male. She will encourage
insults from man, and cry for woman’s rights, and against masculine
maltreatment. She will receive, with open arms, the young father of a
prospective bastard, and commit the equal participant, and prospective,
victimized mother, whose sins can only be equal to those of the father,
to a dungeon, or permit her to accept a life of shame by refusing her
entrance at the threshold.

If these are the privileges of modern society _now_, what would women
do with the fallen ones of their sex had they things as they so much
desire, in “woman’s rights” circles? Every female who had made a
mistake (that should become known) would be tortured at the rack, or
murdered; and few would there be left to tell the tale. The moral
beginning must be with woman. She must not offer premiums for male
licentiousness, and must encourage her fallen sisters to “sin no
more.” She must protect her own sex by showing forgiveness, as well
as censuring. So far as effecting any change, moral teaching is of
the greatest vanity. But these things are not looked upon in their
true light. Sexualists discuss these subjects, who do not appreciate
the first principles of sexual physiology; who do not comprehend that
the sexual relation in itself is the very essence of deception, as of
secrecy. The cunning devices of both male and female are exhausted by
efforts at assignation and debauch. The greater the legal restriction
the greater the deception. The more common, open and generous our
society becomes, the better will be its constituents.




CHAPTER VI.


_Nymphomania._――The most deplorable condition of all, to which the
female is subject, is the uncontrollable, maniacal, erotic desire,
called nymphomania. The disease is fortunately rare, and commonly
makes its appearance at, or soon after puberty, but has been observed
in adult and married women. Of the six cases that have come under my
observation, one was a married woman, the mother of children, four were
girls at puberty and one, which will be hereafter reported, aged 19
years.

In the commencement the sufferer is a prey to perpetual contest between
feelings of modesty and impetuous desires. At an after period she
abandons herself to the latter, seeking no longer to restrain them. In
the last stage the obscenity is disgusting; and the mental alienation,
for such it is, becomes complete. The cause is often obscure, but when
known has been undue irritation, by titilation of the genitals, or
anything that would cause turgescence. The disease is apparently local
in the beginning, but seems to affect the entire nervous organization,
through reflex excitation.

The clitoris, by some, is supposed to be the seat of irritation, and
has been amputated or cauterized, but without generally effecting
any relief. The disease is not generally confined to any particular
locality of the genitals. If allowed, the patient will take the hand of
the male and place it upon the _mons veneris_, and it is only by force
that she will allow it to be taken away. She cannot locate the seat
of pleasure, but will say that the entire surface touched contributes
to the venereal excitement. Another peculiar feature is, that she
obtains no satisfaction from venereal orgasm; but on the contrary it
adds to her maniacal conduct and obscenity. She is not in any manner
responsible for her conduct, and no punishment will cause her to
desist. Everything is sacrificed that is feminine, for that which is
disgusting and vulgar. The more modest she has been in health, the
more obscene she is likely to become in her venereal frenzy. What the
final result would be, without treatment, I have never witnessed, but
must conclude that lunacy would soon be prominent and probably suicide.
There is no tendency to recovery, but to continue from bad to worse,
until publicity is no restraint to the obscenity and indecent conduct
of the victim.

_Case._――Nymphomania, with nocturnal involuntary orgasm. Miss U.――She
was aged 19, very small in stature, only weighing 90 pounds, of very
respectable family and herself perfectly respectable. She was refused
by her probable “intended,” who had discovered signs entirely unnatural
for her, in whom he had placed implicit trust. When the condition was
first manifested in her, the intended, not thinking of anything wrong
on her part, attempted to gratify her morbid erotic desire by coition,
which only made her, as he said, “nearly crazy.” She had heretofore
been modest and distant, but now she was on his lap, and all over him
or leading him to a place of decumbiture. When she visited my office,
and imparted to me her whole confidence, my first treatment toward
her was so rigid and distant that my examination revealed the parts
before orgasm had taken place; but as soon as I touched the nymphæ;
they became lubricated with a thin viscid fluid which was profuse. At
first the clitoris and nymphæ were red, dry and hot; but as my digit
came in contact with the soft parts, she forgot the rough treatment
and my cold conduct toward her, which I had assumed to prevent, if
possible, her venereal crisis, and she became unmanageable for the
time, until she had passed three or four orgasms, as I supposed, one
immediately following the other, when she became more governable. To
carefully portray in words what she said and did would be shocking to
a fastidious doctor. With a speculum in the vagina the os uteri would
contract and dilate in alternation, and undergo orgasms in rapid
succession, with only a few seconds interval. She begged of me not to
withdraw the instrument, but when I had completed my examination she
was partially exhausted and docile. I could discover a mucoid fluid
emitting from the os uteri which evolved a strong venereal odor.

She informed me that she had voluptuous dreams nightly――as many as
three in a night. Her figure is small and round, eyes black, hair coal
black, countenance very sallow and chlorotic. She seemed to know that
this condition was not right, but her modesty was entirely gone, when
in company with a male. The presence of a woman restrained her. Her
own mother had not determined the true nature of her difficulty, only
noticed that something was peculiar with her daughter. The patient had
judgment enough left to go out of the room and isolate herself when a
man would come about. The advent of this disease she says was first
known by a peculiar thrill at the sight of a male, which became more
aggravated from day to day. Now, one year has she suffered from this
intolerable mania.

To pass over and not give the treatment would leave the case quite
incomplete.

_Treatment._――I directed monobromated camph., in two gr. pills, one
every 4 hours, with formula No. 1, as directed; ice-water to the vulva
nights, with daily applications of Faradisation by placing a wetted
sponge upon a chair with the patient seated upon it, to which the
negative pole is attached; used the positive in my left hand, with my
right hand applied to the head and down the spine. Improvement took
place from the beginning, and in forty days she was quite herself.
She was improved in flesh, color and strength. In two months she was
so modest that I could scarce gather courage to ask her if she was
yet troubled with any signs of her old affliction. I could not obtain
consent to make another physical examination, and she remains well,
but is continuing to take the medicine, from formula No. 1. She has
strength of will, I am informed by her “intended,” to refuse any degree
of proximity. He says, “It seems like a dream. I am learning to court
her over again, and succeed very slowly. She is so distant.”

The two cases reported by Prof. S. H. Potter in the April number of
_Am. Med. Journal_, 1876, do not overdraw the picture, any one will
testify who has had a few of these perplexing patients to manage.

    “Miss M. T., age 18 years, of sanguine temperament, quite
    corpulent for her age, a wealthy farmer’s daughter,
    distinguished for her modesty, intelligence, prudence and good
    social qualities.

    “_History._――In the hot weather of August, the writer was
    called 15 miles to consult with Dr. A., the family physician of
    Mr. T. About three weeks prior to this, Miss T. had suddenly
    exhibited paroxysms of uncontrollable desire for coition.
    When any young gentleman chanced to call upon the family, she
    would elevate her apparel under her arms, approach and attempt
    an embrace in the most lascivious manner, until forced to
    desist by the interference of the overpowering strength of the
    persons present. At first these scenes were at intervals, with
    intervening times of great dejection, gloominess and silence.
    The father being of rather a superstitious nature, thought her
    ‘possessed of the devil,’ and resorted to repeated and severe
    flagellations without effecting any perceptible reform. During
    the last week her excitement had been almost continuous, and
    she had been confined to and locked in her room. It may well be
    supposed that the case had excited the entire neighborhood to
    wonder and amazement, and in some of the more thoughtful, deep
    sympathy, and through their advice the physician was called.

    “Examination with a glass speculum showed an irritating fluid
    oozing from the os uteri; the whole surface of the vagina,
    the nymphæ clitoris and the vulva were suffering from active
    congestion. Exalted general sensation was apparent, and the
    slightest touch of the internal labia or clitoris produced the
    most exquisite amorous excitement――an uncontrollable mania.

    “_Case II._――Was called to see Mrs. F., of this city, September
    last, age 30, a grass widow by third marriage. Found her in
    violent hysterical spasms, with usual accompanying symptoms.
    Her aunt, with whom she was then visiting, gave the following:

    “_History of the Case._――For some time past she had exhibited
    lasciviousness; had to be kept under surveillance; to-day
    the aunt had ‘been out shopping;’ on coming home she found
    her niece in a sequestered place with exposed nudity quite
    shocking, and using persistent artifice to effect coition with
    a canine Newfoundlander. The aunt so rashly interposed, that
    the niece ‘went into alarming and persistent spasms.’”

Dr. Potter further says that examination showed this case to be one of
nymphomania, relying upon the turgescence of the clitoris and nymphæ
and ichorous discharge from the os uteri as diagnostic.

It may be remarked that such turgescence not uncommonly produces an
exalted erotic desire which is analogous to turgescence of the urethra
in the male, manifested in gonorrhœal priapism.

Such irritations are not always peripheral in origin, as may be
supposed, but more commonly a general neurasthenia, or at times a
spinal turgescence, which qualifies the genitals for any disturbing
titilations that come along. This may seem more evident, when it is
once considered, that a hyperæmia of the nymphæ and clitoris may and
has often existed and no nymphomania; and if the peculiar centric
condition does not first exist, there will be no local venereal
turgescence of the genitalia.

Ovarian and uterine disease may produce first, a determination of
blood to the cord, and then, by slight irritation of the vulva, the
condition, nymphomania, may be established. Such is perhaps the most
common cause; and the more have we reason to conclude so, from the
fact, that the majority of these cases appear soon after puberty, when
the first crisis of femininity has wrought its effect upon the uterus
and ovaries. At such times is self-pollution most likely to produce a
striking impression upon those organs, and most likely to bring about
nervous shock by calling a superabundance of liquor-sanguinis to the
developing genitalia and reproductive organs. This shock is sometimes
so apparent that fainting results and alarming symptoms follow. To
relate a case will the better illustrate what may sometimes occur.

_Case._――Miss E. H., under the following peculiar circumstances, I
was informed, needed my services, as it was known that I was the
physician of her family. A young man, whom I well knew, came after me
and returned with me to the house, and during our ride, he related the
following story, to which I had reason to give entire credit:

The young man and the patient were “sitting up” with a sick lady.
During the night, when all was quiet, the young man had taken the
liberty to place his hand upon the genitalia of Miss H., when he
noticed that she rolled her eyes in rather a peculiar manner which he
considered only submission, as she leaned toward him in a very passive
manner. He took her in his arms and placed her on a couch, replaced his
hand, introducing his finger into the vagina, when he became alarmed at
seeing her froth at the mouth, with slight muscular twitchings of the
eyes and mouth. He attempted to arouse her, but failed and, becoming
still more frightened, called the family, and hastened to my office.

I found the patient, Miss H., who was aged 18, fleshy (her weight was
150 pounds), had been a very healthy girl, of an excellent family, and
rather pleasant in disposition. She had always been very modest and
retiring; had rosy cheeks, black hair and eyes. She was then in a very
delirious state, with pupils contracted, face flushed, no cramping,
feet cold; head very hot, with occasional epileptiform movements of the
eyes and mouth; biting the tongue and frothing at the mouth; twitching
of the facial muscles and sphincters. I informed an old lady that I
suspected some private trouble and invited her _only_, to remain in
the room while I made an external inspection, which only gave me the
satisfaction of knowing that nothing was the matter with her genitals,
and that the young man had not deceived me and effected intromission,
as the hymen was perfect.

A large dose of chloral hydrate produced quietude for the night, and I
ordered her to be taken home as soon as she was rested by sleep.

I visited her the next morning at her own home. She was conscious, with
pulse at 120; temperature, 102; pupils contracted, and face flushed;
skin dry; tongue dry and red; asking for water often; head drawn back;
throbbing of the carotids, with spasms of the dorsal and posterior
cervical muscles.

She had never been sick, and she had never been of a nervous habit; and
such a condition was entirely unexpected. There was no epidemic of such
a character, and no accountable cause except that given. Her case was
of an inflammatory type and lasted twenty-one days.

Treated by large doses of gelseminum, veratrum viride, and quinine when
safe. The case was a sthenic one throughout, a meningitis without a
doubt, and no cause but venereal shock.

When she recovered I asked her if she remembered what occurred during
the night of her falling sick, and she flushed, but finally confessed
knowing when he put his hand upon her genitalia, when she thought she
fainted; but casually remarked, “I don’t understand it, but I had no
power to prevent him doing so.”

The young man again informed me that his hand was upon the vulva,
perhaps a minute, when he noticed a strange expression on her
countenance.

The shock did not occur at or near her menstrual period, and she
menstruated during convalescence, which her mother informed me was a
period six weeks from her previous time. She never entirely recovered
her mental vigor, and remained single till three years ago, when she
married, and all has gone well.

The shock can only be attributed to that susceptibility to nervous
impressions so common to the female reproductive organs in the stage of
development. There is a strong probability that had this nervous shock
been less impressive in character and more prolonged, a nymphomania
might have occurred.




CHAPTER VII.


_Satyriasis._――Not the female _only_, suffers from an ungovernable
venereal desire, but the male also is, at times, the subject of a
disease, analogous to nymphomania of the female. Such is the disease
termed satyriasis. A young married man says to me, in the following
forcible language, “My penis is stiff all night. I can’t let my wife
rest, and she is nearly dead, and I am tired out myself; but as soon as
I see a woman, my penis rears up like the proud standard of Wellington.
What shall I do?” His penis became erect while I was examining it. I
could not see anything unnatural, only it was enormously large. He
had not been a debauché, neither had he masturbated to any degree
of injury. There was no spermatorrhœa. He said that it required a
more than ordinarily long time to bring about venereal orgasm, after
which erection would remain in situ until he went to the hydrant and
drenched his penis in cold water; but as soon as he went back to bed
with his wife his penis would become erect immediately. He had suffered
a month in this manner. He had not been a very amorous man before
this, but confessed having obtained and enjoyed a usually temperate
allowance previous to marriage. This patient had always been of a
robust appearance, but when he consulted me was beginning to look worn
and anxious, with sunken eyes from want of sleep and mental unrest. He
suffered from pain in his back, head and through his lumbar spine. Deep
pressure revealed tenderness over sacrum and last lumbar vertebra. His
general symptoms were those of spinal hyperæmia.

