A practical treatise on the causes, symptoms, and treatment of spermatorrhoea

Author's Preface

Duking a period of fourteen years, I have collected more than one hundred and fifty cases in which involuntary seminal discharges were sufficiently serious to disorder the health of the patients considerably, and even sometimes to cause death.

Most of these patients have been sent to me on account of suspected cerebral affections of more or less standing. Hence, by a singular chance, it has been in consequence of the publication of my " Mecherches Anatomico-JPathologiques, sur Vencephale et ses dependences," that I have obtained the most remarkable cases of diurnal pollutions ; and I have correctly refused to acknowledge the presence of disease of the brain or its membranes in many cases where the existence of such disease had previously been considered indisputable.

Many other of these patients were supposed to suffer from chronic gastritis, or gastro-enteritis ; from aneurisms near the heart, the early symptoms of phthisis, &c, &c. ; and in other cases from nervous affections, and especially from hypochondriasis.

These few words show how frequent, important, and difficult of detection, are involuntary seminal discharges, and to what deplorable errors of treatment they daily give rise : it may be foreseen, too, that their causes must be very varied, and their treatment present considerable difficulties.

The Brochure of Wickman and the commentaries on it by Sainte- Maria, 1 are the only writings we possess, on a disease that degrades man, poisons the happiness of his best days, and ravages society ! Of the researches of these conscientious observers, too, the profession are almost ignorant.

Theyliave, nevertheless, done all in their power to call the atten-

VI PREFACE.

tion of practitioners to a subject of which they fully felt the importance, and they have stated many valuable truths. Why is it, then, that a more lasting impression has not been made on the medical world ? Doubtless because they have not supported their statements by a sufficient number of well detailed cases, and especially because those related are vaguely and generally stated.

Although Wickmann and Sainte-Maria have stated facts which have not been appreciated, they have left numerous omissions to be supplied, and more than one serious error to be corrected. .

The materials I possess permit me to hope that I shall be more successful: at all events. I consider it my duty to publish them.

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EDITOR'S PREFACE.

In laying the following condensed edition of M. Lallemand's important work on Involuntary Seminal Discharges before my professional brethren in an English dress, I have been actuated by the conviction that the disorder treated of is little understood by the profession generally in this country. The patients affected by it are always hypochondriacal — indeed, the symptoms of hypochondriasis and mental derangement are generally by far the most prominently marked in them— and after the usual remedies for digestive disorder and liver disease have been had recourse to without benefit, the practitioner becomes tired of attending a disease which is at best obscure and does not yield to the usual remedies, and either treats his patient as a malade imaginaire, or leaves him a prey to the wretched balsamselling quacks, who are unfortunately permitted to pollute every periodical publication with their disgusting advertisements.

The subject of Spermatorrhoea is an uninviting one — 'especially to the fastidious — perhaps too fastidious English taste ; — hence, with very few exceptions, it has been generally avoided by regularly educated practitioners in this country. An abstract of M. Lallemand's views was indeed published by my friend Mr. Phillips, in the Medical Gazette in the year 1843, and about the same time some papers appeared in the Lancet on the same subject by Drs. Ranking and Dangerfield, and Messrs. Ryan, Chatto, and Dudgeon. These publications, however, from their transitory nature, were not calculated to remedy the want felt by the profession, of a systematic treatise on this important subject. Mr. Phillips indeed, in the conclusion of his paper in the Medical Gazette, takes occasion to remark: "Since the publication of the first part of this paper, I have been painfully impressed with the conviction, that the evil is more widely spread than I had before conceived; and that it will not be largely alleviated by the means I have adopted for advocating the relief of a particular

remedy The pages of a strictly Medical Journal do not meet

the eyes of the great mass of sufferers."

In a notice also of M. Lallemand's work, in the British and Foreign Medical Review, the reviewer took an opportunity of pointing out the importance of the subject. Nevertheless, authors have always seemed to avoid the subject as dangerous ground, and with the exception of

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an excellent chapter in Mr. Curling's work on Diseases of the Testis, and some observations published by Dr. Smyth, in a work entitled "'Miscellaneous Contributions to Pathology and Therapeutics," I believe the present to be the first attempt to render the profession familiar with this disorder, by any special work in the English language.

Indeed, in Dr. Golding Bird's otherwise excellent book on urinary deposits, the author, although he admits that the spermatozoa are frequently discovered in the urine by microscopic examination, takes occasion to express his opinion, that the subject of spermatorrhoea is one by no means deserving the importance attached to it. He adds, " It certainly is not very consistent with our national character, to dilate so freely on a subject which, in the great majority of cases, can be treated of only as the effects of a most degrading vice." That any physician should relieve himself from the investigation of a most afflicting disease, because the subject treated of is an unpleasant one, appears to me unworthy the general character of our profession. Had similar opinions been held respecting syphilis — a subject quite as repugnant to English feelings as spermatorrhoea, — what misery would have been entailed on the human race !

