The nocturnal pollutions, however, are not formidable to those onanists who are reformed. Inspired by the sentiment of self-preservation, warned by the sufferings, counsels, and by reading, they have resolved to abandon for ever the manœuvres which they know to be dangerous. This resolution they will be able to keep: they, however, anxiously demand if they are not too late. The genital organs rebel against the decision. How melancholy must be the state of the patient! He sees, in perspective, sufferings, even a death, which seems to be inevitable. To avoid it, he had made a sacrifice; he has abandoned those tastes which exercised such absolute control over him: but his organs, which have been irritated, continue the work which he wished to interrupt. He is irritated—he despairs. Let him be of good cheer; when the will perseveres, it generally triumphs. I attended an onanist, who was suddenly converted by reading the work of Tissot, and who experienced all the troubles to which we have alluded. He was constantly tormented by the remembrance of the past night, and the fear of that which was to come. He slept on a coarse bed; and always enveloped the privy parts with linen, wet with vinegar and water, before going to sleep; promising himself to awake, as soon as he was assailed by dreams. By his will, however, he finally succeeded; and he had the power of watching himself during sleep. His pollutions gradually became less frequent, and finally disappeared entirely. This is generally the case where all bad habits cease.
Convulsive spermatorrhœa is not very common, while a person is awake: it then rarely presents the purely convulsive character, with perfect erection, and distinct ejaculation, that is seen in a healthy emission of semen. This state, however, is possible: an instance of it may be seen in the case of satyriasis stated by M. Duprest-Rony. Whenever this young man beheld his mistress looking at him, erection took place, and ejaculation followed. He, however, had refrained from masturbating for two years, and had regained in a great measure his former strength. M. Sainte Marie has reported a case of priapism, during which the patient ejaculated fourteen times in a few hours. But this affection was not in consequence of venereal excesses, and the emission of semen presented nothing more extraordinary than other cases of priapism. Diurnal convulsive pollution is seldom accompanied, in individuals exhausted by abuses of masturbation and coition, with a perfect erection. The size of the penis increases, but it does not become hard. The semen is then emitted only to a short distance, if there be any ejaculation. The least cause, the slightest touch, is sufficient to excite this. Thus, in a man thirty years old, whom Tissot has mentioned, after Boerhaave, the semen escaped whenever there was a commencement of an erection, for it was never complete; and instead of being expelled forcibly, it oozed out drop by drop. The patient became impotent. This symptom (adds Tissot) is very frequent among those who are exhausted, and it contributes to continue the exhaustion. The slightest excitement causes the commencement of an erection, which is followed by an emission. We have seen a similar phenomenon in one of the patients of M. Dalandeterie. There were frequent painful erections, of short duration, which always terminated by a more or less abundant discharge of fluid. These kinds of pollutions were always painful, and were followed by extreme prostration. It is evident, from the remarks we have quoted, that there was no ejaculation in this patient; and probably, also, the erections, though painful, were imperfect. Daily convulsive spermatorrhœa assumes then, as it were, a bastard character in onanists: it occupies an intermediate place between proper convulsive spermatorrhœa, such as occurs during sleep, and the non-convulsive spermatorrhœa, which we shall mention directly.
There is a phenomenon very similar to this bastard spermatorrhœa, and which shows itself when the patient is inclined to indulge in coition or masturbation: the emission of semen takes place on the commencement of the act of venery. It is a quasi involuntary pollution. In this case, which is by no means rare, the erection is not complete, simply because there is not time for it to be so, the premature emission of semen not admitting it to be perfect. Sometimes, erection is radically impossible, and prevents the ejaculation. This was the case with the onanist who wrote to Tissot, that the semen would flow, but there was no ejaculation. Farther: when there is no erection, either because this is impossible, or because the semen is discharged prematurely, the person becomes impotent, because the power of procreating requires erection and ejaculation.
In persons affected with spermatorrhœa, the seminal fluid must preserve its normal characters. It is generally thinner, less opaque, and similar to serum: sometimes it resembles a fetid sanies or corrupt mucus; in other cases:, the seminal vesicles are evidently affected. Sometimes, blood is exhaled from these vesicles, and is even ejaculated. We have already stated instances of this emission. Tissot, also, has published a case of it. It was a young man, less than sixteen years old, who indulged in onanism to such an extent, that blood was finally emitted, instead of semen. This emission was soon followed by excessive pains, and an inflammation of all the genital organs. We must remark, that blood never seems to be discharged, unless the pollution is excited directly: this, at least, would seem to follow from the cases stated, and particularly from one mentioned by Dalandeterie. The erections (said he) always terminate with a more or less abundant flow of mucus—perhaps, also, of prostatic fluid, or even of a very diluted semen. In ejaculations excited by the hand, a semi-clotted, blackish blood comes, instead of semen: sometimes, a teaspoonful is discharged. This is always attended with pains, and followed by great prostration.
We have seen that involuntary pollution may take place, like voluntary pollution, by the convulsive contraction of the ejaculatory muscles, with erection of the penis, and sensations of venery. We have also seen, that the semen may be discharged, although the erection of the penis, the sensation of venery, and the convulsive contraction of the ejaculatory muscles is slight, and almost nothing. When this exists to a still greater degree, we have non-convulsive spermatorrhœa, or diurnal involuntary pollution, as it is called: here there is no erection, convulsion, nor ejaculation; there is no feeling of venery; the semen flows, instead of being expelled; and there is no feeling of pleasure attending this discharge.