_Treatment._――Bromide potassium, grs. xx, 3 times a day, with general
Faradisation and central galvanization (after the method of Beard &
Rockwell), soon gave him relief, and after ten applications no more
difficulty was experienced; but a number of months was required before
his general health was restored.

The symptoms of spinal hyperæmia were very prominent in this case,
viz., pain in the cord, not affected by digital pressure, increased
by lying down and diminished by sitting. His erections were not
troublesome, only when he was in bed lying on his back: this point it
will be well to remember. Many of the symptoms so commonly existing in
spinal hyperæmia are absent.

Many cases occur of a peripheral origin, from inflammation of the
mucous membrane of the urethra or prepuce. Gonorrhœa commonly causes
a peripheral satyriasis; but this soon passes away and is of minor
importance compared to the disease which is intended as the premise
of this chapter. Morbid erections appear without erotic desire, and
peripheral causes commonly give rise to this condition. It may not
be properly considered a disease, as it is so commonly symptomatic
of spinal hyperæmia. And never, as yet, have I observed this morbid
exaltation of the amative desire without spinal symptoms, with the
usual diagnostic signs of spinal hyperæmia of the posterior columns.
The treatment, to be followed by success, must be of such a character
as will relieve any centric local hyperæmia, and as such treatment
seems to give relief is additional evidence of centric turgescence.
As a treatment for the disease, bromide of potass and ergot must be
administered in large doses, with the addition of galvanism alternated
with Faradisation. Cleanliness of the genitalia is indispensable, as
well as the removal of any morbid condition or irritating influence.

Satyriasis may exist as a very troublesome reflex condition in many
painful affections of proximate regions; indurations, hæmorrhoids and
cancer of the rectum, irritation of the bladder or prostate gland, or
by caluli in either bladder or pelvis of the kidney.

_Case._――Jno. C. consulted me on numerous occasions for troublesome
erections. His kidneys were painful under a mild Faradic current;
his water was high-colored and urethra contracted in calibre, with
folicular inflammation periodically appearing, and giving great
annoyance by the discharge produced. Dilatation of the urethra to full
size has finally given permanent relief from the most troublesome
morbid erections, and other reflex nervous manifestations.

In such cases, no agent controls reflex irritations like bromide
potassium; but it must be given in large doses. When causes cannot
be removed, the satyriasis may or may not pass away by appropriate
management, or it may be controlled temporarily and return again. I
have more than once known this condition to appear and reappear in
cancer of the rectum and testes, which was a troublesome feature, with
intervals, during the existence of the patient.

The local causes, if possible, must be removed.

For the treatment of spinal congestion, see page 92.




CHAPTER VIII.


_Sexual Neurasthenia._――Another and more general aspect of the results
of the sexual mismanagement will be studied under the above heading.
The general weakness, nervousness, general debility, general nervous
exhaustion, proceeding from sexual excesses, will be considered from
another stand-point than those, subsequently, which are considered
and named, more from the more attractive phenomena, than from an
understanding of their pathological anatomy. A generalization of signs,
symptoms, and conditions of sexual weakness, covers a multitude of
manifestations found under other names, but calculated more especially
to assist in the study of a weakness not depending upon observable
organic disease.

Sexual neurasthenia differs from neurasthenia of other origin, in that
the former is always coupled with weakness of the genital organs, which
is not necessarily the case in neurasthenia of mental origin. Again,
the genital weakness is always traceable to sexual excesses or juvenile
pollution.

The most troublesome form of neurasthenia is the sexual. There are but
few symptoms in common with neurasthenia from any cause that do not
appear in this variety.

The diagnosis, or line of demarkation between sexual neurasthenia and
the variety of actual organic diseases, is not always well defined. It
undoubtedly forms a stage beyond which is structural disease of sexual
excess, or the cause is perpetuated. I cannot admit that true impotence
and spermatorrhœa are concomitants of neurasthenia, as they are
phenomena of structural changes; but a threatened condition may exist.
In this, I believe, I am at variance with some modern writers high in
authority.

For the most satisfactory description of this disease, and the
application of the term, neurasthenia, the profession is indebted
to Geo. M. Beard, who has given the subject a most thorough review
in periodicals and in Beard and Rockwell’s _Medical and Surgical
Electricity_. In 1869, Beard published an article in the _Boston
Medical and Surgical Journal_, giving illustrations of thirty
cases treated principally by electricity; and again, with a better
understanding of the cerebral and spinal forms, he presented a paper
before the _New York Neurological Society_, in 1877, which was
published in the _New York Medical Journal_. Other papers, by the
same author, have appeared, which evince a careful study of nervous
weakness. Erb has given also a very excellent treatise in vol. XIII of
Ziemssen’s “Cyclopœdia.” Authors have not, thus far, given due credit
to the sexual organs as a cause of neurasthenia. Erb treats of the
disease in a confused manner, in portions of his treatise, compared
to his clearness on other subjects, evincing more book theories than
facts from clinical observation. In generalizing he is clear, but in
classifying, he is not particular enough in pointing out the different
signs of neurasthenia originating from the brain, from that form
belonging to the spinal cord.

The most common form of nervous manifestations is such as would lead
one to think of exhaustion of the forces usually attributed to the
structures of the cord: the nervous energies are very much depleted.
They seem, at times, to be duly supplied, but the forces may as quickly
depart and leave the system languid and depressed, without power to
coordinate the muscles. This more especially applies to a certain class
of cases which assimilate organic trouble in the nervous structure. No
change observable takes place in the circulation, yet it must stand to
reason that the replenishing power of the nerve-matter is deficient.
This must be impaired nutrition, and a lower order of nerve-structure
organized, not capable of evolving so perfect a function or
force――nervous energy. This suspension of nervous energies is only
transitory when a fair degree of activity is established. This would
seem to be caused by depriving the nerve-tissues of elements demanded
to supply natural waste; which is, in all probability, the true nature
of this exhaustion.

We have neither spermatorrhœa nor impotency, in the strict sense of
these terms. They perform the sexual function well, but lack power to
repeat the act as often as healthy people are wont to do. Sometimes
they cannot control their ejaculation during various conditions of
excitement, fear, or fright. It is in this condition that a lack
of confidence in the sexual ability is had at certain times when
copulation would be the most desired. It is in such cases that a young
man complains of chagrin and embarrassment. Many a time have young men
described their afflictions in the language more forcible than elegant,
describing such opportunities with voluptuous “sylphs,” saying, “he
went back on me.” This is a weakness of the genital organ, having lost
its innate power to become erect, in which all the powers of mind and
will, concentrated upon the act, are required to establish the erect
posture. Whenever any great mental effort is required to procure an
erection, either there is local weakness, or there has been too often
repeated sexual contact, which has not been followed by proper rest; or
the female has not a fascinating influence over the male.

The general weakness, so much the cause of alarm in young men, and
yet not of the least danger, is the typical case of neurasthenia. The
young man consults a doctor, with a long discourse of his symptoms: he
has read a book on indiscretions of youth; feels badly; has had erotic
dreams once a month; is “nervous,” feels languid, and apprehends danger.

Medical students, when listening to lectures graphically picturing
disease of the genital organs from sexual debauch, all have each and
every form, with the rare and peculiar sequelæ. They consult the
professor in whom they repose the most confidence, only to receive the
assurance that nothing is the matter, only a little weakness which will
soon of itself subside.

In treating of sexual neurasthenia I can but confine myself to that
functional derangement caused, directly or indirectly, by the supposed
lack of endurance of the genital organs and the coëxisting nervous
weakness.

The fact that nearly all young men have at some period polluted, gives
them a cause to fear that any nervous debility discovered may be
caused by their early indiscretions. In this they are deceived, and
only putting their minds at ease will dispel, often, the cause of this
perpetuation. I am often consulted by literary men, who only need rest
to be free from this languor. A zealous divine consulted me, with the
impression that he was afflicted with some organic nervous disease or
brain disease. After examining him closely, and assuring him that he
had only a nervous weakness of a functional character, he thought best
to confess all by saying that he had been “wild” in his youth, and he
was laboring under great fear that he was beginning to feel its latent
influence upon his brain. I again assured him that it was entirety
impossible for him to become in any manner afflicted with a brain
disease.

The transitory character of all neurasthenic symptoms is quite
sufficient to distinguish this from organic disease. On one day the
patient feels badly, with some signs of organic neurosis; but the next
day he has forgotten that group of symptoms, and another is complained
of; or he may be free and light, and in bright spirits; but whenever
he feels weak and languid, the first thing he thinks of is his early
indiscretion.

_Neurasthenia Caused by Sexual Excess and Domestic Infelicity_――_Case._――Mrs.
M., the mother of two children, passed through four abortions, came
lately from Chicago to this city and, perchance, became my patient, when
I learned her history. She had sustained a fracture of the left parietal
bone and suffered some from compression. The specula was removed in
Chicago. The injury was caused by a heavy glass, hurled by her husband
in a fit of jealous rage. She is fleshy, weighing 135 pounds, and rather
short; has some time been given to drink, to cover domestic infelicity;
her face is florid, and on the least excitement becomes purple and
ecchymosed in spots; she feels, sometimes, as if she would faint; often
has vertigo, tingling in feet and hands, sickness at the stomach; she
never cramps, but often cries, feels languid all the time, and lies in
bed the most of the day; pulse normal, sometimes a little intermittent;
tongue natural and bowels regular; no belt sensation; no tenderness in
the cord; no bladder trouble.

Her husband compelled her to submit to his embraces three or four
times on Sunday and every night during the week; and this had been
practiced, with only menstrual intervals and when too sick to submit,
for six years. She is peevish and fretful, and suffering from general
exhaustion.

There are many manifestations of neurasthenia, when the cause has been
from the sexual; prominent among which is irritability, exhaustion, and
sleeplessness following sexual congress; nervous headache with black
line under both eyes the next day; creeping sensation and itching of
the skin, without any abnormal appearance to cause it; formication,
numbness of the hands and feet, flushed face, tenderness and pains
that are transitory: all without any detection of organic disease;
not but what such symptoms exist in organic disease, but they are
more permanent, when they do exist, and can be associated with some
assurance. I have had my mind on the point of naming and searching for
numerous organic and spinal and cerebral affections, when the patient
would multiply antagonistic symptoms so rapidly that I have often
concluded that my patient had a new and serious combination of lesions.

Organic disease generally has a set of signs and phenomena entirely in
accordance with structures involved; but neurasthenic symptoms are most
commonly such as are antagonistic to any two forms of neurosis.

A greater variety of symptoms exists in neurasthenia than any organic
disease. Symptoms of one organic disease are common one day, and of
another the next day; and though the two organic manifestations were
wholly different, the patient on the third day will perceive them all
combined and aggravated.

Not all cases of neurasthenia can be attributed to the genital organs.
In my experience cases, arising from sexual irritation and other
causes, are very evenly divided. I have often been convinced of genital
irritation being caused from neurasthenia; but as I have intended the
more to discuss sexual neurasthenia, in Neurasthenia from Genital
Irritation, I shall be compelled to leave the subject with only having
mentioned its bearing on sexual irritation as a cause.

Neurasthenia does not differ, when of a genital origin, from the same
disease of other origin; only that the genital irritation antedates the
neurasthenia.

It has been said that neurasthenia usually confines itself to the
nervous diathesis. If we only had a definite condition, known as the
nervous diathesis, that could be relied on, much would be gained. Some
of the most troublesome cases of neurasthenia have appeared in persons
whom no one would point out as possessing a nervous diathesis. Beard
says, “Among the chief signs of a nervous diathesis are fine, soft
skin, fine hair, delicately cut features and tapering extremities.”

These are often marked features in nervous women, but neurasthenia has
existed in persons coarse, dark, thick-skinned, clump-fingered, and
very uncomely in shape; often large and fleshy.

In attempting to show the relation of neurasthenia to the genitals in
both male and female, it will lend information to relate a few cases:

_Case._――Jno. B. wishes to know what makes him so “fidgety and
good-for-nothing.” He says he has visited his intended, to whom he
is “engaged to be married,” twice a week for nearly two years. “We
are very intimate and kiss and embrace: I think too much of her to
do anything wrong. My penis is up all the time I am with her; and
when I go home my testicles are sore, and I lie awake all night.”
This is typical, as a cause from continuance; and if the female is as
amorous as the male, she will also become nervous and irritable. The
restlessness, following the protracted turgescence of the genitals,
is a fruitful cause of neurasthenia. Yet all will gradually pass away
after marriage, which should be advised speedily. With nymphomania,
there commonly exists a neurasthenia that long remains after all signs
of any organic disease have disappeared.