Lecturers on surgery, while entering fully on other diseases of the urethra, appear either not to have been aware of, or by common consent to have omitted, spermatorrhoea from their oral lectures and textbooks of surgery. Professor Miller of Edinburgh having given a short notice of spermatorrhoea in his "Practical Surgery," published in 1846, is, as far as I am aware, the only exception to this rule.

At an early part of my professional life my attention was much engaged by two cases, which to me presented peculiar features of interest. One, the case of a near relative, since dead, proved particularly unfortunate. The other, the case of a friend of about my own age — also studying medicine, — recovered after several relapses; and the patient is at present practising his profession in her Majesty's service. In both cases the best advice the West of England afforded was obtained without success, or indeed, even slight improvement, and in neither case was the cause of the disorder, which particularly affected the brain and digestive organs, recognised.

The interest I took in these cases led me to suspect, from certain hints thrown out by the patients, that their disorders were somehow connected with the genital organs. Further experience has convinced me that my suspicions were correct.

A brief outline of these cases may not be uninteresting.

K. H — , set. thirty-nine, passed the early part of his life in the

country, and was in the habit of taking much and violent exercise. About the age of sixteen, he entered a banking establishment in London, in which by great diligence and steadiness of conduct he rose, before he was twenty-five, to the post of cashier. The affairs of the house fell into disorder, and ultimately a bankruptcy occurred ; Mr. H , from the amount of confidence reposed in him by the

PREFACE. IX

partners of the firm, was much harassed during these unfortunate proceedings. Soon afterwards he became manager of a large mercantile establishment in the city, and about this time commenced some speculations in foreign bonds. From fluctuations in the share market he was a loser to a considerable extent ; his mind was much harassed, and he began to suspect those about him of dishonesty towards their employers. On investigation these suspicions were proved to be totally unfounded ; Mr. H * gave way to great violence of conduct, and resigned his situation. About this time his father died;

and Mr. H was much disappointed at finding that property,

which he had incorrectly believed entailed, and consequently his, as eldest son, was left by will to be equally divided between himself and the rest of his family. His conduct at this period was of the strangest description. He dreaded to go out into the streets of the town where his family resided, refused to join in their meals, and ultimately abruptly left their house to return to London. In 1837 his state had become such that in consequence of his repeated letters, members of his family visited London, and on their return took him with them into Devonshire. About this time his mental disorder put on a decided aspect; and I had then, as well as later, ample opportunities of observing his conduct; and frequently heard his complaints. Emissaries were constantly on the search for him to arrest him for unnatural crimes committed in London; every one who met him in the street read in his countenance the crimes he had committed ; tailors made his coats with his sleeves the wrong way of the cloth, in order to brand him with infamy; the sight of a policeman in the street alarmed him beyond measure ; and often, if a stranger happened to be walking for some little time in the same direction as himself, he would exclaim that he was one of the emissaries sent to seize him. At other times he would lock himself in his room and weep by the hour. He never took his meals with the family, and never tasted food or drink without first preserving a portion for chemical analysis, as he was convinced his friends were in a conspiracy to poison him slowly, in order to wipe out the memory of his crimes. These ideas haunted him night and day. His digestion was much disordered; his sleep broken and restless, and his bowels excessively constipated. His face was flushed, and periodical attacks of cerebral excitement occurred, during which he complained of vertigo, noise in the head, loss of sight, &c. He complained also of loss of memory, and frequently of bodily weakness and lassitude. The best medical advice the neighbourhood afforded was obtained, unavailingly ; the opinions of the gentlemen

consulted were, that Mr. H was labourina; under a^ravated

hypochondriasis, complicated with monomania. Various causes were suggested as giving rise to the disorder, but no previous case of insanity was recollected in any branch of the family. Mr. H

now began to talk of leaving England for America, in order to avoid his persecutors ; and to prevent this he was placed under the care of a private keeper : while with this person he frequently and bitterly com-

