Cold water to the hands, feet and genitals is often followed by surprising results, and should be used night and morning for a long period of time—many months. Tonics do great injury in this class of cases. Quinia, strychnia, phosphorus and iron should never be used in any form.
Electricity.—The downward, constant current, alternated with Faradisation, is indispensable to satisfactory results in the majority of the cases of the congestive type; using the galvanic one day, and the induced the next day, with general Faradisation, if it be followed by pleasant effects and relief of unpleasant nervous symptoms.
Stimulating food, as well as alcoholic and malt liquors, should be proscribed; yet a generous diet is at all times indispensable. Opiates should not be administered, even for the relief of pain.
[The Anæmic Form.]—When this type of spermatorrhœa is satisfactorily diagnosed, the treatment is plain and the agents quite positive in their course of action, when the case is not so far gone that relief could not reasonably be expected. But if there be a doubt as to diagnosis, on account of mixed symptoms—and such is not unfrequently the case—if we are not well satisfied whether there is anæmia or congestion of the cord, the administration of 1/60 of a grain of sulph. strychnia will decide the matter, which will produce some of its physiological effects if there be congestion; but if anæmia exist, there will be no noticeable change, at least no unpleasant effects. With this point clear, we then direct a treatment which is intended to stimulate a free circulation of blood in the cord—spinal stimulants. Strychnia, phosphide zinc, cantharides, pulsatilla, phosphoric acid and collinsonia, are such agents.
Cold spinal and genital douche, with hot foot and hand bathing morning and night, are highly important agents, with strychnia 1/60 gr., three times a day. The author has for many years almost entirely depended upon formula No. 1, not on “general principles,” but as a combination that applies directly to the anæmic condition of the cord and its consequence; and knowing its effects, as he has, so long, could not well do without it in the treatment of these complicated cases. If there be general anæmia, as well as local, chalybeates may be of service, but not until the patient is eating and digesting moderately well: then we prefer the citrate in port wine. Stimulants in moderate quantity are admissible, especially wine and malt liquors. Opium may be administered to allay pain, but chloral is better.
Any agents, used for their stimulating effect upon the cord, must not be expected to act too rapidly. Patience is the all-important motto after the diagnosis is well made.
Counter-irritation will always be of great service, and the cantharidal plaster is the most desirable form. The seaton has in a few instances been of service, but we prefer the emplastrum canth.
Electricity is indispensable, and should be applied daily. The anode should be applied to the tender spots in the cord, and the cathode to the genitals, in the form of a large sponge placed in contact with the perineum, scrotum and penis. Faradisation may be alternated with the constant current daily. General Faradisation may be applied best by a large foot-plate covered with a wetted sponge, and the operator, holding the anode, may place his other hand on the patient’s head, back of his neck and along his spine: the hair of the patient will of course be moistened as the dry hair is a non-conductor of electricity.
A highly nutritious diet should be always advised, and plenty of open-air exercise, even to fatigue; as the mind is thereby employed, and not so much time is found to brood over these physical conditions. The very common and exceedingly troublesome constipation may be overcome by rhamnus purshiana, in teaspoonful doses of the fluid extract, morning and night.
When extreme sleeplessness prevails, grain doses of svapnia have acted excellently; also ten-grain doses of chloral hydrate.