Mrs. M., aged 26; the mother of one healthy child; rather adipose;
short and firm of organization; flushed face; weight, 140 pounds;
apparently a very vigorous woman. She cannot endure any muscular
effort of any kind, as she becomes exhausted; dizziness, formication,
sickness at the stomach, one day; coldness of feet and hands, with
paresis of first one side then the other, tingling of the tongue; no
hysterical manifestations, cramping or fainting, at any time. Uterus
is normal; no tenderness along the spine. Sometimes a local hyperæmia
of the brain exists, but only lasts a short time. Her heart-sounds
are normal, and pulse regular; bowels perfectly regular at all times,
and menses regular. Within a period of two years’ time, she produced
four abortions upon herself. Each time at third month, and each time
did so well that no physician was called. She informed me that she
became more and more nervous after each abortion. I have not benefitted
this case by any manner of treatment, as yet, and still there is no
manifestation of any organic disease.

If ever a physician is perplexed, it is when he is called on to advise
a patient whom he calls “nervous.” This is more commonly the case with
the general practitioner, as he is looking for something to be the
matter, and finds nothing but phenomena which he illy comprehends.

These cases are of vast interest to the neurologist, as he is in an
expansive field for study, and he feels a pleasure with his work; not
as to the rapidity with which he expects to see these manifestations
pass away, but in the assurance that these most troublesome phenomena
are harmless.

_Treatment._――In the management of these peculiar nervous appearances,
many agents may become necessary; but to obtain rest is the
all-important consideration. To aid nutrition is the next in importance,
and thereby build up the structure of the nervous system, improving tone
by assimilation. All causes, of course, must be removed. The medical
treatment will consist of agents that stimulate evolution of
nerve-forces. Tinct. pulsatilla, bromide ammonia, dil. phos. acid, are
agents which act excellently, given one after the other, changed in a
manner to perpetuate their influence. With determination of blood to
the face and head, small doses of gelseminum or bromide potassium, for
temporary relief, and ergotine continued in grain doses.

When the hands and feet are inclined to become cold, the hypophosphites
should be given.

As a tonic in these conditions, and especially when the patient is not
often seen, formula No. 1 will act in a majority of cases very kindly.

Electricity must be resorted to for the permanent relief of nearly all
cases. General Faradisation will be the most generally useful, used
often and by short sittings.

The general bathing, resorted to in bath-houses, is often very
injurious; as no selection of cases as to the peculiar necessities,
and no adaptation, is made; but proper douching is a most excellent
remedial measure, and must be conducted with special care and judgment,
as regards the adaptation of kinds to each and every condition and
temperament.




CHAPTER IX.


_Pseudo-Spermatorrhœa._――A male, enjoying the best of health may,
under certain influences, have an involuntary discharge of seminal
or prostatic fluid; but as the latter will be treated in full
below, I shall first consider accidental discharges of semen as a
pseudo-spermatorrhœa. Impressions are wrought upon the nervous system,
sometimes of a stimulant character――other times like a shock――that are
followed by involuntary losses of semen. It is not uncommon for semen
to be found in the clothing of criminals hanged by the neck; or for
soldiers to ejaculate semen at the time of entering an expected battle.
Involuntary discharges as often occur from the bowels under similar
influences.

But mental shock is not essential to the production of such relaxation
of sphincters. I have on numerous occasions produced an ejaculation of
seminal fluid by the strong currents of electricity passed through the
genitals, localized.

A cold bath has not been uncommonly the cause of such losses, in
perfectly healthy subjects. I was once riding, in company with a
friend, through the country on horseback. My friend had suffered some
rheumatic pains, for which I gave him opium and quinine in large doses
which, under the influence of the friction of the saddle, caused an
ejaculation of semen without erection or erotic thoughts. He was a
robust fellow, and knew nothing of sexual weakness of any kind.

Young men sometimes, and married men that have been continent a long
time, and bachelors commonly, are subject to spermatic ejaculations
involuntary, without genital debility. It has been stated by authors,
high in authority, that seminal losses two or three times a week
were only physiological. From this I must dissent. I do not wish to
be understood as saying that occasional seminal losses are always
injurious, but I do not on the other hand believe, as do some, that
even occasional losses are really and always physiological.

To think that the disease exists entirely in the act of involuntary
emission, is as great an error; as it would seem only rational that,
if a larger quantity of semen was manufactured than the vesiculæ
seminales could hold, the natural result would be an evacuation. Again,
I have known males to live continent and have involuntary losses for
ten years, as often as weekly, and no evidence of any general or local
debility. Yet I believe this to be an exception worthy of note. It is
quite useless to attempt to effect a cure in some of these cases of
pseudo-spermatorrhœa, as no real disease exists. Some of them will
continue: others are only transitory, and need only to be assured that
no wrong exists. Even if it is not physiological or desirable that such
things should exist, yet it is not actually pathological.

Again, so-called mental spermatorrhœa partakes partly of this
character; especially when a young man is so pathophobic, from mere
book-reading fright, derived from specialists and impostors, whose main
business is to scare a young man to pay out his money and be humbugged.
If he has not had emissions oftener than monthly, and he is of a
confiding turn of mind, a troublesome mental disease may be founded.
If no marked physical disturbance follows these occasional losses, I
generally inform the young man that he has been mistaken as to the
gravity of his troubles; thus putting his mind at ease, and the patient
in a position for self-recovery.

_Case._――Not long since, a young man was under my care who was
pathophobic; his mind constantly dwelling upon what he had read; and
the occurrence to his mind, that he had losses of semen as often as
once in six weeks――although he was a vigorous blacksmith――caused him
to imagine himself suffering with all the usual bad feelings of an
advanced case of nightly seminal losses. He appeared in good health;
was able to do a day’s work, and to work well; but, nevertheless, he
was neurasthenic, and at times very feeble; or, at least, he thought
he was. When once he could be made to forget his imagination, he would
be as strong as ever. The simple assurance that he would recover with
simple treatment was unavailing; but when persuaded to think much was
being done, and that his medicine was very potent, he soon ceased to
be troubled with his worry and was quite well, although he had taken
only a simple bitter. He finally became afflicted with a sore upon
his prepuce, which was of a herpetic nature _only_, and for which
he consulted a score of doctors, as the sore would appear from time
to time. All informed him of the harmless nature of the eruption,
but he had faith in no one until a venereal specialist reduced his
purse to vacuity, when he returned to me for advice. He was simply
syphilophobic, and demanded only a deceptive treatment, with assurance
that his trouble was of a local character and never could grow upon
him; but shortly his herpetic trouble ceased to appear, and something
else victimized his imagination. Such is the mental predisposition of
the nervous, imaginative class who _only_ suffer, to any extent, with
what to them appears to be disease.

Such a case of pseudo-spermatorrhœa would not irritate, in body or
mind, any person of good reasoning capacity; but, unfortunately, such
persons are not as common as may be supposed; hence, the deceiving
specialist has many willing victims.

_Prostatorrhœa_, may exist as an independent, uncomplicated and local
disease, or in conjunction with spermatorrhœa. My experience leads me
to remark, that the latter seldom exists without the former, but that
prostatorrhœa commonly exists as an independent disease; and when the
flow of semen does not amount to sufficient, in frequency, to consider
it a cause or a consequence of disease. In my judgment, this flow of
glary, viscid fluid is most commonly observed while straining at stool
from constipation. Young men very commonly apply to specialists and
exhaust their funds and return to the less pretentious family doctor
for a more satisfactory and truthful statement. Even with this little
discharge of prostatic fluid, and when no sign of spermatorrhœa existed
with it, the young man may experience all the phenomena of true and
long-standing spermatorrhœa. His mind suffers, as well as his body,
with imaginary nervous phenomena too numerous to mention. But in
these conditions it is not uncommon to find very troublesome disease
of the prostate gland, brought on by gonorrhœa, sexual excesses or
masturbation, existing alone or with true spermatorrhœa.

An examination will reveal enlargement and tenderness of the gland,
commonly irritation of the neck of the bladder. If we make inquiry, the
history of prostatic inflammation will be obtained, and gonorrhœa or
venereal excesses. Pressure upon the prostate, through the rectum, will
not uncommonly cause a discharge of prostatic liquid, which is followed
by a smarting sensation. Copulation and ejaculation are sometimes
followed by a burning pain in the prostate gland, which lasts sometimes
a few hours――commonly a few moments. Prolonged erection is followed
by a discharge of viscid fluid, not ejaculated, but simply flowing
away. When the bowels are constipated, as scybala pass the gland, a
viscid fluid is pressed out and drips from the end of the penis with
a smarting soreness, prolonged in the gland. The fluid is not hurled
forth, or ejaculated in jets, like semen, but a thin glary fluid. The
disease is commonly only local, and needs very little constitutional
treatment.

The tinct. staphisagria, so highly recommended by many, will often
act very kindly as an adjunct, but will not cure the disease. Cascara
sagrada must be used for a long time, to regulate the bowels and
digestion. Faradisation, localized and general, is the only agency that
may at nearly all times be relied on for permanent relief.

When the disease exists with true spermatorrhœa the above treatment is
none the less essential, and only needs modification to meet special
indications.

The manner of using electricity for the relief of prostatic disease
is very simple. My experience has led me into the habit of placing
the positive pole as closely in contact as possible with the gland. I
sometimes introduce an electrode into the urethra――other times into the
rectum――connecting the anode, and with the cathode and large wetted
sponge stroking the lumbar and sacral regions, especially over the
origin of the hypogastric nerve and plexus. If there be tenderness over
any part of the spinal cord, I change the poles and apply the anode to
the spinal tenderness. Such tenderness is very common over the sacral
plexus. Again, it is important in the way of ascertaining causes, to
know which antedates the other, the prostatic tenderness or the spinal
tenderness; and the anode should be applied to that irritation which is
found to be the most ancient; as, commonly, upon the spinal tenderness
the prostatic irritation depends. But this rule is not always tenable,
yet will answer very well in a new case until an electric test, as it
were, is obtained.

Whenever unrest, pain or fulness follows the use of one pole to the
gland, it is safe to change; as such is not the desired effect. There
is no one thing so needful in the use of electricity as familiarity
with the physiological effects wrought. Every electrician has marked
out the management of a patient, and the course proper to pursue, only
to find an entire change necessary, after the first application. Many
cases are plain, but many more are wonderfully obscure; and only after
repeated practical tests, do we find the proper current, intensity and
quantity adapted to a given case.




CHAPTER X.


_Spermatorrhœa._――That special form of sexual neurosis, which has for
its most common phenomenon the premature and involuntary ejaculation
of seminal fluid, has been the great catch-all of fakirs and venders
of popular sexual literature. Not a town of any size in any country is
without an advertising spermatorrhœa doctor, who cries his vocation
and writes up his fraudulent certificates of thousands of cases cured,
and the great danger of millions more sinking into premature decay.
Strange that laws are not made to prohibit this wholesale deception of
a confiding and innocent class of young men. Spermatorrhœa does exist,
but in proportion to the effects of masturbation and sexual debauch,
grave injury is exceedingly uncommon. Not because spermatorrhœa is a
commonly grave disease, do I insert this paragraph; but because of
the unpopularity of the subject, the isolated cases that are really
bad, and the still more isolated ones that fall into the hands of the
legitimate physician.

The term, spermatorrhœa, has been too loosely applied to a class of cases
which the author has chosen to describe under _pseudo-spermatorrhœa_,
and also to a class of cases more properly called sexual neurasthenia;
when the weakness of a nervous character is only noticeable in a minor
degree, or in contradistinction to centric structural changes. But the
term is useful to describe such losses as are involuntary, and of
frequent occurrence; or, as it were, such as occur without intentional
friction of the glans, or without undue nervous shock from accident or
fear of injury. To such emissions should the term be confined. Healthy
young men sometimes have emissions before or soon after the intromission
of the penis, and such occurrences are not uncommon; but with the
individual such an occurrence rarely happens: such should not be called
spermatorrhœa――only a sexual weakness――neurasthenia. Again, after
prolonged sexual excitement, when the organs are simply weak and the
erotic energy intense, an emission is not sufficient to declare such a
diagnosis.

When it is customary for a male to ejaculate immediately after
intromission of the organ, he may have, and quite likely has, a
spermatorrhœa; but this is not in itself diagnostic of anything further
than mere weakness; and he must at other times than these lose semen,
to constitute that real flow which is the true signification of the
term. When a male commonly ejaculates before venereal friction of the
glans has taken place, and in successive attempts at sexual congress
has been baffled, he most certainly has spermatorrhœa, as well as
partial impotence. Whenever an involuntary emission is followed by
weakness, headache, wakefulness, heat of the skin, there is certainly
great sexual neurasthenia; and, if such losses are continuous, the
diagnosis of spermatorrhœa is without a doubt. It is necessary that
these points should be duly understood, in order that our future study
of the disease may not lead to confusion in the study of the conditions
of the nervous system leading to such phenomena.

In common cases of the disease, the losses of semen are as often as two
or three times a week; not uncommonly, every night, for a week or two;
and then an interval of a week, when the nightly ejaculations occur
with a dreamy, erotic pleasure, with the patient half sleeping. The
young man wakes up and finds his linen soiled: he remembers his dream
and is highly disgusted, and soon visits or writes to a traveling or
standing venerealist, who sends him a circular containing the thousands
of cases treated and cured, with a poetical description of the ten
years hence, and perhaps a Marriage Guide, and the price required to
cure such a case. He feels all the many things pictured in the book,
and if the fee is within reach he is sure to send it, and only too
soon finds how badly he is victimized. Not every case is troublesome
enough to visit a specialist; or the young man is wise enough to first
call upon the family doctor, or a friendly physician, when he is sent
home with an opposite kind of discouragement; or he is treated by the
latter M. D. (?), who has not booked himself on such matters, and the
poor fellow is left to himself and the “_specialists_.”

It is a fact, that the common practitioner is so fastidious on this
subject, that he has neglected to obtain the familiarity due his own
patrons; and if he attempts to treat a case, he will be as likely to
fail as to do good. This lack of familiarity is the great cause of such
confusion, and in the application of the term so loosely to conditions.

