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.”