“Mademoiselle C***, ten years old, of strong constitution and good muscular developments, had been addicted to onanism since she was two years old. She was taught it by her nurse, who remarked that she was quieted, when crying, by titillating the clitoris, in which she was soon imitated by the patient. The habit finally caused great moral and physical degeneration. At first, the cause of her wasting away was unknown; but when it was discovered, the parents tried every mode to break her of it. Their vigilance was in vain—she still continued it. Her mind remained unaffected, but not so with her physical constitution. Mechanical means were now employed: the apparatus of Lafont was applied, but without success; and there was danger of her becoming idiotic. Her parents, after long hesitation, decided to have the clitoris removed. The operation was performed June 26, 1831, with perfect success. The patient became restored, and her voluptuous feelings disappeared.”
Many have scruples in regard to this operation. They ask whether it is right to nip the enjoyments of love in the bud, &c. These considerations seem to me only to impose circumspection in respect to the operation, and to show that the operation never should be employed until all other remedies have been tried. But when life is to be saved, or the mind is to be preserved, then we ought not to hesitate. We then do, as in amputating a limb—we sacrifice a part for the whole. Nor is it demonstrated, that the venereal sense is for ever extinguished, by removing the clitoris. This organ is not the exclusive seat of venereal sensations, as we have already seen, and shall see again. Hence, it may be feared, for this reason, that the operation may not be successful. In fact, only the prominent part of the clitoris is cut off: a large portion of the cavernous bodies remains. If the operation is performed before puberty, perhaps by developing their tissue, this feeling may extend at this period of life: but, even then, if these chances of reparation did not exist—if it were certain to destroy all sexual desires—still this operation ought to be performed; as, without these feelings of love, a female may become a good mother, and a devoted wife.
Our remarks on the cerebellum, spinal marrow, and erectile tissue, may apply to all parts of the genital apparatus; as each part may be a direct cause of venereal excitement, and consequently an indirect cause of venereal excesses. This is certainly true of the mucous membrane, which lines the genito-urinary passages. Every one knows that acute inflammation of the interior of the urethra often causes painful erections, and which may attend a deformity of the penis; and hence the term chordee is applied to these blenorrhœas. We have seen, when speaking of diurnal pollution, that chronic inflammations of this canal may be followed by losses of semen. The presence of a stone in the bladder usually causes an itching and tickling at the end of the penis, which has sometimes been the beginning of bad habits. If, after excesses of the table, coition is indulged in to excess, it is because the abuse of wine and liquors stimulates the mucous membranes, and particularly those of which we are speaking—excites their action, and new desires arise. Is it not on the special character possessed by cantharides, of inflaming the urinary passages, that the violent satyriasis caused by this remedy depends?
The phenomena we have mentioned are seen much more frequently in females than in males, as the mucous membrane of the genital organs is much more extensive and more exposed to the action of external agents in the former. We have known several cases of nymphomania to be caused by herpetic affections, which were seated within the vulva. Biett knew a case of it in a female, sixty years old, affected with prurigo of this part. Trousseau has known similar cases. Hence, the irritations of the vulva, attended with itching, have been considered by many authors among the causes of onanism. Eczema, when it has extended to the vulvo-vaginal mucous membrane, has been known to induce this habit violently in females. Ascarides, which have escaped from the anus, have often caused violent itching, and afterward a venereal excitement, which was followed by the same result. Beck has known these worms to produce nymphomania in a female seventy years old. Bitter injections into the vagina were followed by the evacuation of a great number of these animals, and by the cessation of the symptoms.
The remarks of many authors on the salacity of individuals afflicted with herpetic eruptions must apply particularly to those who are afflicted with pruriginous diseases of the skin around or near the genital organs. The excitement then extends to these organs, and awakes in them the sense of venery; a similar result may attend irritation of the inner surface of the rectum. Wichmann thinks, and a case published by St. Marie confirms the opinion, that simply the presence of ascarides in this instance may cause discharges of semen. Hemorrhoidal irritation has sometimes produced them. Thus Wichmann relates the case of an individual, in whom hemorrhoids caused an obstinate diarrhœa during the day, and frequent pollutions at night. Nymphomania has been produced by drastic enemata, and particularly by those made of gratiola.
It is not uncommon to see symptoms of inflammation appear at the same time or successively in different mucous membranes. The membrane lining the genital organs is not more exempt from this, than others. The heat which patients feel in the genital parts, the redness and swelling which are there developed, are generally the only symptoms which then become known to the physician. But there is another, the excitement of the venereal sense, which often escapes him; either because the patients are too young to explain it, or because a natural feeling prompts them to conceal it. Hence this symptom is frequently unnoticed, except in rare cases, where it exists to a great degree, and presents characters analogous to those of satyriasis and nymphomania. Dr. Desportes was we believe the first one to point out a certain relation between venereal excitement and different catarrhal affections among which he has particularly mentioned the aphthous inflammation of the pharynx termed by Guersent angina pultacea. M. Desportes has known attacks of at least eight cases of this angina to be preceded by a vivid excitement of the reproductive system, an excitement which is sometimes manifested by an irritation, which although not exactly the venereal appetite, is analogous to it, and causes in the patient an evident feeling of distrust, inquietude, and chagrin. As this phenomenon has presented itself as a precursory symptom in at least one half of the cases of angina pultacea observed by him, he regards it as an index of the imminent invasion of this disease. He also thinks and with reason, that this phenomenon may, in young patients, become a cause of masturbation, and even in some cases, may pervert momentarily the ideas and sentiments, so as to impel individuals to the commission of acts reputed criminal or culpable. This opinion of Desportes is supported by eight facts. The most remarkable is that of a lady seventy years old, in whom the angina pultacea, was preceded for about a month with vivid and frequent venereal desires: they became so irresistible, that notwithstanding her religious opinions, she forgot herself so far as to relieve her ardor by onanism.