That the subject may be better understood, I shall arrange my treatment
of it, that view may be had from the several points necessary to
perfect comprehension.

_Causes._――The vice of masturbation is perhaps the most common cause.
In youth, the sexual organs being in an undeveloped state, local
weakness is very commonly produced, and that even before puberty, by
the titilations taught the child by accident or by a designing nurse.
The novel sensation, followed by the profuse flow of semen, commonly
surprises the youth, and through curiosity and a desire to reproduce
the new pleasurable sensation, he continues this very common cause,
masturbation. Ignorant of the consequences that may follow, he pursues
the practice with intense vigor, until the sad effects are wrought, and
too late to repent, he learns the evil of his vice.

Boys of the effeminate type suffer first and most from this vice,
for the reason that they practice the habit more persistently than
phlegmatic children and, it is a fact, that they are willing victims
and their nervous system is much more susceptible to impressions.
Premature development predisposes a child to manipulate the genitals,
as the curiosity is excited in finding such conditions which should
only accompany a more advanced age. Any handling of the genitals may
indirectly give to the child the knowledge of that sexual sensation, or
excite precocity of the genitals.

Boys of a vigorous habit of body are not inclined to play with their
genitals; on the contrary, are often markedly disgusted at an attempt
of a schoolboy to instruct them in the vice. They are therefore not
easily made victims of, and commonly grow up free from, this vice;
but they are the most willing participants in prostitutional debauch,
in a more natural way. With the irritated and excited condition
of the tissues of the genitals at puberty, then passing the first
sexual crisis, what an opportunity for local and general injury must
necessarily be present! The nutrition, so essential to growth and
development, constantly demanded to compensate for the vicarious and
premature waste, great neglect in the natural developments of other
portions must necessarily be a result, which is most likely general in
character.

As the boy grows up, during the years from fourteen to twenty, the
attention he pays to his virile member, and the frequency of his
seminal emissions, would be astonishing to one not acquainted with the
possibilities.

In the above we have the most common cause of spermatorrhœa. I venture
to say that the disease is rare in subjects who never practiced the
vice till after maturity or adult age; but it is nearly as rare to find
an adult male who has not, at some period of his adolescence, practiced
the vice of masturbation.

In addition to the vice of boyhood, the debauch of sexual congress in
the natural way, indulged in to enormous excess, produces a state of
weakness and loss of general health, with actual impairment of the grey
matter of brain and spinal cord, which are reflected upon the genitals
in the form of involuntary seminal losses.

Spermatorrhœa is only a symptom of a disease, and must be studied as a
neurosis. This diseased condition is generally wrought by frequently
repeated erotic crises and sexual orgasms, for a long period of time,
in conjunction with habitual spermal losses, during the period of
development. The frequent repetition of sexual orgasm so completely
destroys the erotic sensorii, that the long practice of masturbation
destroys the venereal orgasm, and an emission is produced without even
a pleasurable sensation; and even the glans penis becomes so anæsthetic
in venereal sensibility that the mental effort _only_ produces a
venereal excitability enough to bring about an erection. In copulation,
such persons do not enjoy a venereal thrill, only by fresh novelties
and different females. The subsidence of the venereal thrill, and the
loss of erotic sensibility and intensity of enjoyment at sexual crisis,
or during sexual orgasm, is evidence that structural changes have
occurred and that the disease has become located.

Not until structural changes are wrought in the nervous system, is it
probable that involuntary seminal losses will continue, or should be
corrected as a disease.

Sexual congress may, under favorable circumstances, when indulged
in to great excess, become a cause of such organic changes in the
nerve-centers as are followed by spermal losses. A few such cases have
come under my observation, that were of an unmistakable character. The
report of one case, which is a typical one, will suffice.

_Case._――Chas. B., a rather gentlemanly fellow, consulted me for
spermatorrhœa, with the following history: When he was a small boy,
some twelve years of age, a servant girl was his room-mate, with other
small children; his parents thinking him too small to interfere with
the servant girl, and did not change his room until a year or more
after she taught him the significance of his erect genital organ, by
coaxing him to an attitude favorable to her own gratification. Thus she
cultivated her new-found pleasure, as he grew up and developed. After
his room was changed, he found no impediment to nightly visits to the
servant’s bed. He was soon able to comply with all demands, and nightly
they indulged in sexual congress to satiety, and grew up together. She,
being much older than he and knowing all the probabilities, exercised
her vigilance and precaution, and all went well until he was twenty-two
years of age; when he found that, upon leaving home and undergoing a
few weeks’ deprivation from sexual contact, an involuntary discharge of
semen occurred two or three times per week, in his sleep, accompanied
by a lascivious dream. The constant and profuse discharge of semen and
prostatic fluid had passed from his glans penis, for which he had often
sought advice in vain. These cases are not very uncommon, although
many a young man has passed through similar experiences with unimpaired
virile powers. I opine that, if a young man passes to the age of twenty
without much sexual excitement, he will not be likely to suffer with
any form of sexual weakness; but if he has the predisposition spoken of
elsewhere, he will not be likely to pass to the age of eighteen without
being fully aware of his sexual instinct, and the pleasure that may be
derived from sexual indulgence or masturbation.

The great author, Lallemand, has given as causes a list of organic
troubles, a great portion of which are, instead of causes, produced
by the genital irritation and spermatorrhœa. He overlooks the general
phenomena which point directly to neurine pathology. As causes,
Lallemand gives, among various organic troubles, prolonged erections,
excited by erotic ideas or lascivious publications; the use of
diuretics, of ergot, of cantharides, etc.; the abuse of alcoholic
drinks, coffee and tea; constipation; ascarides in the rectum;
hemorrhoids, fissures of the anus; heating and irritation of the anal
and perineal regions by habitual sitting, or prolonged horseback riding.

Notwithstanding the eminent authority, it must appear quite impossible
for any of the above conditions to cause spermatorrhœa as a disease.
The few seminal emissions that may occur from such causes are in
isolated cases, and of short duration. Even when spermal losses have
seemed to arise from such causes, I should think grave reasons present
for the suspicion of self-pollution or sexual excess. The simple denial
would not be reason to attribute so permanent a disease to such trivial
causes.

It cannot be disputed with tangible evidence, that Lallemand’s causes
may develop a morbid sexual instinct, by reflex excitation, and act
as a predisposition by exciting sexual desire and self-pollution, and
thereby spermatorrhœa; but the innate condition must be present also in
every case.

While it is well known that various morbid anatomical changes are
found in the genital organs, on careful dissection, yet scarce any can
be said to act as a cause, but rather as a result of long debauch by
pollution and venereal diseases; and as commonly, such changes have
been found in the genito-urinary organs, when spermatorrhœa never had
been suspected.

Roberts Bartholow, in opposition to the views of Lallemand as to
causes, says:

    “To place this question beyond controversy, I have lately made
    a most careful dissection of the sexual apparatus of a young
    man, dead of double pneumonia, who was known to have practiced
    masturbation in an extreme degree for many years. Besides a
    catarrhal condition of the mucous membrane of the seminal and
    prostatic ducts and of the _vesiculæ seminales_, there were
    literally no lesions of these organs. I therefore reject this
    position of Lallemand as untenable, and as leading to improper
    methods of treatment.”

I can but conclude the cause of spermatorrhœa with one definite remark:
That the frequently repeated sexual orgasm, continued for a long time,
causing to be evolved so rapidly the great amount of nerve-force which
must each time be lost forever, must be the only direct cause of that
obscure neurosis upon which spermatorrhœa invariably depends.

_Moral Effect._――There is a moral effect wrought upon the mind of every
person suffering from an inflamed imagination. The constant dwelling
of the mind upon the sexual organs, or the imagination of a future
cohabitation, must stimulate the free flow of seminal fluid to the
overflowing of the _vesiculæ seminales_. Old debauchés frequently feast
upon the virgin countenances that pass street corners, and constantly
stand in wait for an expected girl, to be secured by a procuress,
that they may feast upon her ruin. The cultivation of such morbid
imaginations is an effect, rather than a cause, of long-practiced
sexual debauch, and grows out of a cultivated or congenital grossness
of the sexual instinct.

Elsewhere, the effects of unrequited passion have been fully
elucidated, as cause and effect of local neurasthenia.

_Symptoms._――The physiognomy of a spermatorrhœa patient is often
very striking; especially one who has been an extensive masturbator,
and has been led to think that any physician has but to behold his
countenance to judge of his entire condition and its cause. He bears
the aspect of one who has been convicted of a shameful vice. This
is the picture of an advanced case, yet not beyond the threshold of
reason. As he realizes his condition, he is embarrassed that he is
compelled to converse on the subject and confess his shame. The face
is commonly pallid: the eyes are sunken, with dark lines beneath: the
lips are anæmic: the corners of the mouth are drawn down, and haggard
lines are deep-cut about the face. He looks much older than he is, and
his beard is tardy, isolated and of a dirty color. The general aspect
of hunger is marked upon his entire figure: he is often lean and wan.
He trembles with slight exertion, and complains of fatigue: his muscles
feel doughy, and an unpleasant odor is emitted from his body, strong,
like a goat or a pig, and his voice is feeble. He speaks low, as if he
desired to be very quiet and secret, even when his subject has nothing
in it of a secret character. In common conversation, his voice is
reduced almost to a whisper. He often has pustules on his face――acne.
A young man may have spermatorrhœa with very few of these symptoms
present; but when he has advanced far in the disease――in the nervous
lesions――the above symptoms are only the common manifestations noted
by close observation. Yet all these symptoms may exist from other
causes, and the patient may be free from spermatorrhœa or pollution.
Then, only by the history and physical signs connected with the general
aspect, can we hope to effect an exclusive and conclusive diagnosis.
He relates his history, which is only a confession of his vice and
the story of his spermal losses nightly, with languor, bad digestion,
pains and aches too numerous to mention. His tongue is coated, breath
fœtid, appetite poor, circulation feeble, and heart-sounds feeble and
irregular. Often, a dull aching is located in his back-head, forehead
and eyes, with asthenopia, anthropophobia, agoraphobia, astrophobia,
monophobia, syphilophobia, nocturnal ephidrosis, palmar hyperidrosis,
and neuralgia of different localities and of varied intensity.

_Spinal Congestion._――This is one of the varieties of disease-pictures
that call for a deviation in management, and is, perhaps, as common
as any of the special types, and may be recognized by the following
symptoms: pain in the back, as if from long stooping, not increased
by pressure; also a dull, aching sensation, as after prolonged
exercise. This pain is aggravated by the recumbent posture; hence the
sleeplessness so common in many of these cases. Fainting sensations are
produced by standing long upon the feet: a misstep, or a sudden jolt
in a wagon or car, causes much suffering. Intense burning is often
felt along the cord and base of the brain, which is not influenced
by pressure; hyperæsthesia of the skin of one or both legs and feet,
and the scrotum; testes and penis are often too sensitive to touch;
at times, neuralgic pains in the genitals, with herpes præputialis,
periodically appearing; great tenderness of the anus, with herpetic
eruptions _ab margine ani_. Again, anæsthesia may take the place of
exalted sensibility, with formication――or tingling, or sensation of
“pins and needles”――of the feet and legs. Sometimes they complain of a
sensation of fullness of tissue, as if they were swollen, with no signs
of any puffy or œdemic condition present. I have often observed both
anæsthesia and hyperæsthesia at the same time, in different localities,
upon the same patient. Shooting, neuralgic, or knife-cutting pains
often emanate from the spinal cord and pass into the limbs, testes or
penis. Sometimes a tight belt is felt constricting the limbs, thorax
or abdomen; again a choking sensation, as in globus hystericus, with
a sensation of drawing in the spermatic cord and testes; pain in the
heart, lungs, abdominal viscera and genitals, is of common occurrence.
Irregularities in cardiac movements are not uncommon, with troublesome
erections of the penis in the morning, even when erections were
impossible at night. Such erections are commonly without erotic desire,
and with the bladder empty. They are more troublesome after lying upon
the back during the night, which seems to aggravate the engorged spinal
cord. As these cases advance paralysis may intervene, more or less
profound, generally in the form of paraplegia.

The above, under treatment, will be referred to as the congestive
type of spinal cord disease, where the direct adaptation of agents to
conditions will be pointed out, founded on the only principle that
can lead to ultimate satisfaction――“specific medicine and specific
diagnosis.”

_Spinal Anæmia._――That form of spinal anæmia caused by the sexual
differs from spinal irritation of other causes only in the more
usual beginning at the lower portion of the spinal cord――sacral and
lumbar regions. In this we have a group of symptoms of spermatorrhœa
that is not by any means rare; not always diagnostic yet, coupled
with the necessary history, they afford a condition to which too
little attention has been given. Spinal tenderness is always present,
increased by pressure, relieved by the incumbent position and
aggravated by walking. Unless these symptoms be present, no case is to
be considered anæmia of the cord.

Where spermatorrhœa and spinal anæmia are associated, and sexual
debauch has evidently been the cause of the latter directly, it will
be observed that sexual excesses have existed a long time before the
latter, or before constitutional disturbance had in any way manifested
itself. Spermatorrhœa, when associated with spinal anæmia, appears only
secondarily, as a phenomenon of the disease thus caused.

As spinal anæmia advances and other tender points appear in the cord,
the eccentric symptoms also change and the phenomena are various
in accordance with the location and symptoms coincident with such
phenomena when the causes have been other than sexual.

The lumbar tenderness is generally accompanied by neuralgic pains in
the lower limbs, back, abdomen and rectum, cramps in the bladder, with
difficulty in urinating; at other times incontinence.

