Julius Pagel and other authors have recently drawn attention to the fact that the condition of “erotomania”—excessive amativeness—was fully described by the ancient and medieval physicians, who regarded it as a morbid state. He published (in the Deutsche Medizinal-Zeitung, 1892, p. 841) under the title, “A Historical Contribution to the Chapter of ‘Cures by Disgust,’” the translation of a passage from the Lilium Medicinæ of Bernhard von Gordon in Montpelier, a well-known and favourite compendium of the beginning of the fourteenth century, in which, following the example of Avicenna, the amor (h)ereos was numbered among the melancholicæ passiones, and was considered to constitute a particular section of the group of diseases of the brain (see the edition of the Lilium Medicinæ, p. 210 (Lyons, 1550)). It is, unfortunately, impossible here to deal at any length with the exceedingly instructive and remarkable contents. One of the methods of treatment was to find an old hag as hideous and repulsive as possible, who was to hold under the nose of the erotomaniac a chemise stained with menstrual blood, saying at the same time, talis est amica tua. We may remark, in passing, that this genuine medieval “cure by disgust” diverges, much to its disadvantage, from the manner in which in antiquity (three centuries before Christ) Erasistratos, the pupil of Aristotle, a celebrated physician of the Alexandrian school, cured the son of King Antiochus, who had fallen in love with his stepmother Stratonica. An account of the ancient therapeutic art is also to be found in another work by J. Pagel, “Introduction to the History of Medicine” (Berlin, 1898). In a comprehensive work, “The History of Love Considered as a Disease,” this topic has recently been considered by Hjalmar Crohns. Here we have a theme the literature of which is very extensive, and which might be suitably dealt with in a special treatise.
In the male, sexual frigidity in the majority of cases is associated with sexual weakness or with impotence—that is to say, with the impossibility of copulating or of procreation. The former variety of sexual incapacity (impotentia cœundi) is, properly speaking, peculiar to the male. The second form—true “sterility” (impotentia generandi)—occurs in women as well as in men.
In the case of male impotence, various symptoms, preliminary disturbances, and associated phenomena, make their appearance, and these we shall have to describe separately, since they often occur as independent disorders.
This is, above all, true of the outflow of sexual secretions from the urethra, seminal losses (pollutions[438] and spermatorrhœa), and the evacuation of the secretion of the prostate gland, the so-called “prostatorrhœa.” The literature of these conditions, which are partly physiological (as a proportion of pollutions) and partly morbid, is enormous. Of fundamental importance, notwithstanding the serious exaggerations of the author, is the celebrated work of Dr. M. Lallemand, “Involuntary Losses of Semen.” In recent times this important province of sexual pathology has been more especially advanced by the researches of leading German physicians, above all by those of Curschmann and Fürbringer.
The most important question with regard to seminal losses or pollutions in any case is this: have we to do with physiological processes, lying within the range of health, or have we to do with morbid processes?
As normal, not morbid, seminal losses Lallemand regarded pollutions in healthy, sexually mature, continent individuals, occurring spontaneously during sleep, associated with erection of the penis and voluptuous sensations. He rightly regarded these as physiologically necessary, indicated their purpose to be the discharge of sexual tension, the prevention of an excessive accumulation of the reproductive products, and compared their effect with that of hæmorrhages from the nose, which are so common in youth, and in most cases are distinctly beneficial. But he drew attention to the indeterminate, fluctuating boundary-line between normal and morbid pollutions. This latter point of view is dealt with also by Eulenburg (“Sexual Neurasthenia,” p. 171), in opposition to other authors who regarded all pollutions, even the physiological, as abnormal. In practice, however, it is generally not difficult to distinguish between physiological and morbid seminal losses. The former are characterized, not only by the distinctive signs already mentioned, but also by their occurrence at longer intervals, and by the absence of any disadvantageous effect upon the general state of health. As soon as pollutions have such a deleterious influence they are morbid; and they are generally morbid when they occur abnormally early, before puberty, with abnormal frequency, at abnormal times of the day, and in association with abnormal conditions of the genital organs. According to Fürbringer, the normal intervals between pollutions in the case of continent youths vary between ten and thirty days. Löwenfeld considers pollutions occurring once a