Desportes has attempted to explain this singular feeling, by the connexion of the nerves of the neck with certain parts of the encephalon, the commencement of the spinal marrow. He might, we think, have explained this more naturally, by observing that the genital excitement, instead of appearing simultaneously with the affection of the pharynx, disappeared simply from the appearance of the latter. Thus, in one of these patients, a man of fifty years old, whose habits were chaste, and who was suddenly affected with unusual venereal desires and priapism, these symptoms ceased, when after twenty days, an angina appeared; which was followed by an eczema which affected the hairy scalp, and the parts behind the ears. In another of the cases reported by Desportes, the genital excitement which appeared during convalescence from pleuro pneumonia, was suddenly replaced by an inflammatory irritation of the digestive passages, and particularly of the inner membrane of the mouth. Is it not evident that the irritation was transmitted in these cases from one membrane to another. If, however, Desportes has erred in the manner in which the genital excitement is produced, he deserves credit for pointing out a symptom which merits the attention of practitioners.
The irritation of the internal integuments of the genital parts, is not only, as this physician has thought, a precursory sign of that of the pharynx. It may show itself during the continuance of an inflammation of any other portion of the mucous membranes, or it may even follow this inflammation. Dr. Mirambeau has communicated to me two cases which confirm this fact. The first is that of a boy who was affected after a chill, with a very obstinate gastroenteritis. This disease was nearly terminated, when the mucous surface of the penis became the seat of a very severe irritation, which was soon attended with satyriasis. Things came to such a pass that his hands were obliged to be tied to keep him from those manipulations which he had never indulged in before. The subject of the second case was a girl nine years old, who presented the same circumstances as in the preceding case. She also was obliged to be tied. This fit continued in these two cases, from ten to twelve days.
Hence irritation of the mucous membrane which lines the genito urinary passages may alone cause venereal excitement, and consequently onanism, independent of any affection of the nervous centres. This fact is highly essential on account of the important indications which may be deduced from it. Aware of the possibility of its existence, the physician will be more attentive to discover this irritation; he will find it more frequently and may in a degree prevent a fatal habit: he will also carefully remove every cause of irritation from the mucous integument of the genital parts and discuss as promptly as possible the inflammations which may be developed there. The mode of doing this is by attending to the following rules. To keep the sexual parts perfectly clean by repeated ablutions: to forbid all excesses of the table, and the use of such food and drinks as tend to render the urine more irritating, and the genito urinary mucous surface more irritable; hence to discard the use of wine, liquors, coffee, tea, spices, beer, particularly that made strong with hops: to allay irritations of the interior of the rectum, around the anus or those affecting the integuments around the genital organs. When children complain of itching around the anus, you must ascertain whether this be not caused by ascarides which is easily done by inspecting the parts and the feces: no means should be spared to get rid of these worms when they exist:[1] and finally the most efficient remedies should be used to cure the itching of the genitals as soon as this affection commences. Ozanam communicated to the academy of medicine August 12, 1828, a very acute case of nymphomania which had resisted antispasmodics, narcotics, cold baths, &c.; and which was finally cured by applying to the internal labia and clitoris a solution of four grains of nitrate of silver in an ounce of water. There was a marked inflammation of the parts to which this was applied. (Rev. Med., Sept. 1828.) In 1833, we employed successfully another remedy, for a lady thirty-four years old and subject to nervous affections. She experienced a feeling of heat and irritation in the vulva and vagina which caused her excessive trouble. Solutions and injections of an infusion of the wild cherry-tree, produced no relief. The introduction into the vagina of a pledget of lint moistened with a solution of the extract of belladonna, (one grain to the ounce,) had a better effect. Different symptoms indicated the absorption of this drug into the system and the irritation disappeared. But it returned a few days after, and we then advised the application of ice within the vagina which relieved her, and finally brought about a permanent cure.
The irritation of the uterus in this lady might have had more or less influence in producing these distressing symptoms. Venereal desires, and nymphomania may in fact also depend upon the state of this organ. The excitement preceding and attending the period of menstruation, renders females much more lascivious. This phenomenon is much more marked in the small number of animals who menstruate: it always coexists in them with the period of rutting. This remarkable fact, which has long been known, of asses and monkeys, has lately been ascertained to exist in the roussettes by Carnot and Lesson, and in the genette by Cuvier. Farther inflammations and diseases of the uterus have often been observed in those affected with nymphomania. Helwiel relates the history of a lady, who, after being for a long time indifferent to conjugal pleasures, became extremely salacious. She died some time afterward, and on opening the dead body, fibrous tumours were found in the tissue of the uterus, and hydaleds in the ovaries. Calmeil found in a monomaniac, who was most furiously addicted to onanism, and who had a perfect hymen, that the os tincæ and a part of the neck of the uterus were of a violet colour, and were softened and ulcerated. This author observes that generally, when deranged females imagine themselves pregnant, or that they have been violated, are finally known to think of their genital organs, there is commonly some lesion of the uterus. (Dict. des Sc. Med., art. Alienes.) In the cases which have been mentioned, the affection of the uterus was not so much the cause as the result of the excesses which had been committed, but this cannot be said of those cases where Lisfranc has seen cauterization of the neck of the uterus to be followed in the genital organs with a kind of erethism which is attended with void desires. Is not this an experimental proof, that an irritation of the uterus may produce an exaltation of the venereal sense.