In one case, which was under my care two years without any benefit,
the whole spinal cord was tender to the touch, and the patient was
epileptic and very feeble in mind.

When the dorsal region is involved and tender, as might be supposed,
there will appear gastric troubles; acidity, pyrosis, nausea and
vomiting, gastrodynia; again intercostal neuralgia and rheumatism,
cough and dyspnœa, palpitation, fits of fainting and epileptiform
convulsions.

_Case._――Mrs. P., in addition to unmistakable symptoms of spinal
anæmia, with dorsal tenderness would, at the sudden closure of a
door, complain of great pain in her abdomen, stomach and uterus. On
several occasions she had had involuntary evacuation of fœces and
urine during a thunderstorm. Her skin would be covered with cold sweat
(hyperidrosis). Medicine had very little influence in this case;
but electricity applied daily for three months――a mild current of
Faradisation――effected a very satisfactory improvement. This was a case
of sexual origin and a result of fifteen years’ sexual excess in her
early life; after which she married well to enjoy the remainder of her
life in wedlock under the care of a physician constantly.

The cervical region is not uncommonly affected and may be very tender,
which may produce pain in the stomach and nausea, rejecting everything
swallowed, at times. Sleep is nearly always deranged: sometimes
sleeplessness, and again, in the same patient, profound coma of long
duration is observed, and somnambulism is also likely to occur in
such cases. Twitching of muscles, contraction of flexor tendons,
hiccough, aphonia, vertigo, head-pain through the top, tinnitus aurium,
disturbance of vision, asthenopia, and mental derangements, as the last
stage of the disease, when the brain and entire nervous system are in a
feeble condition: all follow, in rare occurrence, the sexual debauch,
and are symptoms of the entailed conditions, viz., sexual neurosis, of
which spermatorrhœa is only one of the numerous symptoms, yet perhaps
the most attractive.

As these foregoing types or conditions advance, they become complicated
and even change in essential features; but if not remedied, the result
must be toward paralysis, insanity, tabes dorsalis, epilepsy and
imbecility; all of which can best be studied as special diseases in
numerous volumes on diseases of the nervous system.

_Cerebral Sexual Neurosis._――That form of neurosis, brought on by
masturbation in adolescence and sexual excesses, does not exist
independently of other portions of the nervous system, and only as the
spinal cord becomes impaired by excessive sexual shocks and evolution
of nerve-force, which is expended in orgasms during sexual excitement,
does the brain become involved, and its tissues fail, by feeble
perpetuative force, to evolve healthy intellect. When the formative
forces fail to construct as perfect a brain-structure as has existed,
renewal is required more and more often, which cannot be brought
about by the impaired nerve-forces, and softening must, necessarily,
follow or, at least, a mal-renewal and mal-construction of cells and
neuroglia, too unnatural to evolve the elements of healthy mind.

That there is a connecting link between the intellectual and the sexual
there can be no doubt, and that for the sexual to be appreciated,
without the assistance of the intellectual, would be only animal and
should not be considered advisable for human beings, but that the
intellectual should not only predominate, but preside over, all sexual
conditions.

Thomas would have us believe that the cerebellum is the seat of
amative desire, and that that organ presides over the sexual function.
Again, an opposite claim has attempted to overthrow such doctrines, by
experiments to prove that the cerebellum presides over coôrdination of
muscular movements.

I am not prepared to accept the doctrine of either as true, but only
can see evidence that both may be disturbed or lost for a time by
pressure upon, or section of, a part of the cerebellum, and that this
organ perhaps tends to effect an equilibrium of the nervous forces
between the cerebrum and cord, and also as a generator of nerve-force.
We do know that coôrdination of muscular movements is interfered with
by any structural changes in this organ; but it would seem that, if the
sexual was so much depending upon the cerebellum for force, or there
was such an intimate relation between these organs, muscular movement
would be oftener impaired or disturbed by reflex irritation, owing to
the frequency of impotence and other genital diseases, through the
close relations supposed to exist between the genitalia and cerebellum.
The coôrdination of muscles is seldom interfered with by sexual
diseases directly, but only as a secondary issue, by first producing
chronic impairment of the nutritive forces, and thereby effecting the
changes in nerve-cells.

The sensitive nervous organizations are of themselves predisposed to
morbid changes, from too often repeated shocks of pleasure or grief;
such persons are first to suffer mentally through shame, from having
indulged in such vices, and secondly, from actual structural changes
that have occurred.

The vice, commenced at puberty or before, interferes greatly with the
development of the brain, and only a feeble intellect is possible as a
product of such feeble brain-structure. The mental powers often yield,
as it were, when the genital organs possess the power to copulate _ad
libitum_. This is not an uncommon occurrence. Lunatics frequently
possess such genital vigor, when their lunacy has been produced by
masturbation and other sexual debauch.

Roberts Bartholow has, in his monograph, recorded a paragraph worthy of
mention:

    “It is to be remarked that the mental phenomena of
    spermatorrhœa are not always in proportion to seminal losses.
    In the cerebral form, in addition to those lesions of the
    sexual spinal system, of the digestive apparatus and of the
    circulation, described under the genital form, there are
    certain disorders of the mind. That spermatorrhœa will produce,
    in one class of cases, mental disorders, and not in another,
    indicates either that some predisposition to these disorders
    existed, or that the habit of self-pollution was merely an
    expression of mental alienation. The lascivious images which
    pervade the minds of boys, possessed of the highly developed
    nervous organization of masturbators, are those of delusional
    insanity. In one case the spermatorrhœa is a symptom of mental
    disorder; in the other, the spermatorrhœa is an exciting
    cause――the predisposition already existing.”

The general anæmia that so often occurs in spermatorrhœa, caused by
impaired digestion and spermal losses, is secondarily the cause of the
cerebral anæmia, and tertiarily of softening. The digestive powers,
so much impaired by frequent draughts on the vegetative centers, must
be a cause for a great disturbance in the nutritive supply of the
brain. The vicarious expenditure of nerve-force upon the exaggerated
secretory power of the testicles must be a source of great waste, as
well as the actual loss of elements, necessary to the structures of a
body losing annually by decay. The tendency of local spasm is of no
little importance as a cause of local anæmias. Centric irritations,
such as influence the _vaso-motor_ centers, without a doubt, cause
local spasms of the _vasa vasorum_, capillaries and supplying arterial
trunks of organs; and the vessels of the brain are the most likely to
be influenced in such a manner, and the tissues of the brain the most
likely, of all tissues, to suffer from such a condition.

The brain-symptoms do not end with feeble intellection or insanity,
but impairment of the special senses and motility is not unfrequently
present, as a phenomenon evolved from structural changes in the
brain. Asthenopia amblyopia, diplopia, dilatation of the pupil and
hyperæsthesia alternated with anæsthesia of the visionary apparatus,
aphonia, perversion of the sense of taste, with loss of smell and
deafness, are rare yet occasional complications.

The usual catalogue of symptoms bears closely to one of two forms, the
hyperæmic or anæmic, local or general, of the cerebral substance.

The profound impressions wrought upon the minds of these patients
by popular sexual literature must greatly exaggerate the structural
changes, but are not sufficient of themselves, as a rule, to produce
anything but morbid emotions until after enfeeblement has first been
organized.

The records of the State Asylum, at Utica, N. Y., show five hundred and
twenty-one cases admitted directly attributable to this vice; and Dr.
Jno. P. Gray, the able superintendent, thinks this greatly understated.

Sexual excesses, pollution, and other mismanagements of the sexual
functions have received too little attention, and are too seldom
mentioned in the etiology of nervous and brain lesions. Too little
effort has been put forth to ascertain the proportion of mental
diseases caused by the sexual and reproductive organs. A greater
number of brain-lesions occurs, in which the sexual function has been
a remote cause, than any author, as yet, has ventured to affirm.
Statistics of any degree of accuracy are impossible to obtain; but
supposition, imagination, and guess-work only can be found to assist in
making up a statement of the most important of all causes of disease.

_Clinical Illustrations――Case._――Mr. X. came from the South with his
brother to consult a physician in St. Louis. I found the patient, who
was aged 24 years, feeble and wan. He wore a thin, scraggy beard, about
an inch long, over his chin and under his maxilla, but the side of his
face contained only a little furze. When I entered the room it was not
necessary to inquire which one of the young men had come to consult me,
as his general aspect told me that he was a sick man. He was cadaverous
in looks, staggering in gait, anæmic and haggard. He had been a
masturbator, and practiced it as long as he could obtain erection,
which had been until within a year; although I learned that for five
years previous his erections had been only occasional and feeble. His
semen was wasting nocturnally and his genitals flabby, cold and damp:
his scrotum especially was relaxed and pendant. The spinal cord was
very tender to the touch, giving great pain upon examination, over the
lumbar, dorsal and cervical vertebræ. He complained of a sensation of
constriction (girdle) around the body, painful digestion, constipation
of the bowels, and talked incoherently. His mind wandered: he had no
wishes to go home, or to stay, or to live, and became quite passive.
He failed fast, and I soon lost sight of him, as he was placed in an
insane asylum. All treatment failed to benefit him.

I might enumerate scores of similar cases, in which it is impossible to
see any cause but abuse of the sexual function, in which spermatorrhœa
and impotence blend in a very obscure manner, but combined with other
phenomena prove, beyond a doubt, the existence of a sexual neurosis,
peculiar to itself, which needs study as to pathological anatomy; when
it will be discovered that more than mere cause for general neurosis is
found in the sexual abuse so lightly spoken of by authors in treatises
on diseases of the nervous system. It will not require an accurate
observer to discover signs of myelitis and softening in the above case;
but his symptoms had been, long before, markedly those of anæmia, as
related to me by his brother. Many cases selected for this section are
in the advanced stage that I may the better show the termination of
some of these cases. The majority of the cases that I have observed
have been wanting in these distinctly organic features, _only_ for the
reason that they were not so far advanced, and their indulgences had
been limited to a more careful habit of pollution and sexual congress.

The usual course of lesions appears in the following order after
sexual excesses and pollution: Nervous weakness (neurasthenia), anæmia
or congestion, myelitis, and softening. These may point either to
the brain or spinal cord, or both associated, in any given case, in
accordance with compatibility of lesions and conditions.

A most striking condition of sexual neurosis is not uncommonly
observed, that is not confined strictly to a locality, but shows a
general breaking down of the conductors of nerve-force, both motor and
sensory, as well as the nerve-cells, with a tendency to softening of
both brain and spinal cord.

_Case._――A marked case of impaired conductivity is now under my
observation. The patient is a masturbator, and I have thus far failed
to disrupt the vice.

In addition to many symptoms, not of general interest, is the impaired
condition of the sensory conductors. When he is touched, it is a
second before he feels. He sees the finger placed upon his hand or
foot, but does not feel it for one or two seconds: sometimes it is
quicker than at other times. When he is spoken to, he does not receive
the idea for ten or fifteen seconds after he has heard the sound. He
comprehends that such is the condition. He says he does not desire to
practice self-pollution, but simply performs the act because he can’t
help it. He is sensible and strong-minded on some things, and very
feeble on others. He is agoraphobic, but has no pathophobia. He is not
anthropophobic, but even foolish after female society, and still has
no inclination to copulate. He prefers to masturbate, rather than to
accept of coition when accessible.

The motor nerves and centers are rarely, but sometimes, involved
directly. When paralysis does occur, it is from advanced complications
and need not be mentioned here; but sometimes an unnatural class of
movements is produced by this variety of neurosis, generally of a
spasmodic character and located in the involuntary sphere. I wish only
to record, in this place, the fact that such is a lesion of sexual
neurosis, and take it up elsewhere with greater precision.

Tabes dorsalis has not been uncommonly caused by sexual abuse, in
proportion to the frequency of the disease. Loss of sensibility is also
exceedingly rare, but impairment is not uncommon. The loss of venereal
sensation is a very common consequence and will be spoken of elsewhere.

Paralysis of some of the muscles of the genitals and bladder is of
frequent occurrence, especially those connected with urination; the
bladder is often paretic and micturition is frequent, and the quantity
very small: often the natural warning as to time is wanting. The
mental symptoms are often very prominent: loss of memory; conversation
difficult; language incoherent and ideation very imperfect; insanity,
idiocy, imbecility and epilepsy.

Hitzig says, under _Etiology of Paralysis of the Insane_, “Probably
the combination of excessive labor with excesses _in Baccho et Venere_
is the most common cause. The influence of sexual excesses can be
recognized in females also.”

_Case._――An epileptic gentleman, æt. 24, consulted me for his fits. He
had practiced masturbation from childhood to twenty years of age; was
losing semen nightly; often without erection; had been epileptic four
years. At first the fits were as frequent as every four months, but now
they are weekly. His face was of a venous color, as if a venous stasis
was the constant condition. His eyes and hair were black. His face was
expressionless and covered with acne; memory very poor. He was a fine
penman, and had been a book-keeper. He had felt no _aura_, and always
had his fits during the day-time. All treatment failed in this case
to produce any impression upon the fits. The bromides at first could
not be used, as dangerous symptoms followed three successive attempts.
Electricity, if any thing, aggravated his general condition. I cast
lots for general treatment, in an empirical manner, but very little
benefit followed: his general condition was downward, and the epilepsy
continued to grow more frequent. Large doses of bromides benefited him
and increased the interim, but finally four drachms a day failed to
control or to modify them. Galvanization and Faradisation, both singly
and conjointly, were tried in vain. Ergot also was tried, and many
agents of lesser prospects, as he staid with me three years, growing
feebler in body and mind constantly, until he is now nearly imbecile.
Four cases so nearly alike have come under my observation, that the one
will answer as a typical case of them all; not a single one recovering:
two have ended up in the insane asylum: the other two I have lost sight
of, but not until they had passed into a state of dementia.