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plained of constant pollutions while at stool, with darting pain, and a sense of weight between the rectum and bladder. He had also urethral irritation attended with discharge, pains in his loins, and in one groin, weakness of his legs, thick urine, piles, and obstinate costiveness. He kept a diary at this time, which is at present in my hands. Not a day is passed in this diary without mention of the distressing seminal discharges from which he suffered. These were treated as of no importance by his medical attendants, although he never ceased to complain of them, and solicited aid so long as he continued in confinement in England. When led away from his disorder into any discussion on public matters, he was, however, a most amusing and instructive companion ; as a man of business he was equally acute, and to a stranger, as long as nothing was done to offend him, he was, to all appearance, a man of observation and experience in life. For about two years and a half he was under the care of various gentlemen, devoted to the insane, and at length he was discharged from an establishment near Bath, by the visiting magistrates, as a person confined without due cause. His first act was to commence legal proceedings against his friends for his detention, and having gained his action, he immediately proceeded to London, and waylaid and violently assaulted a gentleman of high commercial standing in the city. After this offence he was confined for a considerable period in default of bail, and immediately on his liberation it is believed that he proceeded to America. From this time nothing was heard of him until September, 1843, when a letter was received T)y a gentleman who formerly attended him, in which he stated that the same course of persecution was pursued towards him in America as had been followed in England. He complained of not being able to obtain efficient medical treatment, although he had applied to the most eminent practitioners in Cincinnati, and afterwards at Philadelphia and New York. After this, nothing more was heard of Mr. H until the year 1845, when an American newspaper was forwarded to his friends by an unknown hand, containing an account of his death, and of an inquest held on him, headed, "Death of a Hermit in West Jersey." It was stated that he lived on a small farm, entirely alone, with the exception of a dog, and that he had shunned all intercourse with his neighbours. He was taken suddenly ill, applied to a neighbouring farmer for assistance, but died in the course of the following day. From information subsequently obtained by his friends, it is believed that he died of apoplexy, or perhaps, in one of the attacks of congestion of the brain, from which he frequently suffered before he left his native country.

The symptoms of this unfortunate case strongly resemble those of the thirty-second and fifty-sixth cases related by M. Lallemand. It was more aggravated, however, and presented the somewhat uncommon feature of the patient's discovering the frequent pollutions, and constantly complaining of them : these, unfortunately, were treated as matters of no importance. Mr. H 's insanity, at first, constantly

PREFACE. XI

had reference to his having either committed or been accused of committingunnatural crimes, and this idea never entirely left him, although during the latter part of his life, his more prominent hallucinations had reference to imaginary persecutors constantly watching him, and endeavouring to ruin him by spreading false reports, and to poison him by adulterating his food, and infusing noxious gases into the air. There can be little doubt, on taking into consideration his complaints of weight between the rectum and bladder, with darting pains, &c, in the same region, that the pollutions arose from irritation in the neighbourhood of the prostate, and I think, that if at an early period of his disease this had been relieved, there would have been considerable hope of his recovery from the hallucinations he manifested. The other case to which I have alluded as particularly attracting my attention, and which came under my notice about the same time, was that of a young man of high intellectual power and general talents, studying medicine. This gentleman was one of my most constantcompanions, when almost suddenly a serious change came over him — he shunned society, especially that of females, was morose, taciturn, and frequently shed tears; he sat sometimes for hours in a kind of abstraction, and on being aroused from it, he could give no explanation of his thoughts and feelings ; he constantly expressed to me his conviction that he should never succeed in his profession, and frequently exclaimed that he was ruined both here and hereafter — body and soul — and by his own folly.

About twelve months previous to this depression of spirits, he had a very severe attack of blennorrhagia, with orchitis and phimosis. This left a degree of irritability in the bladder, which required him to pass urine frequently. His digestion became so disordered that the simplest food would not remain on his stomach, and he had frequent eructations of fluid, which blazed like oil if spit out into the fire. This gentleman's father was a physician, and being naturally anxious for his son, obtained for him the advice of many of the most eminent of the faculty. No improvement took place, however. After he had been six months in this state, I had an opportunity of spending three weeks by the sea side, and my friend accompanied me. We slept in the same room, and he was scarcely ever out of my sight. Before our return, his health was almost reestablished, and his spirits had returned to their natural condition. Twelve months later, however, he again fell into the same state of despondency, and this time his condition was much worse than on the. former occasion. He frequently remained in bed three parts of the day, and no threats or entreaties on the part of his father could induce him to get up. His intellectual faculties were totally prostrated, and a vacant stare which took the place of his natural lively expression, induced considerable fears of his ultimately becoming idiotic. I was the only person who possessed any influence over him, which may perhaps be attributed to his feeling that I was aware of the cause of his disorder. This state continued between three and four months, during which time I was with him as much as my other

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duties would permit, and frequently showed him the folly of the course he pursued. At the expiration of this time he gradually recovered. He has since had a slight relapse once only ; he has pursued his professional studies with success, and is at present a medical officer in her Majesty's service.

