[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.