_Case._――Jno. W. My attention was called to this patient by Dr. M.,
who was the attending physician. The patient was in bed, very much
emaciated and feeble; form originally tall, bony and muscular; dark
hair and eyes. The Doctor informed me that he had passed through
the hands of a number of physicians, without relief. His pulse was
feeble and averaging 100: his venous circulation was feeble; a livid
appearance of the skin: the redness would disappear upon pressure and
return very slowly. There was profuse nocturnal hyperidrosis, with
great morning prostration and general coldness. He was exceedingly
irritable and profane; appetite poor, and what little was eaten
was digested with pain; bowels constipated; urine high-colored and
of high specific gravity, containing blood and pus. The spinal cord
was so tender, during its whole extent, that the slightest pressure
produced intense pain. His rectum was indurated and very tender to the
touch. The urethra was diminished in calibre to a No. 8 catheter, and
that was passed with great pain. The prostate gland was enlarged and
hyperæsthetic. He complained much of the girdle sensation, which placed
the diagnosis beyond a doubt as chronic myelitis of the posterior
columns. There were no lesions of motility, but lesions of sensibility
were present throughout the body and lower limbs; anæsthesia of the
skin and hyperæsthesia of the mucous membranes of the rectum, urethra
and bladder. All treatment proved futile, and he died after a year of
most distressed suffering.

He was a debauché, given to extreme sexual indulgence and wine; was a
victim of early indiscretions, and to a great excess: spermatorrhœa was
present up to six months of his death; but was only impotent after he
took his bed from general exhaustion. He was thirty-three years of age
when he died.

Gull’s case of paralysis reported must be quite exceptional, as
paralysis generally found, which has been caused from a sexual
neurosis, has not differed in any manner from the same paralysis
from other causes; and I can only see the sexual neurosis as a cause
of paralysis, and not as a special variety. The same may be said
of an anæsthesia of the skin, or a hyperæsthesia; that the sensory
nerve-roots are influenced by either anæmia or turgescence, and the
phenomena are manifested at the periphera. The phenomena do not
differ, when these conditions are caused by the sexual, from phenomena
when conditions are wrought by other causes; and conditions causing
identical phenomena are in themselves identical, but not as to their
cause; hence so many forms of sexual neurosis, and so many conditions.

_Local Structural Changes._――Structural changes in the genital organs,
in a chronic case of spermatorrhœa, are not a little interesting to the
student of pathology. The scrotum is pendant, baggy and relaxed. The
penis is flabby, cold and pallid. The veins are dilated and tortuous,
and the organs are in a condition of anæsthesia or hyperæsthesia;
and as irritability often exists, causing unnatural attention of the
patient, and he finds much difficulty in dressing to suit his genitals.
The spermatic cord is hypertrophied, and the epididymis enlarged and
baggy. If the examination can be obtained when there is an erection,
tenderness will be observed, along the entire course of the urethra.
The urethral mucous membrane is thickened, and the canal is strictured
throughout its length. The prostate gland is changed and tender to
touch, congested, and its ducts relaxed. (See Prostatorrhœa.) The
anus is sore to manipulate, and at stool, when scybala pass over the
prostate gland, a sensation of pain is felt, and fluid is forced out
of the ducts into the canal and drips from the end of the penis. The
veins of the spermatic cord are varicose, the erections are deficient
in power (see Impotence), and seminal fluid is thin and watery. The
spermatozoa are deficient in size, shape, and amœboid movements. The
urine is of a low specific gravity and contains a superabundance
of urates. The orgasms are feeble and often imperceptible, and the
proportion of spermatozoa to fluid is not great.

_Spermal Changes._――The only known detection of spermzoons is by the
microscope, which only can detect the seminal from the prostatic fluid
in this stage of disease. The reason that spermatozoa have not been
detected oftener in the urine of spermatorrhœa patients, is simply from
the fact that the urine was not examined more than once, perhaps twice.
When I have watched for ten days, making daily observations, before
discovering spermatozoa, I have then found them daily for as many days.
The first object to be determined is, is the patient strictured, or
has he a general narrowing of the calibre of his urethra? If so, then
this is a good reason to suppose there may be spermatozoa in his urine,
providing that he is losing semen; as the fluid is thin, and the walls
of the canal are clumsy in performing those wave movements which are so
essential in ejaculating semen or expelling the last drops of urine;
therefore regurgitation may take place, and semen be found in the next
discharge of urine. When nocturnal losses occur, a large portion may
be expected in the urine at the next micturition. This is commonly the
case in aspermatism, and may act as a cause of sterility.

The married, as well as the unmarried, have involuntary discharges of
semen when every possible opportunity is present for an emission to
take place in the natural way. The newly married, after the novelty
period has subsided may, from excessive indulgence, have an involuntary
emission, which occurred during a lascivious dream, when no desire for
cohabitation preceded his going to sleep. When the cause producing
these involuntary emissions is not transitory, the young man must have
indulged extensively in his boyhood. Such a discharge, if followed by
the usual depressing effects, is invariably pathological; yet with
proper rest, self-recovery is probable when the cause is transitory.

_Sequelæ._――The common results of spermatorrhœa and sexual excesses
become noticeable, either shortly before or soon after marriage.
The young man well knows his defects, and he consults a physician to
ascertain the magnitude of what may occur to him on account of his
indiscretions. He informs us that sexual orgasm occurs very soon after
intromission, on account of which he is grieved, and fears that his
buxom, voluptuous bride will not be satisfied with such tantalizing as
he may be able to afford. A few months’ tonic treatment encourages him,
and he makes a trial of his condition before entering wedlock, that
he may be sure not to disappoint his fresh, true and virtuous maiden.
Again, the matrimonial rites have been consummated, and the young man
fails to reach the expected goal of marital adaptation and aptitude:
the wife is of course unsophisticated, and thinks there is nothing
wrong; but the husband is well satisfied that he is not what will be
expected, or what is necessary to promote marital felicity; and he
consults his physician. Perhaps he was not a little disgusted, upon the
first attempt at intromission, at ejaculating his semen either upon her
linen, thighs, or vulva; she of course being innocent and not knowing
the why such was not the natural procedure, he could excuse himself and
thereby palliate his embarrassment.

Others, less sensitive in organic construction, do not understand these
shortcomings, and are not _quantum sufficit_ for a healthy female, as
ejaculation follows a moment’s rapid copulative movement, leaving
the female aflamed with erotic passion, and physiological turgescence
of the sexual apparatus. These are only the _sequelæ_ of seminal
weakness, such as pertain to the neurotic origin and character of this
disease. The grave and less common results are, as the symptomatology
illustrates, spinal anæmia and congestion, cerebral anæmia and
hyperæmia, insanity, epilepsy, tabes dorsalis (progressive locomotor
ataxia), paralysis, impotence and structural disease of the heart and
blood-vessels.

_Treatment._――The treatment of spermatorrhœa, with its associate
phenomena, demands careful investigation of the lesions and conditions
of every case. The results and character of lesions are so varied that
often a diagnosis as to condition is not an easy task. To know that
spermatorrhœa exists is but a small part of the diagnosis necessary to
arrange a treatment that may rationally result in benefit. As has been
shown, seminal losses may exist when opposite conditions are present;
and only can benefit be rationally expected from equally opposite
methods of treatment. Any physician of experience has, and always will
have, much difficulty in treating and controlling these cases, as they
are hard to manage when even doing well, and only an intelligent and
positive course can succeed in managing them during any great length of
time.

A positive code of government, rigidly followed, is indispensable; as
well as perfect confidence in the managing physician.

The nasty drugs of our old-fashioned materia medica will not cure these
cases The bringing about so-called tonicity, by tonics and nervines,
only needs to be tested for a short period to convince any practical
physician how useless is such a procedure, and how soon his patient
will find another attendant. Drugs are often useful but bad ones,
selected for a tonic principle _only_, will as often do harm. Only
with a definite object in view, should we expect to accomplish such
changes as can result in positive relief. The list of nasty tonics for
indefinite purposes, or such as “have been used in such cases,” the
author has resolved not to, in any manner, refer to, and at no time
will he direct an agent or combination of drugs on so-called “general
principles,” but with definite expectations only.

_Spinal Congestion._――The group of manifestations pointing to spinal
congestion will first receive attention. The remedies are bromide
potassium, bromide ammonium, ergot and belladonna, with electricity.

These are selected also with reference to conditions only; yet the
reader can evidently see that their ultimate effects are aimed at,
as all of this list of agents affect the calibres of capillary
blood-vessels; therefore, the engorged spinal vessels are unloaded by
contraction, perhaps, of capillary _parietes_.

By this effect of drugs we aim at relief of the long compression of
the cord, and liberation of nervous energies and forces supplying the
organs of nutrition and assimilation.

It is pre-supposed that all sexual excesses and vices are under
control; otherwise, all treatment will be useless.

Numerous are the contrivances to control or prevent seminal emissions.
They have all failed, and nothing is lost; as only the effect is
looked upon in their construction, and not the true nature of the
disease; therefore, to prevent spermal losses is not the first object
to accomplish, but to relieve the nerve-centers, which preside over
the manufacture of semen, of these abnormal structural changes; and
the loss of semen will abate. No instrument will then be required; and
if this centric improvement cannot be effected, the patient is beyond
help. No mechanical contrivance will relieve the centric lesions;
therefore, such appliances are useless. The loss of semen is not a
disease, only a manifestation or a phenomenon of centric lesions; and
as we have said heretofore that spermatorrhœa is not even a cause of
such lesions; but sexual shocks, often repeated for a long time, are
the cause of the neurosis through which we have spermal losses――true
spermatorrhœa. This reiteration is made that no mistake may be made in
interpreting the means of relief, which are all aimed at the lesions
instead of their phenomena.

When the patient is not too much debilitated, chloral may be
administered to produce sleep; but very commonly the ergot or ergotine
will allay all nervous irritation and bring on perfect rest. Large
doses are demanded, as much as two grains of Beaujon’s extract three
times per day, or one drachm of Squibb’s fld. ext. or an ext. of equal
strength should be used. Belladonna should be used by commencing with
small doses and gradually increasing until asthenopia is produced, when
small doses should again be used: by this means the extent of tolerance
may be ascertained, and that dose should be continued which does not
affect the eye. When the bladder is involved and urine is voided with
a lack of expulsive energy, or the urine dribbles away, ergot and
belladonna are the remedies. Where there is extensive hyperæsthesia the
bromides are better agents, and also to overcome any reflex irritations.

Hot applications to the spine are often followed by very excellent
effects, as the relief of pain and other troublesome symptoms.

Cold water to the hands, feet and genitals is often followed by
surprising results, and should be used night and morning for a long
period of time――many months. Tonics do great injury in this class of
cases. Quinia, strychnia, phosphorus and iron should never be used in
any form.

_Electricity._――The downward, constant current, alternated with
Faradisation, is indispensable to satisfactory results in the majority
of the cases of the congestive type; using the galvanic one day, and
the induced the next day, with general Faradisation, if it be followed
by pleasant effects and relief of unpleasant nervous symptoms.

Stimulating food, as well as alcoholic and malt liquors, should be
proscribed; yet a generous diet is at all times indispensable. Opiates
should not be administered, even for the relief of pain.

_The Anæmic Form._――When this type of spermatorrhœa is satisfactorily
diagnosed, the treatment is plain and the agents quite positive in
their course of action, when the case is not so far gone that relief
could not reasonably be expected. But if there be a doubt as to
diagnosis, on account of mixed symptoms――and such is not unfrequently
the case――if we are not well satisfied whether there is anæmia or
congestion of the cord, the administration of 1/60 of a grain of
sulph. strychnia will decide the matter, which will produce some of
its physiological effects if there be congestion; but if anæmia exist,
there will be no noticeable change, at least no unpleasant effects.
With this point clear, we then direct a treatment which is intended to
stimulate a free circulation of blood in the cord――_spinal stimulants_.
Strychnia, phosphide zinc, cantharides, pulsatilla, phosphoric acid and
collinsonia, are such agents.

Cold spinal and genital douche, with hot foot and hand bathing morning
and night, are highly important agents, with strychnia 1/60 gr., three
times a day. The author has for many years almost entirely depended
upon formula No. 1, not on “general principles,” but as a combination
that applies directly to the anæmic condition of the cord and its
consequence; and knowing its effects, as he has, so long, could not
well do without it in the treatment of these complicated cases. If
there be general anæmia, as well as local, chalybeates may be of
service, but not until the patient is eating and digesting moderately
well: then we prefer the citrate in port wine. Stimulants in moderate
quantity are admissible, especially wine and malt liquors. Opium may be
administered to allay pain, but chloral is better.

Any agents, used for their stimulating effect upon the cord, must not
be expected to act too rapidly. Patience is the all-important motto
after the diagnosis is well made.

Counter-irritation will always be of great service, and the cantharidal
plaster is the most desirable form. The seaton has in a few instances
been of service, but we prefer the emplastrum canth.

Electricity is indispensable, and should be applied daily. The anode
should be applied to the tender spots in the cord, and the cathode to
the genitals, in the form of a large sponge placed in contact with
the perineum, scrotum and penis. Faradisation may be alternated with
the constant current daily. General Faradisation may be applied best
by a large foot-plate covered with a wetted sponge, and the operator,
holding the anode, may place his other hand on the patient’s head, back
of his neck and along his spine: the hair of the patient will of course
be moistened as the dry hair is a non-conductor of electricity.