On this case, I need only remark, that the symptoms did not arise from involuntary seminal discharges, but from excessive discharges caused by abuse. The various treatment recommended by the distinguished practitioners consulted, proved unsuccessful, because the origin of the disorder was unrecognised, and the remedies consequently useless, while the habits of abuse were continued.

Such were the two cases which first attracted my attention to the influence of the generative organs over the system generally, and the brain especially; and my suspicions once awakened, further observations soon convinced me of their correctness, as well as of the frequent occurrence of such cases. I was soon convinced too, that the profession generally, either were not aware of the immense importance of these discharges, or, that by a kind of common consent they neglected to recognise a subject certainly repugnant to delicacy. As a consequence, sufferers finding themselves neglected by their ordinary medical attendants, rush to find relief wherever there seems to them the slightest chance of its being obtained; and the ignorant and rapacious advertising quacks have a rapid and profitable sale for their injurious nostrums. Several cases of gross imposition by these charlatans have come under my notice, which it is my intention, at some future period, to lay before the profession in one of our medical periodicals. Their introduction here would swell these prefatory observations to an inconvenient length.

It now remains for me to make a few remarks on one or two points of my own experience respecting the symptoms and treatment of spermatorrhoea. One symptom which I have three times met with as the result of masturbation, is little more than alluded to by M. Lalleniand — I mean epilepsy. Masturbation is admitted by most medical men to be a frequent cause of epilepsy; and I am surprised to find that M. Lallemand has related no cases in which epilepsy occurred. Two of the three cases to which I have alluded were simple uncomplicated cases of epilepsy brought on by masturbation. In these, after the masturbation had been arrested the effect ceased. The third case, however, was by no means so successful; it occurred in a lad of weak intellect, aged sixteen. The attacks of epilepsy frequently took place as often as twice in the day. He admitted that he was in the constant habit of practising masturbation, and even seemed aware of the influence the practice had in producing his fits. I have reason to believe that this lad corrected himself; but from the weakness of his intellect, much dependence could not be placed on his statements. As long as he continued to attend the dispensary at which I saw him, little improvement took place in his general health, and the epileptic paroxysms continued very frequent. I regret that I took no notes of

PREFACE. Xlll

this case, and still more, that I lost sight of the patient, as I am inclined to believe that the epileptic paroxysms might have been kept up by involuntary seminal discharges, after having been once excited by masturbation. This is a point which I earnestly recommend to the attention of the profession.

Another very frequent symptom in cases of spermatorrhoea, is the occurrence of urethral discharge from very slight excitement. Several cases of this kind have come under my notice, the patients having consulted me on account of the discharge. These cases often give rise to distressing suspicions, and much family unhappiness, especially as they often occur in married men. The symptoms are often almost as severe as those of virulent clap, and the discharge is attended with great irritation in the neighbourhood of the prostate, and frequent desire of micturition. The discharge came on in one case of a married man who consulted me, after taking a single tumbler of whiskey and water at night — this gentleman not having been in the habit of taking spirits for several years, on account of continued ill health. The discharge in these cases is thicker than that of ordinary clap, and sticks in patches on the linen. These patches may be scaled off. after which there is little mark left, and the discharge seldom penetrates through calico, so that on the opposite side of the shirt there is little or no appearance of stain. On wetting the linen, the discharge feels slippery, and it is washed off with difficulty. I am inclined to believe that these discharges are not contagious; but notwithstanding this, sexual intercourse should be avoided on account of the injury that may result to the patient himself. In most cases indeed, connexion is impossible during the first stages of the discharge, on account of the painful chordee to which excitement gives rise.

I have generally, on questioning these patients, found that such discharges were connected more or less with deficiency of generative power. In the case I have above alluded to, impotence was almost complete ; and in another similar case occurring in the person of a married surgeon, the powers had greatly declined. Both these patients were in the prime of life, and both had, in their youth, led very irregular lives.

The irritation in these cases, I am inclined to believe, is situated in the posterior part of the urethra. Indeed, the surgeon whose case I have just alluded to, believed himself affected by enlarged prostate — many of the symptoms of which generally accompany the discharge I have described, especially frequent desire to pass water, and a feeling as though the bladder were never completely emptied, or as though two or three drops of urine were retained in the posterior part of the urethra.

