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.