A highly nutritious diet should be always advised, and plenty of
open-air exercise, even to fatigue; as the mind is thereby employed,
and not so much time is found to brood over these physical conditions.
The very common and exceedingly troublesome constipation may be
overcome by rhamnus purshiana, in teaspoonful doses of the fluid
extract, morning and night.

When extreme sleeplessness prevails, grain doses of svapnia have acted
excellently; also ten-grain doses of chloral hydrate.

I do not prescribe for seminal losses under any consideration: I
simply ignore them during the whole course of treatment. Where the
general health improves, and with that the nerve-symptoms, the seminal
losses become less frequent and finally cease. As the involuntary
discharges diminish, we may conclude the central lesions are improving.

_Cerebral Sexual Neurosis――Treatment._――The most prominent feature of
the cerebral manifestation is mental asthenia, or feeble-mindedness,
from real exhaustion of all the forces; a general lack of power.

To impart vigor to the general nervous system must be the first
indication. For this purpose dil. phos. acid may be administered. If
the extremities are cold the hypophosphites are of positive benefit,
and must be continued for a month or more. Tinct. nux vomica imparts
tone to the nerve-centres. When active symptoms are present the
bromides act very kindly, and may be combined with ergot, or the latter
may be used separately with most excellent results. But the physician
must be certain that he has a case of hyperæmia, before such agents are
resorted to, and then they should be given in large doses.

Electricity, in the form of general Faradisation, seems to be of the
most service, and must be applied daily for several months. Only a
feeble current should be used.

The structural changes that have occurred in the genitals always demand
attention.

Chronic turgescence of the prostate gland will best be treated by
the internal use of tinct. staphisagria, large doses of bromide of
potassium, and the introduction of catheters increasing in size until
the urethra is fully dilated.

Electricity should be used as recommended under Prostatorrhœa. The
organic stricture, which is so commonly present, should be treated by
dilatation with suitable bougies or catheters. The bougie must be used
as often as twice a week, until the full size and elasticity of the
urethra are obtained.

Injections are sometimes useful. A solution of nitrate of silver,
ten grains to the ounce of water, used only once, and followed by a
solution of brown sugar (sacch. communis), morphine and rose-water,
will answer a most excellent purpose. After the acute inflammation has
subsided the bougies must always be resorted to, and used persistently
until the object for which they are used is accomplished. Any
ulceration may be relieved by injections of permanganate of pot., not
stronger than one-half grain to the ounce.

The glans and prepuce should be closely scrutinized from time to
time, and if the prepuce be of undue proportions, or if the patient
is filthy, permitting accumulations to form beneath the folds and
creating a local irritation, circumcision should be performed without
hesitation.

Reflex irritations have often prevented recovery, and even produced
grave manifestations. Cases of epilepsy have been reported from such
peripheral causes, and cured by relieving the cause, or circumcision.
The division of the sensitive nerves, which occurs in the operation
of circumcision, often prevents involuntary spermal losses, and
even permits such patients to perform normal copulation as had even
ejaculated previous to intromission. Such little causes must not be
overlooked. It is often in attending to little things that great
results are accomplished; and in this we have no exception to the rule.

There is no room for a doubt in my mind that the Jewish rite was first
established from hygienic motives _only_; and as “cleanliness is,” and
always has been, “next to godliness,” circumcision would seem a very
natural sacred rite for any religious sect to adopt.

We have no history of anything more ancient than the operation of
circumcision. The Egyptian priests were practicing circumcision nearly
5,000 years ago. A translation of Herodotus informs us that such
hygienic measures were in existence amongst the Egyptians in the most
ancient of periods; and it is quite reasonable to suppose that the Jews
obtained this rite from the Egyptians.

_Dilatation of the Anus――Anal Plug._――A very troublesome complication
of the genital structural changes occurring in spermatorrhœa is
induration of the mucous membrane and sub-mucous tissues. Where such a
condition is present, little benefit should be expected until relief is
obtained from the local difficulty.

The dilatation should be accomplished by suitable means; such as by
bougies, or a bi-valve rectal speculum. An anal plug may be constructed
that is self-sustaining, polypoid in shape, which will be of more
service than compression of the anal surfaces. The troublesome
pruritus, and hemorrhoidal tumors, and indurated anal tumors, will
gradually subside under such management. Suppositories of iodoform are
also of invaluable service in reducing indurated conditions of the
anus and rectum, as well as enlargement of the prostate gland. The
old-fashioned stretching of the sphincter ani for spermatorrhœa, so
highly recommended by Trousseau in his clinic on this subject, from
indiscriminate use, is neglected, when it is really a most important
means, deviating the reflex current from the genitals as well as
relieving actual structural change in the anus. Roberts Bartholow has
dwelt upon this subject without pointing out definitely such cases as
it has actually relieved, leaving the reader to guess or find out for
himself. The failures from its use have been so numerous, and the
cases in which benefit has followed so few, that it is no wonder that
it is not in better repute as a remedial means.

Whenever this dilating process is restricted to thickening and
induration of the mucous membranes of the anus and rectum, much benefit
will follow its use.

Many peculiar means have been recommended and are resorted to, many of
which only need a condemnatory mention, which seems the more necessary
that they are in almost general use. The most prominent is _the porte
caustique_, which was probably introduced by Ambrose Paré, and improved
and so highly recommended by Lallemand. Other prominent supporters of
this manner of medicating the urethra and prostate gland were Wiseman,
Hunter, Amussat, and Everard Home. The supporters of this manner of
cauterizing the openings of the vesiculæ seminales were under the
impression that spermal losses constituted the essential cause of
the disease, instead of the habit the testicles had taken on by a
hyper-supply or vicarious evolution of nerve-force.

We do not hesitate to say that this method is seldom followed by
beneficial effects, and often by irreparable injury.

Bartholow advises its use in exceptional cases; “those in which,”
he says, “the moral effect of the application is desirable.” From
this I must dissent; as any superabundance of attention demanded may
be bestowed by cauterizing or vesicating the perineum, obtaining
an excellent moral effect and even accomplishing, by way of
counter-irritation, physical improvement.

We might suppose that these harsh means of treatment, owing to the
elevated character of their supporters, were in good repute; and that a
work on this subject would be incomplete without a full detail of them;
but a better success without than with them has led me to discontinue
their use, and conscientiously speaking of the treatment, I can but
manifest my disapprobation of all caustic applications to the urethra
or prostatic ducts.




CHAPTER XI.


_Impotence._――Some misapprehension as to the signification of this
term is prevalent, owing to the extent of weakness and the morbid
conditions to which it has been applied. The wrong application has been
very common; _i. e._, in using it to describe a condition of sexual
neurasthenia and temporary suspension of the sexual powers, from moral
shock. A young man who exercises a doubt as to his ability to copulate
may, upon the occasion, be unable to procure an erection; and yet he
may, after a time, secure his own confidence; or, when he the least is
thinking of it, be in full possession of his potence. The first attempt
at coition, after matrimony, may be unavailing for this reason, and no
trouble occur at any time afterwards.

The penis may be erect at first, and become flaccid before intromission
can be effected. Even this does not constitute, but may be only a
result of, nervous shock or impression produced upon the mind and
sexual instinct, from embarrassment, that may occur to any young man
who is not self-confident, and is no evidence of any permanent disease.

Impotence, as it should be defined and considered, is the
manifestation of a disease in which there is permanent and actual
impairment of the nerve-centres and, as a phenomenon of such centric
changes, inability to procure an erection of the penis, at any and all
times, sufficient to perform the act of coition. This is a chronic
malady, of slow advent, and when once established there is very little
tendency to recovery. The chagrin manifested in a man who is impotent
is at all times striking. He feels that to be impotent is to be worse
than dead. Men pride themselves on their ability to perform coition,
and feel the loss of sexual power more than mind. Money and time are,
therefore, expended exorbitantly to recover this lost power, that they
may feel themselves men once more.

The flabby organ is the centre of attraction. He handles it, and dotes
upon what has been in by-gone years, and mourns over his misspent
fortune only for the possibility of his obtaining relief from his
genital affliction through its influence.

The disease is complicated with spermatorrhœa at nearly all times, and
may be considered only an advanced period of the same neurosis. The
same conditions and types of diseased manifestations are to be studied
in impotence as in spermatorrhœa. Then, to spermatorrhœa we add the
phenomenon, impotence, and the accompanying changes, and we quickly
comprehend the position.

The condition is a loss of excitation-power of the nerve of Eckhard,
whereby all physiological irritation becomes impossible. This nerve
arises from the sacral plexus, any irritation of which, in a healthy
state, causes a flow of blood to the corpus cavernosa and spongiosa
of the penis; but the constant stimulation of this nerve produces a
loss of irritability and paralysis of the parietes of the arterioles
of the erectile bodies of the penis, and no relaxation of their valves
occurs at any time: a perfect vascular inactivity is the result. These
arterioles anastomose with corporal venules which are very tortuous
and sacculated and supplied with very large openings and very small
outlets compared with the magnitude of their calibres; but the often
turgesced condition of these venules causes a dilated condition of
the outlets, and any blood that may be conveyed into the corpora
through the arterioles will flow out so fast through the dilated
venule outlets, that the turgescence necessary to produce erection is
impossible. Again, the innate contractility of the trabecular substance
must antagonize, to a considerable extent, the erectile tendency of
surrounding tissue.

Then there is another condition so closely connected with impotence
that a mention of it will not be out of place. Impotence consists in
a lack of power to effect an erection; but there is a condition, not
always impotence, where the person has lost all desire for copulation,
and will not make an effort to obtain an erection. He does not attempt
to concentrate his will-power, and does not desire any relation
whatever with the opposite sex, although he may have been a debauché in
his early life. When such a condition has been congenital, there would
be reason to suspect deformity or congenital defect. Such person may
not be impotent, and if the desire returns it manifests itself in the
genitals as soon as the mind is allowed to dwell upon erotic thoughts;
and if erection does not occur impotence is present.

The loss of semen often subsides in the aged, and atrophy of the testes
is not an uncommon result; but some people live to be very old, and are
never troubled with senile-impotence.

The penis is at all times flaccid, if impotence be complete. Often
partial impotence will reveal itself, deviating peculiarly in its
character. Sometimes a man will, while entertaining erotic thoughts,
have an erection of the penis which is perfect in all appearance, and
when brought in contact with a female cannot sustain or even procure
the erection, and yet the erotic desire be just as intense as if he be
able to perform the act in a proper manner. These cases are practically
impotent, but the disease has all to do with the mind; and as soon as
the mind can be so corrected that self-control may be exercised as
well as self-confidence, just so soon will the impotence disappear;
and once the act is performed normally, the trouble will be at an end.
But there is a condition in which all the powers of mind and body,
exercised to control, will not impart either the power of erection or
the erotic desire――only a longing for that once felt erotic desire
exists. The condition often exists in which the patient cannot control
the mental impressions, so as to effect that peculiar concentration
of the nervous force which gives energy to the sexual organs; and yet
there may be no disease of such nerves themselves. It is the same
condition that will cause the mental operations to fail during any
course of anxiety, or turbulence of the emotions. A speech-maker may
fail in his efforts at first, even after he considered himself prepared
for every emergency; but as soon as allowed to collect his scattered
mental evolutions, he may compose himself.

Inability to perform the sexual act while suffering from any mental
derangement, or misunderstanding one’s own mental elaborations, is
not impotence; but there must be impairment of the integrity of the
nerve-substance that evolves the force that sustains the sexual organ
in its erect attitude, and also supplies the so-called physiological
irritation. If we attempt to name this peculiar disease from other
stand-points, we shall become confused; as it would only demonstrate a
function-disease, which is an impossibility and leads to confusion.

I have seen cases of so-called impotence from intestinal worms: while
impotence is not generally considered a symptom of worms, yet this is a
case which recovered as soon as the worms were expelled. I have known
two cases that supposed they were permanently impotent, both of which
obtained relief after the expulsion of a tænia solium.

These were cases of symptomatic impotence; which only means phenomena
that may exist in remote structural disease, or by mechanical pressure,
as from foreign bodies, lumbricoide, tapeworms, etc., pressing or
directly or indirectly infringing upon the nervous track that conveys
the force which supplies the erectile tissue of the penis. This is a
paralysis of the vaso-motor variety, in which the impotence is only a
symptom: the disease must be studied under nervous diseases.

To comprehend and study true impotence, the student will be attracted
to the brain and spinal cord; as there only can the pathology be
carefully comprehended.

Nearly all the descriptions of this perplexing malady have been
confined principally to the chronic flaccid penis and the general
nervous phenomena most likely to co-exist. I must say that our
knowledge is very limited beyond the superficial sources of
information; and we have to content ourselves with simply describing
the appearance, for the real disease itself; not but what structural
changes exist in the sexual organs, worthy of note, but such changes
are only secondary.

Depending upon organic disorganization of the nerve-substance, we have
all grades of loss of sexual power, from the simple chronic premature
ejaculation to advanced and perfect paralysis of the organ. Any male
who, from exhaustion of nervous force, cannot perform the act of
copulation in a normal manner, may be said to be in a degree impotent.
If he be able to effect intromission and then unable to complete
the act, from premature ejaculation――providing this is a common
occurrence――he may be said to be impotent. The continent may undergo
premature ejaculation and not be impotent. Neither is flaccidity likely
to follow ejaculation from such cause.

The more advanced cases of impotence are not even capable of procuring
erections; and often semen is discharged in the flaccid condition
without the knowledge of the patient: such may be the result of
spermatorrhœa and impotence combined.

