[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.