This affection may arise from different causes. It is owing most frequently to venereal excesses; and, as but little is known in regard to it, we shall enlarge on the subject. This pollution for a long time was confounded with all the discharges from the urethra, which were blended under the term gonorrhœa. A contrary opinion was then adopted, and the existence of the disease was denied in toto. The remarks of several authors, and particularly of Wichmann, Sante Marie, and Lallemand, place its existence, however, beyond a doubt. The first ideas on this kind of spermatorrhœa may be referred to the earliest periods of medicine. It was known to Hippocrates, who has mentioned (De Morbis, lib. ii., sect. 5) one of the principal symptoms, the loss of semen, during the emission of urine, and of feces, when describing the tabes dorsalis which affects libertines and those lately married. Celsus, also, (De Medicina, lib. iv., ch. 28,) has admitted that there may be loss of semen, without pleasure, without voluptuous dreams, and which may be followed by a fatal consumption. After this, we find no mention of the disease for a long period. Tauvry says positively, (Naw. Anat. raisonnée, 1693, p. 164,) that men who abuse themselves are liable to have emissions of semen on the slightest compression of the seminal vesicles, when they pass urine or feces. Morgagni admits that the semen may escape without any pleasurable sensation, as happens from the effect of an injection which is too warm, and from the excretion of hardened feces; but he adds, that the fluid discharged may come in some from the prostate gland, in others, from the seminal vesicles. There is much uncertainty on this point of science among authors, many of whom have considered as spermatic most of the discharges from the urethra. The dissertation of Wichmann, however, on the subject of diurnal pollution, is valuable. This dissertation was printed in 1782, at Gœttingen. In it, Wichmann states, first, the characters which distinguish diurnal from nocturnal pollution. The first occurs when the patient is awake, and without his experiencing erection or desire. He is unconscious of it; and this circumstance, with the absence of any swelling of the corpora cavernosa, and of all venereal ardor, serves to distinguish this pollution from the flow of the fluid of the prostate gland, or from a loss of semen, which takes place in some persons when they are excited by desire. To these characters, Wichmann adds another, drawn from the mode in which the excretion of semen takes place. In diurnal pollution, (says he,) men do not lose their semen constantly by a continual excretion of this fluid, like females subject to leucorrhea; but they ejaculate, at a single time: and this circumstance has rendered the term pollution applicable to this disease. He does not consider, as a diurnal pollution, the gonorrhœa in which the semen is continually escaping drop by drop. He, however, doubts the existence of this last affection, and remarks that authors are very much confused on the subject. Nor would a pollution which was involuntary, and during the hours of waking, be considered as a diurnal pollution, if the evacuation of semen had been caused by any aphrodisiac substance. And on this topic, he relates the case of a man, who, having been addicted to onanism in his youth, was affected with involuntary pollutions if a blister was applied to him, if he perceived the odor of cantharides, or even spoke of them.
According to Wichmann, the semen never escapes with the urine: thus, it is not a seminal discharge which comes from persons affected with external or internal hemorrhoids, who pass off with their urine a milky fluid. He, however, admits, with Hippocrates, that the straining of persons at stool often occasions, in those affected with diurnal pollution, the discharge of a greater or less quantity of semen. When the existence of this affection is suspected, we must attempt to ascertain its truth; and for this purpose, the patient should be made to urinate freely; and then, in passing the feces, he should sit in such a manner that the penis may be outside, and one can see all that escapes from it in the efforts at stool. In a diurnal pollution, there is rarely as much semen lost as in a nocturnal pollution. The disease is quite as serious, if it be semen which escapes—if it occurs once a-day, and even more frequently; and at the lightest effort to stool, and without any pleasure, to inform one of the risk which is run.
Thus, then, involuntary emissions of semen, while the patient is awake, without erection, without pleasure, and while the patient is ignorant of it; an emission which takes place, not drop by drop, but at one time, and especially while at stool, are, according to Wichmann, specific characters of involuntary diurnal pollution.
The general effects of this diurnal pollution, as he has often observed them, are those seen in onanists. He remarks:—When you see a man extremely thin, pale, stupid, enervated, complaining of great debility, especially in the thighs and loins, lazy in his actions, and with sunken eyes, you have reason to suspect this cause.
Patients in this state never complain of any absolute pain. Their digestive powers are ruined: the appetite, however, continues—even increases, and sometimes becomes voracious. After taking food, they seem to have more strength; but this advantage is soon paid for, by the inconveniences resulting from digestion—especially if that variable appetite be too much indulged. As the stomach and most of the other viscera do not perform their functions properly, the more that is eaten the more the belly is tumefied, by the relaxation of the digestive organs. This swelling is attended with a painful feeling of anxiety, which exists in these unfortunates at other periods of the day, and impels them to avoid society. They are more disposed to sorrow than to joy—that is, the news of an unfortunate event brings with it more sorrow than that of a happy event causes pleasure. In them, as in onanists, there is a want of intelligence; they are stupid; natural sleep does not refresh them; the memory and sight are particularly debilitated. And this is the state of things, until the patient becomes affected with phthisis. At first, neither moral causes, nor affections of the soul, nor disappointment, can be suspected. There is apparently no viscus affected; nor can we ascribe the disease to any deleterious substance concealed in the body, and consuming the flesh. The patient has no pain, excepting that obtuse, compressive pain, which is referred to the hypochondria, and which depends on the swelling of the weak intestines. If you add to the characters the absence of fever, and of the ordinary causes of exhaustion, you may be persuaded that diurnal pollution exists—that it is the hidden cause of all the symptoms. This is a general description of the disease, drawn up from a considerable number of cases which we have observed.