The long-continued and frequent indulgence of masturbation must be
a most frequent cause of impotence. I have only observed a very few
whom I knew to have brought upon themselves this condition without the
habit of masturbation; and even then I am not positive in knowledge.
Yet they were rare debauchés, with money to squander and appetites so
salacious that the almost constant contact with women was their custom.
On the other hand, it seems that a male human being is constructed for
endurance of his sexual organs. A notorious polygamist in practice,
once living in the city of Elmira, New York, was known to lavish his
smiles on his “kept women,” whom he numbered by scores, and still he
was potent till he died in advanced life. We must have a most excellent
example in the famous President Young whose wives, we are inclined to
believe, must have kept him on the _qui vive_, as his children bear
evidence, as well as the fascination and attractiveness of his young
wives.

The exciting cause of impotence must combine a constant and
long-continued sexual debauch with the depraved chain of thought that
must necessarily accompany such degradation; and the practice of
self-pollution must be the most fruitful of all causes.

_Treatment._――In the management of impotence, the patient’s persuasive
influence must not in any way change the intentions of the physician,
or the fast hold of his mind, which is so indispensable to a cure,
will be lost. The patient is always in great haste, and constantly
urging the physician to make rapid progress. Too great firmness cannot
be exercised, and promises of speedy cure will invariably fail.
Time is one of the most important of all elements in the treatment,
as opportunity is afforded for the recuperative powers of nature or
physical forces to become poised.

Perfect confidence in the medical adviser is prerequisite to success,
as by this alone can the patient’s mind be manipulated, and his hope
constantly stimulated. If he has been much exercised in mind about his
case, from reading “self-abuse” literature, moral treatment will be
required to dispel from his mind the pictures there wrought. Not always
can the virile organ be restored to its normal vigor, but elevating the
general health should be first considered, and the patient’s mind kept
constantly thinking about his improving physical condition, instead of
watching for the first erection as he will most naturally do.

When the foregoing conditions cannot be secured, no benefit will result
to the patient. In no disease has mental influence so much to do with
recovery, as in impotence; and I do not hesitate to say, where I can
control my patient’s mind, that I can always effect a very satisfactory
relief. Employment is indispensable, and must be persisted in. The
patient should have no time to play, or brood over his disease, but
must be engaged so constantly that he will be even fatigued after he
has finished his day’s toil, and will sleep long and soundly from
his exhaustion. The most nutritious diet should be selected: meat,
eggs, oysters, milk, etc. Cold bathing at night, before retiring, is
a very important measure; as, first, it washes the parts of a cold,
clammy sweat, and the chill from the water after reaction, produces
a naturally warm feeling, and his attention is not attracted to the
parts by their otherwise doughy, unnatural feeling; and secondly, the
tonic properties of cold are of lasting benefit. The bathing should
extend to the back, perineum, scrotum, penis, and down the thighs. Such
constitutional measures should be resorted to as will favor any of the
imperfect processes in the body. The means should favor assimilation of
food and normal excretion, and the avoidance of stimulating diet and
alcoholic liquors.

For the neurosis upon which impotence depends, I have accomplished
very much by a single combination of medicine (see formula No. 1),
that this preparation has been, as it were, a “stand-by” for many
years; the patient gradually improving under its use, in nearly every
case. I can affirm that it has been tested in hundreds of cases, in a
great majority of which marked improvement has taken place, and many
have been permanently cured. Many were cured before I became familiar
with the importance of electricity in the treatment of such cases; but
since having extensive experience with the various methods of applying
electricity I confess I could not do well without it.

As to the beneficial results following galvanism and Faradisation,
there can be no question; but as to which of these forms should be
applied, I am not always able to say. I have used galvanism without
benefit, a certain length of time, and changed to Faradism with
immediate improvement; and _vice versa_.

I do not opine that either form, if used mildly, will often do harm;
and where improvement does not follow after a reasonable length
of time, I would advise a change. When the patient is wakeful and
restless, a pleasant effect is produced by Faradisation, which is often
a favorable sign, and may be continued with exalted expectations. In
very advanced cases, the galvanic current will oftener establish an
improvement, when a change to the Faradic current will continue the
improvement. I consider no means of the physician demanding so much
judgment and experience as electricity; and in the skilled operator’s
hand much good may be realized from its use.

A very natural manner of applying Faradisation in impotence, as well
as other forms of sexual neurosis, is to seat the patient upon a large
wet sponge, to which the negative is connected, bringing the scrotum
and perineum well in contact with the sponge, and stroking the spinal
column well with the positive, also using a wet sponge. The operator
will be governed by the patient’s sensibilities, as to time of sitting
and strength of current. The current should not be painful or very
unpleasant; and if twenty minutes produces any uneasy sensation, the
next application should not be continued longer than ten minutes.

The galvanic current may be used in a similar manner.

Beard & Rockwell’s method of general Faradisation is a most excellent
one for alternate applications.

A troublesome complication is often constipation of the bowels, which
may be overcome by the judicious use of rhamnus purshiana. Not too much
general bathing, but local bathing, as directed above, with stimulant
friction, is always beneficial.

Turkish baths, so often ordered, must be avoided, as great general
debility and languor often follow their use. No undue warmth can be
made use of, either in dressing or bathing, as the neurosis, upon which
all these unnatural phenomena depend, is aggravated.

The general treatment of neurosis, in impotency, differs very little
from that in the neurosis of spermatorrhœa, as the conditions are
very similar if not identical; only degrees of the same organic
cerebro-spinal changes. The beginning is perhaps only a neurasthenia,
but gradually increasing in intensity to spinal anæmia, or congestion,
finally softening.

Any changes of the genitals must be treated according to principles
mentioned under treatment of structural changes of the genitals.

_Clinical Illustrations._――It must not be expected that all cases
will be confined to one definite condition, or to one combination of
phenomena that may be grouped together and named. No one will so fully
comprehend this as the practical physician. Cases are constantly under
the care of the medical man, suffering with conditions too numerous
to mention, complicated with many strange lesions. Every case must
necessarily be studied from its own merits, in and of itself, or
success will not follow.

It is not uncommon to come in contact with spermatorrhœa and impotence,
both together, also complicated with organic disease of testicles,
prostate gland, and anus or rectum. At the same time the brain and
spinal cord may be drawn upon by a variety of organic lesions. By this
we shall see that a report of clinical cases will bear more upon the
practical than the theoretical, as regards adapting doses to nosology.

_Case._――J. S. consulted me in ’74. He was suffering from spermatorrhœa
and partial impotence. He had tenderness over last lumbar vertebra and
sacrum, anæsthesia of the genitals, dyspepsia, bowels constipated,
and at times very languid; was brooding over his loss of power and
involuntary discharges of semen, which were nocturnal, generally
accompanied by lascivious dreams. The urethral sound revealed
tenderness along the urethra and extreme soreness of the prostate
gland. His semen was thin and spermatozoa scanty and imperfect. He
was thin in flesh, and anæmic. His erections were imperfect, and he
could not perform the act of coitus. He was a masturbator. I directed
pills, formula No. 2, and continued until bowels became regular; also
No. 1, which was continued one year without change, with cold local
bathing and brisk friction over bowels, back, perineum and scrotum. His
recovery has been very satisfactory.

_Case._――J. W., when he first visited my office for examination
and advice, was emaciated, pallid, with his eyes sunken. He was
careworn and haggard in his expression, suffering from pain in his
back and limbs, almost constant pain through the top of his head;
palpitation, with accelerated pulse; formications over his back and in
his finger-ends; bowels constipated, and urine smelled strong like a
horse’s; tender spots along the spinal cord. The testicles and scrotum
were doughy and constantly moist and cold. His scrotum was long and
pendant: his penis was blue and flabby. He could only obtain partial
erections, very occasional. He lost semen often. His urethra was very
tender, also the prostate gland. He was restless and wakeful during the
night. I directed local cold bathing, Faradisation, formula No. 1, for
his general neurotic condition; pills――formula No. 2――for constipation.
He took chloral every night, to produce sleep, for 3 months; tr.
staphisagria, small doses, for prostatic irritation, and occasional
opium suppository. I discharged him after sixteen months, when he
married, and now has a healthy child.

_Case._――R. confided to me his history, which was, he had been a
debauché and masturbator. He was tall, slender, anæmic, beard thin;
was suffering from too much medicine, which he had received from
unprincipled specialists, as he had been three years in their hands.
There was spinal anæmia, judging from the spinal soreness, and
formication at times. He thought he would become paralyzed, as his
hands and feet often became numbed. He was impotent, and often lost
semen. His urine contained spermatozoa. As soon as his mind could
be put at ease he began to improve, under formula No. 1, with cold
local bathing, as directed, with Faradisation. I discharged him after
thirteen months.

_Aspermatism._――Since Roubaud’s description of this condition, and
especially the application of the above term, much has been said in
regard to the causation and true nature of this peculiar deficiency.
Whenever sexual orgasm occurs in the male, after puberty, without
ejaculation, the condition known as aspermatism may be said to exist,
and may be considered as a symptom of disease. This may be partial or
complete. I have known a number of individuals who failed to ejaculate
semen at the time of sexual orgasm, and the semen would pass away in
jets some time after the penis had become flaccid. These cases exist
where there is no sign of organic stricture of the urethra, or any
other organic trouble within the prostate gland or ejaculatory ducts.

Dr. Van Buren is the author of a paper which appeared in the _New York
Med. Journal_, November, 1868, in which he attempts to establish the
cause as a spasmodic condition of the urethra, forcing the seminal
fluid, by reflux action, into the bladder. I can not, at present, think
that this is always the case. Only a little attention to physiology
will familiarize any person with the calibre-contractions that follow
a column of urine from the bladder to the meatus. This same muscular
contraction exists in the veins, and is what constitutes the venous
wave. The same wave exists in the ejaculation of semen; and where the
muscles that perform accelerating movements are paralyzed, the natural
consequence must be, that the fluid will remain in its reservoir until
its place is supplied by new, and a portion is forced out along the
urethra, which drips away when the penis returns to flaccidity. Then, I
can but regard this condition, often, as one of paralysis, in which are
affected the muscles of ejaculation and acceleration. This condition
often exists where the genitals are not impaired as to potence. That
such a condition is present, should not be declared until after bougies
have proven, to entire satisfaction, the absence of organic stricture
or spasmodic contraction.

When such a lesion has come on gradually and is of long standing,
the prognosis is very unfavorable; as relapses will most generally
occur with the slightest indulgence. But when the condition has made
its advent suddenly, from inflammatory causes, the prognosis is very
favorable. A gonorrhœal orchitis will often produce this condition,
which is only transitory, or of a few months’ duration. This is only
symptomatic, and very much unlike the true aspermatism of a neurotic
origin.

A very extraordinary case has of late engaged my attention and
curiosity. No case of the kind have I been able to discover, in medical
literature or in the practice of my medical friends.

_Case._――A young married man consulted me with an affliction (as it
were), much to the discomfort of himself and to the great injury of
his wife. He never had passed the sexual orgasm, nor ejaculated semen
during coition. He is very erotic, and has no difficulty in performing
the marital act, but it is followed without the slightest satisfaction.
He continues in the act of coition until exhausted, and retires with
the wife very much in the same condition after repeated sexual orgasms.
He informs me that one hour is not an uncommon length of time for him
to occupy in the act of coition, participating in the sexual beatitude
during the entire period, until gradually becoming exhausted, when
the pleasure dwindles away, but his penis remains erect for some time
after. He says that he has often applied cold water to facilitate
flaccidity.

After the organ has been reduced he sometimes can detect semen, or
prostatic fluid, on the glans and meatus, and he is very soon ready
to perform the act again. I have often discovered spermatozoa in his
urine. His testicles are well formed, and his penis is normal in
appearance. He has never had a venereal disease, and has no stricture.
Treatment has given no relief as yet. It will be observed that
satyriasis is prominent in this case.

Galvanism will often be found of great service as a paliative measure,
with phosphide zinc and nux vomica. If a few years’ continence can be
obtained, a better prospect for recovery may obtain. When galvanism is
used, an insulated electrode should be passed to the orifices of the
ejaculatory ducts, with the anode attached, and the cathode applied to
the cord with wet sponge. I have derived some benefit from localized
and general Faradisation, after the manner heretofore mentioned.

       *       *       *       *       *

FORMULÆ.


_No. 1._

 ℞. Fld. Ext. Nucis Vom.,
    Tinct. Pulsatillæ,
    Tinct. Canth.,                  _aa_ f. ʒiij.
    Acidi Phos. dil.,                         ℥j.
    Fld. Ext. Collinsoniæ,                   ℥ij.

Misce. Sig.: Dose, 20 drops, three times a day, in water.

_A nerve tonic and stimulant._


_No. 2._

 ℞. Podophyllin,                          grs. v.
    Iridin (ol. resin),                  grs. xx.
    Misce. ft. Pillulæ,                   No. 20.

Sig.: Dose, one to two, to be taken every night, and regulated to suit
case, as to quantity.

_Used to overcome constipation of the bowels. The iridin being slowly
soluble prevents the irritation so commonly known to follow the use of
podophyllin. Hyoscyamus may be substituted for the iridin or added to
the formula._


       *       *       *       *       *


 Transcriber’s Notes:

 ――Text in italics is enclosed by underscores (_italics_).

 ――A List of Chapters has been provided for the convenience of the
   reader.

 ――Obvious punctuation and spelling inaccuracies were silently
   corrected.

 ――Archaic and variable spelling has been preserved.

 ――Variations in hyphenation and compound words have been preserved.