In the treatment of these cases, I have found the application of the solid nitrate of silver most effectual. The condition of the mucous membrane is immediately modified by it; within twelve hours the

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patient experiences a degree of comfort to which, very frequently, he had long been a stranger. The condition of the membrane, too, seems permanently altered by this treatment; and the discharge has never, as far as my experience goes, returned after subsequent excitement — a circumstance which is very apt to occur when the discharge has been arrested by other means. The involuntary seminal discharges often present in these cases, and to which the diminution of virile power is generally due, are also at the same time arrested, and the patient experiences a return of vigour wholly unexpected.

This peculiar form of urethral discharge has hitherto, for the most part, I believe, been confounded with contagious clap ; indeed, many members of our profession are in the habit of setting down all discharges from the urethra indiscriminately as the result of impure connexion, however positive the patient may be that such has not taken place. In all the cases I have hitherto met with, however, the patients have admitted that they had previously been affected with contagious clap — frequently on more than one occasion. The discharges I have described are, I am inclined to believe, from the number of cases I have met with since my attention was first attracted by the subject, by no means uncommon, and certainly deserving the careful attention of the profession.

The diagnosis of spermatorrhoea, in aggravated or long-standing cases, is by no means easy. When frequent diurnal pollutions have deteriorated the patient's health — discharge of watery semen taking place almost every time the patient makes water — the spermatozoa are often only distinguishable under the microscope after a long-continued and patient manipulation ; and perhaps for no researches connected with medical science is it more important to possess one of the best microscopes. When I first commenced the study of this subject, I was more than once tempted to give it up in despair, in consequence of my not possessing a perfect microscope. At present I use one of Powell's instruments, which I prefer to those constructed by Eoss, on account of the greater convenience of the motions of the stage — a matter which will be found of much importance in all researches requiring delicate manipulation. The eighth of an inch object glass will be found almost indispensable in the study of these cases, although the spermatozoa in healthy semen can be perfectly well examined with an object glass of a quarter of an inch focal length.

M. Lallemand has described the operation of cauterization as a very painful one, and its after effects as very severe. This by no means accords with my experience. In no case in which I have performed the operation has the pain been severe, or the subsequent inflammation violent ; indeed, I have several times had difficulty in persuading the patients to remain twenty-four hours in bed after the operation — a precaution which I have thought advisable in all cases. At first I feared that sufficient inflammation had not been excited, and that the operation would require to be repeated — this has only hap-

PREFACE. XV

pened in my practice once, however, and in that case I am inclined to think that the caustic was not properly applied to the surface of the prostate on the first occasion.

The instrument commonly sold for the purpose of cauterizing the prostate, by instrument makers in this country is, in my opinion, exceedingly defective. From its being made nearly straight, it is by no means easily introduced when the patient is lying down — and in no other position ought the operation to be attempted — the irritability of the canal, too, increases the difficulty of introduction, and consequently, every possible facility should be given to the operator, by having the instrument constructed of a convenient form. It is difficult, also, to measure the length of the passage exactly by applying a curved catheter to a nearly straight porte-caustique. I have, therefore, had an instrument constructed of precisely the same curve as the catheters I generally use. This instrument is rather larger than those generally sold, being about the size of a No. 6 catheter, and its bulbous extremity is two sizes larger, or as large as a No. 8 catheter ; with this instrument many of the difficulties of cauterization are avoided. It can be easily introduced like an ordinary catheter while the patient is lying on his back ; the moment when the bulb enters the neck of the bladder is clearly distinguishable by the sensation communicated ; and the caustic, on account of the greater size of the curvette, is more fairly applied to the whole of the inferior surface of the urethra, which is to a certain extent distended by its presence. With regard to the other precautions to be used, I quite agree with M. Lallemand.

In translating the following pages I have endeavoured more to render the sense of the author in as few words as possible, than to give a full and literal translation. I must beg my readers to bear in mind that M. Lallemand's treatise consists of three thick octavo volumes — these having been written at different periods, there are of course many repetitions, which I have as much as possible endeavoured to avoid. The total number of cases related by M. Lallemand is one hundred and fifteen. Of these I have selected sixtytwo, which, after mature consideration, appear to me to illustrate the subject sufficiently. The same reason which induced me to omit so many of M. Lallemand's cases, has prevented me from inserting cases from my own experience. As I have endeavoured to render this entirely a practical work — I have omitted M. Lallemand's interesting researches on the spermatozoa, except as far as they refer to the diagnosis of spermatorrhoea as well as several digressions made by M. L. to topics of no practical interest in this country ; of these a disquisition on the character of J. J. Rousseau is one of the most remarkable.

In speaking of spermatorrhoea arising from contagious urethritis, I have avoided the word gonorrhoea as being a misnomer, substituting for it blennorrliagia, which is certainly more correct in its derivation, although also liable to some objections.