week, and even the transient occurrence of pollutions on several successive nights, as a result of sexual excitement, as being still within normal bounds. But if these repeated pollutions within a single week, or even within a single day, continue for a long time, we are always concerned with morbid pollutions. These sometimes occur not only at night, but also—a fact to which the German physician Wichmann, in his dissertation De Pollutione Diurna (Göttingen, 1782), drew attention—they occur by day (“diurnal pollutions”), in the waking state, without masturbation or coitus, upon slight mechanical or physical stimulation. In such cases erection of the penis is often completely wanting; ejaculation of the semen takes place with the organ flaccid, and even without any voluptuous sensation. In many cases, indeed, these pollutions are accompanied by actual painful sensations in the genital organs, and instead of voluptuous dreams or thoughts, the nocturnal ejaculation is accompanied by anxious dreams, the daylight pollution by an extremely disagreeable sensation. Commonly in these pollutions ordinary semen is at first evacuated—a mixture of the secretions of the testicles, the prostate, the vesiculæ seminales, and Cowper’s glands—containing numerous spermatozoa. After the trouble has lasted a long time the semen becomes thinner (owing to its containing a smaller proportion of the thick testicular secretion) and more transparent; the spermatozoa are less numerous and mostly undeveloped, and ultimately they may be completely absent. Löwenfeld observed a peculiar form of pollution in which the semen was ejaculated only in drops, or might be completely wanting—that is to say, there might be a pollution without ejaculation, purely a voluptuous orgasm.[439]
In such cases Löwenfeld was able to prove that it is not the loss of semen which weakens, as Lallemand assumed, but that it is the nervous disturbance of the lumbar spinal cord which plays the principal part. This irritable weakness of the lumbar spinal cord may have existed for a long time before, or may have developed only as the result of repeated pollutions or of excessive sexual excitement; it may give rise, not only to proper seminal emissions, but, in addition, to “spermatorrhœa”—that is to say, to the outflow of semen accompanying urination or defecation; and it may also cause the rarer “prostatorrhœa”—the outflow of the secretion of the prostate gland. A long duration of all these morbid discharges has a serious effect on the health, and induces the typical picture of sexual neurasthenia. As a cause of seminal losses we must mention masturbation, excessive sexual intercourse, chronic inflammation of the urethra (especially after gonorrhœa), stricture of the urethra, rectal affections, alcoholism, diabetes, and tabes dorsalis.
In women, also, processes analogous to pollution may be observed, although much more rarely than in men, and generally as a consequence of masturbation practised for several years. According to Adler (op. cit., p. 130), pollutions—that is to say, evacuations of the secretion of the vaginal glands and of the uterine mucous membrane, as well as of the secretion of Bartholin’s glands near the vaginal inlet—never occur in chaste and intact virgins, but only in women who have already learned the enjoyment of sexual intercourse, and who are subsequently compelled to lead a continent life. For this reason pollutions are a “trouble of young widows,” and occur in young girls only when they have learned to know the nature of sexual pleasure by means of masturbation. Eulenburg remarks (“Sexual Neurasthenia,” p. 174):
“In connexion with lascivious dreams there occur spontaneous, more or less abundant, discharges of the clear muco-gelatinous secretion of the glands. These form a striking manifestation of sexual neurasthenia in women, and can be compared with the morbid pollutions occurring in similar circumstances in male neurasthenics. We hear less about them, however, and they are insufficiently known, even by medical men. For this reason especially, when they occur in association with physical virginity and a normal genital condition in other respects, they do not usually receive sufficient attention.”
The older physicians, especially those of the eighteenth century,[440] described these pollutions in women very well and thoroughly; in erotic and pornographic literature they have always played a great part. An interesting observation on peculiar processes analogous to pollutions is reported by Paul Bernhardt.[441] A hysterical sempstress, twenty-five years of age, as the result of any kind of annoyance, experienced sexual excitement completely resembling the sensation of sexual intercourse, and ending with a discharge of mucus. This was, however, never accompanied by any trace of voluptuous sensation; on the contrary, it gave rise to lumbar pains. Also, when she dreamed of anything disagreeable or had nightmare, this condition recurred. Erotically the patient is very indifferent, and denies the practice of masturbation.